Beyond Cumulative Risk: A Dimensional Approach to Childhood Adversity

Mechanisms linking childhood trauma exposure and psychopathology: a transdiagnostic model of risk and resilience

BACKGROUND

Transdiagnostic processes confer risk for multiple types of psychopathology and explain the co-occurrence of different disorders. For this reason, transdiagnostic processes provide ideal targets for early intervention and treatment. Childhood trauma exposure is associated with elevated risk for virtually all commonly occurring forms of psychopathology. We articulate a transdiagnostic model of the developmental mechanisms that explain the strong links between childhood trauma and psychopathology as well as protective factors that promote resilience against multiple forms of psychopathology.

MAIN BODY

We present a model of transdiagnostic mechanisms spanning three broad domains: social information processing, emotional processing, and accelerated biological aging. Changes in social information processing that prioritize threat-related information-such as heightened perceptual sensitivity to threat, misclassification of negative and neutral emotions as anger, and attention biases towards threat-related cues-have been consistently observed in children who have experienced trauma. Patterns of emotional processing common in children exposed to trauma include elevated emotional reactivity to threat-related stimuli, low emotional awareness, and difficulties with emotional learning and emotion regulation. More recently, a pattern of accelerated aging across multiple biological metrics, including pubertal development and cellular aging, has been found in trauma-exposed children. Although these changes in social information processing, emotional responding, and the pace of biological aging reflect developmental adaptations that may promote safety and provide other benefits for children raised in dangerous environments, they have been consistently associated with the emergence of multiple forms of internalizing and externalizing psychopathology and explain the link between childhood trauma exposure and transdiagnostic psychopathology. Children with higher levels of social support, particularly from caregivers, are less likely to develop psychopathology following trauma exposure. Caregiver buffering of threat-related processing may be one mechanism explaining this protective effect.

CONCLUSION

Childhood trauma exposure is a powerful transdiagnostic risk factor associated with elevated risk for multiple forms of psychopathology across development. Changes in threat-related social and emotional processing and accelerated biological aging serve as transdiagnostic mechanisms linking childhood trauma with psychopathology. These transdiagnostic mechanisms represent critical targets for early interventions aimed at preventing the emergence of psychopathology in children who have experienced trauma.

Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

BACKGROUND

Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.

OBJECTIVE

We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.

PARTICIPANTS AND SETTING

192 unique samples consisting of 68,830 individuals.

METHODS

We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.

RESULTS

We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.

CONCLUSIONS

These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.

Influences of early-life stress on frontolimbic circuitry: Harnessing a dimensional approach to elucidate the effects of heterogeneity in stress exposure

Early-life stress confers profound and lasting risk for developing cognitive, social, emotional, and physical health problems. The effects of stress on the developing brain contribute to this risk, with frontolimbic circuitry particularly susceptible to early experiences, possibly due to its innervation with glucocorticoid receptors and the timing of frontolimbic circuit maturation. To date, the majority of studies on stress and frontolimbic circuitry have employed a categorical approach, comparing stress-exposed versus non-stress-exposed youth. However, there is vast heterogeneity in the nature of stress exposure and in outcomes. Recent forays into understanding the psychobiological effects of stress have employed a dimensional approach focused on experiential, environmental, and temporal factors that influence the association between stress and subsequent vulnerability. This review highlights empirical findings that inform a dimensional approach to understanding the effects of stress on frontolimbic circuitry. We identify the timing, type, severity, controllability, and predictability of stress, and the degree to which a caregiver is involved, as specific features of stress that may play a substantial role in differential outcomes. We propose a framework for the effects of these features of stress on frontolimbic development that may partially determine how heterogeneity in stress exposure influences this circuitry and, ultimately, mental health.

Teeth as Potential New Tools to Measure Early-Life Adversity and Subsequent Mental Health Risk: An Interdisciplinary Review and Conceptual Model

Early-life adversity affects nearly half of all youths in the United States and is a known risk factor for psychiatric disorders across the life course. One strategy to prevent mental illness may be to target interventions toward children who are exposed to adversity, particularly during sensitive periods when these adversities may have even more enduring effects. However, a major obstacle impeding progress in this area is the lack of tools to reliably and validly measure the existence and timing of early-life adversity. In this review, we summarize empirical work across dentistry, anthropology, and archaeology on human tooth development and discuss how teeth preserve a time-resolved record of our life experiences. Specifically, we articulate how teeth have been examined in these fields as biological fossils in which the history of an individual's early-life experiences is permanently imprinted; this area of research is related to, but distinct from, studies of oral health. We then integrate these insights with knowledge about the role of psychosocial adversity in shaping psychopathology risk to present a working conceptual model, which proposes that teeth may be an understudied yet suggestive new tool to identify individuals at risk for mental health problems following early-life psychosocial stress exposure. We end by presenting a research agenda and discussion of future directions for rigorously testing this possibility and with a call to action for interdisciplinary research to meet the urgent need for new biomarkers of adversity and psychiatric outcomes.

Early Adversity and Critical Periods: Neurodevelopmental Consequences of Violating the Expectable Environment

It is now widely recognized that children exposed to adverse life events in the first years of life are at increased risk for a variety of neural, behavioral, and psychological sequelae. As we discuss in this paper, adverse events represent a violation of the expectable environment. If such violations occur during a critical period of brain development, the detrimental effects of early adversity are likely to be long lasting. Here we discuss the various ways adversity becomes neurobiologically embedded, and how the timing of such adversity plays an important role in determining outcomes. We conclude our paper by offering recommendations for how to elucidate the neural mechanisms responsible for the behavioral sequelae and how best to model the effects of early adversity.

Development of trauma symptoms following adversity in childhood: The moderating role of protective factors

BACKGROUND

Although the buffering effect of protective factors on children's outcomes following exposure to adverse childhood experiences has been well documented, research gaps remain as to whether this buffering effect differs based on the type of adversity experienced (i.e., maltreatment versus household dysfunction).

OBJECTIVE

To examine whether protective factors moderate the association between cumulative adversity, as well as adversity subtypes (i.e., maltreatment and household dysfunction) and child trauma-related distress in a clinical sample referred for treatment following exposure to adversity.

PARTICIPANTS AND SETTING

One-hundred and seventy-six children (aged 3-18) referred to a child abuse treatment clinic and who's files were opened between January 2016 and June 2017 were included.

METHODS

Data were collected, extracted, and coded from clinical files using a standardized data extraction protocol. Protective factors included: using individual coping strategies, peer support, individual social skills, caregiver physical caregiving, caregiver psychological caregiving, and educational involvement.

RESULTS

Cumulative childhood adversity (b = .16, p = .04) positively predicted child trauma-related distress. The link between exposure to cumulative adversity and child trauma-related distress varied as a function of protective factors: there was a positive association between adversity and child trauma-related distress for children who had low levels of protective factors, but not for those with high levels of protective factors (b=-0.56, p=<.001). Similar findings were observed when data was stratified by maltreatment and household dysfunction.

CONCLUSIONS

Bolstering children's protective factors prior to, and during child abuse treatment, may reduce trauma-related distress following exposure to adversity.

