Attending the Paediatric Mental Health Association (PMHA) Winter Conference today, I have enjoyed a talk from Dr. Barry Coughlan, British Academy Research Fellow, University of Cambridge. My notes from this follow:
IMPORTANT STARTING POINT:
- Conceptualising maltreatment is difficult
- Conceptualising mental illness is difficult
- Lots of child maltreatment is never recognised, and no intervention is made
BEST EVIDENCE REVIEW SHOWS :
- Between 12-35% of people report maltreatment in childhood
- Maltreatment is a robust predictor of mental health problems
- The magnitude of associations vary, according to different meta-analysis
Question arises: which forms of maltreatment predict which mental illnesses?
MULTIFINALITY – A given maltreatment experience can have a range of different outcomes
EQUIFINALITY – A range of maltreatment experiences can have the same outcome
RESEARCH FINDINGS:
Contrary to conventional wisdom, the results do not support that some maltreatments are more likely to contribute than others – Associations are similar across the board (internalising vs externalising)
Those on CP plans / Looked after children are (approx. 3x) more likely to be in contact with MH services than those not.
More likely to be referred with DSH/Conduct/Attachment/PTSD
Less likely to be referred with Psychosis/Eating Problems/OCD/Phobias
50% of looked after children experience MH symptoms. But many have no contact with appropriate services – only approx. 20% are in contact – and fewer still of these will be receiving an actual intervention.
Negative Affectivity – view of oneself and the world are generated by the maltreatment, this then predisposes to patterns of negative thinking. NA is a broad personality trait that refers to the stable tendency to experience negative emotions (Watson & Clark, 1984) – a heightened likelihood to experience negative emotions such as worry, apprehension and sadness.
??Double Jeopardy?? – A question to be explored is whether neurodiversity serves as an additional risk factor – ie if there is ASC/ADHD etc, will any maltreatment be magnified in impact?
We discussed the fact that there have been far more presentations (anecdotally) of disordered eating since the pandemic – as a form of self harm, or “care seeking” – as opposed to a clear mental health disorder, such as anorexia nervosa.
Some areas of the country will have dedicated mental health teams who attend to children in care – but this is not universal
TAKE HOME MESSAGE:
- It is clear that maltreatment is a major risk factor for mental illness in childhood – and therefore in later life, too.
- EARLY Investment in mental health provisions for this group, will clearly be time and money well spent.
Connected Child Health 