Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review

Emotion Regulation Flexibility in Adolescents: A Systematic Review from Conceptualization to Methodology

Considerable attention has been devoted to the concept of flexible emotion regulation, which de-emphasizes the importance of any specific regulatory strategy in favor of the flexible deployment of strategies in response to specific situational challenges. The bulk of research in this area has been conducted on adult samples. Research on emotion regulation flexibility (ERF) in youth has been documented in only a limited number of studies and using various definitions. This systematic review aims to gather and summarize different conceptualizations and methodological approaches of adolescent ERF. We incorporate these findings into a general framework to understand ERF and its role in adolescents' emotional, behavioral and social functioning. Adhering to the PRISMA guidelines, 11 studies were included in the review. While ERF has been defined in various and inconsistent ways, the included studies utilized conceptualizations from two overarching domains: the regulation of expressed emotion and the repertoire of emotion regulation strategies. Promising approaches and future directions will be highlighted.

Sensory Processing Assessment and Feedback in the Treatment of Complex Developmental Trauma

This study explored the impact of a sensory processing assessment, recommendations and feedback process on the functioning at school and after-hours environments of children who had been traumatised by abuse. A mixed methods design (Schoonenboom & Johnson, 2017) was utilized incorporating pre (12 months prior) and post (four to eight months after the report) repeated child focused measure, alongside thematic analysis of participants qualitative survey feedback. The methodology included two stages: firstly, an occupational therapy assessment of young people referred by Own Organisation clinicians for a sensory processing assessment and secondly, an evaluation was conducted of the impact of occupational therapy on the young person's behaviour and their carers. The study found significant improvement in family life and relationships as well as a reduction in impairment as evidenced by decreases in HoNOSCA scores across problems with family life and relationships, non-accidental self-injury, problems with emotional and related symptoms, poor school attendance and on the social subscale. These findings were supported by clinician participant reports. A sensory processing assessment provided young people, their carers and teachers with information which contributed to environmental adaptations. These environmental adaptations were associated with improved functioning and behaviour of young people impacted by child abuse. It is recommended future research attempt to replicate and extend our understanding of how sensory processing assessments and interventions can increase children's wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-023-00607-0.

Diagnostic profiles and trauma history among treatment-seeking young adults with positive post-traumatic stress disorder screens: Findings and implications for public mental health care

OBJECTIVES

This study examined diagnostic profiles and trauma history among treatment-seeking young adults with positive PTSD screens in public mental health care.

METHODS

Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment-seeking young adults (aged 18-35) endorsed trauma exposure with a score of at least 45 on the DSM-IV PTSD Checklist, indicating probable PTSD.

RESULTS

Young adults with positive PTSD screens were predominantly female, minority, and diagnosed with mood disorders. Of those with positive screens, only 15% had a chart diagnosis of PTSD; 17.3% (ages 18-24) versus 14.1% (ages 25-35). Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race.

CONCLUSION

Routine PTSD screening for young adults receiving public mental health care should be prioritized to address long-term impacts of trauma.

Behavioral difficulties and associated factors among the 'lost generation' of Syrian children and adolescents

Childhood and adolescence, vital in shaping adult life and society, are profoundly impacted during conflicts like Syria's devastating war. This study explores the prevalence of behavioral disorders in Syrian children and adolescents, examining the influence of war and family-related factors. This cross-sectional study was conducted on children aged 2-17 years at a children's outpatient clinic in Damascus, Syria. We assessed parents' quality of life, war and family-related factors, and behavioral difficulties through parental interviews using two questionnaires: the Arabic version of the Strengths & Difficulties Questionnaire (SDQ) and the brief Arabic version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). 74.67% of children aged 2-4 years and 61.29% of children aged 5-17 years were experiencing behavioral difficulties, with emotional difficulties being the most prevalent ones. Children exposed to kidnapping, family losses, lack of school enrollment, and those with parents having lower education, lower socioeconomic status, and poorer quality of life exhibited higher Total SDQ scores. The high prevalence of behavioral difficulties among children and adolescents in Syria is a major concern, with both direct and indirect war-related factors contributing to this issue.

Hypnosis with depressed children and teens: Building skills, creating connection

Depression in children and teens has been on the rise for several years. Recent increases in anxiety and loneliness, both contributors to the development of depression, are putting more young people at risk for chronic and comorbid mental health struggles. The use of hypnosis with depressed children offers the opportunity to target the identified skills depressed and anxious children need and is a modality clinicians should embrace. This article describes how to create hypnotic interventions focusing on improved emotional and cognitive management, better sleep, and the ability to make positive social connections. Such interventions serve to not only build the resources depressed children need for recovery, but also support a paradigm shift toward prevention in children and families.

Improving adolescent sleep in long-term Juvenile correctional settings: case examples with clinical, research, and policy implications

Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e. insomnia) and promoting sleep health (i.e. improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and well-being in these contexts.

Does affect mediate the relationship between interpersonal trauma and psychosis? A systematic review and meta-analysis

INTRODUCTION

The relationship between interpersonal trauma and psychosis is well established, and research is now focused on identifying mechanisms that may explain this relationship. Models of trauma and psychosis increasingly emphasize a broad range of affective processes, yet the overall effect of these affective processes is not well understood.

AIM

This review systematically examined the effect of any form of long-term affective dysfunction on the relationship between interpersonal trauma and psychosis. Where possible, it used meta-analytic techniques to quantify the overall magnitude of this effect.

METHOD

Searches were conducted using PsychINFO, MEDLINE and CINAHL databases, and eligible studies were appraised for methodological quality. Narrative synthesis and meta-analytic methods were used to evaluate evidence.

RESULTS

Twenty-nine studies met criteria for inclusion. Five affective mediators were found; depression, anxiety, affective dysregulation, loneliness and attachment. Findings from both the narrative synthesis (n = 29) and meta-analysis (n = 8) indicated that, overall, affect is a small but significant mediator of the relationship between interpersonal trauma and psychosis (pooled Cohen's d = 0.178; pooled 95 % CI: 0.022-0.334).

