Objectives Parents of neurodivergent children may experience elevated stress levels. Positive psychology interventions (PPIs) delivered as self-help interventions may offer a promising approach to supporting these parents’ mental health. This study describes the co-creation of ‘Adappt’, a smartphone application specifically designed to support parents of neurodivergent children through accessible, evidence-based PPIs. Methods The first three stages of the CeHRes Roadmap guided the co-creation process. First, a contextual inquiry was conducted through interviews with parents and professionals. Second, based on the findings of the first stage, requirements were formulated regarding the content, functionalities, look and feel, and implementation of the app. Third, the app was developed in six iterative rounds, during which parents and professionals provided feedback on several prototypes and a final functional version of the app. Results Adappt comprises six modules grounded primarily in positive psychology: points of light (e.g., savouring of positive emotions), strength-based empowerment (e.g., use of strengths), attention to yourself (e.g., self-compassion), balanced relationships (e.g., gratitude), accept and let go (e.g., exploration of values), and asking for & receiving help (e.g., forgiveness). Each module consists of an introductory video and five evidence-based exercises adapted for parents of neurodivergent children. The app can be used in a structured or an open mode. Discussion This paper outlines the co-creation process of the development of Adappt. Currently, a pragmatic international randomized controlled trial is conducted to evaluate the effectiveness of the Adappt app in improving adaptability and mental well-being of parents of neurodivergent children up to 18 years.

Parents of autistic children are more prone to high levels of stress in their daily lives. This umbrella review synthesises evidence from 41 reviews on stressors parents face at micro-, meso-, and macrolevels. At microlevel, common stressors included children’s distress behaviours, autism characteristics, child-parent dependency, and parent’s worries and characteristics. At mesolevel, financial, marital, sibling, and community issues (e.g., stigmatisation, social isolation, and lack of social support) were frequent, while macrolevel stressors involved healthcare, education, and other support services. These findings highlight the need for an integrated approach to support parents, more attention to under-researched groups (e.g., fathers and parents of autistic daughters), and longitudinal research on parental stress over time.

Adolescents with autism often face significant challenges, which can lead to emotional dysregulation (ED). For some, existing treatments are inadequate. This study examined whether Psychotherapy Incorporating Horses (PIH), using the Pegasus protocol, supports improvements in emotion regulation through goal attainment in adolescents with autism and persistent ED. This study included 36 adolescents (aged 11–18) with autism and persistent ED. Participants received 15 weekly PIH sessions. Individualised goals were assesed using Goal Attainment Scaling (GAS; -3 to + 2) at baseline and sessions 6, 10, and 15. Combined average GAS (c-GAS) were calculated per participant. Changes over time were analysed using the Friedman test with Bonferroni-corrected post hoc comparisons. Clinically significant improvement was defined as c-GAS ≥ 0. Data from 32 adolescents were analysed (mean age 13.8 years; 56

Classification systems like the DSM-5 and ICD-10 facilitate international comparative research on mental disorders. However, few studies have compared classification distributions in child and adolescent psychiatric settings across countries. This study explored similarities and differences in classification prevalence between German and Dutch children and adolescents referred to psychiatric facilities. Data were retrospectively collected from clinical samples of inpatients and outpatients who underwent diagnostic assessments in Germany (n = 7,089) and the Netherlands (n = 2,574), aged 0-18 years (M = 12.70; SD = 3.82). A multivariate analysis compared primary classifications between the two samples, which were further stratified into three age groups: early childhood (0-5 years), middle childhood (6-12 years), adolescence (13-18 years). The main factor influencing classification was the country. Age and sex showed moderate to low effect sizes, respectively. The impact varied across different age groups and sexes. Patients in the German sample were generally older and had a higher proportion of girls than those in the Dutch sample. Mood, anxiety, disruptive/impulsive-control and conduct, and trauma and stressor-related disorders were more prevalent in the German sample, while autism spectrum disorder and attention-deficit/hyperactivity disorder were more common in the Dutch sample. Our findings suggest that the primary classifications of mental disorders in Dutch and German children and adolescents largely depend on the country. This may have implications for cross-country comparisons and highlights the potential influence of national mental healthcare systems and cultural contexts on classification practices, which could impact policy decisions.

