ATTUNE project: exploring childhood adversity through arts, data, and co-design with young people

Adverse Childhood Experiences (ACEs) are difficult or distressing events that happen before the age of 18. These can include unsafe or abusive environments, neglect, or chronic stress at home. Research shows that three in four young people exposed to multiple ACEs are more likely to develop anxiety, depression, or post-traumatic stress disorder as they grow into adulthood.

But not every young person responds to adversity in the same way. Some are more vulnerable, while others find ways to cope or recover. What makes the difference? And how can we better support those who are struggling?

The ATTUNE project set out to answer these questions by putting young people at the centre of the research and action planning.

How the study worked

ATTUNE used a range of approaches to explore the impact of ACEs and co-create new solutions:

• Creative workshops helped young people share their lived experience and coping strategies.
• Large datasets from projects such as Headstart Cornwall, OxWell, and DASH were analysed to see how factors like gender, socioeconomic background, and neurodivergence interact with ACEs.
• A public health resource, Validating Voices, was co-designed with young people and professionals. It focuses on how to recognise invalidation and embed validating behaviours in everyday settings.
• A digital game, Ace of Hearts, was co-designed to raise awareness of ACEs. Early testing explored how engaging and useful the game could be.
• Economic analysis looked at the costs of ACEs and the potential cost-effectiveness of the resources created.

What we learned

• Young people experience adversity in ways that go beyond the traditional definition of ACEs. They often turn to self-soothing strategies such as pets, nature, and creative arts.
• Invalidation—having experiences dismissed or overlooked—was highlighted as a consistent form of adversity. This finding inspired the creation of Validating Voices.
• Initial feedback on Ace of Hearts suggests that with further development, it could be a valuable tool for supporting young people’s wellbeing.

Next steps

The project has laid important groundwork, but there is more to do. The next priorities include:

• Further developing and evaluating Ace of Hearts through a large-scale trial.
• Applying for funding to build on what was learned and integrate arts-based approaches into mental health services.
• Advocating for co-design as a central method in youth mental health research.
• Re-examining how ACEs are defined, to reflect the realities of young people today.

By placing young people’s voices at the heart of the process, ATTUNE is not only advancing research but also creating practical resources with real potential for impact.

For more information on the project please email Principal Investigator: Professor Kamaldeep Bhui kam.bhui@psych.ox.ac.uk