Adoption is increasingly seen as a lifelong experience, with cascading effects from early life experiences into adulthood. Consequently, support needs can often persist long after adoption. Current post-adoption support has largely been informed by infant studies and developmental theories such as attachment theory, emphasising the importance of early bond forming with adoptive caregivers. Recent evidence and cohort studies as adoptees have grown older suggest that support needs, especially beyond early childhood, are both broad and complex. This systematic review aimed to consolidate research about adoptee support needs as reported by adoptees and/or their families. The review included international, English-language primary studies published between 2002 and 2025 that reported on the lived post-adoption experiences of adoptees and their families, with particular attention to areas of unmet support. Following a review of 120 full texts, 76 were included. Support needs were identified for areas of attachment, identity, neurodevelopmental conditions, mental health and trauma, education, grief/loss, and contact with birth families. Participants reported that neurodevelopmental problems and the role of early adversity and trauma on later mental health outcomes were not well understood among service providers, which created a barrier to diagnoses and interventions received. Practice implications and recommendations for service providers are discussed.

This article explores the stability and impact of birth country and heritage interest among international adoptees from adolescence to adulthood, using data from the English and Romanian Adoptees (ERA) study. While adolescence is often seen as key for ethnic identity development, adulthood may also offer opportunities for reflection and integration. We examined interest in Romania at ages 15 and 23, and its links to earlier neurodevelopmental difficulties, behavioural engagement (e.g., visiting Romania, contact with biological relatives), and adult wellbeing. Four main findings emerged: first, interest in Romania was generally stable – 49% showed persistently low interest, 11% persistently high, 23% increased, and 17% decreased; second, higher interest was linked to visiting Romania and contact with biological relatives, especially mothers and siblings; third, greater interest was associated with fewer childhood attention-deficit/hyperactivity disorder (ADHD) symptoms, but not with other deprivation-related issues or institutional deprivation duration; and fourth, higher interest was associated with fewer emotional problems in adulthood, though not differences in self-esteem or functional outcomes. These findings suggest heritage interest may support mental health in adulthood for some adoptees. Adoption support should encourage heritage engagement and tailor interventions to individual neurodevelopmental profiles, promoting identity exploration across the lifespan.

Early institutional deprivation is associated with a co-occurring constellation of deprivation-specific problems (DSPs), including autism, ADHD, disinhibited social engagement (DSE), and cognitive impairment. While these difficulties often persist into young adulthood, substantial heterogeneity in developmental trajectories suggests that post-adoption environmental factors may influence recovery. This study adopts a transdiagnostic approach to examine how childhood experiences are associated with the long-term trajectories of these diverse neurodevelopmental and mental health domains. Using longitudinal data from 165 Romanian adoptees (total N = 217), we examined whether trajectories from ages 11 to young-adulthood for autism, ADHD, DSE, cognitive impairment, and mental health were predicted by childhood negative family/peer experiences and professional intervention (clinical psychological therapies and special educational support). We tested whether predictions differed between high versus low autism and ADHD symptom groups at age 11. Higher Professional Intervention levels were significantly associated with improving trajectories for autism, ADHD, DSE, and IQ, but not mental health outcomes. Multivariate analysis suggested complementary roles of clinical psychological therapies and special educational support; the former being more strongly associated with ADHD and DSE, and the latter with autism and IQ. Associations were observed across the symptom severity continuum for autism and ADHD, with comparable effect sizes found in both high and low symptom groups. Negative family and peer experiences showed some bivariate associations but were not significant predictors in multivariate models. Childhood professional intervention was associated with improved deprivation-specific outcomes, with effects across symptom severity levels, highlighting tractability despite strong persistence. The differential and complementary effects suggest comprehensive support requires both educational and clinical interventions.

