How to recognise complex trauma in infants and children and promote wellbeing

How to recognise complex trauma in infants and children and promote wellbeing

Trina Hinkley, Ali Knight and Kathryn Lenton
25 August 2021

This webinar explored how practitioners can develop their understanding of complex trauma to effectively support infants and children.

Depressed red haired girl leaning on the sofa while listening to the psychologist

Audio transcript: How to recognise complex trauma in infants and children and promote wellbeing

Audio transcript (edited)

CHRIS DOLMAN: Well, good afternoon everyone, and welcome to today’s webinar, ‘How to recognise complex trauma in infants and children to promote wellbeing’. My name is Chris Dolman. I work with Emerging Minds, the National Workforce Centre for Child Mental Health. And it’s my pleasure to be with you this afternoon to facilitate this webinar. In today’s presentation we’ll be exploring how complex trauma presents itself in infants and children, its impacts on the lives of infants and children and families. And also how practitioners can be responding to children and families where complex trauma is implicated and what’s problematic for their lives as well. For parents, for caregivers, for other people that are concerned by a child’s wellbeing. So thanks very much for putting the time aside to be joining us today, wherever you are.

And we’ll first just have a look at the learning objectives for today’s webinar. Because today we’ll be exploring the evidence behind the prevalence and effects of complex trauma on early child development and wellbeing. We’ll be exploring how to recognise and respond to the effects of complex trauma in practise with infants and children and their parents and caregivers as well. And how to have preventative and early intervention conversations with parents and caregivers of children who have experienced trauma as well. So that’s what’s ahead for the next 60 minutes or so.

As we begin this webinar, Emerging Minds and CFCA would recognise and pay respect to Aboriginal and Torres Strait Islander peoples and the traditional owners of the land on which we work and play and walk throughout this country. We acknowledge and respect their traditional connections to the land and to waters, to spirituality, to family, to community, for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

Today’s webinar is part of a series offered by Emerging Minds and CFCA around infant and child mental health. We’ve got a couple of other webinars coming up the rest of this calendar year, one is in relation to speaking with parents who are going through separation about their children’s wellbeing as well as taking a really close look at infant mental health and why it’s important and how it can be supported in families as well. Previously this year we’ve also looked at things in relation to families and homelessness and supporting parents improving the outcomes for children was the focus of that one. As well as looking at what is this thing called a social model of disability and why is it important to children’s mental health. So they’re some of the themes that we’ve been looking at in this series. And you’re very welcome to access those via the Emerging Minds or CFCA websites, those recordings.

Okay. All right, so yeah, it’s my pleasure to introduce our presenters for today. You’ve already seen the bios that we distributed for our guests, so I’d like to welcome Trina Hinkley, Ali Knight and Kathryn Lenton to the panel today. And rather than getting a restating of the bios, I thought I’d just begin by welcoming – so welcome Kathryn, welcome Ali, and perhaps if you could just begin – maybe we’ll start with you, Ali, in terms of this area of work, working with children in relation to trauma, what is it about this area of work that continues to draw you to it? What is it that you find most engaging or interesting about this part of your practise?

ALI KNIGHT: Oh, hi everyone. Chris, I think for me, what I really appreciate and enjoy about working with infants and young children is that it’s an exciting time in a child’s life in terms of you can really bring about some change. When there has been traumatic events, it doesn’t mean that you can’t help shape a child’s trajectory in a positive direction. So it’s a really – yeah, it’s a window of very exciting change, so I’ve just seen that time and time again. And it keeps me very hopeful and enthused about the work I do.

CHRIS DOLMAN: Great. Yeah, really sustaining. Terrific. Thanks, Ali. Looking forward to your contribution shortly. And Kathryn, welcome to you as well. Perhaps if I could ask you a similar question, really. What is it about this are of practise that continues to interest you and draw you into it?

KATHRYN LENTON: Thanks, Chris, and thank you so much for having me on the panel. It’s such an honour to be here. Similar to Ali, I find the work incredibly rewarding. It’s a real privilege to be able to be working with children and their important adults, and to help them live their best life. And similar to what Ali said, it is such an honour to be able to support children to be able to manage tough times and to be able to develop and grow resilience. And it’s such a joy to be able to work with children and learn from children and their wisdom as well.

CHRIS DOLMAN: Great. Thanks, Kathryn. And again, we’re looking forward to your contribution a bit later in this hour as well. And our third panellist, Trina Hinkley, as it turns out, Trina was not able to join us live today but I love it when a plan B comes off. And so Trina’s actually pre-recorded her presentation. And so we’ll listen to that presentation now and then followed by Ali and Kathryn after that. So please, this is a presentation of Trina for her, presented a few days ago.

TRINA HINKLEY: Hi everyone. I’m Trina Hinkley from the Australian Institute of Family Studies. And I’m just going to talk a little bit at the start of this webinar on this really important topic about what complex trauma actually is. And some of the nuances that we need to consider when we’re thinking about complex trauma, including some of the protective factors. And some of the impacts that you might see in a child if they’ve been exposed to complex trauma.

So to start with, complex trauma occurs when a child repeatedly has experiences of extreme severe stresses or traumatic events over an extended period of time. So this is not just one stressor, one or two stressors or traumatic events. This is multiple events over an extended period of time. And the term complex trauma is actually used to refer to the experience of the traumatic events themselves. So it’s not used to refer to the symptoms that a child might present with if they’ve experienced complex trauma.

Complex trauma can result in both short and long-term effects for the child. The most common types of traumatic events that a child might experience in Australia that would contribute to their experience of complex trauma include physical, sexual, and emotional abuse, neglect, or exposure to domestic or family violence. In other contexts, children might also be exposed to community violence, or medical trauma, but those are less common in Australia.

When we think about complex trauma, it’s really important to consider that the experience of complex trauma will affect every child differently. And their experience will be based on a number of factors. For instance, we know that the negative effects of complex trauma are more likely to be long-term and severe when the trauma occurs early in the child’s life. So when they’re younger rather than when they’re older. The effects will be more severe if they experience a longer duration of trauma as opposed to a shorter duration of trauma. And the effects will be more severe if they experience multiple forms of trauma, and not just one form of trauma. And the final consideration is that the symptoms that the child presents with are their coping strategies. They are their mechanisms for being able to – or trying to manage their experience of complex trauma. That’s their adaptations to their environment.

In terms of protective effects or protective factors, there are a number of these, and most of them revolve around the primary caregiver or other caregivers. But some extend beyond that as well. So a really strong protective factor is having at least one stable and responsive caregiver who is able to apply really positive parenting practising into the child’s life. It’s also protective for a child if they have a caregiver who believes in and validates their experience of trauma, rather than negating or trying to minimise it. And a caregiver who’s able to self-regulate their emotions is important. And this matters, because when children see a caregiver self-regulate their emotions, that acts as a model to them so they can then try and adopt that self-regulation themselves. So it helps them learn self-regulation of their own emotions. One other protective factor for a child is having a positive social support network that can bring emotional support to the child’s life when they need it.

So I’ll move on now to talk about the impacts on the child’s body and brain. And I’ll talk primarily about the child’s stress response system and their brain and developmental skills. So with respect to the child’s stress response system, when a child experiences complex trauma, their stress response system is likely to be excessively and repeatedly activated. So that means that this normal cycle of activation and deactivation, which is normal and healthy in any individual, is not able to occur in a child experiencing complex trauma, because they’re in this heightened state of activation for extended periods of time. And that can actually disrupt the development and regulation of the child’s stress responses, which can lead to the child exhibiting either blunted responses where they underreact compared to a child of similar development stage. Or they might exhibit exaggerated responses where they overreact to a stimuli compared to a child of a similar developmental stage.

Changes to the child’s stress response system can also increase their vulnerability to later mental health problems, such as high levels of stress, and later health problems such as hypertension. With respect to the child’s brain development, we know that there are sensitive or critical periods during which different parts of the child’s brain are developing and growing more rapidly than at other times. If a child experiences complex trauma during one of these times, the child may be more susceptible to impacts from the trauma than at other periods of their development. Some of the symptoms that you might see or that a child might present with include social, emotional, and behavioural difficulty. And children might also present with developmental difficulties such as speech, language, or cognitive difficulties.