Racial Differences in the Relationship between Neighborhood Disorder, Adverse Childhood Experiences, and Child Behavioral Health

The neighborhood and family context in which children grow profoundly influences their development. Informed by ecological systems theory and social disorganization theory, we hypothesized that adverse childhood experiences (ACEs) mediate the relationship between neighborhood disorder and child externalizing and internalizing behaviors, and that these pathways vary by race/ethnicity. We conducted secondary data analysis using Fragile Families and Child Well-being study data. To test hypothesized pathways, we performed a mediation path analysis on a sample of 3001 mothers of children (ages 3 and 5) living in 20 U.S. cities. A moderated mediation path analysis was used to test racial/ethnic differences in hypothesized pathways. We found that living in disordered neighborhoods increased children's likelihood of exhibiting externalizing and internalizing behaviors through childhood ACEs. Compared to Black and Hispanic children, White children's ACEs were more susceptible to negative neighborhood environment effects, suggesting that White children's behavioral health may be more indirectly affected by neighborhood disorder. The finding that ACEs mediated the pathway from neighborhood disorder to child behavior problems provides opportunity for child psychiatrists and pediatricians to interrupt negative pathways by providing interventions for children and families. Our findings on racial/ethnic differences highlight the need for culturally sensitive programming to address children's behavior problems.

Adversity exposure during sensitive periods predicts accelerated epigenetic aging in children

OBJECTIVES

Exposure to adversity has been linked to accelerated biological aging, which in turn has been shown to predict numerous physical and mental health problems. In recent years, measures of DNA methylation-based epigenetic age--known as "epigenetic clocks"--have been used to estimate accelerated epigenetic aging. Although a small number of studies have found an effect of adversity exposure on epigenetic age in children, none have investigated if there are "sensitive periods" when adversity is most impactful.

METHODS

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 973), we tested the prospective association between repeated measures of childhood exposure to seven types of adversity on epigenetic age assessed at age 7.5 using the Horvath and Hannum epigenetic clocks. With a Least Angle Regression variable selection procedure, we evaluated potential sensitive period effects.

RESULTS

We found that exposure to abuse, financial hardship, or neighborhood disadvantage during sensitive periods in early and middle childhood best explained variability in the deviation of Hannum-based epigenetic age from chronological age, even after considering the role of adversity accumulation and recency. Secondary sex-stratified analyses identified particularly strong sensitive period effects. These effects were undetected in analyses comparing children "exposed" versus "unexposed" to adversity. We did not identify any associations between adversity and epigenetic age using the Horvath epigenetic clock.

CONCLUSIONS

Our results suggest that adversity may alter methylation processes in ways that either directly or indirectly perturb normal cellular aging and that these effects may be heightened during specific life stages.

The patterns of adverse childhood experiences among Chinese children: Four-year longitudinal associations with psychopathological symptoms

The objective of this longitudinal study was to identify the contribution of individual, cumulative and patterns of adverse childhood experiences (ACEs) exposure in the prediction of psychopathological outcomes during adolescence in the context of Chinese culture. Children from 3 large elementary schools of Bengbu, Anhui Province, China were enrolled in the 3 waves survey from 2013 (mean age = 8.15 years, SD = 0.88) to 2017 (mean age = 11.92 years, SD = 0.88). Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 10 most common ACEs. Logistic regression was used to examine the association between individual, cumulative and patterns of ACEs and depressive and externalizing symptoms at Wave 3. Of the 1766 respondents included in the sample, 75% had at least 1 and 21.5% reported 4 or more ACEs. We found the dose-response relationship between cumulative ACEs and psychopathological outcomes. Results from LCA revealed three high-risk profiles and one low-risk profile, which were labeled: high ACEs (5.7%), highly abusive and adverse events (20.1%), highly abusive and neglected (21.3%), and low ACEs (52.9%). Compared to low ACEs class, each high-risk profile was differentially associated with psychopathological outcomes over 4-year period. Children exposed to high ACEs were at higher risk for future depressive and externalizing symptoms than other classes. This study provides evidence for the predictive impact of ACEs on adolescent psychopathological symptoms in Chinese culture. Clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE patterns and provide preventive intervention immediately, rather than provide treatment later in life.

Childhood adversity, externalizing behavior, and substance use in adolescence: Mediating effects of anterior cingulate cortex activation during inhibitory errors

Childhood adversity can negatively impact development across various domains, including physical and mental health. Adverse childhood experiences have been linked to aggression and substance use; however, developmental pathways to explain these associations are not well characterized. Understanding early precursors to later problem behavior and substance use can inform preventive interventions. The aim of the current study was to examine neurobiological pathways through which childhood adversity may lead to early adolescent problem behavior and substance use in late adolescence by testing two prospective models. Our first model found that early adolescent externalizing behavior mediates the association between childhood adversity and alcohol, cigarette, and marijuana use in late adolescence. Our second model found that activation in the anterior cingulate cortex (ACC) during an inhibitory control task mediates the association between childhood adversity and early adolescent externalizing behavior, with lower ACC activation associated with higher levels of adversity and more externalizing behavior. Together these findings indicate that the path to substance use in late adolescence from childhood adversity may operate through lower functioning in the ACC related to inhibitory control and externalizing behavior. Early life stressors should be considered an integral component in the etiology and prevention of early and problematic substance use.

Practitioner Review: Twenty years of research with adverse childhood experience scores - Advantages, disadvantages and applications to practice

BACKGROUND

Adverse childhood experience (ACE) scores have become a common approach for considering childhood adversities and are highly influential in public policy and clinical practice. Their use is also controversial. Other ways of measuring adversity - examining single adversities, or using theoretically or empirically driven methods - might have advantages over ACE scores.

METHODS

In this narrative review we critique the conceptualisation and measurement of ACEs in research, clinical practice, public health and public discourse.

RESULTS

The ACE score approach has the advantages - and limitations - of simplicity: its simplicity facilitates wide-ranging applications in public policy, public health and clinical settings but risks over-simplistic communication of risk/causality, determinism and stigma. The other common approach - focussing on single adversities - is also limited because adversities tend to co-occur. Researchers are using rapidly accruing datasets on ACEs to facilitate new theoretical and empirical approaches but this work is at an early stage, e.g. weighting ACEs and including severity, frequency, duration and timing. More research is needed to establish what should be included as an ACE, how individual ACEs should be weighted, how ACEs cluster, and the implications of these findings for clinical work and policy. New ways of conceptualising and measuring ACEs that incorporate this new knowledge, while maintaining some of the simplicity of the current ACE questionnaire, could be helpful for clinicians, practitioners, patients and the public.

CONCLUSIONS

Although we welcome the current focus on ACEs, a more critical view of their conceptualisation, measurement, and application to practice settings is urgently needed.

Differential rearing alters taste reactivity to ethanol, sucrose, and quinine

RATIONALE

Early-life environment influences reinforcer and drug motivation in adulthood; however, the impact on specific components of motivation, including hedonic value ("liking"), remains unknown.

OBJECTIVES

The current study determined whether differential rearing alters liking and aversive responding to ethanol, sucrose, and quinine in an ethanol-naïve rat model.

METHODS

Male and female rats were reared for 30 days starting at postnatal day 21 in either an enriched (EC), isolated (IC), or standard condition (SC). Thereafter, all rats had indwelling intraoral fistulae implanted and their taste reactivity to water, ethanol (5, 10, 20, 30, 40% v/v), sucrose (0.1, 0.25, 0.5 M), and quinine (0.1, 0.5 mM) was recorded and analyzed.

RESULTS

EC rats had higher amounts of liking responses to ethanol, sucrose, and quinine and higher amounts of aversive responses to ethanol and quinine compared to IC rats. While EC and IC rats' responses were different from each other, they both tended to be similar to SCs, who fell in between the EC and IC groups.

CONCLUSIONS

These results suggest that environmental enrichment may enhance sensitivity to a variety of tastants, thereby enhancing liking, while isolation may dull sensitivity, thereby dulling liking. Altogether, the evidence suggests that isolated rats have a shift in the allostatic set-point which may, in part, drive increased responding for a variety of rewards including ethanol and sucrose. Enriched rats have enhanced liking of both sucrose and ethanol suggesting that enrichment may offer a unique phenotype with divergent preferences for incentive motivation.