BackgroundThere are currently more than 750 million women worldwide aged 40–60 years, the age during which the majority undergo menopausal transition. This period is often marked by challenging symptoms that affect physical and mental health, productivity, and quality of life, sometimes becoming severe enough to compromise personal and professional relationships. A substantial proportion of women experience mental health symptoms such as anxiety, depression and cognitive complaints. Mindfulness-based interventions (MBIs) have shown promising results in alleviating menopausal symptoms and represent a safe, self-managing alternative or complement to pharmacological treatments.ObjectivesTo consolidate and review the current state of the literature on the effectiveness of MBIs for mental health symptoms, including anxiety, depression, and cognitive function in women undergoing natural menopause.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It included randomized and non-randomized controlled trials of MBIs in women undergoing natural menopause. The outcomes of interest were mental health, including anxiety, depression, and cognitive function. Databases searched included PubMed, Embase, PsycInfo, CINAHL, and Web of Science. Searches were performed up to October 2025. Reference lists and specialist journals were also hand searched. The methodological quality and risk of bias of the included studies were assessed using the Cochrane Risk of Bias 2.0 (RoB 2) and the Newcastle-Ottawa Scale (NOS). An exploratory random-effects meta-analysis was conducted where measurement consistency permitted.ResultsTen studies (eight randomized controlled trials and two quasi-experimental designs), including a total of 1,270 participants, met the inclusion criteria. Six studies assessed psychosocial quality of life using the MENQOL Psychosocial Domain, enabling meta-analysis; a large pooled effect favoured MBIs (Hedges' g = −1.06, p < 0.001). Secondary outcomes of anxiety and depression, measured independently, showed smaller effects. No study assessed cognitive function using validated cognitive instruments.ConclusionsPreliminary evidence suggests mindfulness-based interventions may improve mental health symptoms during natural menopause. The discrepancy between composite psychosocial effects and standalone mood effects may reflect measurement differences between menopause-specific and generic instruments, or suggest that cognitive complaints contribute to the observed benefits. However, substantial methodological limitations temper confidence in these findings. Future research should prioritise validated cognitive assessment as an independent outcome, investigation of practice dose required to maintain benefits, and comparative effectiveness trials against established treatments.

Purpose Globalisation and the opening of cross-border work opportunities have led to an increase in individuals relocating from their native country to another for professional reasons, a phenomenon called “expatriation”. A wealth of research has focused on expatriation from an adult perspective, but there is also a growing inter-disciplinary literature on how expatriation is affecting the children of adult expatriates. The purpose of this paper is to synthesise the recent published literature on the psychological impact of expatriation on the mental health of these children and adolescent expatriates. Design/methodology/approach A narrative synthesis approach was adopted in order to synthesise evidence from 12 original, peer-reviewed papers with research relevant to the topic. Findings Findings indicate a risk of affective disorders as a result of expatriation experiences, and lower emotional stability with increased stress, predominantly for adolescent expatriates. Some maladaptive behaviours, such as over-reliance on digital technologies, are also noted. Positive gains of expatriation centre around personality development domains, such as cognitive flexibility, open-mindedness and empathy. Research limitations/implications Future research can delve further into the mental health of expatriate youths, to inform clinical practice and policy making, as well as help address diagnostic, treatment and prevention issues that this young, developing population may face. Originality/value This paper focuses solely on children and adolescent expatriates, that may be under-represented in the wider expatriate literature, and considers the psychological outcomes and the potential risks and benefits of expatriation on their mental health.

