Troubled beginnings: the adverse childhood experiences and placement histories of a detained adolescent population with developmental disorders

Abstract

Purpose People with developmental disorders are significantly more likely to experience adverse childhood experiences (ACEs), although the impact of ACEs on this population is not well understood. Furthermore, considerably less is known about the exposure to, and impact of, ACEs in detained adolescents with complex developmental disorder needs. This paper aims to explore the exposure to ACEs in an adolescent population detained in a secure specialist developmental disorder service. Design/methodology/approach A retrospective file review was used to explore ACEs and placement histories within a specialist developmental disorder inpatient service. Data was collated for a convenience sample of 36 adolescents, 9 of whom were female, aged 13–20 years (M = 17.28 years). Findings A total of 33 participants (91.7%) had experienced at least 1 ACE, with 58% experiencing 4 or more ACEs and 36% experiencing 6 or more ACEs. The most common ACEs reported were physical abuse (61.6%), parental separation (58.3%) and emotional abuse (55.6%). The majority of participants had also experienced high levels of disruption prior to admission, with an average of four placement breakdowns (range 1–13, standard deviation = 3.1). ACEs held a significant positive association with the total number of placement breakdowns and total number of mental health diagnoses. Practical implications Adolescents detained in specialist developmental disorder secure care had, at the point of admission, experienced high levels of adversities and had been exposed to high levels of experienced and observed abuse. The level of exposure to adversity and ongoing disruptions in care suggests that Child and Adolescent Mental Health Services’ developmental secure services should consider adopting dual treatment frameworks of developmental disorder and trauma-informed care. Originality/value This study explored the early-life and placement experiences of a marginalised and understudied population.

Profiling referrals to a trauma support service: needs and outcomes for staff working in a secure adult developmental disorder pathway

“…When such staff are exposed to physically aggressive behaviours, the likelihood for severe physical injury is low (Hensel et al, 2012), and thus the psychological impacts of such behaviours are likely greater than the physical impacts. Additionally, this staff group work with a population who often present with extensive trauma histories (Wigham and Emerson, 2015;Morris et al, 2020), and thus contend with additional risk for secondary psychological trauma. Finally, staff often fail to report and seek support for incidents of aggression (Arnetz et al, 2015), particularly in inpatient mental health setting where violence is normalised (Brophy et al, 2017).…”

“…Besides, incidents of aggression, staff working with people with a DD are also at risk for indirect exposure to trauma as a by-product of the narratives of the people in their care. The challenging behaviours often demonstrated by people with DDs have been linked to trauma (Rittmannsberger et al, 2020), and extensive trauma histories are common in this population (Wigham and Emerson, 2015;Morris et al, 2020). As such, staff working in DD services contend with greater risk for trauma, both directly, through exposure to high levels of aggression and behaviours that challenge, and indirectly, as an artefact of the significant trauma histories of the service users they care for.…”

Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?

“…Nevertheless, this relationship has not been empirically explored in people with developmental disorders, and thus, the presence and nature of this relationship cannot be assumed. An earlier study documented that adolescents with more complex developmental disorders had fewer ACEs, forensic care needs and placement breakdowns within services (Morris et al, 2020). Such findings may suggest that the relationship between ACEs and offending behaviour may be mediated by the presence or complexity of a developmental diagnosis and additional sources of trauma.…”

“…This is a prominent omission as people with developmental disorders are over-represented in forensic settings (Hales et al, 2018) in the context of particularly chronic trauma histories (Stinson and Robbins, 2014). Research within adolescent and adult forensic developmental disorder samples documents that 58%-66% experience four or more ACEs (Morris et al, 2019(Morris et al, , 2020, an increase on the 45.5% prevalence rate reported by Ford et al (2019) in a neurotypical forensic sample. Given the high prevalence of pervasive trauma histories and engagement in offending behaviours in people with developmental disorders, consideration of an association between trauma and risk in this group is necessitated.…”

Prevalence of neurodevelopmental disorders (NDDs) in looked after children (Lac) versus children that are not looked after (non-Lac) and adverse outcomes: A systematic review and Meta-analysis

“…The behavioural characteristics can often be misinterpreted by their peers placing them in yet more vulnerable situations (141)(142)(143). More qualitative research on the experiences of adults with bipolar who were previously Lac would contribute to a better understanding of why some of these adults end up in the criminal justice system (144).…”