Conscious memories of childhood maltreatment contribute to psychopathology

Conscious memories of childhood maltreatment contribute to psychopathology

Conscious memories of childhood maltreatment contribute to psychopathology

New analysis from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London has found that an individual’s conscious recollection of child maltreatment is strongly associated with psychopathology.

The research, published in JAMA Psychiatry, analysed studies of both ‘retrospective’ and ‘prospective’ measures of childhood maltreatment, and their association with psychopathology – a collection of symptoms ranging from internalising problems like depression and anxiety to externalising problems such as antisocial behaviour and substance abuse.

Retrospective measures refer to first-person, subjective recollections of childhood events, while prospective measures typically refer to third-person accounts of childhood events, such as from parental testimony or official records.

In a meta-analytic review of 24 studies covering 15,485 individuals, psychopathology was more strongly associated with retrospective measures of childhood maltreatment than prospective measures, suggesting that it is the personal memories of abuse or neglect at a young age and the meanings we attached to them that may contribute to psychopathology later in life.

Child maltreatment encompassed a range of traumatic experiences between birth and the age of 18, including physical, sexual and emotional abuse; or physical or emotional neglect.

Researchers found that the associations between retrospective measures of child maltreatment and psychopathology were particularly strong when the assessment of psychopathology was based on self-reports and focused on emotional disorders such as depression or anxiety.

Furthermore, retrospective reports of emotional abuse showed stronger associations with psychopathology compared to retrospective reports of other types of maltreatment.

Researchers suggest that the findings could have important implications for the treatment of mental health issues that stem from childhood maltreatment. In particular, it highlights the potential role of autobiographical memories of childhood maltreatment, which has not been explored in dominant theories on the outcomes of maltreatment.

Psychoanalytic and physical theories of mental ill-health generally focus on unconscious memories that cannot be accessed by a person’s voluntary recollection. In contrast, our findings support theories that one’s individual interpretation of events, conscious remembering, and the associated thought patterns are more strongly linked with psychopathology than the mere events themselves.”
Dr Jessie Baldwin PhD

Visiting Researcher, IoPPN and Senior Research Fellow, UCL

Our results indicate that evidence-based treatment for trauma-related psychopathology, such as trauma-focused cognitive behavioural therapy, and novel memory therapeutics may hold the key to softening the impact of childhood maltreatment on mental health.”
Miss Oonagh Coleman

PhD Student, King's IoPPN

The role of autobiographical memory in psychopathology has been largely underappreciated outside the work on Post-Traumatic Stress Disorder (PTSD). Advancements in this area can provide novel insights into prevention and treatment for the broad range of psychological disorders emerging after traumatic experiences in childhood.”
Professor Andrea Danese MD

Professor of Child & Adolescent Psychiatry , King's IoPPN

The study’s authors note that the associations between retrospective measures of child maltreatment and psychopathology might be inflated, particularly for emotional disorders, due to recall bias. For example, evidence suggests that increases in depressive symptoms over time may lead to small increases in retrospective reports of maltreatment. However, other recent research from the team suggests that recall bias is unlikely to explain the findings, suggesting that individuals’ memories of maltreatment may contribute to the development of psychopathology.

This research was possible thanks to funding from the Wellcome Trust, Mental Health Research UK, Medical Research Council, National Institute for Health Research Biomedical Research Centre at South London, Maudsley NHS Foundation Trust, and the Medical Research Council.

Prospective and Retrospective Measures of Child Maltreatment and their Association With Psychopathology (Jessie R. Baldwin, PhD; Oonagh Coleman, MSc; Emma R. Francis, PhD; Andrea Danese, MD, PhD) (DOI: 10.1001/jamapsychiatry.2024.0818) was published in JAMA Psychiatry.

For more information, please contact George Fenwick (Senior Communications and Engagement Officer)

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Children with ADHD frequently use healthcare services before diagnosis, study finds

Children with ADHD frequently use healthcare services before diagnosis, study finds

Children with ADHD frequently use healthcare services before diagnosis, study finds

Children and young people with attention deficit hyperactivity disorder (ADHD) use healthcare services twice as often in the two years before their diagnosis, a study by researchers at the University of Nottingham and King’s College London has found.

The research, published today in the journal Archives of Disease in Childhood shows that children with the neurodevelopmental disorder are twice as likely to see their GP, go to hospital for an admission, and even have operations, compared to children without ADHD.

The researchers say the results support the need for healthcare professionals to consider a potential diagnosis of ADHD in children who use their services frequently. This is especially important in cases where the primary reason for attendance is not a mental or behavioural symptom, where ADHD may already be suspected. Children with ADHD use healthcare services for a wide range of common medical symptoms, such as tonsillitis, asthma, or eczema.

The research was carried out by Dr Vibhore Prasad and other researchers working at the University of Nottingham and King’s, funded by the Academy of Medical Sciences.

We know that children with ADHD often face long delays in diagnosis. We didn’t know, until now, that they seek help from the healthcare services twice as often as children without ADHD in the run up to diagnosis. Our findings demonstrate the need for further research so we can identify children with ADHD earlier to get them effective help. The results are significant because we know that identifying ADHD earlier can lead to effective treatment, including talking treatments and medicines, which can prevent a range of serious harms to young people and future adults.

Dr Vibhore Prasad

NIHR East Midlands Scholar, associated with the University of Nottingham, a visiting Lecturer at King's and a GP in Nottinghamshire

The study looked at medical records of children and young people aged between four and 17 years old from the Clinical Practice Research Datalink, a primary care database containing the records of around 15 million people from 730 GP practices and representing seven per cent of the population of the UK. The findings were based on around half of the patients from England who also had linked hospital medical records.