Exposure to violence and neglect images differentially influences fear learning and extinction

The mechanisms by which exposure to adversity contributes to psychopathology development are poorly understood. Recent models link experiences of threat of harm and deprivation to psychopathology via disruptions in learning mechanisms underlying fear acquisition and extinction. We empirically tested dimensional elements of this model, by examining whether exposure to images of community violence or neglect differentially influenced fear learning and extinction relative to exposure to neutral images. Participants were randomly allocated to one of three exposure conditions: viewing images depicting neglect (n = 25), violence (n = 25) or control images (n = 24). All participants then completed a fear conditioning and extinction task in which the CS+ was paired with an aversive tone, and the CS- was presented alone during conditioning. Both CSs were presented alone during extinction and extinction retest. Skin conductance responses (SCR) and subjective ratings were assessed. Relative to control images, viewing scenes of neglect attenuated SCRs to the CSs during conditioning, extinction and extinction retest. Exposure to images of community violence accentuated SCRs during US anticipation on CS+ trials and impaired the retention of safety learning (larger SCRs to the CS+ compared to the CS- at retest and the CS+ at the end of extinction). No significant group differences emerged in subjective ratings. Findings lend preliminary support for suggestions that adverse experiences may be linked to impairments in fear and safety learning and provide key evidence suggesting that the expression of these impairments may differ as a function of the type of adversity.

Complex psychological trauma as a consequence of extreme stress

The article presents a brief review of the concept of complex psychological trauma transformations over thirty years, which occurred since the moment when the term Complex Post-traumatic Stress Disorder (C-PTSD) was proposed as a clinical syndrome of multiple psychological traumatization to its official recognition as a diagnostic construct. The article analyzes the dynamics of ideas about the causes and the nature of psychological trauma manifestations under the influence of extreme stress factors, which is reflected in the current nomenclatures of mental and somatic disorders. A comparative analysis of the specific characteristics of various types of psychological traumas that intersect with the term complex PTSD in the conceptual field of trauma psychology is presented. The basic characteristics of complex psychological trauma that distinguish it from similar terms are defined, and the ways of further research in this direction are outlined.

Early life stress and brain function: Activity and connectivity associated with processing emotion and reward

Investigating the developmental sequelae of early life stress has provided researchers the opportunity to examine adaptive responses to extreme environments. A large body of work has established mechanisms by which the stressful experiences of childhood poverty, maltreatment, and institutional care can impact the brain and the distributed stress systems of the body. These mechanisms are reviewed briefly to lay the foundation upon which the current neuroimaging literature has been built. More recently, developmental cognitive neuroscientists have identified a number of the effects of early adversity, including differential behavior and brain function. Among the most consistent of these findings are differences in the processing of emotion and reward-related information. The neural correlates of emotion processing, particularly frontolimbic functional connectivity, have been well studied in early life stress samples with results indicating accelerated maturation following early adversity. Reward processing has received less attention, but here the evidence suggests a deficit in reward sensitivity. It is as yet unknown whether the accelerated maturation of emotion-regulation circuits comes at the cost of delayed development in other systems, most notably the reward system. This review addresses the early life stress neuroimaging literature that has investigated emotion and reward processing, identifying important next steps in the study of brain function following adversity.

Cumulative risk, teacher-child closeness, executive function and early academic skills in kindergarten children

We tested the role of teacher-child closeness in moderating the associations between early childhood adversity, measured as a cumulative risk index, and child outcomes during the kindergarten year. Using the ECLSK:11, a national dataset of kindergarteners in the 2010-11 academic year, we examined three dimensions of executive function (cognitive flexibility, inhibitory control, working memory), as well as early reading and math scores, as key skills that facilitate the transition to school. Cumulative risk was negatively associated with all outcomes, and teacher-child closeness was positively associated with all outcomes. Teacher-child closeness moderated the relation between cumulative risk and working memory and cumulative risk and reading scores in a protective manner, but not cognitive flexibility, inhibitory control, or math scores. Implications for research in early childhood adversity and education are discussed.

Childhood Adversity and Neural Development: A Systematic Review

An extensive literature on childhood adversity and neurodevelopment has emerged over the past decade. We evaluate two conceptual models of adversity and neurodevelopment-the dimensional model of adversity and stress acceleration model-in a systematic review of 109 studies using MRI-based measures of neural structure and function in children and adolescents. Consistent with the dimensional model, children exposed to threat had reduced amygdala, medial prefrontal cortex (mPFC), and hippocampal volume and heightened amygdala activation to threat in a majority of studies; these patterns were not observed consistently in children exposed to deprivation. In contrast, reduced volume and altered function in frontoparietal regions were observed consistently in children exposed to deprivation but not children exposed to threat. Evidence for accelerated development in amygdala-mPFC circuits was limited but emerged in other metrics of neurodevelopment. Progress in charting neurodevelopmental consequences of adversity requires larger samples, longitudinal designs, and more precise assessments of adversity.

Chronic childhood adversity and speed of transition through stages of alcohol involvement

BACKGROUND

While research suggests that chronic childhood adversities may be predictors of alcohol use disorders, little is known of their influence on accelerated transitions through stages of alcohol involvement. We estimated the speed of transition from first opportunity (to first drink, regular drinking) to alcohol use disorder, by type and number of childhood adversities experienced.

METHODS

Nine-hundred-and-fifteen individuals participated in the Mexican Adolescent Mental Health Survey (a stratified multistage probabilistic sample), first as adolescents (12-17 years of age) and again eight years later as young adults (19-26 years of age). The WHO World Mental Health Composite International Diagnostic Interview (WMH-CIDI) assessed DSM-IV alcohol use disorders and twelve chronic childhood adversities. We calculated random coefficient models to estimate the association of childhood adversities with speed through stages of alcohol use involvement.

RESULTS

Mean time from opportunity to disorder was 4.08 years and the average growth rate was 1.36 years between each stage of involvement. Some, but not all, childhood adversities accelerated the growth rate, decreasing latency between each stage of alcohol use involvement from 1.36 to 0.93 years for witnessing family violence, 0.87 years for having a life-threatening illness, 0.79 years for sexual abuse to 0.77 years for physical abuse (p < 0.01).

CONCLUSIONS

There is a narrower window of opportunity to prevent progression through stages of alcohol involvement in youth who have experienced certain childhood adversities. Our findings are consistent with the dimensional approach of childhood adversity that distinguishes between experiences of threat and deprivation that might differentially influence neurological development.

Adverse experiences in early childhood and their longitudinal impact on later behavioral problems of children living in poverty

BACKGROUND

Adverse childhood experiences (ACEs) are an identified risk factor for the social and emotional development of children. What is less known is the long-term effects of ACEs when poverty and ACEs coincide.

OBJECTIVE

Using longitudinal cohort-panel data, we examined whether exposure to ACEs by the age of three among poor children would longitudinally result in behavioral problems at ages three, five, nine, and 15, after controlling for mothers' socioeconomic status and their children's characteristics.

PARTICIPANTS AND SETTING

We used a subsample of 2750 children and their parents living in urban poverty from the Fragile Families and Child Wellbeing study.

METHODS

Logistic regression modeling was used to obtain adjusted odds ratios of ACE categories predicting behavioral problems after accounting for family socioeconomic position.

