A Diagnosis of Denial: How Mental Health Classification Systems Have Struggled to Recognise Family Violence as a Serious Risk Factor in the Development of Mental Health Issues for Infants, Children, Adolescents and Adults

Child and adolescent mental health services (CAMHS) routinely overlook assessing for, and providing treatment to, infants and children living with family violence, despite family violence being declared endemic across the globe. As contemporary neuro-developmental research recognises the harm of being exposed to early relational trauma, key international diagnostic texts such as the DSM-5 and ICD-10 struggle to acknowledge or appreciate the relational complexities inherent in addressing family violence and its impacts during childhood. These key texts directly influence thinking, funding and research imperatives in adult services as well as CAMHS, however, they rarely reference family violence. Their emphasis is to pathologise conditions over exploring causality which may be attributable to relational violence. Consequently, CAMHS can miss important indicators of family violence, misdiagnose disorders and unwittingly, not address unacceptable risks in the child's caregiving environment. Notwithstanding urgent safety concerns, ongoing exposure to family violence significantly heightens the development of mental illness amongst children. CAMHS providers cannot and should not rely on current diagnostic manuals alone. They need to act now to see family violence as a significant and important risk factor to mental health and to treat its impacts on children before these develop into enduring neurological difficulties

An overview of attachment theory, and perinatal depression

The relationship an infant has with their primary caregiver (in Australian society, this is usually the mother) has a profound impact on the infant’s future development. It is now well recognised that experiences in the first weeks and months of life help shape the developing brain; the most important of these experiences is the attachment relationship between the infant and their primary caregiver.  One of most important tasks of childhood is for the child to develop the ability to express and regulate their emotions; they start to learn to do this from birth with the help of a sensitive and responsive caregiver. The foundation for their future mental health is based on this capacity for emotional regulation. Secure attachment relationships are fundamental to infant development, providing a foundation for healthy social, emotional and cognitive development. A secure attachment relationship begins with facial mirroring and interaction with the baby and moves on to one that involves opportunities for play, everyday activities and sharing of emotions. These relationships facilitate optimal brain development and stimulate the infant’s curiosity to explore and learn. The importance of experiences within the attachment relationship for infant behavioural and emotional regulation, and the neurobiological mechanisms underlying the process of attachment, has been a clinical and research focus. Nurturing, contingent, stable, and predictable early experiences promote healthy brain development and the optimal regulation of physiological stress regulation systems. When early life experiences are full of threat, uncertainty, neglect, or abuse, the infant’s stress management systems are over-activated. This disrupts the architecture of the brain and can contribute to negative health consequences throughout the lifespan. The earliest family relationships are where infants learn how to interact and relate, and this has implications for their sense of connectedness to others and for future participation in society.  --------------------- Achieving a stronger, healthier, more productive future for all Australians begins at the start of life. Although motherhood is a time of great joy and celebration, the experience of new motherhood is, for many mothers, not necessarily what they expected. Many women will struggle with the changes and challenges that come along with accommodating and nurturing a new baby. The unexpected difficulties and challenges that accompany new parenthood can present risks to both mothers’ and fathers’ wellbeing and mental health, as well as to the development and mental health of the infant. Maternal mental health  has a significant impact on children’s mental health and later life outcomes (O’Hara & Swain, 1996; Gutteling et al, 2005; Weissman et al, 2006). It is estimated that one in seven mothers will be diagnosed with perinatal depression in Australia each year (Deloitte, 2012), which poses significant challenges to both maternal and infant mental health, and the future health and wellbeing of the child (Vos, Flaxman, Naghavi, Lozano, Michaud et al, 2012). Depression during the childbearing years has the same symptom profile as depression diagnosed at other life stages and occurs across all cultures.&nbsp

Long-term alteration of the hypothalamic-pituitary-adrenal axis in children undergoing cardiac surgery in the first 6 months of life

Contains fulltext : 179053.pdf (publisher's version ) (Closed access)Children with congenital heart disease (CHD) have poorer neurodevelopmental and psychological outcomes. The mechanisms underlying this remain unclear. One mechanism could be that the stressful experience of cardiac surgery early in life influences long-term hypothalamic–pituitary–adrenal (HPA) axis regulation. Dysregulation of the HPA axis has been linked to poorer neurocognitive and psychological outcomes in other study populations. This case-control study aims to compare HPA-axis regulation (circadian rhythm and reactivity) using salivary cortisol in 3- to 5-year-olds with CHD who did and did not have cardiac surgery prior to 6 months of age. Saliva samples for cortisol analysis were collected from preschoolers with CHD (N = 28, Males = 18, Females = 10) over two weekend days, and before and after an echocardiogram. Caregiver education, child age, sex, and cardiac disease severity score were included as confounders. Multilevel analysis (hierarchical linear modeling) was used to analyze the data. The analysis for the cortisol circadian rhythm shows that the early surgery group has a flatter diurnal slope secondary to lower mean weekend morning waking cortisol levels than controls but similar mean bed time values. Multilevel analysis of the stress response to an echocardiogram indicates that the early surgery group has an increased response when compared to the control group. This is the first study to show that cardiac surgery prior to 6 months of age is associated with a different pattern of HPA-axis regulation at 3-5 years of age.8 p