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144 ACQ Volume 11, Number 3 2009 ACQuiring knowledge in speech, language and hearing
Mental health
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
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.
Children 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
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
Julie Ball (top),
and Ferhana
Khan
This article
has been
peer-
reviewed
Keywords
child
complex
trauma
communication
impairment
mental health
workers
speech
pathology