Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians

Kaiser, Samantha; Zimmet, Marcel; Fraser, Jolene; Liddle, Karen; Roberts, Gehan

doi:10.1111/jpc.14154

Cited by 7 publications

(6 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Household stressor ACEs were common in this cohort, reflecting the combined ACE prevalence in the overall Australian child population 16 and the combined ACE prevalence in a Sydney community paediatric clinic. 17 In the absence of screening, the paediatrician’s discretion determined whether or not enquiry about household stressors occurred; household stressors were possibly under-reported rather than over-reported as many parents might not disclose certain personal details on their first encounter with a new clinician.…”

Section: Discussionmentioning

confidence: 81%

“… 34 Epigenetics suggests mechanisms for environmental trauma and deficit impinging on the foetus and child and for transgenerational transmission of trauma. 16 26 …”

Section: Discussionmentioning

confidence: 99%

“…Much research on ACEs in childhood has looked at the combined effects of abuse, neglect and household stressors 1 10 11 15 ; instead, this paper focuses on possible associations between mental health symptomatology in childhood and household stressor ACEs in the absence of apparent abuse and neglect. Among Australian children, one in five experience three or more combined ACEs 16 and 64% children attending a community paediatric clinic in South Western Sydney had one or more combined ACEs 17 but the community prevalence of household stressor ACEs in the absence of abuse and neglect is unknown, as is the degree to which these stressors themselves may contribute to child morbidity. Another Australian community paediatric clinic study had found a considerable incidence of reported domestic violence, parental mental health problems and parental substance abuse despite difficulties asking about these factors during paediatric consultation.…”

Section: What This Study Adds?mentioning

confidence: 99%

See 2 more Smart Citations

Adverse childhood experiences—household stressors and children’s mental health: a single centre retrospective review

Holmes

Darmanthé

Tee

et al. 2021

bmjpo

View full text Add to dashboard Cite

ObjectiveTo determine the prevalence of reported ‘household stressor’ adverse childhood experiences (ACEs) in families of children presenting with neurodevelopmental, behavioural or emotional difficulties and to determine whether family vulnerabilities, individually or cumulatively, were associated with particular clinical symptomatology.DesignRetrospective chart review followed by statistical analysis of family stressors and clinical symptomatology.SettingA community paediatric clinic in Australia.ParticipantsAll 267 children who attended an initial paediatric appointment during 2018.Results162 (60.7%) children had been exposed to one or more household stressor ACEs, including 116 (43.4%) children exposed to parental mental illness. Behavioural disturbance occurred in 144 (53.9%) children and externalising behaviours (other than attention deficit hyperactivity disorder) were more frequent than internalising behaviours. Externalising and internalising behaviours were associated with individual and cumulative household stressor ACEs. Most other symptomatology apart from genetic/neurological conditions, autistic symptoms and some developmental delays appeared to be partially associated with ACEs.ConclusionHousehold stressor ACEs were common, frequently occurred concurrently, and were associated with much of the symptomatology, in this cohort. Parental mental illness was the most prevalent stressor and behavioural disturbance the most prevalent symptomatology. These findings may have implications for clinical practice and service provision.

show abstract

Section: Discussionmentioning

confidence: 81%

“… 34 Epigenetics suggests mechanisms for environmental trauma and deficit impinging on the foetus and child and for transgenerational transmission of trauma. 16 26 …”

Section: Discussionmentioning

confidence: 99%

Section: What This Study Adds?mentioning

confidence: 99%

See 1 more Smart Citation

Adverse childhood experiences—household stressors and children’s mental health: a single centre retrospective review

Holmes

Darmanthé

Tee

et al. 2021

bmjpo

View full text Add to dashboard Cite

show abstract

“…Paediatricians may work on the assumption that screening for ACEs is only valid if there is an appropriate therapeutic intervention available and does not come with added costs or negative outcomes. 20 Despite significant challenges and limited evidence for any quality screening instruments, 21 an evaluation of neurodevelopmental trauma and adversity is a valuable part of the assessment and formulation 22 with the intention of improving social history taking and evaluation of social risk factors. 23 In our study only 8% of the cohort was recognised as vulnerable.…”

Section: Discussionmentioning

confidence: 99%

Audit of paediatrician recognition of children's vulnerability to harm at the Royal Children's Hospital, Melbourne