BACKGROUND Clinical practice in child and adolescent psychiatry (CAP) relies on internationally shared, empirically grounded guidelines, yet their application is influenced by socioeconomic and cultural differences. Cross-national clinical exchange allows health professionals to learn from similarities and differences. To map cross-national clinical exchange in CAP and summarise reported benefits, challenges, and impacts on clinical practice. METHODS This scoping review was conducted in line with the Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR guidelines. PubMed, PsycINFO and Web of Science were searched for publications between January 2015 and October 2025. Eligible records involved clinicians, trainees, or teams engaged in cross-national expertise exchange within CAP (0–18 years). Findings were synthesised thematically. RESULTS After deduplication, 1,944 records were identified. Twenty-one full text articles were assessed. Three studies were included from the United States, India and the Netherlands. Main themes show that exchange programmes result in awareness of differences and similarities; recognition of the interactions between clinical practice, culture, and mental health care services; and professional development. CONCLUSIONS Evidence is limited, but pilot programmes suggest cross-national exchanges increase awareness of culture and care system organisation shaping clinical practice. Further research should assess the added value, cost-effectiveness, and which formats work best for whom.

Introduction Autism support needs can be viewed as ‘wicked problems’, underpinned by various disrupting factors distributed across time and space. This complexity strains care providers’ ability to act swiftly and decisively. An integrative autopoietic-enactive approach may offer guidance by taking the individual’s interactional social-ecological system as the central unit of analysis. In clinical practice and research, however, this approach is only beginning to take shape. A lack of definition and codification hinders practical guidance and clinical innovation. Method To explore what autopoietic-enactive autism healthcare might mean in practice, this scoping review maps healthcare practices that are already based on autopoietic enactivism or bear affinity with it. Results Forty-nine publications met with inclusion, representing 2.21% of the initial corpus. Findings were synthesized using four analytical lenses: aspects of (I) ecological-, (II) tangible-, (III), intersubjective- , and (IV) socio-cultural life , representing distinguishable albeit not separable dimensions of a person’s social-ecological system. Conclusion Our findings present a rich but still loosely integrated picture of healthcare practices. This scoping review provides a reference point from which the approach may be further defined and consolidated into a clinical research field.

Central to Design Your Life (DYL) is a toolkit that helps autistic young adults develop their own supportive devices. Within a seventeen-month period, fifteen participants worked on a wide variety of devices related to decision-making, nutrition, social interaction, and more. DYL aims to empower end users by (1) providing a supportive device with practical value and (2) offering an insightful and enjoyable design process with intrinsic value. This paper presents the main findings. We used data from fourteen evaluation interviews and ten follow-up interviews, conducted two weeks and three months after the design process. Interview transcripts were thematically analyzed and the outcomes were discussed in a multistakeholder meeting involving members of the autistic community. Overall, participants attributed the most value to supportive technology in the areas of management, self-confidence, and social support. Supportive technology helped several participants better explain their support needs to trusted others. Supportive technology was also described as a sense-making tool, to explore how to navigate a world that is largely shaped for and by non-autistic people. These and other findings bolster new appreciations of supportive technology by autistic young adults.

Autism is classified based on the behavior and development of a child or adult. Subjective assessment plays a significant role during the diagnostic process. Recently, various methods have been developed to enhance diagnostic procedures with more objective instruments. By reviewing recent scientific literature, clinical guidelines, and case studies from practice, a perspective on the current state of the field is provided.