In the English and Romanian Adoptees study, a substantial proportion of adoptees who suffered extended severe deprivation (26 of 101) displayed autistic characteristics termed quasi-autism (QA). Here we directly compare this group with a community sample of early diagnosed autistic individuals (community autism; CA). First, we characterized the QA autism symptom profile (61.5% females) by calculating which of the 32 Social Communication Questionnaire (SCQ) items were statistically more common in the QA group than in a control group of 52 non-deprived UK adoptees (UK Control, 34.6% females) at ages 11, 15, and/or 23 years of age. The latent structure of these QA-characteristic items was explored using confirmatory factor analyses. Second, we compared the QA symptom profiles with CA profiles using a sample from the QUEST study (Salazar et al. 2015). To do this, we identified two QUEST groups, one aged 11 years on average (n = 21) and one aged 15 years (n = 24). The former were compared to ERA SCQ scores at age 11, and the latter at age 15. Nineteen SCQ items were statistically significantly more common in the QA group than in the ERA UK control group at ages 11 and 15. Ten differences persisted into adulthood. These QA-characteristic items ranged across and mapped onto all three standard SCQ domains (social reciprocity, communication, repetitive and stereotyped behaviors). The age 11 CA group scored higher than QA at 11 years across each subscale when all items were considered. However, when only QA-characteristic items were included, only scores for the Repetitive and Stereotyped subscale differentiated QA and CA. When the age 15 comparison was made, no differences were found between CA and QA subscales. QA and CA were associated with similar levels of emotional and conduct problems and overactivity/inattention levels. QA shared many features with CA. QA difficulties extended across all autism domains and were associated to a similar degree with emotional and behavioral problems. However, there were some distinctive elements. Compared to the classic autism profile, the communication domain mainly comprised persistent abnormalities of linguistic expression. In contrast, social reciprocity problems were diffuse, less severe, and declined over time. QA-characteristic repetitive and stereotyped behaviors are broadly expressed and endure into adulthood.

Research examining the effects of severe, prolonged early deprivation has shown elevated rates of neurodevelopmental symptoms, which frequently persist into adulthood and are associated with functional and social relationship difficulties, as well as elevated rates of mental health problems. The behavioural manifestations of these symptoms closely resemble those of ADHD and also ASD. Here, we used qualitative methods to explore and characterise the social experiences and difficulties encountered by young adults exposed to profound early deprivation, in part to highlight any apparent parallels between the experiences in this group and those identified in typically developing samples with ADHD or ASD. To do so, we interviewed young adults and their adoptive parents (N = 18) from the English and Romanian Adoptees study, about their social lives. Participants were keen to describe not only the challenges they faced but also adaptive responses. A semantic/descriptive thematic analysis revealed that the young adults strongly desired social relationships but struggled to navigate social norms, resulting in frustration and frequent loss of relationships. This was accompanied by strong feelings of loss and rejection, all of which were perceived to have a negative impact upon self-esteem and mental health. Adaptive strategies included the fostering of casual friendships with older individuals and seeking employment with strong social components. Similarities and differences between our findings and the social difficulties experienced by typically developing groups with neurodevelopmental problems, and adopted individuals more generally, are discussed.

Severe, prolonged early deprivation is associated with later neurodevelopmental difficulties. Despite elevated levels of contact with service providers, these problems often persist into adult life and are associated with impairment in adulthood (e.g., unemployment, higher rates of depression and anxiety symptoms and poorer subjective wellbeing). Here, we aimed to explore the ongoing service needs and experiences of adoptees and their parents from the English and Romanian Adoptees (ERA) study, in those with a history of early deprivation and neurodevelopmental problems. Our descriptive thematic analysis highlighted difficulties with independent living, particularly financial management and problems with decision-making. Where specific forms of support had been accessed (e.g., medication for attention-deficit/hyperactivity disorder) they were often helpful, although there was some ambivalence towards taking medication due to side effects. However, the neurodevelopmental problems were not well understood and were often overlooked by service providers. There is a need for greater awareness among frontline service providers of the neurodevelopmental impact of early adversity. Participants also identified that their support needs were largely unmet and that their parents were having to fill this gap. Similarities and differences between the experiences highlighted here and those identified with idiopathic neurodevelopmental disorders are discussed, as are several recommendations for educational improvements for service providers.