RESULTS

Our findings indicate that experiencing ACEs in early childhood was significantly associated with later behavioral outcomes from childhood to adolescence. Exposure to multiple ACEs before the age of three was significantly associated with the top-risk behavior group at age five; the odd ratios were 2.0 (CI = 1.3-3.1) and 2.9 (CI = 1.8-4.6) for two ACEs and three or more ACEs, respectively. At both ages nine and 15, children experiencing two or more ACEs had 1.9 to 3.2 times higher odds to demonstrate more the top 10th percentile of behavioral problems. Among covariates, mothers' race and education, and children's gender and temperament were identified as significant factors to determine behavior problems.

CONCLUSIONS

The findings support policies and programs for families with children who have experienced economic disadvantages and early childhood adversity.

The development of stress reactivity and regulation during human development

Adverse experiences during childhood can have long-lasting impacts on physical and mental health. At the heart of most theories of how these effects are transduced into health impacts is the activity of stress-mediating systems, most notably the hypothalamic-pituitary-adrenocortical (HPA) axis. Here we review the anatomy and physiology of the axis, models of stress and development, the development of the axis prenatally through adolescence, the role of experience and sensitive periods in shaping its regulation, the social regulation of the axis at different points in development, and finally conclude with suggestions for future research. We conclude that it is clear that early adversity sculpts the stress system, but we do not understand which dimensions have the most impact and at what points in early development. It is equally clear that secure attachment relationships buffer the developing stress system; however, the mechanisms of social buffering and how these may change with development are not yet clear. Another critical issue that is not understood is when and for whom adversity will result in hypo- vs hyperactivity of stress-mediating systems. These and other issues are important for advancing our understanding of how early adversity "gets under the skin" and shapes human physical and mental health.

Atypical Prefrontal-Amygdala Circuitry Following Childhood Exposure to Abuse: Links With Adolescent Psychopathology

Adverse childhood experiences have been associated with more negative coupling between the ventromedial prefrontal cortex (vmPFC) and amygdala, a brain network involved in emotion regulation in both children and adults. This pattern may be particularly likely to emerge in individuals exposed to threatening experiences during childhood (e.g., exposure to child abuse), although this has not been examined in prior research. We collected functional magnetic resonance imaging data on 57 adolescents during an emotion regulation task. Greater negative functional connectivity between vmPFC and amygdala occurred during viewing of negative compared to neutral images. This vmPFC-amygdala task-related functional connectivity was more negative in adolescents exposed to physical, sexual, or emotional abuse than those without a history of maltreatment and was associated with abuse severity. This pattern of more negative functional connectivity was associated with higher levels of externalizing psychopathology concurrently and 2 years later. Greater negative connectivity in the vmPFC-amygdala network during passive viewing of negative images may reflect disengagement of regulatory responses from vmPFC in situations eliciting strong amygdala reactivity, potentially due to stronger appraisals of threat in children exposed to early threatening environments. This pattern may be adaptive in the short term but place adolescents at higher risk of psychopathology later in life.

Minds Under Siege: Cognitive Signatures of Poverty and Trauma in Refugee and Non-Refugee Adolescents

The impacts of war and displacement on executive function (EF)-what we might call the cognitive signatures of minds under siege-are little known. We surveyed a gender-balanced sample of 12- to 18-year-old Syrian refugees (n = 240) and Jordanian non-refugees (n = 210) living in Jordan. We examined the relative contributions of poverty, trauma exposure, posttraumatic stress, and insecurity to variance in inhibitory control and working memory. We observed associations between poverty and WM, suggesting that, even in populations exposed to substantial violence and fear, poverty is a specific pathway to WM deficit. We did not, however, find associations between EFs and exposures to trauma. Careful distinction between childhood adversities may illuminate which neurocognitive pathways matter for measures of cognitive function.

The Moderating Effects of Sex on Consequences of Childhood Maltreatment: From Clinical Studies to Animal Models

Stress has pronounced effects on the brain, and thus behavioral outputs. This is particularly true when the stress occurs during vulnerable points in development. A review of the clinical literature regarding the moderating effects of sex on psychopathology in individuals exposed to childhood maltreatment (CM) is complicated by a host of variables that are difficult to quantify and control in clinical settings. As a result, the precise role of sex in moderating the consequences of CM remains elusive. In this review, we explore the rationale for studying this important question and their implications for treatment. We examine this issue using the threat/deprivation conceptual framework and highlight a growing body of work demonstrating important sex differences in human studies and in animal models of early life stress (ELS). The challenges and obstacles for effectively studying this question are reviewed and are followed by recommendations on how to move forward at the clinical and preclinical settings. We hope that this review will help inspire additional studies on this important topic.

Potential of ‘stacking’ early childhood interventions to reduce inequities in learning outcomes

Background

Early childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child’s life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children’s reading at 8–9 years.

Methods

Data from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children’s reading at 8–9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage.

Results

A cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=−14.03, 95% CI=−16.61 to −11.44). Effects were similar for disadvantaged and non-disadvantaged children.

Conclusion

This study supports the potential value of ‘stacking’ early interventions across the early years of a child’s life to maximise impacts on child outcomes.

Exposure to violence and low family income are associated with heightened amygdala responsiveness to threat among adolescents

The processing of emotional facial expressions is important for social functioning and is influenced by environmental factors, including early environmental experiences. Low socio-economic status (SES) is associated with greater exposure to uncontrollable stressors, including violence, as well as deprivation, defined as a lack or decreased complexity of expected environmental input. The current study examined amygdala and fusiform gyrus response to facial expressions in 207 early adolescents (mean age = 13.93 years, 63.3% female). Participants viewed faces displaying varying intensities of angry and happy faces during functional MRI. SES was assessed using the income-to-needs ratio (INR) and a measure of subjective social status. Cumulative exposure to violence was also assessed. When considered in isolation, only violence exposure was associated with heightened amygdala response to angry faces. When considered jointly, violence exposure and lower INR were both associated with increased amygdala response to angry faces and interacted, such that lower INR was associated with increased amygdala reactivity to anger only in those youth reporting no exposure to violence. This pattern of findings raises the possibility that greater amygdala reactivity to threat cues in children raised in low-SES conditions may arise from different factors associated with an economically-deprived environment.

Neurobiological Markers of Resilience to Depression Following Childhood Maltreatment: The Role of Neural Circuits Supporting the Cognitive Control of Emotion

BACKGROUND

Childhood adversity is strongly linked to negative mental health outcomes, including depression and anxiety. Leveraging cognitive neuroscience to identify mechanisms that contribute to resilience in children with a history of maltreatment may provide viable intervention targets for the treatment or prevention of psychopathology. We present a conceptual model of a potential neurobiological mechanism of resilience to depression and anxiety following childhood adversity. Specifically, we argue that neural circuits underlying the cognitive control of emotion may promote resilience, wherein a child's ability to recruit the frontoparietal control network to modulate amygdala reactivity to negative emotional cues-such as during cognitive reappraisal-buffers risk for internalizing symptoms following exposure to adversity.

METHODS

We provide preliminary support for this model of resilience in a longitudinal sample of 151 participants 8 to 17 years of age with (n = 79) and without (n = 72) a history of childhood maltreatment who completed a cognitive reappraisal task while undergoing functional magnetic resonance imaging.

RESULTS

Among maltreated youths, those who were better able to recruit prefrontal control regions and modulate amygdala reactivity during reappraisal exhibited lower risk for depression over time. By contrast, no association was observed between neural functioning during reappraisal and depression among youths without a history of maltreatment.

CONCLUSIONS

These preliminary findings support the hypothesis that children who are better able to regulate emotion through recruitment of the frontoparietal network exhibit greater resilience to depression following childhood maltreatment. Interventions targeting cognitive reappraisal and other cognitive emotion regulation strategies may have potential for reducing vulnerability to depression among children exposed to adversity.

