Experiences of cognitive difficulties and engaging in mental health services in service users who have adverse childhood experiences.

Adverse childhood experiences (ACEs) refer to potentially traumatic events occurring before the age of 18, including experiences such as abuse, neglect, and household dysfunction. Extensive research has demonstrated associations between ACEs and a range of adverse mental and physical health outcomes across the lifespan. More recently, evidence has suggested that ACEs are also associated with differences in neuropsychological functioning, particularly executive functions (EFs), which include working memory, inhibitory control, cognitive flexibility, and attention. Quantitative studies indicate that individuals who have experienced ACEs may show poorer performance on executive function tasks in childhood, adolescence, and adulthood. There is also growing evidence that executive functioning may influence engagement with and outcomes from mental health treatment, including adherence, response to interventions, and longer-term service use. However, existing research is predominantly quantitative and relies on standardised cognitive tasks or predefined symptom categories. As a result, little is known about how adults with lived experience of ACEs perceive and experience executive function difficulties in their everyday lives, or how these difficulties affect their ability to access and engage with mental health services. The purpose of this qualitative study is to explore the lived experiences of executive function difficulties among adults with histories of ACEs who are currently accessing mental health services. Specifically, the study aims to understand how participants make sense of these difficulties in daily life and how they perceive their impact on accessing, engaging with, and benefiting from mental health care. Using a qualitative methodology, this study will collect in-depth accounts from service users to capture the of executive function difficulties in real-world contexts, such as managing routines, attending appointments, and engaging in therapeutic activities. By centring participants’ perspectives, the study seeks to generate a nuanced understanding of the intersection between childhood adversity, executive functioning, and mental health service engagement. Expected outcomes include the identification of key themes relating to everyday functioning and service engagement, and practice-relevant insights that may inform trauma-informed and neuropsychologically informed approaches within mental health services. Findings may support clinicians in recognising and accommodating executive function difficulties and contribute to improving engagement and outcomes for adults with histories of childhood adversity.