Children in need of trauma care often being misdiagnosed – psychotherapist

A seven year-old boy and his older sister (9), who watched their mother being bound and kept in a wardrobe for four days, are among the thousands of children who face misdiagnosis with personality or behavioural disorders when in fact they were traumatised, a leading family and child psychotherapist has warned.

Joy Winterbotham, speaking at a conference in Dublin on Thursday on trauma-informed practice, described her work with the children amid concerns about the absence of trauma care for children experiencing multiple adversities.

The conference, hosted by the Lord Mayor of Dublin Alison Gilliland, also heard from Dr Sharon Lambert of the school of applied psychology in University College Cork.

She said too many children particularly in working-class communities were being diagnosed with such disorders as oppositional defiance disorder, attention deficit disorder, conductive disorder and dissociative identity disorder.

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They were medicalised and pathologised, she said, when in fact they needed trauma care. “And all public services should be at least trauma aware,” she said. These included schools.

“There are way too many children who are labelled ‘difficult’ and ‘challenging’ and they’re not. They are upset, they are sad . . . and then they are out of school on reduced timetables, the place that should keep them because it’s a huge protective factor.”

Adverse childhood experiences (ACEs) – including childhood exposure to abuse or neglect, domestic violence, losing a parent, parental mental illness, parental separation or parental addiction – caused significant trauma that impacted physically, emotionally and behaviourally into adulthood, she said.

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Citing a study of young people in diversion projects, she said 63 per cent had experienced four or more ACEs compared with 12½ per cent of the general population, while 74 per cent had lost a parent compared with 22 per cent of the general population.

“Sometimes we look at young people who have been involved in crime and label them bad, when actually what you have a lot of the time is kids who are really, really sad.

“They are not able to express their emotions or access the supports that they need, and sometimes they hurt themselves and other people.”

Describing the case of Callum (7) and his sister Kellie (9), Ms Winterbotham said he was "a gorgeous little fella, blonde, blue-eyed, freckles, earring in his ear – a little man about town.

“He’s telling me how things are. He’s smiling but he’s easily distracted and his concentration is very limited. He’s on a reduced timetable and he’s got learning difficulties. He hangs out on the road with the 15 year-olds. . .

“Kellie, she is wide-eyed. She scans the room, she’s hyper-vigilant and she cautious, she’s withdrawn. She’s fine at school but really defiant at home. She’s protective of Callum.”

Unable to engage with standard talking therapies, Ms Winterbotham, provided trauma care. “Behaviour tells a story . . . How does someone help Callum verbalise the unspeakable?

“His sister and himself watched while his mother was bound and placed in a wardrobe for four days. Kellie was protective of her brother, finding him something to eat on the street, sitting on the steps until someone recognised them and pulled them out of that situation.”

The conference heard from Katie O'Keeffe, co-ordinator of a trauma-informed project working with at-risk children and their families, from the FamiliBase centre in Ballyfermot. She said it had been run on "ad hoc" funding since 2019 which was "unsustainable". She and Ms Winterbotham called for a trauma-care centre to be fully funded, as a first centre of excellence in the approach.