The research focused on the reasons why children see their GP, receive prescriptions from the GP, attend hospital for overnight admissions and have operations in hospital. It showed that children with ADHD make twice as much use of all these services in the two years before diagnosis compared to children without ADHD.

Dr Prasad’s study provides a powerful reminder of both the physical and mental health difficulties that young people have to confront in the years leading up to an ADHD diagnosis. At this point, we cannot be certain that earlier access to ADHD assessment and treatment would alleviate all these difficulties. However, Dr Prasad’s work does highlight that young people who have suspected ADHD are already a vulnerable group and may benefit from coordinated multi-disciplinary care that can provide holistic support whilst they are waiting for specialist mental health services.

Professor Edmund Sonuga-Barke and Dr Johnny Downs

King's IoPPN

Children and young people with ADHD regularly see healthcare professionals but guidance from organisations such as the National Institute for Health and Care Excellence (NICE) and the American Academy of Pediatrics does not currently detail how to detect ADHD earlier. Many parents or carers report needing to know about ADHD in order for the professionals to consider this as a diagnosis.

The researchers say this study shows that more should be done to develop and test interventions to identify ADHD earlier in primary care. There is also a need to urgently review how the health services cater for young people with undiagnosed ADHD.

Dr Vibhore visited the Lambeth ADHD Support Group on several occasions in the process of his research, and has diligently captured the voices of the parents and carers of young people with ADHD. This attention to detail and genuine interest in the welfare of families, has provided valuable insights into how families navigate the healthcare system and engage with their GP prior to an ADHD diagnosis. The identification of patterns of GP interaction for families with a child with ADHD offers valuable insights for both families themselves and professionals.

Michele Reilly

Lead of Lambeth ADHD Support Group

This is ground-breaking research that demonstrates to the Department of Health, NHS UK & local NHS Commissioners, that ADHD should not be trivialised and reduced to core symptoms of hyperactivity, impulsivity and inattention. Undiagnosed untreated ADHD is now proven to result in double the number of health care appointments and procedures children using the NHS for other avoidable health problems and accidents.

Dr Tony Lloyd

CEO, ADHD Foundation Neurodiversity Charity

The full study can be found here.

For more information, please contact Emily Webb (School Communications Manager – School of Academic Psychiatry

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Pears Maudsley Centre to put young people first

Pears Maudsley Centre to put young people first

When the Pears Maudsley Centre opens, it will transform the mental health of children and young people. Young service users, their families, researchers and clinicians have been involved in designing the Pears Maudsley Centre from the start.

a young girl holding a leaf

It’s been designed to maximise natural light. The use of colour, dimmable lighting, artwork, natural materials and windows will calm and inspire the senses, and inpatient rooms will be homely and welcoming, separate from other treatment areas.

David Bradley, Chief Executive from the South London and Maudsley NHS Foundation Trust explains our design principles behind the centre in the latest Network Magazine by Design in Mental Health.

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Going to school when you’re in hospital

Going to school when you’re in hospital

When young people use mental health services at South London and Maudsley NHS Trust as inpatients, their education isn’t interrupted or delayed. In fact, many young people find the continuity of education at the Bethlem and Maudsley School both reassuring and normalising during what is, for many, a very significant time in their lives.

“There is routine, a school, teachers, classrooms, progression and people talking about life beyond this period in hospital, a focus on the future,” said Maarten Crommelin, Head of School.

“But with the Bethlem and Maudsley School, no educational journey is imposed on our young people — we start with their needs first and then provide a personalised education approach based on that. Each journey is different.”

a young girl holding a leaf

Maarten Crommelin, Head of School at the Bethlem and Maudsley School

The school teaches young people who are inpatients or use community services at two sites, the Bethlem Royal Hospital in Bromley and at Maudsley Hospital in Denmark Hill.

While some young people join the hospital school from schools they will return to following their time at the Trust, some young people don’t yet have a school placement or have fallen out of the system. As a result, the school works closely with families, carers and community teams to support young people to reintegrate with their schools in the community following their time in hospital.

During the Covid-19 pandemic, some of these processes changed, but the school remained open and teachers adapted quickly to remote teaching.

“We were focussed on making sure we could reach all our pupils, virtually and face-to-face and have worked to support our pupils in remaining engaged with daily education, preparing for the future, building assessment evidence for last year’s interrupted GCSEs and achieving qualifications whilst in hospital” said Maarten.

“We are working to equip our pupils with what they need to succeed in the next steps of their education pathways, and look forward to our day patients returning and to be able to resume seamless reintegration for pupils back to their schools in the community.”

The school, which has just received an Outstanding OFSTED inspection, also offers careers education, helps young people to identify college placements, organises school trips to the theatre and encourages young people to continue with hobbies. It is also forming partnerships in the wider community, currently working together with the City of London Sinfonia and Young Minds.

Maarten added: “We continue to work with the hospital and the teams we work with in shared working to support young people. As a school we need to be building on our third outstanding OFSTED and developing our outstanding practise further for the benefit of our learners.”

The Bethlem and Maudsley Hospital School has an exciting future. The Pears Maudsley Centre for Children and Young People, which is set to open its doors in 2023, will be the new home to the Bethlem and Maudsley Hospital School’s departments based at the Maudsley site.

“We are pleased to have worked closely with the designers and architects so the space in the new building will enrich pupils’ learning and education,” said Maarten.

Architects impression of a classroom in the new Pears Maudsley Centre — doors open in 2024

The school is in a unique position to be able to support children and young people with mental health needs in the wider community and internationally at a time when children’s mental health has been highlighted as a priority.

Maarten added: “We work closely with Southwark to share our expertise and together with our partners at the Trust we’re also putting hospital education on the international stage. We have a lot to look forward to.”

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