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Thursday, 21 November 2013

Better outcomes for vulnerable kids

Over the past few months we have had an increasing number of requests to present and provide training on what trauma informed care means. We have also noticed more and more training organisations are adding a trauma informed care course to their training packages. 

So, it was interesting to read more about what is being done to help organisations and systems that work with children, to work in a way that promotes the best interests of traumatised children. One of ways this is being done in the United States, is through Trauma Systems Therapy (TST).  TST has been developed by New York University and aims to enhance trauma informed systems in a way that they are able to work more effectively with children. It does not take the place of individual therapy for the child, but helps to change the systems that are involved in providing care and support for the child. A recent article in the Huffington Post talks about the application of TST with a young boy with a history of complex trauma. 

TST is based on the belief that traumatised children have a great deal of difficulty in regulating their emotional states and that the systems that support them is not able to assist the child to contain this dysregulation.
"the essence of TST is to help the child gain control over emotions and behaviour via enhancing the child's capacity to regulate emotion and diminishing the ongoing stresses and threats in the social environment. TST was also designed to build the capacity of significant others in the child's environment to help the child control his or her emotional and behavioural responses".  

TST is starting to be implemented in an increasing number of settings across the US. There has been some evaluation done that has shown positive outcomes, especially in working with children involved with child protection systems. 

Helping families, schools, child protection systems and other organisations that work with children, to understand more about how trauma impacts on children and to find the most effective ways to work with traumatised kids, can only lead to better outcomes for this vulnerable group. 

Thursday, 26 September 2013

Treating kids affected by child sexual abuse: What's the evidence for psychoanalytic therapy?

Childhood sexual abuse has a devastating impact on many of the children and adolescents who are affected by it. It is a significant problem worldwide and has the potential to have serious negative impacts on mental health and physical health. 
Experiencing childhood sexual abuse often has negative impacts on the individual’s ability to function socially, emotionally and sexually in adulthood.  Childhood sexual abuse not only impacts on the child, but also on the family and the community more broadly.
It is difficult to conclusively state the estimated prevalence of childhood sexual abuse, often due to variations in the definition of sexual abuse. However, a recent meta-analysis of prevalence rates of child sexual abuse estimated a worldwide rate of self-reported sexual abuse of 18% for female participants and 7.6% of male participants (Stoltenborg et al 2011).
Not all children who have experienced childhood sexual abuse will require a therapeutic or mental health intervention. The impact of the sexual abuse can be mitigated by factors such as parental support and family functioning and can be worsened by the presence of other adversities, the severity and duration of the abuse and the lack of support from parents and other carers. Children and adolescents who do require therapeutic treatment following childhood sexual abuse obviously benefit from a treatment that is tailored to the developmental stage and needs of the individual.
This new Cochrane review aimed to:
"Assess the effectiveness of psychoanalytic / psychodynamic psychotherapeutic approaches in treating the effects of sexual abuse (psychologically and in terms of behaviour and social functioning) in children and adolescents."
Another commonly used approach, Cognitive Behavioural Therapy (CBT), was recently the subject of a separate Cochrane systematic review (Macdonald et al, 2012) that found that CBT was potentially able to address the adverse consequences of childhood sexual abuse. This review also concluded that there was a need for other therapeutic approaches, especially psychodynamic therapy, to be evaluated.
A simplistic definition of psychodynamic / psychoanalytic psychotherapy is that it:
"Attempts to explore, through talking, play (with younger children) and the formation of a therapeutic relationship, how earlier experiences influence and perhaps seriously distort current thoughts, feelings, behaviors (actions) and relationships."
You can read more about psychoanalytic / psychodynamic psychotherapy on the PsychCentral website.
The Cochrane reviewers searched for randomised trials, including quasi-randomised trials, that evaluated a psychoanalytic or psychodynamic psychotherapy versus treatment as usual or versus no treatment control or a waiting list control. Studies that compared psychoanalytic or psychodynamic therapy against an active comparison group (for example, CBT) were excluded. The reviewers also searched for studies that were limited to participants up to 18 years of age and who had experienced sexual abuse. The participants needed to be displaying some symptoms that required treatment. The reviewers were open to including interventions of any duration that were delivered to either individuals and/ or groups and were described as, or judged to be, psychoanalytic or psychodynamic in nature.
Out of the 2,982 studies that were initially identified through extensive database searching only 20 studies were assessed for eligibility against the inclusion criteria for the review. All 20 of these studies were found to be ineligible for the review for a number of reasons including the study type being ineligible, the participants were ineligible, the interventions were ineligible or the control group was ineligible. One of the studies was not able to be included as it discussed a planned trial, rather than one that had already commenced.