Tuning of brain-autonomic coupling by prior threat exposure: Implications for internalizing problems in Mexican-origin adolescents

Exposure to threat increases the risk for internalizing problems in adolescence. Deficits in integrating bodily cues into representations of emotion are thought to contribute to internalizing problems. Given the role of the medial prefrontal cortex in regulating bodily responses and integrating them into representations of emotional states, coordination between activity in the medial prefrontal cortex and autonomic nervous system responses may be influenced by past threat exposure with consequences for the emergence of internalizing problems. A sample of 179 Mexican-origin adolescents (88 female) reported on neighborhood and school crime, peer victimization, and discrimination when they were 10-16 years old. At age 17, participants underwent a functional neuroimaging scan during which they viewed pictures of emotional faces while respiratory sinus arrhythmia (RSA) and skin conductance responses were measured. Adolescents also reported symptoms of internalizing problems. Greater exposure to threats across adolescence was associated with more internalizing problems. Threat exposure was also associated with stronger negative coupling between the ventromedial prefrontal cortex and RSA. Stronger negative ventromedial prefrontal cortex-RSA coupling was associated with fewer internalizing problems. These results suggest the degree of coordinated activity between the brain and parasympathetic nervous system is both enhanced by threat experiences and decreased in adolescents with more internalizing problems.

Transgenerational associations between maternal childhood stress exposure and profiles of infant emotional reactivity

Childhood exposure to stress can induce prolonged negative effects on health, which in turn confer risks for the next generation, but greater specificity is needed to inform intervention. A first step is to measure individual differences in emotional reactivity to stress early in life in ways that can account for heterogeneity in child exposure. The present study tested the hypothesis that mothers' childhood exposure to stress would be differentially associated with patterns of positive and negative emotional reactivity in their offspring, suggesting transmission of stress response across generations. Participants were 268 young mothers (age 14-23 years) followed longitudinally since childhood, and their infants aged 3-9 months. Latent class analysis of infant emotions expressed before and during the still-face paradigm yielded five subgroups that varied in valence, intensity, and reactivity. After accounting for sociodemographic factors, infant temperament, and postpartum depression, multinomial regression models showed that, relative to an emotionally regulated still-face response, infants showing low negative reactivity were more likely to have mothers exposed to childhood emotional abuse, and infants showing high and increasing negative reactivity were more likely to have mothers exposed to childhood emotional neglect. Mechanisms by which early maternal stress exposure influences emotional reactivity in offspring are discussed.

Comparing alternative methods of measuring cumulative risk based on multiple risk indicators: Are there differential effects on children's externalizing problems?

This study examined several alternative methods to measure cumulative risk (CR) based on multiple risk indicators. Several methods for measuring CR are presented and their conceptual and methodological assumptions are assessed. More specifically, at the individual risk level, we examined the implications of various measurement approaches (i.e., dichotomous, proportion- and z-scores). At the composite level, we measured CR as an observed score, and compared this approach with two variable-centered approaches (consisting of reflective and formative indicators) and two person-centered approaches (consisting of latent class analysis and latent profile analysis). A decision tree was proposed to aid researchers in comparing and choosing the alternative methods. Using a sample of 169 low-income families (children approximately 5 years old, 51% girls; 74% African American, and their primary caregiver), we specified models to represent each of the alternative methods. Across models, the multiple risk composite was based on a set of 12 individual risk indicators including low maternal education, hunger, meal and money unpredictability, maternal psychopathology, maternal substance use, harsh parenting, family stress, and family violence. For each model, we estimated the effect size of the composite CR variable on children's externalizing problems. Results indicated that the variable-centered CR composites had larger effects than the observed summary score CR indices and the person-centered methods.

A sex-disaggregated analysis of how emotional violence relates to suicide ideation in low- and middle-income countries

BACKGROUND

In recent years, research has increasingly focused on examining the relationship between one type of child maltreatment -- emotional violence -- and suicidal behaviors. However, the growing body of empirical evidence supporting these associations has been mostly limited to high-income contexts.

OBJECTIVE

This study examines how exposure to emotional violence is associated with suicide ideation in childhood and adolescence in low- and middle-income countries (LMICs), and whether this association differs by sex.

PARTICIPANTS AND SETTING

We employ nationally representative samples of 13-24 year-old males and females from the Violence Against Children Surveys in Tanzania (conducted in 2009), Kenya (2010), and Haiti (2012).

METHODS

We use logistic regressions to estimate the odds of ever reporting suicide ideation, separately, for each country; models control for self-reported exposure to emotional violence, physical violence from a caregiver, physical violence by an adult in the community, sexual violence, intimate partner violence, and age. Formal moderation by sex for each form of child maltreatment is tested using interaction terms.

RESULTS

We find the odds of suicide ideation are consistently and significantly greater for adolescents who report ever exposure to emotional violence. This same consistency is not observed for any other form of maltreatment across countries. The size of the relationship between emotional violence and suicide ideation is statistically significantly larger for males in Kenya only.

CONCLUSION

Research in LMICs should explore the mediating factors linking emotional abuse in childhood and adolescence to suicide ideation in adolescence, paying special attention to whether these pathways might operate differently by sex.

Trajectories of childhood adversity and the risk of depression in young adulthood: Results from the Avon Longitudinal Study of Parents and Children

BACKGROUND

The significance of the timing and chronicity of childhood adversity for depression outcomes later in life is unclear. Identifying trajectories of adversity throughout childhood would allow classification of children according to the accumulation, timing, and persistence of adversity, and may provide unique insights into the risk of subsequent depression.

METHODS

Using data from the Avon Longitudinal Study of Parents and Children, we created a composite adversity score comprised of 10 prospectively assessed domains (e.g., violent victimization, inter-parental conflict, and financial hardship) for each of eight time points from birth through age 11.5 years. We used semiparametric group-based trajectory modeling to derive childhood adversity trajectories and examined the association between childhood adversity and depression outcomes at the age of 18 years.

RESULTS

Among 9,665 participants, five adversity trajectories were identified, representing stable-low levels (46.3%), stable-mild levels (37.1%), decreasing levels (8.9%), increasing levels (5.3%), and stable-high levels of adversity (2.5%) from birth through late childhood. Approximately 8% of the sample met criteria for probable depression at 18 years and the mean depression severity score was 3.20 (standard deviation = 3.95, range 0-21). The risk of depression in young adulthood was elevated in the decreasing (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.19-2.48), increasing (OR = 1.81, 95% CI = 1.15-2.86), and stable-high (OR = 1.80, 95% CI = 1.00-3.23) adversity groups, compared to those with stable-low adversity, when adjusting for potential confounders.

CONCLUSIONS

Children in trajectory groups characterized by moderate or high levels of adversity at some point in childhood exhibited consistently greater depression risk and depression severity, regardless of the timing of adversity.

Association between early-life trauma and obsessive compulsive symptoms in community youth

BACKGROUND

Obsessive-compulsive symptoms (OCS) in youth are common, have heterogeneous manifestations, and have been shown to be associated with serious psychopathology. While early-life trauma exposure is associated with increased risk for obsessive-compulsive disorder (OCD), its association with different OCS and its clinical relevance for serious psychopathology is unclear. Here we aimed to evaluate associations among traumatic stressful events (TSE), OCS, and serious psychiatric conditions in community youth.

METHODS

We studied nonmental-help seeking youths from the Philadelphia Neurodevelopmental Cohort (N = 7054, aged 11-21, 54% females, 52% prepubertal), assessed for lifetime TSE exposure and OCS. Regression models investigated cross-sectional associations of TSEs with OCS, and associations with depression, suicide ideation and psychosis. Models examined sex and puberty effects, controlling for age and socioeconomic status.

