Assessing a child's experience of multiple maltreatment types: Some unfinished business

Youth Reported Perpetrators of Victimization Within a Foster Care Sample

Maltreatment type, severity, and chronicity are predictors of poor youth outcomes, yet youth reported perpetrators of abuse have gone largely unstudied. Little is known about variation in perpetration across youth characteristics (e.g., age, gender, placement type) and abuse features. This study aims to describe youth reported perpetrators of victimization within a foster care sample. 503 youth in foster care (ages 8-21 years) reported on experiences of physical, sexual, and psychological abuse. Follow up questions assessed abuse frequency and perpetrators. Mann-Whitney U Tests were used to compare central tendency differences in number of perpetrators reported across youth characteristics and victimization features. Biological caregivers were commonly endorsed perpetrators of physical and psychological abuse, though youth also reported high levels of peer victimization. For sexual abuse, non-related adults were commonly reported perpetrators, however, youth reported higher levels of victimization from peers. Older youth and youth residing in residential care reported higher numbers of perpetrators; girls reported more perpetrators of psychological and sexual abuse as compared to boys. Abuse severity, chronicity, and number of perpetrators were positively associated, and number of perpetrators differed across abuse severity levels. Perpetrator count and type may be important features of victimization experiences, particularly for youth in foster care.

Larger comfortable interpersonal distances in adults exposed to child maltreatment: The role of depressive symptoms and social anxiety

Previous studies report a preference for larger comfortable interpersonal distance (CIPD) in individuals with child maltreatment (CM) when being approached by others. Yet, research on approaching others, as opposed to being approached, as well as on potential effects of social anxiety and depression is lacking. We investigated if CM and depressive symptoms influence CIPD and if social anxiety mediates the possible association of CM and CIPD when approaching a female stranger. One hundred ten participants with CM (CM) and 58 participants without CM (non-CM) experiences performed the stop-distance paradigm and stopped first when feeling uncomfortable (D1) and again when feeling very uncomfortable (D2). CM experiences were associated with a preference for larger CIPD, independent of depressive symptoms. All CM subtypes were associated with a larger D2. The relationship between CM and CIPD was partially mediated by social anxiety. These novel findings can help to develop interventions strengthening socially relevant skills and processes in those affected by CM, targeting alterations in social anxiety and depression.

Childhood Maltreatment and Leukocyte Telomere Length: Cardiac Vagal Activity Influences the Relation in Older Adults

OBJECTIVE

Childhood maltreatment is associated with shorter leukocyte telomere length (LTL). However, the influence of cardiac vagal control on this relation is unknown. We examined whether cardiac vagal control at rest and in response to stress moderates or cross-sectionally mediates the relationship between childhood maltreatment and LTL.

METHODS

Participants were 1179 men and women (aged 65 [7.2] years) suffering from coronary artery disease or non-cardiovascular chronic disease. They completed a childhood maltreatment questionnaire and underwent a stress protocol while electrocardiogram was monitored. High-frequency heart rate variability (HF-HRV) measures were obtained at rest, during stress, and after stress in absolute and normalized units (nu). LTL was measured using quantitative polymerase chain reaction. Mediation and moderation analyses were performed.

RESULT

HF-HRV and HF-HRV in normalized units (HFnu) measures did not mediate the childhood maltreatment-LTL relation. However, baseline HFnu ( p = .027) and HFnu reactivity ( p = .051) moderated the relation. Specifically, maltreatment was associated with significantly lower LTL among those with baseline HFnu at ( b = -0.059, p = .003) or below the mean ( b = -0.103, p < .001), but not among those with higher baseline HFnu. It was also associated with significantly lower LTL among participants who showed either blunted ( b = -0.058, p = .004) or increased HFnu ( b = -0.099, p = .001) responses to stress but not in those with large decreases in HFnu.

CONCLUSIONS

Childhood maltreatment was associated with lower LTL in those who showed a distinct cardiac vagal profile at baseline and in response to stress. The mechanisms and implications remain to be determined.

Childhood maltreatment and internalizing/externalizing disorders in trauma-exposed adolescents: Does posttraumatic stress disorder (PTSD) severity have a mediating role?

Childhood maltreatment is associated with wide-ranging psychopathology at all stages of life. In the current study, we investigated whether posttraumatic stress disorder (PTSD) severity mediated the association between childhood maltreatment and internalizing and externalizing disorders among 262 South African trauma-exposed adolescents (aged 12-18 years). Childhood maltreatment and PTSD symptom severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were assessed utilizing the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version and were grouped into internalizing or externalizing disorders. Hierarchal logistic regression was used to assess the association of childhood maltreatment subtype with internalizing and externalizing disorders, controlling for age and gender, with PTSD symptom severity added to the final model. We found that sexual abuse was significantly associated with internalizing disorders, although this effect was no longer significant when PTSD was added to the model demonstrating that PTSD mediated the association between sexual abuse and internalizing disorders. Physical abuse, but not PTSD, was associated with externalizing disorders. Physical abuse, emotional neglect, and PTSD were associated with comorbid internalizing and externalizing disorders. These findings have implications for intervention and prevention strategies targeted at trauma-exposed adolescents with a history of childhood maltreatment.

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

Latent classes in preschoolers' internal working models of attachment and emotional security: Roles of family risk

Children's relationships inform their internal working models (IWMs) of the world around them. Attachment and emotional security theory (EST) emphasize the importance of parent-child and interparental relationships, respectively, for IWM. The current study examined (a) data-driven classes in child attachment and emotional security IWM, (b) associations between IWM classes and demographic variables, maltreatment, intimate partner violence (IPV), and maternal depressive symptoms, and (c) consistency in attachment and emotional security IWM classes, including as a function of maltreatment, IPV, and maternal depressive symptoms. Participants were 234 preschool-aged children (n = 152 experienced maltreatment and n = 82 had not experienced maltreatment) and their mothers. Children participated in a narrative-based assessment of IWM. Mothers reported demographics, IPV, and maternal depressive symptoms. Latent class analyses revealed three attachment IWM classes and three emotional security IWM classes. Maltreatment was associated with lower likelihood of being in the secure attachment class and elevated likelihood of being in the insecure dysregulated attachment class. Inconsistencies in classification across attachment and emotional security IWM classes were related to maltreatment, IPV, and maternal depressive symptoms. The current study juxtaposes attachment and EST and provides insight into impacts of family adversity on children's IWM across different family relationships.

