Developmental effects of child abuse: a review

The Long-Term Health and Human Capital Consequences of Adverse Childhood Experiences in the Birth to Thirty Cohort: Single, Cumulative, and Clustered Adversity

Human capital-that is the cumulative abilities, education, social skills, and mental and physical health one possesses-is increasingly recognized as key to the reduction of inequality in societies. Adverse childhood experiences have been linked to a range of human capital indicators, with the majority of research in high-income, western settings. This study aims to examine the link between adverse childhood experiences and adult human capital in a South African birth cohort and to test whether associations differ by measurement of adversity. Secondary analysis of data from the Birth to Thirty study was undertaken. Exposure data on adversity was collected prospectively throughout childhood and retrospectively at age 22. Human capital outcomes were collected at age 28. Adversity was measured as single adverse experiences, cumulative adversity, and clustered adversity. All three measurements of adversity were linked to poor human capital outcomes, with risk for poor human capital increasing with the accumulation of adversity. Adversity was clustered by quantity (low versus high) and type (household dysfunction versus abuse). Adversity in childhood was linked to a broad range of negative outcomes in young adulthood regardless of how it was measured. Nevertheless, issues of measurement are important to understand the risk mechanisms that underlie the association between adversity and poor human capital.

Childhood adversities and mental health outcomes: Does the perception or age of the event matter?

The current study extends knowledge regarding the individual contribution of different adverse experiences to mental health symptoms in late adolescence by including the perception of how upsetting each experience was to the adolescent and the age at the first occurrence. We also sought to move beyond sum scores of adverse experiences by using a person-centered approach to classifying individuals with similar co-occurrence of adversities. The data came from a longitudinal study of maltreatment on adolescent development (N = 454). Self-reported childhood adversities were assessed at Wave 4 (average of 7 years postbaseline) and examined with respect to current mental health symptoms (depression, PTSD, anxiety, and externalizing). Although the adversity sum score was a potent predictor of all mental health outcomes, the results indicated that the use of a sum score obscures information about the importance of individual adversities. Additionally, the influence of age of occurrence varied based on the adversity and outcome, while the perception of the event did not add much unique variance. Finally, the latent class analyses provided unique information about the patterns of co-occurring adversity in this sample, and that membership in either of the multiple-adversity classes was associated with more mental health symptoms.

Correlates of therapy referral in foster children

In order to identify the correlates of the behavioral maladjustment of children in foster care, a group of children in foster care who had been referred for therapy was compared to a group of children who had never been in therapy during their foster care placement on several relevant variables. Referred and nonreferred children differed on several important behavioral indicators: number of externalizing and internalizing behavior problems, behavioral competence, and mental age. Results of this comparison suggest that the age of the child when first placed in care, the number of different placements the child experiences during care, and the type of foster care placement (kinship vs. nonkinship) may all be related to the need for clinical services in this population. Theoretical and practical implications of these relationships are explored.

Evaluation of Threshold: an independent living program for homeless adolescents

The Threshold Project, a residential treatment program, was designed to work with homeless and alienated young women who were approaching 18 years of age but lacked the skills, values, and attitudes necessary to care for themselves and assume the responsibilities of adulthood. Project services were designed to prepare these young women for independent living and to break the intergenerational cycle of abuse and neglect experienced by this population. Threshold offered a series of progressively more independent living experiences to young homeless women ages 16-18 years, who had been sexually/physically/emotionally abused or neglected, and who had been involved in or at high risk for prostitution. A majority of the clients responded well to the requirements of the program, including the expectation that they maintain employment and participate in educational programs during the semi-independent living phase of the project. A follow-up assessment undertaken after clients left the project found that 42% of the young women met all "success" criteria, that is, they lived independently (or in stable situations), attended school and/or were employed, had not engaged in prostitution or other offense behavior, and did not abuse alcohol or other substances.