RESULTS

Trauma exposure was associated with higher OCS rates, especially in females (Trauma × Sex interaction Wald = 7.93, p = 0.005) and prepuberty (Trauma × Puberty interaction Wald = 7.68, p = 0.006). TSEs were associated with all OCS manifestations, most prominently with bad intrusive thoughts (odds ratio [OR] = 1.63). Assaultive TSEs, especially sexual assault, showed stronger associations with OCS compared with nonassaultive TSEs. While TSEs and OCS were independently associated with depression, suicide ideation, and psychosis, a significant interaction was observed only in association with increased rates of psychosis (Trauma × OCS interaction Wald = 5.08, p = 0.024).

CONCLUSION

Early-life trauma is associated with OCS in a dose-response manner, more so in females and prepuberty. The trauma-OCS association varied by load, type of trauma, and by OCS subtypes. Trauma-OCS appears a detrimental combination in association with psychosis.

The moderating effects of traumatic stress on vulnerability to emotional distress during pregnancy

Emotional distress during pregnancy is likely influenced by both maternal history of adversity and concurrent prenatal stressors, but prospective longitudinal studies are lacking. Guided by a life span model of pregnancy health and stress sensitization theories, this study investigated the influence of intimate partner violence (IPV) during pregnancy on the association between childhood adversity and prenatal emotional distress. Participants included an urban, community-based sample of 200 pregnant women (aged 18-24) assessed annually from ages 8 to 17 for a range of adversity domains, including traumatic violence, harsh parenting, caregiver loss, and compromised parenting. Models tested both linear and nonlinear effects of adversity as well as their interactions with IPV on prenatal anxiety and depression symptoms, controlling for potential confounds such as poverty and childhood anxiety and depression. Results showed that the associations between childhood adversity and pregnancy emotional distress were moderated by prenatal IPV, supporting a life span conceptualization of pregnancy health. Patterns of interactions were nonlinear, consistent with theories conceptualizing stress sensitization through an "adaptive calibration" lens. Furthermore, results diverged based on adversity subdomain and type of prenatal IPV (physical vs. emotional abuse). Findings are discussed in the context of existing stress sensitization theories and highlight important avenues for future research and practice.

The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial

OBJECTIVE

Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.

METHODS

The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.

RESULTS

Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03).

CONCLUSIONS

The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.

CLINICAL TRIAL REGISTRATION

NCT00747396.

Differential Associations of Deprivation and Threat With Cognitive Control and Fear Conditioning in Early Childhood

Early-life adversity (ELA) is strongly associated with risk for psychopathology. Within adversity, deprivation, and threat may lead to psychopathology through different intermediary pathways. Specifically, deprivation, defined as the absence of expected cognitive and social inputs, is associated with lower performance on complex cognitive tasks whereas threatening experiences, defined as the presence of experiences that reflect harm to the child, are associated with atypical fear learning and emotional processes. However, distinct associations of deprivation and threat on behavioral outcomes have not been examined in early childhood. The present study examines how deprivation and threat are associated with cognitive and emotional outcomes in early childhood. Children 4–7 years old completed behavioral tasks assessing cognitive control (N = 58) and fear conditioning (N = 45); deprivation and threat were assessed using child interview and parent questionnaires. Regression analyses were performed including deprivation and threat scores and controls for age, gender, and IQ. Because this is the first time these variables have been examined in early childhood, interactions with age were also examined. Deprivation, but not threat was associated with worse performance on the cognitive control task. Threat, but not deprivation interacted with age to predict fear learning. Young children who experienced high levels of threat showed evidence of fear learning measured by differential skin conductance response even at the earliest age measured. In contrast, for children not exposed to threat, fear learning emerged only in older ages. Children who experienced higher levels of threat also showed blunted reactivity measured by amplitude of skin conductance response to the reinforced stimuli regardless of age. Results suggest differential influences of deprivation and threat on cognitive and emotional outcomes even in early childhood. Future work should examine the neural mechanisms underlying these behavioral changes and link changes with increased risk for negative outcomes associated with adversity exposure, such as psychopathology.

Association of Different Types of Childhood Maltreatment With Emotional Responding and Response Control Among Youths

Importance

Childhood maltreatment is associated with serious developmental consequences that may be different depending on the form of maltreatment. However, relatively little research has investigated this issue despite implications for understanding the development of psychiatric disorders after maltreatment.

Objective

To determine the association of childhood maltreatment and potential differential associations of childhood abuse or neglect with neural responsiveness within regions of the brain implicated in emotional responding and response control.

Design, Setting, and Participants

In this cross-sectional study, participants aged 10 to 18 years with varying levels of prior maltreatment as indexed by the Childhood Trauma Questionnaire (CTQ) were recruited from a residential care facility and the surrounding community. Blood oxygen level-dependent response data were analyzed via 2 analyses of covariance that examined 2 (sex) × 3 (task condition [view, congruent, incongruent]) × 3 (valence [negative, neutral, positive]) with Blom-transformed covariates: (1) total CTQ score; and (2) abuse and neglect subscores. Data were collected from April 1, 2016, to June 30, 2018. Data analyses occurred from June 10, 2018, to October 31, 2018.

Main Outcomes and Measures

Blood oxygenation level-dependent signals in response to an Affective Stroop task were measured via functional magnetic resonance imaging.

Results

The sample included 116 youths (mean [SD] age, 15.0 [2.2] years; 70 [60.3%] male). Fifteen participants reported no prior maltreatment. The remaining 101 participants (87.1%) reported at least some prior maltreatment, and 55 (54.5%) reported significant maltreatment, ie, total CTQ scores were greater than the validated CTQ score threshold of 40. There were significant total CTQ score × task condition associations within the bilateral postcentral gyrus, left precentral gyrus, midcingulate cortex, middle temporal gyrus, and superior temporal gyrus (left postcentral gyrus: F = 11.73; partial η2 = 0.14; right postcentral and precentral gyrus: F = 9.81; partial η2 = 0.10; midcingulate cortex: F = 12.76; partial η2 = 0.12; middle temporal gyrus: F = 13.24; partial η2 = 0.10; superior temporal gyrus: F = 10.33; partial η2 = 0.11). In all examined regions of the brain, increased maltreatment was associated with decreased differential responsiveness to incongruent task trials compared with view trials (left postcentral gyrus: r = -0.34; 95% CI, -0.17 to -0.51; right postcentral and precentral gyrus: r = -0.31; 95% CI, -0.14 to -0.49; midcingulate cortex: r = -0.36; 95% CI, -0.18 to -0.53; middle temporal gyrus: r = -0.35; 95% CI, -0.17 to -0.52; superior temporal gyrus: r = -0.37; 95% CI, -0.20 to -0.55). These interactions were particularly associated with level of abuse rather than neglect. A second analysis of covariance revealed significant abuse × task condition (but not neglect × task) interactions within the midcingulate cortex (F = 13.96; partial η2 = 0.11), right postcentral gyrus and inferior parietal lobule (F = 15.21; partial η2 = 0.12), left postcentral and precentral gyri (F = 11.16; partial η2 = 0.12), and rostromedial frontal cortex (F = 10.36; partial η2 = 0.08)). In all examined regions of the brain, increased abuse was associated with decreased differential responsiveness to incongruent task trials compared with view trials (midcingulate cortex: partial r = -0.33; P < .001; right postcentral gyrus and inferior parietal lobule: partial r = -0.41; P < .001; left postcentral and precentral gyri: partial r = -0.40; P < .001; and rostromedial frontal cortex: partial r = -0.40; P < .001).

Conclusions and Relevance

These data document associations of different forms of childhood maltreatment with atypical neural response. This suggests that forms of maltreatment may differentially influence the development of psychiatric pathology.

