Welcome to ACAMH ACEs SIG Newsletter No 42
This is Issue 42 the ACEs Special Interest Group Newsletter. It gives an overview of the most interesting articles and papers relating to Adverse Childhood Experiences. It has been compiled by Arnon Bentovim, Chair of the ACEs SIG, Tess Rugg, and Sarah Halligan, University of Bath. Please send any items to include in future newsletters Arnon Bentovim
Webinar
Dr. Saul Hillmanis a Senior Research Fellow at Anna Freud and an Honorary Lecturer at University College London. This webinar introduces the Adolescent Story Stem Profile (ASSP), an online assessment designed to help practitioners explore adolescents’ internal worlds, including attachment representations, affect regulation, mentalization, and interpersonal functioning. Developed as an extension of the well-established Story Stem Assessment Profile (SSAP)—used internationally in clinical practice, training, and research for more than 25 years—the ASSP adapts the story stem methodology to reflect the developmental challenges and increasing relational complexity of adolescence. 24 November 2026 5.00 pm
Themes
ACEs Measurement and Conceptual Issues
Karen Hughes, University of Bangor and John Moores University Liverpool, updated estimates of the health and financial burden of adverse childhood experiences (ACEs) in England and Wales and estimates for English regions. Population attributable fractions (PAFs) for ACEs were calculated for risks and causes of ill-health from 10 cross-sectional ACE studies. Participants were 28,449 residents aged ≥18 years. Outcome measures were PAFs for ACE exposure categories (1 ACE, 2–3 ACEs and ≥4 ACEs) for four health risks (smoking, high alcohol use, drug use and high body mass index (BMI)) and seven causes of ill health (violence, mental illness, cancer, type 2 diabetes, heart disease, respiratory disease and stroke).
Relative risks for all outcomes increased with ACEs, with risk ratios for ≥4 ACEs ranging from 1.063 for high BMI to 9.147 for drug use. For health risks, PAFs were highest for drug use (Wales 60.3% and England 56.7%), costs were highest for smoking (Wales £1.8 billion and England £22.7 billion). For causes of ill health, PAFs were highest for violence (Wales 49.2% and England 46.2%), and costs were highest for mental illness (Wales £1.8 billion and England £37.8 billion). Total ACE-attributable costs were £7.8 billion for Wales and £115.6 billion for England; regional costs ranged from £6.3 billion (Northeast England) to £18.0 billion (Southeast England). There is an urgent and economically justified need for action to prevent ACEs and support those affected by them to reduce the health and economic burden of poor-quality childhoods.
Bruna Cardone Pedroso Elorza Department of Biological and Health Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil and colleagues state that Adverse childhood experiences (ACEs) scores mask substantial heterogeneity within the 2-, 3-, and ≥ 4- ACE exposure categories. Using the US-based 2023 National Survey of Children’s Health (N = 55,162), caregivers reported lifetime exposure to 10 ACEs covering family dysfunction and community- and discrimination-related adversities.
The conducted ACE co-occurrence analyses among children with ≥2 ACEs (n = 7897). Fifty combinations accounted for 5204 (66%) of children with ≥2 ACEs. Parental divorce/separation appeared in 34 of the 50 displayed patterns, household substance uses in 23, and household mental illness in 20. Conclusions: ACE scores masked heterogeneity in exposure patterns. Simple diagnostics such as combinatorial coverage can make this heterogeneity explicit and may support pattern-specific analyses of outcome.
Chiara Morale, Department of Dynamic, Clinical and Health Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy, and colleagues state that dermatological conditions are a major contributor to global nonfatal disease burden. Evidence suggests that psychological stress and trauma, including adverse childhood experiences (ACEs), stressful life events (SLEs), and post-traumatic stress disorder (PTSD), may affect the onset and severity of inflammatory and stress-responsive skin diseases, though findings remain fragmented. This systematic review synthesised evidence on associations between stress- and trauma-related exposures and dermatological conditions across the lifespan.
Thirty studies met inclusion criteria. Stress- and trauma-related exposures were associated with increased risk, earlier onset, or greater severity of conditions, particularly psoriasis, atopic dermatitis, alopecia areata, and chronic urticaria. Associations were strongest for early-life adversity and cumulative stress. Results support an association between trauma-related exposures and dermatological outcomes, but longitudinal studies are needed to clarify temporal relationships and inform psychosocial assessment
Ao Ren, Shaanxi Normal University, Xi’an, China, and colleagues highlight recent expansion of research on the impact of childhood maltreatment on emotional intelligence – the ability to perceive, use, understand, manage, and handle emotions. However, systematic meta-analytic integration of this evidence remains lacking. The present study employed a three-level meta-analytic framework to evaluate the effects of different maltreatment types on emotional intelligence and to examine potential moderators.
A systematic search identified 45 eligible studies. Results revealed a significant negative association between childhood maltreatment and emotional intelligence. Among maltreatment subtypes, emotional neglect exhibited the strongest adverse effect, exceeding that of physical abuse, emotional abuse, and sexual abuse, while the effects of physical neglect and emotional abuse were greater than those of sexual abuse. Moderator analyses indicated that participant age and methodological rigor significantly influenced effect sizes, whereas cultural context, sample characteristics, measurement instruments, and publication type did not. This review advances understanding of early adversity and emotional development, and underscores the importance of early detection and age-appropriate interventions
Jiajia Wang, Department of Forensic Psychiatry, Judicial Identification Center of Shaoxing University, Shaoxing, Zhejiang, China, and colleagues state that Adverse childhood experiences (ACEs) represent a critical environmental trigger for the adult comorbidity of depression and autoimmune diseases.