So if we think a little bit about the changes in developmental skills, one aspect could be delayed language skills. So children might have an impaired ability to listen, an impaired ability to be able to understand what’s being conveyed to them, or they may have delays or impairments in their ability to speak. With respect to children’s cognitive skills, children who experience complex trauma may have problems with attention or concentration. They might have challenges to their higher level planning and reasoning skills. Or they might have impacts on their cognitive ability or their IQ.

So I’ll move on now to the possible impacts of complex trauma on children’s behaviours. And these include how a child might respond in a situation. And impacts on their health behaviours. So with respect to how a child might respond, normal responses to a stressful situation are primarily fight or flight. So we turn around to attack or we turn around to run away. Children generally don’t have access to those responses because of their age and the environments in which they are. So instead they might turn to a dissociative response, a freeze response, or appear as though they’re numbed or disengaged. And sometimes this can be interpreted as attention problems or daydreaming, but it’s really important to remember that this might be a child’s only defence to the complex trauma that they’re actually experiencing.

And children might present with changes in their levels of arousal or vigilance. So they might be overly aroused, where they’re more easily startled by stimuli in their environment than a child of a similar developmental stage. Or where they’re overly alert or vigilant to potential threats in their environment. Or children might present with under-arousal, where they are experiencing and exhibiting those dissociative features such as the numbing and disengaging behaviours, where they have a lower level of response or arousal to stimuli. Children might also experience changes in response to sensory stimuli such as touch or sound. And this might be particularly evident if they are triggers to the trauma that the child’s experienced.

With respect to changes in children’s behaviours, some of the things that they might present with could include sleep disturbances. So they may not want to go to bed, they have difficulties falling asleep, they may have nightmares or night terrors. Or changes in their feeding and eating behaviours. And this could include behaviours like hoarding, where they’re trying to have some control over their environment. Or overeating or undereating behaviours.

So we’ll move on to changes in the child’s wellbeing. And these can include impacts on attachment, social wellbeing, and emotional wellbeing. When we look at attachment, complex trauma can compromise the development of the attachment relationship between the child and the caregiver. And this is most likely to happen if the complex trauma occurs within the context of that child/caregiver relationship or if the complex trauma is perceived as a threat to that child/caregiver relationship. If children have difficulties with attachment in their child/caregiver relationship, this could present as difficulties in separating from the parent. So they might be clingy. There might be inconsistent behaviours towards the parent or caregiver. So this could be alternately clingy or dismissive or aggressive towards the caregiver. Or they might lack trust towards the caregiver. So they may have lower levels of eye contact or less engagement with the caregiver than you would expect from a child of a similar developmental stage.

With respect to the child’s social wellbeing, this could be impacted in terms of their ability to form relationships and friendships. And this could present as children distrusting other people or being very vigilant or guarded when they’re interacting with other people. Children might also experience problems in relating to authority figures such as teachers or educators. And they may struggle with their social skills, which of course also impact their ability to form friendships. And in terms of children’s emotional wellbeing, children may be hyperresponsive to angry facial features if they’ve experienced complex trauma. They may have difficulties in self-soothing. I find that word so difficult to say. And they might be susceptible to triggers for traumatic memories. And this might be particularly evidence in terms of their inability to regulate their emotions, particularly if they’re experiencing a high level of negative emotions.

So I’ve just touched at a really high level on some of the considerations around complex trauma. I’m sure Kathryn and Ali will do a fabulous job of providing a lot of rich depth and context to their experiences in dealing with complex trauma. And I would really encourage you to read some of the resources that Emerging Minds have on this topic.

CHRIS DOLMAN: Great. Really appreciated the way Trina set a context really for some of our discussions around practise and responding to families where children have experienced that complex trauma. And so now I’d like to invite Ali to continue the presentation now. So yeah, thanks Ali.

ALI KNIGHT: Hi, everyone. I wanted to start off by just talking a bit about the relationship between a child and their caregiver when they’ve experienced trauma. So when we think about an infant or a young child, the relationship with a caregiver is their environment. So the recovery process is really dependent on the quality of care they provide. So we know that infants and young children are really sensitive to their caregiving environments. And Trina touched on this point in her presentation just now that if a parent is able to provide sensitive care that is developmentally appropriate and the caregiver is able to provide the stability and consistency, then for that infant or young child, the recovery process is going to be much smoother. And the other thing I think that is worth keeping in mind is that the relational patterns that we establish early in life – so for that infant or young child, they’ll go on and have those sort of patterns going forward. And it’s 80% predictive of relationships through life that are really established in that early kind of – early few years. So you can sort of see the importance of that environment for the infant.

So the other thing I wanted to touch on was if you’re thinking about a young child or an infant who experienced trauma, this could be a shared trauma. So it could be that the parent has also experienced the traumatic events. And an example of that might be domestic violence. So if this is the case, it’s really important that the parent also has access to therapeutic support because then they’ll be in a much better place to support their child’s recovery. And the other thing that is also really, really important is thinking about the parent’s own experiences. So they may have had traumatic experiences in their childhood. And I think as clinicians if we make space for that story to be heard and understood, then that young child is going to again have a better recovery process, because if a parent can reflect on their own experiences, then they can – we find that they’re better able to make sense of the experience their child has had. And that’s going to be protective for that child in the future, from experiencing any further trauma. And for that child going forward for their recovery.

I thought it would be worth mentioning that if anyone’s interested in finding out a little bit more, I would recommend that you look at – just look on YouTube for videos of Alicia Lieberman talking about ghosts in the nursery. Which is really a way of understanding how the parent’s early experiences of parenting, which might be harsh or traumatic experiences, are present in how they’re parenting their child.

So I wanted to go on to talk about when you’re working therapeutically with an infant or a young child, a really important part of the work is helping the parent think about the child’s experience. So around the parent’s capacity to make sense of the child’s behaviours in terms of the trauma that the child’s experienced. So it’s quite complex work, really, because I’m sure as a lot of you can probably appreciate, as a therapist, you’re engaging in a relationship with the infant or the young child, and also with their parent, but you’re also keeping in mind and thinking about the relationship between the parent and the infant. Because when there’s been trauma – and Trina did touch on this in her presentation – that that often impacts on that parent/infant relationship. So it’s really important as part of the work to recover that you’re supporting that parent/infant relationship, because that’s going to be very protective for the infant or the young child as they go forward in their life.

So the quality of the therapeutic relationship that you establish with the family is so important and so if you’re thinking about the parent, if they – you know, in their relationship with you, they feel understood, if they feel supported, and contained, then they’re going to be in a much better position to provide that for their child. So when we think about trauma, often what happens is it can rupture the protective shield that may have been in place that the parent sort of – in the parent/child relationship. So we’re thinking about that sense of grown-ups being bigger, stronger, wiser, and kind, so we really want to do that work around the parent and child relationship to assist in the repair when it’s safe to do so.

The other thing I wanted to touch on is that it’s really important as part of working with trauma for young children and for any person, but we’re thinking about infants and young children, to make meaning of – you know, for the experience. So when people can tell a coherent story about what they’ve been through, they tend to do better. So for young children, it’s not necessarily like a linear type of – in a linear way or a narrative. You know, this happened and then that happened. Sometimes it’s more often around themes. And children will express that in their play. So making space for that play to occur is really important. But around that, being – you know, the child being able to regulate their emotions is really important as well. And again, it’s about the parent being able to support their child to regulate and then they can do the important work they need to do.

One thing about trauma is it’s very powerful learning. So it’s worth thinking about what did that experience of trauma teach the child? So sometimes it’s about – you know, children will then be questioning – because of the traumatic experience, can I trust you? Will you leave me? Will you hurt me? Am I lovable? Am I capable? So we really need to be thinking about restorative experiences after trauma. And children and infants learning something different and experiencing something different. So every interaction that children have with us, they are learning. So they need to experience something else over and over again so they know they can count on us. So that’s where you need to be thinking about repetition of experiences over and over.

