Purpose <p>Autistic youth experience high rates of adverse childhood experiences (ACEs), yet little is known about how different ACEs are associated with mental and physical health outcomes. The aims of this study were to identify latent classes of ACEs in autistic youth and examine how ACEs, measured via cumulative risk or latent class approaches, were associated with mental and physical health outcomes in autistic youth.</p> Methods <p>We conducted a secondary analysis of the 2021–2022 National Survey of Children’s Health, a U.S. cross-sectional dataset. The sample included 1,332 autistic youth aged 12–17. A latent class analysis (LCA) of 12 ACE indicators was conducted. Logistic regressions examined associations between ACEs and mental health (anxiety or depression diagnosis) and physical health (poor/fair vs. good/excellent health), controlling for youth characteristics. For each outcome, two regressions were conducted: one using cumulative ACE count (0–12) and one using latent class membership.</p> Results <p>A 3-class LCA model best fit the data: (1) <i>Low ACEs</i>, (2) <i>Bullying and Discrimination</i>, and (3) <i>Household Disruption and Community Violence</i>. For each outcome, cumulative ACE count and latent classes predicted similar variability. Compared to the Low ACEs class, youth in Class 2 and Class 3 were &gt; 120% more likely to have a diagnosis of anxiety or depression; youth in Class 2 were &gt; 75% more likely to have poor physical health.</p> Conclusion <p>Findings highlight distinct patterns of ACEs among autistic youth and their links to health outcomes. Tailoring supports to specific types of adversities experienced by youth may foster resilience and promote well-being.</p>