BackgroundChildhood trauma is pervasive, with approximately 50% of adolescents experiencing at least one potentially traumatic event before adulthood. Eight percent to 33% of potentially traumatic event–exposed adolescents develop posttraumatic stress disorder (PTSD), which can cause extreme suffering and coincides with numerous comorbid illnesses and high-risk behaviors. PTSD can be effectively treated in adolescents through weekly sessions of eye movement desensitization and reprocessing or trauma-focused cognitive behavioral therapy. Despite the availability of these treatments, numerous severely traumatized adolescents do not receive available treatment options due to high treatment avoidance. In adolescents who receive care, a large group of youth does not experience a sufficient symptom decrease after regular treatment. In addition, dropout rates during prolonged treatment are substantial, varying between 10% and 30%. This underscores the need for innovative and brief trauma treatment. Pilot studies indicate that Brief Intensive Trauma Treatment (BITT) can be a safe and effective treatment for adolescents with PTSD. However, randomized controlled trials on its effectiveness are crucial and urgently needed. ObjectiveThis is the first study to test the effectiveness of a 1-week BITT in adolescents with PTSD and comorbid symptoms and their caregivers. MethodsThis multicenter, single-blinded randomized controlled trial will be conducted in 4 youth care centers in the European and Caribbean Netherlands: Levvel, Karakter, Fornhese-GGz Centraal, and Mental Health Caribbean (Bonaire). We will randomize adolescents (12-18 years old) with PTSD to a BITT (n=50) or waitlist control group (WLCG; n=50). BITT comprises 1-week (ie, 5 consecutive workdays) intensive trauma treatment, encompassing daily 90-minute manualized sessions of trauma-focused cognitive behavioral therapy and eye movement desensitization and reprocessing. The day begins and ends with psychomotor therapy. Caregivers receive daily parental counseling sessions consisting of psychoeducation and social support skill training. We will conduct measurements at similar intervals for both groups: at baseline; directly after BITT or WLCG; and at 3, 6, and 9 months’ follow-up. The WLCG will receive BITT after the 3-month follow-up assessment. We will assess all study parameters using digital or face-to-face questionnaires and semistructured interviews. We will assess the primary outcome PTSD symptoms using the Child and Adolescent Trauma Screen 2 (CATS-2) and the Clinician-Administered PTSD Scale for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition])-Child/Adolescent Version (CAPS-CA-5). ResultsAs of September 2022, we enrolled 104 participants. Data will be collected until December 2025. Results are expected to be published in the summer of 2026. ConclusionsThis first, innovative study on BITT’s effectiveness may enhance treatment outcomes for PTSD by preventing dropout, reducing avoidance, shortening therapy duration, and empowering therapists by working together intensively. This research will provide valuable insights across cultures for treating severely traumatized adolescents who do not benefit sufficiently from regular treatment. Trial RegistrationClinicalTrials.gov NCT06143982, http://clinicaltrials.gov/ct2/show/NCT06143982 International Registered Report Identifier (IRRID)DERR1-10.2196/66115

Purpose Parents of neurodivergent children face elevated risks of mental health challenges. Positive psychology interventions (PPIs) may offer support. This systematic review explores studies evaluating PPIs and their mental health benefits for these parents. Methods Six databases (Scopus, PubMed, PsycINFO, Clinicaltrials.gov, PROSPERO, and Cochrane) were searched for studies on PPIs for parents of neurodivergent children. Data on intervention, participant and study characteristics, and outcomes were extracted and narratively synthesised. Risk of bias (RoB) of the review as whole as well as included papers were assessed. Results Eighteen studies on sixteen interventions met inclusion criteria, including a total of 896 parents. Most combined PPIs with additional components and were delivered in group formats. Eleven studies were classified as randomised controlled trials (RCTs), four as quasi-RCTs, and three as pre-post design. RoB assessment of the review indicated a high risk due to the absence of a pre-registered protocol. Most included studies were underpowered, and lacked proof of baseline comparability or randomisation of study arms. Most studies reported reduced distress and improved well-being and positive functioning in parents following the PPI. Conclusion PPIs hold promise for supporting parental mental health, though evidence is preliminary due to the high RoB or low quality of the studies to date. Future research should prioritise robust and adequately powered RCTs, identify working mechanisms, and explore digital formats to increase accessibility for parents.