And so in connection with that, trauma also can impact on what we can update in terms of positive experiences. So that’s another reason why repetition in terms of the recovery process is so important. And so it’s often worth thinking about that in relation to yourself as a therapist and the space that you’re creating for your work with infants and young children. So little things can really be important. So making your sessions the same time, the same day, the same place, having the room set up in the same way, all those things are really important for children feeling safe and their recovery from trauma.

So I wanted to share an example. The other thing is, in terms of how you are as – in your interactions and your presentation in your work with the young child and the – and the parent is really important. And one family I worked with, with a baby and a mum, I think just highlights that in terms of this is a mum who had a very emotionally abusive parent in her upbringing. And so there was an element of unpredictability. So she never sort of knew how her mum was going to present. And this continued on to her adult life and her adult relationship with her mum. But she shared with me that the work that we did in therapy, she said that when – she knew every time she came in that I would be the same. And that was really important for her, that I was sort of – you know, she had such unpredictability in her family relationships that just knowing that I’d be calm and available to her was really important in terms of her feeling supported and contained. And then going on to she could then provide that for her baby.

So lastly – I’ve shared a lot of I guess of my learnings, but I wanted to just refer you to – and this is attached as one of the resources for this webinar. There’s 12 principles of early childhood development that I find really, really helpful in my work with infants and young children. So these principles have been developed by Alicia Lieberman. And they’re just a really useful thing to keep in mind when you’re working with trauma. So I won’t go through them all, but I just wanted to touch on a couple that are really useful. For example, thinking about young children crying and clinging in terms of this is their way of communicating they’re in immediate need for the parent’s closeness and care. And if we think about separation distress as an expression of the child’s fear of losing their parent, another one is that young children will imitate their parent’s behaviour, because they want to be like them. And they assume that the parent’s behaviour is a model to emulate. So you can see that that’s really a useful principle when you think about, for example, the context of domestic violence and how children might be acting out aggressively if they’ve seen that in the home.

And lastly, I wanted to highlight the one around memory. So memory start at birth and we know that babies and young children can remember experiences long before they can speak about them. So yeah, they’re storing them, and that’s I guess why play is such an important way for young children to be able to express their experiences and how they feel. So thanks everyone. That’s all from me.

CHRIS DOLMAN: Great. Thanks very much, Ali. That’s been very generous in sharing some of your learnings with us today. And there’s been a number of questions coming in that I’ll hopefully get a chance to ask a bit about later, particularly in relation to supporting parents, among other things. So thank you for that. And Kathryn? Over to you. We’d love to hear some more about some of your learnings and practise wisdom that’s come about on account of engaging with children and families.

KATHRYN LENTON: Thank you so much, Chris. And really interesting insights from Trina and Ali. I’d like to begin by also paying my respects to the traditional custodians of the land that we’re meeting on. And pay my respects to elders past and present. I extend a warm welcome to any first nations participants that join us today. But I must acknowledge that the research and ideas that I’ll be referencing come from the perspective of western medicine. And do not fully take into account the impact of colonisation and intergenerational trauma that’s been experienced by first nations people.

As we’ve heard, the impact of developmental trauma is far reaching on children’s brain development, their relationships, their ability to play and learn, and on their mental health. I really encourage continued learning and professional development, and the resource list we’ll provide you with plenty of options for further learning. And self-care really is a must for anyone who’s working with a child with trauma, who’s supporting a child with trauma, or has experienced trauma in their own childhood. Ongoing professional learning and external supports are essential. As the saying goes, we can’t pour from an empty cup. I encourage you to look at small steps forward as being a win. It’s so important to celebrate these wins because within the wins hold hope. And within hope there’s healing.

Some of the people who we work with wonder with us about why developmental trauma that has occurred prenatally or in infancy or in early childhood has such impact on children’s mental health. And into adulthood, particularly as infants and young children won’t explicitly remember abuse. The way I understand it is that one of the answers is in the difference between implicit and explicit memory and brain development, which Ali just touched on. Explicit memory relates to things that we can relatively easily recall. Implicit memory is unconscious and unintentional, like how we remember to ride a bike after years of not practising. Implicit memory includes feelings, and feelings can exist in utero. But humans don’t start forming the explicit memories until around the age of three. We may not remember traumatic events but the body remembers the feelings. If early childhood feelings are dominated by fear, confusion, anxiety, or even terror, the body continues to hold these memories into later childhood and into adulthood.

The human brain is incredibly adapted to its environment, particularly in infancy and early childhood. The brain is wired to predict and respond to threat in order to increase the chance of survival. The experience of trauma can impact the development of the brain’s ability to regulate emotions and can disrupt mood, which can lead to mental health issues in childhood and adulthood. Trauma can literally change the structure and function of the brain. As psychiatrist, Doctor Bessel van der Kolk so clearly articulates, “The body keeps the score.” It’s a really excellent resource, which I highly recommend for further information about the experience of body-based trauma memories.

When we’re supporting a child, we often consider their age when making assessments. This is particularly important for a child who has experienced trauma. Developmental tasks, milestone, and chronological ages for children are connected but separate. Chronological age relates to how many months or years old a person is. Developmental tasks are different to developmental milestones. Milestones are related to physical activities that a child can and can’t do yet. For example, being able to hold up their head or to wave. Developmental tasks though are more complex. And I’ll just invite Chris to pop up the first slide.

For the purpose of what I’m about to talk about, I’m referencing the developmental tasks that are described by the Synergetic Play Therapy Institute, which focuses on a child’s internal world and sense of self. There is this resource that’s available on the resource list. As you can see on the slide, developmental tasks can correlate with a child’s age. However, trauma can impact on a child’s ability to fulfil developmental tasks. These developmental tasks help us understand a child’s internal world and how it might be impacts by the experience of trauma. For mental health clinicians and medical staff, the use of psychometric assessments can be useful in documenting and understanding the impact of trauma. However, these assessments should be taken as part of a wider assessment and psychometric assessments often do not take into consideration the impact of colonisation and intergenerational trauma, so should be used with caution.

It is important to consider a child’s worldview and how their experiences have shaped their world, which is sometimes referred to as the child’s trauma world versus the now world. The trauma world is the world that a child’s brain has adapted to in order to make sense of the world and how to survive it. A child’s trauma world is influenced by many things. Including the trauma itself, the developmental stage in which they experienced it, and who, if anyone, was able to soothe and protect them during a traumatic experience. A child’s brain adapts to the trauma world and they can develop templates based on their experience, such as, ‘I can’t trust anyone’, ‘No-one will look after me’, or ‘Will I ever have enough food to eat?’ A child’s brain is so wise and smart as it adapts to scary and unpredictable situations. The child’s brain does not automatically shift once they’re in a physically safe environment. An environment where an adult is not abusive can seem super strange and scary to a child who’s experienced abuse. An adult saying, “You’re safe now. You can trust me,” won’t hold weight for an abused child. Their brain has developed clever ways of keeping them safe. And as Ali was saying, they need to be shown over and over and over again that the now world can be trusted.

A child who’s experienced developmental trauma has developed lots of ways to survive. And they’re not going to be easily tricked into letting down their guard. It’s so important to remember that a child would need hundreds, if not thousands of repetitions of safety before their brain allows them to feel safe. Physical safety does not equate to a felt sense of safety. That comes with loads of patience, care, and attunement. So I’ll just invite Chris to pop up the next slide for me.

The experience of developmental trauma can manifest in symptoms that look like other diagnoses. For example, a child with development trauma might have challenges with attention and impulse control than can look like ADHD. Or they might have a strong need for control and challenges with their social relationships that can look like autism. This is not to say that a diagnosis is not correct or a child with developmental trauma doesn’t have a medical condition. However, it is to invite a stronger consideration to the impact of trauma on a child’s developing brain. To illustrate this point, I’m referencing the Venn diagram developed by clinical psychologist Doctor Susan Chequer. The overlap of symptoms and experiences between trauma, ADHD, and autism is significant and should not be considered in isolation from each symptom set.

The approach, regardless of whether a child has ADHD, autism, or trauma, or all three, is the same. The felt sense of safety that occurs in relationships is what all children need. Children’s brains grow within relationships. They are able to be their best selves when they feel safe. I strongly encourage people to use the PACE approach by Doctor Dan Hughes, and read the work of Dan Hughes and Doctor Tina Payne Bryson on therapeutic parenting. Particularly the books, ‘The Whole Brain Child’ and ‘No Drama Discipline’. These are suggested in the resource list.

