Maltreatment's wake: the relationship of maltreatment dimensions to child outcomes

Trying to Fit a Square Peg in a Round Hole? Testing the Robustness of Maltreatment Measurement Models for Youth

Research on maltreatment exposure often demonstrates mixed findings and a potential explanation for this may be the measurement of maltreatment. One approach for addressing measurement concerns, which also accounts for maltreatment's multidimensional nature, is the use of a measurement or latent model. However, there is minimal evidence on the generalizability of this approach across populations of youth. This study examined measurement invariance of a one-factor maltreatment model across two samples of youth exposed to maltreatment using case file data from the SPARK and LONGSCAN datasets (N = 1286). Results showed that only partial metric invariance could be established for the one-factor model between SPARK and LONGSCAN subsamples, and neglect and emotional abuse indicators tended to show low factor loadings. Findings highlight the need to consider how potential differences in documentation and maltreatment rates influence model performance and the need for research on which maltreatment characteristics may best capture youths' experiences.

The Association Between Child Maltreatment and Loneliness Across the Lifespan: A Systematic Review and Multilevel Meta-Analysis

While there is evidence that child maltreatment is positively associated with loneliness, the strength of this association is not yet clear. It is also unclear whether the magnitude and statistical significance of this association varies across groups of individuals. Therefore, this meta-analysis examines whether there are differences in loneliness between individuals with and without maltreatment histories, and which factors may influence the association between child maltreatment and loneliness. A three-level meta-analysis was conducted on 52 studies reporting 116 effect sizes (N = 1,705,493; Mage = 30.93; 49.6% females). Results showed a medium overall effect (g = 0.45, p < .001, 95% CI [0.36, 0.53]), indicating that individuals with maltreatment histories, on average, feel lonelier than individuals without maltreatment histories. Moderator analyses showed that effect sizes were larger for emotional abuse and emotional neglect as compared to other types of child maltreatment and decreased when participants were older at the time of loneliness assessment. These findings suggest that individuals with maltreatment histories, especially those who have been emotionally abused and/or emotionally neglected, are vulnerable to experiencing loneliness across the lifespan. The results also suggest that feelings of loneliness warrant attention in prevention and intervention programs for individuals with maltreatment histories.

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.

Identifying Trajectories of Maltreatment Revictimization and Juvenile Justice Outcome: A Latent Class Analysis of Subtype, Timing, and Chronicity

Continued exposure to abuse or neglect is a strong predictor for immediate and long-term negative developmental outcomes including developmental delays, disabilities, poor school performance, criminal behavior, and mental health issues. The purpose of this study was to identify distinct subgroups of children with repeat victimization based on maltreatment timing, subtype, and chronicity and to examine how the unique subgroups are related to youth's juvenile justice outcome. Using data from Longitudinal Studies of Child Abuse and Neglect, this study included 286 children (47% males, 41% blacks) with more than one report for substantiated maltreatment from birth to age 17. Latent class analysis was employed to identify heterogeneity in the patterns of maltreatment revictimization. Four latent classes emerged: (a) Prevailing Early Neglect (52.6%); (b) Co-occurring Maltreatments in Preschool Age (20.1%); (c) Incremental Neglect with Sexual Abuse in School Age (18.7%); and (d) Co-occurring Maltreatments in School Age (8.6%). Black children were overrepresented in Incremental Neglect with Sexual Abuse in School Age compared to white and other racial groups of children. Ordinal logistic regression analysis indicated that there was no significant difference in the juvenile justice outcome across four subgroups of children with revictimization. Our person-centered investigations of maltreatment subtype, timing, and chronicity highlight the need for precise assessment and prevention strategies based on a more nuanced understanding of various patterns of childhood maltreatment revictimization.

Measurement Models of Child Maltreatment and Associations With Suicidal Ideation Endorsement by Youth in Foster Care: A Multiverse Analytic Approach

Youth suicidal ideation is a prevalent experience, particularly among youth exposed to maltreatment, with a variety of indicators such as youth statements of ideation. To better understand suicidal ideation, and the associations with youth mental health outcomes, a fruitful path may be through the study of the dimensions (e.g., severity, frequency) of maltreatment exposure. While there exists extensive work on methods to best operationalize casefile records of maltreatment, such work has not been undertaken for youth self-reports, which are an important indicator of youth functioning following exposure. To address the lack of clarity of how to best operationalize youth self-reports of maltreatment, a multiverse analytic approach was taken to operationalize severity and frequency in a sample of 471 8- to 17-year-old children in foster care. We examined differences across measurement models and the models' associations with caregiver reports of youth suicidal ideation statements. Results indicate that the operationalizations used to define maltreatment resulted in differing measurement models that further differed in their associations with reports of youth suicidal ideation. This study highlights the importance of how researchers operationalize their data and the role dimensions of maltreatment have in further elucidating differential outcomes for youth exposed to maltreatment.

