We know more about how childhood shapes adulthood than previous generations did. But when we talk about adversity, there could be an endless range of experiences. Losing at Monopoly after landing on Mayfair with a hotel may have felt devastating as a child, but adverse childhood experiences (ACEs) refer to more severe stressors, ranging from abuse and neglect to bullying, traumatic experiences, or family breakdown.
For some people, they can leave lasting scars that extend into adulthood. These scars can look different from person to person, from an increased risk of a host of mental health disorders (see Camille’s Mental Elf blog), to a greater likelihood of smoking or even increased mortality risk (Zheng et al., 2025).
ACEs have also been consistently linked with an increased likelihood of psychotic-like experiences, such as hearing voices or holding unusual beliefs (Mongan et al., 2019) as well as a greater risk of a psychosis diagnosis (Fusar-Poli et al., 2017). However, isolating the role of ACEs is difficult, as factors like genetic susceptibility and socioeconomic status (SES) may also contribute to these experiences (see Rebecca and Sarah’s Mental Elf blog).
Most psychotic-like experiences are transient, with only around 20% persisting over follow-up periods of up to eight years (Linscott & van Os, 2013). However, persistent experiences are associated with a greater risk of psychosis and other mental health disorders.
But are all ACEs equally important? Differences between more serious forms of adversity are less clear. Hudson and colleagues (2026) therefore set out to investigate whether specific types of ACEs were associated with persistent psychotic-like experiences from childhood into early adulthood.
Methods
The authors used data from 4,448 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort. Participants had provided information on psychotic-like experiences at one or more of three timepoints: ages 12, 18 and 24.
The researchers examined:
- Psychotic-like experiences, assessed using semi-structured interviews, where interviewers rated experiences as either ‘suspected’ or ‘definite’.
- Exposure to six types of ACEs before age 12, including bullying, childhood maltreatment, parental mental health problems, parental substance abuse, parental separation, and parental intimate partner violence.
The authors then categorised participants into distinct groups based on their trajectories of psychotic-like experiences over time. They examined whether different types of ACEs were associated with belonging to each group, accounting for factors including SES, genetic susceptibility and exposure to other ACEs.
Results
The authors discovered that the pattern of psychotic-like experiences from 12 to 24 years old fit into three groups:
Participants in the high or increasing groups were more likely to have experienced ACEs than those in the low group. However, when looking at specific types of ACEs, the story became more nuanced:
- Childhood maltreatment (i.e., abuse and neglect) was associated with roughly a 1.5 times higher relative likelihood of belonging to the increasing group compared to the low group (relative risk ratio = 1.47, 95% CI [1.03 to 2.10]).
- Bullying was associated with an almost 2 times higher relative likelihood of belonging to either the increasing group (relative risk ratio = 1.83, 95% CI [1.26 to 2.66]) or the high group (relative risk ratio = 1.78, 95% CI [1.07 to 2.93]), compared to the low group.
Other types of ACEs were not significantly associated with psychotic-like experience trajectories after accounting for potential confounders and exposure to other ACEs. Importantly, these results largely held even when accounting for participants’ individual genetic risk for schizophrenia and depression, meaning the links between childhood maltreatment, bullying, and psychotic-like experiences are not fully explained by the genetic susceptibility measured in this study.
Conclusions
Hudson et al. (2026) suggest that not all ACEs are equal when it comes to persistent psychotic-like experiences. Put simply, bullying was associated with both persistent and increasing psychotic-like experiences between ages 12 and 24, while childhood maltreatment was associated with increasing experiences over time. These findings suggest that forms of interpersonal trauma may require special attention when considering intervention and prevention for young people.
Strengths and limitations
There are several strengths to this study, including a large sample size, prospective ACE measurement, and involvement of people with lived experience of psychosis and childhood adversity. The authors also accounted for important factors that could explain the relationship between ACEs and psychotic-like experiences, including genetic susceptibility and SES, which have previously been linked to psychotic experiences (Loch et al., 2017; Mamah et al., 2021; Woolway et al., 2022). This strengthens confidence in the findings, although we cannot rule out residual confounding.