The idea of autism as a form of neurodiversity has gained increased ground in supportive technology design. This includes a broader focus on the lived experiences and self-defined support needs of autistic individuals, and less on autism's diagnostic profile. In this paper, we contribute to the field by presenting the results of Design Your Life, a participatory design research project centred around a toolkit that helps end users develop, test, and evaluate personalised supportive technology. The DYL toolkit was examined in a multi-case study setting with fifteen participants, to find out if, which, and in what ways the toolkit enabled them to reflect on their lived experiences and apply their insights directly to the design process. Data analysis revealed a rich variety of sensory, habitual, social, and affective considerations underlying participants' design decisions, but also the need for professional designers to provide technical support to bring creative ideas to fruition.

Objective Problematic school absence (PSA) can severely impact children's mental health. Research on the prevalence of PSA in child and adolescent psychiatry is still limited. This study explores the prevalence and severity of PSA in Dutch and German young people with mental health problems.Methods This study included 354 patients aged 6-20 years (M = 13.0; SD = 3.5) from three psychiatric clinics in the Netherlands and Germany (151 Dutch and 203 German children), recruited between March and June 2019. Parents completed the Strengths and Difficulties Questionnaire and the School-Non-Attendance-ChecKlist. The study analysed PSA and associated factors.Results School absence occurred in 66.9% of the sample. Any PSA was significantly associated with inpatient treatment, conduct problems and comorbidity, while attention-deficit/hyperactivity disorder, and other behavioural disorders were negatively associated. Severe PSA (missing 8 or more of 20 school days) was associated with higher age, inpatient treatment, and phobic anxiety disorders.Conclusion This study showed a high prevalence of PSA among children with mental health problems in an international sample. Given its impact on children's development and future prospects, addressing PSA should be a priority for mental health professionals working with young people with mental health problems.

The neurodiversity approach recognizes autism as a natural variation of human experience, emphasizing unique strengths while acknowledging social and behavioral challenges that may affect quality of life. Peer support, based on shared experiences and mutual understanding, has shown benefits in mental health care, yet its impact for autistic individuals remains underexplored. This review is of peer-support programs for individuals with autism, focusing on impact, facilitators, and barriers. A systematic literature review was conducted using Cochrane Library, Web of Science, PubMed, Embase, PsycINFO, and Sociological Abstracts. Studies involving peer-support programs for autistic individuals aged 12 and older were selected. Fifteen articles described 12 unique peer-support programs with varying goals, such as enhancing personal development. Studies reported diverse improvements, including enhanced well-being, self-esteem, and academic performance. Many participants valued connecting with peers in an autism-focused context. Most articles discussed some facilitators and barriers. Peer support shows promising benefits for autistic individuals, fostering empowerment and well-being. However, the methodological limitations of the included studies, such as small sample sizes and lack of control groups, limit the strength of these conclusions. Future research should therefore use more robust research methods and investigate accessibility and potential risks to optimize peer support for this population.Lay AbstractConnecting through peer support: Understanding the impact of peer-support programs on individuals with autism and exploring barriers and facilitators.Aim and Purpose of the Research: This study aims to explore the impact of peer-support programs for autistic individuals. Peer support is defined as a supportive relationship between people with shared lived experiences. This review examines the impact of these programs on autistic individuals and identifies key challenges and facilitators that may influence outcomes.Background: Autism, characterized by differences in social interaction and behavior, can affect many aspects of daily life, including social and academic functioning, which can lead to a reduced quality of life. While peer support has proven beneficial in general healthcare, its potential for autistic individuals remains underexplored. Peer-support programs may offer mutual understanding and emotional support, making them a promising approach to improving well-being for people with autism.Methods: A systematic review was conducted using multiple databases to identify research articles published up to January 17, 2024. Studies included focused on peer-support programs for autistic individuals aged 12 and older, employing methods such as interviews or questionnaires to assess their impact.Results and Importance: The findings indicate that peer-support programs generally have a positive impact, including improved self-esteem, academic performance, and overall well-being. Participants valued the opportunity to connect with others with similar experiences. Although the findings are promising, most studies were small and low quality, so more research is needed. Future research should also investigate the factors contributing to successful peer support and explore ways to optimize these programs for autistic individuals.

