New interconnection materials are always necessary as a result of evolving packaging technologies and increasing performance and environmental demands on electronic systems. In particular, anisotropic conductive adhesives (ACAs) have gained popularity as a potential replacement for solder interconnects. Despite numerous benefits, ACA-type packages pose several reliability problems. During the last 10 years, tremendous research and development efforts have been spent on improving the reliability of ACA joints. In this paper, the effects of the bonding process (including the bonding temperature, bonding pressure, curing conditions and reflow processes) on the reliability of ACA joints are presented. Then the effects of the environmental factors (including high temperature, humidity, thermal cycling, impact load, etc.) on the reliability of ACA joints are discussed. Finally, the effects of the properties of the components (including properties of substrates, ACAs, conductive particles and the bump height) on the reliability of ACA joints are reviewed. Additionally, future research areas and remaining issues are pointed out.