The authors summarised their main results as:
"Our review did not find any randomized trials comparing psychoanalytic / psychodynamic psychotherapy with either treatment as usual or a no treatment / waiting list control for children or adolescents who have been sexually abused."
They found this surprising given that they believe that:
"many children and adolescents have been treated in this way and for many health professionals it would still be considered the psychotherapeutic treatment of choice."
There are many possible reasons that the reviewers were unable to identify any suitable studies. Typically there has not been much evidence based research in this area and case studies have been the favoured method for research and review in psychodynamic / psychoanalytic psychotherapy, with the belief that using case studies can richly elaborate the complexity of each case. There has also been reluctance in the field to engage in the scientific evidence base, though many would argue that it is important to bring more empirical evidence to this field in order to bring about a greater understanding of the intervention.
There are also many ethical considerations when it comes to researching children who have experienced sexual abuse. This is especially the case when it comes to developing randomised controlled trials that include no treatment as a comparator for children who have been sexually abused.
The authors highlighted one study that did not meet the criteria for the review. The study was a well designed RCT, but as it compared individual psychodynamic psychotherapy with psycho educational group therapy (rather than no treatment) for girls who had been sexually abused it was excluded. The study did find that the intervention appeared to be effective and therefore does provide limited evidence that the use of psychodynamic therapy be continued (Trowell, 2002).
Sexual abuse rarely occurs in isolation and children who experience sexual abuse are also often faced with many other potentially traumatic events, such as neglect, physical abuse, parental mental health or substance abuse and living in poverty as well as other adversities.  It is often difficult to separate out these children through one single traumatic event, and it may be more prudent to include a broader category of child maltreatment. However it seems that most therapies, including psychoanalytic / psychodynamic therapy have developed specific theoretical models and treatment approaches for different forms of abuse and therefore it may make sense for research to evaluate interventions of these specific forms of abuse, rather than grouping them together.
More research is needed and this should be in the form of carefully designed and well thought out studies that take into account the many ethical considerations that come with working with this already very vulnerable and damaged group of children and young people.
It is vital that children who have been affected by childhood sexual abuse receive the best therapeutic help that they can get. This will benefit them throughout their childhood and adolescence and into adulthood. The reviewers concluded that
"Further examination of the process of psychoanalytic / psychodynamic psychotherapy for this population and what aspects bring about change is also needed. This would greatly help therapists to increase the effectiveness of the intervention.

This article appeared first on the Mental Elf blog. 


Parker B, Turner W. Psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD008162. DOI: 10.1002/14651858.CD008162.pub2.
Macdonald G, Higgins JPT, Ramchandani P, Valentine JC, Bronger LP, Klein P, O’Daniel R, Pickering M, Rademaker B, Richardson G, Taylor M. Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001930. DOI: 10.1002/14651858.CD001930.pub3.
Stoltenborg M, Van IJzendoorn M, Euser E. Bakermans-Kranenburg M. A Global Perspective on Child Sexual Abuse: Meta-Analysis of Prevalence Around the World. Child Maltreatment 2011; 16(2): 79 – 101. [Abstract]
Trowell J, Kolvin I, Weeramanthri T, Sadowski H, Berelowitz M, Glasser D, Leitch I. Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change. British Journal of Psychiatry 2002; 180: 234 – 47.
Psychodynamic Therapy. Jim Haggerty, PsychCentral website. 

Wednesday, 18 September 2013

A tiered approach to addressing childhood trauma and adversity

The experience of childhood trauma and adversity remains a significant problem in Australia. Lots of kids will be exposed to potentially traumatic events and whilst many of them will be resilient, some will go on to develop difficulties with their physical health, mental health, relationships, self esteem and education. 

