The psychobiology of neglect

Identifying Maternal Depression in Pediatric Primary Care: Changes Over a Decade

OBJECTIVE

Maternal depression affects 10% to 40% of mothers with young children and has negative consequences for children's health and development. The American Academy of Pediatrics (AAP) recommends that pediatricians identify women with maternal depression. The authors examined trends in inquiring about (asking informal questions) or screening for (using a standardized instrument) maternal depression by pediatricians in 2004 and 2013 and identified correlates of usually inquiring/screening to identify maternal depression.

METHODS

Data were ascertained from 778 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2004 (n = 457) and 2013 (n = 321) AAP Periodic Surveys. Pediatricians answered questions about physician and practice characteristics, training, attitudes, and inquiring/screening to identify maternal depression. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted.

RESULTS

The prevalence of usually inquiring/screening to identify maternal depression increased from 33% to 44% (p < .01). In both years, pediatricians who usually inquired about child/adolescent depression had increased odds of usually inquiring/screening to identify maternal depression. Patient race/ethnicity and training in adult Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for depression were associated with inquiring/screening in 2004, and believing that family screening is within the scope of the pediatrician was associated with inquiring/screening in 2013.

CONCLUSION

Although inquiring/screening about maternal depression has increased since 2004, less than half of pediatricians usually screen or inquire about maternal depression, representing a missed opportunity to identify depression and manage or refer women for treatment. Further training on the importance of mental and family health to children's health may increase identification of maternal depression in pediatric primary care.

Multiple adverse experiences and child cognitive development

During childhood and adolescence, children's social environments shape their cognitive development. Children exposed to multiple adversities in their social environment are more likely to have poorer cognitive outcomes. These findings have prompted interest among pediatric and public health communities to screen and connect youth to appropriate interventions that ameliorate the detrimental effects of adverse exposures. Such intervention efforts can be improved with a stronger conceptual understanding of the relationship between multiple adverse exposures and child cognitive development. This includes disentangling adverse exposures from other risk factors or underlying mechanisms, specifying mechanisms of action, and determining when adverse exposures are most detrimental. This review summarizes findings from the literature on each of these areas and proposes a conceptual model to guide further research and intervention.

When mothering goes awry: Challenges and opportunities for utilizing evidence across rodent, nonhuman primate and human studies to better define the biological consequences of negative early caregiving

This article is part of a Special Issue "Parental Care".Across mammalian species, mothers shape socio-emotional development and serve as essential external regulators of infant physiology, brain development, behavior patterns, and emotional regulation. Caregiving quality, consistency and predictability shape the infant's underlying neurobiological processes. Although the requirements for "optimal" caregiving differ across species, the negative long-term consequences of the absence of needed caregiving (e.g. neglect) or the presence of harmful/aversive caregiving (e.g. physical abuse), are translatable across species. Recognizing the significant potential of cross species comparisons in terms of defining underlying mechanisms, effective translation requires consideration of the evolutionary, ecological, and fundamental biological and developmental differences between and among species. This review provides both an overview of several success stories of cross-species translations in relation to negative caregiving and a template for future studies seeking to most effectively define the underlying biological processes and advance research dedicated to mitigating the lasting negative health consequences of child maltreatment.

Childhood neglect predicts disorganization in schizophrenia through grey matter decrease in dorsolateral prefrontal cortex

OBJECTIVE

Psychosocial trauma during childhood is associated with schizophrenia vulnerability. The pattern of grey matter decrease is similar to brain alterations seen in schizophrenia. Our objective was to explore the links between childhood trauma, brain morphology and schizophrenia symptoms.

METHOD

Twenty-one patients with schizophrenia stabilized with atypical antipsychotic monotherapy and 30 healthy control subjects completed the study. Anatomical MRI images were analysed using optimized voxel-based morphometry (VBM). Childhood trauma was assessed with the Childhood Trauma Questionnaire, and symptoms were rated on the Scale for the Assessment of Negative Symptoms (SANS) and Scale for the Assessment of Positive Symptoms (SAPS) (disorganization, positive and negative symptoms). In the schizophrenia group, we used structural equation modelling in a path analysis.

RESULTS

Total grey matter volume was negatively associated with emotional neglect (EN) in patients with schizophrenia. Whole-brain VBM analyses of grey matter in the schizophrenia group revealed a specific inversed association between EN and the right dorsolateral prefrontal cortex (DLPFC). Path analyses identified a well-fitted model in which EN predicted grey matter density in DLPFC, which in turn predicted the disorganization score.

CONCLUSION

Our findings suggest that EN during childhood could have an impact on psychopathology in schizophrenia, which would be mediated by developmental effects on brain regions such as the DLPFC.

Social buffering of stress responses in nonhuman primates: Maternal regulation of the development of emotional regulatory brain circuits

Social buffering, the phenomenon by which the presence of a familiar individual reduces or even eliminates stress- and fear-induced responses, exists in different animal species and has been examined in the context of the mother-infant relationship, in addition to adults. Although it is a well-known effect, the biological mechanisms that underlie it as well as its developmental impact are not well understood. Here, we provide a review of evidence of social and maternal buffering of stress reactivity in nonhuman primates, and some data from our group suggesting that when the mother-infant relationship is disrupted, maternal buffering is impaired. This evidence underscores the critical role that maternal care plays for proper regulation and development of emotional and stress responses of primate infants. Disruptions of the parent-infant bond constitute early adverse experiences associated with increased risk for psychopathology. We will focus on infant maltreatment, a devastating experience not only for humans, but for nonhuman primates as well. Taking advantage of this naturalistic animal model of adverse maternal caregiving, we have shown that competent maternal care is critical for the development of healthy attachment, social behavior, and emotional and stress regulation, as well as of the neural circuits underlying these functions.

