Understanding Early Trauma: The case for supporting parent-infant relationships

Sally Hogg
Sally Hogg is Deputy CEO at the Parent-Infant Foundation, a national charity that supports the development, growth and quality of specialised parent-infant relationship teams. Sally leads work to raise awareness of the importance of early relationships and babies’ emotional development, and to drive change at a local and national level. This includes coordinating the 1001 Days Movement and All-Party Parliamentary Group. Prior to this, Sally held a number of roles in mental health and children’s charities, and has been a local authority commissioner and a civil servant working on Children’s Policy in the UK and Australia.

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Understanding of adverse childhood experiences has grown in recent years. We now know more about how external circumstances cause psychological trauma in some children. When we understand early trauma – and the importance of early relationships – we are better able to prevent, and respond to, children’s mental health problems.

Background

Over 20 years ago, researchers showed that exposure to abuse and household dysfunction in childhood was strongly related to the risk of leading causes of death in adults . These researchers identified 10 types of childhood adversity, known as “ACEs”.

Since then, research has consistently shown that ACEs are associated with the increased risk of a range of poor outcomes throughout life. As the Early Intervention Foundation describe “this consistent and compelling evidence has brought greater focus from a wide range of policymakers and public services on the harm caused by child abuse, neglect and other adversities.

Understanding of adverse childhood experiences has also grown in recent years. It is clear that the timing and pattern of adversity, and the intensity of stress and distress experienced by the child influence the extent to which external adversity will lead to psychological trauma and impact their development. Newer evidence shows that we should be particularly concerned about adversity when it occurs early in a child’s life, and about the presence – or absence – of nurturing parent-infant relationships .

The importance of early trauma

Evidence from many branches of science shows us that development during the first 1001 days, from pregnancy until a child is two, lays the foundations for later learning, wellbeing, mental and physical health.

We now know that when experienced in this period, trauma can have a particularly significant impact on children’s development. The brain is particularly plastic and susceptible to influences during this time, so experiences can have greater impact on development with potentially widespread and long-term consequences.

Human brains adapt to our circumstances, and so children’s brains change in response to adversity. Children who have experienced early trauma might have a heightened response to stress, for example, living in “fight or flight or freeze” mode. This could be useful if they need to escape violence and abuse at home. But it can also mean they are more likely to overreact to situations and find it hard to regulate their emotions, which is unhelpful in other settings, such school or the playground.

Scientists call the brain changes that occur in response to early trauma “latent vulnerability” because they can make a child at greater risk of problems. Early psychological trauma can affect emotional, behavioural, cognitive and social functioning. Many CAMHS professionals will see some of these consequences in children they work with.

The role of relationships

A significant predictor of how external adversity will impact a child is the strength and security of their relationship with their parent. A nurturing relationship can make a child more resilient to negative event, whereas without a nurturing relationship, children experience negative events as more traumatic. If we imagine two babies who are exposed to adult conflict: a baby who is held securely and soothed by a trusted caregiver during this conflict will experience less stress than a child who does not have this comfort.

If the relationship between parents and a baby is abusive or neglectful, this is can be more damaging than other forms of early trauma.

Public opinion and understanding

Our new research , suggests that the public, teachers and early education professionals understand the impact of early trauma and the importance of relationships. Although few people understand the full range of ways in which early trauma can affect wellbeing, many knew that it had some impact. Teachers and other professionals told us of how early trauma affects the children they work with:

“I have a child with very significant early trauma. She is extremely hypervigilant and so almost wholly preoccupied with adults in the classroom. She is unable to form relationships with children … She is quick to anger…and can be unkind to other children…She has had no professional therapeutic support.” Primary School Teacher

97% of professionals and 75% of the public responding to our survey recognised that that early relationships are “very important”. 84% of the public agreed or agreed strongly that health services should offer support to families with issues in early parent-infant relationships.

Going forward

If we understand early trauma, and how to support resilience and recovery, then we can help more children to thrive. With this understanding, policies and practice should:

  • Reduce trauma and adversity experienced by young children.
  • Strengthen early relationships between babies and their parents.
  • Provide timely support to those who have experienced early trauma to help them to recover, and to respond appropriately to their needs.

Specialised parent-infant relationship teams can play an important role in strengthening and repairing early relationships to give children the best start in life.

They are multidisciplinary teams led by mental health professionals such as psychotherapists or psychologists, with expertise in working with babies and their families. Parent-infant teams work with families experiencing severe, complex and/or enduring difficulties, offering a tailored package of therapeutic support to strengthen and repair early relationships. They also drive change across their local systems through offering training, consultation and supervision to other professionals in health and children’s services.

We believe that such teams are a vital part of the comprehensive system of mental health support from 0–25-year-olds – a system that works for all the babies, children and young people who need it. The survey results above suggest that the public would agree.

Conclusions

Early relationships protect children from adversity and help them to recover from early trauma. They are also at the heart of many other aspects of early cognitive, social and emotional development. Once we understand early trauma, it is clear that supporting early relationships is a key part of the nation’s mental health services.

References

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.

Asmussen, K., Fischer, F., Drayton, E., & McBride, T.(2020). Adverse childhood experiences: What we know, what we don’t know, and what should happen next. Early Intervention Foundation.

Hambrick, E. P., Brawner, T. W., Perry, B. D., Brandt, K., Hofmeister, C., & Collins, J. O.(2019). Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children. Archives of Psychiatric
Nursing, 33(3), 238-247.

National Scientific Council on the Developing Child (2007). The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper No. 5. Retrieved from www.developingchild.harvard.edu.

National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved from www.developingchild.harvard.edu.

McCrory, E. and Indi Gerin, M. (No date given) Childhood Trauma and the Brain — Deep Dives What happens when relationships go wrong? UK Trauma Council. https://uktraumacouncil.link/documents/UKTC-What-happens-whenrelationships-go-wrong.pdf

Parent-Infant Foundation (2022) Understanding early trauma and the importance of relationships.

Please note that this is an external blog and may not reflect the views of ACAMH

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