The PACE approach that I’ve just mentioned might be familiar or it might be a new idea. PACE is based on developmental attachment theory and is a model for relationship development and trauma resolution. It’s particularly helpful to practise PACE with children who have developmental trauma. PACE stands for Playful, Acceptance, Curiosity, and Empathy. Children learn through play, so we need to be playful. When we accept a child for where they are at, we are standing in non-judgement. When we can be curious about a child’s feelings, we are connecting with them and teaching them regulation. And when we have empathy, we’re offering them a safe place to land. We must connect with a child before we correct them. Some examples of PACE sentence starters might be, “I wonder if your feelings are because I said no to more TV?” Or, “It’s really hard when I say no to more sweets.” Or, “Is that you trying to say hello to me?” In the words of Kim Golding and Dan Hughes, PACE does not compromise discipline. It empowers discipline.

If you’re interested in learning more, I’d really encourage you to have a look at the resource list and also consider registering for some of the professional learning that’s available. Thank you so much for the opportunity to join you on this webinar. And please remember to take care of yourself as you care for others and celebrate those wins. They really matter. Thank you.

CHRIS DOLMAN: Great. Thanks very much, Kathryn, again really generous sharing of learning and practise wisdom that you’ve generated through your experience. And I guess through the contribution of people you’ve worked with as well. So thank you so much for that.

And thanks to everyone that’s been sending through questions, for both of our panellists today. So we’re going to move on and ask some of those questions of both Ali and Kathryn. Ali, as I mentioned, there were a number of questions coming through in relation to supporting parents when working with children. And I think you’ve touched on some of these themes already as you continued to speak, but one of them a bit about, concerned about shaming. Inadvertently shaming the parents by talking with them about children. So there’s questions around the theme was, you know, how to talk to parents about children’s behaviour being a result of trauma, without shaming or blaming the parent. Without making them perhaps feel guilty that they hadn’t taken action earlier perhaps, those kind of themes. So yeah, do you have some thoughts in relation to that?

ALI KNIGHT: Yeah, I think that’s a really tricky – it’s a great question. I think it’s a tricky thing, isn’t it? Because you don’t’ want to contribute to a parent feeling worse about the situation than they probably already are. So for me I suppose it’s just I would really – I think if you – as I talked about in my presentation, it’s really about the relationship that you’re forming with the parent that will allow some of those difficult conversations to happen. And building up that trust in the relationship. So I suppose if you do have that – the relationship where you can then start to have some kind of tougher conversations, but also I think for me, it’s important when I’m in a therapeutic relationship with a family to – if I get a sense that okay, I’ve actually – I’ve maybe said something that’s a bit too confronting, then I will just acknowledge that. That’s like, “I’m really sorry that that – you know, what I’ve said has actually contributed to how you’re feeling right now. And I apologise for that.”

So it’s about sort of just a bit of – you know, trying to have conversations that are open and honest, I suppose, about the child’s experience, but in a way that supports the parent where they’re at and to – you know, I suppose it is important for the parent to be able to take some responsibility for where they’re at, but also not in a way that they feel helpless or powerless about moving forward. So it’s a bit of a fine line really. So it’s a complex thing, isn't it really? But I think it just comes back to the quality of the relationship you’ve got and spending time to really – to do that before you charge in there and say something that’s too challenging, if that makes sense, Chris.

CHRIS DOLMAN: Yeah, that certainly does make sense. Yeah. Kathryn was there anything else you wanted to add to that in relation to mitigating a parent’s sense of shame in relation to the effects of trauma on their child?

KATHRYN LENTON: Sure. And I completely agree with what Ali said. I think she’s made some lovely points. I think to build on what Ali said, I think it’s important to understand the felt difference between shame and blame. Blame might be, “I’ve done something bad,” where shame is, “I am bad.” And I think shame can be really prevalent with people who have experienced trauma and they might be more vulnerable to experiencing shame. I think being very gentle and respectful, as Ali indicated, but some of the things that I do when I’m talking with parents is I’m trying to think with them in terms of offering a concept or an idea and then wondering with them what they might think about that. Or how would they use that if they were going to use that idea. And acknowledging that it might be a new practise. I hope that makes sense.

CHRIS DOLMAN: It certainly does. Yeah. And I thank you both for those responses. There’s some other questions, actually picking up a bit on that diagram, the second one that you shared, Kathryn, in relation to these kind of intersections between trauma and other labels or diagnoses. So there’s a few questions here. One of them is I guess, you’ve started to respond to this, how you differentiate between that. And I was wondering if you could expand a bit more when you talked about that actually the response is what’s important, no matter where the intersections are. Could you say a bit more about that in terms of when you’re perhaps not sure about what the child’s experiencing might be the effect of trauma or something else that’s going on for them, what is it that’s most important for you in terms of how you’re working with and responding to that child when you’re in that place of not knowing?

KATHRYN LENTON: Of course, that’s a really fabulous question. And it’s certainly something that we like to think with people regularly about. When we’re looking at what’s happening for a child, I’m most interested in the child’s felt experience rather than looking for a diagnosis. And I think that’s probably a framework that we use at the Australian Childhood Foundation is we’re not seeking to diagnose, although diagnosis can be incredibly important and incredibly useful. But we’re wanting to know what is life like for this child and what is the child’s internal world. And if we can come from the perspective of what does this child need, rather than what is a diagnosis, we can be connecting with the child and understanding what they need to feel safe.

Because in order for any healing to happen, there needs to be safety. So if we’re reaching for a diagnosis or reaching for medication, we can miss opportunities for connection. And if a child has got a diagnosis of ADHD, they need empathy, they need understanding, they need curiosity. If a child has a diagnosis of autism, they might need something different. So it’s about understanding what does this child need and seeing the child as an individual rather than seeing the symptom set.

CHRIS DOLMAN: Great. Thanks, Kathryn. Your theme with safety reminds me of a couple of other questions that have come through in relation to what if – or how to work with complex trauma where there remain kind of safety concerns in the home. How to do that or to what extent is that possible even – yeah, I’d love to hear from both of you if you’ve got some thoughts about how to work with complex trauma where safety is still a concern. And I guess that could well be the circumstances of many children, wouldn’t it?

KATHRYN LENTON: It is. I’ll answer, then I’ll hand over to Ali. I think if I was thinking about supporting the child who might be living in a situation that there are safety concerns, going into deep therapy may not be the right timing, because in order for therapy to be safe, there needs to be safety. However, I might be looking at trying to resource the parent or the caregiver about what can they do to be supporting the child, or what can they do to be increasing opportunities for safety and connection, and looking at other agencies that might be able to resource the family to help their safety.

CHRIS DOLMAN: Great, thanks. Ali, is there something you’d like to add there?

ALI KNIGHT: Can I just add to – yeah, so Kathryn – so great points there. I think for me it’s a really good question and it’s a very tricky place to sit, I think, when you do have concerns about a child’s safety and you’re trying to be working with the family to support them to move forward and support their child. I think often it’s really helpful if you’re working in partnership with other professionals and you can have a bit of a care team around the family. Because it’s often really difficult, I think, when you’re sitting with a level of risk when you’re working with a family, and so I mean, I’ve worked in work contexts where we worked really closely – our service worked really closely with the child protection – the statutory child protection body. And so one thing we would do, for example, is have regular conversations about – and the family were aware of these conversations taking place. Everyone was on the same page about what was happening. And if there were concerns, we’ll be talking together and working as a bit of a team to how those would be addressed. So that is really good I think. So having a level of transparency around that. And just making sure that there’s no kind of dangerous practise happening. And it’s really – you know, works well for the child in that context.

CHRIS DOLMAN: Yeah. Thank you both for that. On that theme, or extending that theme even in a slightly different direction, there’s a couple of questions around how can support be provided for young children from refugee and migrant communities as well, who have experienced complex trauma or who continue to live in difficult circumstances? Are there special considerations in working with children from those communities? When you hear that question, what sort of comes to mind for you in terms of a few practise ideas or positioning for you on working with kids from those communities?