This review synthesizes evidence showing that ACEs induce persistent dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system, thereby promoting a chronic low-grade inflammatory state. This state is characterized by elevated pro-inflammatory cytokines (e.g., IL-6, TNF-α), immune cell dysfunction, and epigenetic modifications. Facilitated by microglial activation and monocyte-mediated disruption of the blood–brain barrier, this pro-inflammatory milieu disrupts central nervous system homeostasis, contributing to the pathogenesis of both depressive symptoms and autoimmune disorders. Future research must delineate developmental windows of vulnerability and the differential effects of adversity types to translate these insights into novel therapeutic strategies targeting the neuroimmune axis—such as anti-cytokine therapies or vagus nerve stimulation—for high-risk populations.
Words Matter hosted an important expert-led discussion at the House of Commons on the impact and prevention of childhood verbal abuse in education. The discussion represented a critical step in its ongoing mission to end childhood verbal abuse (CVA), which affects 2 in 5 (41%) children and can have long lasting consequences, damaging a child’s sense of self, their future relationships and their ability to function at home, school, work and in social situations.
Policymakers, educators, safeguarding professionals, researchers, clinicians and child development and mental health experts highlighted why addressing childhood verbal abuse in education must become a central part of the Government’s education and safeguarding strategy. Verbal abuse is now specifically referenced in the Department for Education’s statutory guidance, Keeping Children Safe in Education (KCSIE). Words Matter have launched a number of free parenting courses to address Verbal Abuse.
Jessica Opie Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK and colleagues state that attachment theory is influential for professionals working with young children. However, practitioners face challenges translating attachment theory and research into practical applications. This manifests in attachment myths, theoretical misinterpretations, and inconsistency of application. This state-of-the-art review is authored by 47 attachment researchers and practitioners examines key insights from attachment theory to facilitate attachment-aware practice for professionals working with children and their caregivers.
They review core attachment propositions, and common misconceptions that hinder adequate practical applications, and measures of attachment and sensitive parenting. They also review evidence-based attachment interventions, and core components of (preventative) support for parents or caregivers and the children in their care, understanding crucial insights into caregiving and early socioemotional development e.g., secure base phenomena; the value of safe, stable, and shared good-enough care.
Alan Meehan and colleagues, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK, highlight that identification of strong associations between adverse childhood experiences (ACEs) and later mental and physical health problems has prompted screening to identify vulnerable children and adults. However, evidence supporting routine ACE screening in clinical practice remains limited.
The authors argue that while cumulative ACE scores demonstrate robust population‐level associations, their individual predictive accuracy is consistently poor, with substantial false‐positive and false‐negative classifications. They fail to identify factors that may promote resilience, and there is an absence of clearly established, evidence‐based clinical pathways. Future approaches that move beyond cumulative adversity counts towards more nuanced, personalised and proportionate ACE measures, which also consider broader developmental, social and protective factors, have the potential to inform more personalised risk assessment following childhood adversity. Clinicians should look towards more personalised and proportionate approaches to risk detection that consider adversity alongside other developmental, social and protective factors, while also embedding trauma-informed approaches across healthcare more broadly
Neural correlates of resilience to trauma during adolescence: A multi-modal study
Lu Zhang, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia, and colleagues state that understanding resilience mechanisms is important for advancing early intervention, yet research on the neurobiology of resilience in adolescents is limited. They examined the brain structural and resting-state functional connectivity (rsFC) correlates of resilience to internalizing and externalizing symptoms in a large sample of adolescents categorized as resilient, maladaptive, vulnerable, or control group based on reports of traumatic events and internalizing/externalizing symptoms 3 years later.
For internalizing symptoms, increased odds of being resilient were associated with postcentral gyrus thickness, relevant to sensory processing. For externalizing symptoms, for structural outcomes there were associations with putamen volume, and with rsFC between the dorsal and ventral attention networks and between cortical networks and hippocampus. However, for externalising symptoms it was unclear whether these associations truly reflect resilience versus trauma exposure or psychopathology. This underscores the need for further research into the neurobiological basis of resilience during adolescence.
Childhood Adversity and maltreatment, the impact on Child and Adolescent Mental and Physical Health – Risk and Protective Factors
Sexual Offences against under 13’s
A Guardian investigation revealed at least 1,700 sexual offences against under-13s, including multiple rapes, are reported to police every year. Close to five sexual crimes against children aged 12 and younger were recorded on average by police every day in primary and secondary schools in England and Wales, according to Guardian analysis of police data for 2021-25. The figures include reports of almost 2,000 rapes and attempted rapes, which is equivalent to an average of one allegation of rape at a school received by the police every single day. More than a third of the rape victims were children under 13.
The new data showed at least 8,500 sexual offences against under-13s were recorded by police as having occurred on school premises or nearby between 2021 and 2025 – equivalent to 4.7 offences reported each day. While most of the police reports did not specify the age of the alleged perpetrator, they are likely to be fellow pupils, and in at least 1,890 of the offences reported as being committed against under-13s the offender was described as under 18.
Girls are more likely to be victims of sexual offences than boys, according to the analysis, which found that close to two-thirds of reported crimes affecting under-13s where the sex of the victim was documented had involved female victims.
Child maltreatment-when to suspect maltreatment in under 18s (NICE CG89).
Gail Bishop Northumbria Healthcare NHS Foundation Trust, North Shields, UK and colleagues introduce the updating of the UK NICE guideline child maltreatment: when to suspect maltreatment in under 18s (CG89), updated in December 2025, provides a comprehensive framework for recognising child maltreatment. This includes outlining alerting signs of neglect, physical, sexual and emotional abuse, as well as fabricated or induced illness.
