Healing the child when one parent kills the other: Rosie Waterhouse reports on the forgotten 'orphans' and how psychiatrists are helping them to deal with post-traumatic stress disorder

THE RESULTS of a study into the effects on children when one parent kills the other are to be presented at a conference of child psychiatrists next month.

Every year in England and Wales the courts convict between 40 and 50 men and a handful of women of killing their partners, leaving any children effectively orphaned.

Until recently there was no specialist knowledge or service for such bereaved children. Academic papers had considered the possibility of psychological problems, such as post-traumatic stress disorder, but not how best to treat and counsel these children; how to assess where they should live in the short and long term; how to help them grieve; how to decide on contact with the surviving parent; and ultimately how to enable them to grow up without too many emotional and psychological scars.

Last year at the Royal Free Hospital in Hampstead, north London, a special clinic opened for children who have suffered acute psychological trauma. And on 1 September at a conference of the Association of Child Psychologists and Psychiatrists in Winchester, Hampshire, Dr Dora Black, the child psychiatrist in charge of the clinic, will present the findings of the world's first study into the effects on children after one parent has killed the other. The research was conducted with other child psychiatrists involved with the clinic, Dr Jean Harris Hendricks and Dr Tony Kaplan.

Since 1986 they have seen 270 children from about 100 families; in about 12 cases the mother was the killer. The treatment tries to limit post- traumatic stress symptoms through 'crisis intervention' thus preventing, they hope, long-term emotional and psychological problems.

The doctors help the children talk about what they saw and how they feel. The child is encouraged to draw a picture or tell a story about the traumatic experience. 'Families' of dolls are also used to help re-enact the scene.

In their book When Father Kills Mother: Guiding Children through Trauma and Grief, the doctors draw up basic principles for dealing with the impact on children and the aftermath.

In their study of the first 100 children, one notable finding was that 40 per cent of the children were under five at the time of the killing. This is consistent with other reports that marital satisfaction is at its lowest when there is a child under five in the house, and the more children under five the greater the risk of clinical depression in the mother. Other common factors were previous violence and wife battering, alcoholism leading to violence and jealousy.

In their latest follow-up survey of the original 100 children, the findings showed a remarkable apparent recovery in many. Asked how many children had suffered further emotional, behaviour or psychosomatic problems, (such as stomach pains, asthma and anorexia nervosa) the responder said the majority showed no outward signs of such problems. About 30 per cent showed signs of suffering emotional problems, 26 per cent behaviour problems and 3 per cent psychosomatic problems.

Asked about the effectiveness of the doctors' brief intervention, the respondents estimated that 18 children had improved significantly, 16 had improved marginally, 17 were the same, one was worse and in 9 cases the outcome was not known. The child who deteriorated was believed to have reacted badly to the intensive debriefing conducted by the doctors.

Explaining the results, Dr Kaplan said the estimates of emotional problems had probably been underestimated because the children themselves were not asked how they felt. However, he said: 'Some children are remarkably resilient and are able to overcome extreme adversity while others will receive a quality of care which will confer that resilience on them . . . The most important factor is the quality of care they receive after the loss.'