Parenting begets parenting: A neurobiological perspective on early adversity and the transmission of parenting styles across generations

The developing brains of young children are highly sensitive to input from their social environment. Nurturing social experience during this time promotes the acquisition of social and cognitive skills and emotional competencies. However, many young children are confronted with obstacles to healthy development, including poverty, inappropriate care, and violence, and their enhanced sensitivity to the social environment means that they are highly susceptible to these adverse childhood experiences. One source of social adversity in early life can stem from parenting that is harsh, inconsistent, non-sensitive or hostile. Parenting is considered to be the cornerstone of early socio-emotional development and an adverse parenting style is associated with adjustment problems and a higher risk of developing mood and behavioral disorders. Importantly, there is a growing literature showing that an important predictor of parenting behavior is how parents, especially mothers, were parented themselves. In this review, we examine how adversity in early-life affects mothering behavior in later-life and how these effects may be perpetuated inter-generationally. Relying on studies in humans and animal models, we consider evidence for the intergenerational transmission of mothering styles. We then describe the psychological underpinnings of mothering, including responsiveness to young, executive function and affect, as well as the physiological mediators of mothering behavior, including hormones, brain regions and neurotransmitters, and we consider how development in these relevant domains may be affected by adversity experienced in early life. Finally, we explore how genes and early experience interact to predict mothering behavior, including the involvement of epigenetic mechanisms. Understanding how adverse parenting begets adverse parenting in the next generation is critical for designing interventions aimed at preventing this intergenerational cycle of early adversity.

The moderating effect of relationships on intergenerational risk for infant neglect by young mothers

Infant neglect is the form of child maltreatment that occurs most often, yet has been least amenable to prevention. A maternal history of childhood maltreatment is a potent risk factor for child neglect, yet most maltreated mothers break intergenerational cycles of child abuse and neglect. Little is known about what protective factors support discontinuity in intergenerational transmission. This study examined whether certain factors (positive childhood care, older maternal age, social support) buffer intergenerational risk for neglect among the infants of young mothers, a population at high risk of being victimized. For young mothers in the sample (<21 years at birth; n=447), the effect of a maternal history was assessed separately for different maltreatment types according to data on substantiated reports from Child Protective Services. Early risk for neglect was assessed using maternal self-report of parenting empathy. The results revealed that both infants and their mothers experienced neglect more often than any other maltreatment type. However, approximately 77% of maltreated mothers broke the cycle with their infants (<30 months). Maternal age moderated the relation between a maternal history of neglect and infant neglect, and social support moderated the relation between childhood neglect and maternal empathy. Neglected mothers had considerably higher levels of parenting empathy when they had frequent access to social support than when they had less frequent support, whereas the protective effect of social support was not nearly as strong for non-maltreated mothers. Study findings highlight resilience in parenting despite risk for infant neglect, but underscore the context specificity of protective processes.

Factorial Validity of the Short Form of the Childhood Trauma Questionnaire (CTQ—SF) in German Psychiatric Patients, Inmates, and University Students

For the purpose of retrospective assessment and characterization of childhood trauma in adults, the factorial validity of the short form of the Childhood Trauma Questionnaire (CTQ–SF) in Germany was evaluated by conducting confirmatory factor analyses for three samples including 1,524 adult psychiatric patients, 224 inmates, and 295 university students. In addition, sex-specific confirmatory factor analyses were performed within each sample. Because several authors have suggested a different factor structure than that originally proposed in the manual, two competing models focusing on the Physical neglect subscale were examined. In psychiatric patients and inmates, the fit indices were reasonable to good. Among the students, factor loadings were markedly lower, and fit indices were poor. Sex-specific analyses did not indicate sex differences. Comparing the original and the alternative models revealed better fit indices of the original factor structure. The present findings indicate that the German version of the CTQ–SF has factorial validity in psychiatric patients and inmates, but not in students.

Moderation of maltreatment effects on childhood borderline personality symptoms by gender and oxytocin receptor and FK506 binding protein 5 genes

In this investigation, gene-environment-gender interaction effects in predicting child borderline personality disorder symptomatology among maltreated and nonmaltreated low-income children (N = 1,051) were examined. In the context of a summer research camp, adult-, peer-, and self-report assessments of borderline precursor indicators were obtained, as well as child self-report on the Borderline Personality Features Scale for Children. Genetic variants of the oxytocin receptor genotype and the FK506 binding protein 5 gene CATT haplotype were investigated. Children who self-reported high levels of borderline personality symptomatology were differentiated by adults, peers, and additional self-report on indicators of emotional instability, conflictual relationships with peers and adults, preoccupied attachment, and indicators of self-harm and suicidal ideation. Maltreated children also were more likely to evince many of these difficulties relative to nonmaltreated children. A series of analyses of covariance, controlling for age and ancestrally informative markers, indicated significant Maltreatment × Gene × Gender three-way interactions. Consideration of the maltreatment parameters of subtype, onset, and recency expanded understanding of variation among maltreated children. The three-way interaction effects demonstrated differential patterns among girls and boys. Among girls, the gene-environment interaction was more consistent with a diathesis-stress model, whereas among boys a differential-sensitivity interaction effect was indicated. Moreover, the genetic variants associated with greater risk for higher borderline symptomatology, dependent on maltreatment experiences, were opposite in girls compared to boys. The findings have important implications for understanding variability in early predictors of borderline personality pathology.

'Eventually you just get used to it': an interpretative phenomenological analysis of 10-16 year-old girls' experiences of the transition into temporary accommodation after exposure to domestic violence perpetrated by men against their mothers

Moving suddenly into temporary accommodation with their mothers is a reality for many children who live with domestic violence. The experience of this transition is under-researched despite being considered a unique event for children alongside that of being exposed to domestic violence involving their mothers. This piece of qualitative research aimed to address the following question: 'How do girls aged 10-16 years old experience the transition into temporary accommodation following exposure to domestic violence'? Five girls aged 10-16 years who had moved into either refuge or 'bed and breakfast' accommodation with their mothers were interviewed. Interviews were analysed using interpretative phenomenological analysis. Three master themes emerged: (1) 'Out of their hands: The transition into a whole new world with loss and change', (2) 'The relentlessness of feeling unsafe and uncertain', (3) 'Coping with the transition: At the mercy of their environment and the actions of others'. All themes show how a lack of agency was experienced by the girls throughout the transition. Findings suggest that the environment of temporary accommodation may inhibit the child's capacity to emotionally process the transition. The role of others was central to either facilitating or constraining coping for the girls throughout this transition.

