ACQ_Vol_11_no_3_2009

Mental health

Communication and childhood complex trauma An evaluation of speech pathology consultation liaison and assessment services to a complex trauma treatment team Julie Ball and Ferhana Khan

Communication difficulties in children are not always obvious and present a potential barrier to the child’s care and recovery from complex trauma. Many aspects of complex trauma intervention rely on the young person understanding, reasoning and incorporating ideas; and telling the mental health clinician about knowledge, events and thoughts. This paper reports the perceptions of nine mental health workers before and after collaboration with speech pathologists and investigates the potential role of the speech pathologist within the complex trauma treatment team. C hildren who have experienced abuse and neglect are at risk of demonstrating developmental difficulties and are more likely to utilise medical, mental health, correctional and social services (van der Kolk, 2005). Children who have experienced abuse and neglect and who have subsequently been placed in foster care are at greater risk of suffering from feelings of anxiety, abandonment, rejection and fear (Grigsby, 1994), are more likely to use mental health services (Bilaver, Jaudes, Koepke, & George, 1999; Coombs-Orme, Chernoff, & Kager, 1991; James, Landsverk, Slymen, & Leslie, 2004), and are at increased risk of demonstrating developmental delays (Leslie et al., 2005). The literature dealing with maltreated children reveals clear evidence of communication impairment within the population of children that have been abused or neglected (Law & Conway, 1992). For example, Lynch and Roberts (1982) found that language difficulties were more common in children who had been exposed to abuse and neglect as compared to other developmental delays. There is a reciprocal relationship between child maltreatment and communication difficulties. Children with communication difficulties and mild learning difficulties have been found to be at greater risk of neglect, emotional, and physical abuse. For example, in one recent British study, children with communication difficulties were found to be three times more likely to be registered with child protection services (Spencer et al., 2005). Conversely, children who have been maltreated are at greater risk of developing poor language abilities (Allen & Oliver, 1982). It is hypothesised that mothers who neglect their young child create a linguistically disadvantaged environment and communicate

in a style that is less stimulating and less sensitive than typical mothers (Crittenden, 1989). Young people from a background of maltreatment are often out of touch with their feelings; they lack understanding and the insight of cause-effect and their own impact on the social problem (van der Kolk, 2005). These children also have reduced self-talk to regulate their emotions as their poor high-level language impacts on their range of emotional vocabulary necessary for self-talk and self-regulation. Poor social information processing skills together with the child’s higher aroused state results in poor interpretation of ambiguous faces in social contexts. Further, they have difficulty understanding and relating their life story through narrative. Due to a history of inadequate pro social modelling and failed social interactions, the child may adopt strategies that appear maladaptive to others including: tactlessness, interrupting inappropriately, and an inability to empathise with other points of view. It seems likely, the child has adopted these patterns of interaction to accommodate their frustration and lack of understanding. There is an increasing awareness of the need for speech pathology involvement with children who have experienced abuse and neglect because of their poorer outcomes across the lifespan, including the risk of dropping out of school, poorer education and vocational outcomes, increased involvement in the justice system and increased need for adult psychiatry services (Clegg, Hollis, Mawhood & Rutter, 2005). Identification of persons with speech and language impairment is a specialist field and the child’s communication difficulty may not be immediately obvious to health professionals who have not had specialist training (Enderby & Philipp, 1986). Speech pathologists who work in child and youth mental health assist mental health clinicians to have an understanding of their client’s communication abilities and difficulties, thus ensuring suitable diagnosis and intervention (Speech Pathology Australia, 2009). The current study The complex trauma treatment team is multidisciplinary and connected to an interagency panel of senior practitioners from child safety, education, disability services and mental health. The model of service delivery incorporates attachment, neurobiology, developmental, and systemic frameworks of intervention. The clinical team consists of a psychiatrist, clinical psychologists, social workers, occupational therapists, and an indigenous health worker. Due to the intensity of the service each clinician has only a small case load. Although previously the team did not

This article has been peer- reviewed Keywords child complex trauma communication impairment mental health workers speech pathology

Julie Ball (top), and Ferhana Khan

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing