Given that resilience is the ability to cope with adversities, and impulsivity is characterized with rapid reactions without foresight, we aimed to explore the pathways between intra-familial childhood adversities, resilience, impulsivity and suicidal behaviors among adolescents in Mahdia and Gafsa cities (Tunisia). We conducted a cross-sectional study in secondary schools from January to February 2020. Exposure to intra-familial early life experiences was evaluated by the Adverse Childhood Experiences (ACEs)-International Questionnaire. Resilience and impulsivity were assessed via the Adolescent Psychological Resilience and the Barratt Impulsivity Scale. A total of 3170 students were recruited with a response rate of 74%. About 81.1% of them reported being emotionally abused. The resilience mean score was 86.10 ± 9.85. Impulsivity was screened among 42.2% of them. About 38% of students presented suicidal thoughts, 16.4% had a suicide plan, and 10.8% have made a suicide attempt. We found that exposure to intra-familial ACEs predicts suicidal behaviors through impulsiveness (% mediated = 18% for emotional violence) and interpersonal resilience (% mediated = 24% for emotional violence; % mediated = 20.4% for physical violence). Our results emphasize the need to prevent ACEs, and to seek out a way to promote ACE protective factors among adolescents such as resilience.

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition requiring long-term, coordinated, and multidisciplinary care. Although ASD services in Tunisia have improved, coordination across health, education, and social sectors remains limited, affecting equitable access and continuity of care. This study aimed to develop a national, evidence-based clinical practice guideline for the screening, diagnosis, and management of children and adolescents with ASD adapted to the Tunisian healthcare context. Assessment of guideline development and practice implications: The guideline was developed by the Tunisian Society of Child and Adolescent Psychiatry and accredited by the National Authority for Evaluation and Accreditation in Health. Using the ADAPTE framework, a multidisciplinary panel adapted international ASD guidelines to the Tunisian context. After systematic searches and AGREE II appraisal, the 2023 Singapore ASD guideline was selected as the main source document. Recommendations were adopted, adapted, or newly developed according to contextual relevance and applicability. An additional literature search was performed to incorporate high-level evidence published between June 2023 and January 2025. Actionable recommendations: The final guideline includes 96 evidence-based recommendations and 87 good practice points organized into ten chapters, covering the screening, diagnosis, intervention, and follow-up of autism spectrum disorder in children and adolescents across all levels of care in Tunisia. This article summarizes the key practice-oriented recommendations across these chapters. Conclusion: This first Tunisian ASD guideline aims to harmonize practices, improve the quality of care, and strengthen integrated care pathways.