{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:03:44Z","timestamp":1789621424140,"version":"build-2803163510"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adult ADHD and autism assessment services increasingly receive clinically heterogeneous referrals in which the sequelae of childhood adversity may overlap with neurodevelopmental presentations. The distribution and clinical significance of adverse childhood experiences (ACEs) in this referral population remain insufficiently characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional cohort study analyzed routinely collected clinical data from 389 adults who attended either the ADHD or the autism diagnostic pathway of a regional National Health Service (NHS) Adult ADHD and Autism Service. The analytic sample consisted of 233 adults with a definitive diagnostic outcome at data extraction; 149 were awaiting an outcome, six had an inconclusive outcome, and one underage case was excluded. ACE exposure was measured with the 10-item ACE Questionnaire. Psychiatric symptom burden was assessed with routinely administered screening instruments (PHQ-9, GAD-7, AUDIT, DAST-10, MDQ, HELPS and IPDS). The primary analysis examined the association between ACE score, analyzed as a continuous variable, and diagnostic outcome, with adjustment for age, gender and assessment pathway in binary logistic regression; all other analyses were exploratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-seven participants (20.2%) received a diagnosis of ADHD or autism and 186 (79.8%) did not meet DSM-5 criteria. The mean ACE score was 3.10 (SD = 2.59), and 39.7% of participants reported four or more ACEs, compared with 8.3% in an English national household survey. Participants who were not diagnosed reported higher ACE scores than participants who were diagnosed (3.37 vs. 2.04; Hedges\n                      <jats:italic>g<\/jats:italic>\n                      = 0.52, 95% CI 0.19\u20130.84,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002). In the adjusted model, each additional ACE was associated with lower odds of receiving a neurodevelopmental diagnosis (odds ratio 0.85, 95% CI 0.73\u20130.99,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.040). The proportion diagnosed declined across ACE categories from 35.6% (no adversity) to 6.2% (six or more ACEs). ACE scores correlated positively with depressive symptoms (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.37), anxiety symptoms (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.28) and drug use scores (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.27), but not alcohol use, and were higher among participants screening positive for possible personality disorder, head injury and mood disorder. In an exploratory model additionally adjusting for depressive symptoms and personality disorder screening status, the ACE association attenuated and was no longer statistically significant, indicating that it is not independent of concurrent psychiatric symptom burden.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ACE exposure in this referral cohort was substantially higher than English population estimates and was associated with diagnostic non-confirmation and with greater psychiatric symptom burden. These findings support consideration of childhood adversity within trauma-informed formulation during adult neurodevelopmental assessment. Prospective studies incorporating direct measures of trauma-related psychopathology are needed to determine whether trauma-related mechanisms contribute to neurodevelopmental-like presentations. The cross-sectional retrospective design precludes causal inference.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1898116","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:29:57Z","timestamp":1789619397000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adverse childhood experiences in adults completing ADHD and autism diagnostic assessment: associations with diagnostic outcome and psychiatric symptom burden"],"prefix":"10.3389","volume":"17","author":[{"given":"Marios","family":"Adamou","sequence":"first","affiliation":[{"name":"School of Human and Health Sciences, University of Huddersfield","place":["Huddersfield, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Louise","family":"Jones","sequence":"additional","affiliation":[{"name":"Adult ADHD and Autism Service, South West Yorkshire Partnership NHS Foundation Trust","place":["Wakefield, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Smith","sequence":"additional","affiliation":[{"name":"Adult ADHD and Autism Service, South West Yorkshire Partnership NHS Foundation Trust","place":["Wakefield, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"B1","unstructured":"Sacramento, CA\n          California Department of Health Care Services\n          ACE Screening Clinical Workflows, ACEs and Toxic Stress Risk Assessment Algorithm, and ACE-associated Health Conditions\n          \n          2019"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1380410","DOI":"10.3389\/fpsyt.2024.1380410","article-title":"The adult ADHD assessment quality assurance standard [Policy and Practice Reviews]","volume":"15","author":"Adamou","year":"2024","journal-title":"Front. Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1108\/AIA-10-2020-0059","article-title":"AAA screening in adults with ASD: a retrospective cohort study","volume":"8","author":"Adamou","year":"2022","journal-title":"Adv. Autism."},{"key":"B4","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1370\/afm.1139","article-title":"Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population","volume":"8","author":"Arroll","year":"2010","journal-title":"Ann. Family Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/1741-7015-12-72","article-title":"National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England","volume":"12","author":"Bellis","year":"2014","journal-title":"BMC Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1192\/pb.bp.108.020230","article-title":"Developmental disorders come of age","volume":"33","author":"Berney","year":"2009","journal-title":"Psych. Bull."},{"key":"B7","unstructured":"Capolino\n              A. C.\n            \n          \n          Kingston, RI\n          University of Rhode Island\n          Attention-deficit\/hyperactivity disorder and adverse childhood experiences: a cluster analysis differentiating internalizing and externalizing behaviors of children\n          \n          2022"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0211850","DOI":"10.1371\/journal.pone.0211850","article-title":"Associations between adverse childhood experiences and health outcomes in adults aged 18\u201359 years","volume":"14","author":"Chang","year":"2019","journal-title":"PLoS ONE"},{"key":"B9","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.jad.2003.12.013","article-title":"Adverse childhood experiences and the risk of depressive disorders in adulthood","volume":"82","author":"Chapman","year":"2004","journal-title":"J. Affect. Disord."},{"key":"B10","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1192\/apt.bp.109.006924","article-title":"Developing integrated mental health services for adults with ADHD","volume":"17","author":"Crimlisk","year":"2011","journal-title":"Adv Psychiatr. Treat."},{"key":"B11","doi-asserted-by":"publisher","first-page":"335","DOI":"10.59890\/ijeps.v3i4.75","article-title":"Adverse childhood experiences and anxiety: a systematic review","volume":"3","author":"Dahlan","year":"2025","journal-title":"Int. J. Educ. Psychol. Sci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1001\/jamapsychiatry.2024.0039","article-title":"Adverse childhood experiences and adult mental health outcomes","volume":"81","author":"Dan\u00edelsd\u00f3ttir","year":"2024","journal-title":"JAMA Psychiatry"},{"key":"B13","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/S0091-7435(03)00123-3","article-title":"The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900","volume":"37","author":"Dube","year":"2003","journal-title":"Prev. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study","volume":"14","author":"Felitti","year":"1998","journal-title":"Am. J. Prev. Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00787-022-02081-9","article-title":"Double jeopardy: implications of neurodevelopmental conditions and adverse childhood experiences for child health","volume":"32","author":"Gajwani","year":"2023","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1027\/1015-5759\/a000003","article-title":"The Iowa personality disorder screen","volume":"26","author":"Germans","year":"2010","journal-title":"Eur. J. Psychol. Assess."},{"key":"B17","doi-asserted-by":"publisher","first-page":"100013","DOI":"10.1016\/j.ssmmh.2021.100013","article-title":"Adverse childhood experiences and multiple mental health outcomes through adulthood: a prospective birth cohort study","volume":"1","author":"Gondek","year":"2021","journal-title":"SSM-Mental Health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3390\/jpm13020200","article-title":"Eye Movement Desensitization and Reprocessing (EMDR) as a possible evidence-based rehabilitation treatment option for a patient with ADHD and history of adverse childhood experiences: a case report study","volume":"13","author":"Guidetti","year":"2023","journal-title":"J. Pers. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"29","DOI":"10.15453\/0191-5096.4682","article-title":"The impact of adverse childhood experiences on mental and physical health for low-income women receiving TANF","volume":"50","author":"Hendrix","year":"2023","journal-title":"J. Sociol. Soc. Welf."