Patterns of Mother, Father, and Peer Attachment Quality as Moderators of Child Maltreatment Risk for Depression and PTSD Symptoms in Adolescent Females

Child maltreatment (CM) is a robust risk factor for adolescent depressive and post-traumatic stress disorder (PTSD) symptoms. Quality attachment relationships have been posited as a protective factor but findings are equivocal and studies have not adequately considered the complex network of interpersonal relationships that adolescents rely on. The current study applied a person-centered approach to (a) identify subgroups of adolescent females characterized by distinct patterns of attachment quality with peers, fathers, and mothers and (b) determine if the effect of maltreatment on depressive and PTSD symptoms varied as a function of distinct patterns of attachment quality. Data came from a prospective, longitudinal cohort study of 464 racially diverse and adolescent females designed to examine the developmental sequelae of substantiated CM (260 maltreated and 204 demographically matched, nonmaltreated comparisons). Latent profile analysis (LPA) revealed four profiles of attachment characterized by: (a) above-average attachment quality across all three relationships (N = 207, 44.6%); (b) below-average quality with father and friends and above-average quality with mothers (N = 128, 27.6%); (c) below-average quality across all three relationships (N = 106, 22.9%); and (d) very low-(-1 SD) quality with mothers and above-average quality with fathers and friends (N = 23, 5.0%). Moderation models revealed that cumulative maltreatment exposure resulted in greater adolescent depressive symptoms only for those with a profile of attachment consisting of very low-quality maternal attachment and high-quality father and friend attachments. Profiles did not significantly moderate the effect of maltreatment on PTSD symptoms. Results identify subgroups of maltreatment survivors most vulnerable to the development of depression in adolescence. Such groups should be targets for the provision of finite clinical resources with clinical interventions that seek to promote healthy maternal attachment relationships to mitigate the impact of maltreatment on depression.

The impact of adverse childhood experiences on adult depression severity and treatment outcomes

BACKGROUND

Past research has established that adverse childhood experiences (ACE) are correlated with depression severity. The purpose of the present study was to examine how the number and nature of ACE exposure is associated with symptomatology and treatment outcomes in adult patients with treatment resistant depression (TRD).

METHODS

Participants include 454 patients with a diagnosis of major depression or persistent depressive disorder. A one-way analysis of variance (ANOVA) was used to assess whether number of ACEs was associated with certain outcomes. Linear regression analyses were performed to model the associations between the five ACE subtypes (e.g., sexual abuse, physical violence, injury/illness, childhood grief, and parental upheaval) and symptom severity. Logistic regression analyses were then used to model the association between ACE subtypes and history of lifetime suicide attempt(s) and inpatient admission(s).

RESULTS

Greater ACE exposure was associated with more severe symptomatology and treatment outcomes, but these differences were only seen between patients reporting no ACEs versus 3+ ACEs. Only the subtypes of violence and illness/injury were significant predictors of more severe symptomatology. The ACE subtypes of sexual trauma and violence uniquely predicted a lifetime suicide attempt(s), and only the subtype of sexual trauma predicted lifetime inpatient admission(s).

LIMITATIONS

Limitations of the present study include retrospective adult assessments of childhood trauma, lack of data on ACE severity and timing, and the cross-sectional reporting of multiple study measures.

CONCLUSIONS

Exposure to multiple ACE subtypes, particularly sexual and physical trauma, is associated with depression symptom severity, and history of suicidality, and inpatient admission(s).

The prevalence and nature of multi-type child maltreatment in Australia

OBJECTIVES

To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences.

DESIGN

Retrospective cross-sectional survey using a validated questionnaire.

SETTING AND PARTICIPANTS

Mobile phone random digit-dial sample of the Australian population aged 16 years and older.

MAIN OUTCOME MEASURES

National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study).

RESULTS

Of 8503 participants, 62.2% (95% CI, 60.9-63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7-24.0%), whereas 39.4% (95% CI, 38.1-40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0-4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7-78.7%]) and women (43.2% [95% CI, 41.3-45.1%]) than for men (34.9% [95% CI, 33.0-36.7%]). Multi-type maltreatment prevalence was highest for those aged 25-44 years. Family-related adverse childhood experiences - especially mental illness and alcohol or substance misuse - increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns.

CONCLUSIONS

Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment.

Population-Based Estimates of Associations Between Child Maltreatment Types: A Meta-Analysis

Although it is accepted that experiences of child maltreatment are multidimensional and often include several correlated but distinct experiences, many clinical and research decisions regarding exposure and treatment do not consider their potential overlap or potential independence. The purpose of this meta-analysis-using a single retrospective self-report measure, the Childhood Trauma Questionnaire (CTQ), in population-representative samples-was to investigate the magnitude and specificity of associations between forms of child maltreatment. A systematic review of studies available on PubMed, PsycINFO, and Google Scholar was conducted, resulting in the inclusion of nine journal articles, 11 independent samples, and 25,415 participants. Data were converted from Pearson correlations to Z statistics and pooled using a random effects model. All maltreatment types were positively and significantly associated. Effect sizes varied from medium to large, with (1) physical abuse and emotional abuse (Z = 0.72, 95% CI [.48, .96]), (2) physical neglect and emotional neglect (Z = 0.62, 95% CI [.43, .81]), and (3) emotional abuse and emotional neglect (Z = 0.54, 95% CI [.35, .72]) demonstrating the strongest associations. These analyses provide evidence of the associations between types of child maltreatment, indicate the likelihood of shared risk, and point to characteristics that may link different types of maltreatment. These findings have important clinical implications as they may help guide comprehensive screening for associated maltreatment types as well as intervention and prevention efforts. Limitations include the relatively few studies included and those associated with the CTQ-a retrospective, self-report measure that does not account for the concurrence of experiences.

Latent classes of child neglect types and associated characteristics

BACKGROUND

Children who experience neglect typically endure multiple types of neglect and abuse during a single maltreatment incident. However, research on the phenomenology and predictors of neglect types has primarily examined neglect types in isolation.

OBJECTIVE

To advance understanding of neglect incidents that more accurately reflect the experiences of children who have been neglected, we examined latent classes of neglect defined by co-occurring neglect types and multiple forms of abuse. To inform efforts to identify families at-risk for particular classes of neglect, associations between child, parent, and family characteristics and latent classes were examined.

PARTICIPANTS AND SETTING

390 child neglect incidents substantiated at U.S. Army installations.

METHODS

Neglect types and incident severity were coded using the Modified Maltreatment Classification System. Child, parent, and family characteristics were coded using information drawn from case records.

RESULTS

Latent class analysis yielded 5 classes: exposure to violence, failure to provide, supervisory lapses, substance-related endangerment, and non-specific. The exposure to violence and substance-related endangerment classes were characterized as highly severe. High and low severity classes were associated with distinct child, parent, and family characteristics. The latent classes were also differentiated by distal outcomes, including probability of law enforcement investigation, child removal from home, and offender removal from home.

CONCLUSIONS

By identifying the types of neglect and abuse that are likely to occur concomitantly as well as the child, parent, and family characteristics associated with increased risk of latent classes of neglect, results advance knowledge regarding the phenomenology of neglect types and inform prevention efforts.

Social thinning and stress generation after childhood maltreatment: a neurocognitive social transactional model of psychiatric vulnerability

Childhood maltreatment is associated with significant, enduring risk of psychiatric disorder. In this paper, we review how neurocognitive alterations after maltreatment might indirectly increase the risk of psychiatric disorder via their impact on social functioning. We propose a neurocognitive social transactional model, within which the neurocognitive sequelae of maltreatment are postulated to affect how an individual's social architecture is constructed across development, including the quality and quantity of relationships in an individual's social network. We review extant evidence in two areas in relation to maltreatment: stress generation (a process by which individuals are more likely to experience interpersonal stressor events) and social thinning (an attenuation in the number and quality of relationships over time). We consider how neurocognitive alterations could contribute to these interactive and autocatalytic social processes, which gradually impoverish an individual's actual or potential social environment and ultimately increase psychiatric risk. We conclude by considering the implications of this neurocognitive social transactional model for the prevention of psychiatric disorder after childhood maltreatment.