ALI KNIGHT: Do you want to start, Kathryn? Or shall I? Maybe I’ll just throw a few things out there. I mean, I guess this is like an area of expertise for me, but I would always be wanting to be working in partnership with the family and learning about where they’ve come from and what their experiences have been. And trying to be sensitive to that. But I guess it comes down to thinking about the young child’s sense of safety and trying to build that up in your work with the family. And I just was reminded of Kathryn’s point about just because a child is physically safe, doesn’t mean they feel emotionally safe. And so I guess that would ring true I think with a lot of children, young children who’ve had some very traumatic experiences and have had to come to Australia and may not be feeling that sense of safety. So I think just having those principles as you work with the family would be really helpful.

CHRIS DOLMAN: Yeah. Thanks, Ali.

KATHRYN LENTON: So I might just build on what Ali – sorry, Chris, I just cut you off. I really like what Ali said. TO build on that, I’d be looking at a systems approach and really wanting to include people that might have expertise in multicultural mental health or refugee trauma counselling service in your local state or territory. I would certainly be asking for advice from a service that did have expertise in working cross-culturally. But I would also want to be thinking about the relationship and the quality of relationship between the child and their primary caregiver. Because if we – you know, there may be a biological family member or it might be a foster carer or a kinship carer. But I’d really want to be resourcing that relationship as well to increase the child’s sense of safety. And that might be also supporting the adult caregiver to be seeking their own appropriate mental health support as well.

ALI KNIGHT: And that just made me think of another thing, Kathryn, when you said that about my point in my presentation about a shared trauma experience that the family might have had. So we just I think always need to be mindful of we’re working with a family who have all experienced trauma and thinking about the child’s needs within that context. And being sensitive to that.

CHRIS DOLMAN: And someone’s also asked a question – made a statement a bit about the protective factors that are present as well within those – the community from which the child is from. A refugee/migrant community as well. And perhaps really has meant that question or comment has me thinking a bit about the different stories of survival and resilience or courage or whatever that are also circulating in those communities that can be really sustaining for children as well. So thanks to people – our contributors, participants as well. Okay, we’ve got – thank you so much, everyone, for the many questions you’ve sent in. Those we don’t have time for we will be making a recording to respond to those after the end of this webinar. We have got just a couple of minutes. There’s a question about how does trauma impact on children with disabilities differently. And I’m guessing that might also be influenced by the actual – the disability and the particulars of that that the child is living with I guess. But is there something from your own experience that kind of again guides you in working with children who are living with disability who have experiences of trauma as well? In terms of what’s more important for you to be mindful of? Or working from in terms of a position around?

ALI KNIGHT: Maybe I’ll jump in. I guess –

KATHRYN LENTON: Absolutely.

ALI KNIGHT: Yeah. I think for me it’s just really going back to Kathryn’s point earlier about just trying to really get a good understanding of the child and where they’re at. And that might be trying to get a sense of their trauma experience, but also where they’re at in terms of their development and what the impact of – like the sort of intersection between the disability and the trauma. And finding a way forward to work with whether the child’s at so they can express themselves in terms of what was their trauma. You know, with a lot of young children, I mentioned that they could be playing out their experiences rather than talking. So that might be true for a lot of children who have got a disability, you might have to be thinking about other ways so they can be heard and understood and their story can – you know, as I mentioned about making meaning of their story. And just – you have to get a bit creative sometimes, which children really respond to. They love working playfully and creatively. So I think that would be my kind of thoughts on that.

CHRIS DOLMAN: Terrific. Thanks, Ali. Great. Okay. In fact, there was a couple of questions around play, and I know you both mentioned play is an important part of – are there any kind of – there was a question around what types of play or conversation starters or emotional support tips or ideas about that. In the last minute, is there something that immediately comes to mind, for each of you, around that, that practitioners could immediately draw on?

KATHRYN LENTON: I would encourage people..

ALI KNIGHT: You go, Kathryn.

KATHRYN LENTON: No you go, Ali.

ALI KNIGHT: I was just going to say, well just quickly, that children – I think if you’ve got some toys that are trauma informed there, and you’ve put them in the space and give children an invitation, they will quite easily and quickly slip into play. It’s a natural thing for children. It’s how they learn. It’s how they express themselves. And so having some basic toys, doll house, and cooking stuff, a baby, toy animals, maybe some stuff which corresponds to their trauma experience like police or ambulance or things like that. And they will be able to express themselves and we all sort of – the rest, you know, you don’t need to do a lot. So that would be my kind of suggestion. It’s just about setting it up and being there to support them with what they want to show you.

CHRIS DOLMAN: Thanks Ali.

KATHRYN LENTON: And completely agree. And I think if people are interested in further professional learning, I would encourage them to look at Synergetic Play Therapy or Dyadic Developmental Psychotherapy, as really excellent trauma informed frameworks for professional learning. But the greatest toy in the room is the therapist. So you don’t need all the fancy bells and whistles. You need to be child-centred and child-directed.

CHRIS DOLMAN: Okay, so Ali and Kathryn will continue on now to respond to some further questions that have been submitted by the webinar participants. And there’s a question that reflects a number of people’s interest, actually, in working with Aboriginal families and communities. And this person says, “I work in the area of child protection and constantly come up against attachment in Aboriginal families being different. And given the attachment relationship is so important, I often struggle to then make the link between different attachment relationships and trauma. Do you have any advice or particular considerations that need to be taken into account when working with Aboriginal children?” And yeah, really significant question there. So when you hear that person’s experience and hear them ask the question, what comes to mind for each of you in relation to that?

ALI KNIGHT: I think for me, if I can just start, I guess with Aboriginal families, there can be more of a community of care around bringing up children. So I guess I would want to explore who the significant relationships were for that child and then just think about those relationships. So there might not be just one primary caregiver. There might be a number of caregivers, which I guess makes the picture a little bit more complicated potentially, but I think we just need to be starting from that point and just engaging and working out who’s important in this child’s life. And yeah, I guess for me it’s just being open to learning about, in different cultures, how children are cared for and what those relationships look like. So I think we just need to be sensitive to differences in different cultures. And I don’t think I’m an expert, so I would be wanting to draw on some cultural consultants in working with Aboriginal families. And also the family themselves, about being open to learning. And I think Kathryn touched on this earlier about just every family we work with, we do learn something about children or families or culture, so I’m always really open to that I think.

CHRIS DOLMAN: Great. Yeah, thanks Ali. Would you like to complement that in some way, Kathryn?

KATHRYN LENTON: I Wholeheartedly agree with what Ali said. And I think to add to that, I would be wanting to think about the experience of the family in a broader historical context in understanding generations that have come before the family that the practitioner has worked with. In terms of their experience and what life has been like for them and their families and understanding how historical traumas might impact on quality of relationships. And when we’re working with people who have experienced trauma, we really need to see them within a context of their system and their history. And I must acknowledge that I am not an Aboriginal practitioner and I am not an expert in any way, so I’d really be seeking advice and guidance from appropriate elders, or Aboriginal health agencies, as Ali has mentioned. But we must acknowledge what has come before us in context of colonisation, in context of the Stolen Generation. And we must consider how that has impacted on families that have come before.

And so thinking more broadly than the individual child in this context would be something that I would want to be considering. But also really wanting to explore what the child thinks. You know, what the caregivers think, and really looking to them to help me understand what life has been like for them. And perhaps understanding, can we make sense of their behaviour or their attachment in the context of what life has been like for them. But very much being guided by Aboriginal health workers or the elders, to help me understand as a non-Indigenous person, the historical context and also community context.

ALI KNIGHT: Yeah, I would agree with that, Kathryn. I think that context of intergenerational, the cultural trauma is really important to be thinking about in any work with Aboriginal families, for sure.

KATHRYN LENTON: Yeah. I think what comes to mind for me in my earlier days and one of the most important lessons that I learnt working in community was to not make assumptions. And to ask. And going back to the PACE model of being curious and accepting and empathic, and not presuming that I am in any way expert in what life is like for this person. So kind of really wanting to work with, not work for, is really important.