Jialing Lin. International Centre for Future Health Systems, University of New South Wales, Sydney, New South Wales, Australia and colleagues state that Adverse childhood experiences (ACEs) and neurodevelopmental disorders (NDDs) are frequent yet the relationship between cumulative ACEs and multiple NDDs remains poorly understood. Using data from 120,629 children aged 3-17 years they examined associations between ACEs and multiple NDDs, include intellectual disabilities, autism spectrum disorder, attention deficit/hyperactivity disorder, communication disorders, and specific learning disorders – defined as the presence of ≥ 2 NDDs. They also assessed associations for common NDD combinations and individual ACEs.
The prevalence of multiple NDDs increased with the number of ACEs: 4.5% (95% for 0 ACE, 8.4% for 1 ACE, 11.9% for 2 ACEs, and 17.8% for ≥ 3 ACEs. Each additional ACE was associated with 13% higher odds of multiple NDDs. Associations were consistent across three NDD combinations. Individually, health- or disability-related maltreatment, household mental illness, and economic hardship showed significant associations. This relationship is likely dynamic, multifactorial, and bidirectional. While ACEs may influence neurodevelopment through mechanisms involving stress regulation, neuroendocrine function, and neural connectivity, co‐occurring NDDs are also strongly shaped by shared genetic and neurobiological vulnerabilities. Developmental traits associated with NDDs may additionally increase exposure to adversity through impacts on family stress, educational experiences, adaptive functioning, peer relationships, and caregiving burden. Shared neurobiological pathways include the hypothalamic‐pituitary‐adrenal axis, immune system regulation, and neural connectivity. Children with higher ACE exposure were more likely to present broader and more complex NDD profiles compared with peers with no ACEs. Coordinated responses need to account for the diverse adversities experienced by many families and children.
Emily C. Sweiss, Chapman University, USA and colleagues state that ADHD symptoms, including inattention, impulsivity, and/or hyperactivity, increase family stress and interfere with children’s participation in important tasks, such as academic readiness and achievement. Early risk factors include genetic heritability, prenatal substance exposure; maternal pre-and postnatal mental health problems; lower parental education; and male sex. Robust environmental contributors include parental divorce or incarceration, traumatic experiences, and significant negative life events. Exposure to unpredictability in childhood is also strongly linked to aspects of executive functioning that are also implicated in ADHD, such as decreased effortful control and self-regulation across ages
Participants were drawn from two independent cohorts participating in ongoing longitudinal studies of exposure to ELA. Unpredictability was measured by the Questionnaire of Unpredictability in Childhood, and ADHD symptoms were measured by the CBCL Attention Deficit/Hyperactivity Problems subscale, the Behavior Rating Inventory of Executive Function, and the Kiddie Schedules for Affective Disorders and Schizophrenia ADHD Screener. Childhood experiences of unpredictability were associated with ADHD symptoms in both cohorts and during childhood and adolescence. Further, associations were stronger in females than males. These findings show that unpredictability is a risk factor for ADHD, which suggests that it should be explored as an early target for intervention to reduce the development of ADHD symptoms
Jessica Oldridge School of Health and Wellbeing, University of Glasgow, Glasgow and colleagues studied the adversity histories of 378 young children in foster care, aged 0-5 years, and their emotional, behavioural, and attachment disorder outcomes over time. Children with Reactive Attachment Disorders (RAD) find it difficult to form, seek and accept closeness from others, heightened behavioural outbursts, emotional dysregulation, and fearfulness. A child with Disinhibited Social Engagement Disorder (DSED) will demonstrate indiscriminate behaviour towards adults, a willingness to leave caregivers or engage in familiar behaviour. Adversity and outcome variables were measured at two timepoints among 378 young children in foster care, a few weeks after entering care, and 2.5 years later.
Two thirds of children experienced 4 or more ACEs. The older the age at which a child entered foster care the higher number of ACEs and increased severity of maltreatment a child experienced. Increase in emotional and behavioural difficulties after 2.5 years in care was predicted by number of pre-care ACEs. Attachment disorder symptoms were lower at 2.5 years in care as compared to levels at entry to care, a clinically positive finding. Higher quality caregiving, in line with findings with children placed in adoptive families, resulted in attachment security and stability, and reduced exposure to further ACEs. Foster care may buffer some of the negative impacts of early experiences. Tailored interventions for the emotional and behavioural wellbeing of young children in care are essential.
Predictors of Substance Use among Adolescent Psychiatric Inpatients: The Role of ACEs.
Taylor Walker, Department of Psychology, William James College, 1 Wells Ave, Newton, MA, 02459, US, and colleagues comprehensively examined correlates of substance use behaviour in a sample of adolescent inpatients undergoing psychiatric hospitalization, with emphasis on the role of ACEs.
In a retrospective review of medical records 40.3% of the sample were classified as substance users, and number of reported ACEs was high. The odds of substance use increased by 10.4% with each additional ACE, an association that remained when adjusting for a post-traumatic stress disorder diagnosis. This indicates that substances are being used to manage a broad spectrum of distress, emotional dysregulation, and complex trauma that may not neatly fit into a single diagnostic category. Substance use complicates by overlapping with, masking, or exacerbating other psychiatric, making the controlled environment of an inpatient unit necessary for accurate assessment and intervention. Findings highlight the role of early-life stressors in shaping substance use behaviours among adolescents in psychiatric care
Patterns of psychopathology and personal strengths among youth in psychiatric care.
Logan R Cummings Simches Division of Child and Adolescent Psychiatry McLean Hospital Harvard Medical School Belmont Massachusetts USA and colleague’s states that The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have declared a National State of Emergency in Children’s Mental Health. They have called for improved approaches to address youth mental health. The authors have based their approach on a care initiative to advance understanding of how both psychopathology and social-emotional skills are related among youth patients, as these associations are rarely examined together.