An investigation of preschool teachers' recognition of possible child abuse and neglect in Izmir, Turkey

Child abuse and neglect have a potentially deleterious impact on children's physical, social, and psychological development. Preschool teachers may play a crucial role in the protection, early detection, and the intervention of child abuse and neglect, as they have the opportunity to establish a close contact with the families and to observe day-to-day changes in pupils' behavior. The main purpose of this study is to investigate preschool teachers' experiences and characteristics in relation to their awareness of possible child abuse and neglect signs. A questionnaire survey was designed and administered to 197 preschool teachers who work for the public preschools in the Izmir province of Turkey. In addition to the questionnaire items, a 34-item Likert-type scale measuring the level of familiarity with possible signs of child abuse and neglect was developed. This scale had an internal consistency of 0.94. The results revealed that 10.65% of preschool teachers had training regarding violence against children and 2.03% of them had training in child abuse and neglect. Overall, 35% of all teachers reported that they had prior experience with pupils who were exposed to child abuse and neglect. Moreover, statistical analyses indicated that being a parent and having training in child abuse and neglect, having experience with maltreated children, and having higher job status were significant factors in preschool teachers' ability to recognize the possible signs of child abuse and neglect. Our results support that teacher training in child abuse and neglect can play an important role in preschool teachers' awareness of the possible signs of child abuse and neglect.

Propagation of maternal behavior across generations is associated with changes in non-maternal cognitive and behavioral processes

Over a number of years we have studied the phenomenology of maternal behavior from endocrine, neural, experiential, and ontogenetic perspectives. Here, we focus on the effects of early life experiences with and without the mother on subsequent maternal and non-maternal behaviors of the offspring. We have used an artificial rearing procedure, which entails removing rat pups from their mother and raising them in isolation, while controlling and manipulating several aspects of their upbringing. As adults, mother-reared (MR) and artificially-reared (AR) rats are assessed on their own maternal behavior, as well several other behaviors. While both AR and MR rats nurse and successfully wean their young, the AR rats spend less time licking, grooming, and crouching over their young. Hence, being raised in social isolation does not seem to affect primary maternal motivational dynamics. Instead, isolation rearing produces alterations in the ongoing execution of the behavior and its effective organization. Here, we present evidence that changes in maternal behavior, as a result of social isolation from mother and siblings, are due to changes in top-down (e.g., sustained attention, flexibility) and bottom-up process (e.g., increased stimulus-driven behavior). These changes are likely due to alterations in brain dopamine systems, which are sensitive to early life manipulations and are modulators of bottom-up and top-down processes. Finally, we draw parallels between the rat and human maternal behavior. This article is part of a Special Issue entitled: In Honor of Jerry Hogan.

Review: Adoption, fostering, and the needs of looked-after and adopted children

BACKGROUND

This review of the literature examines adoption, fostering, and the needs of looked-after and adopted children. Three domains of research about looked-after children are examined.

FINDINGS

There is extensive evidence that early adverse experiences affect psychological and neurobiological development in looked-after and adopted children. There is also evidence that some looked-after and adopted children show remarkable resilience in the face of adversity; intervention research provides evidence of the ability to reduce risks and promote positive outcomes in this population. The intervention studies have revealed not only the potential for improved behavioral trajectories but also the plasticity of neurobiological systems affected by early stress.

CONCLUSION

Foster and adopted children face many challenges, but scientific knowledge also provides reason for hope and information about how to maximize positive outcomes.

Childhood maltreatment and executive functions in adolescents

BACKGROUND

The aim of this study was to investigate differences in executive functions between adolescents exposed to different forms of single- and multitype childhood maltreatment.

METHOD

The sample was composed of 83 adolescents, divided into three groups: single-type maltreatment (n = 24), multitype maltreatment (n = 19), and no history of maltreatment (n = 40), matched for education and sex.

RESULTS

The results showed that teenagers who suffered a single type of childhood maltreatment performed worse than the other two groups on tasks of cognitive flexibility and visual processing speed. Individuals who suffered multitype maltreatment had worse initiation and lower verbal processing speed than the other two groups.

CONCLUSIONS

Childhood maltreatment may have a significant impact on executive functioning in adolescence.

Early-life experience, epigenetics, and the developing brain

Development is a dynamic process that involves interplay between genes and the environment. In mammals, the quality of the postnatal environment is shaped by parent-offspring interactions that promote growth and survival and can lead to divergent developmental trajectories with implications for later-life neurobiological and behavioral characteristics. Emerging evidence suggests that epigenetic factors (ie, DNA methylation, posttranslational histone modifications, and small non-coding RNAs) may have a critical role in these parental care effects. Although this evidence is drawn primarily from rodent studies, there is increasing support for these effects in humans. Through these molecular mechanisms, variation in risk of psychopathology may emerge, particularly as a consequence of early-life neglect and abuse. Here we will highlight evidence of dynamic epigenetic changes in the developing brain in response to variation in the quality of postnatal parent-offspring interactions. The recruitment of epigenetic pathways for the biological embedding of early-life experience may also have transgenerational consequences and we will describe and contrast two routes through which this transmission can occur: experience dependent vs germline inheritance. Finally, we will speculate regarding the future directions of epigenetic research and how it can help us gain a better understanding of the developmental origins of psychiatric dysfunction.