We talk alot about the impact that trauma and adversity has on kids. But what we really need to know is how to stop kids from being adversely affected from their exposure to trauma and adversity. How do you do this?? It can seem almost impossible. How can we stop children being exposed to abuse and neglect? We can't stop children from being exposed to other adversities, such as separation and divorce, car accidents, a death in the family.

This is why there needs to be a tiered approach to the way that we address the impact of trauma and adversity in children. A tiered approach means having a suite of interventions that are appropriate at different ages and stages and that work to prevent and intervene early in cases of trauma and adversity.

1. Early home visiting programs and parenting support programs for parents with children under 3 years.
Early home visiting programs that target vulnerable families and provide intensive support through regular home visits over an extended period have been shown to be a cost effective way for governments to address the issues of child abuse and neglect. These programs often target vulnerable parents and families, such as first time young parents and those that have a history of abuse themselves and work to form a consistent, supportive relationship between the visiting nurse and the mother with the aim of improving the health and wellbeing of both the parents and the child. The Nurse Family Partnership program in the US has been in operation for 30 years and has demonstrated many positive outcomes.  Outcomes from this program have shown improved parental health, fewer childhood injuries, increased maternal employment and improved school readiness. A similar program is now in Australia, working to support Indigenous mothers.

Another parenting program, with demonstrated outcomes, that has been available in Australia for many years now, is the Triple P program (Positive Parenting Program). This program aims to prevent severe behavioural, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents. This program has been offers support in many different forms - from DVD's that can watched at home, through to group programs and home visiting. There have been several studies that have shown that Triple P works to improve children's behaviour, improve parent child interactions and reduce child maltreatment, out of home care placements and hospital visits.

2. Programs that target kids and families and help to build resilience
Adversity is unavoidable, so helping kids and families have the skills necessary to get through tough times is essential. There are many programs for kids that help to support and build resilience. Kids Matter is an early childhood and primary school initiative that has been successful in reaching out to a great number of children and improving mental health and wellbeing. 

3. Increasing the knowledge and information that is available to families and the community
Families and the community need to know more about the impact that trauma and adversity has on kids. This includes more information about how kids of different ages and stages respond to trauma and adversity, what factors may make children more vulnerable in the face of adversity and what families can do to protect and support children. The Trauma and Grief Network: Supporting Families website has worked to develop tip sheets and resources that increase family knowledge of these impacts and their ability to respond to them. 

4. Increasing professionals knowledge and information about the impacts of trauma and adversity and how this contributes to other mental health difficulties
We know from the large body of research that is now available, that trauma and adversity has the potential to impact on a childs mental health, physical health, behaviour and education. The diverse range of professionals who work with children need more knowledge and information about how trauma impact on children. Mental health professionals need more information and knowledge about how trauma and adversity impacts on a child's mental health. School professionals need more information and knowledge about how trauma and adversity may impact on the child's ability to learn and their ability to function in the classroom. Early childhood professionals and those working with vulnerable families need more informaiton and knowledge on the impacts on behaviour and parent child relationships. Our (the Australian Child & Adolescent Trauma, Loss & Grief Network) website has been working to develop resources, hold webinars and is currently developing an e-learning module to increase knowledge and information for a diverse range of professionals working with children. 

5. Trauma informed systems and incorporating knowledge about and response to trauma within services
The practice of considering trauma needs to be incorporated into the systems and practices of agencies working with children affected by trauma and adversity. Recently, at the Journey 2 Recovery conference, there were some great stories of services that had successfully incorporated trauma informed care into their programs for kids, and with great success for both the staff and the children they worked with. A presentation by Burnside on incorporating a trauma informed system into their residential care was particularly inspiring. 

