‘ACEs, Attachment, and Trauma: new advances in understanding and treatment’ – 2020 Emanuel Miller Memorial Lecture and National Conference


Event type National Conference

Royal College of Physicians, 11 St Andrews Pl, London NW1 4LE

The Emanuel Miller Memorial Lecture and National Conference returns with a truly incredible line-up, focusing on ‘ACEs, Attachment, and Trauma: new advances in understanding and treatment’

Quick links about the event

About the day
Key takeaways
About the talks
About the speakers

About the day

Through decades of research studies coupled with our understanding of child and adolescent brain development, the evidence is now clearer than ever: adverse early experiences, in terms of ACEs and attachment security, have a pronounced, pervasive impact across the lifespan, that come at a high individual and societal cost. Now, more than ever, the critical importance of the caregiver-child attachment and mitigating the effects of ACEs and early trauma, is being emphasized, and has propelled the development of innovative early interventions to improve child and adolescent well-being, reduce suffering, empower parents, and reduce the financial strain on society.

Key takeaways

  • A critical stance on attachment and its application over the years in research and practice, to see what is working and what is not
  • Discover the very latest research findings on Adverse Childhood Experiences and its links with neurodevelopment
  • Disentangling complex trauma and the links with psychopathology in children and adolescents
  • The development of psychological trauma and adapting to exposure to danger
  • Designing and implementing early interventions for children exposed to trauma

About the talks

Dr. Patricia M. Crittenden
Psychological Trauma & Resilience: A Strengths Perspective

Psychological trauma will be considered in terms of delayed opportunities for learning to protect one’s self and family members from danger. The basic hypothesis is that unprotected exposure to danger can lead to psychological shortcuts that leave one vulnerable to psychological trauma and re-exposure to danger in the future. Reflective review of past exposure can reveal the shortcuts, leading to more accurate differentiation of danger and safety and more effective self-protective strategies. This, in turn, can increase resilience in the face of future threats. Analysis of data on patients with PTSD, patients with other disorders, and non-patients will be used to test the hypothesis of incomplete learning being tied to psychological trauma. People with chronic PTSD for adulthood endangerment differed from others in having psychological traumas from events in childhood during which they had had neither protection nor comfort and from which they had developed psychological shortcuts. Implications for treatment will be discussed.

Key learning points:

  1. Differentiating ACEs (adverse childhood events) from distorted psychological processing about the events;
  2. Considering reflective integration as two steps: untransforming distorted information and integrating accurate information;
  3. Considering human resilience to be the process of adaptation to changing conditions;
  4. Recognizing the power of successfully resolving a succession of increasingly complex dangers (in one’s everchanging zone of proximal development) to yield resilience.

Dr. Stephanie Lewis
What is so complex about complex trauma?

The term ‘complex trauma’ describes traumatic events that involve multiple interpersonal threats in childhood, such as repeated child abuse or severe bullying. In this talk I will describe psychiatric presentations experienced by young people exposed to this type of trauma, and contrast this with presentations experienced by young people exposed to other non-complex types of trauma. Additionally, I will consider the origins of these presentations, by explaining the role of pre-existing vulnerabilities. Throughout, I will highlight implications for clinical practice and future research.

I will discuss how research on these topics has important implications, including for clinical practice – informing assessment, treatment, and prevention – and for future research – informing theory and study design. I will focus on trauma associated with an increased vulnerability for psychiatric presentations, and will also discuss factors that are associated with increased vulnerability for trauma exposure.

Key learning points

  1. To understand the nature of psychiatric presentations experienced by young people exposed to complex and non-complex traumas
  2. To recognise vulnerabilities linked to increased risk of complex and non-complex trauma exposure
  3. To appreciate the role of pre-existing vulnerabilities in psychiatric presentations experienced by young people exposed to complex and non-complex trauma

Professor Helen Minnis
Trauma and Neurodevelopment

This presentation will discuss the close links between early childhood abuse and neglect and neurodevelopmental problems like ADHD and Autism.  As well as presenting some research findings the talk will include practical suggestions for clinical practice.

About the speakers

Professor Peter Fonagy
Professor Peter Fonagy

Professor Peter Fonagy OBE FMedSci FAcSS FBA PhD is Head of the Division of Psychology and Language Sciences at UCL; Chief Executive of the Anna Freud National Centre for Children and Families, London; Consultant to the Child and Family Programme at the Menninger Department of Psychiatry and Behavioural Sciences at Baylor College of Medicine; and holds visiting professorships at Yale and Harvard Medical Schools. He has occupied a number of key national leadership positions including Chair of the Outcomes Measurement Reference Group at the Department of Health, Chair of two NICE Guideline Development Groups, Chair of the Strategy Group for National Occupational Standards for Psychological Therapies and co-chaired the Department of Health’s Expert Reference Group on Vulnerable Children.

