Childhood adversity, executive function and mental health support.
Research type
Research Study
Full title
Experiences of cognitive difficulties and engaging in mental health services in service users who have adverse childhood experiences.
IRAS ID
352657
Contact name
Lynne Patience
Contact email
Sponsor organisation
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Duration of Study in the UK
0 years, 8 months, 22 days
Research summary
Research suggests that experiencing adverse childhood experiences (ACEs; any potentially traumatic event before age 18) can cause executive function(EF) difficulties in adulthood. EFs are skills such as memory, planning, problem solving, organising and impulsivity. Research suggests that those with EF challenges, may have less favourable outcomes when accessing mental health services. Most current research uses questionnaires with predefined responses and does not tell us the day-to-day EF difficulties those who have endured ACEs experience nor do they tell us their experiences of engaging in mental health services. The current study aims to talk to those aged 18- 65 who are accessing CNTW, NHS services who identify as having EF difficulties (unrelated to brain injury/age) and have experienced ACEs with the aim of looking to answer the questions of:
1. What are service users’ who have experienced ACEs everyday experiences of EF difficulties and what sense do they make of these?
2. What are the impacts of EF difficulties for service users who have experienced ACEs on accessing and engaging in mental health services?
The study will use screening tools to look at self-reported EF difficulties and ACEs. It will then use individual interviews with service users to explore responses further and answer the research questions. These interviews will last approximately 1 hour. The research aims to increase our understanding of the cognitive impacts of ACEs and how combined, this contributes to accessing and engaging in services. A more in depth understanding may enhance skills of delivering trauma-informed care in the NHS and may suggest that EF difficulties need to be taken into account when providing treatment to those accessing mental health services so that they can have more favourable outcomes. The research may also have implications for early intervention services for children and young people who are currently facing or have faced ACEs.Lay summary of study results: Experiences of cognitive difficulties and engaging in mental health services in service users who have adverse childhood experiences.
This study was carried out by Emma Huby, a trainee clinical psychologist completing a Doctorate in Clinical Psychology, and was sponsored by Cumbria, Northumberland, Tyne and Wear (CNTW) NHS Foundation Trust. The project was supervised by Dr Lynne Patience (Principal Clinical Neuropsychologist) The design of the materials used in the study was supported by an expert by experience via CNTW involvement bank. The study took place service users who were engaging with CNTW Adult Mental Health Community Treatment Teams, with data collected between January 2026-May 2026.
Adverse childhood experiences (ACEs) are potentially traumatic events occurring from birth to age 18, such as abuse, bullying, or neglect and are linked to poorer mental health outcomes and may also contribute to differences in executive function (EF). Executive functions refer to the brain processes that support purposeful, adaptable control over thinking and behaviour, including managing emotions and impulses, starting and switching between tasks, and remembering information. Previous research has focused on questionnaire-based studies and has identified associations between ACEs and EF differences. However, questionnaire-based studies do not offer an opportunity for individuals to share their experiences or meaning of the answers provided in predefined questionnaire questions and answers. Therefore, little was known about how adults experience these differences in daily life, or how they might affect engagement with mental health services. This study therefore aimed to explore the lived experience of EF differences among adults with ACEs accessing mental health services, including their experience of engaging with care and treatment.
Eight service users took part (62.5% female; average age 31.88), all of whom identified as having both ACEs and EF differences. This was not a treatment trial, so participants did not receive any intervention; they completed screening questionnaires confirming their ACE history and EF differences, followed by an in-depth one-to-one interview about their everyday experience of EF differences and their experience of mental health care. No adverse events occurred during the study.
Following in-depth one-to-one interview, interviews were analysed using Interpretative Phenomenological Analysis, an approach designed to explore in detail how people make sense of their own experiences.Through the researching analysing the interview transcripts, Four main themes were identified: the daily burden of living with EF differences; making sense of a mind that works differently; the invisibility and consequences of unacknowledged EF differences; and when services get it right. Together, the findings suggest EF differences may be one mechanism linking ACEs to poorer treatment engagement and outcomes. The study provides an in-depth account of how adults with ACEs subjectively experience EF differences, including the varied ways participants made sense of these differences in relation to their early experiences. The findings point to implications for trauma-informed mental health care, suggesting that relatively small service adaptations, combined with greater professional recognition of EF differences, could meaningfully improve engagement and outcomes for this population.
REC name
London - Bloomsbury Research Ethics Committee
REC reference
25/PR/1109
Date of REC Opinion
29 Aug 2025
REC opinion
Further Information Favourable Opinion