6. Trauma specific systems - with evidence based interventions for kids that directly target the impact that the trauma has had on the child.
Trauma specific services are those that treat kids that we already know have experienced a significant trauma. Judy Atkinson recently wrote a great paper on trauma informed services and trauma specific care. Once children are recognised as experiencing difficulties as a result of trauma or adversity, they then needed to be treated with approaches that we know are going to help them. In our last blog, we discussed the treatment guidelines for Post Traumatic Stress Disorder (PTSD) from the Australian Centre for Post Traumatic Mental Health. There are a number of interventions that are used to treat children who have PTSD or other mental health or emotional difficulties as a result of trauma, however, many of these need further research to ensure that they are actually effective in their approach. 

In the end, we all need to be keeping trauma and adversity in mind in our work with children. And we need to continue to make these issues part of the national agenda. Intervening early for kids who have experienced trauma and adversity means preventing the onset of many mental health, social, emotional and educational difficulties. 

Thursday, 29 August 2013

Australian guidelines on treating trauma

This week, the Australian Centre for Posttraumatic Mental Health (ACPMH) released their latest Guidelines on the treatment of Posttraumatic Stresss Disorder (PTSD) and Acute Stress Disorder (ASD). The ACPMH are to be congratulated on the development of such a comprehensive resource. 

Of course, we were particularly interested to read what they had to say about the treatment of trauma in kids. The guidelines highlight that around two third of kids in the US will experience a traumatic event by the time that they are 16 years old, and we can say that similar statistics have been found in Australia as well. Whilst most of these events will be potentially traumatic events (ie most kids will be resilient but some will experience negative outcomes as a result of the trauma), it really show us the need to pay more attention to kids and trauma. 

The guidelines provide great guidance for clinicians on the important considerations around family: such as the impact that the family functioning will have on the child's response to the traumatic event; the importance and need to engage with the family, especially in the treatment of younger children; and the differences that can sometimes be present in the child and parents understanding of the impact of the traumatic event. 

The ACPMH has included a good summary of the literature around the pre and post trauma risk factors for the development of trauma in children. The identification of these risk factors being so important in the prevention and early intervention of trauma. 

These guidelines provide us with some interesting insights around the treatment of PTSD in children and adolescents. First of all, it is worth noting that the guidelines remind us that when a child is exposed to trauma, it is not only PTSD that they may develop. Children and young people exposed to trauma often present for treatment for depression or anxiety and increasingly difficulties with behaviour and education. Trauma focussed cognitive behavioural therapy (TF CBT) is featured as the treatment with the greatest evidence base for children. The guidelines also feature information on the success of TF CBT in school environments, especially post disaster, with these interventions reaching greater numbers of kids who stay engaged with the intervention for longer periods of time. The role that school professionals play in these interventions needs to be recognised and supported. 

What we can also gain from reading these guidelines is that there remains so much important work to be done in the area of childhood trauma. There needs to a lot more work done in the area of complex trauma, which we know has the potential to be so damaging for children and young people. We also need to be looking more closely at the needs of infants who experience trauma. After a disaster, or other mass trauma, infants are often overlooked when providing assistance and interventions and they often miss out on the benefits of school based interventions. And, of course, we need to keep finding out more about what works to help kids who are traumatised.

Thursday, 25 July 2013

Children seeking asylum: trauma and adversity

Children seeking asylum: trauma and adversity

In the images of asylum seekers that are in the media at the moment, we are seeing many faces of adolescents, children and babies. It is a reminder that we need to be thinking more about what these children are experiencing. Some of them are travelling with their parents, some with other family members and some are alone. All of them have been on a journey that most of us can not begin to imagine. 

Children who are refugees or asylum seekers face huge adversities and traumatic experiences. Recently, the Network released this resource that discusses the refugee experience and how it impacts on children. Some of the adversities that are outlined in the resource include the impact of parental stress on children, children's exposure to violence and the potential exploitation of vulnerable children. 

What adversities are these children facing?

Children generally tend to follow a healthy pattern of development when they are in a safe, protective environment with adults who nurture them. Children need parents to respond appropriately and consistently to them, something that can be particularly difficult to do when they are under constant stress, living in uncertainty and finding it difficult to cope themselves. The nature of the refugee experience is one that places extreme stress on children and their families. The journey is usually arduous and may involve the loss or death of others making the same journey. The process for asylum seekers leads to further stress of prolonged detention and the uncertainty of the length of that detention and what the outcome will be at the end of this time. All of these contributing to the poor mental health of the parents and in turn the mental health of the child. 