Deficit‐based approaches, common in both physical and mental illness, focus on diagnosing and treating psychiatric syndromes, and impairment in functioning. Strengths‐based approaches may be a viable approach to not only reduce syndrome severity, but also promote factors associated with well‐being (e.g., increased feelings of belonging, self‐efficacy, strengthening of social support networks, promotion of positive attributes). In this study, youth patients receiving a continuum of intensive outpatient to short-term residential programs completed self-report measures of psychopathology and social-emotional skills. Seven profiles were identified. Profiles with overlapping syndromes were differentiated by highly distinct patterns of socio-emotional strengths and challenges. Integrating strengths- and resilience-based frameworks into psychiatric assessment and treatment planning—supports the shift beyond treatment models focused solely on reducing symptoms and skills deficits, toward more personalized approaches that also leverage youths’ existing capacities for growth and recovery.
Elizabeth Swedo, Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, US, and colleagues state that recent national studies report that ACEs are common among US high school students, but the prevalence of ACEs by state and local jurisdiction is unknown. The study objective was to estimate the prevalence of individual and cumulative ACEs among high school students in 16 US jurisdictions. Using 2023 Youth Risk Behavior Survey data, they estimated the self-reported prevalence of eight individual (emotional, physical or sexual abuse; physical neglect; witnessed intimate partner violence; parental substance use problems; parental mental health problems; incarcerated or detained parent/guardian) and cumulative ACEs (0, 1, 2‒3, ≥4) among high school students <18 years in 16 US jurisdictions that included ACEs questions on their survey.
Emotional abuse was the most reported ACE (range: 49.3%–64.0%) in all jurisdictions. In 13 of 16 jurisdictions, the other most common ACEs included physical abuse (20.8%–46.9%), parental mental health problems (23.6%–38.6%) and parental substance use problems (17.6%–33.1%). Jurisdiction-specific variation in the relative commonality and prevalence of individual and cumulative ACEs was present. While some estimates overlapped, individual ACEs prevalence varied widely by site, highlighting the need for local data to inform prevention strategies. Local estimates can help decision makers understand communities’ unique risks and strengths and evaluate progress towards preventing and mitigating ACEs using strategies from Centers for Disease Control and Prevention’s Preventing Adverse Childhood Experiences Resource for Action.
- Strengthen economic supports for families: Provide financial security and family-friendly work policies (such as paid leave and flexible schedules) to reduce household stress.
- Promote social norms that protect against violence and adversity: Use public education campaigns, bystander approaches, and policies to reduce corporal punishment and change cultural acceptance of harsh discipline
- Ensure a strong start for children: Expand early childhood home visitation programs, high-quality childcare, and preschool enrichment.
- Teach parenting skills: Offer evidence-based training programs to promote healthy child development, positive parent-child communication, and emotional management.
- Connect youth to caring adults and activities: Implement mentoring programs, after-school activities, and social-emotional learning. [1, 2]
- Intervene to lessen immediate and long-term harms: Provide enhanced primary care, victim-cantered services, and evidence-based trauma-informed treatment (such as cognitive behavioral therapy) for children and families already exposed to ACEs
Nicky Wright, School of Psychology, Manchester Metropolitan University, Manchester, UK, and colleagues explored the impact of the Covid-19 pandemic on child emotional and behavioural problems, examining longitudinal trajectories of children’s emotional and behavioural difficulties both before and during the pandemic in a prospective birth cohort (ALSPAC).
Children’s emotional and behavioural difficulties trajectories pre-pandemic increased during infancy peaking around the age of 2 and then declined throughout the rest of childhood. Pre-pandemic, decline in difficulties scores after age 2 was 0.6 points per month; but reduced by 35% during the pandemic. This slower decline in scores translated to older children having difficulty scores higher than would be expected during the pandemic. By age 8.5, there is a 9.5-point difference in pre- and during-pandemic scores (95% CI: 4.5–14.5). This represents an average 48% increase from scores expected at this age (pre-pandemic mean score = 20; 95% CI: [15–25]). The Covid‐19 data collection in this study occurred during these periods of high restriction stringency. The lengthy and repeated school and nursery closures, which may result in a loss of structure and routine, support from school staff, time with peers, adequate nutrition, and physical activity may all have negatively impacted on child emotional and behavioural difficulties. Parental anxiety and stress was associated with higher child trajectories of emotional and behavioural problems. This increased parental stress is, in turn, likely to negatively influence child mental health via parenting practices.
Childhood Adversity and maltreatment and impact on Adult Mental and Physical Health – Risk and Protective Factors.
Mariagrazia Merola Department of Clinical and Biological Sciences, University of Turin, Turin, Italy and colleagues state that ACEs are critical contributors to the development of psychiatric disorders, yet childhood neglect remains underexplored. Here, they performed a comprehensive synthesis of the association between neglect subtypes and psychiatric disorders and the association with specific psychiatric disorders. Studies focused on adult populations with diagnosed psychiatric disorders. Meta-analyses assessed overall associations between neglect and psychiatric disorders, as well as subtypes-specific associations.
Strong associations were found between neglect and psychiatric disorders across all subtypes, unspecified neglect, physical neglect, emotional neglect.
- The strongest association was noted between unspecified neglect and bipolar disorder, Given the strong heritability of bipolar disorder, disorder in caregivers may contribute to difficulties in providing stable and consistent caregiving, potentially leading to neglectful environments, influencing the clinical course of bipolar disorder.
- Physical neglect is associated with more severe negative symptoms of schizophrenia spectrum disorders in, including flattened affect, reduced social engagement and diminished motivation.
