In this episode, Doctor Elaine McCulloch, Chartered Clinical
Psychologist and independent consultant for Family Futures,
explains and explores the thinking behind the Family
Futures therapy model, neurophysiological psychotherapy
or NPP, and the research that underpins it.
We discussed the physical and emotional impact of
developmental trauma on the nervous system, how safety and
Co regulation are at the heart of healing, and what the latest
findings show about long term outcomes for children and
families. Elaine explains how the MPP
model supports developmentally traumatized children and young
people to access calm, connection and cognitive growth.
It's a powerful conversation about trauma and neurobiology.
You can find the time stamp, topic guide and glossary of
terms in the show notes. To find out more about Family
Futures or our research, visit www.familyfutures.co.uk.
Thanks for listening. I am Doctor Elaine McCulloch.
I am a clinical psychologist. I'm also ADDP practitioner and
consultant. I worked for Family Futures for
about 7 years. I was the first clinical
psychologist and I helped, I set up as part of that fantastic
experience of learning about the MPP model.
I helped, I led on their research.
And so I have since I am. So since then, I have since
moved away and I I'm an independent practitioner, but I
remain A consultant to family features and and supervisor
psychology staff, but also I lead continue to lead on the
research there as well. So I think what would be really
helpful for people to know is an overview of what is the MPP
model in the, it's, I know it can be quite hard to sort of
briefly explain, but if you could, what is MPP, what does it
mean? And for anyone listening here
has absolutely no idea what we're talking about or about to
be talking about. OK.
So I think you probably have done other podcasts on MPP, so
they probably have. Yes.
And so the probably people will have gone into the model in more
depth than I think we have time for here.
Yeah, just an overview. Yeah.
But for me, the MPP model is essentially a model that's
about, it's a relational model that focuses on Co regulation
and that can be and essentially it's a somatos sense, somatos
sensory. So it works with the body and
the sensory system in helping children and young people who
have experienced developmental trauma to feel safe and to be
regulated and in the context of the relationship, in the context
of the dyad with the parent. So the focus is always on
meeting the child where they're at and helping them to regulate
so that they come in to a place where they've got a balanced
nervous system and they're in a state of of regulation.
And it's in that place, in that window of tolerance that they
can begin to make connections. So it's only when you get, when
a child is help, when you're able to use porges and you know,
to use his polyvagal theory, what we're doing is activating
the ventral vagus nerves. So the nerve that's present when
the parasympathetic nervous system is is, is activated,
which helps us bring in, bring on board that sense of safety.
And then we can then do all the other work in terms of
connecting up, you know, and doing the talking, making
connections with helping the child connect, make sense of
their experience, bringing their attention to this sense of, you
know, I'm, I'm OK, and I'm here with my parent and they're
helping me to feel safe. And they, they get me.
And what in that sense of safety, they can really then
begin to make more connections. And that's where the that's when
the learning happens, if that makes sense.
That does make sense. You have said a few terms that
I'm not so familiar with, so could you?
You were talking about the vagus nerve and the paravagus nerve.
So the Poly vagal theory, Poly vagal theory, vagus nerve.
So when I talk about the autonomic nervous system, I'm
referring to the the sympathetic nervous system, which is the
part that we, that is activated when we go, when we are excited
or when we are going to fight or flight, when we get hyper
aroused. And most people will be familiar
with that. That's, that's quite common in
our that that's quite familiar to most people.
And, and then the parasympathetic branch of the
autonomic nervous system is the part that helps us to go into
rest and restore. What it's the part that when
we're, we're sitting down watching a film that that will
be activated, that will be in that zone.
And, and one of the things that enables us to go into rest and
restore or, or even to be excited.
And it is that sense of safety. You know, we, so, so it's the
sense of safety is activated by the ventral vagus nerve, which
is cranial. I don't want to go into it too
much, but it's a cranial nerve that connects up with our with
our heart and our lungs and our organs.
And when it's above our diaphragm, it's the ventral
vagal. And when that particular vagus,
that vagus nerve, it goes beneath the diagram and
diaphragm. Look for this story, I'm really
testing you here. Like it's really interesting
when you break it down that it's a, we're looking at two things.
It's physical. It's really, really physical.
What's happening in your body, what's actively your body is
doing and how it's responding to that.
And correct me if I've got any of this wrong, how you're
responding to the situation and it's emotional.
It's also how you know how you're feeling as well, which I
think is, is So what is so interesting about NPP and what
also when we're talking about it, because we talk, you talk
about a lot more than me, but I talk about it as well.
And it's easy to kind of you explaining it now in such detail
about the physiological part of it.
She sort of forget because we talk a lot about feelings.
We talk about how you're feeling in the body.
But I guess what I'm sort of oddly surprised by is how
physiological is how is really what is happening in your body
and how that is presenting and that and that kind of minute
level that we're thinking about it of what's going on, which is
so interesting. Yeah.
And that's what what I mean. So, so presence or absence after
the ventral, there's a vagus nerve and the ventral part of it
is the part that runs that from our heart, you know, above our
diaphragm. And when that's activated, it
means that it brings a pop, it brings in a sense of safety.
And often it's activated in the context of of of a relationship
of when we get cues of safety. OK.
And so in the MPP model, we're always working with bringing on
board that ventral, we call the Ventral Vegas break bringing
that on board. And often we have to work with
we, we're always working with the nervous system to give the
nervous system cues of safety. So, so that can be through play.
I talked about this amount of sensory work that can be through
sensory integration because of course, lots of the children
that come to family futures do have sensory processing
difficulties because of the, the over stimulation or the under
stimulation that they experienced in, in, in their
infancy. So giving, so they're often
overwhelmed. There's their, their nervous
system is often overwhelmed by the, the inability to process
all of that sensory input. And so the MPP model works with
the sensory system to help the child to process all of that.
And, and that brings a, you know, that triggers that sense
of safety. And we do that in the context of
the relationship with the parent, where the parent is a
safe person. So and the parent and the child
also gets to see that the parent gets them essentially that the
parent understands their experience and can help them.
So, so that sense of safety that is that we work in with and that
we that happens in the that's brought upon using the MPP model
is then we kind of garner that we take advantage of that to
them to make those connections. If that makes sense to fit them
to do the thinking bit, which is why we would never go straight
in and do a talking therapy with a developmentally traumatized
child. Because they can't access that
higher order part of their brain, that part of their brain
executive control system is shut down when, when the body, when
the nervous system is dominated by the sympathetic nervous
system response, by the fight flight response.
So we can't think, you know, none of us can really think
clearly. Even now I'm not thinking so
clearly because I'm having because we're doing, you're
recording, really explaining. No.
Because you're recording me. And I'm quizzing you at all
these times that you're then having to.
Yeah, exactly so. So we need to calm that.
We need to calm that sympathetic nervous system response by
giving cues to safety. And we work with lots of
flooded, aren't they by sensations and emotions and
feelings. They're not thinking, Oh yes,
my, my, my, my sympathetic nervous system is activated
here. I need to do this, that they're
just in that state, aren't they? So what we're doing all the time
with the MPP model is really being acutely.
That's a lovely thing. That's one of the lovely things
about family futures is that all of the staff, they might have
their own modalities. So they might be, there might
be, you know, an art therapist or a clinical psychologist or a
drama therapist or you know, we're whatever their own
modality, everyone is trained in in the model.
So once you have specialist and sensory integration
practitioners, everyone will have some training in that.
So when they're working with a child, they're looking at what
does this child need to feel safe?
Do they need more proprioceptive inputs or do they use need to be
getting more information into their muscles and joints?
Do they need less stimulation? Do we need to just slow it down,
calm it down? You know, sometimes we need to
up regulate children, children who are more dissociated and
shut down, who are in what we would call it coming back to
the, the Vegas system, the the dorsal vagal dominant part
nervous system response. So we need to up regulate and
bring them in, up into the window of tolerance.
So every member of staff is trained to understand what's
happening in the body and to go, OK, I know what to do here.
And before I can help this child to to really reflect on their
experience, to deepen their understanding, to bring it to
even to bring attention to this different state of calmness.
Does that make sense? Yeah, that totally.
And the I'm going to get it wrong now, the dorsal vein,
dorsal Vegas. Branch of the Yeah, the of the
vagus. Nerve.
Yeah, the vagus nerve, the dorsal Vegas branch that needs
to be activated. Is it a little bit like kind of
muscle memory in a way, or is it, is it a combination so that
if your child who's grown up in an unsafe environment and you
haven't often accessed that, that hasn't been working, you
haven't felt safe? Is it something, it's obviously
something you learn to do through repetition and through
finding that safe person, that parent who can model that or
help you get to that safe place? Is that the more that that you
you do that work, the easier it becomes for that child or young
person? So, so, yeah, so, so just to go
back, the dorsal Vegas, the branch of the Vegas system that
is the dorsal vagus nerve is, is not what we want to be
activated. We want to activate the ventral
that's the upper. Part.
So that's the part that brings and when we activate that we put
the Vegas brake on, that's the bit that triggers a sense of
safety. So, yeah, so the more so the
more that that a child experiences that state of
feeling safe and they're and in those states, they're able to
experience their parent or carer as someone who who can bring
about that sense of safety. They can notice because they've
got access in that moment to their higher order executive
control. Because remember, that's
switched off, shot down when we're in sympathetic.
So they've got high, they've got a greater access to that part of
their brain. And so they can notice, hey,
here's my you know, here's my mom or my dad or my my foster
carer. And and they're here for me and
they're not. And and they're not hurting me.
They're keeping me safe and they're understanding me and
they're coming, you know, and, and they're and they're loving
me. So yes, absolutely.
I think we they do build for memories of that.
And over time, that sense of that internalized sense of
safety with this parental carer builds and they build.
What we're hoping is that they're building neural.
They're the neurons are, are firing and wiring around those
experiences. And alongside that, they're also
build building pathways between those lower order systems.
Well, that that trigger the fight flight responses and the
higher order executive brain, the controlling part of the
brain that goes, hey, we've been here before.
This is OK. Actually, this is this is my
mum. She's a safe person.
She's not going to hurt me. And they can.
So they can think in those moments and go, actually, this
is OK. I know, I know what I need here.
So for sure, yeah, in a sense, a bit like muscle memory that that
they can access, that they build those memories and those
connections are building in the window of tolerance.
So our job as therapist is always to create as much safety
as possible, connecting with the child, where they're at in that
moment and providing Co regulation, whether that's
through sensory or somatic work or through the use of ourselves
and our tone of voice and offering our empathy or holding
back on empathy because it's too much for some children.
Whatever it takes to bring about that sense of safety.
And I think that's one of the lovely things, as I said before
about Family Futures is that all the staff are trained in the
model. So it's not as though they'll go
and have, you know, this intervention with one therapist
and then this intervention with another therapist.
And they will to some degree, some, some will have a series
of, of sensory integration and sessions and some will have
therapy. But it's very rare that you
wouldn't have someone who's offering therapy, you know, that
they wouldn't also be thinking what's happening in this child
sensory system and what do I need to do?
And integrating those and holding, you know, the
principles of DDP and having a paceful attitude in those
moments. So and that might be all that
that child can tolerate at that, at that stage.
In those early stages, we might move from sensory integration
with theraplay into something that's much more when they feel
calmer and safer in their body, moving much more into adiadic
therapy and working with the parent and child engaging in and
more traditional talking therapy in that sense.
And that's where, you know, I mean, featured where staff would
be drawing more on DDP, but they might still use some Thera play
games. They might still be get be using
strategies from sensory integration because they'll have
a sensory profile of that child and they'll know what helps that
child to feel safe. So it but it always starts with
that thinking about the MPP model and using that model to
make them feel safe in the room before they can get to that.
So it's step one. Yeah, absolutely.
Wherever they are in the stage of the model.
So whilst the model is neuro sequential, it's not linear.
It's not like we do this and then we do that and we do this.
We might be working neuro sequentially in the room in the
moment. Well.
We would be. Yeah, we are.
We do. So why did it feel important or
how did this what we're here, although I could talk about this
for ages, it's so interesting, but we're talking about the
research that we've done on the MPP model.
And why did it feel important to explore the outcomes and to
explore the MPP model? Because the first round of
research was in 2016, I believe, and that was when it was
published. So you must have started quite
some time before that. So how did that come about?
Absolutely. So that came about.
I joined, I'm guess I'm guessing here, I think I joined Family
Futures back in about 20, 11/20/12 and what I was noticing
was that hey, these are some of the most traumatised children
and with huge complex needs, really challenging behaviour in
terms of the levels of dysregulation that they were
presenting with at the time, Family features was.
Almost like a national service. They were taking referrals from
all over the country. They there weren't other
organisations like it. So it was a specialist service.
It's a specialist service and but they but because it was so
specialist, often local authorities, this was pre the
regional adoption agency, the local authorities when they
really had, you know, exhausted all of their local services in
terms and they and they and they didn't know what else to do.
Often they would refer to family futures or sometimes parents
would know this is what I want and I and would argue and make
the case for the children to be set to be referred to family
futures so that they, the children would typically present
with a high level of complex needs.
And often there'd be a, you know, part of a sibling pair or
maybe there would be 3, sometimes even four children who
have been adopted and experienced developmental trauma
and those in their birth families.
So what I was noticing was that despite this complexity, you
know, the team were making real differences and I could see that
they were really staying with, they were really alongside those
children and those parents. Most important to me, because I
think parents are often the are they often the agents have
changed because they're the ones that have to go, they go home
and parent and these children. So it was through that real
connectedness with the children and parents and staying
alongside and offering this model and, and I was seeing, I
was noticing clinic within the clinic, you know, changes,
clinical changes. And I was thinking, well, are
we, are we getting this? Are we, are we, how are we
harnessing these changes? Are how it was sharp.
Let's let's just do an audit. So that's what happened.
So we just did a simple, you know, outcomes test really
analysis rather for those children who had the whole of
the model. So some families might not have
had all of the model. So we just and for those
children who had baseline measures because I think when
family. Features the whole of the,
sorry, the whole of the model. What does that?
Mean so so all of the levels. So they would have had some
somatosensory work, so they would have had sensory
integration work or or somatic experience work.
They would have had theraplay DDP, therapeutic life story
work. So they would have had all
parts. So, so though that was one of
the inclusion criteria, another was that they had baseline
measures. So when they come in for an
assessment, they would have had they would have been screened
using certain psychometric tools.
Yeah. And most people are familiar
with those and most people are familiar with the SDQ.
We family features don't use the SDQ, they use the child
behaviour checklist and the brief, which is a measure of
executive functioning. And we can talk about that a bit
more. So not all the families in the
early stages of the development of family features had those
baseline measures. So that reduced our numbers.
But for those that had and for those who had all parts of the
treatment we just looked at, we just compared their baseline
outcomes with their their outcomes following the
intervention. And what we found were
significant differences in areas of executive control and
behaviour, mostly aggressive behaviour and we found positive
long term outcomes. So the child, you know,
predominantly they remained in school, they were able to access
the curriculum and they weren't involved with the criminal
justice system. They weren't referred to
multiple, you know, other agencies.
And so and they had better relationships with their parents
and with peers, which is very important.
And so, yeah, so that's where it started.
Wow, wow. And the first research paper
that came out in 2016 and I mean, I've seen what we have on
our website and the kind of the outcomes and how that's
displayed. And then what prompted the
second round of research in 2019?
So, so. It was always in our minds that
if if just with this simple pre post intervention and testing,
if the outcomes were positive and suggested indicated that
this was an effective intervention as we knew
anecdotally that it was, then you know, let's compare it to
those who didn't have the intervention.
So there was a natural control group in the form of those
families that had come in for an assessment.
So they would have had the same level of presenting
difficulties, same types of presentation as the other
children who had the treatment model but didn't for various
reasons receive the model, whether that was due to costs,
location, the fact that they were referred on to other
services such as CAMS, etcetera. But so that was what prompted
it. We always had it in our minds,
but we needed that first bit of evidence because, you know,
carrying out research was costly.
So we did that. And so then those years between
2016 and the publishing of the paper in 2019 was spent
identifying the control group, contacting them, recruiting
them, and then carrying out the same interviews and getting them
to complete the same psychometric screening tools.
And what was the findings then in the 2019?
Can you just give an overview of the comparison?
Sure. So what we find were that there
were significant differences and those were on again, which is
for me the most, one of the most exciting things is that that
those differences lay within executive control.
So the ability to inhibit responses, to monitor, self
monitor to, to plan, to organise oneself to yeah.
And then consequently, which would be linked to that would be
aggressive behaviour as well. Externalising behaviour.
There's difference in externalising behaviour.
And interestingly, we repeated the well, there was also a
difference between on on teachers report for the brief as
well for the executive control. Oh.
Really. Yeah, which was really
interesting. And you know, there is a there's
some weakness there because there would be obviously there
would be a different teacher reporting because of some years
have passed. However, you know, they, that's
where they, you know, there's greatest demand upon the
executive system is in school and why our children really do
can struggle in, in mainstream schools because there's a,
there's a cognitive demand, isn't there?
You know, and also there's a demand on the, on the, on the
body. It's not just to sit, you know,
to be still, to concentrate, all of those things that we know are
difficult for our children who are prone to dysregulation.
And so we find differences in the teachers report for
executive control as well, which was really encouraging.
And I think, I mean, you can see the, the outcomes on our
website, but there's, I've been looking through these when I
first joined and there's they're quite profound.
They're quite shocking the comparison.
I'll just go through a couple of them now just while people are
listening. But obviously I would include a
link as well. So the child relationships, as
you said, so parent child relationships for the children
and young people that received treatment.
So they've received the full model, 94% had an improved
relationship with the parent child relationship compared to
the control group where 57% improved the relationship, 29%
the relationship deteriorated and 14% it stayed the same.
Some other really shocking ones as well is placement disruption.
So for our treatment group, so that is they received a full MPP
model, 91% stayed together and for the control group, 33%
disrupted, which is really, really, really high.
And we're always, you know, talking about, you know, the
making, we're keeping families together.
And that's what everyone who's, you know, working in this this
industry and supporting families is trying to keep families
together. And 33% is so high.
And there's some other ones as well as we've got child mental
health being prescribed medication for their mental
health. So our treatment group 81%
weren't prescribed medication as a full of treatment and then for
the control group, 62% were prescribed medication.
That's really, really high. And a lot of what this that we
have obviously results for the education system as well.
So access mainstream education again 76% access mainstream
education compared to 58% not accessing mainstream education.
And a lot of what this evidence is, is pressure put on other
services. And I don't want to get too
political, but I think it's a really interesting comparison of
what we all talk about so much is early intervention and but
the right intervention and how that has a has an effect on, you
know, society in general. But also, like I said, the the
pressure on other services and the outcomes for these children
and young people. And that's what's so
interesting. And I know that you're we're
doing that. We have another round of
research that is going to be due to be coming out or published
next year at the end of this year.
And well, hopefully the end of this year or next year, yeah.
And I've just done a kind of whistle drop tour of shocking
statistics that I've read out. Is there anything that sticks
out greatly to you from the previous rounds of research?
Or maybe you could talk a bit about why we've done this, this
third round of research, why that was important?
I think, yeah, I can definitely answer both of those questions.
I mean, all the things that you said stick out for sure.
I think those. It's hard to choose one when
you're looking at it because it is also shocking I guess.
Yeah, I mean, it's, it's shocking.
It's it's exciting. I.
Mean from a theoretical perspective, you know, we would
hope to see because there's so much focus on on Co regulation
and supporting that the access to, you know, the executive
functioning systems, the higher order brain.
So we would hope to see changes in, in, in executive control and
we saw that and therefore a reduction in, in externalising
behaviour. So that was really exciting.
But then to hear, but then to, to have the actual child and
parents report on their own experiences and their own
outcomes was really exciting to see that, you know, you know,
none of the, none of the parents separated and, or got divorced.
You know, that was that was amazing really.
And to see that most of the children were able to remain in
in, in education and there were fewer exclusions.
And also, you know, when you think you were talking about
cost to society in terms of additional diagnosis, access to
other mental health services and the demand upon society, you
know, the majority of children, I think at the time, and I put
it in the, in the paper, none of the children and young people
who had gone through the treatment model had been, had
received any sort of formal caution or charge or had been
imprisoned, which is amazing given the level of their
dysregulation and the challenging behavioural
difficulties. So so.
I think and the statistics for children who've been through the
care system in. General as well.
Absolutely, absolutely. I think I think that statistic
has changed since we did that. I think one person has, and
they, you know, and a young person came to us already out
of, you know, who they were already not with their adoptive
parents and had been in, in, you know, in another, in another
care provision at the time and was an older young person at the
time a referral. So we can and we can understand
that exception. But otherwise, you know, it's
remarkable. And for me, you know, I, I
think, well, why are we not having a constant, you know, a
cost analysis. You know, I've, I've, I have
invited some people to, to look at this and, and we've had no
takers. And I just think, well, surely
if you want, if you were to invest in providing this wrap
around support that we know can make real differences to
children's outcomes, including going, you know, more, you know,
you know, access more mental health, you know, putting a
demand on mental health services, putting, you know,
being involved in the criminal justice system.
Why would we not? Why would we not look at the
cost of this and think, what is there a cost saving here?
Is it better to invest? It's always better to invest in
children's lives early on rather than to have to, you know, you
know, just on a societal cost level, it's more costly if we,
you know, later on. But on a human level, why
wouldn't we want to give these children and young people a
better chance in life and to make the quality of their life
better and hopefully to stop intergenerational trauma
continuing? It's a new brain, I'm nodding.
I'm nodding. People can't.
I'm. Not doing?
Yeah. So.
So that was what excited me and also frustrated me because it
was really hard to get any further interest in that, you
know, a lot. Yeah.
I'm not going to get into the politics of it.
So the other part of your question was why then did we
look at prenatal alcohol exposure?
And I think. That that's the next.
That was the. Next, this is the current round
of research. So that's our research linking
to prenatal alcohol exposure. Yes, OK.
Right. So, so I think how that came
about was that because a lot of the children presenting have,
you know, neurodevelopmental trauma, but also
neurodevelopmental issues as well.
We have a, we have a, a clinic that tries to differentiate what
is developmental trauma and what is say for example, ASC or
autism or or ADHD. And then also looking at giving
the fact that a lot of, I think it's adoption UK site statistic
that 27% of children who are adopted have had prenatal
alcohol exposure. I need to check that.
Where is it FASD? But however, but we know and we
we do in depth file searches when a family come into
treatment. So we know that a lot of the
children who have been referred into the service have
experienced prenatal alcohol exposure.
So of course we know from all the research on that and that
can cause structural deficits. And so the obvious question and
I think it came, I think the question might have come from
Raja Mukherjee, who's the national lead for FASD in the
country. And he might, I think he
suggested to Jay, our clinic, your clinical director.
And you know, why don't you look at PAE and see whether the
outcomes are, are the same. And, and that's what we've done.
And we were able to go back through the files and then
categorise the children as to into categories as to whether
they had definitely had PAE or whether it was strongly
indicated or really not very clear or there was no indication
or no reference to alcohol. So, and that's what we did and
then to look at whether the outcomes were the same.
So there were two parts of that research because we had a bigger
treatment group, group, cohort, cohort.
So the last time we did any retesting was back in, you know,
2018, 20/17/2018. So we had more families to
follow up who had completed treatment since then.
So we did that so with and the exciting part about, so we did
the, we did the analysis again the comparison between treatment
and control group and we found even better results.
We now had evidence that the intervention supported better
emotional control as well as other aspects of the executive
control and functioning that we'd find before.
So that was really positive and. And then we were able to, then
what we did was we categorised those treatment, that treatment
group and just did a simple, so far what we've done is just a
simple pre treatment, post treatment comparison for those,
for those groups. And what we found was that well,
first of all, what we did was we controlled for PAE when we did
the analysis. So we did the whole analysis
again and taking out controlling for which is the presence or
absence of prenatal alcohol exposure and find that the
presence or absence didn't make any difference to the outcomes.
So. That's huge.
So to me that's as well that that suggests that if if PAE is
president that the outcomes will remain the same.
And essentially our our pre and post analysis have have
supported that. So when we have just have
definite PAE, we do the analysis, we find that the the
the changes that we reported earlier remain present for that
group and when we are strongly indicated that the effects or
the differences become even stronger and so on.
So that's really encouraging. So, so the treatment model works
especially well for children and young people who've experienced
prenatal alcohol exposure. I'm just trying to.
Well, it's interesting you should say that because actually
for the definite group, this the the the 100.
Percent no. We'd absolutely know that there
was pre alcohol exposure. So for that group that the the
differences were actually stronger than for the highly
indicated, strongly indicated. But that's because though, you
know, my sense was that for the strongly indicated, there were
there were a few, there were a couple of outliers, but when we
grouped them together that that that became that those outcomes
remained present. So, so it doesn't say that it
that it's even better for for the for the presence for those
who had to be Natal alcohol exposure, but it certainly
suggests that it makes can still make a difference, a significant
difference even when there has been prenatal alcohol exposure
and prenatal. Alcohol exposure I've I'm
assuming I think I know that just means when when mum is
pregnant she's been having alcohol.
That's right. Yeah, OK.
So and part of that, you mentioned the clinic, there's so
much that unpick here and I'm aware of the time and we've been
talking for quite some time. But you mentioned the clinic
looking at children who've experienced developmental trauma
and looking at what part of their presentation, again, just
correct me if I've got this wrong, What part of their
presentation is developmental trauma, is neurodiversity, so
ASD or ADHD or is FASD? Yeah.
And do we have any kind of indication, maybe it might be a
kind of worms here? Do we have any kind of
indication of the effects of the model, the outcomes of the model
with children who are neurodiverse as well as and I
imagine that's quite hard, a hard thing throwing loads of
questions that you hear, but imagine that's quite a hard
thing to unpick of what is mental trauma and then what is
the presentation of, you know, diversity for FASD yes, the.
Differentiation of those can be difficult, but it also can be
conclusive for some where ASC is clearly indicated.
I would say that a lot of our children meet criteria for ADHD.
And so one of the the issues is, is really teasing out what is AD
if you're ADHD and what is, you know, development of trauma
with, you know, significant sensory processing difficulties
that, you know, so a child really struggles to sit still.
It needs lots of pro receptive input that's over stimulated by
the sound in the classroom and that who's easily triggered into
dysregulated sympathetic nervous system state.
And I mean, that's that's that's really tricky.
I mean, it's interesting looking at the statistic where the
children who were in the treatment model didn't go on to
get as many of their diagnosis or or as the control group or
receive the same level of medication.
And that. So it makes me wonder whether
the fact that we're focusing on Co regulation, focusing on the
development of self regulation, of working with the sensory
system, working with the nervous system.
And actually that meant that intervention meant that that
those some of those children didn't end up getting that
diagnosis and having to be prescribed.
I don't know. That's a different.
That's the. Bigger.
It's quite interesting though, isn't it, that to think that
both things present very similarly to the point where
it's hard to unpick which is which, or challenging to unpitch
which is which. But the intervention works very
well for children, young people who that have Eve either or.
I don't want to generalize too much, but yeah, I.
Don't want to make, I don't want.
To. To make claims that are not
substantiated. But I guess it's a good research
question. I mean, I wouldn't say there's
nothing, you know, it's not curative in terms of the, you
know, for example, you know, you know, I wouldn't say that this
is a treatment model for children with ASC.
However, is this a model for children with ASC who have
experienced developmental trauma?
For sure. Now, you have to also remember
that when we did the research, we, we took out those with a
diagnosis of, of ASD. At the time, there weren't that
many. I can't remember off the top of
my head how many we, we excluded.
But now we're going to include all of those children because I
think for those children, you know, there will be, you know,
children, children who have FASD might also, there's an overlap
between their presentation and the presentation of children
with ADHD and ASC. So amongst that group, there
will be some children who definitely have prenatal alcohol
exposure and may even have a diagnosis of FASD.
So it would just be interesting to get to follow those young
people up. Yeah.
So I'm not making any claims about the the model in terms of
its efficacy for neurodevelopmental disorders and
I'm not. But what I am saying is that,
you know, the focus on Co regulation and the sensory
system could therefore impact on how to make a difference for
those who would otherwise meet criteria for ADHDI am curious
about that. Quite an interesting question.
I mean, my final question is probably quite hard one because
as we spoke about everything still with the research, the
model and the outcomes, it's all very interesting and exciting.
Is there anything with this that you are particularly interested
and excited about or any kind of final thoughts that you'd like
to, if they leave this discussion, but maybe pause this
discussion because I feel like we could do a whole other
broadcast. I do think that it is important
to talk about what next and I guess you know what, what's our
learning? What's the hypothesis about,
about the fact that this intervention for, well, the the
outcomes so far suggest that it's as effective for children
who had PAE as those who didn't. So that makes me wonder, I mean,
some of how many of those meet criteria for FASD, They won't
all have been seen at the FASD clinic.