A social network analysis of perpetrators of child maltreatment reported by youth in foster care

OBJECTIVE

Prior research on child maltreatment has focused on distinct features of maltreatment (type, severity, chronicity) important for youth outcomes, yet perpetrators of child maltreatment reported by youth have gone largely unstudied. The present study examines connections between perpetrators, the total number and type of perpetrators reported, and the frequency at which each type of perpetrator was reported across 24 relationship types to provide a foundation for future research seeking to provide comprehensive measurement of perpetrator profiles.

METHODS

Data from 503 youth in foster care (8-21 years old) were collected through the Studying Pathways to Adjustment and Resilience in Kids (SPARK) Project. Youth reported on their history of physical, sexual, and psychological maltreatment. Social Network Analysis (SNA) was used to visualize links between perpetrators within maltreatment type and paired samples t-tests were used to compare differences between network edge weights.

RESULTS

Full sample SNA results were highly interconnected and variable across maltreatment types. Biological parents and peers were the most common perpetrators of physical and psychological abuse with peers and non-family adults being most common for sexual abuse. Family and community member groupings were most distinct in the physical and psychological abuse networks whereas in the sexual abuse network, ties between perpetrators were more equidistant.

CONCLUSIONS

Differences exist in perpetrator profiles across maltreatment types, adding a layer of complexity to how maltreatment experiences are captured, and variability in profiles might provide insight to differing youth outcomes. Understanding individual youth perpetrator profiles could be used to inform foster care placements and reduce the risk of revictimization.

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Out-of-home care characteristics associated with childhood educational underachievement, mental disorder, and police contacts in an Australian population sample

BACKGROUND

Children in out-of-home care (OOHC) are generally at increased risk of health and social adversities compared to their peers. However, the experiences of children in OOHC are not uniform and their associated health and social indices may vary in relation to characteristics of OOHC placements and child protection contact.

OBJECTIVE

To examine associations between a range of characteristics of OOHC placements and child protection contact (e.g., number, type, and age of placement) with educational underachievement, mental disorder, and police contact (as a victim, witness, or person of interest) in childhood.

PARTICIPANTS AND SETTING

Participants were Australian children drawn from the New South Wales Child Development Study cohort who had been placed in OOHC at least once between the ages of 0-13 years (n = 2082).

METHODS

Logistic regression was used to examine prospective associations of OOHC placement and child protection contact characteristics (type of carer, placement instability, duration and frequency of maltreatment, and amount of time in care) with educational underachievement, mental disorder diagnosis and any type of police contact.

RESULTS

Placements with foster carers, greater placement instability, longer and more frequent exposure to maltreatment, and longer time spent in care were each associated with greater likelihood of consequences in all domains of functioning.

CONCLUSIONS

Children with certain placement characteristics are at higher risk of adverse consequences and should be prioritised for support services. The magnitude of relationships was not uniform across different health and social indices, highlighting the need for holistic, multiagency approaches to support children placed in care.

Minor Forms of Parental Maltreatment and Educational Achievement of Immigrant Youths in Young Adulthood: A Longitudinal Study

Parental hostility and emotional rejection-or aggregated as general harsh family interactions with parents-have received little research attention due to such parent-child interactions being counted as minor forms of parental maltreatment and regarded as being less harmful. However, recent research showed that these minor forms of parental maltreatment on youth development are far from negligibility on account of their frequency, chronicity, and incessancy. In this longitudinal study, we investigated how parental hostility, emotional rejection, and harsh family interactions with parents of in early adolescence of immigrant youths (wave-1 M_age = 14) adversely impact successful college graduation of immigrant youths in young adulthood (wave-3 M_age = 24) through the mediation of their development of academic aspirations in late adolescence (wave-2 M_age = 17). Using data from a representative sample of the Children of Immigrants Longitudinal Study (N = 3344), the current study revealed that parental hostility, emotional rejection, and harsh family interactions with parents significantly impaired successful college graduation of immigrant youths in young adulthood, with the decreased odds of 20.1% to 30.22%. Furthermore, academic aspirations of immigrant youths in late adolescence not only significantly mediated the abovementioned relationships but also contributed to the higher odds of immigrant youths' college graduation by 2.226 to 2.257 times. Findings of this study related to educational innovations, family services, and policy implications are discussed herein.