- The association between emotional neglect and major depressive disorder may suggest that lack of care, emotional validation and consistent support during critical developmental periods may uniquely impair attachment, emotional regulation and resilience, key factors in the pathogenesis of MDD
These findings highlight the need for early identification and tailored interventions to mitigate neglect’s long-term burden on mental health.
Genevieve Palazzolo, College of Health Professions, Department of Public Health, Grand Valley State University, Grand Rapids, Michigan, USA and colleagues evaluated the associations between ACEs and postpartum depressive symptoms (PDS) and utilisation of postpartum care (maternal postpartum checkup and depression screening). They used the Pregnancy Risk Assessment and Monitoring System (PRAMS), a population‐based surveillance system implemented by state health departments among women who have had a recent live birth. Self‐reported outcomes included receipt of a postpartum checkup, being asked about depression during the postpartum visit, and PDS.
The prevalence of 0 ACEs was 48.8%, ≥ 4 ACEs 7.6%. The prevalence of PDS was 15.2%. Higher ACE scores and individual ACEs were associated with increased prevalence of experiencing PDS among women 2 to 4 months postpartum. In addition, ACEs were associated with not receiving a postpartum checkup, which is a critical opportunity to identify and educate women on postpartum depression and other maternal outcomes that impact both maternal and infant health. Continued support to train healthcare workers in trauma‐informed care and evaluation of early postpartum mental health, as well as linkage to resources and follow‐up care are critically important. Embedding of ACE-related questions could help support future research and monitoring of population‐based trends.
Barry Coughlan, Department of Public Health and Primary Care, University of Cambridge, and colleagues state that numerous meta-analyses have established associations between child maltreatment (CM) and mental health (MH). However, variation exists regarding the magnitude of effects. To address this, they undertook a meta-analysis of meta-analyses to describe the associations between various types of CM and MH.
The authors examined CM domains of physical abuse, emotional abuse, sexual abuse, neglect, and exposure to intimate partner violence. MH outcomes were: externalising problems, internalising problems, thought problems, suicidal distress, substance misuse, and other psychological difficulties. They combined effect sizes from 148 quantitative meta-analyses. CM was associated with all MH outcomes. Associations tend to be of similar magnitude for different forms of CM.
Findings reaffirm that, at a population level, CM is associated with a diverse range of mental health difficulties. Recent health service research on risk profiles in mental health services shows that adversity in its various forms is a transdiagnostic risk factor for various mental health difficulties – multifinality in developmental psychopathology. Some common processes (e.g., negative affectivity or executive function problems) are involved across different mental illnesses, despite their phenotypic variation. As such, heightened propensity to experience symptoms that cut across traditional nosological categories among CM survivors could be explained by associations between CM such common processes. For example, CM may lead to elevated thought problems, negative affectivity and/or lower effort control, leading to various and complex mental health issues – equifinality: the idea that various developmental experiences can contribute to the same outcome. Survivors of CM benefit from being offered a flexible suite of assessments, mental health supports and interventions a transdiagnostic approach to service provision for survivors of CM.
Heidemarie Laurent, Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA, and colleagues state that pregnancy represents a critical juncture for intergenerational transmission of stress‐related health vulnerabilities, when child‐bearers’ history of maltreatment may precipitate biological stress responses that adversely impact maternal and foetal outcomes. They probed links between child maltreatment (CM) and inflammation, testing the hypotheses that CM would predict inflammatory responses to acute stress in late pregnancy, and that these inflammatory responses would relate to subsequent obstetric complications.
Participants in a community sample of women reported a history of maltreatment and completed the Trier Social Stress Test during the third trimester of pregnancy. Five saliva samples collected before and after the task were assayed for pro‐inflammatory cytokines (IL1β, IL6, TNFα) and C‐reactive protein (CRP) to index oral inflammation. At 3 months postnatal, women reported pregnancy and birth complications, and birth outcomes.
Multilevel models of inflammatory response trajectories supported hypothesized paths: Greater childhood maltreatment—especially physical neglect and sexual abuse—predicted higher and/or extended inflammatory stress responses. In turn, higher inflammatory stress responses related to greater pregnancy and birth complications, and extended inflammatory responses related to a greater likelihood of preterm birth. Findings support oral inflammatory response to stress as a potential link to target in intergenerational health risk transmission.
Sabrina Page, University of Edinburgh, Scotland, Global Child Safety Institute, UK and colleagues examined the mental health conditions, emotional characteristics, and adverse childhood experiences (ACEs) documented among individuals who perpetrate technology-facilitated child sexual exploitation and abuse (TF-CSEA). A narrative synthesis of 22 studies was conducted.
Evidence reviewed comprised justice-involved, self-referred, and anonymous online samples from predominantly Western, high-income countries (n = 8 to 3,500). Results showed that TF-CSEA perpetrators are heterogeneous. Depression (29%–60%), anxiety (28%–52%), antisocial personality disorder (~42%), and compulsive sexual behaviour (42%) were prevalent across identification methods. Emotional dysregulation was pervasive, with shame, guilt, chronic loneliness, social avoidance, and emotional detachment consistently reported as both antecedents to and consequences of offending. ACEs were widely documented, including childhood sexual abuse (17%–45%), emotional abuse (27%–31%), and physical neglect, with higher cumulative ACE burden associated with more compulsive offending patterns.
Subgroup analyses identified: justice-identified individuals exhibited more entrenched antisocial and externalising traits, whilst self-referred or anonymously identified individuals more commonly reported internalising symptoms, emotional conflict, and desire to desist. It is also important to consider sexual deviance, antisocial cognition, and opportunity structures. Future research priorities include prospective longitudinal designs, standardised measurement, comparison groups, and greater demographic diversity.
