Do you believe early life trauma/adverse childhood experiences impact on a child’s functioning and development, and impact on later life outcomes?
Yes, Felitti et al’s study (published 1998) evidences well the chronic negative impact of Adverse Childhood Experiences (ACEs) on life outcomes.
It is important to note that the 10 ACEs put forward for this study did not include:
•Separation at birth/maternal loss or prenatal exposure to alcohol or toxins.
•Living outside of the birth family, e.g. being ‘care-experienced’ or issues surrounding attachment trauma.
•A person identifying as having any protected characteristics and the socio-political effects of living as a marginalised/minoritised person.
This is important as many adoptive children/young people have identities that intersect across protected characteristics, increasing their vulnerability.
What are some of the issues that may arise from a child who has experienced early life trauma?
This is a very complex and nuanced question. Here is a brief list:
•Developmental delay
•Learning needs
•Attachment needs (delayed and regressive behaviour)
•Interpersonal/relational challenges
•Mental health needs
•Problems with emotional regulation
•Dysregulated nervous system
•Sensory processing needs
These can all present as activated behaviours, both hyper and hypo in nature, including ‘misbehaviour’ or being ‘overly compliant and suggestible,’ leading to highly increased vulnerability. Hyper and hypo behaviours are signs of distress.
If a child is provided with positive, safe care, is this enough for the trauma to heal on its own?
Early life trauma happens across the child’s whole system—emotionally, psychologically, and physiologically. Stability in the home and positive, safe, predictable, and sustained parental attunement is crucial, but reparative therapeutic interventions are essential. Professional support is needed, including for the caregiving system around the child, school, and ongoing support into adulthood.
If a child has experienced early life trauma, what is the best approach to help them heal, succeed emotionally, and thrive in life?
I advocate for systemic support that helps primary parents/carers provide sustained, attuned, resilient, present, responsive love and care. This requires parents/carers to manage uncertainty, highly challenging behaviours, relentless needs, and compounding stressors from education, social, and health systems.
What a child needs to heal and thrive is an ‘unassailable safe base’ (Sarah Naish, NATP) that supports attachment reinforcement, therapeutically parents every behaviour, and builds a secure attachment over time. Parents/carers need to be well-resourced, well-supported, well-trained, rested, believed, and respected.
What is the best way to help a family in crisis, and what could be done better?
A bespoke family-centred therapeutic plan could include:
•Therapy for the child/young person, such as DDP, Filial therapy, or Theraplay.
•Sensory assessment.
•Additional educational psychological assessment and IEP/EHCP to support mental, social, and relational health in school.
•Bespoke support for parents/carers, such as respite, personal psychotherapy, or trauma therapy to process events resulting from parenting.
Many parents experience witnessing risk-taking behaviours like self-harm, suicide attempts, or child-on-parent abuse, leading to compassion fatigue, burnout, secondary stress, or even PTSD. Identifying and treating PTSD is essential for maintaining family relationships and reducing the risk of family breakdown.
Adopters are experiencing shame and blame for not managing complex family issues. What do you think the cause of this is?
The lack of trauma-informed and trauma-specialist professional settings (e.g. education, social services, health services) contributes to this issue.
Framing a child’s dysregulated and activated behaviours as poor parenting is a reductionist view. Prolonged exposure to extreme stress in the home can impact the parent’s ability to remain attuned, especially during highly dysregulated periods. This is not a parenting flaw but a psychologically protective state.
Blaming parents for behaviours arising from conditions such as developmental trauma or FASD ignores the root causes and further harms the parents’ capacity, esteem, and mental health.
Family breakdown, adoption crisis, and disruption are said to be on the increase. Why do you think this is?
There is a perfect storm of:
•Increasing numbers of children in crisis with mental health needs, especially since the pandemic.
•More children in care with complex trauma-based needs being adopted.
•Cuts in services, especially CAMHS, which leave families without support.
With two-year waiting lists for CAMHS for young people showing self-harming behaviours and suicidal ideation, families are left in significant, chronic, and compounding distress.
When parenting children with significant adversity and trauma, what best supports parents/carers?
Effective preparation includes:
•Individual psychological support to process their own history.
•Developing emotional regulation skills.
•Understanding unique strengths and vulnerabilities.
•Accessing clear resources and pathways for support when needed, encouraging preventative rather than reactive practices.
There appears to be a propensity for professionals to believe allegations made by children. What is the impact, and how can this be addressed?
Children who have been through trauma are often dishonest or untruthful due to confabulation or traumatic memory patterns. Professionals reacting solely to allegations can lead to:
•Parents leaving the family home.
•Arrests or suspension from work.
•Significant damage to the parents’ mental health and well-being.
Working with a multidisciplinary team (MDT) trained in confabulation, traumatic memory, triangulation, and attachment-seeking themes can help professionals take a trauma-informed approach to allegations.
Social workers are central to adoption crises and disruptions. What are your views?
There are brilliant social workers, but an MDT approach, including professionals from education, health services, and therapy, can enhance family support. Bespoke interventions, such as OT sensory processing assessments, respite, and enhanced educational input (e.g. EHCP, SEND, or residential provision), can provide much-needed breaks and support.
Ongoing 1:1 therapy for parents/carers and children post-disruption is essential.
If a parent is suffering from secondary trauma or survival mode, how can they be supported?
Secondary trauma can escalate into chronic trauma responses, such as PTSD, if left untreated. Therapy with a specialist trained in adoption, developmental trauma, and CPA is crucial.
For some parents, the trauma is not secondary but primary (e.g. violence from their child). Parents often minimise the effects of CPA, but being hurt, intimidated, or living with escalating behaviours can be traumatising and must be addressed.
What skills and knowledge should an effective practitioner have when working with families in crisis?
Practitioners should:
•Work within their scope and know their limitations.
•Build networks to refer or liaise with professionals in complementary fields.
•Follow frameworks like the Scottish Transforming Psychological Trauma Framework, which outlines professional pathways for scope, triage, and referral.