Child Abuse Review Vol.

25: 89–101 (2016)

Published online 2 March 2015 in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/car.2376

Intervening with Severely Tristan Milot*

Département de psychoéducation,

and Chronically Neglected

Université du Québec à Trois-Rivières,
Trois-Rivières, QC, Canada

Children and their Diane St-Laurent

Louise S. Éthier
Families: The Département de psychologie,
Université du Québec à Trois-Rivières,
Trois-Rivières, QC, Canada

Contribution of Trauma-
Informed Approaches
Many clinicians and researchers have proposed considering child abuse and neglect from
a traumatic stress perspective to better understand how they so profoundly impact child
development. According to this perspective, child maltreatment (both child abuse and
neglect) is viewed as a chronic interpersonal trauma which may severely interfere with
normal developmental processes, often resulting in long-lasting behavioural, emotional
and psychophysiological dysregulations. In this paper, we summarise theoretical and ‘We summarise
empirical literature addressing the traumatic nature of child neglect, with a specific focus
on short-term consequences of neglect in childhood. We then give an overview of some theoretical and
key intervention elements stemming from trauma-informed approaches with traumatised empirical literature
children and their families.Copyright © 2015 John Wiley & Sons, Ltd.
addressing the
KEY PRACTITIONER MESSAGES: traumatic nature of
• Child neglect is viewed as a chronic interpersonal trauma which may severely child neglect’
interfere with normal developmental processes, often resulting in long-lasting
behavioural, emotional and psychophysiological dysregulations.
• Key intervention guidelines stemming from trauma-informed approaches include:
• A detailed assessment of the child’s trauma history and characteristics
• Providing a safe environment for the child
• Helping the child build feelings of emotional security
• Improving parental sensitivity
• Developing child emotional self-regulation
• Offering emotional therapeutic support to the parent.

KEY WORDS: neglected children; trauma symptoms; complex trauma; trauma-informed

approaches

his paper addresses the potential contribution of using a trauma-informed

T approach when intervening with chronically and severely neglected
children and their families. In the last decades, many clinicians and researchers

Correspondence to: Tristan Milot, Département de psychoéducation, Université du Québec à Trois-Rivières,

3351, boul. des Forges, Trois-Rivières, QC, Canada, G9A 5H7. E-mail: tristan.milot@uqtr.ca

Copyright © 2015 John Wiley & Sons, Ltd. Accepted: 23 November 2014
90 Milot et al.

have proposed considering child abuse and neglect from a traumatic stress
perspective to better understand how they so profoundly impact child
development (e.g. Briere, 2002; Cook et al., 2005; De Bellis, 2005; Ford and
‘Few empirical studies Courtois, 2009; van der Kolk et al., 2009). According to this perspective, child
have addressed the maltreatment (both child abuse and neglect) is viewed as a chronic interpersonal
trauma which may severely interfere with normal developmental processes, often
specific relation resulting in long-lasting behavioural, emotional and psychophysiological
between child neglect dysregulations. However, to date, few empirical studies have addressed the
and trauma specific relation between child neglect and trauma symptomatology, most studies
having focused on violence and sexual abuse. In this paper, we summarise
symptomatology’ theoretical and empirical literature addressing the traumatic nature of child
neglect, with a specific focus on short-term consequences of neglect in childhood.
We then give an overview of clinical guidelines stemming from trauma-informed
interventions with traumatised children and their families.

