Disorganised attachment, child maltreatment

and the unique role of health visitors

Professor David Shemmings OBE PhDUniversity of Kent UK

Visiting Professor of Child Protection Research

Royal Holloway University of London

co-Director of the ADAM Project and co-Director of the

University of Kent’s online Child Protection Centre

Director of the West London Advanced Child Protection Pathway

d.shemmings@kent.ac.uk

importance of ‘base rate’ in risk assessment and

the ‘fallacy of reverse inference’

Mental ill-health

27% in SCRs

But 25% in Gen Pop

Substance misuse

44% in SCRs

But 34% in Gen Pop (9% drug; 25% alcohol)

Domestic Abuse

34% from SCRs

But 24% in Gen Pop

Ch

ild m

altre

atm

en

tCa

rer

risk

fac

tors

Assessment …‘At a distance’

Linkages, mechanisms, pathways

disconnected parenting

extremely insensitive parenting

disorganised

attachment

behaviour (there may be

sub-divisions)

unresolved loss

and trauma

low mentalising

capacity

dissociation /

PTSD

(Other – e.g. one-off extreme violence, family suicide/homicide)

DRD4 7+ polymorphism, MAO-A, 5HTT … and other influences?

Ch

ild m

altre

atm

en

tCa

rer

risk

fac

tors

Impulsivity , low

distress tolerance,

low consequence

appraisal

enhanced communication skills

Needed for assessment, help and

support … but also to share

concerns

Intelligent kindness

Unsentimental compassion

Non-directive – i.e.‘gentle’ - curiosity

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