IntroductionA group of youth in child-and-adolescent psychiatry (CAP) experiences severe and enduring mental health problems (SEMHP) transcending current classification systems. To support these youth timely and effectively, their characteristics require further exploration in clinical practice. Hence, this study aims to deepen our understanding of SEMHP characteristics in youth, taking into account perspectives from multiple stakeholders.Materials and methodsFollowing an exploratory sequential design identifying SEMHP characteristics initially in depth (in a literature and qualitative study), digital questionnaires were completed in three subgroups of in total 155 participants, 1) 81 youth (Mage = 21, SD = 3), 2) 31 caregivers (Mage = 51, SD = 5), and 3) 43 clinicians (Mage = 41, SD = 11), rating each characteristic. All participants described being familiar as youth with SEMHP, a caregiver of youth with SEMHP, or a clinician working with SEMHP, and thus able to evaluate their nature.ResultsThe characteristics prolonged suffering, several areas of life affected, interpersonal distrust, internalization of SEMHP, limited daily functioning, and hopelessness were consistently recognized by the three participant groups. Youth tend to score higher on the individual characteristics, with a significant difference between groups in the recognition of masking behavior. Family characteristics and unsafe environments are far less recognized by caregivers, while societal characteristics including societal ignorance, stigma and overemphasis on classifying are significantly less recognized by clinicians.DiscussionYouth, caregivers, and clinicians shared common ground in recognizing the pervasiveness of SEMHP. However, differences in perspectives on characteristics present challenges for diagnostics of these youth. Masking behavior of youth is unsurprising and indicates that these youth need a specific approach in diagnostics. A holistic and multi-perspective understanding of SEMHP is crucial for effective support, as care for these youth must take a systemic and connection-focused approach. Additionally, clinicians must be critically aware of the societal context.

Unhealthy lifestyle behaviours, such as sleep problems, low physical activity, poor diet, and excessive screen time, are common among children and adolescents. Lifestyle has a significant impact on children’s physical and mental health. This study examined the prevalence of unhealthy lifestyle habits in children and adolescents in psychiatric care, and how they vary by age, gender, and diagnosis. Parent-reported data on sleep, physical activity, diet (i.e., vegetables and fruit), and screen time from 4,633 children and adolescents (ages 0–18 years) referred for specialized psychiatric care were used. Parents reported high levels of unhealthy lifestyle habits among children with mental disorders. Adolescents (13–18 years) exhibited the unhealthiest lifestyles, with more sleep problems, less physical activity, more screen time and less fruit intake. Reported lifestyle habits were worse for girls than boys, with girls exhibited less physical activity, more sleeping problems, more screen time and less fruit intake. Children and adolescents with depression and anxiety disorders reported the least physical activity, most screen time and the least fruit and vegetable intake. Children and adolescents with trauma and stressor related disorders had the most sleep problems. To conclude, parents report high amounts of unhealthy lifestyle habits in their children with mental disorders. These unhealthy lifestyle habits appeared to be highly prevalent in this group of children compared to those in the normative population. Given the high prevalence of unhealthy lifestyle in this clinical population of children, it is crucial to place greater emphasis on improving lifestyle interventions within psychiatric care.

