Adversity and resilience-supporting conditions in children with intellectual disabilities and their families Findings from specialised care contexts in the Netherlands

Children with intellectual disabilities experience persistent health inequities yet remain underrepresented in research on cumulative Adverse Childhood Experiences (ACEs). Positive Childhood Experiences (PCEs) and resilience-supporting conditions have received similarly limited attention. This dissertation addressed these gaps through six connected studies in specialised Dutch care, child protection, and professional contexts.
The review identified substantial heterogeneity in how adversity and resilience-supporting conditions were conceptualised and measured. Where cumulative exposure was examined, polyvictimisation was associated with adverse psychosocial outcomes across emotional, behavioural, and developmental domains. Across case-file studies, documented ACE exposure was common and frequently co-occurred with parental adversity, family-context risks, and prior placements, although specific co-occurrences varied across studies and settings. Relevant indicators extended beyond original ACE categories to socioeconomic difficulties, limited social support, and, among children with moderate-to-profound intellectual disabilities, medical, procedural, and care-organisation-related adversity.
The multi-source developmental study mapped adversity and resilience-supporting conditions across six developmental phases and identified recurring patterns around transitions, medical and procedural burden, and care organisation. Predictability, continuity, relational attunement, and parental involvement emerged as resilience-supporting conditions, whereas fragmented care and poor alignment with children’s and families’ needs were described as sources of strain. Resilience emerged as a dynamic, co-produced process across child, family, relational, and service-system levels. The Dutch ARTIC-35 total score was supported for group-level monitoring of trauma-informed attitudes, whereas the subscales were insufficiently distinct for differentiated interpretation.
Together, these studies contribute to an underdeveloped field by providing an initial evidence base and directions for further research and developmentally sensitive, family-oriented, context-responsive trauma-informed care.