Involvement of Nitric Oxide, Neurotrophins and HPA Axis in Neurobehavioural Alterations Induced by Prenatal Stress

Several studies suggest that negative emotions during pregnancy generate adverse effects on the cognitive, behavioural and emotional development of the descendants. The psychoneuroendocrine pathways involve the transplacentary passage of maternal glucocorticoids in order to influence directly on fetal growth and brain development.Nitric oxide is a gaseous neurotransmitter that plays an important role in the control of neural activity by diffusing into neurons and participates in learning and memory processes. It has been demonstrated that nitric oxide is involved in the regulation of corticosterone secretion. Thus, it has been found that the neuronal isoform of nitric oxide synthase (nNOS) is an endogenous inhibitor of glucocorticoid receptor (GR) in the hippocampus and that nNOS in the hippocampus may participate in the modulation of hypothalamic-pituitary-adrenal axis activity via GR.Neurotrophins are a family of secreted growth factors consisting of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT3) and NT4. Although initially described in the nervous system, they regulate processes such as cell survival, proliferation and differentiation in several other compartments. It has been demonstrated that the NO-citrulline cycle acts together with BDNF in maintaining the progress of neural differentiation.In the present chapter, we explore the interrelation between nitric oxide, glucocorticoids and neurotrophins in brain areas that are key structures in learning and memory processes. The participation of this interrelation in the behavioural and cognitive alterations induced in the offspring by maternal stress is also addressed.

Childhood Adversity Among Institutionalized Male Juvenile Offenders and Other High-Risk Groups Without Offense Records in Portugal

The literature has shown that delinquent adolescents report high rates of childhood adversity and family dysfunction. However, it is important to know both the degree of adversity among delinquent adolescents in comparison with other high-risk samples and the contribution of each single form of adversity to this comparison. The purpose of this study was to evaluate childhood adversity, psychopathology, and risk behaviors among 4 high-risk groups, including incarcerated delinquent youths. The participants were 120 male youths between 13 and 19 years old (M = 16.18, SD = 1.26), including 30 youths who were arrested and held in detention centers as a consequence of violent crimes; 30 youths who were identified by Child Protective Services (CPS) and remained with their families; 30 youths who were identified by CPS, removed from their homes, and placed in child and youth residential care; and 30 youths who were randomly selected from schools. The incarcerated youths reported significantly more adversity, global psychopathology, and global index of risk behaviors. When considering each risk behavior, the incarcerated youths reported higher percentages of alcohol abuse, drug use, early smoking initiation, physical assault, carrying weapons, early initiation of sexual intercourse, sexual intercourse under the influence of drugs, and sexual intercourse without condom use. The logistic regression analyses showed that only emotional neglect was significantly associated with delinquency. This study suggests that delinquent youths are exposed to a great magnitude of adversities in childhood, with emotional neglect as an independent risk factor for delinquency. In addition, these youths have higher rates of psychopathology and risk behaviors compared to other high-risk samples.

Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale

The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning (RF) and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood.

The effect of severe stress on early brain development, attachment, and emotions: a psychoanatomical formulation

Child abuse is the most extreme form of stress in childhood and adolescence, and has severe effects on the child's development. Limbic nuclei and circuitry development are especially vulnerable to child abuse and neglect during the first year of life. Development at the neuronal level can be severely disturbed by trauma during early infancy, resulting in maladaptive synaptic formation, impeding experience-expectant brain development. Development of basic emotions may favor the development of negative instead of positive emotions. The new concept of psychoanatomical formulation is introduced. A case vignette is presented and analyzed, based on the disturbed neuroanatomy underlying symptom expression.

More than words: the emotional maltreatment of children

Emotional maltreatment may be the most complex, prevalent, and damaging form of child maltreatment and can occur simultaneously with other forms of abuse. Children in the first few years of life seem to be at the greatest risk of suffering the most negative outcomes. Medical professionals can help identify and protect victims of emotional maltreatment by carefully observing caregiver-child interactions, paying attention to a family's social history, making referrals to community or counseling programs when necessary, and reporting any suspicions of maltreatment to Child Protective Services. A well-coordinated, multidisciplinary response must be enacted whenever emotional maltreatment is suspected or reported.

Typologies of Violence Exposure and Cognitive Processing in Incarcerated Male Adolescents

Incarcerated youth experience high rates of violence exposure (VE), cognitive processing (CP) deficits, and mental health (MH) problems. It is not clear whether VE combined with CP deficits are particularly salient risk factors for MH dysfunction. Male incarcerated youth offenders (n = 115) completed standardized self-reports of MH and VE. CP was measured with executive functioning tasks and academic assessments. Person-centered Ward's Squared Euclidian Distance cluster analysis was used to examine unique patterns of CP and VE. Cluster analysis defined five distinct profiles of MH functioning, CP, and VE rates within incarcerated adolescents. Two groups, with high rates of VE and CP deficits, showed high rates of MH problems. Linear techniques may obscure important differences within this population.

An ecological analysis of infant neglect by adolescent mothers

To inform efforts to prevent child neglect, we investigated a wide range of risk factors that have been largely unexamined in relation to infant neglect, the most commonly occurring form of child maltreatment. Using an ecological model of child neglect, we assessed the influence of characteristics at the level of the child, the mother, the family, and broader childrearing contexts on adolescent mothers' likelihood of being a perpetrator in a substantiated case of neglect against their firstborn infants (n=383, M=12 months). Several factors were associated with infant neglect by young mothers: median block income, low infant birth weight, maternal smoking, maternal childhood history of neglect and of positive care, intimate partner violence (IPV) perpetrated by either the mother or her partner, and maternal use of mental health services. In multivariate models, income, a maternal childhood history of positive care, IPV by either a mother or her partner, and mental health service usage made significant contributions to the odds that a mother neglected her infant. Our findings suggest that these factors have particular salience to policymakers' and practitioners' efforts to identify high risk families and to intervene during the earliest months of life to prevent child neglect.

