1. Mike Mawby Independent Consultant Working with Adults in Children’s Lives 1 Mike Mawby Consultancy Limited SC509365

2. What do you see? 2 Mike Mawby Consultancy Limited SC509365

3. What do you see? 3 Mike Mawby Consultancy Limited SC509365

4. The Dress Debate! 4 Mike Mawby Consultancy Limited SC509365

5. What do you see? Mike Mawby Consultancy Limited SC509365 5

6. Risks before and at birth Adversity before and at birth can result in lasting developmental impairment and impaired brain function Such adversity can also have an impact on the capacity of the child to benefit from the attachment process Kate Cairns (Akamas) 6 Mike Mawby Consultancy Limited SC509365

7. Impairment may be caused by: Mike Mawby Consultancy Limited SC509365 7 Adverse genetic inheritance Maternal exposure to illness, extreme deprivation, extreme trauma, toxic substances At birth: head injuries, lack of oxygen, complications of prematurity or low birth weight Kate Cairns (Akamas)

8. Developmental trauma Trauma means injury Unregulated stress causes injury to the brain Children with unmet attachment needs often cannot regulate stress Injuries acquired through stress dysregulation because of unmet attachment needs may be described as developmental trauma Kate Cairns (Akamas) 8 Mike Mawby Consultancy Limited SC509365

9. Emotional trauma Once children can process feelings and can think, they may be injured through exposure to terrifying events Such events lead to extreme stress which injures the brain Injuries acquired through exposure to overwhelming fear or horror may be described as emotional trauma. 9 Mike Mawby Consultancy Limited SC509365

10. Post Traumatic Stress The child feels overwhelmed, out of control, terrified. The child is living in a traumatised mind where the sense of threat is CURRENT. Memories of the trauma intrude and flashbacks are like reliving a film clip. They feel overwhelming and real. The mind dissociates in an attempt to avoid reliving the emotions. 10 Mike Mawby Consultancy Limited SC509365

11. Trauma and stress pile-up: Allen 2001 PAST TRAUMA: afraid and alone Sensitised nervous system CURRENT STRESS: reminders of trauma Unbearably painful emotional states RETREAT isolation dissociation depression SELF-DESTRUCTIVE ACTIONS substance abuse eating disorders self-harm suicidal ideation DESTRUCTIVE ACTS aggression violence rages 11 Mike Mawby Consultancy Limited SC509365

12. Impact on the Developing Brain 12 Mike Mawby Consultancy Limited SC509365

13. Traumatised Children Children’s responses to trauma are complex and different to those of an adult...... But... the trauma doesn’t disappear once children become adults! 13 Mike Mawby Consultancy Limited SC509365

14. Spectrum of Dissociation Daydreaming Autopilot e.g. motorway hypnosis Emotional shutdown hearing of trauma Crisis experienced/observed Dissociation to survive (depersonalisation/derealisation) With repeated trauma – dissociation becomes a way of life 14 Mike Mawby Consultancy Limited SC509365

15. Impact on the adult brain 15 Mike Mawby Consultancy Limited SC509365

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18. How common is trauma? 97% of homeless women with mental illness (Goodman et al,1997) 82% of adolescents in an inpatient setting (LeBel et al, 2004) 51% of State Hospital female patients had history of Child Sexual Abuse (Craine et al, 1988) 67% of female outpatients had history of abuse (Muenzenmaier et al,1993) Adults with schizophrenia 85% history of Child Sexual Abuse or Physical Abuse (Holowka,2003) Female outpatients with schizophrenia 78% had history of Child Sexual Abuse (Friedman,2002) 18 Mike Mawby Consultancy Limited SC509365

19. Consequences of Trauma These fall into four major categories: Persistent fear state Disorders of memory Dysregulation of emotion Avoidance of intimacy

20. Within a traumatised population there is likely to be an increased incidence of: Mood disorders Suicidal ideation Substance misuse, Personality disorders Dissociative disorders Psychotic disorders Self-harm, eating disorders and anxiety disorders 20 Mike Mawby Consultancy Limited SC509365

21. So why do we need to think about trauma in the context of adults caring for children? Across psychiatric diagnosis, patients with childhood trauma have earlier first admissions, more admissions, more seclusion, more self-mutilation, more suicide attempts, more successful suicide attempts, more medication, and higher global symptom severity (Read, 2005) 21 Mike Mawby Consultancy Limited SC509365

22. Age Secure/optimal development Sub-optimal/ Insecure/trauma etc Intervention eg foster/ residential care. Emotionally intelligent best friend Attuned, psychologically minded teacher, drama/music therapy David Howe 2009 22 Mike Mawby Consultancy Limited SC509365