Xiyao Liu, University of Wisconsin-Milwaukee, USA and colleagues, state that associations between (ACEs) and poor mental health are well documented, but it remains unclear to what degree these effects vary among demographic subgroups. This systematic review and meta-analysis synthesized the evidence linking ACEs to depression, anxiety, and posttraumatic stress disorder (PTSD) while exploring whether these associations vary by gender, race/ethnicity, and economic status.
A systematic literature search yielded 45 studies with 110,556 participants. ACEs were positively associated with depression, anxiety, and PTSD. Associations were significant across genders, economic statuses, and most racial/ethnic groups, with no evidence of subgroup differences. Findings confirmed that ACEs are significantly linked to adult mental health outcomes, with an especially strong connection to PTSD. The lack of subgroup differences suggests that ACEs are universally harmful, underscoring the urgent need for ACE prevention strategies and trauma-responsive interventions that can be scaled at the population level
Sophie Höfels, School of Psychology, University of Leeds, UK, and colleagues state that neurocognitive changes in executive function and emotion regulation due to the chronic exposure to stress from childhood trauma can act as transdiagnostic risk factors for psychopathology. This umbrella review aimed to identify the strength of the relationships between childhood trauma and the modifiable targets of executive function (impaired decision making, learning and memory deficits), impulsivity, and perseverative cognition (worry and rumination).
Twenty-two systematic reviews and meta-analyses, encompassing 639 unique primary studies, were included. Across included reviews, an enduring impact of childhood trauma on each of these transdiagnostic risk factors was identified. Most reviews focussed on executive function, found a negative association between childhood trauma and cognition. Most consistent evidence was found for executive function domains working memory and processing speed. Importantly, childhood trauma uniquely contributes to these impairments, regardless of clinical status. Fewer reviews considered impulsivity and perseverative cognition but positive associations between childhood trauma and these risk factors were consistently reported. Interventions ought to target these modifiable factors, with further longitudinal cohort studies to identify the impact of childhood trauma on these domains as well as trials of interventions to limit the impact of childhood trauma being needed.
Amber John, Department of Psychology, University of Liverpool, and colleagues, state that emerging evidence suggests that attention-deficit hyperactivity disorder (ADHD) may be associated with increased likelihood of experiencing interpersonal harm, including from intimate partners. Therefore, they aimed to test the long-term associations between ADHD traits in childhood and experiences of intimate partner violence (IPV) up to midlife (age 51 years).
Data were from the 1970 British Cohort Study, a nationally representative longitudinal study of people born during 1970. ADHD traits were assessed at age 10 years. Lifetime experience of five types of IPV was measured at age 51 years (harassment, economic abuse, physical violence, threats/coercive control, sexual violence).
Adjusted models showed that ADHD traits in childhood were associated with higher risk of experiencing any form of IPV, a greater number of different IPV experiences and all individual subtypes of IPV by age 51 years. Post-estimation showed that around one in seven men and one in four women without high ADHD traits experience some form of IPV by midlife. In people with high ADHD traits (4.40%), these estimates increase to approximately one in five men and one in three women.
The observed association may be attributable to a range of underlying mechanisms and broader pathways. First, people with ADHD are more likely to experience co-occurring mental health problems, shaped by broader social determinants and systemic disadvantages across the life course. These include financial difficulties, instability, adverse childhood experiences and substance use, all of which are independently associated with increased IPV risk. Beyond these structural risks, people with ADHD may face heightened vulnerability because of social and psychological factors. Differences in impulsivity, emotional regulation and social communication can increase peer rejection and make people more susceptible to harm. Stigma and stereotypes that frame ADHD traits as laziness or irresponsibility can serve to legitimise mistreatment. Underdiagnosis and limited institutional support leave many adults without adequate safeguards. Finally, evidence suggests that people who experience societal exclusion because of disability may be actively targeted by abusive partners
Ludvig Daae Bjørndal, Department of Psychology, PROMENTA Research Center, University of Oslo, Norway, state that genetic and environmental factors contribute to eating disorder risk, yet their interplay is poorly understood. They examined whether childhood maltreatment and polygenic scores for anorexia nervosa (PGS-AN) and binge-eating broad (PGS-BEB) are associated with eating disorders. They also examined the interactions between childhood maltreatment and PGSs in predicting eating disorders.
This nested case-control study used data from up to 63,989 mothers in the MoBa (Norwegian Mother, Father and Child Cohort Study). Mothers reported on their own experiences of 4 childhood maltreatment types: long-term humiliation or degradation, threats to self or someone close, physical abuse, and sexual abuse. Diagnoses of AN, bulimia nervosa (BN), binge-eating disorder (BED), purging disorder (PD), and binge-eating spectrum disorders (BESP) were obtained using self-report data from 5 time points and population health registers.
All childhood maltreatment types were strongly associated with elevated eating disorder likelihood, as were eating disorder PGSs. There were no multiplicative interaction effects between childhood maltreatment and PGSs. Small additive interactions were observed between PGS-AN and PGS-BEB and degradation/humiliation for BN and BESP in exploratory analyses, tentatively suggesting that the combination of polygenic liability and child maltreatment could further elevate the risk of some eating disorders.
Sena Inanoglu, Department of Psychological Sciences, William and Mary, USA and colleagues note that despite a growing body of literature examining specific effects of individual ACEs on psychopathology, few studies have included specific effects of community ACEs or examined whether unique effects of individual ACEs generalize across cultural contexts. The present study aimed to expand on prior findings by investigating unique mental health outcomes of individual ACEs and by testing cross-national invariance of these associations.