A person-centered approach to the assessment of early life stress: Associations with the volume of stress-sensitive brain regions in early adolescence

Researchers are becoming increasingly interested in linking specific forms of early life stress (ELS) to specific neurobiological markers, including alterations in the morphology of stress-sensitive brain regions. We used a person-centered, multi-informant approach to investigate the associations of specific constellations of ELS with hippocampal and amygdala volume in a community sample of 211 9- to 13-year-old early adolescents. Further, we compared this approach to a cumulative risk model of ELS, in which ELS was quantified by the total number of stressors reported. Using latent class analysis, we identified three classes of ELS (labeled typical/low, family instability, and direct victimization) that were distinguished by experiences of family instability and victimization. Adolescents in the direct victimization class had significantly smaller hippocampal volume than did adolescents in the typical/low class; ELS classes were not significantly associated with amygdala volume. The cumulative risk model of ELS had a poorer fit than did the person-centered model; moreover, cumulative ELS was not significantly associated with hippocampal or amygdala volume. Our results underscore the utility of taking a person-centered approach to identify alterations in stress-sensitive brain regions based on constellations of ELS, and suggest victimization is specifically associated with hippocampal hypotrophy observed in early adolescence.

Developing a neurobehavioral animal model of poverty: Drawing cross-species connections between environments of scarcity-adversity, parenting quality, and infant outcome

Children reared in impoverished environments are at risk for enduring psychological and physical health problems. Mechanisms by which poverty affects development, however, remain unclear. To explore one potential mechanism of poverty's impact on social-emotional and cognitive development, an experimental examination of a rodent model of scarcity-adversity was conducted and compared to results from a longitudinal study of human infants and families followed from birth (N = 1,292) who faced high levels of poverty-related scarcity-adversity. Cross-species results supported the hypothesis that altered caregiving is one pathway by which poverty adversely impacts development. Rodent mothers assigned to the scarcity-adversity condition exhibited decreased sensitive parenting and increased negative parenting relative to mothers assigned to the control condition. Furthermore, scarcity-adversity reared pups exhibited decreased developmental competence as indicated by disrupted nipple attachment, distress vocalization when in physical contact with an anesthetized mother, and reduced preference for maternal odor with corresponding changes in brain activation. Human results indicated that scarcity-adversity was inversely correlated with sensitive parenting and positively correlated with negative parenting, and that parenting fully mediated the association of poverty-related risk with infant indicators of developmental competence. Findings are discussed from the perspective of the usefulness of bidirectional-translational research to inform interventions for at-risk families.

Evidence for a sensitive period in the effects of early life stress on hippocampal volume

Exposure to stress has been causally linked to changes in hippocampal volume (HV). Given that the hippocampus undergoes rapid changes in the first years of life, stressful experiences during this period may be particularly important in understanding individual differences in the development of the hippocampus. One hundred seventy-eight early adolescents (ages 9-13 years; 43% male) were interviewed regarding exposure to and age of onset of experiences of stress; the severity of each stressful event was rated by an objective panel. All participants underwent structural magnetic resonance imaging, from which HVs were automatically segmented. Without considering the age of onset for stressful experiences, there was a small but statistically significant negative association of stress severity with bilateral HV. When considering the age of onset, there was a moderate and significant negative association between stress severity during early childhood (through 5 years of age) and HV; there was no association between stress severity during later childhood (age 6 years and older) and HV. We provide evidence of a sensitive period through 5 years of age for the effects of life stress on HV in adolescence. It will be important in future research to elucidate how reduced HV stemming from early life stress may contribute to stress-related health outcomes.

Mechanisms linking childhood adversity with psychopathology: Learning as an intervention target

Exposure to childhood adversity is common and a powerful risk factor for many forms of psychopathology. In this opinion piece, we argue for greater translation of knowledge about the developmental processes that are influenced by childhood adversity into targeted interventions to prevent the onset of psychopathology. Existing evidence has consistently identified several neurodevelopmental pathways that serve as mechanisms linking adversity with psychopathology. We highlight three domains in which these mechanisms are well-established and point to clear targets for intervention: 1) threat-related social information processing biases; 2) heightened emotional reactivity and difficulties with emotion regulation; and 3) disruptions in reward processing. In contrast to these established pathways, knowledge of how childhood adversity influences emotional learning mechanisms, including fear and reward learning, is remarkably limited. We see the investigation of these mechanisms as a critical next step for the field that will not only advance understanding of developmental pathways linking childhood adversity with psychopathology, but also provide clear targets for behavioral interventions. Knowledge of the mechanisms linking childhood adversity with psychopathology has advanced rapidly, and the time has come to translate that knowledge into clinical interventions to prevent the onset of mental health problems in children who have experienced adversity.

Validation of the Traumatic Events Screening Inventory for ACEs

OBJECTIVES

Our purpose in this study was to adapt and validate the Traumatic Events Screening Inventory (TESI) as a primary-care childhood adversity screening tool for children living in vulnerable neighborhoods using a community-partnered approach.

METHODS

In this cross-sectional, descriptive study, we used a sample of 261 children (3-16 years old) who were seeking services at a Federally Qualified Health Center with colocated behavioral health services in Chicago and had a positive Pediatric Symptom Checklist screen result or received a referral for behavioral health evaluation. The TESI was adapted as a screening tool to be sensitive to adverse childhood experiences (ACEs) unique to the clinic communities. ACEs were mapped by zip code with objective neighborhood crime data, and latent class analysis was performed to identify ACE subgroups.

RESULTS

The mapping validation suggested face validity for geographic overlap between participant ACEs and objective violent-crime occurrence. With latent class analysis, we identified 3 ACE subgroups: (1) high ACE (18.0% of the sample; polyvictimization and/or maltreatment), (2) moderate ACE (52.1%; violent environments), and (3) low ACE (29.9%; few adverse experiences). Membership in the high-ACE subgroup was associated with higher odds of a clinically significant Pediatric Symptom Checklist score (odds ratio = 3.83) and clinical-level attention problems (odds ratio = 3.58) even after accounting for child resilience and parent depression.

CONCLUSIONS

ACEs play a significant role in predicting a need for behavioral health services among children seeking primary-care services. The community-adapted TESI is a valid ACE screening tool.

Early Experiences of Threat, but Not Deprivation, Are Associated With Accelerated Biological Aging in Children and Adolescents

BACKGROUND

Recent conceptual models argue that early life adversity (ELA) accelerates development, which may contribute to poor mental and physical health outcomes. Evidence for accelerated development in youths comes from studies of telomere shortening or advanced pubertal development following circumscribed ELA experiences and neuroimaging studies of circuits involved in emotional processing. It is unclear whether all ELA is associated with accelerated development across global metrics of biological aging or whether this pattern emerges following specific adversity types.

METHODS

In 247 children and adolescents 8 to 16 years of age with wide variability in ELA exposure, we evaluated the hypothesis that early environments characterized by threat, but not deprivation, would be associated with accelerated development across two global biological aging metrics: DNA methylation (DNAm) age and pubertal stage relative to chronological age. We also examined whether accelerated development explained associations of ELA with depressive symptoms and externalizing problems.

RESULTS

Exposure to threat-related ELA (e.g., violence) was associated with accelerated DNAm age and advanced pubertal stage, but exposure to deprivation (e.g., neglect, food insecurity) was not. In models including both ELA types, threat-related ELA was uniquely associated with accelerated DNAm age (β = .18) and advanced pubertal stage (β = .28), whereas deprivation was uniquely associated with delayed pubertal stage (β = -.21). Older DNAm age was related to greater depressive symptoms, and a significant indirect effect of threat exposure on depressive symptoms was observed through DNAm age.

