Effectiveness of psychosocial and therapeutic interventions for children and adolescents with adverse childhood experiences: A systematic review and meta‐analysis

Background Adverse Childhood Experiences (ACEs) are important risk factors for a range of mental health conditions among children and adolescents. This meta‐analysis examined the effectiveness of psychosocial and therapeutic interventions on anxiety, depression, post‐traumatic stress disorder (PTSD), and psychosocial functioning among children aged ≤18 years with documented ACE exposure. Methods We systematically searched randomized controlled trials (RCTs) published between January 1, 2000 and September 17, 2026 that evaluated psychosocial and therapeutic interventions and reported relevant mental health outcomes among children and adolescents with documented ACE exposure. Searches were conducted in eight electronic databases (PubMed, MEDLINE [Ovid], Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science, and EBSCOhost). Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Pooled effect sizes (Hedges' g ) were estimated using random‐effects meta‐analysis. Subgroup analyses were conducted by intervention modality, duration, setting, country income level, and reported ACE exposure characteristics. Results After duplicate removal, 6087 records were screened, and 21 RCTs involving 2450 children from nine countries were included. Eleven studies were found to have low risk of bias, and 10 had some concerns, with no studies assessed as high risk of bias. Meta‐analysis of six RCTs showed that cognitive behavioral therapy (CBT), trauma‐focused and resilience‐building interventions significantly reduced anxiety symptoms (Hedges' g = −0.46; 95% CI −0.86 to −0.06). Particularly, trauma‐focused interventions demonstrated significant reductions in anxiety in subgroup analyses (Hedges' g = −0.90; 95% CI −1.66 to −0.14). Meta‐analysis of four RCTs indicated that CBT and resilience‐building interventions lasting ≥8 weeks significantly reduced depressive symptoms (Hedges' g = −0.26; 95% CI −0.44 to −0.07). No significant pooled or subgroup effects were observed for PTSD or broader psychosocial outcomes. Conclusion CBT‐based, trauma‐focused and resilience building interventions effectively reduce anxiety and depressive symptoms among children with documented ACE exposure. Integrating evidence‐based psychological interventions with trauma‐informed principles may strengthen the delivery of mental health care for children and adolescents with documented ACE exposure and mental health needs.