Childhood trauma and maltreatment — structured clinical viva

Exposure and burden. Every year in high-income countries, about 4-16% of children are physically abused and one in ten is neglected or psychologically abused. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences.^[2]

ACE science. The original ACE study found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.^[1]

Assessment. The AACAP practice parameter highlights early identification of PTSD, gathering information from parents and children, and the assessment and treatment of comorbid disorders.^[4] Trauma-informed practice uses a strengths-based approach to encourage engagement, built on safety, trustworthiness, choice, collaboration and empowerment.^[8]

Reporting. In Australia, mandatory reporting of child abuse and neglect was first introduced in Tasmania in 1974, and most of the other Australian states followed to varying degrees, so the legislation differs between states.^[9]

Mechanisms (brief). Maltreated individuals with depressive, anxiety and substance use disorders have an earlier age at onset, greater symptom severity, more comorbidity, a greater risk for suicide and poorer treatment response than non-maltreated individuals with the same diagnoses.^[6]

Treatment. TF-CBT is a flexible, components-based model that gives children and parents stress management skills before direct discussion and processing of the traumatic experience, summarised as PRACTICE.^[7] In children with sexual-abuse-related PTSD symptoms, TF-CBT gave more improvement than child-centred therapy in PTSD, depression, behaviour problems, shame and abuse-related attributions.^[3] The practice parameter presents evidence for trauma-focused psychotherapy, medications, and a combination in a multimodal approach.^[4]