CONCLUSIONS

Overall, findings support affective pathways to psychosis, though highlight the need for further research on broader affective mediators (loneliness, shame). The small effect size found in the meta-analysis also points to the potential importance of non-affective mediators. Clinically, these findings highlight the value of treatment modalities that attend to multiple mechanisms in the relationship between interpersonal trauma and psychosis. Future research should focus on the interplay and causal sequence between these mechanisms to further understand pathways between interpersonal trauma and psychosis.

Creating Space for Adolescents and Families With Lived Experience of Homelessness to Build Familial Empathy, Communication, and Emotional Regulation: A Qualitative Study of Facilitators of Implementation

Youth experiencing homelessness are vulnerable to commercial sexual exploitation (CSE). Structural racism disproportionately entraps marginalized youth into CSE while simultaneously obscuring their identification as victims. Adaptation and tailoring of effective interventions to mitigate associated sequelae and inequities is warranted. Support To Reunite, Involve, and Value Each Other (STRIVE) is a strengths-based dyadic intervention with demonstrated efficacy in reducing delinquency, substance use, and high-risk sexual behaviors among marginalized adolescents experiencing homelessness. The adapted STRIVE+ was piloted to explore potential for reducing youth risk factors for CSE. The current article reports findings from interviews exploring participants' experiences with STRIVE+. Youth and caregivers reported increased empathy, communication, and emotional regulation post-STRIVE+ and found relevance and meaning through participating in the adapted intervention. Feasibility of recruitment, engagement, and retention of minoritized adolescents and their caregivers were also demonstrated. Findings warrant larger scale implementation trials of STRIVE+ among minoritized youth at highest risk for CSE. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 27-35.].

Leveraging the developmental neuroscience of caregiving to promote resilience among youth exposed to adversity

Early adversity is a major risk factor for the emergence of psychopathology across development. Identifying mechanisms that support resilience, or favorable mental health outcomes despite exposure to adversity, is critical for informing clinical intervention and guiding policy to promote youth mental health. Here we propose that caregivers play a central role in fostering resilience among children exposed to adversity via caregiving influences on children's corticolimbic circuitry and emotional functioning. We first delineate the numerous ways that caregivers support youth emotional learning and regulation and describe how early attachment lays the foundation for optimal caregiver support of youth emotional functioning in a developmental stage-specific manner. Second, we outline neural mechanisms by which caregivers foster resilience-namely, by modulating offspring corticolimbic circuitry to support emotion regulation and buffer stress reactivity. Next, we highlight the importance of developmental timing and sensitive periods in understanding caregiving-related mechanisms of resilience. Finally, we discuss clinical implications of this line of research and how findings can be translated to guide policy that promotes the well-being of youth and families.

The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults

OBJECTIVE

The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults.

METHOD

This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder.

RESULTS

The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores.

CONCLUSION

This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.

MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

The relationship of posttraumatic stress disorder and developmental trauma disorder with childhood psychopathology: A network analysis

OBJECTIVE

Potentially traumatic experiences are a major risk factor for mental disorders in children and adolescents. Posttraumatic psychopathology includes trauma-specific disorders such as posttraumatic stress disorder (PTSD) as well as other psychiatric disorders. Developmental Trauma Disorder (DTD) has been proposed as a developmentally sensitive diagnosis. We aimed to further illuminate the co-occurrence of psychiatric conditions with DTD and PTSD.

METHOD

In a convenience sample of families of 507 children and adolescents (mean age = 12.11 years old, SD = 2.92; 48.5% female), we assessed DTD, PTSD, and screened for psychiatric disorders. We estimated network models including DTD, PTSD and ten psychiatric conditions.

RESULTS

We found that DTD and PTSD share both common and differential comorbidity features on disorder-, domain-, and symptom-level. The differential comorbidity patterns of the DTD and PTSD domains placed DTD close to both externalizing and internalizing psychopathology while PTSD was primarily linked to internalizing conditions.

CONCLUSIONS

Our study provides evidence for the complex clinical presentation of posttraumatic psychopathology over and above PTSD in children. DTD and PTSD provide useful and distinct diagnostic categories for children who are also experiencing internalizing conditions, and DTD may be especially relevant for children who are experiencing externalizing psychopathology.

Longitudinal Investigation of Bidirectional Relations Between Childhood Trauma and Emotion-Driven Impulsivity in the Adolescent Brain Cognitive Development Study

OBJECTIVE

Exposure to childhood trauma is associated with numerous adverse mental health consequences. Addressing important gaps in the existing research, the proposed study clarifies the longitudinal and bidirectional associations between childhood trauma and both negative and positive emotion-driven impulsivity.

METHOD

This study utilized a sample of 11,872 9- to 10-years-olds recruited from 21 research sites across the United States from the Adolescent Brain Cognitive Ddevelopment (ABCD) Study. Childhood trauma was assessed at one- and two-year follow-ups. Negative and positive urgency were assessed at baseline and two-year follow-up. Cross-lagged panel models evaluated the longitudinal and bidirectional associations between childhood trauma and both negative and positive emotion-driven impulsivity.

RESULTS

Findings showed that earlier childhood trauma was associated with higher levels of later negative (β = 0.133, p < .001) and positive (β = 0.125, p < .001) emotion-driven impulsivity. Further, higher levels of earlier positive (β = 0.033, p < .006), but not negative (β = 0.010, p = .405), emotion-driven impulsivity were associated with later childhood trauma. Finally, the strength of the relations between childhood trauma and emotion-driven impulsivity did not differ by sex (ΔX2 = 10.228, p > .05).

DISCUSSION

Identification of both negative and positive emotion-driven impulsivity among children exposed to trauma may serve as a point of intervention to reduce subsequent risk for deleterious health outcomes.