It has been reported that adult adoptees with histories of maltreatment face particular challenges when they become parents. Here we explore this issue using a qualitative analysis of the views of 14 adoptee mothers, who suffered severe institutional deprivation in the Romanian orphanages of the late 1980s before being adopted into the UK, and their adoptive parents. Following a thematic analysis, we report several perceived benefits of becoming a parent, as well as co-occurring difficulties and challenges. Benefits included a sense of accomplishment and fulfilment, feeling more motivated personally and professionally and the positive experience of having a relationship with a biological relative. Challenges related, in particular, to some adoptee parents’ abilities to appraise risk relating to their children and to difficulties in organising day-to-day activities. Practical and emotional support from adoptive grandparents was very often crucial for adoptee parents’ success and wellbeing. Implications for research and practice are discussed, emphasising that deprivation-related difficulties expand into adulthood and for some can impact their ability to parent.

Background: There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based interventions. To examine this, we had two main aims; (1) to meta-analyze psychotherapy effects on (i) depression and (ii) self-esteem, and (2) to investigate the relationship between reductions in depression symptoms and improvements in self-esteem. Design: A systematic review and meta-analysis.Methods: Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of psy-chotherapy for adult depression, which included a self-esteem outcome at post-treatment. Nineteen studies with a total of 3423 participants met the inclusion criteria. For each comparison between psychotherapy and a control condition, we calculated Hedges' g both for depression and self-esteem and pooled them in two separate meta-analyses. Furthermore, meta-regression was used to explore the association between the effect of psychother-apy for depression and its effect on self-esteem.Results: The effects on depression were large and significant (Hedges' g =-0.95; [95 % CI:-1.27, -0.63]). We found evidence of smaller, albeit still moderate, effects on self-esteem (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with sustained effects at 6-12 months (Hedges'g = 0.70; [95 % CI:-0.03, 1.43]). We also found a strong inverse association between the effects of psychotherapy for depression and self-esteem (beta =-0.60, p < 0.001). Limitations: Heterogeneity was very high (I2 = 97 %), and out of 19 trials, only 6 trials were rated as having a low risk of bias.Conclusions: The results suggest that psychotherapy for depression may improve self-esteem to a moderate degree.

Rutter and colleagues' seminal observation that extended early life exposure to extreme institutional deprivation can result in what he termed quasi-autism (QA), informed both our understanding of the effects of adversity on development and the nature of autism. Here we provide the first detailed analysis of the adult outcomes of the group of institutionally deprived-then-adopted children identified as displaying QA. Twenty-six adult adoptees identified with QA in childhood ( Childhood QA+ ) were compared to 75 adoptees who experienced extended institutional deprivation (>6 months) but no QA ( Childhood QA −), and 116 adoptees exposed to Low/No institutional deprivation . The outcomes were child-to-adult developmental trajectories of neuro-developmental symptoms (autism, attention-deficit/hyperactivity disorder (ADHD), disinhibited social engagement (DSE) and cognitive impairment), adult functioning, life satisfaction and mental health. Childhood QA+ was associated with elevated and persistent trajectories of broad-based autism-related difficulties, ADHD and DSE symptoms and low IQ, as well as adult mental health difficulties and functional impairment, including high rates of low educational attainment and unemployment. Life satisfaction and self-esteem were unaffected. Autism-related communication problems, in particular, predicted negative adult outcomes. Childhood QA+ was still associated with poor outcomes even when ADHD, DSE and IQ were controlled. Early and time-limited institutional deprivation has a critical impact on adult functioning, in part via its association with an early established and persistent variant of autism, especially related to communication difficulties. Apparent similarities and differences to non-deprivation related autism are discussed.

