OBJECTIVE: To test and improve upon the list of adverse childhood experiences from the Adverse Childhood Experiences (ACE) Study scale by examining the ability of a broader range to correlate with mental health symptoms. DESIGN: Nationally representative sample of children and adolescents. SETTING AND PARTICIPANTS: Telephone interviews with a nationally representative sample of 2030 youth aged 10 to 17 years who were asked about lifetime adversities and current distress symptoms. MAIN OUTCOME MEASURES: Lifetime adversities and current distress symptoms. RESULTS: The adversities from the original ACE scale items were associated with mental health symptoms among the participants, but the association was significantly improved (from R2 = 0.21 to R2 = 0.34) by removing some of the original ACE scale items and adding others in the domains of peer rejection, peer victimization, community violence exposure, school performance, and socioeconomic status. CONCLUSIONS: Our understanding of the most harmful childhood adversities is still incomplete because of complex interrelationships among them, but we know enough to proceed to interventional studies to determine whether prevention and remediation can improve long-term outcomes.