His clinical interests centre on issues of early attachment relationships, social cognition, borderline personality disorder and violence. He has published over 500 scientific papers, 260 chapters and has authored or co-authored 19 books. He is a Fellow of the British Academy, the Academy of Medical Sciences, the Academy of Social Sciences and the American Association for Psychological Science and was elected to Honorary Fellowship by the American College of Psychiatrists. He has received Lifetime Achievement Awards from several national and international professional associations including the British Psychological Society, the International Society for the Study of Personality Disorder, the British and Irish Group for the Study of Personality Disorder, the World Association for Infant Mental Health and was in 2015 the first UK recipient of the Wiley Prize of the British Academy for Outstanding Achievements in Psychology by an international scholar.

Dr. Patricia Crittenden
Dr. Patricia Crittenden

Dr. Patricia M. Crittenden studied under Mary. D. Ainsworth from 1978 until 1983, when she received her Ph.D. as a psychologist in the Social Ecology and Development Program at the University of Virginia. In addition to Mary Ainsworth’s guidance and support, her psychology master’s thesis, on the CARE-Index, was developed in consultation with John Bowlby and her family systems research, on patterns of family functioning in maltreating families, was accomplished with guidance from E. Mavis Hetherington. She also holds a Master’s Degree in Special Education, with specializations in mental retardation and emotional disturbance (University of Virginia, 1969.)

Dr. Patricia Crittenden has served on the Faculties of Psychology at the Universities of Virginia and Miami and held visiting professorships at the Universities of Helsinki (Finland) and Bologna (Italy) as well as San Diego State University (USA) and Edith Cowan University (Australia).

In 1992, she received a Senior Post-doctoral Fellowship, with a focus on child sexual abuse and the development of individual differences in human sexuality, at the Family Research Laboratory, University of New Hampshire. In 1993-4 she was awarded the Beverley Professorship at the Clark Institute of Psychiatry (Canada).

In the last two decades, Dr. Patricia Crittenden has worked cross-culturally as a developmental psychopathologist developing the Dynamic-Maturational Model (DMM) of attachment and adaptation, along with a developmentally attuned, life-span set of procedures for assessing self-protective strategies. DMM-based theory and empirical research authored by Dr. Patricia Crittenden have been widely published as books, chapters in books, and empirical articles in developmental and clinical journals.

In 2004, Dr. Patricia Crittenden received a career achievement award for “Outstanding Contributions to the Field of Child and Family Development” from the European Family Therapy Association in Berlin. Currently, Dr. Patricia Crittenden’s work is focused on preventive and culture-sensitive applications of the DMM to mental health treatment, child protection, and criminal rehabilitation.

Professor Helen Minnis
Professor Helen Minnis

Professor Helen Minnis is a Professor of Child and Adolescent Psychiatry at the University of Glasgow. She spent time working as an Orphanage Doctor in Guatemala in the early 1990s prior to training in Psychiatry, and this stimulated an interest in the effects of early maltreatment on children’s development. Her research focus has been on Attachment Disorder: clinical aspects, assessment tools and behavioural genetics. She is now conducting intervention research for maltreated children, including a randomised controlled trial of an infant mental health service for young children in foster care.

Dr. Stephanie Lewis

Dr. Stephanie Lewis is a Clinical Lecturer in Child and Adolescent Psychiatry. She studied medicine at Imperial College London, and since graduating has undertaken integrated clinical and academic training, including psychiatry training at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. She is currently undertaking an MRC Clinical Research Training Fellowship, and continues to work as a psychiatrist in child and adolescent mental health services.

Steph’s research focusses on understanding the mental health difficulties experienced by young people who have been exposed to traumatic events, in order to inform and improve psychiatric care for those affected. As part of this work, she has studied trauma and post-traumatic stress disorder (PTSD) in young people, to understand the prevalence and clinical features of trauma and PTSD, and factors that predict the development of PTSD after trauma exposure. She also studies mental health difficulties experienced by young people exposed to different types of trauma, including complex types of trauma, such as child abuse or bullying. Additionally, she studies health service use and the recognition and treatment of PTSD and other psychiatric disorders in child and adolescent mental health services.


Slides are password protected, those we have permission to share will be made available when they are supplied to us.

  • Dr. Patricia Crittenden – slides
  • Professor Helen Minnis – slides
  • Professor Stephen Scott – slides tbc
  • Dr. Stephanie Lewis – slides will not be available for download
  • Peter Fonagy – slides will not be available for download