Although these adaptations can be helpful to reduce threats, they may lead over time to maladaptive outcomes including mental health problems. For example, inflammation levels are higher in individuals who have experienced maltreatment compared to those who haven’t, and are associated with mental health problems later on.

In the Stress & Development Lab, we have conducted several detailed epidemiological studies based on large population-based birth cohorts to, firstly, investigate the impact of childhood trauma exposure on mental health outcomes, and secondly, identify which children are most at risk of developing PTSD.

Through analyses in the Environmental Risk (E-Risk) Longitudinal Twin Study (which observed twins born between 1994-95 until they were aged 18 years), in a paper led by Dr Stephanie Lewis, Clinical Lecturer at the IoPPN, we found that children with PTSD are eight times more likely to self-harm and 10 times more likely to attempt suicide than those without PTSD. In absolute terms, this means that about half of children with PTSD report self-harming and one in five report attempting suicide. Children with PTSD are also significantly more likely to have a violent offence record and not be in education, employment or training (NEET). This is alongside being at increased risk of co-occurring psychiatric diagnoses, including depression, generalised anxiety disorder, conduct problems, substance misuse or attention deficit and hyperactivity disorder (ADHD).

These findings highlight that childhood traumas are key modifiable risk factors for psychopathology in childhood and onwards – if we target the processes involved in responding to trauma, we may then be able to reduce the prevalence of mental health disorders and other negative health outcomes. As a result, childhood trauma is a major focus for research and clinical practice in mental health.

As part of my work to reduce the negative impact of childhood trauma and PTSD, I co-lead the National & Specialist CAMHS Clinic for Trauma, Anxiety, and Depression at South London and Maudsley NHS Foundation Trust, where we deliver assessment and treatment to children and adolescents who experience severe and/or treatment-resistant PTSD, anxiety disorders and depression.

When we undertake assessments of PTSD in children who have been exposed to traumatic experiences, we look at a cluster of symptoms that are typical of developing PTSD. For example, asking:

• Does the child relive traumatic experiences through distressing memories or nightmares?
• Do they show avoidance of anything that reminds them of their trauma, such as context or people that reminds them of their trauma?
• Do they express feelings of guilt, isolation or detachment?
• Do they still feel under threat, as we can understand because they continue expressing irritability, impulsivity or difficulty concentrating, for example?

There are several evidence-based psychological treatments for PTSD in children that have been endorsed by the National Institute for Health and Care Excellence (NICE) and that we use in the CAMHS Clinic. These include trauma-focused psychotherapies which target cognitive and behavioural factors that contribute to the reinforcement of PTSD. These therapies generally include psychoeducation to provide information to children and families about PTSD symptoms and the treatment rationale, coping skills training to better manage intense negative emotions, gradual exposure to trauma memories and reminders to address avoidance and build a coherent trauma narrative, and cognitive restructuring to address biased appraisals related to the trauma memory. Consultant Clinical Psychologist and Reader, Dr Patrick Smith, and others at IoPPN have developed one form of this evidence-based treatment.

There is also limited but growing evidence to indicate that eye movement desensitisation and reprocessing (EMDR), which involves recalling traumatic events while performing tasks that generate bilateral sensory stimulation, may be beneficial for young people with PTSD.

Barriers to support and how to overcome them

We know it is impossible to implement interventions if child trauma and trauma-related psychopathology go undetected. As a result, our team is currently trying to map barriers to access healthcare to improve recognition of PTSD in children and adolescents.

One of the barriers to getting professional support for childhood PTSD are the symptoms and thought patterns themselves. Children may experience trauma-related avoidance, low motivation, hopelessness, distrust, shame, guilt, or fear of not being believed or being reprimanded by the perpetrators of the trauma. These factors may make them less likely to open up about the traumatic event or how they are feeling.

Another key barrier relates to the parents or caregivers’ response to their child’s trauma. For example, deliberate concealment of trauma by perpetrators or to avoid reprisal by perpetrators, fear of being blamed, fear of having their child taken by child protective services, or poor understanding and stigma around mental health. There may also be structural barriers, including lack of insurance, access to mental health care facilities or transportation.

Family can act as a great support system for children exposed to trauma. Children who received a family intervention which taught parents and caregivers about trauma symptoms, how to improve family communication, and coping skills to manage symptoms were significantly less likely to have a PTSD diagnosis three months after the intervention.

It is also important to remember that PTSD is not the only or even the most common mental health problem in children exposed to traumatic events, and parents and professionals need to also monitor symptoms of other anxiety disorders, depression and substance misuse in particular.

The future of mental health care and research: The King’s Maudsley Partnership for Children and Young People

Through his work in the Stress & Development Lab and National & Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, Professor Andrea Danese is one of the many experts who are transforming our understanding and treatment of young people’s mental health as part of the King’s Maudsley Partnership for Children and Young People. The Partnership, which will have its home in the Pears Maudsley Centre for Children and Young People, is a unique collaboration between specialist clinicians from the South London and Maudsley NHS Foundation Trust and leading academics at King’s College London.

Together, King’s and The Trust host the largest group of mental health scientists and clinical academics in Europe. Through the Partnership, clinicians and researchers will collaborate even more closely to find new ways to predict, prevent and treat mental health disorders, such as childhood trauma and PTSD. This will enable us to translate research into practical treatments in the shortest possible time, and will benefit children locally, nationally and across the globe.