Many children who are refugees or seeking asylum will also be exposed to violence. Often, their parents will have limited opportunities to protect their children from this violence. We already know from the research that exposure to violence can be particularly damaging to children. When this exposure is extreme or repeated, these traumatic experiences are likely to leave an indelible impression on the child. 

Children who are alone, or without a parent, become particularly vulnerable to exploitation at all stages of the refugee journey and whilst seeking asylum. They may experience physical or sexual abuse or witness violence or other inappropriate acts of others that their parents would otherwise shield them from. 

Long term impact of trauma

We know that many children can be resilient in the face of adversity, but we also know that the greater the number of adversities that a child faces, the more chance there is that there will be a detrimental impact on their outcomes. Trauma impacts on the physical and mental health of children, as well as their development, social functioning and their academic achievement. We know that the impact of trauma can last for a lifetime

It is everyone's role to make sure that children are protected from the harmful impact of trauma and adversity. We need to be thinking more about what can be done to protect this particularly vulnerable group of children. 

Wednesday, 10 July 2013

The ongoing impact of childhood trauma

We are now seeing a steady flow of research that is telling us more about the connections between childhood trauma and mental and physical health difficulties later in life. But, what is really great to see, is more research from here in Australia, talking about this.

New research that has just been published, has used an Australian community based survey (the 2007 National Survey of Mental Health and Wellbeing) to look at the relationship between child abuse and the long-term health care costs and impact on wellbeing.

This is what they have found:

".... that adults with a history of childhood abuse suffer from significantly more health conditions, incur higher annual health care costs and are more likely to harm themselves. Our results suggest that child abuse has long-lasting economic and welfare costs. These costs are greatest for those who experienced both physical and sexual abuse."

There have been many studies that have linked childhood trauma and child abuse to poor long term mental and physical health outcomes. The Adverse Childhood Experience (ACE) study in America has identified that childhood trauma contributes towards substance abuse, heart disease, smoking, suicide attempts, depression and many other illnesses in adulthood.

This new Australian research has not only shown a correlation between poor mental and physical health outcomes, but has also provided an estimate of the increased cost each year that childhood trauma is having. This research has found that for adults who were both physically and sexually abused as a child, the annual healthcare cost per person is approximately $1856 higher than for those in the general population. This means that childhood trauma has huge implications for the health care system and for the cost to the community as a whole.

What impact does childhood trauma have? 
The paper describes the many ways that childhood trauma can lead to poor adult health outcomes and increased health care costs. There is the immediate harm that is done to the child and the impact of the prolonged stress that the child lives under. This prolonged stress causes damaging, long term negative effects on the body, which become particularly apparent in the damage done to the heart and circulatory system. Prolonged stress also damages the immune system and leaves the child more vulnerable to a range of physical health problems that can last into adulthood.

Childhood trauma is also strongly associated with a range of mental health difficulties such as depression, anxiety and psychosis. Childhood trauma has negative impacts on self esteem and the child's ability to interact with others and develop appropriate interpersonal skills that are needed to develop and maintain the protective relationships of family and loved ones.

Adults who have experienced childhood trauma are also more likely to engage in more risk taking such as excessive drinking and drug taking, all of which we already know play a major role in contributing to poor health outcomes. They are also more likely to engage in self harming or suicide.

Another major area that childhood trauma impacts on, that is not mentioned in this current study, is the impact on educational engagement and success. Children who experience trauma or adversity are more likely to experience educational difficulties and poor academic achievement. This then impacts on their ability to be successful at school and go on to be a productive working member of the community.

What next? 
With the expanding body of research continuing to demonstrate that childhood trauma has such negative long term impacts, it is essential that more is done now to intervene early; to increase the knowledge around and awareness of these impacts; and to be more effective in treating children who have experienced trauma.

Wednesday, 26 June 2013

Treating traumatised kids

Are the current approaches to treating traumatized kids actually making them better?  