Self-reported mental health of children known to child protection services: an Australian population-based record linkage study

Maltreated children are vulnerable to adverse mental health outcomes. Information about how children's mental health needs vary according to different levels of child protection contact (potentially culminating in out-of-home care [OOHC]) is valuable for the effective provision of services. This study aimed to examine associations between different levels of contact with child protection services before the age of 10 years and self-reported mental health difficulties at age 11 years. Participants (n = 26,960) were drawn from the New South Wales Child Development Study, a multiagency, multigenerational, longitudinal record linkage study that combines administrative records with cross-sectional survey data. We examined associations between four levels of child protection response (non-threshold reports, unsubstantiated reports, substantiated reports, OOHC; each relative to no report) and six domains of self-reported mental health difficulties (including internalising and externalising symptoms, and psychotic-like experiences). All levels of contact with child protection services were associated with increased odds of mental health difficulties in all domains. Children who had been placed in OOHC and children with substantiated reports had the highest odds of reporting clinical levels of mental health difficulties; 48.1% of children with an OOHC placement and 45.6% of those with substantiated child protection reports showed clinical levels of mental health difficulties in at least one domain. Children with child protection reports that were unsubstantiated, or determined not to meet the threshold for risk-of-significant harm, were also at increased risk of mental health difficulties in middle childhood. These findings underscore the importance of early detection and intervention for all children at risk of maltreatment.

Complex early childhood experiences: Characteristics of Northern Territory children across health, education and child protection data

Early identification of vulnerable children to protect them from harm and support them in achieving their long-term potential is a community priority. This is particularly important in the Northern Territory (NT) of Australia, where Aboriginal children are about 40% of all children, and for whom the trauma and disadvantage experienced by Aboriginal Australians has ongoing intergenerational impacts. Given that shared social determinants influence child outcomes across the domains of health, education and welfare, there is growing interest in collaborative interventions that simultaneously respond to outcomes in all domains. There is increasing recognition that many children receive services from multiple NT government agencies, however there is limited understanding of the pattern and scale of overlap of these services. In this paper, NT health, education, child protection and perinatal datasets have been linked for the first time. The records of 8,267 children born in the NT in 2006-2009 were analysed using a person-centred analytic approach. Unsupervised machine learning techniques were used to discover clusters of NT children who experience different patterns of risk. Modelling revealed four or five distinct clusters including a cluster of children who are predominantly ill and experience some neglect, a cluster who predominantly experience abuse and a cluster who predominantly experience neglect. These three, high risk clusters all have low school attendance and together comprise 10-15% of the population. There is a large group of thriving children, with low health needs, high school attendance and low CPS contact. Finally, an unexpected cluster is a modestly sized group of non-attendees, mostly Aboriginal children, who have low school attendance but are otherwise thriving. The high risk groups experience vulnerability in all three domains of health, education and child protection, supporting the need for a flexible, rather than strictly differentiated response. Interagency cooperation would be valuable to provide a suitably collective and coordinated response for the most vulnerable children.

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.

Methodological inconsistencies confound understanding of language measurement in the child maltreatment population: A systematic review

BACKGROUND

While researchers have found a link between childhood maltreatment and language difficulties, the underlying mechanisms remain unclear and replication across the literature is inconsistent.

OBJECTIVE

To conduct a systematic review examining the methodological inconsistencies related to studies' samples construction, maltreatment measurement, and language outcomes using a language acquisition theory-based approach.

METHODS

Using the PRISMA framework, a literature search was conducted across five databases to identify studies that have investigated the effects of maltreatment on the language dimensions of vocabulary and grammar. Data were extracted for participant and maltreatment characteristics.

RESULTS

Fifty articles were reviewed. The results revealed: 1) maltreated children performed consistently below peers on grammar but not vocabulary assessments, 2) disproportionate use of vocabulary assessments, 3) considerable variability on participant characteristics and limited multidimensional measurement of maltreatment exposure, and 4) only nine studies analyzed the relationship between a maltreatment dimension (e.g., type, severity) and language.