The emergence of attachment following early social deprivation

This study examined the formation and quality of attachment of 65 postinstitutionalized (PI) toddlers with their parents at 1-3 and 7-9 months postadoption compared to 52 nonadopted (NA) children. The formation of attachment relationships of PI children with adoptive parents occurred relatively quickly. Children exposed to greater preadoption adversity took longer to form an attachment to their adoptive parents, although by 7-9 months postadoption, nearly all (90%) of the children achieved the highest level on an attachment formation rating scale. PI children did not differ from NA children in attachment security, based either on the Attachment Q-Sort or Strange Situation categorical scoring. However, the PI children were more likely to be disorganized in their attachment patterns. Preadoption adversity was related to lower Q-sort security scores especially at the initial assessment 1-3 months postadoption. The results indicated that attachment formation and attachment quality in PI children are differentiable constructs with different precursors.

Childhood history of abuse and child abuse potential: the role of parent's gender and timing of childhood abuse

It has been suggested that being physically abused leads to someone becoming a perpetrator of abuse which could be associated to parents' gender, timing of the physical abuse and specific socio-demographic variables. This study aims to investigate the role the parents' gender, timing of childhood abuse and socio-demographic variables on the relationship between parents' history of childhood physical abuse and current risk for children. The sample consisted of 920 parents (414 fathers, 506 mothers) from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect who completed the Childhood History Questionnaire and the Child Abuse Potential Inventory. The results showed that fathers had lower current potential risk of becoming physical abuse perpetrators with their children than mothers although they did not differed in their physical victimization history. Moreover, the risk was higher in parents (both genders) with continuous history of victimization than in parents without victimization. Prediction models showed that for fathers and mothers separately similar socio-demographic variables (family income, number of children at home, employment status and marital status) predicted the potential risk of becoming physical abuses perpetrators. Nevertheless, the timing of victimization was different for fathers (before 13 years old) and mothers (after 13 years old). Then our study targets specific variables (timing of physical abuse, parents' gender and specific socio-demographic variables), which may enable professionals to select groups of parents at greater need of participating in abuse prevention programs.

Different early rearing experiences have long-term effects on cortical organization in captive chimpanzees (Pan troglodytes)

Consequences of rearing history in chimpanzees (Pan troglodytes) have been explored in relation to behavioral abnormalities and cognition; however, little is known about the effects of rearing conditions on anatomical brain development. Human studies have revealed that experiences of maltreatment and neglect during infancy and childhood can have detrimental effects on brain development and cognition. In this study, we evaluated the effects of early rearing experience on brain morphology in 92 captive chimpanzees (ages 11-43) who were either reared by their mothers (n = 46) or in a nursery (n = 46) with age-group peers. Magnetic resonance brain images were analyzed with a processing program (BrainVISA) that extracts cortical sulci. We obtained various measurements from 11 sulci located throughout the brain, as well as whole brain gyrification and white and grey matter volumes. We found that mother-reared chimpanzees have greater global white-to-grey matter volume, more cortical folding and thinner grey matter within the cortical folds than nursery-reared animals. The findings reported here are the first to demonstrate that differences in early rearing conditions have significant consequences on brain morphology in chimpanzees and suggests potential differences in the development of white matter expansion and myelination.

Childhood maltreatment and corpus callosum volume in recently diagnosed patients with bipolar I disorder: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM)

Childhood trauma (CT) has been associated with abnormalities in the corpus callosum (CC). Decreased CC volumes have been reported in children and adolescents with trauma as well as adults with CT compared to healthy controls. CC morphology is potentially susceptible to the effects of Bipolar Disorder (BD) itself. Therefore, we evaluated the relationship between CT and CC morphology in BD. We using magnetic resonance imaging in 53 adults with BD recently recovered from their first manic episode, with (n = 23) and without (n = 30) CT, defined using the Childhood Trauma Questionnaire (CTQ) and 16 healthy controls without trauma. ANCOVA was performed with age, gender and intracranial volume as covariates in order to evaluate group differences in CC volume. The total CC volume was found to be smaller in BD patients with trauma compared to BD patients without trauma (p < .05). The differences were more pronounced in the anterior region of the CC. There was a significant negative correlation between CTQ scores and total CC volume in BD patients with trauma (p = .01). We did not find significant differences in the CC volume of patients with/without trauma compared to the healthy subjects. Our sample consists of patients recovered from a first episode of mania and are early in the course of illness and reductions in CC volume may occur late in the course of BD. It might mean there may be two sources of CC volume reduction in these patients: the reduction due to trauma, and the further reduction due to the illness.

Early life trauma and attachment: immediate and enduring effects on neurobehavioral and stress axis development

Over half a century of converging clinical and animal research indicates that early life experiences induce enduring neuroplasticity of the HPA-axis and the developing brain. This experience-induced neuroplasticity is due to alterations in the frequency and intensity of stimulation of pups' sensory systems (i.e., olfactory, somatosensory, gustatory) embedded in mother-infant interactions. This stimulation provides "hidden regulators" of pups' behavioral, physiological, and neural responses that have both immediate and enduring consequences, including those involving the stress response. While variation in stimulation can produce individual differences and adaptive behaviors, pathological early life experiences can induce maladaptive behaviors, initiate a pathway to pathology, and increase risk for later-life psychopathologies, such as mood and affective disorders, suggesting that infant-attachment relationships program later-life neurobehavioral function. Recent evidence suggests that the effects of maternal presence or absence during this sensory stimulation provide a major modulatory role in neural and endocrine system responses, which have minimal impact on pups' immediate neurobehavior but a robust impact on neurobehavioral development. This concept is reviewed here using two complementary rodent models of infant trauma within attachment: infant paired-odor-shock conditioning (mimicking maternal odor attachment learning) and rearing with an abusive mother that converge in producing a similar behavioral phenotype in later-life including depressive-like behavior as well as disrupted HPA-axis and amygdala function. The importance of maternal social presence on pups' immediate and enduring brain and behavior suggests unique processing of sensory stimuli in early life that could provide insight into the development of novel strategies for prevention and therapeutic interventions for trauma experienced with the abusive caregiver.