More and more research is telling us about the long-term negative consequences of trauma and adversity in childhood with correlations between childhood trauma and poor mental and physical health outcomes across the lifespan. So, it makes sense that there should be a good evidence base for treating the effects of childhood trauma.

In February this year, researchers in the United States undertook a Comparative Effectiveness Review (CER) examining the evidence for interventions that target traumatic stress symptoms and syndromes associated with nonrelational trauma, such as exposure to war, disasters and accidents. The review was sponsored by the Agency for Healthcare Research and Quality (AHRQ). CER’s are designed to guide health care decisions by providing evidence on the effectiveness, benefits and harms of different types of interventions.

The authors noted in their paper – although several guidelines on the treatment of PTSD in childhood and adolescence exist, the recommendations are inconsistent and largely not based on evidence from high-quality clinical trials or comparative effectiveness reviews (CER’s).

·       The literature, including the grey literature, was systematically reviewed to identify 21 trials and 1 observational study that evaluated 6 different types of interventions. These studies included 7 studies that targeted children identified as exposed to trauma and 15 studies targeting children with trauma exposure who already had symptoms. These interventions included psychological as well as pharmacological treatments.
·      The researchers used qualitative rather than quantitative analysis methods, which they stated was due to there being insufficient numbers of similar studies, variation in outcome reporting and statistical heterogeneity (the level of differences present in the data).
·       At least 1 outcome in the studies included in this CER had to relate to the assessment of traumatic stress symptoms or syndromes.

·       Interventions that included trauma-focused CBT, child and family traumatic stress intervention and 2 different school interventions with elements of CBT reported some improvement in outcomes.
·       Studies that included early psychological intervention and medication with propanonol showed no improvement in any outcomes.
·       The child and family traumatic stress intervention was the only study that showed evidence of benefit with an active group comparator.
·       School based interventions with elements of CBT were promising based on the magnitude and precision of effects.

Overall the study found that there was very little evidence to support the current interventions that are being used to treat children presenting with adverse symptoms as a result of nonrelational trauma.

In their systematic review of the literature the authors were able to identify many more studies assessing interventions than those that were included here. Most of these studies were not included in this review as they did not meet the inclusion criteria for the CER or the interventions had only been trialed with children exposed to relational traumas, such as child maltreatment or sexual abuse. This raises the obvious point that there is a need for a more consistent and evidence based approach and also the need for research that is embedded in practice in order to collate evidence about those interventions that are being used to treat trauma in children. However, as the authors note, studying traumatized children is a particularly sensitive area and one that can be difficult to recruit participants into.

The authors concluded that:
Psychotherapeutic intervention may provide benefit relative to no treatment in children with traumatic stress symptoms or exposed to traumatic events and appears not to have associated harms.

For practitioners working with children who have been exposed to trauma, it is worth noting that the CER found that interventions with components of CBT were amongst those that demonstrated some efficacy. A review and meta-analysis of CBT for the treatment of posttraumatic stress disorder (PTSD) in children (Kowalk et al) also found that interventions that incorporated CBT were the most effective in treating trauma in children.

Another point to note is that many of the current interventions and much of the research only focuses on the short to medium term outcomes of trauma in children, when we know that the experience of traumatic is likely to have long term negative impacts on development. This leaves us with a large gap of knowledge about what actually helps children and young people over time.

Given what we now know regarding the poor outcomes of many children and young people who are exposed to trauma, it is essential that the knowledge base continues to be developed in order ensure the wellbeing of children, young people and their families.

This article has also appeared on The Mental Elf blog

Valerie L. Forman-Hoffman, Adam J. Zolotor, Joni L. McKeeman, Roberto Blanco, Stefanie R. Knauer, Stacey W. Lloyd, Jenifer Goldman Fraser , Meera Viswanathan. Comparative effectiveness of interventions for children exposed to nonrelational traumatic events. Peadiatrics; originally published online February 11, 2013.

Joanna Kowalik, Jennifer Weller, Jacob Venter, David Drachman. Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: A review and meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry. 2011 42 405 – 413.

Monday, 17 June 2013

A little bit about trauma and adversity and Australian kids.....