Child Neglect and Posttraumatic Stress Disorder (PTSD) Symptoms

Child neglect is a ‘failure to provide minimum standards of care as well as

adequate supervision’ (Cicchetti and Valentino, 2006, p. 132). It is the most
common type of child maltreatment, with estimated prevalence rates of
163/1000 for physical neglect and 184/1000 for emotional neglect
(Stoltenborgh et al., 2013). Surprisingly, very few empirical studies have
specifically examined the relation between child neglect and trauma
symptomatology. One of the first studies to document the link between child
neglect and trauma symptoms is Widom’s (1999) prospective study, in which
she assessed the risk of developing adult PTSD after having been exposed to
childhood maltreatment experiences (including physical abuse, sexual abuse
and neglect). Results of this study showed that 31 per cent of participants victim
of child neglect met lifetime PTSD diagnosis. There was also a significant
relationship the link between childhood neglect and the number of PTSD
symptoms was only marginally significant. However, when controlling for the
‘Child neglect… is effect of eight other factors (e.g. having a parent who was arrested or had
associated with alcohol or drug problems), the link between childhood neglect and a lifetime
PTSD diagnosis and the number of symptoms was only marginally significant.
increased risk of Since Widom’s pioneer work, other studies conducted with neglected children
developing trauma- and adolescents have shown that child neglect, alone or in combination with
related symptoms’ other forms of maltreatment or risk factors, is associated with increased risk
of developing trauma-related symptoms (dissociation and posttraumatic
intrusion/avoidance/hyperarousal) as early as the preschool years. In a study
conducted with neglected and non-neglected/non-maltreated preschoolers,
Milot et al. (2010a) reported that neglected children show higher levels of both
PTSD and dissociative symptoms than non-neglected/non-maltreated ones. In
another study conducted with maltreated preschoolers in foster care, Hulette
et al. (2008) found no significant difference in the levels of PTSD and
dissociative symptoms between children who had only experienced neglect
(without other forms of maltreatment) and children who had been physically
or sexually abused (with or without neglect). Also, in a study assessing the
effects of multiple forms of child maltreatment in a sample of adolescent
inpatients, Sullivan et al. (2006) observed relationships between childhood
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
 Child Neglect and Complex Trauma 91

experiences of physical and emotional neglect and PTSD symptoms in ‘We address two
adolescence. However, in this study, when the presence of other forms of child potential mechanisms
maltreatment was taken into account, the relationships between emotional and
physical neglect and PTSD were no longer significant. In the next paragraphs, that may underlie the
we address two potential mechanisms that may underlie the traumatic nature traumatic nature of
of neglect: (1) the key role of parent-child relations; and (2) child neglect as a neglect’
risk factor for other forms of traumas.

The Key Role of the Parent-Child Affective Relationship

Children, in particular very young children, rely mostly on their caregivers for
physiological, emotional and behavioural regulation. Especially in stressful
situations, mothers and fathers may serve as external regulators of children’s
overwhelming feelings. Without this external support, it might be very challenging
for a child to get back to homeostasis. Unfortunately, neglected children often rely
on unavailable, unreliable or unpredictable caregivers who may fail to offer the
necessary support when needed. Literature on parent-child relationships in ‘Neglectful mothers
neglectful families suggests that parents show many difficulties when interacting are generally less
with their children. For example, Edwards et al. (2005) observed that neglectful interactive than non-
mothers are generally less interactive than non-neglectful mothers. Neglectful
mothers also provide less support in response to their child’s emotional displays
neglectful mothers’
(Bousha and Twentyman, 1984) and are less accurate at labelling infant’s
emotions (Hildyard and Wolfe, 2007). Consequently, neglected children may be
at risk of experiencing long-lasting stressful psychological states, even when
dealing with normative challenging situations.
In order to test the hypothesis that an unavailable caregiver may be a risk factor
for developing PTSD symptomatology in childhood, Milot et al. (2010a)
examined the links between child neglect, the affective quality of mother-child
communication (as a proxy of mother’s availability) and a child’s PTSD
symptomatology in a sample of 33 neglected and 72 non-neglected children
(mean age: 60 months). PTSD symptoms and dissociation – a related feature of
trauma symptomatology – were measured using preschool teacher reports,
whereas the affective quality of mother-child communication was assessed during
an unstructured observational context. Teachers reported more dissociative and ‘Teachers reported
PTSD symptoms in neglected children than in non-neglected ones. Moreover, more dissociative and
consistent with other studies, results showed a lower quality of mother-child
affective communication in neglectful dyads when compared to non-neglectful PTSD symptoms in
dyads. Further analyses revealed that the quality of mother-child communication neglected children’
is an important factor contributing both to dissociative and PTSD symptoms in
neglected children, even after having controlled for child neglect status. These
findings lend further support to the assumption that child neglect is associated with
higher risks of developing trauma symptomatology. They also suggest that the ‘The ability to express
ability to express and share emotions (both positive and negative) with an and share emotions…
attachment figure is a key factor for the development of emotional self-regulation,
thus supporting the role of a deficient parent-child affective relationship as a with an attachment
mechanism linking child neglect and the development of trauma symptomatology. figure is a key factor
for the development of
Child Neglect as a Risk Factor for Other Forms of Trauma
emotional self-
Besides the intrinsic traumatic nature of parent-child relationships in regulation’
neglectful families, another way in which being neglected may be a
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
92 Milot et al.

