Rachel Wood – Recruitment Manager

Rachel Wood is the Recruitment Manager for Positive Care Ireland. Rachel originally began her career in the world of theatre and gradually moved to more office based roles on the production side before making the transfer to the field of recruitment. Rachel has over 10 years experience in recruitment, having started her career with a large recruitment agency where she set up and managed the nursing desk and a number of overseas recruitment drives for the growing private hospital sector.

Since joining Positive Care Ireland in 2010 Rachel has worked closely with the Unit Managers, Regional Managers and Directors ensuring that our staffing levels grow as the company does and that we have the highest quality of staff available at all time to work with our young people. Ensuring that all skills and talents are utilized to the best advantage of the team and the young people.

Early Stress Exposure:Concepts, Findings and Implications with Particular Emphasis on Attachment Disturbances

Early intervention studies have been noted for their efficacy in Psychological literature for many years. This is an interesting hypothesis as these findings may be applicable to young people who are in a care setting. Such research highlights the significance of early intervention and allows us to ascertain the impact of such interventions on later development. This article which is a literature review on the aforementioned research investigates the efficacy of this claim as evidenced by recent studies. The authors argue that recent research which demonstrates the efficacy of early intervention studies are methodologically flawed as they rely solely on animal studies. They also review the implications of these studies for the conceptualisation of early treatment in terms of child parent attachment.

Two models of early stress exposure and the effects such exposure has on the individual (if any) are the cumulative risk model and the developmental programming model. The cumulative model posits that the effects of early risk exposure can be limited if protective measures are introduced early on in the trajectory. The developmental programming model proposes that such exposure could possibly have long term effects on development. Indeed, as noted in this article, many of the earlier studies which investigated this hypothesis demonstrated a correlation between early stress exposure and biological and behavioural development. These findings were limited in their generalizability however as most of this research was initially conducted with animals. The reason such a sample was chosen is that it is extremely difficult to control for psychosocial factors (such as poverty exposure to violence etc.) with young people. Recently however there has been more of an emphasis on attempting to demonstrate the efficacy of this claim with young people. Recent studies have demonstrated a correlation between social and cognitive development deficits and early exposure to deprivation despite (ex-institutionalised children) living in a low/normal risk home. It is not clear whether any other type intervention (apart from removal from the home) was used in this study. A significant amount of later studies also indicated that traditionally, young people who were placed in institutional care developed social, cognitive and behavioural impairments in later life. This led to the classification of reactive attachment disorder in the DSM and ICD. This classification posits two types of disorder which are linked to early caregiver disturbances: Disinhibited (‘indiscriminately friendly’) and inhibited (withdrawn, hypervigilant) forms. An adoptee study which was conducted in England and Romania demonstrated approx. 30% of children who experienced 24-42 months of institutionalised care exhibited a severe disrupted disturbance. This finding indicates that only a minority of children are effected by exposure to early stress in the long term and that interventions can be effective in the outcomes for such children. There is also evidence that intervention does not necessarily have a positive effect on all children. Later studies demonstrated that such disturbances are not linked to institutionalised care but rather to caregiver (parental) deprivation.

A certain amount of caution should be exercised when interpreting these findings. Whilst they seem to indicate that intervention (removal from environment) can be effective in the improvement of outcomes for those exposed to early stress, this finding cannot be generalised. In addition, the literature reviewed in this article did not contain a randomized control trial. Therefore these studies are methodologically flawed.

The full text of this report is available in the Child and Adolescent Psychiatry and Mental Health journal.