Diagnostic shortfalls in early childhood chronic stress: a review of the issues

Clinical effects of early childhood chronic stress should be regarded as causing a developmental brain injury. However, current diagnostic constructs fail to capture the associated disabilities in emotional-behavioural regulation of stress and attachment functions adequately. We first focus on neglect as a prototypical early childhood chronic stressor; next we explore clinical associations of neglect; and finally we cite research pertaining to possible underlying pathophysiology of the effects of early childhood chronic stress. In addition, we discuss diagnostic labels that children with histories of early childhood neglect commonly acquire, and implications for treatment.

Limiting home visiting effects: maternal depression as a moderator of child maltreatment

OBJECTIVE

To test, with a sample of adolescent mothers (16-20 at childbirth) and their first-born infants/toddlers (average age 1 year), whether the impact of a home visiting (HV) child maltreatment prevention program was moderated by maternal depression.

METHODS

The study design was a randomized controlled trial of Healthy Families Massachusetts, a statewide child maltreatment prevention program. A total of 707 first-time mothers were randomly assigned to the HV or control group. The HV group received visits from paraprofessional home visitors. Mothers in the control group were referred to other service providers. The outcome variable consisted of state Child Protective Services reports of child abuse and neglect (mother or other person as perpetrator). Maternal depression was assessed by maternal report (Center for Epidemiologic Studies-Depression questionnaire).

RESULTS

A considerable proportion of families had child maltreatment reports (30% of sample) and maternal depression (38% had clinically significant symptoms). Most maltreatment was neglect. Among control group mothers, reports of maltreatment did not vary according to depressive symptoms. For HV mothers, probability of reports varied with levels of depressive symptoms. Nonsymptomatic HV mothers were less likely to have a child who was reported for maltreatment compared with HV mothers who endorsed clinical levels of depressive symptoms.

CONCLUSIONS

The prevalence of maternal depressive symptoms in this sample, and the link between depression and child maltreatment prevention program effectiveness, suggest that home visitors be alert to maternal depression. Programs also should be aware of possible surveillance effects related to maternal depression.

Development of socio-emotional competence in bonobos

Social and emotional skills are tightly interlinked in human development, and both are negatively impacted by disrupted social development. The same interplay between social and emotional skills, including expressions of empathy, has received scant attention in other primates however, despite the growing interest in caring, friendships, and the fitness benefits of social skills. Here we examine the development of socio-emotional competence in juvenile bonobos (Pan paniscus) at a sanctuary in the Democratic Republic of the Congo, focusing on the interplay between various skills, including empathy-related responding. Most subjects were rehabilitated orphans, but some were born at the sanctuary and mother-reared there. We observed how juveniles with different rearing backgrounds responded to stressful events, both when the stress affected themselves (e.g., a lost fight) or others (e.g., witnessing the distress of others). The main dependent variable was the consolation of distressed parties by means of calming body contact. As in children, consolation was predicted by overall social competence and effective emotion regulation, as reflected in the speed of recovery from self-distress and behavioral measures of anxiety. Juveniles more effective at self-regulation were more likely to console others in distress, and such behavior was more typical of mother-reared juveniles than orphans. These results highlight the interplay between the development of social and emotional skills in our ape relatives and the importance of the mother-offspring bond in shaping socio-emotional competence.

Adoption: biological and social processes linked to adaptation

Children join adoptive families through domestic adoption from the public child welfare system, infant adoption through private agencies, and international adoption. Each pathway presents distinctive developmental opportunities and challenges. Adopted children are at higher risk than the general population for problems with adaptation, especially externalizing, internalizing, and attention problems. This review moves beyond the field's emphasis on adoptee-nonadoptee differences to highlight biological and social processes that affect adaptation of adoptees across time. The experience of stress, whether prenatal, postnatal/preadoption, or during the adoption transition, can have significant impacts on the developing neuroendocrine system. These effects can contribute to problems with physical growth, brain development, and sleep, activating cascading effects on social, emotional, and cognitive development. Family processes involving contact between adoptive and birth family members, co-parenting in gay and lesbian adoptive families, and racial socialization in transracially adoptive families affect social development of adopted children into adulthood.

Cortisol reactivity in two-year-old children prenatally exposed to methamphetamine

OBJECTIVE

Until now, the functioning of the hypothalamic-pituitary-adrenal (HPA) axis in children with prenatal methamphetamine exposure (PME) had been unexamined. Previous research indicates that prenatal exposure to stimulant drugs is associated with dose-response alterations in neural growth and connectivity and consequent neurobehavioral deficits. In addition, children of drug-using parents are at an increased risk for exposure to chronic postnatal stress. In this preliminary study, we examined the associations of PME and postnatal environmental stress with cortisol stress reactivity in children with PME.

METHOD

Participants were 2-year-old children (N = 123; 55.3% male) with PME from a multicenter longitudinal Infant, Development, Environment, and Lifestyle Study. Saliva samples were obtained before and after a stress-inducing separation task. Hierarchical multiple regression analyses examined prenatal drug exposure, methodological and postnatal stress covariates, and interactions between levels of PME and postnatal stress.

RESULTS

Mild to moderate potential for child physical abuse moderated increased cortisol reactivity in high exposed children with PME. Blunted cortisol reactivity was associated with caregiver's postnatal alcohol use, child's behavioral dysregulation, and the interaction between higher levels of PME and caregiver's psychopathology.

CONCLUSIONS

Consistent with the known effects of stimulant drugs and chronically stressful environments on the HPA axis and, thus, the toxic stress and allostatic load phenomena, our results imply that elevated PME may be associated with alterations in the programming of the HPA axis reflecting hyperactivity, which under significant and chronic environmental stress then may become hypoactive.