However, a few limitations stand out:
- Missing data: The final sample was just 28% of the original ALSPAC cohort and those with missing data were more likely to have experienced childhood maltreatment and parental intimate partner violence. Throughout the ALSPAC cohort, study drop-out has been linked to lower SES (Howe et al., 2013), biasing the sample towards higher SES participants, meaning findings may not be generalisable.
- Incomplete data on psychotic-like experiences: Not all participants provided data at all three timepoints, meaning some may have been assigned to the wrong trajectory group. Although the findings were broadly similar when analyses were restricted to participants with complete data, the association between bullying and the high group was no longer statistically significant, adding uncertainty to this finding.
- White-only cohort: The authors’ rationale for including only white participants was to do with genetic risk scores being less reliable outside white/European ancestry. However, this does again limit the generalisability of these findings. Psychotic-like experiences are more commonly reported in ethnic minority groups (Ruiz-Yu et al., 2022), and the inclusion of a more diverse sample may have produced different results; this is something that future research needs to explore further.
- Model entropy: Entropy measures how confidently participants can be assigned to their trajectory groups, with 1 indicating complete confidence. Generally, an entropy of 0.8 is considered desirable, but here it was 0.72. This suggests some participants may have been assigned to a group that wasn’t quite the right fit, adding uncertainty to the findings.
- Confidence intervals: The association between childhood maltreatment and increasing psychotic-like experiences had a relatively wide confidence interval (95% CI [1.03 to 2.10]). The lower end is very close to 1 (which would indicate no association), meaning this finding is less precise than the headline figure might suggest.
Despite these limitations, the findings are consistent with previous twin studies (Arseneault et al., 2011), large cohort studies (Karcher et al., 2020), and a meta-analysis (Trotta et al., 2015).
Implications for practice
What does this mean for intervention?
Many overlapping factors contribute to the risk of psychotic-like experiences, including deep-rooted, systemic factors such as socioeconomic disadvantage and discrimination that can be incredibly hard to change. While this kind of evidence may not tell us how to address these wider inequalities, it is still informative when considering where to direct interventions and support.
If bullying is particularly strongly associated with persistent psychotic-like experiences, then well-resourced, evidence-based anti-bullying interventions in schools may be one place to start. However, while these interventions have been shown to reduce bullying, we don’t yet know whether they can prevent persistent psychotic-like experiences specifically.
Previous research in this area suggests that mechanisms such as posttraumatic avoidance, hyperarousal, and numbing may connect ACEs and psychosis, leading the authors to suggest that interventions to help hone coping strategies may also be helpful:
Targeted interventions for young people exposed to trauma to support them to develop adaptive coping strategies may aid in breaking the cycle between ACEs and psychosis.
Of course, helping young people develop coping strategies should not come at the expense of preventing bullying and maltreatment in the first place.
What should come next?
We need studies that are more ethnically diverse and cover a broader range of SES to understand whether the associations found here are present across different populations. As discussed in a previous Mental Elf blog by Jennifer Murphy, we also need research that looks at the severity, timing and duration of ACEs exposure to better inform intervention strategies.
Equally, a longer follow-up period would help us understand whether psychotic-like experiences persist beyond age 24 and into older adulthood. Future research also needs to explore why bullying and maltreatment may be particularly important, and whether interventions targeting these experiences can reduce the likelihood of persistent psychotic-like experiences.
A final thought
Losing at Monopoly may put you in a grump for the afternoon, but adversity that repeatedly threatens a child’s feeling of safety or sense of self can have a long-lasting impact. This study suggests that the type of adversity a child experiences may matter when considering the likelihood of persistent psychotic-like experiences, with bullying and childhood maltreatment emerging as particularly salient factors. While this distinction doesn’t mean we can ignore systemic risk factors, such as socioeconomic disadvantage and discrimination, it does give us somewhere to start. Supporting young people who have experienced adversity, alongside efforts to prevent bullying and maltreatment in the first place, may be an important part of that response.
Statement of interests
Orla Mitchell has no conflicting interests to declare.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Georgie Hudson, Jessie Baldwin, Katharine Sykes, Craig Mackie, Rachel Hiller, Claire Powell, & James B. Kirkbride (2026). The longitudinal association between adverse childhood experiences and persistence of psychotic-like experiences in young people: evidence from the ALSPAC birth cohort. Psychological Medicine, 56, e135. https://doi.org/10.1017/S0033291726104383
Other references
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