A Person-Centered Approach to Emotional Security: Latent Profile Analysis of the Dark Triad and Psychological Symptoms

Few studies have examined emotional security utilizing a person-centered approach. Therefore, in the present study, we conceptualized a multidimensional construct that includes psychological symptoms (i.e., depression, anxiety, and stress) and the dark triad traits (i.e., Machiavellianism, narcissism, and psychopathy). Applying latent profile analysis (LPA) allows the exploration of the interaction of emotional security with the dark triad traits and psychological symptoms in the sample at the level of sub-classes. Depression, stress, anxiety, Machiavellianism, narcissism, and psychopathy were determined as profile indicators. Moreover, satisfaction with life and the psychological well-being of the sub-classes were predicted. Data were gathered from 558 participants (418 females, %74.9) with an average age of 22.44 years). LPA indicated four distinct profiles: 'High emotional security and low psychological symptoms, and dark triad traits' (22%), 'Low emotional security and high psychological symptoms, dark triad traits' (5%), 'Low emotional security and moderate dark triad traits' (28%), 'Moderate emotional security, psychological symptoms, and dark triad traits' (45%). Mixture modeling approach-based research provides a complementary view of the previous psychopathology literature. The findings could help practitioners target at-risk university students with low emotional security, low psychological well-being, and low life satisfaction and design programs to aid them in alleviating the psychological symptoms and the dark triad traits.

Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature

Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches. To systematically review existing literature on interventions for prevention or treatment of SUDs among adolescents (aged 10-24) with a history of trauma, with or without PTSD, we searched databases (PubMed, PsycInfo, CINAHL, Cochrane CENTRAL) using search terms related to substance use, trauma, adolescents, and interventions. Searches identified 8134 unique articles, 68 of which prompted full-text screening. Authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. Thirty three articles met eligibility criteria, including 13 RCTs. Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma, predominantly via individual therapy based on cognitive-behavioral principles, although group therapy, case management, and other approaches have also been studied. Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes. Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings. Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments. Several promising interventions have been recently developed.

Psychological empowerment and future orientation among adolescents in a youth participatory action research program

Youth participatory action research (YPAR) empowers youth to address challenges in their environment. Empowerment is associated with prosocial behaviors; however, understanding of how empowerment may serve as a protective factor and promote emotional health remains limited. We sought to characterize protective factors (future orientation and resilience) and emotional health (difficulties regulating emotion and psychological distress) among youth engaged in YPAR and examine associations with psychological empowerment. We administered cross-sectional surveys to 63 youth in YPAR programming. Multivariable linear regression examined relationships between psychological empowerment, protective factors, and emotional health. Participants had high future orientation and resilience with high psychological distress. Empowerment was significantly associated with higher future orientation. There was no significant relationship between empowerment and measures of emotional health. We demonstrate the importance of evaluating protective factors and emotional health constructs in empowerment frameworks, calling for strategies that incorporate such protective factors and more directly address emotional health.

Neural correlates of irritability symptom relief in adolescents pre- and post-trauma-focused cognitive behavioral therapy: A pilot study on reward processing

Despite that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a first-line, evidence-based treatment for youths experiencing trauma-related symptoms, treatment responses vary and it remains unclear for whom and how this treatment works. In this context, we examined pre-treatment neural reward processing and pre- vs. post-treatment changes in neural reward processing, in relation to irritability - a transdiagnostic and dimensional feature present in multiple trauma-related syndromes, following TF-CBT. Adolescents (N = 22) with childhood trauma history completed a child-friendly monetary incentive delay task during fMRI acquisition, prior to and after the treatment, and irritability symptoms were assessed at five time points over the course of the treatment. Individual irritability slopes (i.e., irritability change rate) and intercepts (i.e., initial irritability level), generated by linear growth curve modeling, were integrated with fMRI data. Repeated ANCOVAs demonstrated that both pre-treatment neural response to reward and pre- vs. post-treatment changes in neural reward processing correlated with irritability symptom relief, such that opposite baseline neural reward processing profiles and differential changing patterns were observed in individuals showing irritability symptom relief vs. not. Together, our findings provide proof of concept that integrating brain information with clinical information has the potential to identify predictors and mechanisms of symptom relief.

Interpersonal early adversity demonstrates dissimilarity from early socioeconomic disadvantage in the course of human brain development: A meta-analysis

It has been established that early-life adversity impacts brain development, but the role of development itself has largely been ignored. We take a developmentally-sensitive approach to examine the neurodevelopmental sequelae of early adversity in a preregistered meta-analysis of 27,234 youth (birth to 18-years-old), providing the largest group of adversity-exposed youth to date. Findings demonstrate that early-life adversity does not have an ontogenetically uniform impact on brain volumes, but instead exhibits age-, experience-, and region-specific associations. Relative to non-exposed comparisons, interpersonal early adversity (e.g., family-based maltreatment) was associated with initially larger volumes in frontolimbic regions until ∼10-years-old, after which these exposures were linked to increasingly smaller volumes. By contrast, socioeconomic disadvantage (e.g., poverty) was associated with smaller volumes in temporal-limbic regions in childhood, which were attenuated at older ages. These findings advance ongoing debates regarding why, when, and how early-life adversity shapes later neural outcomes.

The Flexible Regulation of Emotional Expression Scale for Youth (FREE-Y): Adaptation and Validation Across a Varied Sample of Children and Adolescents

Flexible self-regulation has been shown to be an adaptive ability. This study adapted and validated the adult Flexible Regulation of Emotional Expression (FREE) Scale for use with youth (FREE-Y) in community and maltreatment samples. The FREE-Y measures the ability to flexibly enhance and suppress emotion expression across an array of hypothetical social scenarios. Participants (N = 654, 8-19 years) were included from three studies. Confirmatory factor analysis (CFA) confirmed a theoretically appropriate higher order factor structure. Using multiple-group CFAs, measurement invariance was achieved across maltreatment status, age, and gender. Reliabilities were adequate and construct validity was demonstrated through associations with measures of emotion regulation, psychopathology, IQ, and executive functioning. Group comparisons indicated lower Suppression and Flexibility scores for maltreated versus comparison participants. Findings suggest that the FREE-Y is a valid measure of expressive regulation ability in youth that can be applied across a range of populations.

