Abstract To date, Adverse Childhood Experiences (ACEs) in adolescents with special educational and care needs have received little attention as an important risk factor for their behavioral, emotional, and learning problems. This study provides insight into ACE prevalence and family risk factors in three Dutch special educational and care settings for vulnerable school-aged youth. 268 adolescents (10–18 years old) with severe and persistent problems at individual and family level, from a special educational setting (setting 1; n = 59), a residential care setting (setting 2; n = 86) and an alternative educational setting (setting 3; n = 123) were included. A retrospective cross-sectional study design was used. Data were collected between 2016 and 2019 through structured case-file analysis. A substantial proportion of the adolescents in all settings experienced at least one ACE, with 69.5% in setting 1, 84.9% in setting 2 and 95.1% in setting 3. Family risk factors were relatively common, among which a limited social network in all settings (20–50%) and debts in setting 2 and 3 (25–40%). The substantial ACE prevalence underlines the need for early ACE awareness. Trauma-informed care and education are needed to adequately understand trauma-related behaviors, prevent retraumatization, and enhance learning and healthy development. Given that ACEs regarding household dysfunction and family risk factors seem to be common in adolescents with special educational and care needs, family centered approaches should be implemented as well in the interest of lifelong health and well-being for both adolescents and their families.