BackgroundRutter and colleagues' seminal observation that extended early life exposure to extreme institutional deprivation can result in what he termed quasi‐autism (QA), informed both our understanding of the effects of adversity on development and the nature of autism. Here we provide the first detailed analysis of the adult outcomes of the group of institutionally deprived‐then‐adopted children identified as displaying QA.MethodsTwenty‐six adult adoptees identified with QA in childhood (Childhood QA+) were compared to 75 adoptees who experienced extended institutional deprivation (>6 months) but no QA (Childhood QA−), and 116 adoptees exposed to Low/No institutional deprivation. The outcomes were child‐to‐adult developmental trajectories of neuro‐developmental symptoms (autism, attention‐deficit/hyperactivity disorder (ADHD), disinhibited social engagement (DSE) and cognitive impairment), adult functioning, life satisfaction and mental health.ResultsChildhood QA+ was associated with elevated and persistent trajectories of broad‐based autism‐related difficulties, ADHD and DSE symptoms and low IQ, as well as adult mental health difficulties and functional impairment, including high rates of low educational attainment and unemployment. Life satisfaction and self‐esteem were unaffected. Autism‐related communication problems, in particular, predicted negative adult outcomes. Childhood QA+ was still associated with poor outcomes even when ADHD, DSE and IQ were controlled.ConclusionsEarly and time‐limited institutional deprivation has a critical impact on adult functioning, in part via its association with an early established and persistent variant of autism, especially related to communication difficulties. Apparent similarities and differences to non‐deprivation related autism are discussed.

Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22-25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence.

Background: Childhood institutional deprivation is associated with growth stunting in childhood but long-term effects in adulthood remain uncertain. Objective: To examine the impact of global institutional deprivation experienced in early childhood on subsequent growth with a special focus on final adult height and puberty timing. Participants & setting: The study was originally set in the UK, though some adoptive families lived abroad by the time of the adult follow up. 165 individuals adopted by UK families before 43 months of age from Romanian orphanages after the fall of the Ceausescu regime in the early 1990's were compared to 51 non-deprived UK adoptees, adopted before the age of 6 months. Methods: The English and Romanian Adoptees (ERA) study is a 20-year longitudinal natural experiment on the effects of institutional deprivation on development. Key growth milestones were extracted from growth curve modelling of height data collected at ages 4, 6, 11, 15 and 23 years using a Bayesian approach to fit the JPA2 model. Results: Deprivation effects on height were present at the take-off point of accelerating adolescent growth and persisted into adulthood - the largest effects being for individuals who experienced over six months of deprivation. Deprivation was associated with earlier take-off and achievement

BackgroundUsing data from the English & Romanian Adoptees (ERA) study, we recently reported that early time‐limited exposure to severe institutional deprivation is associated with early‐onset and persistent neurodevelopmental problems and later‐onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early‐appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress.MethodsThe ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self‐reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships.ResultsThe path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive.ConclusionsOur analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model.

Using data from the English & Romanian Adoptees (ERA) study, we recently reported that early time-limited exposure to severe institutional deprivation is associated with early -onset and persistent neurodevelopmental problems and later -onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships. The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive. Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model.

Institutionally deprived young children often display distinctive patterns of attachment, classified as insecure/other (INS/OTH), with their adoptive parents. The associations between INS/OTH and developmental trajectories of mental health and neurodevelopmental symptoms were examined. Age 4 attachment status was determined for 97 Romanian adoptees exposed to up to 24 months of deprivation in Romanian orphanages and 49 nondeprived UK adoptees. Autism, inattention/overactivity and disinhibited-social-engagement symptoms, emotional problems, and IQ were measured at 4, 6, 11, and 15 years and in young adulthood. Romanian adoptees with over 6 months deprivation (Rom>6) were more often classified as INS/OTH than UK and Romanian adoptees with less than 6 months deprivation combined. INS/OTH was associated with cognitive impairment at age 4 years. The interaction between deprivation, attachment status, and age for autism spectrum disorder assessment was significant, with greater symptom persistence in Rom>6 INS/OTH(+) than other groups. This effect was reduced when IQ at age 4 was controlled for. Age 4 INS/OTH in Rom>6 was associated with worse autism spectrum disorder outcomes up to two decades later. Its association with cognitive impairment at age 4 is consistent with INS/OTH being an early marker of this negative developmental trajectory, rather than its cause.

