Background: Young people in out-of-home care are substantially more likely to meet criteria for PTSD than their peers, while their early maltreatment exposure may also place them at greater risk of developing the newly proposed complex PTSD. Yet, there remains limited empirical evidence for the mechanisms that might drive either PTSD or complex features in this group, and ongoing debate about the suitability of existing cognitive behavioural models and their related NICE-recommended treatments. In a prospective study of young people in out-of-home care, we sought to identify demographic and cognitive processes that may contribute to the maintenance of both PTSD symptom and complex features. Methods: We assessed 120 10-to 18-year-olds in out-of-home care and their primary carer at two assessments: an initial assessment and 12-month follow-up. Participants completed questionnaires on trauma history, PTSD symptoms and complex features, while young people only also self-reported on trauma-related (a) maladaptive appraisals, (b) memory quality and (c) coping. Social workers reported on maltreatment severity. Results: Young people's maltreatment severity was not a robust predictor of either PTSD symptoms or complex features. All three cognitive processes were moderately-to-strongly correlated with baseline and 12-month PTSD symptoms and complex features, with maladaptive appraisals the most robust unique driver of both, even when controlling for initial PTSD symptom severity. Conclusions: Existing cognitive models of PTSD are applicable in this more complex sample of young people. The model was also found to be applicable to the additional features of complex PTSD, with the same processes driving both outcomes at both time points. Clinical implications are discussed.

PurposeMany patients in residential and secure settings have no formal diagnosis of Autism but may in fact be on the spectrum. This paper seeks to outline the diagnosis and subsequent treatment and intervention planning for a young woman in a low secure hospital.Design/methodology/approachThis paper summarises the literature in relation to the diagnosis of Pathological Demand Avoidance (an atypical presentation of Autism Spectrum Disorder) in children and describes how this diagnosis may present in adults. This search revealed that whilst there was a growing literature around PDA in Children, there was very little literature available about either the clinical presentation or management guidance in adults. A case study design was adopted.FindingsThe paper concludes that the lack of an appropriate diagnosis and inappropriate formulation of the underlying causes of challenging behaviour can lead to patients becoming impossible to manage. Many may benefit from diagnosis and Autism‐specific intervention.Originality/valueThis paper highlights the challenges of adult diagnosis of Autism in highly complex individuals and outlines novel approaches to treatment.

Aim: An National Health Service (NHS) mental health trust developed a pathway offering eye movement desensitization reprocessing (EMDR) to healthcare professionals (HCPs). This research aimed to evaluate whether EMDR was linked to improvements in posttraumatic stress disorder (PTSD) and sought to understand the experiences of service users. Method: Pre- and post-outcome measures of the Impact of Events Scale—Revised, patient health questionnaire-9, generalized anxiety disorder-7, and work and social adjustment scale were evaluated. Subsequently, a feedback survey was circulated to those who had accessed the service. Results: Analysis revealed statistically significant improvements in measures of PTSD, depression, anxiety, and functioning. The service was rated highly for accessibility and experience. Perceived treatment effectiveness was variable; however, reliving symptoms and sickness absence were reduced, and improvements made during therapy were reportedly maintained. Conclusion: This service evaluation offers preliminary support for the use of EMDR as a useful intervention for HCW. Recommendations that may be more broadly applicable for service development and considerations for future research are discussed.