Adverse Childhood Experiences and Complex Trauma in Looked After Children

What are adverse childhood experiences?

Adverse childhood experiences (ACEs) refer to a range of potentially traumatic events experienced by people in childhood that can have profound and lasting effects on health and well-being (Felitti et al., 1998). ACEs can include, but are not limited to:

• Emotional, physical or sexual abuse;
• Emotional and physical neglect;
• Household domestic violence;
• Household mental illness;
• Household substance abuse;
• Parental or caregiver incarceration;
• Parental or caregiver separation.

Exposure to ACEs is quite common in the general population. According to one UK study of 1,567 people, 47.1% experienced at least one adverse event in childhood (Bellis, Lowey, Leckenby, Hughes & Harrison, 2014). In vulnerable groups such as Looked After Children, the rate of exposure is thought to be much higher, as they are more likely to be exposed to deprivation, family breakdown, family mental illness and substance abuse by caregivers (Ford, Vostanis, Meltzer & Goodman, 2007). Approximately 69% of Looked After Children have experienced neglect, 48% physical abuse, 37% emotional abuse and 23% sexual abuse (Chambers et al., 2010).

What are the effects of adverse childhood experiences in Looked After Children?

Given that ACEs can be experienced by many people and vulnerable groups including Looked After Children, research is interested in identifying physical and psychological changes that can happen across the lifespan. Studies (e.g. Fisher, Level, Delker, Roos & Cooper, 2016) have consistently shown that ACEs can be associated with:

• Challenging behaviour at school and in the community;
• Engagement in anti-social behaviour;
• PTSD symptoms – as high as 75% prevalence rate (Morris, Salkovskis, Adams, Lister & Meiser-Stedman, 2015);
• Self-harm and suicide;
• Substance use in adulthood;
• Unemployment;
• Vulnerability to developing mental and physical health problems;
• Vulnerability to experiencing further victimisation in the home or community.

What is complex trauma?

Looked After Children may experience a range of ACEs or prolonged traumatic events such as physical and sexual abuse in their early development (Denton, Frogley, Jackson, John & Querstret, 2016). This is significant as the cumulative effects of frequent ACEs are associated with poorer outcomes in adulthood, compared to one isolated event (Finklehor, Shattuck, Turner, Ormrod & Hamby, 2011). It has been suggested that experiencing multiple and prolonged events can lead to other difficulties besides PTSD, such as complex trauma.

Complex trauma is distinct from PTSD in that it considers the cumulative impact of long-term exposure to traumatic events on children and their future lives as adults (Herman, 1992). Although there is no official diagnosis of ‘complex trauma’ at present, it can be associated with significant behavioural, cognitive and emotional difficulties among children in foster care (Jee et al., 2010; van der Kolk, 2005), including:

• Challenging behaviour in the home and at school;
• Development of pathology (e.g. ADHD, anxiety, depression)
• Difficulty forming appropriate relationships with others;
• Feeling detached from their surroundings;
• Frequent entry and re-entry into care services;
• Harmful sexual behaviour;
• Lack of trust towards carers and professionals;
• Low self-esteem;
• Over-compliance and over-reliance within relationships;
• Poor management of emotions;
• Self-blame.

How can CCATS support traumatised Looked After Children?
The therapeutic model adopted by CCATS of working with traumatised children is grounded in current trauma theory and practice within the Good Lives Model (GLM; Ward & Gannon, 2006). The GLM is a leading approach focuses on a person’s strengths as a means to achieve positive change.

CCATS provides psychologically-informed treatments to young people with emotional needs. Interventions can include cognitive-behavioural therapy and play therapy.

References

Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2014). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36, 81-91.

Chambers, M. F., Saunders, A. M., New, B. D., Williams, C. L., & Stachurska, A. (2010). Assessment of children coming into care: Processes, pitfalls and partnerships. Clinical Child Psychology and Psychiatry, 15, 511-527.

Denton, R., Frogley, C., Jackson, S., John, M., & Querstret, D. (2016). The assessment of developmental trauma in children and adolescents: a systematic review. Clinical Child Psychology and Psychiatry. Advance online publication.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245-258.

Finkelhor, D., Shattuck, A., Turner, H. A., Ormrod, R., & Hamby, S. L. (2011). Polyvictimization in developmental context. Journal of Child & Adolescent Trauma, 4, 291-300.

Fisher, P.A., Level, L.D., Delker, B., Roos, L., Cooper, B. (2016). A developmental psychopathology perspective on foster care research. In D. Cicchetti (Ed.), Developmental Psychopathology. Hoboken, NJ: Wiley.

Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. The British Journal of Psychiatry, 190, 319-325.

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377-391.

Jee, S. H., Conn, A. M., Szilagyi, P. G., Blumkin, A., Baldwin, C. D., & Szilagyi, M. A. (2010). Identification of social‐emotional problems among young children in foster care. Journal of Child Psychology and Psychiatry, 51, 1351-1358.

van der Kolk, B. A. (2005). Developmental trauma disorder. Psychiatric Annals, 35, 401-408.

Morris, L., Salkovskis, P., Adams, J., Lister, A., & Meiser-Stedman, R. (2015). Screening for post-traumatic stress symptoms in looked after children. Journal of Children’s Services, 10, 365-375.

Ward, T., & Gannon, T. A. (2006). Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders. Aggression and Violent Behaviour, 11, 77-94.

Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2014). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36, 81-91.

Chambers, M. F., Saunders, A. M., New, B. D., Williams, C. L., & Stachurska, A. (2010). Assessment of children coming into care: Processes, pitfalls and partnerships. Clinical Child Psychology and Psychiatry, 15, 511-527.

Denton, R., Frogley, C., Jackson, S., John, M., & Querstret, D. (2016). The assessment of developmental trauma in children and adolescents: a systematic review. Clinical Child Psychology and Psychiatry. Advance online publication.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245-258.

Finkelhor, D., Shattuck, A., Turner, H. A., Ormrod, R., & Hamby, S. L. (2011). Polyvictimization in developmental context. Journal of Child & Adolescent Trauma, 4, 291-300.

Fisher, P.A., Level, L.D., Delker, B., Roos, L., Cooper, B. (2016). A developmental psychopathology perspective on foster care research. In D. Cicchetti (Ed.), Developmental Psychopathology. Hoboken, NJ: Wiley.

Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. The British Journal of Psychiatry, 190, 319-325.

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377-391.

Jee, S. H., Conn, A. M., Szilagyi, P. G., Blumkin, A., Baldwin, C. D., & Szilagyi, M. A. (2010). Identification of social‐emotional problems among young children in foster care. Journal of Child Psychology and Psychiatry, 51, 1351-1358.

van der Kolk, B. A. (2005). Developmental trauma disorder. Psychiatric Annals, 35, 401-408.

Morris, L., Salkovskis, P., Adams, J., Lister, A., & Meiser-Stedman, R. (2015). Screening for post-traumatic stress symptoms in looked after children. Journal of Children’s Services, 10, 365-375.

Ward, T., & Gannon, T. A. (2006). Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders. Aggression and Violent Behaviour, 11, 77-94.