BACKGROUND:For people with autism spectrum disorder (ASD), daily life can be highly stressful with many unpredictable events that can evoke emotion dysregulation (ED): a strong difficulty with appropriately negative affect regulation. For some of the patients with ASD, treatment as usual does not prove to be effective for ED. They may be at risk of life-long impairment, development of other disorders and loss of motivation for most regular forms of therapy. A highly promising method that may prove effective for therapy-resistant individuals with ASD is Psychotherapy incorporating horses (PIH). PIH uses the interactions of the horse and the patients on the ground and does not include horseriding. While often met with prejudgment and scepticism, reports from parents and therapists as well as a recent systematic review suggest that PIH may have beneficial effects on youths with ASD. Therefore, we examine clinical outcomes both in the short and in the long terms of PIH offered to adolescents with ASD and severe ED despite regular therapy. METHODS:A total of 35 adolescents aged 11-18 years with ASD will receive PIH during 15 sessions once a week with randomization to five different groups differentiating in baseline phase from 2 to 6 weeks. PIH uses horses to promote social awareness and self-awareness as well as relationship management and self-management. The primary outcome is the response to treatment on the Emotion Dysregulation Index (EDI). The secondary outcome measures include ASD symptom severity, quality of life, self-esteem, global and family functioning, and goal attainment. Assessments take place at the baseline (T0), at the end of baseline phase A (T1), after completion of intervention phase B (T2), after the end of post-measurement phase C (T3) and after one year (T4). Qualitative interviews of participants, parents and therapists will be held to reveal facilitators and barriers of PIH and a cost-effectiveness study will be performed. DISCUSSION:This study aims at contributing to clinical practice for adolescents with ASD and persistent emotion regulation problems despite 1.5 year of treatment by offering Psychotherapy incorporating horses in a study with series of randomised, baseline controlled n-of-1 trials. TRIAL REGISTRATION:www. CLINICALTRIALS:gov NCT05200351, December 10th 2021.

Supportive technologies for autistic individuals are promising in principle, yet their uptake remains limited. Critics argue that in current designs of supportive technologies, autism is mostly framed as a 'disorder' whose limitations can be pragmatically compensated for. To increase uptake, designers should get a better handle on how to incorporate the full richness of the autistic experience into the design process. This paper presents an integrative framework of the autistic lifeworld, called Autistic Lifeworld Design (hereafter: ALD). ALD evolved in a transdisciplinary research setting, substantiated by 11 design case studies with autistic young adults as well as theoretical inquiries into enactivism, design and autism. It consists of four dimensions of experience - sensory, habitual, social, and affective -, each providing specific pointers on how to better understand how autistic people experience the world and how supportive technologies may complement that experience. By adopting an enactive approach, ALD enables a reframing of supportive technology as helping to sustain different levels of homoeostasis. It offers a novel lens that allows designers to put the lived experiences of autistic individuals at the centre of the design process, with special attention to the role of bodily structures and processing in shaping these experiences.

AbstractBackgroundThe COVID‐19 pandemic negatively affected child and adolescent mental health and at the end of the pandemic (April 2022) child mental health had not returned to pre‐pandemic levels. We investigated whether this observed increase in mental health problems has continued, halted, or reversed after the end of the pandemic in children from the general population and in children in psychiatric care.MethodsWe collected parent‐reported and child‐reported data at two additional post‐pandemic time points (November/December 2022 and March/April 2023) in children (8–18 years) from two general population samples (N = 818–1056 per measurement) and one clinical sample receiving psychiatric care (N = 320–370) and compared these with data from before the pandemic. We collected parent‐reported data on internalizing and externalizing problems with the Brief Problem Monitor and self‐reported data on Anxiety, Depressive symptoms, Sleep‐related impairments, Anger, Global health, and Peer relations with the Patient‐Reported Outcomes Measurement Information System (PROMIS®).ResultsIn the general population, parents reported no changes in externalizing problems but did report higher internalizing problems post‐pandemic than pre‐pandemic (p < 0.001). Children also reported increased mental health problems post‐pandemic, especially in anxiety and depression, to a lesser extent in sleep‐related impairment and global health, and least in anger (all ps < 0.01). In the clinical sample, parents reported higher internalizing (p < 0.001), but not externalizing problems post‐pandemic compared to the start of the pandemic. Children reported greatest increases in problems in anxiety, depression, and global health, to a lesser extent on sleep‐related impairment, and least on anger (all ps < 0.05).ConclusionsChild mental health problems in the general population are substantially higher post‐pandemic compared to pre‐pandemic measurements. In children in psychiatric care mental health problems have increased during the pandemic and are substantially higher post‐pandemic than at the start of the pandemic. Longitudinal and comparative studies are needed to assess what the most important drivers of these changes are.