Denial or receipt of expected reward through maternal contact during the neonatal period differentially affect the development of the rat amygdala and program its function in adulthood in a sex-dimorphic way

Early experiences affect brain development and thus adult brain function and behavior. We employed a novel early experience model involving denial (DER) or receipt of expected reward (RER) through maternal contact in a T-maze. Exposure to the DER experience for the first time, on postnatal day 10 (PND10), was stressful for the pups, as assessed by increased corticosterone levels, and was accompanied by enhanced activation of the amygdala, as assessed by c-Fos immunohistochemistry. Re-exposure to the same experience on days 11-13 led to adaptation. Corticosterone levels of the RER pups did not differ on the first and last days of training (PND10 and 13 respectively), while on PND11 and 12 they were lower than those of the CTR. The RER experience did not lead to activation of the amygdala. Males and females exposed as neonates to the DER or RER experience, and controls were tested as adults in the open field task (OF), the elevated plus maze (EPM), and cued and contextual fear conditioning (FC). No group differences were found in the EPM, while in the OF, both male and female DER animals, showed increased rearings, compared to the controls. In the FC, the RER males had increased memory for both context and cued conditioned fear, than either the DER or CTR. On the other hand, the DER males, but not females showed an increased activation, as assessed by c-Fos expression, of the amygdala following fear conditioning. Our results show that the DER early experience programmed the function of the adult amygdala as to render it more sensitive to fearful stimuli. This programming by the DER early experience could be mediated through epigenetic modifications of histones leading to chromatin opening, as indicated by our results showing increased levels of phospho-acetyl-histone-3 in the amygdala of the DER males.

The impact of neglect on initial adaptation to school

This study examined the impact of child neglect during the first 4 years of life on adaptation to school during kindergarten and first grade in the context of neighborhood poverty (NP). Processes related to the development of school competencies were examined, including the mediational role of cognitive functioning and ego-resiliency (ER) in shaping children's school outcomes. A total of 170 low-income urban children were followed prospectively for 2 years (ages 4-6). Results indicated that neglected children had significantly lower scores on kindergarten classroom behavior and first-grade academic performance than nonneglected children. Children's cognitive performance at age 4, controlling for maternal intelligence quotient, mediated the relation between severity of neglect and children's behavior in kindergarten as well as their academic performance in first grade. Moreover, severity of neglect was related to children's ER at age 4. However, additional ecological adversity in the form of NP moderated the link between ER and classroom behavior, such that at lower levels of poverty, ER mediated the relation between severity of neglect and school adaptation. Conversely, when NP was extreme, the effects of ER were attenuated and ER ceased to predict behavioral performance in kindergarten. The implications of these findings for prevention and intervention are discussed.

Prenatal and gestational cocaine exposure: Effects on the oxytocin system and social behavior with implications for addiction

Drug abuse during pregnancy is a major public health concern, with negative consequences throughout development. Prenatal cocaine exposure (PCE) in rats produces social behavior deficits with corresponding changes in neuroendocrine and monoaminergic signaling. The relevance of parental care in social behavior maturity cannot be ignored, and gestational exposure to cocaine severely disrupts parental care, thus impacting the early environment of the offspring. Oxytocin (Oxt) is critical in regulating social behaviors and central levels are disrupted following acute and chronic cocaine (CC) treatment in postpartum rat dams, coincident with deficits in maternal care. We will discuss studies aimed to determine the relative contribution of PCE and CC-induced deficits in maternal care to social behaviors and Oxt signaling across development. PCE results in decreased social (including parental) behaviors in adolescence and adulthood. PCE is also associated with increased aggression in adults. Rearing by CC-exposed mothers synergistically increases the behavioral effects of PCE. Rearing by CC-exposed mothers, but not PCE, disrupts Oxt levels and mRNA in regions relevant to social behavior, but does not affect receptors in postpartum adult offspring. Preliminary work indicates that PCE/CC rearing has dynamic effects on Oxt levels and receptors in neonatal rat pups, suggesting very early regulation of Oxt signaling. This work highlights how the interactive role of Oxt signaling and behavioral context throughout development can be derailed by drug abuse during pregnancy. The relevance of disrupted Oxt to intergenerational transmission of addiction is briefly discussed.

The role of cortisol and psychopathy in the cycle of violence

RATIONALE

Child abuse and neglect are universal risk factors for delinquency, violence, and aggression; this phenomenon is known as the cycle of violence. Additional factors-psychopathy, impulsiveness, and disruptions in the hypothalamic-pituitary-adrenal (HPA) axis-play a role in aggressive behavior but have rarely been examined in the same conceptual and experimental framework.

OBJECTIVES

We sought to examine the above-mentioned risk factors for aggression in a prospective study employing psychopharmacologic and psychometric techniques.

METHODS

Sixty-seven adult participants were given an acute dose of 20 mg cortisol in a placebo-controlled, within-subject, counter-balanced dosing design. Salivary cortisol was measured at baseline and at regular intervals across a 5 h testing period. Following dosing, state-aggressive behavior was measured by a laboratory task, the Point-Subtraction Aggression Paradigm. History of child abuse/neglect, psychopathy, impulsivity, and a trait measure of aggression were assessed through self-report questionnaires.

RESULTS

Using multiple regression, a model including abuse/neglect, psychopathy, impulsivity, and baseline cortisol explained 58 % of the variance in trait aggression and 26 % of the variance in state aggression. Abuse/neglect predicted diminished HPA-axis reactivity and HPA-axis reactivity showed a trend toward predicting state and trait aggression, although it was not a significant mediating variable between abuse/neglect and aggression.

CONCLUSIONS

The results indicate that child maltreatment, psychopathy and HPA-axis reactivity interact to provide a confluence over aggressive behavior, and intervention efforts need to consider all these factors.