CONCLUSIONS

Early threat-related experiences are particularly associated with accelerated biological aging in youths, which may be a mechanism linking ELA with depressive symptoms.

Characterizing adverse prenatal and postnatal experiences in children

BACKGROUND

Prenatal and postnatal adversities, including prenatal alcohol exposure (PAE), prenatal exposure to other substances, toxic stress, lack of adequate resources, and postnatal abuse or neglect, often co-occur. These exposures can have cumulative effects, or interact with each other, leading to worse outcomes than single exposures. However, given their complexity and heterogeneity, exposures can be difficult to characterize. Clinical services and research often overlook additional exposures and attribute outcomes solely to one factor.

METHODS

We propose a framework for characterizing adverse prenatal and postnatal exposures and apply it to a cohort of 77 children. Our approach considers type, timing, and frequency to quantify PAE, other prenatal substance exposure, prenatal toxic stress, postnatal threat (harm or threat of harm), and postnatal deprivation (failure to meet basic needs) using a 4-point Likert-type scale. Postnatal deprivation and harm were separated into early (<24 months of age) and late (≥24 months) time periods, giving seven exposure variables. Exposures were ascertained via health records, child welfare records, interviews with birth parents, caregivers, and/or close family/friends.

RESULTS

Nearly all children had co-occurring prenatal exposures, and two-thirds had both prenatal and postnatal adversities. Children with high PAE were more likely to experience late postnatal adversities, and children with other prenatal substance exposure were more likely to have early postnatal deprivation. Postnatal adversities were more likely to co-occur.

CONCLUSION

This framework provides a comprehensive picture of a child's adverse exposures, which can inform assessment and intervention approaches and policy and will be useful for future research.

Assessing within- and between-family variations in an expanded measure of childhood adversity

Previous measures of childhood adversity have enabled the identification of powerful links with later-life wellbeing. The challenge for the next generation of childhood adversity assessment is to better characterize those links through comprehensive, fine-grained measurement strategies. The expanded, retrospective measure of childhood adversity presented here leveraged analytic and theoretical advances to examine multiple domains of childhood adversity at both the microlevel of siblings and the macrolevel of families. Despite the fact that childhood adversity most often occurs in the context of families, there is a dearth of studies that have validated childhood adversity measures on multiple members of the same families. Multilevel psychometric analyses of this childhood adversity measure administered to 1,194 siblings in 500 families indicated that the additional categories of childhood adversity were widely endorsed, and increased understanding of the sources and sequalae of childhood adversity when partitioned into within- and between-family levels. For example, multilevel confirmatory factor analyses (MCFAs) indicated that financial stress, unsafe neighborhood, and parental unemployment were often experienced similarly by siblings in the same families and stemmed primarily from family wide (between-family) sources. On the other hand, being bullied and school stressors were often experienced differently by siblings and derived primarily from individual (within-family) processes. Multilevel structural equation modeling (MSEM) further illuminated differential criterion validity correlations between these categories of childhood adversity with midlife psychological, social, and physical health. Expanded, multidomain, and multilevel measures of childhood adversity appear to hold promise for identifying layered causes and consequences of adverse childhood experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Comparing cumulative index and factor analytic approaches to measuring maltreatment in the National Longitudinal Study of Adolescent to Adult Health

Child maltreatment is a complex and multifaceted construct in need of advanced statistical techniques to improve its measurement. The current study compared the predictive utility of a cumulative index to a factor analytic approach for constructing a measure of maltreatment. Data were from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (Wave III: n = 14,800; Wave IV: n = 12,288). As adults, participants retrospectively reported on their childhood experiences of physical abuse, sexual abuse, emotional abuse, physical neglect, supervisory neglect, and social services investigations. Both the cumulative index and a two-factor solution showed evidence of convergent validity, predicting lifetime incidence of homelessness, being paid for sex, and various measures of running away or living apart from biological parents, and prospectively predicting depression, substance use, and criminal behavior. The latent variables, derived from a factor analytic approach, had greater explanatory power for many outcomes compared to the cumulative index, even when controlling for sociodemographic variables. Results suggest that factor analysis is a better methodology than a cumulative index for measuring maltreatment in large datasets when explanatory power for external outcomes is of greatest concern.

Association between traumatic stress load, psychopathology, and cognition in the Philadelphia Neurodevelopmental Cohort

BACKGROUND

Traumatic stressors during childhood and adolescence are associated with psychopathology, mostly studied in the context of post-traumatic stress disorder (PTSD) and depression. We investigated broader associations of traumatic stress exposure with psychopathology and cognition in a youth community sample.

METHODS

The Philadelphia Neurodevelopmental Cohort (N = 9498) is an investigation of clinical and neurobehavioral phenotypes in a diverse (56% Caucasian, 33% African American, 11% other) US youth community population (aged 8-21). Participants were ascertained through children's hospital pediatric (not psychiatric) healthcare network in 2009-2011. Structured psychiatric evaluation included screening for lifetime exposure to traumatic stressors, and a neurocognitive battery was administered.

RESULTS

Exposure rate to traumatic stressful events was high (none, N = 5204; one, N = 2182; two, N = 1092; three or more, N = 830). Higher stress load was associated with increased psychopathology across all clinical domains evaluated: mood/anxiety (standardized β = .378); psychosis spectrum (β = .360); externalizing behaviors (β = .311); and fear (β = .256) (controlling for covariates, all p &lt; 0.001). Associations remained significant controlling for lifetime PTSD and depression. Exposure to high-stress load was robustly associated with suicidal ideation and cannabis use (odds ratio compared with non-exposed 5.3 and 3.2, respectively, both p &lt; 0.001). Among youths who experienced traumatic stress (N = 4104), history of assaultive trauma was associated with greater psychopathology and, in males, vulnerability to psychosis and externalizing symptoms. Stress load was negatively associated with performance on executive functioning, complex reasoning, and social cognition.

CONCLUSIONS

Traumatic stress exposure in community non-psychiatric help-seeking youth is substantial, and is associated with more severe psychopathology and neurocognitive deficits across domains, beyond PTSD and depression.

Dimensions of deprivation and threat, psychopathology, and potential mediators: A multi-year longitudinal analysis

Prior research demonstrates a link between exposure to childhood adversity and psychopathology later in development. However, work on mechanisms linking adversity to psychopathology fails to account for specificity in these pathways across different types of adversity. Here, we test a conceptual model that distinguishes deprivation and threat as distinct forms of childhood adversity with different pathways to psychopathology. Deprivation involves an absence of inputs from the environment, such as cognitive and social stimulation, that influence psychopathology by altering cognitive development, such as verbal abilities. Threat includes experiences involving harm or threat of harm that increase risk for psychopathology through disruptions in social-emotional processing. We test the prediction that deprivation, but not threat, increases risk for psychopathology through altered verbal abilities. Data were drawn from the Child Development Project (N = 585), which followed children for over a decade. We analyze data from assessment points at age 5, 6, 14, and 17 years. Mothers completed interviews at age 5 and 6 on exposure to threat and deprivation experiences. Youth verbal abilities were assessed at age 14. At age 17, mothers reported on child psychopathology. A path analysis model tested longitudinal paths to internalizing and externalizing problems from experiences of deprivation and threat. Consistent with predictions, deprivation was associated with risk for externalizing problems via effects on verbal abilities at age 14. Threat was associated longitudinally with both internalizing and externalizing problems, but these effects were not mediated by verbal abilities. Results suggest that unique developmental mechanisms link different forms of adversity with psychopathology. (PsycINFO Database Record