ALI KNIGHT: I think I just – yeah, I would agree with that, Kathryn. I just wanted to add I think it’s really trick work, working in the child protection space, and we know that Aboriginal families are overrepresented. And I think it’s really hard to get the balance right if you’re a practitioner working in that space, because you don’t want children to be at risk, but you know, we’re just aware of the layers of the history in terms of the Stolen Generation and just wanting to get it right. And that’s a really tricky space to be in. So I think I sort of see that in the work I do and I have done. There’s just a struggle – and you know, getting the balance right I think. But just going into it with an open mind and a curious mind I think is a good place to start, definitely.

KATHRYN LENTON: And I think – you’ve just triggered a thought for me, Ali, about the importance of supervision. And having access to really good supervision to help the practitioner think through some of the complexities. And within supervision, because able to acknowledge that the theories and structures that we use often do relate to western ideas. And how might that translate to cultural safety as well.

ALI KNIGHT: Yeah, absolutely. And I think the point of cultural safety is really critical. Because I know just from my experience of working in a reunification service, I guess I just was pretty conscious of what that’s like for an Aboriginal family to step into that space. And it was a child protection context as well. And just supporting – well, my aim was to try and support them to feel safe in that space but that’s – you know, it’s a big ask for anyone, let alone when you’ve got those layers of potentially intergenerational trauma, cultural trauma. So I think it’s a really difficult thing, I imagine, for an Aboriginal family to step into that space. So trying to work out ways as a clinician, as an organisation, that you can support and promote cultural safety is really important I think, for sure.

KATHRYN LENTON: Yeah. I think cultural humility training for any organisation is incredibly useful. And I would say essential. For your local context. Because we know that the experience and culture of Aboriginal and Torres Strait Islander people is vastly different across countries and communities and states and territories. So having access to cultural humility that’s relevant for your local context is incredibly helpful.

CHRIS DOLMAN: Great. Yeah, thank you, both of you, for those responses. Yeah, so much to be cognisant of, being mindful and reflecting about in our practise, so thank you for that, responding to the question in that way. We’ll have a look at another question now. Yes, again, this question reflects a few others that were asked along similar lines. And it is, can there be a delay in the presentation of responses to trauma? For example, the person says, response to trauma experienced in early childhood first present in teenage years or later. Is this possible or is this something that you’ve noticed in your work with families? This delay in presentation.

ALI KNIGHT: I think for me I’ve certainly seen trauma present in different ways at different developmental stages. So for example, just thinking about your point about the teenage years, certainly I think that’s quite a unique stage in development, isn’t it really? In terms of your identity, who am I, and then thinking about someone’s trauma experience or particularly if it’s happened in the context of their family, it can bring up a lot of different issues that you might see earlier. So I don’t know, have you found that, Kathryn, in your work? It might pop up in different ways at different points in a child’s life?

KATHRYN LENTON: Absolutely. And my mind goes to children who have had early childhood experience of trauma or they might have had their birth parent experience trauma during their pregnancy. And I’m thinking particularly of children who might have grown up in a kinship placement or with a foster placement or may have been adopted. And may not have had experiences that we would consider traumatic during early childhood, but may have experienced trauma during the in utero period or very early in their childhood. And then have had a – I guess a health childhood and then experienced trauma in teenage years. And that can be incredibly challenging for parents or carers or foster carers to understand.

And I think if we’re thinking particularly around the changes in the brain for adolescents and coming into teenage years, I would be really curious about understanding in the context of neuro development. Because around the age of 12, the brain starts to prune away parts that it doesn’t need anymore, in terms of skills or ideas or habits that it’s not using. And the brain can start to rewire itself. And that’s a period of rapid adaption and changes. And that’s why we see teens be so – sometimes big changes in their personality or big changes in their mood. And we do start to see behaviour that’s quite impulsive. And there may be some trauma related behaviours that start to appear at that time. And we can really understand that in the context of early childhood trauma. And I think my suggestion for anyone who is worried about a young person that you might be seeing those changes with is to seek appropriate professional advice from a clinician in mental health, a social worker, or a psychologist that’s got an interest in trauma and has done further training in trauma, who will help the young person make sense of what’s happening for them. But also be able to help their parents or important adults to be supportive in helping that young person with these transitions.

ALI KNIGHT: Yeah, absolutely. And I think the other thing I was just thinking about when you were talking, Kathryn, was just about the importance for children who have been in care or kinship care or foster care for – you know, they might have been there since they were quite a young baby but having a big of a narrative around their early experiences. And sometimes I think for children, they don’t get that opportunity to work in therapy setting around some of those early experiences, what happened to them. Because we know that the experiences are stored in the body, but then thy don’t have a narrative around it. So it’s like they haven’t really – you know, there’s a bit of a mismatch I suppose, their mind doesn’t really – it’s hard to put into words, really, but it’s like putting the two together is really important I think for moving forward in a way that promotes positive mental health. So if you’ve got all this stuff stored in your body but you don’t have the words to express it, it’s like there’s a bit of a mismatch or something sort of not cohesive going on. So I’m a big fan of advocating for every child who’s experienced trauma to have access to the early sort of therapeutic support. Even if they seem to be tracking well early on. So I think that’s really helpful.

And then particularly moving into the teenage years and you’ve already had that opportunity to make sense of things. And then you might need to be making sense of it again as your brain kind of develops and you’ve got more mature thinking. So that’s really important, I think.

KATHRYN LENTON: Yeah. And I think for any child who is in out of home care, it is incredibly helpful and useful for a child to have access to their story of why they came into care in a really appropriate and child-focused safe way, as Ali mentioned. And therapeutic life story work is a wonderful way to support children who are in out of home care. And depending on the child safety practise, they may have a version of that for their individual local agency of how they would work with a child. But there’s a phrase that we use that you’ve got to name it to tame it. And I think that’s exactly what you’re talking about, Ali. We have to be able to put words to our body experiences. And for some people who have experienced trauma, they don’t know what their body feels like. So you need to kind of step back and start to be able to put words to their body-based memories before they can integrate their story.

ALI KNIGHT: Yeah. I hadn’t heard that name –

KATHRYN LENTON: You’ve got to name it to tame it.

ALI KNIGHT: The other way of talking about that from child-parent psychotherapy is speaking in the unspeakable. So putting words to those experiences of trauma. So it’s the same kind of thing, it’s linking up your body experiences with a narrative.

CHRIS DOLMAN: You’ve both touched on a theme in relation to children in out of home care and foster care, kinship care, which reflects a couple of questions as well that have come through. And in fact one person has asked about, do you have any advice for when a child is in out of home care and the foster carers do not know about the trauma the child’s experienced? Or understand the trauma the child has experienced? Is there something you’d like to add to what you’ve already said about that?

ALI KNIGHT: Well, they definitely – the foster parent really needs to know. And so I’ve come across this quite a few times in my work where there’s just been a – I suppose they haven't been given enough information. And so it’s really been a bit of a barrier because the foster parent needs to really have that information so they can make sense of the child’s behaviours in the context of their trauma. So I would always advocate very strongly, if I was working with the child protection agency, to be able to – that to be shared. They really need to know everything to understand that fully. So it’s critical, I think. Absolutely.

KATHRYN LENTON: Yeah. And I think in order to be able to hold compassion, we need to understand. And when we’re seeing a child’s trauma-based behaviours, which can be extraordinarily challenging, for an adult to stay regulated, we need to understand. So I think if the adult foster carer or kinship carer or even parent doesn’t understand why, it’s very challenging to hold compassion. And when you can’t hold compassion, you’re likely to respond from your own dysregulation. Because if a child is being very challenging in their behaviour or using really big behaviours to show the adult how distressed or dysregulated they are. The adult needs all the skills and opportunities and information to be able to support that child. So I completely agree with what Ali has said. I think depending on the age of the child, the child – when a young person really needs to have a voice of how that story is shared and do they want a seat at that table with the child protection officer, talk to the carer, or so on. So I think it’s really important to think about from a child-focused way, but I completely agree with what Ali said.

