The Impact of a Neurocollaborative Theraplay® Informed Intervention on the Presentations of Developmental Trauma and Attachment Difficulties in Adopted Children with Prenatal Alcohol Exposure: An Extended Case Study

Purrington, Jack; Price, Alan D; Godfrey, Chloe; Lynch, Jacqueline; Cook, Penny A; Raja, ·; Mukherjee, A S; Price, Alan D

Abstract

The UK incident rate of Fetal Alcohol Spectrum Disorders (FASD) in looked after populations is estimated to be 27%. The vast majority of these children enter care due to experiences synonymous with the prodromal stages of developmental trauma and all of them experience some form of attachment disruption. The intersection between developmental trauma, attachment disruptions, prenatal alcohol exposure (PAE), and FASD is an emerging and complex research area however there are currently no evidence based interventions specifically designed for young people with both FASD and early life trauma. Therefore, the purpose of this extended case study is to explore the impact of a novel, practice-based, neurocollaborative Theraplay®-informed intervention on the presentations of developmental trauma and attachment difficulties in adopted children with PAE. The study was based in a specialist trauma and attachment service based in the North of England. A total 16 families engaged in a therapeutic intervention based on the principles of Theraplay, sensory interventions, and Dyadic Developmental Parenting. Outcomes were measured on the Trauma Symptom Checklist for Young Children (TSCYC), the Child Behaviour Checklist (CBCL), the Behaviour Rating Inventory of Executive Function, and the Assessment Checklist for Children. The TSCYC Depression subscale demonstrated a significant difference following therapy with a further three TSCYC scales approaching significance. Clinically meaningful change was also demonstrated for several participants across the outcome measures. Implications and limitations are discussed. It is hoped that this study can provide proof of concept for interventions targeting pre-and post-natal adversities such as PAE and developmental trauma. Keywords Prenatal alcohol exposure · Trauma · Attachment disruption · Adoption · FASD The term Fetal Alcohol Spectrum Disorder (FASD) is uti-lised to describe the wide range of lifelong neurobiological differences which are experienced by certain individuals who experience prenatal alcohol exposure (PAE) during gestation (Popova et al., 2023). Worldwide, an estimated prevalence of PAE places Ireland (60.4%), Belarus (46.6%), UK (41.3%), Denmark (45.8%), and Russia (36.5%) as the top five countries with the highest rates of prenatal alcohol exposure; see Popova et al. (2017) for a comprehensive overview by country and region. However, it is important to note that rates of PAE do not coherently correspond to prevalence of FASD in the general population. Research suggests that factors such as frequency, intensity, duration, onset, and pattern of alcohol exposure, alongside genetic and environmental factors may influence the relationship between PAE and FASD (Popova et al., 2023). Separately therefore, Lange et al. (2017) completed a meta-analytic global prevalence study of FASD in children, reporting estimated rates to be 4.8% in Ireland, 3.7% in Belarus, 3.2% in the UK, 3.6% in Denmark, and 2.9% in Russia. However, some of the most prevalent figures included rates of 11

• Journal Article Type: Article
• Acceptance Date: Apr 29, 2025
• Online Publication Date: May 31, 2025
• Deposit Date: Jun 3, 2025
• Publicly Available Date: Jun 3, 2025
• Journal: Journal of Child & Adolescent Trauma
• Print ISSN: 1936-1521
• Electronic ISSN: 1936-153X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s40653-025-00715-z
• Additional Information: Accepted: 29 April 2025; First Online: 31 May 2025; : ; : The first and fourth author are currently employed at the host service in which this piece of research took place however the authors feel that this did not present a conflict of interest particularly as all data analysis was completed independent of the host service by the second author.