traumatic experience relies on the fact that children who are neglected by
their caregivers are also more at risk of being exposed to other forms of
trauma. First, neglected children are at risk of experiencing other forms of
maltreatment, such as physical abuse, domestic violence, etc. (Armour
et al., 2014). In their analysis of child welfare case records of an urban,
ethnically diverse sample of youths, Mennen et al. (2010) reported that 95
per cent of the neglect cases were accompanied by other types of
maltreatment. Moreover, several studies have shown that experiencing
multiple forms of trauma is associated with greater difficulties (e.g. Cloitre
et al., 2009; Finkelhor et al., 2007; Hodges et al., 2013). Also, many
neglected children do not receive appropriate supervision, which may
increase the risks of being exposed to trauma and violence. In a prospective
study conducted over a five-year period, Manly et al. (2013) examined the
interrelations between severity of child neglect at age four, level of
neighbourhood crime from age four to six and teachers’ evaluation of
‘They observed an externalising problems at age nine. They observed an association between
association between severity of neglect and neighbourhood crime, with severely neglected
children living in the neighbourhoods with the highest number of violent
severity of neglect and crimes. Interestingly, although severity of child neglect was related with a
neighbourhood crime’ later level of externalising problems, this relation was mediated by the level
of neighbourhood crime.

PTSD Symptoms as a Path to Other Difficulties

Many studies conducted with victims of child abuse and neglect have shown
that PTSD symptomatology may be considered as a psychological mechanism
linking child maltreatment to psychosocial maladjustment. In a recent study
conducted with maltreated and non-maltreated children, Milot et al. (2010b)
observed that trauma symptomatology was a significant predictor of both
internalising and externalising behaviours. In another study conducted with
1317 adolescents, Wolfe et al. (2004) found that trauma-related symptoms
mediated the relation between experiences of childhood maltreatment and
dating violence. Another study conducted with victims of child maltreatment
showed that trauma symptomatology was a predictor of non-suicidal self-
injury in adolescence (Shenk et al., 2010). Another study conducted with
women who were sexually assaulted in adolescence indicated that
posttraumatic stress symptoms partially mediated the relation between sexual
assault severity and health outcomes (Eadie et al., 2008). Finally, a study
conducted with a community sample showed that posttraumatic symptoms
(as well as affect dysregulation) mediate the relation between accumulated
exposure to several types of interpersonal trauma and dysfunctional avoidance
behaviours (Briere et al., 2010)

‘Several authors have Trauma-Related Symptomatology: Broadening the Scope

called for a broader
Although the construct of PTSD has been quite helpful in studying difficulties
conceptualisation of related to child abuse and neglect, several authors have called for a broader
trauma’ conceptualisation of trauma, which is usually referred to as complex trauma
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
 Child Neglect and Complex Trauma 93