CHRIS DOLMAN: Yes, there’s some questions around foster carers or parents responding to challenging behaviour. And I really appreciate your phrase around holding onto compassion and so having an understanding of what the child’s experienced can support that holding onto compassion I guess, in terms of supporting the parent or carer to respond in a way that they prefer to be responding, rather than other things getting the better of them, I guess.

ALI KNIGHT: And also, I suppose, just for the parent or carer understanding their response, and putting it into context. So if they’re responding in a way that’s quite harsh, for example, like being able to think in the therapeutic space about what’s going on there and is that something about my own kind of experiences that have been touched on. And it goes back to the concepts of ghosts in the nursery. Sometimes they need a bit of gentle exploration to sort of support that foster parent to be able to really be able to respond in a way the child needs. So that’s pretty important, I think, too.

KATHRYN LENTON: And I think it’s so important to remember who’s there at 3.00am with the child. And when we’re thinking as professionals about supporting a child or a young person, who’s going to be there at 3.00am when the child’s distressed or dysregulated? And adults aren’t their best selves at 3.00am generally. A few exceptions, I’m sure. But if we can support the adult to really understand the child’s needs and that these behaviours are because of unmet need, it can change the adult’s capacity to respond in a therapeutic way.

CHRIS DOLMAN: Thank you. Yeah, we need to finish shortly. Thanks for your time. But I did want to kind of bring in another question that people have asked. And it kind of builds on something that you’ve said, Kathryn, in relation to giving children a choice if they’re seated at the table and what they get to say about their own experience and – so the question is about how can we increase the child’s voice in our practise? And I guess there’s a multitude of ways, isn't there?

ALI KNIGHT: There is.

CHRIS DOLMAN: Yeah. But to respond to that question, are there a couple of key ideas or ways that you really seek to ensure that children are having a voice, having a say in the work you’re doing with them?

KATHRYN LENTON: I think children have got lots of ways to be able to give us feedback, but for them to be able to give us authentic feedback for them, we need to have relationships. And we need to have relational safety. So I think it’s about thinking about who is the best person in the child’s life or young person’s life to give feedback to. There are some really beautiful feedback tools for younger children and adolescents and teens though the Australian Childhood Foundation. It’s a child feedback toolkit, which has some really beautiful ways to gather feedback. But I think being really developmentally appropriate of how you ask questions, depending on the child’s age. They can draw something or they can explain it or they – you know, we have young people that write songs about their experience. And some young people and children come to their care team meetings. I think it’s about seeing where the child is at, asking them, and giving them options to participate or not. But it’s got to be the right person asking them, in terms of who’s got the safest relationship.

CHRIS DOLMAN: Ali, is there something you’d like to add to that?

ALI KNIGHT: Yeah, definitely. I suppose I was just thinking about my work with babies and very young children. So they’re not going to really be able to maybe give you feedback in a couple of sentences or that kind of thing, but I think for me it’s about trying to understand for a young child, what their behaviour is showing us, and making sense of that in the context of with the parent or the foster parent, whoever it is. And sometimes we’ve had to really think carefully about what children are telling us. If they’re showing some very distressed behaviours, what does that mean? And how can we support them with that message that they’re communicating? And really just looking carefully about that, and thinking about that in the context of their trauma, and their key relationships. So you do kind of need to be sometimes just trying to sort of – this child is telling me something very strongly here. And I think we need to be listening and we need to be acting on it. So it’s a little bit trickier, I think, when you’re working with a baby or a young child, because they’ve got their behaviours and they can cry – you know, there’s limited ways they can show us, so we really need to look carefully and listen carefully to those things that are happening.

CHRIS DOLMAN: Terrific, yeah. Great. Well, we must finish there. Thank you so much, Kathryn and Ali, for your presentations and for your responses to questions from the webinar participants. I’ve really appreciated hearing some of your reflections on those things. So thank you very much.

KATHRYN LENTON: You’re welcome, Chris. Thank you.

WEBINAR CONCLUDED

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Slide outline: How to recognise complex trauma in infants and children and promote wellbeing

1. How to recognise complex trauma in infants and children to promote wellbeing

Trina Hinkley, Ali Knight and Kathryn Lenton
CFCA Emerging Minds Webinar 25 August 2021

2. How to recognise complex trauma in infants and children to promote wellbeing
Trina Hinkley, Ali Knight and Kathryn Lenton

3. Learning outcomes

This webinar will explore:

  • The evidence behind the prevalence and effects of complex trauma on early child development and wellbeing
  • How to recognise and respond to the effects of complex trauma in practice with infants and children, and their parents and caregivers
  • How to have preventative and early intervention conversations with parents and caregivers of infants and children who have experienced complex trauma.

4. Acknowledgements

We recognise and pay respect to Aboriginal and Torres Strait Islander peoples as the Traditional Owners of the Lands we work, play and walk on throughout this Country. We acknowledge and respect their Traditional connections to their Land and Waters, culture, spirituality, family and community for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

5. Webinar series

CFCA and Emerging Minds webinar series: Focus on infant and child mental health

Upcoming webinars include:

  • Speaking with separating parents about their children’s wellbeing
  • What is infant mental health, why is it important, and how can it be supported?

Previous webinars in 2021:

  • Families and homelessness: Supporting parents and improving outcomes for children
  • What is the social model of disability and why is it important in child mental health?

6. Housekeeping

  • Send through your questions via the chat box at any time during the webinar.
  • All our webinars are recorded.
  • The slides are available in the handout section on the webinar platform.
  • The video, audio, transcript and presenters’ responses to additional questions will be posted on our website and YouTube channel in the coming week.

7. Presenters

Trina Hinkley
Research Fellow,
Australian Institute of Family Studies

Ali Knight
Early Years Specialist, Child and Adolescent Mental Health Service (SA)

Kathryn Lenton
Program Manager,
Australian Childhood Foundation (Tas.)

Chris Dolman (Facilitator)
Senior Workforce Development Officer
Emerging Minds

8. Venn diagram

  • Trauma (PTSD) - Exposure to trauma: physical, sexual, emotional abuse, neglect &/or family violence
    • Recurrent & intrusive distressing memories
    • Nightmares & flashbacks
    • Avoidance of trauma triggers, incl. thoughts, people, places
    • Negative beliefs of self & others (incl. self-loathing & extreme distrust)
    • Irritability/angry outbursts
    • Self-destructive behaviour
    • Hypervigilance
    • Low mood
  • ADHD
    • Unable to play quietly
    • Talks excessively
  • AUTISM
    • Deficits in nonverbal communication
    • Ritualised patterns of verbal and non-verbal behaviour
    • Highly restricted, fixated interests.
  • TRAUMA (PTSD) AND ADHD
    • Inattention
      • Difficulty sustaining attention
      • Seems to not listen/they are elsewhere (disassociates re trauma)
      • Failure to follow through instructions
      • Forgetful
    • Impulsivity
      • Runs or climbs when inappropriate
      • Interrupts/intrudes on others
      • Disruptive in class
      • 'On the go'
      • Reckless
  • TRAUMA (PTSD) AND AUTISM
    • Social deficits
      • difficulty developing and maintaining relationships
      • issues with social-emotional reciprocity 
      • may have blunted affect
    • Sensitive to environmental cues/triggers
    • Need for routine
  • AUTISM AND ADHD
    • Difficulty taking turns
    • Repetitive behaviours
  • TRAUMA (PTSD), ADHD AND AUTISM
    • Difficulty taking turns
    • Repetitive behaviours

Devised by S. Chequer 2017, based on the diagnostic criteria outlined in the Diagnostic Statistical Manual of Mental Disorders, fifth addition (DSM-5; American Psychiatric Association, 2013).

9. Synergetic Play Therapy

  • Who Am I? 
    +11 Years
  • How Well Can I Do It?
    7-11 Years
  • How Much Can I Do?
    3-6 Years
  • Am I Okay?
    18 Months-26 Months
  • Is the World Okay?
    Birth-18 Months
  • Do I Exist?
    Conception-Birth 

Adapted from Duey Freeman’s Developmental Model with credit to Heather Gunther, Certified SPT Therapist, for Do I Exist? Stage.

10. Q & A Discussion

11. Feedback survey

Thanks for joining us.