Someone asked me a question today. They wanted to know why talking about childhood trauma and adversity was so important. This person knew that bad things happened to children and they also knew that these things could be really damaging to kids. But they didn't know much more than that. 

About two thirds of children, by the time they reach 18, will have been exposed to a traumatic event or adversity. Now, it is not necessarily true that these traumatic experiences or adversities will lead to negative outcomes for all children. 35 - 65% of children are likely to be resilient to these potentially traumatic events 2 years after they occur.  We know that most children are resilient in the face of adversity. But we can say that most children will encounter potentially traumatic events at some time in their childhood or adolescence. 

What are these potentially traumatic events?
There are a long list of stressful events or adversities that may occur in a child's life. There are the traumatic events such as child abuse and neglect and exposure to domestic violence that we know causes great distress and disruption to the lives of children. Then there are the adversities or difficulties that may be present in the lives of many children. And these are events such as a disaster (such as floods or fires); a death in the family; legal problems in the family; a serious injury or assault in the family; family financial hardship; the child experiencing an injury or an accident; substance abuse problems in the household where the child lives; single parent households; arguementative or hostile relationships between parents; hostile parenting; children residing in foster care or other out of home care; parental mental health difficulties; the child having a chronic health or developmental difficulty; parents separated or divorced; and being bullied. There are also the adversities that are associated with different communities, such at the experience of being a refugeee or asylum seeker; living in a rural or remote area; and being Indigenous

An important Australian study, the Longitudinal Study of Australian Children (LSAC), has been tracking the lives of around 9000  children over the past 8 years and has been able to provide us with some valuable insight into just how many of our children are experiencing these potentially traumatic events in their lives. Just over 47% of children included in the LSAC have been bullied at school; over 24% have a chronic health or developmental condition; over 20% have parents who have separated or divorced; and over 12% have been exposed to parental violence. Now, we know that children who are exposed to 3 or more adversities are likely to have poorer outcomes in terms of mental health and wellbeing, and it seems that there are around 20% of children who fall into this group. 

What are the negative outcomes of childhood trauma and adversity? 
There has been a great deal of research into the impact of childhood trauma and adversity over the past 10 years. As a result of many, many studies we now know that early trauma and adversity leads to poor mental health AND physical health outcomes in childhood, adolescence and adulthood. Childhood trauma and adversity has been reported to contribute to 44.6% of childhood onset mental health disorders and 32.4% of adult psychiatric disorders. This includes depression and other mood disorders, anxiety disorders and psychotic disorders. 

There has also been a great deal of research that can demonstrate that exposure to adverisity and trauma in childhood can increase the likelihood of a range of poor physical health outcomes as an adult and this includes increasing vulnerability to heart disease, stroke and diabetes. 

Talk more about trauma and adversity
The impact of poor mental and physical health is a huge burden on individuals and families as well as the community. This is why it is essential that we talk more about the trauma and adversity that children face. Learning more about the impact of trauma and adversity on children and helping parents, carers and the community to recognise when kids are going through tough times, and how they can help, are the first steps towards protecting our kids, looking after their wellbeing and helping them to have a better future! 

Tuesday, 4 June 2013

Hello and welcome to our blog! 

Here at the Australian Child & Adolescent Trauma, Loss & Grief Network (or ACATLGN for short) we really want to make as much information about kids, trauma and adversity as accessible as possible for everyone. 

We really believe that the traumatic experiences and the adversities that kids face has a lasting impact on many of them. It is definitely true that many kids will be resilient when faced with trauma and adversity, but what about the ones who are not? Did you know that childhood trauma and adversity can lead to poor mental health outcomes such as depression, anxiety, post traumatic stress disorder, suicide, substance abuse and even psychosis? In fact, lots of kids who are being taken to psychologists, GP's, counsellors and paediatricians with mental health difficulties have been exposed to trauma and adversity. 

On this blog we will be posting links to news, resources and research that focuses on childhood trauma and adversity. We will also be providing you with summaries of the latest research, so that it is easier for you to quickly catch up on new developments in the field. 

If you have any suggestions on what you would like to see in this blog - remember it is for you! - then feel free to send us an email at