Validation and standardization of the Childhood Trauma Screener (CTS) in the general population

BACKGROUND

A valid, quick and widely applicable retrospective screening tool for child maltreatment is of great importance to better adapt interventions and treatments. The Childhood Trauma Screener (CTS), derived from the Childhood Trauma Questionnaire (CTQ), is one such instrument that aims to increase the likelihood of detecting mental and physical disorders that have manifested in adulthood as a result of traumatic experiences and maltreatment in childhood and adolescence. The present study aimed to investigate the psychometric properties of the CTS and generate normative data.

METHODS

Data from two representative surveys were combined. Both surveys used identical methods. The CTS, consisting of five items, other self-report instruments, and demographic characteristics were used. Construct validity was examined using confirmatory factor analysis (CFA). A subsample was used to examine convergent validity with the Adverse Childhood Experiences Questionnaire (ACE). Normative data are reported for age groups and gender.

RESULTS

A total of 5039 study participants provided valid responses to the 5-items questionnaire (54.3% female, response rate = 78.9%). CFA showed good fit indices for a 2-factor solution. Convergent validity was generally supported by moderate intercorrelations with the ACE.

CONCLUSIONS

The results confirm the solid psychometric properties of the CTS as an easy-to-use, ultra-short retrospective measure of child maltreatment. The data can be used to compare sample or individual results with reference data provided.

Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis

Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.

Cumulative risk, factor analysis, and latent class analysis of childhood adversity data in a nationally representative sample

BACKGROUND

Childhood adversity is a multifaceted construct that is in need of comprehensive operationalisation.

OBJECTIVE

The aim of this study was to explore the optimal method to operationalise a scale of adverse childhood experiences (ACEs).

PARTICIPANTS AND SETTING

Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Participants from three age groups (20-25, 40-45, 60-65) retrospectively reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, verbal abuse, neglect, poverty).

METHODS

We compared three approaches to operationalising the 17-item scale: a cumulative risk approach, factor analysis, and latent class analysis (LCA). The cumulative risk and dimensional models were represented by a unidimensional and two-dimensional model respectively using confirmatory factor analysis (CFA).

RESULTS

The cumulative risk approach and LCA were viable approaches to operationalising ACE data in PATH. CFA of the dimensional model produced latent factors of threat and deprivation that were highly correlated, potentially leading to problems with multicollinearity when estimating associations. LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction.

CONCLUSION

Our study found multiple latent classes within a 17-item questionnaire assessing domestic adversity. Using both the cumulative method and latent class approach may be a more informative approach when examining the relationship between ACEs and later health outcomes. Future ACE studies may benefit by considering multi-dimensional approaches to operationalising adversity.

Differences in developmental problems between victims of different types of child maltreatment

This study examined differences in developmental problems between children who were victims of two child maltreatment dimensions: abuse versus neglect, and physical versus emotional maltreatment. Family demographics and developmental problems were examined in a clinical sample of 146 Dutch children from families involved in a Multisystemic Therapy - Child Abuse and Neglect treatment trajectory. No differences were found in child behavior problems within the dimension abuse versus neglect. However, more externalizing behavior problems (e.g., aggressive problems) were found in children who experienced physical maltreatment compared to children who experienced emotional maltreatment. Further, more behavior problems (e.g., social problems, attention problems, and trauma symptoms) were found in victims of multitype maltreatment compared to victims of any single-type maltreatment. The results of this study increase the understanding of the impact of child maltreatment poly-victimization, and highlight the value of classifying child maltreatment into physical and emotional maltreatment.

The Centrality of Child Maltreatment to Criminology

Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.

Differences in late adolescent psychopathology among youth with histories of co-occurring abuse and neglect experiences

BACKGROUND

Knowledge about the impacts of child abuse and neglect (CAN) experiences on late adolescent psychopathology has been limited by a failure to consider the frequent co-occurrence of CAN types and potential unique impacts of specific combinations.

OBJECTIVE

Using person-centered analyses, we aimed to identify unobserved groups of youth with similar patterns of lifetime CAN experiences before age 16 and differences in psychopathology symptom counts between groups two years later.

PARTICIPANTS AND SETTING

Participants were 919 adolescent-caregiver dyads (56% female; 56% Black, 7% Latina/o, 13% mixed/other).

METHODS

Prospective, multi-informant data, including child protective services records and caregiver and youth reports were collected, and youth completed a diagnostic interview at age 18.

RESULTS

Latent Class Analyses classified adolescents into four distinct groups based on patterns of physical neglect, supervisory neglect, and physical, sexual, and psychological abuse: "Low-Risk" (37%), "Neglect" (19%), "Abuse" (11%), and "Multi-type CAN" (33%). The Multi-type CAN class had significantly more major depressive, generalized anxiety, and nicotine use symptoms than the Low-Risk class, and more post-traumatic stress, antisocial personality, and illicit substance use symptoms, than Low-Risk and Neglect classes. The Abuse class had significantly more generalized anxiety and attention deficit/hyperactivity symptoms than the Low-Risk class, and more major depressive, antisocial personality, and illicit substance use symptoms, than Low-Risk and Neglect classes. The Neglect class did not have elevated psychopathology symptoms.

CONCLUSION

Findings highlight important differences in the associations between lifetime CAN experience patterns and psychopathology. Researchers should explore mechanisms underlying psychopathology that are impacted by different CAN experience patterns.

The value of a modular, multi-focal, therapeutic approach to addressing child maltreatment: Hope for Children and Families Intervention Resources - a discussion article

This discussion article begins by highlighting two trends apparent in the field of child maltreatment. The first, an awareness that multiple forms of maltreatment - polyvictimization - is the rule in populations of abused and neglected children rather than the exception. The second is that current types of child maltreatment are being extended to include Adverse Childhood Experiences (ACEs). These include intra-familial violence, mental health, substance misuse, and inter-generational abuse. The paper introduces an innovative strategy to help the field better organise and prevent the extensive sequelae of polyvictimization and ACEs. This strategy involves the development of a modular approach, which identifies common treatment elements and common factors across the field of effective interventions and organizes them, providing a co-ordinated framework for practitioners to use to address the diverse needs of children and families when vulnerability or maltreatment are identified. The development of this approach, the Hope for Children and Families (HfCF) Intervention Resources, is described using a case example to illustrate its logic and structure. Findings from the HFCF pilot and subsequent training programs suggest that this new approach could be an important milestone in the protection of children from violence, abuse and neglect on the 30th Anniversary of the United Nation's Convention on the Rights of the Child (1989).