The Role of Dimensions of Emotion Dysregulation Following Exposure to Maltreatment and Adult Victimization

Child maltreatment is related to a host of negative consequences, including difficulties with emotion regulation (ER), posttraumatic stress symptoms (PTSS), and greater risk for revictimization. Yet, the literature has largely focused on sexual revictimization, while relations between maltreatment and other adult victimization types (e.g., intimate partner violence [IPV]) are less clear. Further, associations between emotion dysregulation and both child and adult trauma exposure have been identified, but aspects of dysregulation (i.e., nonacceptance of emotional responses, difficulties engaging in goal-directed behavior, impulsivity, lack of emotional awareness, limited access to ER strategies, and lack of emotional clarity) have received less attention. This study aimed to: (1) investigate the associations between maltreatment and adult victimization and the six ER dimensions while accounting for PTSS, and (2) determine whether there are indirect effects between maltreatment and adult victimization through each ER component. Seven hundred and forty-four undergraduates from two universities participated in the study (M_age = 21.48, SD = 4.12; 80.9% women; 56.2% white). Maltreatment and PTSS were directly linked with adult victimization (B = 0.14, B = 0.01, respectively). PTSS was inversely associated with each ER aspect (Bs = 0.02-0.10). Unexpectedly, neither maltreatment nor adult victimization was related to the ER dimensions, and no indirect effects were observed between maltreatment and adult victimization through emotion dysregulation. These findings suggest that specific components of emotion dysregulation may not be tied to trauma exposure outside of PTSS. Further, it may be that the ER dimensions are not differentially related to increased risk for adult victimization.

Interpersonal early adversity demonstrates dissimilarity from early socioeconomic disadvantage in the course of human brain development: A meta-analysis

It has been established that early-life adversity impacts brain development, but the role of development itself has largely been ignored. We take a developmentally-sensitive approach to examine the neurodevelopmental sequelae of early adversity in a preregistered meta-analysis of 27,234 youth (birth to 18-years-old), providing the largest group of adversity-exposed youth to date. Findings demonstrate that early-life adversity does not have an ontogenetically uniform impact on brain volumes, but instead exhibits age-, experience-, and region-specific associations. Relative to non-exposed comparisons, interpersonal early adversity (e.g., family-based maltreatment) was associated with initially larger volumes in frontolimbic regions until ~10-years-old, after which these exposures were linked to increasingly smaller volumes. By contrast, socioeconomic disadvantage (e.g., poverty) was associated with smaller volumes in temporal-limbic regions in childhood, which were attenuated at older ages. These findings advance ongoing debates regarding why, when, and how early-life adversity shapes later neural outcomes.

The association between exposure to community violence and somatic symptoms through bullying victimization among African American adolescents in Chicago: A developmental trauma approach

BACKGROUND

The developmental trauma theory suggests that traumatic events impede the ability of individuals to form interpersonal relationships, impair cognition, affect, and increase the vulnerability of adolescents to develop psychopathology. However, few studies have examined the applicability of this theory among African American adolescents who were exposed to community violence and adverse outcomes, including bullying victimization and somatic symptoms.

AIMS

Therefore, the purpose of the present study is to first test the association between exposure to community violence and somatic symptoms. Then, we explored whether bullying victimization mediated the relationship between exposure to community violence and somatic symptoms while controlling for gender differences and substance use (n = 622).

RESULTS

Results suggest that exposure to community violence is positively associated with somatic symptoms. Moreover, the association between exposure to community violence and somatic symptoms was mediated by bullying victimization.

DISCUSSION AND CONCLUSION

These results were consistent with the developmental trauma theory, such that trauma could increase the vulnerability for future victimization, thus, leading to somatic symptoms. Implications for research and practice are discussed.

Adolescents in the Covid Net: What Impact on their Mental Health?

Given the impact of traumatic events in adolescence and early adulthood, the current Covid 19 pandemic poses a high risk to the well-being and mental health of this population. This study aims to shed light on the traumatic impact of Covid-19 on adolescents and young adults, taking into account their personal experiences, with a particular focus on their emotional regulation skills. From May 2021 to May 2022, 216 adolescents and young adults were surveyed using a series of self-report questionnaires to assess the potentially traumatic effects of Covid-19 and its impact on adolescents' and young adults' emotional regulation skills. Analyses revealed a significant traumatic effect of Covid-19 on the adolescents in our sample. Significant correlations also emerged between the impact of the traumatic event and adolescents' emotional regulation skills. Our findings underscore the importance of considering the psychological impact of Covid-19 on adolescents from both a restorative and preventive perspective.

Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication

OBJECTIVE

Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study.

METHODS

The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity.

RESULTS

A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct.

CONCLUSION

This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.

A Public Health Perspective of Post-Traumatic Stress Disorder

Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.

Child Posttraumatic Stress after Parental Cancer: Associations with Individual and Family Factors

Objective

This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms.

Methods

The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6–20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression.

Results

Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors.

Conclusions

The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD.

Investigating emotion regulation and social information processing as mechanisms linking adverse childhood experiences with psychosocial functioning in young swiss adults: the FACE epidemiological accelerated cohort study

Background

Adverse childhood experiences increase the risk for psychological disorders and lower psychosocial functioning across the lifespan. However, less is known about the processes through which ACE are linked to multiple negative outcomes. The aim of the FACE epidemiological study is to investigate emotion regulation (emotional reactivity, perseverative thinking and self-efficacy for managing emotions) and social information processing (rejection sensitivity, interpretation biases and social understanding) as potential mechanisms linking adverse childhood experiences and psychosocial functioning in a large population sample of young adults. It is embedded in a larger project that also includes an ecological momentary assessment of emotion regulation and social information processing and informs the development and evaluation of an online self-help intervention for young adults with a history of ACE.