IntroductionParents of children with a neurodevelopmental disorder (NDD) experience more stress than parents of typically developing children. In a cocreation process with experts and parents, a low-threshold application that uses exercises based on the principles of positive psychology and mindfulness was developed. This application, called "Adappt," aims at enhancing the ability to adapt of the parents and caregivers of children with NDDs and at supporting their mental health. This protocol describes the evaluation study of the effectiveness of Adappt, its core working mechanisms and user experiences.MethodA pragmatic international multicenter randomized controlled trial will compare the effectiveness of Adappt with a (delayed) waitlist control condition. At least 212 parents or primary caregivers of children younger than 18 years diagnosed with or suspected of a NDD will be randomly assigned to the intervention or waitlist control condition. Participants are excluded if they have severe anxiety or depression levels or are in treatment for mental health issues. Measures will be collected online at baseline, post-intervention (1 month after baseline), and 4 and 7 months after baseline. The primary outcome is the improvement in generic sense of ability to adapt as measured with the Generic Sense of Ability to Adapt Scale (GSAAS; (Front Psychol 14:985408, 2023)) at 4-month follow-up. Secondary outcomes are mental well-being, (parental) distress, and client satisfaction with "Adappt."DiscussionResults of this study will contribute to knowledge on the effectiveness of a low-threshold application for parents of children with a NDD in multiple countries. If the application is found to be effective in improving mental health, recommendations will be made for implementation in health care.Trial registrationThis study is registered on clinicaltrials.gov (NCT06248762) on February 8, 2024, and the Open Science Framework (https://osf.io/5znqv).

Background: Childhood adversity can have lasting negative effects on physical and mental health. This study contributes to the existing literature by describing the prevalence rates and mental health outcomes related to adverse childhood experiences (ACEs) among adolescents registered for mental health care.Methods: Participants in this cross-sectional study were youths (aged 12-18 years) who were referred to outpatient psychiatric departments in the Netherlands. Demographic information was collected from the medical records. The Child Trauma Screening Questionnaire (CTSQ) was used to examine the presence of ACEs and posttraumatic stress symptoms (PTSS). To assess mental health problems, we used the Dutch translation of the Youth Self Report. Descriptive statistics and frequencies were used to calculate prevalence rates across the various ACEs domains. ANOVA and chi-square tests were used to explore the relationship between ACEs and mental health.Results: Of the 1373 participants, 69.1% reported having experienced at least one ACE and 17.1% indicated exposure to four or more ACEs in their lives. Although there was substantial overlap among all ACE categories, the most frequently reported were bullying (49.2%), emotional abuse (17.8%), physical abuse (12.2%), and sexual abuse (10.1%). Female adolescents (72.7%) reported significantly more ACEs than their male counterparts (27.0%). Furthermore, a higher number of ACEs was associated with significantly more self-reported general mental health problems, an elevated prevalence of both mood and post-traumatic stress disorders, and a greater presence of two or more co-existing psychiatric diagnoses (comorbid psychiatric classification).Conclusions: This cross-sectional study on childhood adversity and its association with mental health showed that ACEs are highly prevalent in youth registered for mental health care. This study provides support for a graded and cumulative relationship between childhood adversity and mental health problems.