The Cycle of Violence: Examining Attitudes Toward and Experiences of Corporal Punishment in a Representative German Sample

The use of corporal punishment (CP) is controversial despite the negative consequences of its use that have been documented. Consequences include the use of CP by those who experienced CP themselves, described in the theory of the cycle of violence. There are little data on the cycle of violence, especially on those who break it and in representative samples. This study examines the cycle of violence in a representative sample by analyzing experiences of and attitudes toward CP. Attitudes toward, and own experiences of, CP by their parents were assessed in a sample of 2,519 individuals (female 54.6%, age range = 14-99 years, M = 48.9 years). Latent class analysis (LCA) was used to identify subgroups of participants who support and oppose CP. Breaking the cycle, defined as having experienced CP and opposing CP, was examined. Factors associated with positive and negative attitudes toward CP were identified using group comparisons and binary logistic regression. The majority of the sample opposed CP (56%), whereas one third supported less severe forms of CP and 8.2% also supported severe CP. Those supporting CP reported having experienced CP by their parents more often. Of those who had experienced CP, 47% were identified as breaking the cycle. Female gender, younger age, not being divorced, and being married and living together, as well as a higher level of education were associated with breaking the cycle. Even though CP was legally banned in Germany, a relatively high proportion still reports positive attitudes toward and experiences of CP. The ban of CP by the federal government seems to be an effective measure to change attitudes on a societal level as rates were lower in comparison with earlier studies. Future studies should examine interactions between different types of CP, attitudes toward its use, and additional mediating factors.

Rethinking Concepts and Categories for Understanding the Neurodevelopmental Effects of Childhood Adversity

Discovering the processes through which early adverse experiences affect children's nervous-system development, health, and behavior is critically important for developing effective interventions. However, advances in our understanding of these processes have been constrained by conceptualizations that rely on categories of adversity that are overlapping, have vague boundaries, and lack consistent biological evidence. Here, we discuss central problems in understanding the link between early-life adversity and children's brain development. We conclude by suggesting alternative formulations that hold promise for advancing knowledge about the neurobiological mechanisms through which adversity affects human development.

Early life stress and development: potential mechanisms for adverse outcomes

BACKGROUND

Chronic and/or extreme stress in early life, often referred to as early adversity, childhood trauma, or early life stress, has been associated with a wide range of adverse effects on development. However, while early life stress has been linked to negative effects on a number of neural systems, the specific mechanisms through which early life stress influences development and individual differences in children's outcomes are still not well understood.

MAIN TEXT

The current paper reviews the existing literature on the neurobiological effects of early life stress and their ties to children's psychological and behavioral development.

CONCLUSIONS

Early life stress has persistent and pervasive effects on prefrontal-hypothalamic-amygdala and dopaminergic circuits that are at least partially mediated by alterations in hypothalamic-pituitary-adrenal axis function. However, to date, this research has primarily utilized methods of assessment that focus solely on children's event exposures. Incorporating assessment of factors that influence children's interpretation of stressors, along with stressful events, has the potential to provide further insight into the mechanisms contributing to individual differences in neurodevelopmental effects of early life stress. This can aid in further elucidating specific mechanisms through which these neurobiological changes influence development and contribute to risk for psychopathology and health disorders.

Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood

BACKGROUND

Interpersonal violence is a leading cause of death and disability globally, has immediate and long-term impacts on individuals' health and wellbeing, and impacts global health care expenditures and national economies. A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global research has demonstrated that childhood adversity increases risk of a range of poor outcomes across the lifecourse. This study examined the association between being a victim of child abuse and the risk of physical assault (PA), intimate partner violence (IPV), and sexual violence (SV) victimisation in adulthood.

METHODS

Data from a nationally representative survey of household residents (adults aged 16 to 59 years; n = 21,845) was analysed. Types of child abuse examined included physical, sexual, and psychological abuse and witnessing domestic violence. Logistic regressions examined the independent relationships between child abuse types, experiencing multiple types, and adulthood violence outcomes.

RESULTS

Most individual types of child abuse were significantly associated with each adulthood violence outcome, after controlling for sociodemographics and other abuse types. Compared to individuals who experienced no abuse in childhood, those who experienced one form of abuse were over twice as likely to experience PA in the past year and three times as likely to have experienced IPV and/or SV since age 16 years, whilst individuals who experienced multiple types were three, six, and seven times more likely to experience PA, IPV, and SV, respectively. After controlling for sociodemographics and multi-type childhood victimisation, the type or combination of types which remained significant differed by violence outcome; child psychological and physical abuse were significantly associated with IPV; psychological and sexual abuse with SV; and psychological abuse with PA.

CONCLUSIONS

Prevention of child abuse is an important goal, and evidence from the current study suggests such efforts will have a downstream effect on preventing interpersonal violence across the lifecourse. With adulthood victimisation likely to compound the already detrimental effects of childhood abuse, and given that many associated outcomes also represent adversities for the next generation, breaking the cycle of violence should be a public health priority.

Prospective Associations of Child Maltreatment Subtypes With Adult Educational Attainment: Tests of Mediating Mechanisms Through School-Related Outcomes

This study tests a developmental cascades model in which childhood maltreatment is hypothesized to influence adult educational attainment by increasing attention problems and reducing successful school experiences during adolescence. Two path models tested direct and indirect associations of childhood maltreatment with adult educational attainment. Model 1 used three parent-reported subtypes of childhood maltreatment (physical/emotional abuse, sexual abuse, neglect). Model 2 added an agency-reported measure of childhood maltreatment. Both models detected indirect effects of childhood maltreatment subtypes on adult educational attainment through attention and school discipline problems, poor school engagement, and low extracurricular involvement. Model 2 also detected a direct effect of agency-reported childhood maltreatment on the adult outcome. Regardless of the type of maltreatment or data source used, school factors mediated the associations of childhood maltreatment on adult educational attainment. Promoting school engagement and reducing disciplinary referrals for maltreated youth could improve their educational attainment over the long term.

Association Between Dating Violence and Behavioral and Health Outcomes Among Early Adolescents From Denmark: The Role of Exposure to Childhood Maltreatment

AIM

To examine the unique contribution of child maltreatment victimization on the association between adolescent dating violence (ADV) and four negative behavioral and health-related factors.

METHOD

In total, 2,934 7th grade students (M = 13.5, SD = .5) filled out questionnaires at school. Binominal logistic regression was performed to assess the impact of child maltreatment on the relationship between ADV and behavioral and health-related factors.

RESULTS

After child maltreatment was taken into account, associations between ADV and the negative behavioral and health-related factors became weaker.

CONCLUSIONS

The findings from the present study suggest that focusing on one victimization type (such as ADV) when examining psychological outcomes, can be problematic as the causal relationship may be misrepresented when an adolescent's broader victimization profile and context is not considered.

Caught in a web of trauma: Network analysis of childhood adversity and adult mental ill-health

BACKGROUND

Current interventions for adverse childhood experiences have only limited effectiveness.

OBJECTIVE

We sought to identify optimal targets for the development of new interventions against adverse childhood experiences (ACE), that is, ACEs that a) are so central in the network of childhood adversity that curbing them is likely to impact other types of adversity, too, and b) are so central to the link of childhood adversity and adult mental ill-health that curbing them is likely to prevent this negative long-term effect from developing.

PARTICIPANTS AND SETTING

384 adult psychiatric inpatients.

METHODS

Using the R packages qgraph and IsingFit, we analyzed the ACE network and the common network of ACEs and adult mental disorders.