Technology Enhanced Learning (TEL) has become a common feature of Higher Education. However, research has been hindered by a lack of differentiation between usage and engagement and not recognising the heterogeneity of TEL applications. The current study aimed to assess the impact of emotional, cognitive and behavioural engagement with TEL on students’ grades and to also look at how motivation levels differentially predict engagement across different types of TEL. In a sample of 524 undergraduate students, we measured engagement and usage of TEL, student learning motivations and self-report student grades. Our results indicate that intrinsic motivations predict engagement, whilst extrinsic motivations predict usage. Importantly, engagement was predictive of grades whereas usage was not. Furthermore, when TEL was broken down by type, the use of social media groups was a significant predictor of grade, whereas reviewing lecture slides/recordings, reading additional content and using course blogs/discussion boards were not. We conclude that a sole focus on usage of TEL is misleading. Implications for researchers and educators are discussed.

Working Health Service Scotland (WHSS) supports the self-employed and employees of small and medium-sized enterprises (SMEs) in Scotland with a health condition affecting their ability to work, who are either absent or at risk of becoming absent due to it. To evaluate the impact on health and work outcomes of WHSS clients over a 4-year period. Data were collected at enrolment, entry, discharge and follow-up at 3 and 6 months after discharge. Clients completed up to three validated health questionnaires at entry and discharge-EuroQol five dimensions (EQ-5D) and visual analogue scale (VAS); Hospital Anxiety and Depression Scale (HADS); and Canadian Occupational Performance Measure (COPM). A total of 13463 referrals occurred in the 4-year period; 11748 (87%) were eligible and completed entry assessment and 60% of the latter completed discharge paperwork. The majority of referrals were due to musculoskeletal conditions (84%) while 12% were referred with mental health conditions. Almost a fifth (18%) of cases were absent at entry and back at work at discharge. Work days lost while in WHSS was associated with age, length of absence prior to entering WHSS, primary health condition and time in programme. All health measures showed significant improvements from entry to discharge. Improvement in general health was sustained at 3- and 6-month follow-up. The WHSS evaluation findings indicate that participation was associated with positive changes to health and return-to-work. The extent of the positive change in health measures and work ability can be highly important economically for employees and employers.

This study evaluated flares (defined as increased itching/redness or new/spreading lesions) in a real-world setting among adults with moderate-to-severe AD treated with systemic agents prior to recent dupilumab approval. Adults (≥18 yr) with an AD diagnosis in the last 5 yr (as of May '16), and a prescription for an immunosuppressant, systemic corticosteroid, or phototherapy in the last 6 months, were identified from the Optum Research Database. Moderate-to-severe AD patients (self-assessed based on Rajka-Langeland criteria) took part in a baseline paper survey and monthly web-based surveys over 12 months. We report 6-month survey data on flares. 801 patients completed baseline survey (mean±SD age: 45±14 yr; female: 72%; white: 84%; employed: 79%; AD severity: moderate 74%, severe 26%); 629 patients completed ≥1 survey between months 1–6. At baseline, in the past month, 23.3% of patients reported having 1 flare, 19.7% had 2 flares, and 38.3% had >2 flares. Of those reporting a flare, 49.6% reported each flare lasted between 13 weeks; 28.0% reported each flare lasted for ≥3 weeks. 91.6% reported worrying about a flare during the past month. At months 16, in the past month, 28.3–35.3% of patients reported having 1 flare, 19.7–24.6% had 2 flares, and 27.0–32.8% had >2 flares. Of those reporting a flare, 50.453.1% reported each flare lasted between 13 weeks; 13.5–16.8% reported each flare lasted for ≥3 weeks. 88.9–93.2% reported worrying about a flare during the past month. In this study, patients with moderate-to-severe AD continuously reported a substantial number and prolonged duration of recurrent flares, suggesting unmet therapeutic needs in long-term disease control.