or developmental trauma disorder (Cook et al., 2005; Ford and Courtois, 2009;
van der Kolk et al., 2009). According to these authors, PTSD symptomatology
only accounts for a subset of the numerous difficulties generally observed in
neglected and abused children. PTSD diagnosis mainly relies upon three clusters
of symptoms (now 4 clusters in the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorder, American Psychiatric Association, 2013), namely,
the re-experiencing, avoidance and hyper arousal clusters. However, evidence ‘Neglected children…
from both clinical experience and the scientific literature indicates that neglected
children – as well as abused children – are at risk of presenting a much wider are at risk of
range of developmental difficulties, such as severe and persistent emotional presenting a much
and behavioural dysregulation (Dubowitz et al., 2002; Erickson and Egeland, wider range of
2002), social isolation and withdrawal (Horwath, 2007), and dissociation
(Hulette et al., 2008; Macfie et al., 2001; Milot et al., 2010a).
developmental
The construct of complex trauma, which first appeared in the early 1990s, difficulties’
has been increasingly called upon in recent years to better describe and
understand the widespread diversity and great severity of developmental
sequelae associated with child abuse and neglect. The label ‘complex’ was first
used by Judith L. Herman (1992) in her work with patients who were
repeatedly abused during their childhood. In her work, Herman referred to
complex PTSD (CPTSD) to describe the complexity of clinical symptoms
presented by these patients, including alterations in relationships, identity ‘Herman argued that
disturbance and alterations in systems of meaning. Herman argued that response to trauma is
response to trauma is best understood as a spectrum of conditions (in
opposition with a single disorder), and emphasised the importance of
best understood as a
interpreting patient’s complex symptomatology in the light of past (or present) spectrum of
disturbed relationships. A few years before Herman’s formulation of CPTSD, conditions’
Finkelhor and Browne (1985) stated that the PTSD concept was insufficient
to explain the numerous consequences resulting from sexual abuse. Among
other things, they argued that PTSD symptoms did not account for the variety
of symptoms observed in victims of sexual abuse. They also argued that the
strict use of the PTSD concept for understanding the consequences of sexual
abuse may cause prejudice among victims who did not meet criteria for PTSD
diagnosis, thus leading to erroneously concluding that they were less
traumatised. To better account for the range and variety of symptoms found in
victims of sexual abuse, they proposed a more complex model – the
Traumagenic Dynamics Model. In 1991, another clinician and theorist, Leonor
C. Terr, emphasised the importance of distinguishing between two types of
trauma in childhood. The first type of trauma (to which she referred to as type
I traumas) results from a single unexpected event (e.g. accident), and generally
leads to the conditioning of behavioural and physiological responses related to
this specific event. On the other hand, the type II traumas result from multiple, ‘Type II traumas result
long-lasting or repeated exposure to extreme events, such as child maltreatment, from multiple, long-
and have a more negative effect on the development of emotional and lasting or repeated
behavioural self-regulation skills, including psychic numbing, rage, dissociation,
somatisation and changes in the perception of self and others. exposure to extreme
Ford and Courtois (2009) define complex trauma as: (1) involving repeated events’
or prolonged exposure to traumatic agents; (2) involving direct harm,
abandonment or neglect from caregivers or responsible adults; (3) occurring
during key stages of development; and (4) posing a severe threat that may
seriously jeopardise the development of the child. Complex trauma covers
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
94 Milot et al.

situations in which children grow up in chaotic, scary and unpredictable

environments, requiring constant adaptation in order to cope with the threats.
Given the number of people who may be involved (parents, siblings, etc.)
and the great vulnerability of children, the consequences of complex trauma
are numerous and they may persist throughout life. Complex trauma is
considered a developmental trauma in that normal development is severely
altered, many developmental areas being affected (van der Kolk et al., 2009).
‘Children growing up Children growing up in a violent and neglectful environment must devote most
of their resources to survival. These particularly stressful events provoke a
in a violent and
series of neurobiological reactions, including the activation of the various
neglectful systems involved in dealing with stress (e.g. the limbic system and the
environment must neuroendocrine system). These systems predispose the body to efficiently react
devote most of their to various stressors. They are adaptive and they allow for the individual’s
survival. However, exposure to chronic stress – as might be the case for a
resources to survival’ neglected child – may alter the normal functioning of these systems and
profoundly impact a child’s development (see de Bellis, 2005, for a review
of the impacts of child neglect on brain development). According to Briere’s
(2002) Self-Trauma Model, the deficits in self-capacities often observed in
maltreated children – such as deficits in affect regulation – impede the normal
processing of both conditioned emotional responses and distorted cognitions
resulting from trauma. As Briere notes, the survivor of extreme abuse and
neglect may have to deal with both the triggering of sudden abuse-related
stimuli and the absence of effective emotional regulation skills. This may put
the child at risk of experiencing a prolonged overwhelmed emotional state,
which may lead to the use of massive avoidance strategies and a chronic
dissociative state.