RESULTS

We found two clusters of ACEs: direct interactions with the child and indirect traumatization via adverse circumstances. When controlling for interrelatedness, the associations of sexual abuse with posttraumatic stress disorder and borderline personality disorder were the only direct links between ACEs and adult mental disorders.

CONCLUSIONS

As neglect and violence against the mother were the most influential ACEs, curbing them is likely to destabilize the whole network of adversity. Thus, neglect and violence against the mother lend themselves as candidate targets for the development of new interventions. As sexual abuse was the only link between childhood adversity and adult mental ill-health, interventions against it seem most likely to keep this negative long-term effect from developing. Further, ideally prospective, research is needed to corroborate these findings.

The contribution of interpersonal violence victimization types to psychological distress among youth

BACKGROUND

Associations between different types of victimization and symptomology among youth remain unclear due to methodological limitations preventing the identification of the independent contribution of each type of violence.

OBJECTIVE

The purpose was to examine associations between different types of victimization and the odds of experiencing clinically significant levels of anxiety, depression, and anger/aggression. We also examined the unique contribution of each type of victimization to these outcomes.

PARTICIPANTS

Participants were a nationally representative sample of youth ages 10-17 (n = 1019) who were residing in the United States when data were collected in 2002-2003.

METHODS

Youth reported on their experiences of different forms of victimization (e.g., physical abuse, emotional abuse, neglect, sibling abuse, bullying, sexual assault, and witnessing violence) within the past year. Logistic regression and relative weights analyses were used to examine associations between victimization and symptoms of depression, anxiety, and anger/aggression.

RESULTS

The prevalence of reported victimization ranged from 1.3 % for neglect to 41.3% for sibling abuse. Physical and emotional child abuse, sibling abuse, bullying, and emotional bullying were associated with increased odds of clinically significant anxiety, depression, and anger/aggression. Witnessing parent intimate partner violence was associated with increased odds of clinically significant anger/aggression. Witnessing parental assault of a sibling was associated with increased odds of clinically significant anxiety and anger/aggression. Emotional bullying predicted the largest percentage of variance in anxiety and depression, followed by emotional abuse and sibling aggression.

CONCLUSIONS

These findings underscore the need for further assessment and treatment for sibling abuse and emotional bullying.

The Role of Trauma Type and Age in the Relation Between Trauma Exposure and Intelligence

Experiencing potentially traumatic events (PTEs) is associated with deficits in cognitive functioning for youth. Previous research has demonstrated that PTE type may influence the association between PTE experiences and intelligence, such that IQ scores may differ by the type of PTE experienced. Additionally, mixed findings in the literature suggest that these associations might differ by age. The current study examined the association between PTE type and IQ and how age may moderate this association. In a sample of youth in foster care (N = 328, M_age = 13.25), physical, psychological, and sexual abuse and family PTEs were directly associated with verbal and nonverbal IQ. Age significantly moderated the association between IQ and neglect and academic PTEs. Results suggest that broad PTE grouping methods or failing to account for both maltreatment and general PTEs in samples of youth in foster care may conceal differences in how PTEs relate to intellectual functioning.

Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents

BACKGROUND

To explore the association between different types of childhood maltreatment and sleep disturbance among Chinese adolescents, with a particular focus on gender differences.

METHODS

A cross-sectional study was conducted in 7 randomly selected provinces of China via the 2015 School-Based Chinese Adolescents Health Survey. Questionnaires from 153,547 students were completed and were eligible for this study. The Chinese Version of the Pittsburgh Sleep Quality Index (CPSQI) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess sleep disturbance and childhood maltreatment, respectively.

RESULTS

The prevalence of sleep disturbance among adolescents in China was 21.6%. A significantly increased risk of sleep disturbance was associated with physical abuse (aOR=1.22, 95% CI=1.21-1.24), emotional abuse (aOR=1.15, 95% CI=1.14-1.15), sexual abuse (aOR=1.16, 95% CI=1.15-1.18), physical neglect (aOR=1.04, 95% CI=1.03-1.05), and emotional neglect (aOR=1.03, 95% CI=1.02-1.03). A significant dose-response relationship was found between cumulative childhood maltreatment experiences and sleep disturbance. The interaction terms (between physical abuse/emotional abuse/sexual abuse/physical neglect/emotional neglect/number of childhood traumas and gender) were significantly associated with sleep disturbance. Further stratification analyses by gender showed that girls who reported experiencing one or more of these five types of childhood maltreatment had a higher risk of sleep disturbance than boys.

LIMITATIONS

The study only included school students, and the cross-sectional design limited our ability to make causal inferences.

CONCLUSIONS

The study findings suggest that childhood maltreatment increases the risk of sleep disturbance in adolescents. Furthermore, exposure to single and multiple types of childhood maltreatment predicts lower sleep quality in girls.

Childhood maltreatment and DNA methylation: A systematic review

DNA methylation (DNAm) - an epigenetic process that regulates gene expression - may represent a mechanism for the biological embedding of early traumatic experiences, including childhood maltreatment. Here, we conducted the first systematic review of human studies linking childhood maltreatment to DNAm. In total, 72 studies were included in the review (2008-2018). The majority of extant studies (i) were based on retrospective data in adults, (ii) employed a candidate gene approach (iii) focused on global maltreatment, (iv) were based on easily accessible peripheral tissues, typically blood; and (v) were cross-sectional. Two-thirds of studies (n = 48) also examined maltreatment-related outcomes, such as stress reactivity and psychiatric symptoms. While findings generally support an association between childhood maltreatment and altered patterns of DNAm, factors such as the lack of longitudinal data, low comparability across studies as well as potential genetic and 'pre-exposure' environmental confounding currently limit the conclusions that can be drawn. Key challenges are discussed and concrete recommendations for future research are provided to move the field forward.

Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies

OBJECTIVES

Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies.

METHODS

Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design.

RESULTS

This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types.

CONCLUSIONS

Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.

Effect of race on the relationship between child maltreatment and obesity in Whites and Blacks

This cross-sectional study was designed to determine what role race plays in the relationship between obesity and child maltreatment (CM), which is currently unknown. One hundred fifteen participants successfully completed the study, including Whites (n = 60) and Blacks (n = 55) of both sexes. CM was assessed using the Childhood Trauma Questionnaire. Total fat, trunk/total fat ratio, visceral adipose tissue (VAT), and VAT/trunk ratio, were measured through Dual Energy X-ray Absorptiometry (DXA) and Corescan software estimation. A significant interaction between identifying as White and having a history of CM was found to predict body mass index (BMI) (β = 5.02, p = .025), total fat (kg) (β = 9.81, p = .036), and VAT (kg) (β = 0.542, p = .025), whereas race by itself was an insignificant predictor. An interaction between having history of physical abuse and identifying as White was found to predict BMI (β = 6.993, p = .003), total fat (β = 12.683, p = .010), and VAT (β = 0.591, p = .018). An interaction between having multiple CM subtypes and identifying as White predicts increased total fat (β = 5.667, p = .034) and VAT (β = 0.335, p = .014). Our findings indicate that the relationship between CM and obesity, measured through BMI, total body fat, and VAT, is seen in Whites but not in Blacks. Future research should investigate the nature of this racial influence to guide obesity prevention and target at-risk populations.