CONCLUSIONS

Based on the results of this review, we propose three calls to action: 1) more language acquisition research in the child maltreatment field, 2) specificity when constructing samples with maltreated children, and 3) comprehensive and multidimensional maltreatment measurement. Implications for education were examined.

Maltreatment Type Classifications and Transitions During Childhood for a California Birth Cohort

Childhood maltreatment involves dynamics between the type of maltreatment experienced and the context of maltreatment. Reports of alleged maltreatment to child protective services may overlap and shift over time, complicating understanding of their independent and interacting nature, including how child protection systems respond. Latent class analysis (LCA) and latent transition analysis (LTA) were used to construct data-based models of longitudinal dynamics of alleged maltreatment throughout childhood. We sought to identify patterns leading to system decisions to substantiate allegations of maltreatment and place children in foster care. Using linked birth and child protection records, we defined a cohort of children born in California in 1999, 29.4% of whom had at least one referral for alleged maltreatment before their 18th birthday. Maltreatment and perpetrator indicators were coded, and LCA identified five alleged maltreatment classes and one class of children without referrals. LTA determined consistency of classifications and estimated transitions between classes over age periods. Children with multitype maltreatment patterns or experiences of neglect were most likely to experience future maltreatment allegations. Estimated probabilities of placement indicated children with Multitype Maltreatment allegations were more likely to experience substantiated maltreatment allegations and out-of-home placements. Findings identify a repeatable method for better understanding complex systems.

Emotional maltreatment and neglect impact neural activation upon exclusion in early and mid-adolescence: An event-related fMRI study

Child maltreatment gives rise to atypical patterns of social functioning with peers which might be particularly pronounced in early adolescence when peer influence typically peaks. Yet, few neuroimaging studies in adolescents use peer interaction paradigms to parse neural correlates of distinct maltreatment exposures. This fMRI study examines effects of abuse, neglect, and emotional maltreatment (EM) among 98 youth (n = 58 maltreated; n = 40 matched controls) using an event-related Cyberball paradigm affording assessment of both social exclusion and inclusion across early and mid-adolescence (≤13.5 years, n = 50; >13.5 years, n = 48). Younger adolescents showed increased activation to social exclusion versus inclusion in regions implicated in mentalizing (e.g., superior temporal gyrus). Individual exposure-specific analyses suggested that neglect and EM coincided with less reduction of activation to social exclusion relative to inclusion in the dorsal anterior cingulate cortex/pre-supplementary motor area (dACC/pre-SMA) among younger versus older adolescents. Integrative follow-up analyses showed that EM accounted for this dACC/pre-SMA activation pattern over and above other exposures. Moreover, age-independent results within respective exposure groups revealed that greater magnitude of neglect predicted blunted exclusion-related activity in the parahippocampal gyrus, while EM predicted increased activation to social exclusion in the precuneus/posterior cingulate cortex.

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.

Examining the unique contributions of parental and youth maltreatment in association with youth mental health problems

BACKGROUND

Extensive research seeks to understand the intergenerational impact of child maltreatment. However, it remains unclear how parent's history of child maltreatment (PCM) is associated with child mental health, after accounting for children's experiences of maltreatment and other proximal risk factors.

OBJECTIVE

This study examines the associations between PCM and youth internalizing and externalizing problems, while accounting for youth experiences of maltreatment (YM), and parent mental health and positive parenting.

PARTICIPANTS AND SETTING

Youth aged 14 to 17 years (N = 2266) participated in the 2014 Ontario Child Heath Study.

METHODS

Parents and youth reported their experiences of child maltreatment. Parent-report and self-reports of youth internalizing and externalizing problems were also collected. Number of subtypes of maltreatment and specific subtypes of maltreatment were examined. Parents reported their own mental health problems and positive parenting practices.

RESULTS

Regarding number of maltreatment subtypes, initially PCM was associated with parent-reported, but not self-reported, youth internalizing and externalizing problems. After accounting for YM, parent mental health problems and positive parenting, only YM remained significant. Regarding specific subtypes of maltreatment, both parent and youth emotional abuse were related to parent- and youth-reported internalizing and externalizing problems, after controlling for other maltreatment subtypes. However, the effects of parent emotional abuse became nonsignificant after accounting for YM and proximal risk factors.

