Child to Parent Violence

Professor Stephen Scott


Professor Stephen Scott CBE FRCPsych FMedSci, Chair of ACAMH. Stephen is a Consultant Child and Adolescent Psychiatrist in the CAMHS Adoption and Fostering Service and the Conduct Problems Service at the South London and Maudsley NHS Foundation Trust. He is also a Professor of Child Health and Behaviour at the Institute of Psychiatry, King’s College London and the Director of the National Academy for Parenting Research, London.

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On the 31 July 2018 ITV news ran a story about child to parent violence. It was based on a report published on 11 July called Let’s Talk About: Child to Parent Violence and Aggression by the authors Dr Wendy Thorley and Al Coates MBE. This book is an online survey, as far as it is possible to tell (it costs £18 and is not in a peer reviewed journal) about child to parent violence chiefly in adoptive families, although slightly under half of respondents were birth families. It is very welcome that this issue is being highlighted, since there is rather little research on it. However, this issue actually occurs in a whole range of families, the majority of cases are in birth families, but there is a higher prevalence in fostered and adopted children since the latter are more likely to have disruptive behaviour problems. The difficulty with online surveys is that those who respond are an atypical sample, what is needed is a systematic survey of the total population, as happens in the Office of National Statistics surveys.

Nonetheless this is an important issue and it is crucial to recognise how frightened and traumatised parents can be when children coerce them, bully them and physically batter them. Julie Selwyn and Sarah Meakins in an important study published in the British Journal of Social Work in 2016 studied adolescent  to parent violence in adoptive families and found two patterns, that which occurred early before puberty which got worse in adolescence and then some which emerged during and after puberty. She found that the shame associated with aggression and violence on parents stopped people admitting the difficulty, they often saw it was their failure to control the child. The concern with the Thorley and Coates survey is that it distinguishes children who intend to be violent and those who do not. This is perhaps rather unfair on children, since if they have had an abusive upbringing, which nearly all fostered and adopted children do, and additionally often have neurodevelopmental disorders such an ADHD and autism, it’s hard to really say it is their fault and intended, since it is not usually under their control.

Antisocial behaviour and aggression is the commonest child mental health problem, occurring in 5% of the general population and 20 to 25% of the looked after population. It doesn’t just involve violence to parents but is typically widespread with defiance, aggression, destructiveness and lying and stealing both at home and at school, and with siblings and friends. It is part of a picture called conduct problems and when it is severe conduct disorder, or oppositional defiant disorder in younger children. It can be considerably helped through parenting interventions, but before that one needs a full assessment to see if the child has ADHD or Autism or some other reason underlying the aggression. Also, the parent child relationship by then will be very poor or have probably broken down. Parenting programmes can help considerably and there have been several trials showing child aggression and violence can be improved, which needs to be brought to the attention of authorities. In 2013 there was a NICE guideline thoroughly reviewing the evidence and recommending this approach, but unfortunately Child and Adolescent Mental Health Services have largely disinvested from this important problem. This is particular shame since the good news is that we can improve matters considerably with skilled intervention.

In summary, this study is welcome in highlighting the problem, which is often not properly recognised by local authorities and social services: they’re now good at recognising abuse from parents to children, thus the whole child abuse and neglect area is a major concern, and now partner violence between partners or parents is also well recognised. But now we need to recognise a third level of difficulties, aggression from children towards adults who can be traumatised and terrified of their children. It is welcome that the Home Office says they are going to do a comprehensive review of this area and the Domestic Abuse Bill, which is due to come out in the future. It needs to be carefully scrutinised to cover this area.

Discussion

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Thank you for this blog. Just starting my research in this area as a Level 6/Level 7 Diploma (Psycho-Traumatology) student. I am also an adoptive parent and although I don’t experience this myself, I see it daily (hourly) being reported in online forums and facebook groups. With one particular recent post describing the effects on the primary carer being so difficult (PTSD/C-PTSD) that they tried to take their own life. Services not responding to the building complexity of this. Adoptive parents are often turned away, not believed, berated and even investigated, with the ‘advocacy burnout’ adding to chronic and prolonged stress response for the parent/carer.

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