Child Maltreatment Severity Questionnaire (MSQ) for Professionals: Development, Validity, and Reliability Evidence

This article presents the development and validation of the child Maltreatment Severity Questionnaire (MSQ), aiming to contribute to increase the quality and efficiency of evaluation processes in the Child Protection System (CPS). To obtain a valid and reliable instrument, a set of studies was developed: Study 1—Based on two previous studies, the questionnaire was developed and the severity level of the items within maltreatment subtypes was assigned by 93 professionals from the welfare and CPS system. Consensus about the severity levels was assessed and described in terms of within-item reliability rankings; Study 2—The MSQ was filled out for 253 children and adolescents referred to the CPS. To ensure that the items within different subtypes of maltreatment were homogenous and had internal consistency, a reliability analysis was performed; Study 3—The MSQ was filled out for 1,000 children and adolescents referred to the CPS. This study involved testing validity evidence through an exploratory and a confirmatory factor analysis. We also analyzed the internal consistency, sensibility (i.e., sex and age differences) and concurrent validity of the MSQ. Findings support the adequacy and reliability of the MSQ to be used by CPS professionals in evaluating child maltreatment.

The Prevalence of Sexual Abuse in Institutions: Results From a Representative Population-Based Sample in Germany

The lifetime prevalence of sexual abuse in institutional settings in Germany was examined in a sample representative of the general adult population (N = 2,437). Participants completed a survey on whether they had ever experienced such abuse, its nature (contact, noncontact, forced sexual, intercourse), the type of institution (e.g. school, club), and the relationship of perpetrator to victim (peer, caregiver, staff member). Overall, 3.1% of adult respondents (women: 4.8%, men: 0.8%) reported having experienced some type of sexual abuse in institutions. Adult women reported higher rates of all types than did men, with rates of 3.9% versus 0.8% for contact sexual abuse, 1.2% versus 0.3% for noncontact sexual abuse, and 1.7% versus 0.2% for forced sexual intercourse. We conclude that a remarkable proportion of the general population experiences sexual abuse in institutions, underscoring the need for development of protective strategies. Especially, schools seem to represent good starting points for primary prevention strategies.

Reluctance Versus Urge to Disclose Child Maltreatment: The Impact of Multi-Type Maltreatment

Child maltreatment is a major public health issue in Israel. According to a recent Israeli national epidemiological survey, approximately half of Jewish and Arab girls and boys between the ages 12 and 17 experienced at least one type of child maltreatment, at any severity level. The purpose of the present study was to investigate the influence of multi-type maltreatment on Israeli children and youth survivors' reluctance versus urge to disclose; with the effects of gender, age, and ethnicity taken into account. The study is important since non-disclosure has deleterious effects in terms of continuation of the abuse, delays in criminal prosecution and commencement of treatment. A self-report questionnaire incorporating the following instruments was administered: the Juvenile Victimization Questionnaire, the Childhood Trauma Questionnaire, and the Disclosure of Trauma Questionnaire. The sample consisted of 6,253 Jewish and Arab children and youth who reported experiencing at least one lifetime child maltreatment event. Study results indicated that children and youth's reluctance to disclose is positively associated with their emotional reactions to disclosure, as well as with higher instances of child maltreatment exposure; whereas urge to talk is negatively correlated with their emotional reactions to disclosure.

Child abuse and physical health: A population-based study on physical health complaints among adolescents and young adults

Aims: To investigate whether adolescents and young adults with a history of child abuse had more physical health complaints compared to their unexposed peers. We also aimed to estimate associations between different child abuse types with physical health complaints and associations between the number of child abuse types and physical health complaints. Methods: This population-based telephone survey over two waves included 506 adolescents and young adults exposed to child abuse and 504 non-abused peers aged 16-33 years. We applied linear regression analyses to investigate associations between child abuse types and physical health complaints, unadjusted and mutually adjusted for co-occurring abuse, and to investigate how the number of child abuse types associated with physical health complaints. Results: Participants exposed to child abuse reported significantly more physical health complaints. The child abuse types strongly co-occurred. When adjusting for co-occurring child abuse, only sexual and emotional abuse were significantly associated with physical health complaints. Physical health complaints increased with the higher number of child abuse types experienced. Conclusions: Our findings suggest that exposure to abuse, particularly sexual and emotional, during childhood predicts physical health complaints in adolescence and early adulthood. In a public health perspective, early identification of child abuse may be beneficial in preventing physical health complaints later in life.

Connecting Child Maltreatment Risk With Crime and Neighborhood Disadvantage Across Time and Place: A Bayesian Spatiotemporal Analysis

Child maltreatment is a major public health problem. Although maltreatment rates vary over time and are influenced by neighborhood characteristics, the unique effects of crime and disadvantage on risk are not well understood. This study utilized a Bayesian spatiotemporal approach to examine risk factors for substantiated child abuse and neglect over a 9-year period across zip codes in Davidson County, TN. Risk of child sexual and physical abuse decreased from 2008 to 2016. In contrast, risk of child neglect increased from 2011 to 2014, followed by a rapid decrease in risk. Whereas higher percentages of families living in poverty were associated with higher risk of all maltreatment subtypes, higher unemployment rates were uniquely associated with risk of child neglect. Crime rates were positively associated with risk of child physical and sexual abuse but not neglect. Results have implications for tailoring prevention strategies according to geographic area and maltreatment subtype.

Intergenerational continuity/discontinuity of child maltreatment among low-income mother–child dyads: The roles of childhood maltreatment characteristics, maternal psychological functioning, and family ecology

Despite evidence of some intergenerational continuity of maltreatment, a notable proportion of parents maltreated in childhood do not perpetuate the cycle of maltreatment. The aim of this study was to identify factors that would distinguish mother–child dyads where intergenerational continuity was present from dyads characterized by intergenerational discontinuity. The sample included 193 children and their mothers, drawn from two populations: 74 maltreated children recruited through Child Protection Services and 119 nonmaltreated children recruited among low-income families. Factors investigated included maternal childhood maltreatment, psychological functioning, and family ecology. Compared to maltreated mothers who broke the cycle of maltreatment, those who perpetuated the cycle were more likely to have experienced childhood physical neglect and multitype maltreatment, and to experience sociodemographic risk, intimate partner violence, and lack of family support. Compared to nonmaltreated mothers who maintained a nonmaltreating child-rearing environment: (a) maltreated mothers who broke the cycle were more likely to experience residential instability and lack of family support, and (b) nonmaltreated mothers whose child was maltreated were more likely to experience sociodemographic risk and lack of family support. Maternal psychological functioning did not discriminate maltreatment groups. Lending empirical support to a diathesis-stress model of poor parenting, these findings suggest that family-ecology related stress, but not maternal psychological difficulties, may create additional burden that will precipitate the risk of maltreatment intergenerational continuity.

