Attachment and Complex Trauma: Evaluating Outcomes for Children in Therapeutic Residential Care
- PMID: 41253160
- DOI: 10.1177/13591045251401092
Attachment and Complex Trauma: Evaluating Outcomes for Children in Therapeutic Residential Care
Abstract
This repeat measures study assessed the progress of 45 children in a therapeutic residential school in terms of attachment, trauma/loss, affect regulation and educational attainment. The aim was to build a profile of complex trauma in severely maltreated children and estimate any changes over a two year period. Attachment, trauma and affect regulation were assessed using the Child Attachment and Play Assessment (CAPA), based on Crittenden's Dynamic Maturational Model of attachment (DMM). Based on a matrix combining attachment risk, unresolved loss or trauma and observed high or low states of physiological arousal, 51% of children improved and 33% showed deterioration. There was a general improvement in education scores but no significant gains made by children whose stories were assessed with unresolved trauma. While insecure attachment can act as a buffer against severe maltreatment, unresolved trauma or loss is pernicious and continues to affect children's development. Specific Adverse Childhood Experiences (ACEs), rather than ACE accumulation, influenced improvement compared with deterioration. In particular perinatal neglect may have had a particularly potent impact on change. DMM Type A+ attachment was more susceptible to loss of regulation than Type C+ and the two attachment patterns require different approaches. The CAPA offers a more finely calibrated analysis than that obtained by the more usual questionnaire assessment of complex trauma and is useful in devising treatment plans for individual children.
Keywords: Attachment; Complex trauma; DMM; The CAPA; Therapeutic residential care.
Plain language summary
This study should be of interest to anyone who wants to know more about the impact of abuse and neglect on children aged 7 to 13 years, and what factors might hinder positive change. These 45 children had experienced such severe levels of abuse they were living in a well-established therapeutic children’s home. The research assessed the children six months after they entered the home and two years later, before they left. As well as educational attainment we were interested in types and levels of abuse (Adverse Childhood Experiences) and psychiatric diagnoses. The main focus was attachment and what is termed complex or developmental trauma. All children have an attachment strategy. Attachment is the way we organise our behaviour with other people when we feel angry, scared or want comfort and protection. Complex trauma refers to the damage caused by abuse and neglect that attachment behaviour cannot cope with. Hence, only some abused children are traumatised. Trauma leads to breakdowns in communication and instinctive behaviours of flight, fight or freeze. You can read more about our approach on our website The-CAPA.com. Our main finding was that while attachment offered these children some protection, trauma did not go away and the traumatised children had considerable problems in terms of poor educational achievement and diagnoses of depression and attachment disorder. 51% of the children improved while 33% actually deteriorated. It was possible that some children felt safe enough to start to think about their lives and were going through a period of depression which made it look as if they had not made any progress. Some children assessed as deteriorated had likely suffered as babies with young mothers, under 20, or mothers with severe mental health problems. We think use of this assessment offers more detailed information than trauma questionnaires and can help plan interventions for individual children.
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