CONCLUSIONS

Findings indicate: 1) the unique associations between specific PCM and YM subtypes and youth mental health problems; 2) the role of proximal risk factors in explaining the association between PCM and youth mental health; and 3) the importance of multiple informants of youth mental health problems.

Informant Discrepancies in Child Maltreatment Reporting: A Systematic Review

Potential informants on child maltreatment include the youth who has experienced the alleged maltreatment, and the youth's caregivers, social workers and case files. When multiple informants are compared, they often disagree about whether or not a youth has experienced maltreatment. Such determinations are critical as endorsement-or lack of endorsement-of maltreatment can have significant consequences on the child's safety, future living arrangements and referral for treatment and services. The current study provides a systematic review of the literature on informant discrepancies in child maltreatment. Three databases-PsychINFO, Web of Science, and PubMed-were used to identify studies for the review and 13 articles met inclusion criteria. Results showed that more youth tend to report physical, sexual and emotional abuse than seen in case files. By contrast, more case files include neglect than reported by youth. Implications and future directions are discussed.

Exploring the Contribution of Proximal Family Risk Factors on SLC6A4 DNA Methylation in Children with a History of Maltreatment: A Preliminary Study

The cumulative effects of proximal family risk factors have been associated with a high number of adverse outcomes in childhood maltreatment, and DNA methylation of the serotonin transporter gene (SLC6A4) has been associated with child maltreatment. However, the relationships between proximal family risk factors and SLC6A4 methylation remains unexplored. We examined the association among cumulative family risk factors, maltreatment experiences and DNA methylation in the SLC6A4 gene in a sample of 33 child victims of maltreatment. We computed a cumulative family risk (CFR) index that included proximal family risk factors, such as drug or alcohol abuse, psychopathology, parents’ experiences of maltreatment/abuse in childhood, criminal history, and domestic violence. The majority of children (90.9%) experienced more than one type of maltreatment. Hierarchical regression models suggested that the higher the CFR index score and the number of maltreatment experiences, and the older the children, the higher the SLC6A4 DNA methylation levels. Although preliminary, our findings suggest that, along with childhood maltreatment experiences per se, cumulative proximal family risk factors are seemingly critically associated with DNA methylation at the SLC6A4 gene.

Child maltreatment and the development of psychopathology: The role of developmental timing and chronicity

BACKGROUND

The effects of child maltreatment (CM) on psychopathology are well-established, yet the complex effects of timing and chronicity of maltreatment exposure on the development of psychopathology are still unclear.

OBJECTIVE

To elucidate developmental pathways from distinct dimensions of CM (chronicity and timing) to psychopathology during emerging adulthood using data from a longitudinal, multi-method study.

PARTICIPANTS AND SETTING

Children with and without maltreatment exposure were recruited at wave 1 (ages 10-12) to participate in a research summer camp. At wave 2, participants were recontacted during emerging adulthood (ages 18-22). The current study includes 391 participants (51.3% female; 77.5% Black, 11.3% white, 7.4% Hispanic, 3.8% other race).

METHODS

Timing and chronicity of maltreatment exposures were coded from child protective services records using the Maltreatment Classification System. Childhood internalizing and externalizing symptoms were assessed using child- and camp counselor-report. Emerging adults completed self-report questionnaires and were interviewed about their current and past symptoms of psychopathology. Structural equation modeling was used to estimate direct and indirect links between childhood maltreatment dimensions (chronicity and timing) to adult psychopathology via childhood internalizing and externalizing.

RESULTS

Child maltreatment experiences that spanned several developmental periods, including both early and later childhood stages, predicted a cascade of both internalizing and externalizing symptoms in childhood that eventuated in greater symptoms of anxiety, depression, substance use disorder, and antisocial personality disorder in emerging adulthood.

CONCLUSIONS

Results suggest that chronic childhood maltreatment exposure is associated with multifinality in psychopathology presentations that can be detected in childhood and extend into emerging adulthood. Early prevention and intervention efforts to promote positive and safe parenting are essential to decrease the burden of mental health symptoms conferred by chronic maltreatment exposures on individuals, families, and public health systems.