Clinical Guidelines Stemming From Trauma-Informed Interventions

‘For many clinicians For many clinicians and researchers, the construct of complex trauma has
and researchers, the proven helpful for a better understanding of the consequences of child abuse
and neglect as well as informative for the development of trauma-informed
construct of complex interventions. Theoretical and clinical literature on the traumatic nature of
trauma has proven child maltreatment is burgeoning and several evidence-based intervention
helpful’ programmes for traumatised children and adolescents have emerged such as
Trauma-Focused – Cognitive-Behavioral Therapy (Cohen et al., 2006),
Integrative Treatment of Complex Trauma for Adolescents (Briere and
Lanktree, 2012), Attachment, Self-Regulation and Competency (Blaustein
and Kinniburgh, 2010), Attachment and Biobehavioral Catch-up Intervention
(Dozier et al., 2005), Child-Parent Psychotherapy (Lieberman, 2004) and
Être (Éthier, 2010). The positive effects of these different programmes on
the functioning of traumatised children and adolescents have been
empirically supported (Bernard et al., 2012; Cohen et al., 2012; Éthier,
2010; Ghosh Ippen et al., 2011; Hodgdon et al., 2013; Lanktree et al.,
2012). These programmes all include a coherent and specific set of
intervention strategies. Despite the fact that these programmes may vary in
terms of a targeted population (e.g. age group, individual child vs parent-
child dyad) and intervention goals (e.g. reducing trauma symptoms,
improving child adaptation), it is possible to identify a number of
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
 Child Neglect and Complex Trauma 95

intervention guidelines that may be considered when working with severely

neglected children and their families. In the following sections, we give an
overview of these guidelines.

Assessing Trauma Experiences and Sequelae

An important step of a trauma-informed intervention is to conduct an
exhaustive assessment of the characteristics of traumas experienced by the
child (e.g. type of trauma, age of onset, duration, etc.) and the strengths and
weaknesses within both the child and the child’s environment. There is an
abundant literature addressing the multiple consequences of child neglect,
suggesting that child victims of neglect are at risk of developing difficulties
in several domains. However, although complex trauma is hypothesised to
impact several developmental spheres, specific complex traumatic responses ‘Specific complex
may vary from one child to another. As noted by Briere and Spinazzola traumatic responses
(2009, p. 117), a:
may vary from one
‘one-size-fits-all diagnosis often is untenable. […] the clinician should consider the entire child to another’
range of posttraumatic responses potentially attributable to a given client’s history and risk
factors.’

Carefully and properly assessing a child’s environment and trauma history and
his/her current level of functioning will help tailor the intervention to the
child’s needs as well as identify resiliency domains that can serve as building
blocks for recovery.