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1176\/appi.ajp.157.11.1873","article-title":"Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire","volume":"157","author":"Hirschfeld","year":"2000","journal-title":"Am. J. Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/978-3-030-49414-8_17","article-title":"\u201cTrauma in children with neurodevelopmental disorders: autism, intellectual disability, and attention-deficit\/hyperactivity disorder,\u201d","author":"Hoover","year":"2020","journal-title":"Childhood Trauma in Mental Disorders: A Comprehensive Approach"},{"key":"B22","doi-asserted-by":"publisher","first-page":"9974791","DOI":"10.1155\/2021\/9974791","article-title":"The effectiveness of RAADS-R as a screening tool for adult ASD populations","volume":"2021","author":"Jones","year":"2021","journal-title":"Autism Res. Treat."},{"key":"B23","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1108\/AIA-02-2024-0015","article-title":"Distinguishing between autism and the consequences of early traumatisation during diagnostic assessment: a clinical case study","volume":"10","author":"Kildahl","year":"2024","journal-title":"Adv. Autism."},{"key":"B24","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1080\/13607863.2019.1693974","article-title":"Adverse childhood experience patterns, major depressive disorder, and substance use disorder in older adults","volume":"25","author":"Kim","year":"2021","journal-title":"Aging Ment. Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1521\/pedi.1999.13.1.75","article-title":"The Iowa personality disorder screen: development and preliminary validation of a brief screening interview","volume":"13","author":"Langbehn","year":"1999","journal-title":"J. Pers. Disord."},{"key":"B27","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1097\/DBP.0000000000000999","article-title":"Importance of trauma-informed practice in evaluation of children diagnosed with autism spectrum disorder","volume":"42","author":"Langenfeld","year":"2021","journal-title":"J. Dev. Behav. Pediatr."},{"key":"B28","doi-asserted-by":"publisher","first-page":"107561","DOI":"10.1016\/j.chiabu.2025.107561","article-title":"Clinical phenotypes occurring after adverse childhood events: differences and similarities with attention deficit and hyperactivity\/impulsivity disorder","volume":"167","author":"Lazzaro","year":"2025","journal-title":"Child Abuse Neglect"},{"key":"B29","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/MLR.0b013e318160d093","article-title":"Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population","volume":"46","author":"L\u00f6we","year":"2008","journal-title":"Med. Care"},{"key":"B30","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.genhosppsych.2014.09.009","article-title":"A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression","volume":"37","author":"Manea","year":"2015","journal-title":"Gen. Hosp. Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"01230","DOI":"10.3389\/fpsyg.2016.01230","article-title":"Executive dysfunctions: the role in attention deficit hyperactivity and post-traumatic stress neuropsychiatric disorders [Review]","volume":"7","author":"Mart\u00ednez","year":"2016","journal-title":"Front. Psychol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/j.encep.2022.01.012","article-title":"Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit\/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: barriers and recommendations","volume":"48","author":"Maurice","year":"2022","journal-title":"L'Enc\u00e9phale"},{"key":"B33","volume-title":"Differentiating between complex trauma and ADHD presentations in children: an experimental study of racial bias in differential diagnosis","author":"McCauley","year":"2024"},{"key":"B34","doi-asserted-by":"publisher","first-page":"S792","DOI":"10.1192\/j.eurpsy.2025.1610","article-title":"The Bottleneck effect: wait times for adult ADHD assessment at a private clinic in Australia","volume":"68","author":"Mendonsa","year":"2025","journal-title":"Eur. Psychiatry"},{"key":"B35","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1002\/pits.22769","article-title":"Best practices and emerging trends in assessment of trauma in students with autism spectrum disorder","volume":"60","author":"Michna","year":"2023","journal-title":"Psychol. Schools"},{"key":"B36","doi-asserted-by":"publisher","first-page":"259","DOI":"10.17744\/mehc.46.3.04","article-title":"Adverse childhood experiences, substance use, and poor mental health among the U.S. adult population","volume":"46","author":"Mugoya","year":"2024","journal-title":"J. Ment. Health Counsel."