Parents' experiences of childhood abuse and neglect are differentially associated with behavioral and autonomic responses to their offspring

Although childhood maltreatment has been shown to compromise adaptive parental behavior, little is known what happens in terms of physiological regulation when parents with a history of childhood maltreatment interact with their offspring. Using a sample of 229 parents (131 women), the present study examined whether childhood maltreatment experiences are associated with parents’ behavioral and autonomic responses while resolving conflict with their offspring. Self‐reported experienced child maltreatment was measured using a questionnaire assessing abuse and neglect. Parents (M_age = 52.7 years, range_age = 26.6–88.4 years) and their offspring (M_age = 24.6 years, range_age = 7.5–65.6 years) participated in a videotaped parent–offspring conflict interaction task. Parental warmth, negativity, and emotional support were coded. In addition, their pre‐ejection period and respiratory sinus arrhythmia were measured as indicators of underlying sympathetic and parasympathetic nervous system reactivity, respectively. Findings demonstrated that experiences of abuse and neglect were associated with behavioral and physiological responses in different ways. Separating these two types of maltreatment in research and in clinical practice might be important.

Child maltreatment and the development of substance use and disorder

Children who experience maltreatment are at well-documented risk for the development of problematic substance use and disorder in adolescence and beyond. This review applies a developmental psychopathology framework to discuss the complex multilevel probabilistic pathways from child maltreatment to substance use and substance use disorder (SUD). We begin with an overview of the myriad vulnerabilities associated with child maltreatment, including the development of substance use and SUD. Prominent pathways that may potentiate liability for SUD are discussed. Specifically, we highlight the robust empirical support for the prominent externalizing pathway of risk, and also discuss the state of the research regarding the internalizing pathway. Consistent with the developmental psychopathology perspective, we then review biological processes such as neuroendrocrine mechanisms, allostatic load, and neurobiological pathways that may underlie child maltreatment risk, as well as discuss broader contextual issues. Elucidating the processes underlying the development of substance use and disorder among children exposed to this form of early adversity is paramount for not only informing developmental theories, but also designing effective prevention and intervention programs. Thus, implications for preventive interventions are provided. Finally, critical next steps for research within the area of child maltreatment and the developmental psychopathology of substance use and SUD are proffered.

The mediating role of posttraumatic stress reactions in the relationship between child abuse and physical health complaints in adolescence and young adulthood

Background: Child abuse is associated with physical health problems in adolescence and adulthood, but the mechanisms involved are unclear. A possible mediating effect of posttraumatic stress reactions (PTSR) linking child abuse with later physical health complaints has not been fully investigated. Objective: The current study investigated whether PTSR could be a potential mediator in the relationship between child abuse and physical health complaints in adolescents and young adults. If so, we also investigated whether this was the case for different child abuse types alone or in combination. Method: The study sample comprised 506 adolescents and young adult victims of child abuse and 504 unexposed matched controls aged 16-33 from a community sample. We measured child abuse retrospectively and current PTSR at wave 1 (2013), and current physical health complaints at wave 2 (2014/15). We tested a model of PTSR as a possible mediator between child abuse and physical health complaints and conducted causal mediation analysis to estimate direct and indirect pathways. Each child abuse type was studied in isolation and in combination with other abuse types. Results: PTSR had a notable, significant mediating effect on the relationship between child abuse and physical health complaints in our overall model (average causal mediation effect; ACME = 0.14, p < 0.001), accounting for 85% of the total effect. The mediated pathway was also significant in analyses of the different child abuse types. The mediating effect of PTSR was most prominent in individuals reporting exposure to more than one child abuse type. Conclusions: The current study indicates that PTSR may be an important mediator in the relationship between child abuse and physical health complaints. Health professionals should be aware of the important role that PTSR may have in maintaining or exacerbating physical health problems in child abuse victims. However, a reverse model could not be tested in this study and the results need confirmation in future prospective studies.

Associations of adverse childhood experiences and bullying on physical pain in the general population of Germany

Background

Chronic pain is a frequent burden in the general population. Child maltreatment and bullying are risk factors for the development of chronic pain. Aim of this cross-sectional study was to investigate the association of child maltreatment and bullying and pain experiences in a representative sample of the general population.

Materials and methods

A total of N=2,491 people from the general population of Germany participated in the study (M_age=48.3 years [SD=18.2], 53.2 % female). Child maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ), pain was rated with the Polytrauma Outcome (POLO)-physical state domain, depression scores were assessed with the Patient Health Questionnaire, and anxiety scores via the General Anxiety Disorder Questionnaire. Regression analyses were calculated to investigate the effect of bullying and child maltreatment, as well as depression, anxiety, and gender on pain experiences.

Results

A significant correlation between increasing pain levels and number of adverse childhood experiences was found. With regard to specific types of maltreatment, largest effect sizes were found for emotional abuse. Bullying was significantly, but overall rather moderately, related to pain suffering. In women, all forms of maltreatment were associated with pain, while in men only sexual and physical abuse revealed significant effects. Although depression and anxiety scores were significantly associated with the experience of current pain, they did not change the effect of child maltreatment on pain significantly.

Conclusion

In this sample of the general population, adverse childhood experiences were significantly associated with pain and showed cumulative effects, over and above depressive and anxiety symptoms.

Associations of specific and multiple types of childhood abuse and neglect with personality pathology among adolescents referred for mental health services

The present study investigated the unique association between five types of childhood abuse and neglect and 18 lower-order dimensions of personality pathology, and using latent classes analysis (LCA) explored patterns of childhood abuse or neglect experiences. Further differences across latent classes on personality pathology traits, personality disorder symptom count and a diagnosis of personality disorder were examined. Participants were 178 adolescents and young adults (12-22 years; M = 16.02, 65.7% girls; 83% Axis I/II disorder) from the Netherlands referred for mental health services. Emotional abuse was uniquely associated with 11 personality pathology traits; sexual and physical were associated with three and four traits, respectively. LCA yielded three classes, namely, severe maltreatment (class 1), low-moderate emotional maltreatment and sexual abuse (class 2), and least maltreatment (class 3). After controlling for age, gender, presence of any Axis I disorder, multivariate analysis of covariance indicated that classes with more types of maltreatment experiences and higher severity (classes 1 and 2) endorsed more personality pathology traits, personality disorder symptom counts and a diagnosis of a personality disorder than the least maltreatment class. Findings have theoretical and clinical implications entailing the identification of patterns of maltreatment types and related personality pathology traits among youth.

Gender Differences in Intimate Partner Violence: A Predictive Analysis of IPV by Child Abuse and Domestic Violence Exposure During Early Childhood

This study focused on gender differences in the prediction of adult intimate partner violence (IPV) by subtypes of child abuse and children's exposure to IPV. Latent classes of adult IPV consisted of a no violence (20.3%), a psychological violence only (46.2%), a psychological and sexual violence (9.2%), a multitype violence and intimidation (6.8%), and a psychological and physical violence with low intimidation class (17.5%). Physical-emotional child abuse and domestic violence exposure predicted a higher likelihood of multitype violence for males. Sexual abuse predicted a higher likelihood of this same class for females. Implications for future research and prevention are discussed.

