The objective of this longitudinal study was to identify the contribution of individual, cumulative and patterns of adverse childhood experiences (ACEs) exposure in the prediction of psychopathological outcomes during adolescence in the context of Chinese culture. Children from 3 large elementary schools of Bengbu, Anhui Province, China were enrolled in the 3 waves survey from 2013 (mean age = 8.15 years, SD = 0.88) to 2017 (mean age = 11.92 years, SD = 0.88). Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 10 most common ACEs. Logistic regression was used to examine the association between individual, cumulative and patterns of ACEs and depressive and externalizing symptoms at Wave 3. Of the 1766 respondents included in the sample, 75% had at least 1 and 21.5% reported 4 or more ACEs. We found the dose-response relationship between cumulative ACEs and psychopathological outcomes. Results from LCA revealed three high-risk profiles and one low-risk profile, which were labeled: high ACEs (5.7%), highly abusive and adverse events (20.1%), highly abusive and neglected (21.3%), and low ACEs (52.9%). Compared to low ACEs class, each high-risk profile was differentially associated with psychopathological outcomes over 4-year period. Children exposed to high ACEs were at higher risk for future depressive and externalizing symptoms than other classes. This study provides evidence for the predictive impact of ACEs on adolescent psychopathological symptoms in Chinese culture. Clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE patterns and provide preventive intervention immediately, rather than provide treatment later in life.