The most disadvantaged people in society are the most likely to have experienced adverse childhood experiences. These are highly stressful events such as neglect and abuse, and can have long-lasting effects on people’s lives. Young people may struggle to develop socially and academically as a direct result. They are at increased risk of physical and mental health problems both at the time and years later.
But poor outcomes are not inevitable and early intervention can make a difference.
Recent research funded by the National Institute for Health and Care Research (NIHR) identifies the types of support young people feel they need from services, and offers ways to support the mental health of children in care and those adopted from care.
Young people need emotional and practical support
Every child is unique and responds to adverse experiences in their own way. The impact of these experiences is complex. It depends on a range of factors, including the circumstances in which the child lives, and how resilient they are.
A recent NIHR-funded review explored the kinds of services and support these young people said they need. The young people in this study had experienced different types of adversity, but they had common needs from services.
They wanted emotional support from a trusted adult who showed empathy, was non-judgmental, and an active listener. They valued practical support to manage everyday challenges, and wanted their needs to be at the heart of services.
This research was part of a larger study which identified areas of mismatch between young people’s needs and the types of support they were offered. For example, young people described the importance of stability and continuity in the support they receive. This allows time to build their trust. Yet many interventions were short-term, lasting just a few weeks, and were delivered by people otherwise unknown to the young person.
Support groups are seen as especially valuable by those who self-harm
Nearly all children and young people under local authority care will have had some adverse childhood experiences. They are at greater risk of mental health problems, including self-harm, than those not in care. Recent research provides insights into the support that young people who self-harm find helpful. The views of young people with and without experience of the care system were included.
Support groups were seen as especially valuable by those in care who self-harm. Yet only one in five had experience of them. This could represent an underused source of support.
Most young people, whether in care or not, reported finding informal support helpful – including from friends, carers and pets. The researchers say that focusing only on professional services for self-harm ignores the importance of informal support.
Young people in care were more likely to attend accident and emergency departments for self-harm than those not in care. However, many found the support unhelpful. Their views on child and adolescent mental health services (CAMHS) were mixed; almost equal numbers of young people ranked CAMHS as the most or least helpful. Further research is needed to explore the negative views of professional services and find ways to improve the services for young people.
Detailed information about life before adoption could help
Like those in care, most young people who are adopted from care have suffered adverse childhood experiences. They are at higher risk of poor mental health than the general population.
Recent research looked at whether children’s mental health improved after adoption, and whether it was related to adversity before being adopted from care. Findings showed that their mental health had not improved four years after adoption. Problems increased with the number of adverse childhood experiences young people had before adoption.
The researchers recommend that adoptive parents and social workers should have as much information as possible about a child’s life before adoption. This could help identify possible mental health problems early.
Adopted children are more likely to have symptoms of post-traumatic stress than the general population. But post-traumatic stress is not a single condition. Some people feel emotionally numb (avoidance), others are jumpy and tense (arousal) or have nightmares and flashbacks (intrusive thoughts).
A recent study found the type of early adversity adopted children lived through was linked to the type of post-traumatic stress they went on to develop. For example, children who had experienced multiple risks were most likely to show avoidance and arousal. Those who had experienced adversity in early life were more likely to have intrusive thoughts. These findings have implications for care planning for individual children. They suggest that adopted children need tailored support based on the types of adversity they have experienced.
Ongoing NIHR research will inform future care
Recognising the need to support children and young people exposed to adversity, the NIHR has a growing portfolio of research. Research currently underway could suggest more ways to improve the lives of children and young people who have had adverse childhood experiences. Particular areas of focus include new ways for professionals to work, training for carers, and interventions to improve mental health.
Caring for children and young people who have had adverse experiences is complex. It requires support from across health and social care services. We hope our NIHR Evidence Collection offers useful information to help those who provide this care to improve the support available.
ENDS
Written by Dr Jemma Kwint, Senior Research Fellow (Evidence) and Lauren Hoskin, Communications and Engagement Manager, at the National Institute for Health and Care Research
Dr. Jemma Kwint leads on NIHR Evidence’s Themed Reviews, which bring together recent research on topics of strategic importance for the UK health and social care system. She has a background in postdoctoral medical research embedded in an NHS setting and extensive experience of working within the NIHR. Prior to joining CED, Jemma worked for 10 years identifying and prioritising research topics for NIHR commissioning.
Please note that this is an external blog and may not reflect the views of ACAMH.
Discussion
I wholeheartedly agree with the need for children adopted from care and all their supporting adults to have as much information regarding their pre adoption trauma’s as possible. I am concerned that a group of young people who tend to be forgotten in this area are the children and families who live within their extended family through a special guardianship order. These families are regularly dealing with the same level of ACE’s.