Providing a Safe Environment

Creating a sense of safety for the child should be one of the first objectives of
the intervention (Lieberman, 2004). For neglected children whose daily life is
characterised by a lack of structure and routines and the occurrence of
unpredictable potentially traumatic events, it appears particularly important to
focus on establishing an environment that is safe for the child. In a more
predictable environment, the child will be better able to develop adequate
physiological monitoring and start learning from new experiences. This first
phase of the intervention, to develop a safer environment at home, should be
done in collaboration with youth protection services. The safety of the living ‘The safety of the
environment must be maintained throughout the interventions with the child living environment
and parent.
must be maintained
Building a Feeling of Emotional Security throughout the
Neglected children are particularly at risk of developing an insecure attachment
interventions with the
to the parent, including a disorganised attachment (e.g. Cicchetti et al., 2006; child and parent’
Moss et al., 2011). Yet, it is through the attachment relationship with their
caregivers that children learn to regulate their emotions and behaviours and
form their identity (Bowlby, 1988). The sense of emotional security that stems
from a healthy parent-child relationship allows children to effectively explore
their inner world and to experience emotions without being overwhelmed by
them. It is also through this relationship that children gradually develop the
capacity to face diverse stressful situations which can vary in intensity, and that
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
96 Milot et al.

they acquire the self-regulatory skills necessary to cope with the challenges
‘A secure base is a they encounter. According to Bowlby (1988), a secure base is a crucial element
crucial element for the for the success of psychotherapy. Intervention with neglected children who
show insecure attachment should aim at restoring a feeling of affective security.
success of In order to do so, it is important to create a stable emotional environment for
psychotherapy’ the child. If the child lives with his/her biological parents, it is often necessary
to offer support to the parents and give them tools that will help them provide a
more secure and predictable environment.

Improving Parental Sensitivity

Traumatised neglected children sometimes have reactions that may seem
excessive, uncontrolled and unjustified. It might be particularly difficult for
parents to identify and understand the underlying causes and the real nature
of these behaviours or reactions. Understanding the reactions of the child is
much easier when the parent is aware of his/her own feelings when facing
the child’s behaviours. Parents of neglected children have often been
maltreated in their childhood (Milot et al., 2014) and the child’s
manifestations of stress might evoke in them powerful negative feelings that
are related to their own past traumatic experiences. Consequently, they may
feel rejected, attacked or humiliated by their child and respond accordingly.
Furthermore, even though the parent might eventually understand the
underlying causes of the child’s extreme reactions (and link them with trauma
experienced by the child), it can be quite challenging for any adult to face a
child in crisis, who appears terrified or displays aggressive behaviour. The
child’s behaviours might trigger feelings of anger, hostility or helplessness
‘Parents who develop in parents. Parents who develop good emotional regulation skills can support
good emotional their child more effectively in difficult situations. In the context of child
protection services, offering group or individual counselling to parents in
regulation skills can order to support parenting and improve sensitivity to the child’s needs and
support their child signals is often necessary. Recent studies with maltreating families have
more effectively’ shown that attachment-based intervention programmes are particularly
efficient at increasing parental sensitivity and fostering child attachment
security (Cicchetti et al., 2006; Moss et al., 2011).

Developing Child Emotional Self-Regulation

A major deficit quite common among maltreated children is the lack of
adequate emotional self-regulation (Dubowitz et al., 2002; Kim-Spoon et al.,
2013; Shields and Cicchetti, 2001). Self-regulatory skills are a necessary
building block towards healthy social and emotional adjustment. They become
even more critical as a tool to promote resilience or recovery following trauma
exposure. Therefore, intervention with neglected children, and especially
severely neglected ones, should favour the acquisition of emotional self-
regulatory skills. Many neglected children have difficulty using words to
describe their internal world and their subjective experience (Beeghly and
Cicchetti, 1996), and they also lack the ability to relate their feelings with
external or internal stimuli (i.e. to understand the reasons [causes] underlying
their feelings). Traumatised children may also fail to differentiate between
positive and negative feelings, which leaves them with no clear comprehension
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
 Child Neglect and Complex Trauma 97