Maternal separation with early weaning: a rodent model providing novel insights into neglect associated developmental deficits

Child neglect is the most prevalent form of child maltreatment in the United States, and poses a serious public health concern. Children who survive such episodes go on to experience long-lasting psychological and behavioral problems, including higher rates of post-traumatic stress disorder symptoms, depression, alcohol and drug abuse, attention-deficit/hyperactivity disorder, and cognitive deficits. To date, most research into the causes of these life-long problems has focused on well-established targets such as stress responsive systems, including the hypothalamus-pituitary-adrenal axis. Using the maternal separation and early weaning model, we have attempted to provide comprehensive molecular profiling of a model of early-life neglect in an organism amenable to genomic manipulation: the mouse. In this article, we report new findings generated with this model using chromatin immunoprecipitation sequencing, diffuse tensor magnetic resonance imaging, and behavioral analyses. We also review the validity of the maternal separation and early weaning model, which reflects behavioral deficits observed in neglected humans including hyperactivity, anxiety, and attentional deficits. Finally, we summarize the molecular characterization of these animals, including RNA profiling and label-free proteomics, which highlight protein translation and myelination as novel pathways of interest.

Early traumatic events in psychopaths

The relationship between diverse early traumatic events and psychopathy was studied in 194 male inmates. Criminal history transcripts were revised, and clinical interviews were conducted to determine the level of psychopathy using the Psychopathy Checklist-Revised (PCL-R) Form, and the Early Trauma Inventory was applied to assess the incidence of abuse before 18 years of age. Psychopathic inmates presented a higher victimization level and were more exposed to certain types of intended abuse than sociopathic inmates, while the sum of events and emotional abuse were associated with the PCL-R score. Our studies support the influence of early adverse events in the development of psychopathic offenders.

Annual Research Review: Resilient functioning in maltreated children--past, present, and future perspectives

BACKGROUND

Through a process of probabilistic epigenesis, child maltreatment progressively contributes to compromised adaptation on a variety of developmental domains central to successful adjustment. These developmental failures pose significant risk for the emergence of psychopathology across the life course. In addition to the psychological consequences of maltreatment, a growing body of research has documented the deleterious effects of abuse and neglect on biological processes. Nonetheless, not all maltreated children develop maladaptively. Indeed, some percentage of maltreated children develops in a resilient fashion despite the significant adversity and stress they experience.

METHODS

The literature on the determinants of resilience in maltreated children is selectively reviewed and criteria for the inclusion of the studies are delineated.

RESULTS

The majority of the research on the contributors to resilient functioning has focused on a single level of analysis and on psychosocial processes. Multilevel investigations have begun to appear, resulting in several studies on the processes to resilient functioning that integrate biological/genetic and psychological domains.

CONCLUSIONS

Much additional research on the determinants of resilient functioning must be completed before we possess adequate knowledge based on a multiple levels of analysis approach that is commensurate with the complexity inherent in this dynamic developmental process. Suggestions for future research on the development of resilient functioning in maltreated children are proffered and intervention implications are discussed.

Familial, social, and individual factors contributing to risk for adolescent substance use

Data from the National Institute on Drug Abuse (NIDA) and the Centers for Disease Control and Prevention (CDC) reveal high numbers of adolescent substance use in the United States. Substance use among adolescents can lead to increased risk of transmission of sexually transmitted infections, vehicular fatalities, juvenile delinquency, and other problems associated with physical and mental health. Adolescents are particularly susceptible to involvement in substance use due to the underdeveloped state of the adolescent brain, which can lead to reduced decision-making ability and increased long-term effects of drugs and alcohol. Understanding the causes of adolescent substance use is vital for successful prevention and intervention programs.

Intervention Effects on Morning and Stimulated Cortisol Responses Among Toddlers in Foster Care

Toddlers in child welfare often have a dysregulated stress response. We tested whether toddlers with caregivers randomized to a 10-week attachment-based intervention, Promoting First Relationships (PFR; Kelly, Sandoval, Zuckerman, & Buehlman, 2008) would show post-intervention change in stimulated salivary cortisol patterns during a research home visit involving a separation-reunion procedure, compared to a condition including child development and resource advice, but no attachment strategies. At baseline and post intervention, toddlers with a caregiver change within 7 weeks of enrollment (n=48, age 10-25 months) provided 4 saliva samples during a 1.5-hour research visit, and samples the next morning. The categorical dependent variable was the pattern of cortisol activity during the course of the post-intervention research visit: Flat, Decreasing, Increasing. Multinomial logistic regression was used to test for post-intervention group differences in cortisol patterns, controlling for time of day, child's age, morning cortisol level, and baseline cortisol pattern. At baseline and post-intervention 92% of children demonstrated atypically low morning cortisol (< .21 ig/dL); Post-intervention, Flat, Decreasing and Increasing patterns were exhibited by 70%, 15%, and 15% of the sample, respectively. Significantly more children in the PFR condition showed an Increasing pattern. This may signal an intervention effect on separation-based stress response physiology.

Overlapping and segregated resting-state functional connectivity in patients with major depressive disorder with and without childhood neglect

Many studies have suggested that childhood maltreatment increase risk of adulthood major depressive disorder (MDD) and predict its unfavorable treatment outcome, yet the neural underpinnings associated with childhood maltreatment in MDD remain poorly understood. Here, we seek to investigate the whole-brain functional connectivity patterns in MDD patients with childhood maltreatment. Resting-state functional magnetic resonance imaging was used to explore intrinsic or spontaneous functional connectivity networks of 18 MDD patients with childhood neglect, 20 MDD patients without childhood neglect, and 20 healthy controls. Whole-brain functional networks were constructed by measuring the temporal correlations of every pairs of brain voxels and were further analyzed by using graph-theory approaches. Relative to the healthy control group, the two MDD patient groups showed overlapping reduced functional connectivity strength in bilateral ventral medial prefrontal cortex/ventral anterior cingulate cortex. However, compared with MDD patients without a history of childhood maltreatment, those patients with such a history displayed widespread reduction of functional connectivity strength primarily in brain regions within the prefrontal-limbic-thalamic-cerebellar circuitry, and these reductions significantly correlated with measures of childhood neglect. Together, we showed that the MDD groups with and without childhood neglect exhibited overlapping and segregated functional connectivity patterns in the whole-brain networks, providing empirical evidence for the contribution of early life stress to the pathophysiology of MDD.