I have been trying to understand the impact of negative early experiences on children who experience social emotional and mental health needs (SEMH), for many years. The difficulties they often have with emotion regulation, socialisation and learning are obvious. Their SLCN tends to be less recognised, of course. Over the years, I have encountered many theories about why these children and young people experience so many barriers to positive development and similarly a variety of approaches to help them. A taxi driver once told me that all they needed was a ‘clip round the ear’.
It is heartening therefore to hear the terms ‘attachment’ and ‘trauma’ used more frequently in the media, hopefully signalling a greater understanding of how they can negatively impact on children’s lives and a greater awareness of humane and effective ways to help. It is also fascinating how recent research, is helping us understand how early interactions and experiences impact on development, the science of what Dan Siegel 1 calls, ‘interpersonal neurobiology.’
However, there are also misunderstandings and controversies. An insecure attachment is a risk factor for mental health difficulties, but not necessarily a problem in itself, and is actually very common, around 40% of all of us didn’t experience a secure attachment as children. Attachment status is not obvious, nor is it simple to assess, so we need to be cautious about making assumptions based on either a child’s history or their behaviour.
Also, exposure to trauma in childhood is relatively common although it does not always lead to long term problems such as PTSD. Nonetheless, Adverse Childhood Experience (ACES) 2 can have an impact on an adult’s mental and physical health but asking about ACES may not be the best way to use this research 3. Firstly, because ACE studies give us insight into risks at a population not an individual level. It can also be re-traumatising to be asked such questions. What seems most significant to a positive outcome is not the number of ACES someone has experienced, but the positive relationships that person has which can provide a buffer.
What do Speech and Language Therapy services need to offer?
So how is all this relevant to speech and language therapy? It is clearly very important that we understand the potential impact of attachment and trauma on a child so we can help them access whatever services we offer. This can be a challenge as what they need first and foremost is time. Time to feel safe and to build a trusting relationship. We also need to take time if we’re going to gain an accurate and holistic assessment of their communication skills.
We also need to be flexible and imaginative, these young people are unlikely to fit into narrow ‘pathways of care’, they also need functional approaches to intervention, which they recognise as meeting their needs.
Speech and language therapists need to know about how attachment and trauma can impact on language and communication skills because this can give us insight into potential skills gaps. Then what? I was once told ‘but you just teach skills’ which left me very puzzled about my contribution as a SLT. Surely that’s not a bad thing? We need to draw on evidence-based approaches, but in the absence of much specific research about language and communication interventions specific to those with SEMH as well as SLCN, we also need to be creative, in an evidence informed way!
What support do Speech and Language Therapists need?
We need more research; research that evaluates current intervention, helps us understand more about how the difficulties these children and young people experience arise and that helps us support these young people more effectively. The RCSLT has a large journal collection accessible to members, which is a good place to begin exploring current research in this area 4.
Opportunities to collaborate with colleagues from other professions, both to learn and influence are a great privilege and also sadly rather rare. It’s important to take every opportunity to cultivate them.
It is easier to find other SLTs who work in this field through the Royal College of Speech and Language Therapists SEMH Clinical Excellence Network 5, which are very supportive, and who have been very active in developing relevant resources in collaboration with RCSLT 6.
Secondary trauma can occur when we work with traumatised children and we become affected by their experiences, so SLTs working with this group need good trauma informed supervision 7. SLT can be attachment and trauma friendly but it is especially important here that we ‘do as much good as we can for others while doing the least harm to ourselves’.
Do you want to learn and think about these issues further?
Come to the next course beetle course – Understanding and supporting attachment difficulties and complex trauma. How they can affect children and young people’s development, including their communication skills. We’ll discuss the theory behind attachment and trauma and consider how it applies to the children and young people we work with. We will also consider the potential impact on language and communication development and how SLTs might contribute to supporting these young people. There will also be opportunities to discuss ideas sparked from this with colleagues.