Perceived Social Status and Suicidal Ideation in Maltreated Children and Adolescents

Recent decades have seen an alarming increase in rates of suicide among young people, including children and adolescents (“youth”). Although child maltreatment constitutes a well-established risk factor for suicidal ideation in youth, few efforts have focused on identifying factors associated with maltreated youths’ increased risk for suicidal ideation, especially across development. The present study examined the relations between maltreated youths' (N = 279, M = 12.06 years, 52% female, 53% Latinx) perceptions of their social status and suicidal ideation and compared those relations between pre-adolescents and adolescents. Findings revealed unique developmental patterns: Perceived social status was associated with suicidal ideation, but only in adolescents, who showed greater risk for suicidal ideation if they viewed themselves as lower ranked in society and lower risk for suicidal ideation if they viewed themselves as higher ranked in society. Findings have implications for scientific and practical efforts aimed at better understanding and preventing suicide in a high-risk developmental population.

Emotional awareness, empathy, and generosity in high-risk youths

Although maltreatment places youths at risk for substantial deficits in prosociality, effective methods of improving these deficits have yet to be identified. The current investigation tested whether prosociality could be enhanced in maltreated youths by increasing their awareness of others' sadness. Maltreated youths (n = 145) and matched community youths (n = 106) aged 6-17 years completed a sharing task within which labels about a peer's emotions (sad vs. neutral) were experimentally manipulated. Youths who received the sad emotion label about a peer's feelings showed greater empathic concern, and in turn generosity, toward that peer than youths who received the neutral label. Findings offer new insight into potential methods of improving prosocial responding in youths and thus provide direction for intervention efforts.

Profiles of Maltreatment in the Child Welfare System: Predicting Mental Health Outcomes and Examining Age as a Moderator

This longitudinal study explored the unique profiles of maltreatment among youth in the child welfare system and examined their relation to mental health outcomes over time. We additionally examined the moderating role of age. Participants included 316 youth in the foster care system (age range: 6-13 years). Data were collected through the Department of Children and Family Services upon youths' entry into foster care, then quarterly for the duration of care. A latent profile analysis identified five profiles of maltreatment, categorized as primary neglect (PN), neglect and physical abuse (PA), complex trauma, complex trauma with severe sexual abuse (SA), and neglect with SA. A hierarchical general linear model applied to the data revealed that all four classes predicted higher internalizing symptom trajectories compared with the PN reference class, event rate ratios (eRRs) = 1.19-1.37, but none of these associations were significantly moderated by age. Membership in the two classes categorized by complex trauma predicted higher externalizing behavior trajectories as compared to the PN reference class, eRRs = 1.11-1.13. The relation between membership in the neglect with SA class and externalizing behaviors was moderated by age, eRR = 0.83. Finally, membership in all four classes predicted higher posttraumatic stress symptoms as compared with the reference group, eRRs = 1.84-2.45, and with all associations moderated by age, eRRs = 0.51-0.53. These findings provide insight into the maltreatment experiences of youth in the child welfare system and have important implications for treatment needs.

Exploring the mediating effect of academic engagement on math and reading achievement for students who have experienced maltreatment

BACKGROUND

Students who experience maltreatment tend to underperform academically relative to their peers, requiring an understanding of academically-related mechanisms that are potential intervention targets. Academic engagement, a multidimensional construct that is influential in students' investment in learning and the school context, is one such mechanism that has been associated with positive academic outcomes and develops through interactions between students and their environment.

OBJECTIVE

The purpose of this study was to examine how maltreatment experiences and trauma symptoms were indirectly associated with academic achievement in adolescence through academic engagement.

PARTICIPANTS AND SETTING

The study was conducting on a subsample of 583 youths from the National Study of Child and Adolescent Wellbeing II (NSCAW II) cohort.

METHODS

Structural equation modeling was used to examine the indirect effect engagement on the relationship between maltreatment and trauma symptomology and academic achievement.

RESULTS

Academic engagement significantly mediated trauma symptoms and later standardized reading (β = -0.02; 95 % CI [-0.04, -0.0004]) and math (β = -0.02; 95 % CI [-0.05, -0.0003]) achievement test scores. However, similar mediating effects were not found for engagement on maltreatment and later standardized reading (β = -0.01; 95 % CI [-0.03, 0.01]) and math (β = -0.01; 95 % CI [-0.03, 0.01]) achievement test scores.