Participants were 5945 university students recruited from seven countries (i.e., United States [Colorado, New Mexico, New York, Virginia], Argentina, Spain, Uruguay, England, Canada, and South Africa) across 12 universities.Students’ adverse experiences were assessed with the Adverse Childhood Experiences- International Questionnaire (ACE-IQ). Mental health was assessed with the general depression, traumatic intrusions, and social anxiety subscales of the Inventory of Depression and Anxiety Symptoms (IDAS).
Sexual abuse, emotional neglect, household mental illness, household violence, and bullying independently predicted all three mental health outcomes, whereas community violence uniquely predicted depression and PTSS. Multigroup models corroborated these patterns across countries, with the exception that emotional neglect was not consistently associated with anxiety and PTSS (particularly in non-American contexts). American society heavily emphasizes self-reliance, emotional expression, and independent identity formation. When a child’s emotional needs are neglected, it severely damages their self-construct, manifested as heightened social anxiety (fear of being judged or rejected by others). Other countries feature more collectivistic or family-centric social norms, emotional networks distributed across extended family, community members, and tight-knit peer groups, acting as a buffer. Findings of the present study can be used to inform targeted mental health programs for university students.
Trauma Informed Interventions
Parent perspectives on the integration of a parenting assessment tool into pediatric primary care.
Victoria Carr University of Michigan, USA, and colleagues explored parents’ perspectives on integrating a brief parenting assessment tool into pediatric primary care visits. The authors highlight the importance of screening for parental behaviours, particularly those associated with Adverse Childhood Experiences (ACE). However, such behaviours are not routinely assessed in pediatric care, representing a missed opportunity for early intervention.
The Quick Parenting Assessment (QPA), a 13-item tool that screens for five unhealthy parenting behaviours, was integrated into routine well child visits at 15 months, 30 months, 5 years and 8 years within a pediatric primary care clinic. Following the visits, parents invited to complete a brief survey about their experiences with the QPA. Of the 538 parents approached, 490 (91%) participated. Among respondents, 402 (82%) reported completing the QPA, with 189 (47%) reported discussing the results with the healthcare provider. Overall, parents were receptive to the use of the QPA in primary care and reported that it facilitated conversations about discipline, influenced their disciplinary practices, and increased their likelihood of seeking parenting advice from their doctor. These findings suggest that introducing routine parenting assessments in pediatric care may help to mitigate against ACEs, prevent child abuse, and promote child health and wellbeing.
Matthew Reeson, University of Alberta, Canada, and colleagues evaluated a one-year multimodal treatment program for children and young people who had experienced Child Sexual Abuse (CSA). CSA is a severe early-life trauma associated with an increased risk of post-traumatic stress disorder, mood disorders, substance misuse, suicidal ideation, and other adverse outcomes. Although multimodal interventions for youth survivors of CSA have demonstrated promising benefits, there is currently no ‘gold standard’ treatment. This paper presents findings from a longitudinal evaluation of an episodic, multimodal treatment program delivered in Canada.
In a sample of Canadian child and youth survivors of CSA (n=201; aged 8-17 years), participation in a one-year multimodal trauma-informed treatment program was associated with reductions in PTSD symptoms, depression and anxiety. Persistent clinical PTSD symptoms at program completion were linked to greater family dysfunction, more complex trauma history, and lower resilience. Findings suggest multimodal interventions for young CSA survivors, although conclusions are limited by the absence of a control group and long-term follow up.
Julia Fleckman, Washington University in St. Louis, USA, and colleagues evaluated two brief parenting interventions in a randomized controlled trial. Despite strong evidence that parenting programmes benefit both parents and children, their cost can hinder wider implementation. Brief interventions may therefore represent a more scalable option, especially when administered in settings such as pediatric clinics.
Women with children aged 2-7 years (n=716) were recruited from New Orleans Women Infants, and Children clinics and assigned to one of three groups: Triple P-Level 2, Play Nicely, or usual care control group. Participants in both intervention groups reported improvements in parent-child communication, greater patience, and increased use of quiet time or time out strategies for discipline. Triple P-Level 2 participants additionally described using logical consequences and rewards for positive behaviour, while Place Nicely participants reported reducing or stopping the use of physical punishment. In contrast, most participants in the control group reported no changes to their discipline practices. Fleckman and colleagues concluded that brief parenting interventions delivered within family health service settings may improve parenting practices and reduce the use of harsh disciplinary strategies, including physical punishment.
Livia van Leuven and colleges at Karolinska Institutet, Sweden, evaluated a 30-month parenting program designed for rapid implementation following suspected child abuse. They authors note that children exposed to physical or emotional abuse by caregivers are at increased risk of behavioural and mental health difficulties. While parenting programs based on social learning theory are considered the most affective approaches to preventing child abuse, few have been specifically developed for or evaluated in families where abuse is already suspected.
In a Swedish randomized controlled trial, 112 families assigned to the Safer Kids parenting intervention (n=96) and intervention as usual (IAU; n=98). Although Safer Kids was not consistently more effective than IAU across all outcomes, families in the program had fewer cumulative reports of suspected abuse over the 30-month follow up. While there was no difference between groups in the time to the first new abuse report, children in the Safer Kids group showed better mental health outcomes at 30 months. The authors conclude that, although the intervention did not delay the occurrence of a first new abuse report, it may have preventative benefits by reducing the overall number of suspected abuse reports and improving child mental health among families where abuse is suspected.
Suicide Mortality Among Adolescents and Young Adults After Launch of a Suicide and Crisis Lifeline.
Vishal Patel Harvard Medical School, Boston, USA and colleagues note that suicide remains a leading cause of death among adolescents and young adults in the United States. In July 2022, the 988 Suicide and Crisis Lifeline was launched, and contacts to the service doubled over the following three years, with high uptake among young people. However, it remained unclear whether the introduction of the lifeline was associated with changes in population-level suicide mortality among adolescents and young adults.
Patel and colleagues analysed the quarterly suicide mortality rates among 15-34-year olds using a US death certificate registry. They found that the launch of the 988 lifeline was associated with significant reductions in suicide mortality among adolescents and young adults, with the largest decreases observed in the states with the highest uptake of the service. However, the authors note that sustaining access to the lifeline will require continued investment, as current funding is projected to be insufficient to meet demand in nearly half US sates. They also highlight the discontinuation of specialised 988 services for LGBTQ+ youth, a group that previously accounted for 10% of contacts. The authors conclude that maintaining and expanding crisis support services will be crucial to the ongoing efforts to reduce suicide mortality in adolescents and young adults.
Impact of physical exercise interventions on post-traumatic stress disorder symptoms.
Hongliang Wang, Yancheng Normal University, China, and colleagues note that physical exercise and other body or movement based interventions are receiving increasing attention as potential adjunctive or alternative treatments for post-traumatic stress disorder (PTSD). However, evidence regarding effectiveness remains inconsistent, highlighting the need for further evaluation of their therapeutic benefits.
A systematic review and meta-analysis of 16 randomized controlled trials involving 663 participants (average ages ranging from 45-69 years) found that exercise-based interventions were associated with significant reductions in PTSD symptoms. Although subgroup analyses suggested larger effects for yoga-based interventions and military populations, these differences were not statistically significant. The authors conclude that physical exercise may be an effective approach for reducing PTSD symptoms.
Reducing Stress After Trauma in Physically Injured Children: A Randomized Clinical Trial.
Linda Ewing-Cobbs, McGovern Medical School at UTHealth, USA, and colleagues report that posttraumatic stress symptoms (PTSS) affect nearly half of children experiencing physical trauma and are associated with poorer health-related quality of life. To address this, the authors evaluated the effectiveness of an online therapist-assisted, trauma focused intervention designed to reduce PTSS in children after hospitalization for physical injury.
In a randomized clinical trial, 93 children aged 8 to 17 years who had been hospitalised for physical injruies were assigned to either usual care (n=46) or the ReSeT Program (n=47), an online therapist-assisted intervention comprising psychoeducational modules and cognitive behavioural therapy-based support. Parents also received optional psychoeducational resources. Children in the ReSeT group showed greater reductions in PTSS than those receiving usual care, with benefits maintained at 6-month follow-up. The authors conclude that the ReSet is an effective, brief trauma-focused intervention with the potential to be both cost-effective and scalable.
Initial Evaluation of a Brief, Transdiagnostic Intervention for Youth in School Mental Health Care
Dryburgh Nicole, McMaster University, Canada, and colleagues emphasise the importance of school-based mental health interventions, especially in response to pandemic era disruptions, and given the scarcity of dedicated mental health services available to young people. However, implementation is often challenged by high school caseloads, limited session time, competing demands, and resource constraints. The authors suggest that brief school-based interventions may offer a practical and scalable approach while still producing meaningful benefits for youth mental health.
Data from 53 school mental health professionals who delivered a brief digital intervention to 213 students with mild to moderate mental health concerns between 2021 and 2024 were evaluated. The intervention comprised four brief digital modules teaching transdiagnostic, evidence-based skills, alongside an embedded progress monitoring tool that tracked students’ internalising and externalising difficulties and self-identified “top problems” at each session. Both students and professionals reported positive experiences with the program. Key barriers included technological difficulties and the time required for training, while ease of use and strong student engagement were noted as facilitators. Significant reductions were observed in internalising difficulties, externalising difficulties, and top problem severity from pre- to post-intervention. The authors conclude that brief digital interventions may be an acceptable and promising approach for school-based mental health care, although further evaluation using randomized controlled trials is needed.
Jeanne Wolstencroft, University College London, UK, and colleagues discuss how next-generation sequencing technologies are routinely used in the NHS to identify rare genetic conditions (RGCs) in children with intellectual and developmental disabilities (IDDs). Therefore, the number of children diagnosed in early childhood (<6 years) is rising rapidly. Although the risk of mental health conditions is high, anecdotal evidence suggests that the mental health provision is limited.
The authors conducted focus groups with parents of children with RGC and IDD (n=11), as well as neurodisability professionals (n=4). Framework Analysis identified barriers to accessing mental health support, including limited post-diagnostic support, difficulties navigating services, diagnostic overshadowing (where RGC diagnosis was an exclusion for accessing services), and the emotional burden of seeking help. Facilitators included parental resilience, advocacy, and having a diagnoses that was more widely recognised. Parents and professionals identified shared priorities, including better post-diagnostic support, improved professional training, earlier mental health intervention, and greater care co-ordination. The authors conclude that children with IDD and RGC diagnosed in early childhood, and their caregivers, face unique challenges in accessing mental health support and require more coordinated and informed services.
Supporting parenting in early childhood to foster human development and mental health
Jorge Cuartas, Universidad de los Andes, Colombia, and colleagues discuss the central role of parents and caregivers in child development and mental health. This critical discussion examines current evidence and unresolved questions surrounding parenting practice, including engagement in play and learning activities, as well as approaches to discipline and punishment.
The authors explore how parenting practices are shaped by wider social, cultural, economic, and environmental influences and have long-term implications for child development. Evidence indicates that engagement in learning activities and nonphysical discipline support positive cognitive, social, and emotional outcomes, while physical punishments are associated with poorer development and mental health outcomes. The authors conclude that parenting support programs currently show strong potential for promoting positive parenting and child development, however, further research is needed to enhance their long-term effectiveness, implementation and scalability across diverse contexts.