Methods

The study plans to recruit 5000 young adults aged 18 to 21 from the German-speaking Swiss population. Addresses are provided by Swiss Federal Statistical Office and participants are invited by mail to complete a self-report online survey. If the targeted sample size will not be reached, a second additional sample will be recruited via educational facilities such as universities or teacher training colleges or military training schools. Three follow-ups are planned after 1 year, 2 years and 3 years, resulting in ages 18–24 being covered. The main exposure variable is self-reported adverse childhood experiences before the age of 18, measured at the baseline. Primary outcomes are psychosocial functioning across the study period. Secondary outcomes are social information processing, emotion regulation and health care service use. Statistical analyses include a range of latent variable models to identify patterns of adverse childhood experiences and patterns and trajectories of psychosocial adaptation.

Discussion

The results will contribute to the understanding of the underlying mechanisms that link ACE with psychosocial functioning which is crucial for an improved insight into risk and resilience processes and for tailoring interventions. Furthermore, the identification of factors that facilitate or hinder service use among young adults with ACE informs healthcare policies and the provision of appropriate healthcare services.

Trial registration number: NCT05122988. The study was reviewed and authorized by the ethical committee of Northwestern and Central Switzerland (BASEC number 2021-01204).

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

The early identification of youth at risk for restraint incidents is an important next step to reducing the likelihood of such incidents. Yet, the extant research has not comprehensively investigated the idiographic factors that contribute to the restraint of youth in psychiatric residential treatment facilities (PRTFs). The current study investigated client-level predictors of restraint incidents, with specific emphasis on youth client trauma history and traumatic stress symptoms as assessed at admission. Participants were children and adolescents (N = 150; 55.3% female, 66.7% White, 33.3% Black or biracial) aged 6-17 (M = 11.8 years) admitted to a PRTF in the northeastern United States. A negative binomial regression with maximum likelihood estimation was conducted to examine the relative contributions of age, gender, length of stay, number of psychiatric diagnoses, body mass index (BMI), and traumatic stress symptoms at intake to the frequency of restraint incidents. The model was significant, χ² (6, N = 150) = 30.326, p < .001, and both length of stay, β = .005, p < .001, IRR = 1.005, and traumatic stress symptoms at intake, β = .072, p = .007, IRR = 1.074, were identified as significant predictors within the model. Although length of stay is an obvious predictor of restraint incidents, the current study is the first of which we are aware to identify traumatic stress symptoms at intake as a potential indicator of restraint frequency following admission. Clinical implications of these results are discussed.

Cumulative interpersonal childhood adversity and post-traumatic stress symptoms across heterosexual, cisgender and gender and sexually diverse adolescents: The mediating role of emotion regulation

BACKGROUND

Emotion regulation has been identified as an explanatory factor in the association between interpersonal childhood adversity and post-traumatic stress symptoms (PTSS). However, most studies focused on adults or older adolescents, neglecting youth from the community, especially gender and sexually diverse (GSD) adolescents, who have a higher risk for exposure to adverse events and psychological difficulties, compared to their heterosexual, cisgender (HC) peers.

OBJECTIVE

The present cross-sectional study aimed to examine the mediating role of emotion regulation difficulties in the association between cumulative interpersonal childhood adversity and PTSS across HC and GSD adolescents.

METHODS

A sample of 2904 ninth grade students (M_age = 14.53, SD = 0.61) completed a self-report survey. Multigroup path analyses were conducted to examine the proposed mediation model in all groups, and comparisons were made using chi-square difference tests.

RESULTS

Greater difficulties in emotion regulation mediated the association between greater cumulative interpersonal childhood adversity (β = 0.36, p < .001) and greater PTSS (β = 0.35, p < .001) - regardless of HC or GSD status - although the direct association between cumulative interpersonal childhood adversity and PTSS was significantly stronger among GSD boys (β = 0.36, p < .001) and GSD girls (β = 0.35, p < .001) than among HC boys (β = 0.21, p < .001) and HC girls (β = 0.25, p < .001).

CONCLUSIONS

Findings offer a modifiable target for prevention and/or intervention among middle adolescents, as emotion regulation difficulties may partially explain the presence of PTSS following cumulative interpersonal childhood adversity.

Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients

BACKGROUND

Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. Although evidence-based interventions exist, some therapists are concerned that trauma-focused psychotherapy with exposure-based elements may lead to the deterioration of associated dysfunctional behaviors in adolescents and young adults. Therefore, we examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment.

METHODS

Daily assessments from a randomized controlled trial (RCT) of Developmentally adapted Cognitive Processing Therapy (D-CPT) were analyzed to test for differences in the stated dysfunctional behaviors between the four treatment phases. We conducted multilevel modeling and repeated measure ANOVAs.

RESULTS

We did not find any significant differences between the treatment phases concerning the stated dysfunctional behaviors, either at the level of urge or at the level of actual actions. On the contrary, in some primary outcomes (self-injury, aggressive behavior), as well as secondary outcomes (distress caused by trauma, joy), we observed significant improvements.

DISCUSSION

Overall, during D-CPT, adolescents and young adults showed no deterioration in dysfunctional behaviors, while even showing improvements in some, suggesting that trauma-focused treatment preceded by skills building was not deleterious to this population. Hence, the dissemination of effective interventions such as D-CPT should be fostered, whilst the concerns of the therapists regarding exposure-based components need to be addressed during appropriate training. Nevertheless, further studies with momentary assessment, extended measurement methods, a control group and larger sample sizes are needed to confirm our preliminary findings.

TRIAL REGISTRATION

The trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787 .

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

BACKGROUND

Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD).

OBJECTIVE

To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD.

METHOD

Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians.

RESULTS

A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X² (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X²(3) = 84.66, p < .001).