},{"key":"B37","article-title":"Generalised anxiety disorder and panic disorder in adults: management in primary, secondary and community care","year":"2011","journal-title":"Clinical guideline CG113"},{"key":"B38","doi-asserted-by":"publisher","first-page":"344","DOI":"10.3109\/08039488.2012.748824","article-title":"Attention-deficit\/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in adult psychiatry. A 20-year register study","volume":"67","author":"Nylander","year":"2013","journal-title":"Nord. J. Psychiatry"},{"key":"B39","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s40653-019-00253-5","article-title":"Trauma and autism spectrum disorder: review, proposed treatment adaptations and future directions","volume":"12","author":"Peterson","year":"2019","journal-title":"J. Child Adolesc. Trauma"},{"key":"B40","volume-title":"HELPS Brain Injury Screening Tool","author":"Picard","year":"1991"},{"key":"B41","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1192\/bjb.2023.77","article-title":"Adult ADHD in the Republic of Ireland: the evolving response","volume":"48","author":"Raaj","year":"2024","journal-title":"BJPsych Bull."},{"key":"B42","doi-asserted-by":"publisher","first-page":"S164","DOI":"10.1192\/bjo.2024.423","article-title":"Cambridgeshire lifespan autism spectrum service clinic: managing demand, capacity and flow of referrals for adult autism assessment","volume":"10","author":"Robinson","year":"2024","journal-title":"BJPsych Open"},{"key":"B43","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"key":"B44","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1016\/j.pmrj.2014.01.013","article-title":"Adverse childhood experiences and disability in U.S. adults","volume":"6","author":"Sch\u00fcssler-Fiorenza Rose","year":"2014","journal-title":"PMandR"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e97238","DOI":"10.7759\/cureus.97238","article-title":"Sparking attention: qualitative assessment of general practitioners' perceptions of rising adult attention deficit hyperactivity disorder presentations in a scottish setting","volume":"17","author":"Silcock","year":"2025","journal-title":"Cureus"},{"key":"B46","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/0306-4603(82)90005-3","article-title":"The drug abuse screening test","volume":"7","author":"Skinner","year":"1982","journal-title":"Addict. Behav."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1192\/bjb.2023.88","article-title":"UK adult ADHD services in crisis","volume":"48","author":"Smith","year":"2024","journal-title":"BJPsych Bull."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"B49","volume-title":"ADHD versus PTSD in preschool-aged children: implications for misdiagnosis","author":"Stewart","year":"2015"},{"key":"B50","doi-asserted-by":"publisher","first-page":"106091","DOI":"10.1016\/j.chiabu.2023.106091","article-title":"Type and dose-response effect of adverse childhood experiences in predicting depression: a systematic review and meta-analysis","volume":"139","author":"Tan","year":"2023","journal-title":"Child Abuse Neglect"},{"key":"B51","doi-asserted-by":"publisher","first-page":"e2525708","DOI":"10.1001\/jamanetworkopen.2025.25708","article-title":"Adverse childhood experiences and health at age 50 years in the national child development study","volume":"8","author":"Timmins","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"B52","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1016\/j.jad.2018.12.096","article-title":"Adverse Childhood Experiences (ACE) in outpatients with anxiety and depressive disorders and their association with psychiatric and somatic comorbidity and revictimization. Cross-sectional observational study","volume":"246","author":"van der Feltz-Cornelis","year":"2019","journal-title":"J. Affect. Disord."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"The Lancet"},{"key":"B54","doi-asserted-by":"publisher","first-page":"3115","DOI":"10.2147\/NDT.S192871","article-title":"Attention deficit hyperactivity disorder and borderline personality disorder in adults: a review of their links and risks","volume":"15","author":"Weiner","year":"2019","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"B55","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/S0272-7358(98)00107-X","article-title":"Attention-deficit hyperactivity disorder and posttraumatic stress disorder: differential diagnosis in childhood sexual abuse","volume":"20","author":"Weinstein","year":"2000","journal-title":"Clin. Psychol. Rev."},{"key":"B56","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.jsat.2006.08.002","article-title":"A comprehensive review of the psychometric properties of the drug abuse screening test","volume":"32","author":"Yudko","year":"2007","journal-title":"J. Subst. Abuse Treat."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1898116\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:30:01Z","timestamp":1789619401000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1898116\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":56,"alternative-id":["10.3389\/fpsyg.2026.1898116"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1898116","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"1898116"}}