In vitro studies of multiple impact injury to mammalian CNS neurons: prevention of perikaryal damage and death by ketamine

We have developed an in vitro model of rapid acceleration injury (RAI) to study the effects of multiple impact (220 g/impact, 3-5 s intervals) trauma on cultures of mammalian CNS cells. Our initial investigations have shown that: (1) multiple impacts delivered tangential to the plane of growth caused neuronal death while normal impacts did not; (2) glia were not affected by tangential or normal RAI; (3) most neuronal death occurred within 15 min; (4) the threshold for neuronal death was above 440 g (cumulative); (5) neuronal death reached a maximum of 50% at cumulative accelerations greater than or equal to 1100 g; (6) somal swelling and increased nuclear prominence were often observed after tangential RAI, and the frequency of these changes increased with the cumulative acceleration; and (7) ketamine prevented neuronal death and morphological changes during tangential RAI. We hypothesize that neuronal sensitivity to multiple impact RAI depends on the density of N-methyl-D-aspartate (NMDA) complexes in the dendrosomatic membranes. We also hypothesize that the events leading to neuronal death during multiple impact injury are: (1) calcium leakage through NMDA channels causes weakening of the cytoskeleton; (2) loss of cytoskeletal integrity allows nuclear shifting during impact; and (3) nuclear pressure disrupts the plasmalemma causing a lethal influx of calcium.

Methodological considerations in research on child sexual abuse

Child sexual abuse research presents practical, methodological and statistical challenges. This paper examines some recent literature about the incidence and effects of child sexual abuse. Researchers who use epidemiological studies to attempt to ascertain the prevalence of different forms of abuse should be aware of the different populations studied, different methodologies used, diverse definitions of sexual abuse and practical limitations on participants' memories. Common problems in retrospective and prospective studies into the effects of child sexual abuse include the use of atypical populations, inappropriate statistical analyses, the use of unvalidated psychometric instruments and limited sources of information on child functioning. Attention must also be paid to potentially confounding demographic and family variables. A thorough understanding of, and attention to, these problem areas in child sexual abuse research will give a clearer picture of the prevalence and effects of abuse, thus indicating the most appropriate forms of prevention and treatment.

Predicting child abuse and neglect in New Zealand

We describe the three stages of our attempt to predict parenting problems and child abuse antenatally. In the first stage, we made an intuitive check list of ten items from 173 risk factors drawn from the literature. The check list was useful in predicting who would relinquish care or have major parenting difficulty in two different samples drawn four years apart and before and after some major sociocultural changes in New Zealand. In the second stage we used statistical techniques rather than intuition to maximise the predictive ability of the checklist and produced a new one of 9 items. In the third stage we validated the new list in a random sample of pregnant mothers. It was effective in predicting parenting difficulty in the 2 years after childbirth. We recommend it for routine use in a New Zealand setting. We do not know how useful the checklist will be in other cultural settings.

Depressive characteristics of physically abused children

Physically abused and nonabused children were compared on child-completed measures of depression, hopelessness, self-esteem, and locus of control. Results indicated that, in comparison with nonabused controls, abused children evidenced more depressive symptoms, heightened externality, lower self-esteem, and greater hopelessness about the future. Group differences in depressive symptomatology were not accounted for on the basis of differences in age, sex, race, gender, IQ, or socioeconomic status. Results replicate the results of Kazdin, Moser, Colbus, and Bell (1985) derived from a sample of physically abused psychiatric inpatients and extend the generality of these findings to abused children of nonpatient status. Implications of the findings for clinical interventions, theoretical models of child depression, and future research are discussed.

Psychological and behavioral correlates of family violence in child witnesses and victims

Abused and nonabused child witnesses to parental violence temporarily residing in a battered women's shelter were compared to children from a similar economic background on measures of self-esteem, anxiety, depression, and behavior problems, using mothers' and self-reports. Results indicated significantly more distress in the abused-witness children than in the comparison group, with nonabused witness children's scores falling between the two. Age of child and types of violence were mediating factors. Implications of the findings are discussed.