Mahindroo¹,

Smith

Roberts

2020

J Paediatrics Child Health

Self Cite

View full text Add to dashboard Cite

Aim Vulnerable children can be defined as those at risk of child abuse and neglect and long‐term adverse health, neurodevelopmental and behavioural outcomes. This study examined whether a cohort of paediatricians and advanced trainees at the Royal Children's Hospital, Melbourne, recognised children's vulnerability. Methods We reviewed the clinical note in the electronic medical record (EMR) for 425 new patients presenting to five paediatric clinics between 1 July 2017 and 31 December 2017. We examined paediatrician documentation of adverse childhood experiences (ACE), risk and resilience factors, referrals for intervention to improve psychosocial well‐being and the application of ‘vulnerable child’ alert flags in the EMR to indicate vulnerability to harm. Children were deemed vulnerable if the paediatrician explicitly stated it in the EMR, if the child had a ‘vulnerable child’ alert placed in their record or had an appropriate referral for management of neurodevelopmental trauma. Results Of the original cohort, 8% was documented as vulnerable, 21% had a referral for intervention and 2% had a ‘vulnerable child’ alert. Overall, paediatricians infrequently documented ACE, risk and protective factors. The odds of identifying vulnerability increased with each added risk factor recorded (odds ratio (OR) 2.6, P < 0.001, 95% confidence interval (1.9–3.5)), with an ACE score was >4 (OR 72, P < 0.001 (14.3–361)) and decreased with each added protective factor recorded (OR 0.6, P < 0.001 (0.5–0.8)). Conclusion Paediatricians infrequently document ACE, risk and protective factors and rarely ‘flag’ children's vulnerability to harm. Identification of the vulnerable child is correlated with documentation of risk and resilience factors at the initial consultation.

show abstract

“…In contrast, patients who experience emotional distress with the original family appeared to have di culty in setting emotional boundaries with others, self-blame, and fear of forgetting about the loss. Disorganized attachment is more commonly observed in children who have experienced developmental trauma, occurring when their parent may be perceived as a source of harm [11]. Hence, we hypothesized that patients who have perceived psychological con ict with the original family may have an insecure attachment style, and consequently exhibit poor adjustment after perinatal loss.…”

Section: Data Collectionmentioning

confidence: 99%

Factors Affecting the Grief Process After Perinatal Loss: A Case Control Study

Kishimoto

Yamaguchi

Niimura

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Factors associated with the grief process in response to perinatal loss have been investigated. However, few studies focused on the intrapersonal factors, such as developmental and personality traits. To investigate medical and psychosocial risk factors, including inter- and intrapersonal factors for the development of complicated grief following perinatal loss, while considering emotional support.Methods: A total of 50 subjects who were treated for grief due to perinatal loss at the National Center for Child Health and Development were divided into two groups according to the treatment period (<6 months: n = 28; ≥6 months: n = 22). We compared medical and psychosocial variables between the two groups using the χ2 test and t-test. All data were further analyzed using a logistic regression model to adjust for confounding effects.Results: Subjects who had traits of developmental/personality disorders (adjusted odds ratio [OR]: 7.21, 95% confidence interval (CI): 1.21–42.9, P =.030), and those treated with psychoactive drugs (adjusted OR: 5.77, 95% CI: 1.09–30.5, P =.039) required a longer treatment period (≥6 months).Conclusions: Patients with personality/developmental traits and those with active psychiatric symptoms required a more extended treatment period in response to loss, suggesting the accumulation of negative factors in these patients; thus, more intensive and specialized care is necessary for these patients. Precise analysis of the coping style, attachment style, communication skills, and life history including relationship with the original family of the patients may have implications on the approach toward patients with complicated grief after perinatal loss. Studies with larger sample size are required to increase the reliability of the present findings, and future research should address the effects of the differential attachment and coping styles of patients with developmental/personality traits on the grief process.

show abstract

Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians

Cited by 7 publications

References 59 publications

Adverse childhood experiences—household stressors and children’s mental health: a single centre retrospective review

Adverse childhood experiences—household stressors and children’s mental health: a single centre retrospective review

Audit of paediatrician recognition of children's vulnerability to harm at the Royal Children's Hospital, Melbourne

Factors Affecting the Grief Process After Perinatal Loss: A Case Control Study

Contact Info

Product

Resources

About