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Exposure to adverse childhood experiences (ACEs) can have physiological effects that may alter how the brain responds to injury, yet the effects of ACEs on white matter injury and recovery processes remain unclear. This study examined whether a history of ACEs is associated with patterns of longitudinal change in white matter microstructure in children with mTBI. Ninety-six concussed adolescents (mean age=14.9 years, range =11.4\u201317.9, 51% female) from the CARE4Kids consortium completed the Pediatric ACEs and Related Life-Events Screener and underwent diffusion-weighted MRI at baseline (7-35 days after injury) and follow-up (2 months later). Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), orientation dispersion index (ODI), and intracellular volume fraction (ICVF) were estimated using tract-based spatial statistics and harmonized across sites. Differences in the magnitude and direction of change in diffusion metrics over time were examined in 15 tracts of interest. Higher ACE exposure was associated with smaller absolute change in AD, MD, ODI, and ICVF across several white matter tracts, including the corpus callosum, internal and external capsules, corona radiata, and posterior thalamic radiation. Groups did not differ in the direction of white matter change for any tract-metric combination. These findings suggest that ACE exposure may blunt white matter reactivity to injury and\/or reorganization during recovery processes.<\/jats:p>","DOI":"10.64898\/2026.07.22.26358355","type":"posted-content","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:05:17Z","timestamp":1784937917000},"source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal White Matter Changes in Concussed Adolescents with Adverse Childhood Experiences"],"prefix":"10.64898","author":[{"given":"Finian","family":"Keleher","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Utah, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian I","family":"Onicas","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Utah, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8389-8922","authenticated-orcid":false,"given":"Kevin C","family":"Bickart","sequence":"additional","affiliation":[{"name":"UCLA BrainSPORT Program, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine L","family":"Mac Donald","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Brown","sequence":"additional","affiliation":[{"name":"UCLA BrainSPORT Program, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Cook","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, University of Utah, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick P","family":"Rivara","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington and Seattle Children\u2019s Research Institute, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard A","family":"Gioia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neuropsychology, Children\u2019s National Hospital, and George Washington University School of Medicine, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5721-2667","authenticated-orcid":false,"given":"Christopher C","family":"Giza","sequence":"additional","affiliation":[{"name":"UCLA BrainSPORT Program, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7112-4009","authenticated-orcid":false,"given":"Emily L","family":"Dennis","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Utah, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Concussion Assessment, Research, and Education for Kids (CARE4Kids) consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026072801500680000_2026.07.22.26358355v1.1","doi-asserted-by":"crossref","first-page":"e182853","DOI":"10.1001\/jamapediatrics.2018.2853","article-title":"Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children","volume":"172","year":"2018","journal-title":"JAMA Pediatr"},{"key":"2026072801500680000_2026.07.22.26358355v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(25)00154-1"},{"key":"2026072801500680000_2026.07.22.26358355v1.3","doi-asserted-by":"crossref","unstructured":"Sheldrake E , Al-Hakeem H , Lam B , Goldstein BI , Wheeler AL , Burke M , et al. 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