And it's not always conclusive. Often there's not enough and
about mental history information, we don't know for
sure whether alcohol was taken during pregnancy and to what
extent. And also we know that that not
all the children will have the facial markers for FASD.
But we, what we do know is FASD can create structural deficits
in the brain, which impacts on cognitive functioning and
adaptive functioning. So the actual functioning of the
child in terms of relationships and being able to, to just get
on and with their everyday life. So I, I suppose I'm interested
in what's that's, where's those structural deficits cannot be
changed. How much of this support with
coal regulation is helping alternative pathways to develop
through the, the those neural connections being made a new
wiring occurring? Are there, you know, pathways
being created that support those deficits that enable this
executive control to, to to develop?
You know, I don't know. That's, that's what I'm, I'm
curious about. That's what we we're
hypothesising for for the non PAE group, but does it also
happen for for the PAE group? Wow, that's a big exciting
question. It is, it is and the only way, I
guess. I have reached out to some
neuroscientists to say, you know, well, it's what, what
would that look like? How could you test that, You
know, do would neuroimaging test that?
I mean, we know that even with IPA that the neglects can cause
huge atrophy on the brain. So we're neglecting and, and
abuse and, you know, has huge impact on the developing brain.
Of course we know that. So there are neuro, there are
neuroimaging and images of the atrophy that's caused by by by
that. So I'm curious as to what, you
know, a pre and post brain scan of, you know, following the
intervention whether we would see any differences.
Yeah, I don't even know whether I'm asking the right question
because I'm not a neuroscientist.
But there's a lot. Well, I've been looking at, I've
been to doing some, some other stuff, looking at the history of
FF and I saw something, you know, in the research that was
done or some research, not this research that was done on
children. I'm going to have to link it
because I'm not going to get all the information correct here in
terms of who did the research or not.
But it basically it showed that children who've been through
developmental trauma when they had brain scans, it was very
similar physical damage to children who'd been in car
accidents. And when that was explained to
me or mentioned at some point in some internal training, some
discussion, that really, really stuck out to me.
And again, it's taken back to what we were talking about
initially in in our discussion was the very real physical
impact of trauma. And I think a lot of people
think about it as a sort of emotional trauma that you can
work through, which yes, to understand is true, but it's the
physical damage. It's actual physical damage that
is done when children are not given the right care and are not
able to be provided with the right care and to create that
emotional safe space. I think that's what is so
incredible that it causes actual physical damage.
And I know we talk about the brain being plastic, and I think
you've evidenced that quite well in the beginning of the
discussion about how pathways can be created and recreated.
But yeah, I think it's incredible that it's physical
damage that is caused, but that there is some repair that can
happen through the right intervention, through
specifically this intervention, which we have proven, you have
proven through the research. I think that was just a
statement rather than a question.
Proven is a is a big claim, but what we're showing is that yeah,
yeah, what what it indicates is that sure there are there are
these improvements in an executive control and in
behavior and in relationships suggest that something is has
you know, it is happening on a on an on a on a on a on within
the brain. And it's as you say, it's not
just it's not just a cognitive psychological issue.
It's a it's a that's felt sense of safety that ability to access
it, you know, quickly in the moment information that I am
safe. This isn't happening to me
anymore. I am, I am loved.
I am worthwhile. I have you know, I, I can do
this. And that ability to have
self-control is is huge. So one would assume that that
was either that some repair had occurred and or that new
pathways had been created in this relational context of Co
regular scaffolding and Co regulation.
That's what we all hope. All of us who work with
developmentally traumatized children are, you know, hope
that that that is what's happening.
And that's what we see. We definitely see it for sure.
And that's not to say that you know, that they they won't get
distressed or they won't get dysregulated.
It just means that they have access to something alternative
to the adaptive information that will, you know, all around.
Actually, in this moment here I am OK.
And it, I mean, the outcomes show that that that ability and,
you know, going from thrive from survive to thrive.
Yeah. And I think that's what's so
exciting. Thanks.
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