of what they are experiencing. Thus, a key step of the intervention should be to ‘A key step of the
help them identify and understand their emotions and feelings, as well as learn intervention should be
to modulate and express them adequately. This can be done using various
intervention strategies, such as the identification of emotions from images, to help them identify
stories, puppets, or from verbalisations uttered by the child. and understand their
emotions and feelings’
Offering Emotional Therapeutic Support to the Parent
Neglected children often come from families where the parents themselves
have been traumatised. In a study conducted with mothers from neglectful
families, Milot et al. (2014) observed that a majority had experienced trauma
during their childhood, and that, for many, traumatic psychological processes
related to these experiences were still active in adulthood. It is likely that these
past traumas interfere with the exercise of their parental role. According to the
attachment literature, parents with unresolved traumas are more at risk of
adopting atypical parental behaviours (Lyons-Ruth et al., 2005) and
frightened/frightening behaviours (Main and Hesse, 1990) which, in turn, are
associated with increased risk for the child to develop a disorganised
attachment. Therefore, intervention should incorporate strategies which
include offering emotional therapeutic support, not only to the child, but also
to the parent. According to Moran and colleagues (2008), this therapeutic
emotional support should include an acknowledgment of the parents’ trauma
history and helping them realise how these past experiences might exert an
influence on their capacity to engage and interact with significant others, in
particular with their own child. One important aspect of the intervention should
be to:

‘assist parents in reflecting on how past experiences trigger defensive processes that
materialise within the mother-child relationship, so that they can use this insight to change
their responses’ (Moran et al., 2008, p. 390)

Therapeutic efforts should also be devoted to increasing parents’ coping skills

such as emotional and behavioural regulation, distress tolerance and self-
reflectiveness. Finally, great caution must be observed when working with
traumatised parents who may be particularly fragile and not yet ‘Traumatised parents…
psychologically ready to ‘work through’ their traumas (Moran et al., 2008). may be particularly
fragile and not yet
Conclusion psychologically ready
to ‘work through’ their
The theoretical, clinical and empirical developments in the last two decades
concerning the importance of trauma sequelae among victims of maltreatment traumas’
have alerted clinicians and researchers to the wide range of developmental
spheres that are negatively impacted by severe and chronic neglect. A growing
number of studies have highlighted the relationship between child neglect and
trauma symptomatology (e.g. Hulette et al., 2008). However, whether this
relationship is direct, indirect or confounded by other variables still needs to
be clarified. Recent findings have shown that a low quality of mother-child
affective communication may contribute to this relation (Milot et al., 2010a),
suggesting that improving parental sensitivity to the child’s emotional needs
might constitute a key factor in improving neglected children’s functioning.
Copyright © 2015 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 25: 89–101 (2016)
DOI: 10.1002/car
98 Milot et al.

The central role of sensitive and supporting caregivers surrounding or following

traumatic experiences is also highlighted in another study which revealed that
‘Supportive parenting supportive parenting during childhood is associated with improved
psychological adjustment in adult survivors of childhood sexual abuse (Godbout
during childhood is
et al., 2014). In addition, other studies (e.g. Sullivan et al., 2006; Widom, 1999)
associated with have shown that the presence of certain risk factors, such as being exposed to
improved other forms of abuse and parental difficulties, may contribute to the development
psychological of trauma symptomatology in victims of child neglect. These findings highlight
the necessity to conduct a proper assessment of the child’s family environment
adjustment in adult as well as his/her trauma history prior to intervention in order to ensure that
survivors’ the intervention is well suited to the child’s specific needs.
Finally, considering neglect from a traumatic stress perspective underlines
the complexity of how best to intervene with neglected children and their
families, and suggests that several targets of intervention might be considered
‘Several targets of for better results: the child, the parent, the parent-child relationship and the
intervention might be overall family environment. In the last decade, a number of innovative
intervention programmes have been developed for traumatised maltreated
considered for better children and adolescents. Based on these different programmes, it is possible
results’ to identify some key intervention guidelines: providing a safe environment
for the child, building the child’s feeling of emotional security, developing
his/her emotional self-regulation, improving parental sensitivity and offering
emotional therapeutic support to the parent. Yet, in order to foster intervention
strategies specifically designed for neglected children, further research should
address questions such as how do trauma symptoms develop and evolve in
neglected children, are there moderating and mediating factors associated with
trauma symptomatology in neglected children, and are some trauma-informed
approaches more effective than others with severally neglected children?

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