A short feedback survey will pop up as you leave the webinar. If you could spare 5 mins to answer it, we would greatly appreciate it.

We will continue answering your questions offline and post this extra content online with the recording of the webinar.

This webinar was held on Wednesday 25 August 2021.

Complex trauma in early childhood is distinct from other kinds of trauma. It can manifest in ways which affect body and brain development, and lead to poor long-term outcomes if not addressed. Early identification and support, including through trauma-informed practice, is critical to supporting infants and children who have experienced complex trauma.

Effective trauma-informed practice can promote recovery and resilience in infants and children. However, it requires a comprehensive understanding of the signs and effects of complex trauma and the skills to hold protective conversations with parents and caregivers.

This webinar explored:

  • The evidence about what complex trauma is, how it might present in children and how it can impact their development
  • How to recognise and respond to the effects of complex trauma in practice with infants and children, and their parents and caregivers
  • How to have preventative and early intervention conversations with parents and caregivers of infants and children who have experienced complex trauma.

This webinar is of interest to professionals working with infants and children, and/or their caregivers across early learning and care services, maternal and child health and other family support services.

Questions answered during presenter Q&A

To view the presenter Q&A, go to 41:50 in the recording

  1. How can we help parents to understand how their children have been impacted by trauma, without parents feeling blamed/shamed?
  2. How can you tell the difference between trauma and other diagnosed behaviors?
  3. How to work with complex trauma where there remains safety concerns in the home?
  4. How do you work with children from refugee and migrant communities who may have experienced complex trauma?
  5. What do you need to be mindful of when working with a child with a disability who has experienced trauma?
  6. What types of play can be useful in helping children to express trauma?
  7. What additional considerations do we need to think about when working with or supporting Aboriginal and Torres Strait Islander children?
  8. Can there be a delay in the presentation of responses to trauma?
  9. Do you have any advice for when child is in out-of-home care and the foster carers do not know of/understand the trauma the child has experienced?
  10. How do we include the voice of the child when responding to complex trauma?

Related resources


This webinar was co-produced by CFCA and Emerging Minds in a series focusing on children’s mental health. They are working together as part of the Emerging Minds: National Workforce Centre for Child Mental Health, which is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.

Emerging Minds logo


Featured image: © GettyImages/Zinkevych

About the presenters

Trina Hinkley

Dr Trina Hinkley’s background is in behavioural epidemiology and behaviour change, with a particular focus on the impacts of behaviour on wellbeing and other outcomes. Her experience includes research for not-for-profit and government organisations with a focus on making lasting change happen at a population level. She is skilled in stakeholder engagement, facilitation, knowledge translation, and program development, delivery and evaluation. Trina completed her doctoral thesis in 2011, where she examined multidimensional correlates of physical activity during early childhood. Her research has informed multiple sets of Australian and international guidelines and reports.

Ali Knight

Ali Knight is an Early Years Specialist at the Child and Adolescent Mental Health Service in Adelaide, South Australia. Alongside this, Ali works as an Accredited Mental Health Social Worker in private practice with children, young people and their families. Ali has over 25 years of experience as a Social Worker, primarily in Health, where she has provided assessment and therapeutic services for infants, children and their families impacted by trauma and abuse. Ali is passionate about Infant Mental Health and has seen first-hand how timely therapeutic intervention can change a child’s trajectory. 

Kathryn Lenton

Kathryn Lenton is the Program Manager for the Australian Childhood Foundation in Tasmania.  She holds a Bachelor of Social Work and a Master of Counselling, and has been working in the mental health industry for 20 years.  Kathryn’s clinical experience has included both clinical interventions and leadership in trauma therapy for children, adolescents and adults, disaster recovery, child protection, health social work, older persons care, community development, mental health in education, suicide postvention, and child and adolescent mental health. Kathryn has a particular interest in complex developmental trauma and the impact on children.

Comments

I have living experience in this issue, I would like to understand how can one see “red flags” in children. My belief is that if we pay attention and address the issues earlier in particular as parents, we can responde better in their teenage years
Alba
In a sitiariam of BPD, is there a way to identity “red flags” in behaviours?
Alba
Noting the complexity and high amount of inter generational trauma that a lot of Indigenous families face, particularly children. With the topics discussed in the webinar, is there anything that could be tailored through a Indigenous specific lens and be applied for Indigenous families to address the unique issues they can face/are facing if the standard approaches don't exactly fit the circumstances
Jamie
Thank you for running this webinar! I am wondering if this Is this going to be recorded?
Emma
Hi Emma, Yes, a recording of the presentation, including powerpoint slides, audio and transcript, will be made available on the CFCA website soon. If you haven’t already, you can subscribe to CFCA News to be notified once the webinar recording is available: http://aifs.gov.au/cfca/subscribe.
Claire Farrugia
Thank you, I was wondering about a recording too, but you have answered that question!
Tanya
Hello, Will this event be recorded or will there be another one sometime soon ? I’m a ESO student and am interested but I will be on my work placement while this is happening but it’s still something I would like to pursue. Thank you
Samantha McCrae
Hi Samantha, Yes, a recording of the presentation, including powerpoint slides, audio and transcript, will be made available on the CFCA website soon. If you haven’t already, you can subscribe to CFCA News to be notified once the webinar recording is available: http://aifs.gov.au/cfca/subscribe.
Amanda Coleiro
Hi I was wondering if this webinar would be appropriate for me as I work with High School Students 12 - 18 years of age?
Tracey Carr
Hi Tracey, the webinar will focus on trauma in the context of early childhood development (Emerging Minds' focus is on children aged birth to 12 years), and most of the webinar will focus on that age group. Information about impacts on developmental milestones will likely be applicable to 12-18 year olds, and the idea of a trauma-informed lens will be similar for all ages.
Amanda Coleiro
As a Child Protection practitioner I am always looking to update my knowledge around trauma.
Melissa Tremain
I'll be busy at the time of the webinar. Will it be recorded and able to be sent to me? Thank you Jane
Dr Jane Selby
Hi Jane, Thanks for your comment. A recording of the presentation, including powerpoint slides, audio and transcript, will be made available on this webpage after the webinar. If you haven’t already, you can subscribe to CFCA News to be notified once the recording is available: http://aifs.gov.au/cfca/subscribe
Cat Strawa
Looking forward to seeing the recorded version of your webinar as unfortunately it now coincides with a Royal Childrens Hospital forum on Facebook on Childrens Mental Health in Covid a very welcome initiative as I feel wellbeing of families and children has not been given adequate recognition since Covid pandemic emerged March 2020. Press conferences focus on data and regulations . The impact of the disruption in family and children's lives will be experienced as a form of trauma.With the stress on family life/parents/uncertainty re income, jobs , absence of protective experience school and friends offers, children may hv experienced stuff they hv never had to deal with before. No school & pressures of remote learning huge esp in disadvantaged families.See work by Deb Challis in UK on Lancet Psychiatry podcast on work with school children age 9 to 11 in UK the Fading Rainbows project.Helping children record and process Covid experience
Diana Yallop
Looking forward to hear more about this topic
Sanela Colo
Looking forward to hear more about this topic
Julie-Anne Ryan
I did try to print the slides from Kathryn's presentation but was unsuccessful, however, I note they will be available. I was particularly interested in the overlap b/n ADHD, Autism and Trauma, which I have often discussed with clients but not seen so well depicted. The pyramid was new to me.
Shaune Meyer
Thank you all SO much for these presentations !!! It was absolutely fantastic and very very inspiring !!! I love learning about the developing child and their brain development, to understand better what I am observing. This was a presentation of information I have wanted for a long time !!!! MY DEEP THANKS TO EACH ONE OF YOU !!!
Heather Hawkins
Great to hear Heather! I hope you join us for another webinar soon.
Claire Farrugia
Thanks so much to you all for this professional learning session. I really enjoyed in learning more about supporting children through trauma and the various areas of assistance that can been found to support children and their families. This learning today for me was so relevant as is happening in a lot of communities within our country and our world.
Trish Todd
You're very welcome Trish, we're glad you found the webinar useful for your work. Hopefully we will see you at another webinar shortly.
Mitchell Bowden