CONCLUSION

Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families

BACKGROUND

Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study.

OBJECTIVE

To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents.

METHODS

To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age.

RESULTS

Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls.

CONCLUSIONS

The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.

The ripple effect: a cross-sectional study on the repercussions of child maltreatment among Egyptian college students

Background

Child maltreatment is a global risk factor for mental health. The burden of child maltreatment is heaviest in low- and lower-middle-income countries, where most of the world’s children live. This study sheds light on the occurrence of child maltreatment within Egypt’s upper social class stratum, countering a long-held belief that violence against children only occurs within low-income households. In addition, the study examines the association between exposure to child maltreatment and psychopathology, life satisfaction and resilience among emerging adults in Egypt, and whether emotion dysregulation mediates these relationships. Participants were 171 college students who were selected based on a series of questionnaires about exposure to child abuse and neglect, psychopathology, satisfaction with life, and resilience, as well as difficulties in emotion regulation.

Results

A rate of 48% of exposure to at least one type of child maltreatment before the age of 18 was found. Experiencing antipathy and/or sexual abuse was most strongly associated with PTSD and depression, while exposure only to antipathy contributed to lower life satisfaction and resilience. Emotion dysregulation mediated the associations between antipathy and PTSD, depression, life satisfaction, and resilience, as well as the associations between sexual abuse and PTSD and depression.

Conclusions

The present study hints at a comparably high rate of exposure to child maltreatment among the higher social class stratum, producing data that highlights the association between child maltreatment and mental health in emerging adults in Egypt. These findings emphasize that child maltreatment transcends social class, and that attempting to address the issue requires changing social and cultural belief systems that bolster violent behavior.

Social Trust and Reciprocity Among Adolescent Girls Exposed to Interpersonal Violence

Trauma research has traditionally focused on altered emotion regulation and its role in psychopathology, whereas mechanisms of social behavior remain comparatively unexplored, particularly among adolescents. It has been previously reported that adolescents with histories of interpersonal violence (IV) demonstrate disrupted social learning, and the degree to which they are impaired during social interactions requiring trustful behaviors may be associated with their levels of anxiety. In the present study, 52 adolescent females (n = 26 control; n = 26 IV-exposed) between ages of 11 and 17 completed a multi-round adaptation of the Trust Game in which they interacted with a confederate peer run by a computer program, alternating between the roles of investor and investee. The task was designed to operationalize the social behaviors of trust and trust reciprocity, where the magnitude of the participants' monetary investment in the confederate during the investor role represented trust while the proportion of investment returned to the confederate in the investee role represented trust reciprocity. IV-exposed and control participants did not differ in trust (i.e., as investors); however, IV-exposed participants without anxiety diagnoses demonstrated lower trust than those with anxiety diagnoses. For trust reciprocity (i.e., as investees), there were again no differences between IV-exposed participants and controls; however, IV-exposed participants with anxiety diagnoses had increased trust reciprocity compared with both other groups. Similarly, caregiver-reported anxiety symptoms were associated with trust reciprocity behaviors among the IV-exposed adolescents. Findings suggest that IV exposure and associated anxiety impacts adolescents' trust behaviors, demonstrating potential mechanisms for maladaptive social behavior among trauma-exposed youth.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Routineversorgung für Jugendliche und junge Erwachsene mit Posttraumatischer Belastungsstörung nach sexualisierter und physischer Gewalt in Deutschland

Zusammenfassung. Theoretischer Hintergrund: Für die Behandlung der Posttraumatischen Belastungsstörung (PTBS) im Jugend- und jungen Erwachsenenalter liegen diverse evidenzbasierte Interventionen (EBIs) vor. Fragestellung: Inwiefern sind EBIs für Jugendliche und junge Erwachsene mit PTBS nach sexualisierter und physischer Gewalt in Deutschland verfügbar? Methode: Es wurden die Daten von 39 Teilnehmenden einer multizentrischen Behandlungsstudie analysiert, die für die Diagnose einer PTBS ambulante Behandlungsempfehlungen erhalten hatten. Ergebnisse: In den folgenden sieben Monaten erhielten 21 der Teilnehmenden eine Behandlung; bei nur acht wurden in deren Rahmen die traumatischen Erfahrungen adressiert. Alle Teilnehmenden verbesserten sich hinsichtlich der PTBS-Symptomatik unabhängig von der Art der Behandlung. Diskussion und Schlussfolgerung: Die Ergebnisse weisen auf Barrieren für den Zugang zu EBIs in unserer Stichprobe hin. Künftige Forschung sollte die Hintergründe für diese Barrieren fokussieren.

Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy

Posttraumatic stress disorder (PTSD) is not uncommon among adolescents and young adults (AYAs). Left untreated, transition to adulthood might be especially challenging and/or prolonged for AYAs. However, it is unclear whether AYAs are adequately represented in current PTSD treatment research and whether they benefit to the same degree as younger or older individuals. In the first part of the paper, we reflect on developmental considerations in the treatment of AYAs and give an overview of current age-specific results in PTSD treatment research. Furthermore, we review individual trauma-focused evidence-based treatments that were examined in AYAs over the last 10 years. In the second part, we present data from an uncontrolled feasibility trial evaluating cognitive processing therapy (CPT) with some age-adapted modifications and an exposure component (written accounts). We treated 17 AYAs (aged 14 to 21) suffering from posttraumatic stress symptoms (PTSS). At posttreatment, participants had improved significantly with respect to clinician-rated PTSS severity (d = 1.32). Treatment gains were maintained throughout the 6-week and 6-month follow-ups. Results indicated that CPT, with only minor adaptations, was feasible and safe in AYAs. The recommendations for future research focus on the inclusion of young adults in trials with adolescents, more refined age reporting in clinical trials, and the encouragement of dismantling studies in youth. To conclude, clinical recommendations for caregiver involvement and the addressing of developmental tasks, motivational issues and emotion regulation problems are discussed.

The Impact of COVID-19 on Adolescent Mental Health: Preliminary Findings From a Longitudinal Sample of Healthy and At-Risk Adolescents

Background: The COVID-19 pandemic has brought on far-reaching consequences for adolescents. Adolescents with early life stress (ELS) may be at particular risk. We sought to examine how COVID-19 impacted psychological functioning in a sample of healthy and ELS-exposed adolescents during the pandemic. Methods: A total of 24 adolescents (15 healthy, nine ELS) completed self-report measures prior to and during the COVID-19 pandemic. The effect of COVID-19 on symptoms of depression and anxiety were explored using linear mixed-effect analyses. Results: With the onset of the pandemic, healthy but not ELS-exposed adolescents evidenced increased symptoms of depression and anxiety (ps < 0.05). Coping by talking with friends and prioritizing sleep had a protective effect against anxiety for healthy adolescents (t = -3.76, p = 0.002). Conclusions: On average, this study demonstrated large increases in depression and anxiety in adolescents who were healthy prior to the COVID-19 pandemic, while ELS-exposed adolescents evidenced high but stable symptoms over time.

Classifying childhood war trauma exposure: latent profile analyses of Sierra Leone's former child soldiers

BACKGROUND

Former child soldiers are at elevated risk for mental health problems (e.g., traumatic stress, emotion dysregulation, and internalizing and externalizing problems). To examine which groups of former child soldiers are more likely to have difficulties with emotion regulation, interpersonal relationships, and mental health postconflict, we explored patterns of war trauma exposure and their effects on subsequent mental health problems among former child soldiers in Sierra Leone.

METHODS

Participants were 415 (23.86% female) Sierra Leonean former child soldiers participating in a 15-year, four-wave longitudinal study. At T1 (2002), 282 former child soldiers (aged 10-17) were recruited. T2 (2004) included 186 participants from T1 and an additional cohort of self-reintegrated former child soldiers (NT2 = 132). T3 (2008) and T4 (2016/2017) participants were youth enrolled in previous waves (NT3 = 315; NT4 = 364). Latent profile analysis (LPA) was used to classify participants based on the first-time reports of eight forms of war exposure (separation and loss of assets, parental loss, loss of loved ones, witnessing violence, victimization, perpetrating violence, noncombat activities, and deprivation). ANOVA examined whether patterns of war exposure were associated with sociodemographic characteristics and mental health outcomes between T1 and T4.

RESULTS

LPA identified two profiles: higher exposure versus lower exposure, using cumulative scores of eight forms of war-related trauma exposure. The 'higher war exposure' group comprised 226 (54.5%) former child soldiers and the 'lower war exposure' group included 189 (45.5%). Significantly higher levels of violence-related and combat experiences characterized the group exposed to more traumatic events. The 'higher war exposure' group reported more PTSD symptoms at T2, more hyperarousal symptoms across all waves, and more difficulties in emotion regulation at T4.

CONCLUSIONS

Former child soldiers exposed to higher levels of war-related traumatic events and loss should be prioritized for mental health services immediately postconflict and as they transition into adulthood.

Foster children's complex psychopathology in the context of cumulative childhood trauma: The interplay of ICD-11 complex PTSD, dissociation, depression, and emotion regulation

BACKGROUND

Foster children experience maltreatment at exceptionally high rates with increased risk to develop ICD-11 complex posttraumatic stress disorder (CPTSD). While rates of comorbidity between CPTSD and various disorders are high, the interplay between constituent aspects of psychopathology is not clearly understood. No study used network analysis to model the interplay between these aspects as potentially maintaining a stable condition of psychopathology, and research on the etiology and maintenance of CPTSD in children is especially scarce.

METHODS

Altogether, 208 Austrian foster children completed a set of standardized measures, resulting in a final sample of N = 122 foster children meeting the inclusion criteria. Experiences of childhood trauma, ICD-11 CPTSD, depression, dissociation, adaptive, and maladaptive emotion regulation were assessed. Following an exploratory approach, analyses were conducted using latent single indicator factor scores in two network models.

RESULTS

Domains of CPTSD, PTSD and disturbances in self-organization (DSO), evidenced as most central factors in children's complex psychopathology. Including cumulative childhood trauma did not influence the connectedness of factors in any relevant way. Shortest direct paths from cumulative childhood trauma to CPTSD included dissociation (PTSD) and adaptive emotion regulation (DSO) as mediating factors.

LIMITATIONS

Results are based on a small sample of highly-traumatized foster children, potentially limiting current findings' generalizability.

CONCLUSIONS

CPTSD identified as central in children's complex psychopathology, while the role of childhood trauma seems stronger for the onset than the maintenance of such psychopathology. The current network revealed central disorders and distinct mediating factors as important targets for treatment strategies and future research.

Psychodynamic Psychotherapy for Children as a Trauma-Informed Intervention

This article outlines the underpinnings of a psychodynamic approach for the treatment of childhood trauma through strengthening the implicit emotion regulation system. Childhood trauma impairs the functioning of the emotion regulation system, where deficits are common in children with post-traumatic stress disorder (PTSD). Difficulties with emotion regulation arise out of disruptions in the development of neurobiological pathways through the interaction of constitutional determinants with environmental factors, including the child's relationships with caregivers and the broader environment. We propose that a therapeutic focus on traumatized children's defenses can overcome the damaging reverberations of trauma. This approach may bypass the difficulties of high attrition rates, expense, and limited generalizability characteristic of skills training-based modalities. An illustration of an intervention to help children address unbearable emotions in traumatic experiences through defense interpretation is presented. The manualization and study of this approach within a project titled Regulation Focused Psychotherapy for Children (RFP-C) presents a unique opportunity to contribute to the evidence-based canon of treatments for children with histories of trauma.

Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R)

Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.

