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Maltreatment-Associated Psychiatric Problems - How Trauma and ESSENCE are Linked

Birgit Olsson Lecture 2019

Professor Helen Minnis' lecture "Maltreatment-Associated Psychiatric Problems - How Trauma and ESSENCE are Linked"

About Professor Helen Minnis

Helen Minnis is Professor of Child and Adolescent Psychiatry at the University of Glasgow. She spent time working as an Orphanage Doctor in Guatemala in the early 1990s prior to training in Psychiatry, and this stimulated an interest in the effects of early maltreatment on children's development. She has published research on the role of genetics and environment in Reactive Attachment Disorder and has developed the first published standardised assessment tools for school aged children with this disorder. She is now conducting intervention research for maltreated children including a randomised controlled trial of an infant mental health service for young children in foster care.



"Maltreatment-Associated Psychiatric Problems - How Trauma and ESSENCE are Linked"

Children with neurodevelopmental problems, like ADHD, Autism and intellectual disability, are at higher risk of being abused and neglected. Children who have been abused and neglected are at higher risk of having neurodevelopmental problems. How are trauma and neurodevelopmental problems linked? Humans are adapted to cope with stress. All of us will have to deal with traumas, like having a car accident or experiencing the death of a loved one, at some point in our lives. Attachment relationships, in our families and communities, support us to calibrate our stress system and restore our physiology to normal after trauma. But if stress calibration goes seriously awry, violence or even suicide can result.  Children with neurodevelopmental problems often struggle to calibrate their stress systems at the best of times – and the symptoms of their neurodevelopmental problems (e.g. hyperactivity, hypersensitivity, insistence on routines) can make them much harder to parent. If parents’ stress systems become overwhelmed, and abuse and neglect is the result, then young children can become emotionally withdrawn. This leads to a vicious cycle where the child already has problems dealing with stress, doesn’t seek comfort when stressed, doesn’t get parental help …and stress calibration becomes worse and worse. We suspect this might be an important mechanism for the development of serious psychiatric problems later in life. A recent study our group has conducted is the first evidence that this might be the case.
Pulling all of this together, prevention strategies should include supporting stressed parents (e.g. family centres) and offering relationship-focused interventions for struggling families with young children (e.g. Video Interaction Guidance). If a child or adult has already experienced abuse or neglect, then we need to avoid specialisation and ensure that the person receives a comprehensive assessment that considers both trauma-related and neurodevelopmental problems.