Disentangling the mental health impact of childhood abuse and neglect: A replication and extension study in a Brazilian sample of high-risk youth

Childhood maltreatment is a key predictor of mental health problems across the life span. Yet, how maltreatment types independently and jointly influence the risk for psychiatric problems remains unclear. The aim of the study was two-fold: first, to replicate recent findings regarding the impact of maltreatment types on youth psychiatric symptoms, based on a Brazilian sample of high-risk adolescents (n = 347; age range = 11-17 yrs), and second, to extend existing findings by examining whether this relationship is mediated by bullying victimization and/or perpetration. Measures included self-report ratings of childhood maltreatment and peer victimization, as well as multi-informant reports of internalizing and externalizing symptoms. Consistent with prior research, we found that: (i) maltreatment types often co-occurred; (ii) there was a linear association between number of maltreatment types experienced and symptom severity (i.e. cumulative effect); and (iii) emotional abuse emerged as the most consistent independent predictor of poor mental health across domains, raters, and gender. Additionally, this study extends previous findings by showing that the influence of maltreatment on psychiatric outcomes is partially mediated by peer victimization, but not by bullying perpetration. In conclusion, these findings expand our understanding of the heterogeneity in individual responses to maltreatment as well as highlighting emotional abuse as an important predictor of poor mental health.

Trends in child maltreatment in Germany: comparison of two representative population-based studies

BACKGROUND

Child maltreatment of all types is a serious concern for society, and it is important to monitor trends in incidence in order to inform child welfare agencies and policy-makers about emerging issues. In Germany, however, information on such trends is limited: apart from official sources, the only published study is a comparison of surveys conducted in 1992 and 2011 that had focused primarily on sexual abuse. The present study is the first to look at more recent trends and to examine other types of maltreatment as well.

METHODS

We compared the datasets of two population-based nationwide surveys, one conducted in 2010 (N = 2504) and the other in 2016 (N = 2510). Both had used identical methodology. Participants aged 14 years and older had been selected randomly using the Kish selection grid method, and information about childhood experiences of abuse had been solicited using the Childhood Trauma Questionnaire.

RESULTS

The overall percentage of respondents who reported having experienced at least one type of child maltreatment decreased over the 6 years, from 35.3% in 2010 to 31.0% in 2016; however, the percentages who reported multiple types of maltreatment remained stable. The decrease in any type of maltreatment was mainly driven by fewer reports of physical neglect, which was likelier to be reported by older respondents who had experienced privation during the (post-) war years and whose representation was lower in the later survey. There was a significant increase over time in the prevalence of emotional abuse, with respondents aged 26-45 years reporting higher rates of this type of maltreatment. The prevalence rates of other types of maltreatment remained unchanged. All effect sizes were very small.

CONCLUSIONS

At present, the systems in place in Germany for monitoring the occurrence of child maltreatment are insufficient. While this study contributes to a better understanding, more information is needed, particularly on populations that have been excluded or underrepresented in previous research efforts. As has been done elsewhere, large databases should be set up, using identical methodologies and definitions, in order to accurately assess trends over time in different types of abuse and neglect.

All Unhappy Childhoods Are Unhappy in Their Own Way-Differential Impact of Dimensions of Adverse Childhood Experiences on Adult Mental Health and Health Behavior

Adverse childhood experiences have consistently been linked with poor mental and somatic health in adulthood. However, due to methodological restraints of the main lines of research using cumulative or selective models, little is known about the differential impact of different dimensions of adverse childhood experiences. Therefore, we gathered data from 396 psychiatric in-patients on the Adverse Childhood Experiences (ACE) questionnaire, extracted dimensions using factor analysis and compared this dimensional model of adverse childhood experiences to cumulative and selective models. Household Dysfunction (violence against the mother, parental divorce, substance abuse or incarceration of a household member) was associated with poor health behaviors (smoking, alcohol dependency and obesity as proxy marker for an imbalance between energy intake and physical activity) and with poorer socio-economic achievement (lower education and income) in adulthood. The previously reported associations of maltreatment and sexual abuse with these outcome criteria could not be corroborated. Both Maltreatment (emotional and physical neglect and abuse) and Sexual Abuse predicted BPD, PTSD and suicidal behavior. However, the two ACE dimensions showed sufficiently divergent validity to warrant separate consideration in future studies: Maltreatment was associated with affective and anxiety disorders such as social phobia, panic disorder and major depressive disorder, whereas Sexual Abuse was associated with dysregulation of bodily sensations such as pain intensity and hunger/satiation. Also, we found both quantitative and qualitative evidence for the superiority of the dimensional approach to exploring the consequences of adverse childhood experiences in comparison to the cumulative and selective approaches.

Differential impacts of participation in organized activities and maltreatment types on adolescent academic and socioemotional development

Participation in organized activities has been largely regarded as beneficial for academic and socioemotional development for adolescents, but the impacts of various types of organized activities for adolescents at risk for maltreatment have been rarely tested. In this study, we investigated the differential impacts of five types of maltreatment exposure (physical maltreatment, sexual maltreatment, neglect, other type, and multiple types) on the associations between four types of organized activities (mentored groups, art and music clubs, sport clubs, and academic clubs) and academic and socioemotional development (school engagement, delinquency, depressive symptoms, and trauma symptoms) of adolescents who were investigated by Child Protective Services (CPS) for maltreatment exposure. Data came from a national, longitudinal sample of 790 adolescents in contact with CPS in the U.S. After controlling for demographic characteristics of participants and prior levels of each outcome, multiple linear regression models were fitted to the data with interactions between the organized activities and the maltreatment types. The main findings of this study included: 1) adolescents who participated in mentored groups, sport clubs, and academic clubs reported higher levels of school engagement; 2) adolescents who participated in academic clubs reported fewer depressive symptoms; 3) adolescents who participated in art and music clubs reported more trauma symptoms compared to non-participants; and 4) the effects of participation in mentored groups on delinquency and trauma symptoms differed by maltreatment type. These results indicate both possible benefits and risks of organized activity participation for adolescents with certain maltreatment exposures.

Differential associations between patterns of child maltreatment and comorbidity in adult depressed patients

BACKGROUND

Types of maltreatment often co-occur and it is unclear how maltreatment patterns impact on comorbidity in depressed patients.

METHODS

We analysed associations of maltreatment patterns with a broad range of comorbidities assessed with diagnostic interviews in 311 treatment-seeking depressed outpatients.

RESULTS

Latent class analyses identified a "no maltreatment class" (39%), a "mild to moderate abuse and neglect class" (34%), a "severe abuse and neglect class" (14%) and a "severe neglect class" (13%). We found a dose-response association for the first three classes with comorbid disorders, a general psychopathology factor and an interpersonal insecurity factor. Patients in the "severe abuse and neglect" class had increased odds ratios (OR) of suffering from an anxiety disorder (OR 3.58), PTSD (OR 7.09), Borderline personality disorder (OR 7.97) and suicidality (OR 10.04) compared to those without child maltreatment. Patients in the "severe neglect" class did not have a higher risk for comorbidity than those in the "no maltreatment" class.

LIMITATIONS

Class sizes in the "severe abuse and neglect" and the "severe neglect" classes were small and findings should be replicated with other clinical and population samples.

CONCLUSIONS

A higher severity rather than the constellation of types of child abuse and neglect was associated with more comorbid disorders. An exception were patients reporting solely severe emotional and physical neglect who had a similar risk for comorbidity as patients without a history of child maltreatment. This may be associated with distinct learning experiences and may inform treatment decisions.