Perspective matters: Differences between child- and caregiver-reports of emotion regulation mediating the relationship between cumulative childhood trauma and mental health problems in foster children

BACKGROUND

Cumulative childhood trauma predicts mental health problems in children, mediated by emotion regulation (ER). To assess trauma history and mental health in children, different informants may be addressed, assessing data from different perspectives. Despite differences between child- and caregiver-reports as robust finding in child psychology, it remains unclear to which extent perspective matters when examining these variables and related associations.

OBJECTIVE

The current study was set to (1) examine whether ER mediates the relationship between cumulative childhood trauma and mental health problems in children, (2) test whether results differ with examined perspective, and (3) investigate if meaningful patterns of child-caregiver-reported discrepancies can be identified.

METHODS

Data were collected from 145 children living in foster care by child- and caregiver-reports using standardized measures to assess trauma history (CTQ), ER (FEEL-KJ), and mental health problems (CBCL). Mediation and latent profile analysis were calculated.

RESULTS

Mediation analysis identified ER as mediator for internalizing and externalizing mental health problems. Using data from different perspectives, mediation models differed considerably regarding significance, direction, and magnitude of effects. Using latent profile analysis, meaningful patterns of child-caregiver-reported discrepancies were identified and associated with children's sociodemographic and psychopathological characteristics.

CONCLUSIONS

Adaptive and maladaptive ER distinctively mediate the relationship between cumulative childhood trauma and mental health problems in children. Perspective matters when examining these variables and child- and caregiver-reports are not interchangeable. Practitioners and researchers should be aware of inherent limitations when using data from distinct perspectives. Informant discrepancies can carry meaning and should not be ignored, but examined and interpreted instead.

The Role of Gender in the Associations Among Posttraumatic Stress Symptoms, Anger, and Aggression in Russian Adolescents

Symptoms of posttraumatic stress disorder (PTSD) have been linked to anger and aggressive behavior in adult and veteran populations. However, research on the associations among anger, aggression, and PTSD in adolescents is lacking, particularly regarding differences between the sexes. To address this research gap, we used self-report data from Russian adolescents (N = 2,810; age range: 13-17 years) to perform a full path analysis examining the associations between PTSD symptoms and the emotional (anger traits) and cognitive (rumination) components of anger as well as physical/verbal and social aggression, after adjusting for depressive symptoms. We also examined the interaction effects between PTSD symptoms and sex on anger and aggression. The results indicated that girls scored higher on measures of anger and PTSD symptoms, ds = 0.20-0.32, whereas boys scored higher on measures of physical and verbal aggression, d = 0.54. Clinical levels of PTSD symptoms were associated with anger rumination, β = .16, and trait anger, β = .06, and an interaction effect for PTSD symptoms and sex was found for aggression, whereby boys with clinical levels of PTSD symptoms reported more physical/verbal and social aggression, βs = .05 and .20, respectively. Our findings suggest that PTSD symptoms may have an important impact on anger, anger rumination, and aggression during adolescence. In particular, boys seem to have an increased risk for aggressive behavior in the presence of PTSD symptoms. The present results highlight the importance of taking anger and aggression into account when evaluating PTSD.

Perceived neighborhood violence and crime, emotion regulation, and PTSD symptoms among justice-involved, urban African-American adolescent girls

OBJECTIVE

African-American adolescent girls in urban areas are overrepresented in the juvenile justice system, and they are also disproportionately impacted by neighborhood violence and crime (NVC), which has been shown to positively associate with posttraumatic stress disorder (PTSD) symptoms. Guided by an ecological (individual X context) perspective, the present study aimed to examine the main and interactive effects of perceived NVC and emotion regulation (ER) strategies in a sample of justice-involved, urban African-American adolescent girls (n = 85) following their release from detention centers.

METHOD

We investigated this research question longitudinally. Multiple linear regression models were conducted. PTSD symptoms at 3 months after release was used as the outcome variable, predicted by ER strategies, perceived NVC, and their interactions before release, controlling for PTSD symptoms and a brief screening of trauma events assessed beforen release. Simple slope analysis was used to probe significant interaction terms.

RESULTS

The main effects of perceived NVC and dysfunctional ER were significant. A significant interaction effect was found between perceived NVC and internal dysfunction ER at baseline to predict PTSD symptoms at 3 months after release. High levels of internal dysfunctional ER intensified the positive association of baseline perceived NVC and PTSD symptoms.

CONCLUSIONS

Justice-involved African-American adolescent girls who report high NVC and use dysfunctional ER strategies are particularly vulnerable to the development of PTSD symptoms. Interventions with this population may benefit from targeting dysfunctional ER strategies to mitigate or prevent neighborhood violence related PTSD symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth

Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.

Factor Structure of the Difficulties in Emotion Regulation Scale in Treatment Seeking Adults with Eating Disorders

The Difficulties in Emotion Regulation Scale (DERS) is extensively used as a measure of emotion (dys-)regulation ability in both clinical and nonclinical populations. This is the first study to examine the factor structure of both the original 36-item and short 16-item version of the DERS in adults with eating disorders and to test measurement invariance across diagnostic subgroups. The factor structure of the scale was examined using confirmatory factor analysis in a psychiatric sample of adults with eating disorders (N = 857). Four primary factor structures were fitted to the data: (1) a unidimensional model, (2) a six-factor correlated-traits model, (3) a higher-order factor solution, and (4) a bifactor model. Measurement invariance was tested for diagnostic subgroups of anorexia nervosa and bulimia nervosa and associations between factors and eating pathology were examined in each diagnostic group. Results indicated that a modified bifactor solution fitted the data adequately for both the 36-item and 16-item version of the DERS. A general factor explained most of the variance (86%) and reliability was high for the general factor of DERS (total) but lower for the subscales. Measurement invariance of the bifactor model was supported across diagnostic subgroups and test of factor means reveled that bulimia nervosa had a higher factor mean than anorexia nervosa on the general factor. The general factor accounted for a significant proportion of variance in eating pathology. Our results support the use of the total scale of both the 36-item and 16-item version among adults with eating disorders.