CONCLUSIONS

These findings suggest that variability in academic outcomes was indirectly associated with engagement but only for students who exhibited trauma symptoms rather than experiencing maltreatment alone. The findings suggest future researchers should consider engagement should as an academically-related mechanism to help students who were maltreated succeed academically.

"Is there anything else you would like me to know?": Applying a trauma-informed approach to the administration of the adverse childhood experiences questionnaire

Nearly ubiquitous agreement exists regarding the potentially negative impact of adverse childhood experiences (ACEs) on health and well-being across the lifespan. This has propelled a movement across the nation for consistent screening of ACEs. Despite agreement regarding the consequences of ACEs, little research related specifically to the administration of the ACE questionnaire exists. Using data from a mixed-methods study of first-time mothers as means of illustration, this paper examines shortcomings of the ACE questionnaire. Participant responses revealed ambiguity with item structure, limited breadth of included events, and failure to capture the gravity of the experience. These shortcomings underscore inadequacies of the measure in accurately understanding individuals' lived experiences and call for the application of trauma-informed (TI) values, both in its content and administration. We apply the main tenets of a TI framework to the ACE questionnaire and make recommendations for its administration, translating theoretical underpinnings of a TI approach into action.

The impact of the Regional Partnership Grant program on adult recovery and well-being, and child safety, permanency, and well-being outcomes

BACKGROUND

Adult substance use contributes to high rates of child maltreatment, adverse parenting, and poor child well-being outcomes. The Children's Bureau in the Administration for Children and Families, U.S. Department of Health and Human Services funded the Regional Partnership Grant (RPG) program to improve safety, well-being, and permanency outcomes for children at risk of or in out-of-home placements because of caregivers' substance use.

OBJECTIVE

This study estimates the effect of the RPG program on adult parenting and recovery outcomes, as well as child safety, permanency, and well-being outcomes.

PARTICIPANTS AND SETTING

This study included samples from three RPG projects funded in 2014. A total of 437 families were included in the evaluation: 198 enrolled in RPG and 239 in the comparison group.

METHODS

Outcomes included both administrative data and standardized instruments collected at program entry and exit. Impacts were calculated by comparing regression-adjusted differences between RPG participants and a well-matched comparison group.

RESULTS

The RPG program showed two favorable and statistically significant impacts on adult outcomes: reduced trauma symptoms (ES = -0.25, p = 0.02), and depressive symptoms (ES = -0.25, p = 0.03). In addition, children enrolled in RPG had reduced behavior problems (ES = -0.31, p = 0.02) and reduced executive functioning deficits (ES = -0.31, p = 0.04). There were no significant impacts observed for child safety and permanency outcomes.

CONCLUSIONS

The RPG approach has produced several favorable impacts on key mental health needs of caregivers and children, establishing foundational evidence of program effectiveness. Additional evaluation research is necessary to understand the effectiveness on additional outcomes with a larger, more generalizable sample.

Childhood Maltreatment and Psychosis: A Comparative Validity Study of Maltreatment Indices

Childhood maltreatment is a robust risk factor for psychosis, but it remains unclear whether different measurement methods provide equivalent validity in predicting psychotic symptoms. This study compared the predictive validity of two common indices of maltreatment at age 12-children's self-report and Child Protective Services (CPS) reports-on the development of psychotic symptoms at age 18 using data from a large, multisite longitudinal study (N = 629). Consistent with prior research, agreement was low between indices, with the prevalence of self-reported maltreatment being 2-3 times higher. A quarter of the sample endorsed at least one psychotic symptom at age 18, most commonly delusions. While CPS-indicated maltreatment was generally not associated with later psychotic symptoms, all forms of self-reported maltreatment were. Sexual abuse demonstrated a particularly strong relationship with psychosis, especially hallucinations. These results suggest that self-reports may provide stronger predictive validity than CPS indications of maltreatment in the assessment of psychosis risk, indicating that a child's interpretation of trauma matters more than the traumatic event itself in this regard.

The trajectory of PTSD among youth in foster care: A survival analysis examining maltreatment experiences prior to entry into care

BACKGROUND

Youth in foster care are more likely than non-foster care youth to experience posttraumatic stress disorder (PTSD). While research has identified maltreatment as a risk factor for PTSD, this research remains limited because it tends to only (a) examine a single type or dimension of maltreatment and ignore the polyvictimization and heterogeneity in exposure, and (b) study this relation across a short period time or retrospectively at the end of care.

OBJECTIVE

The current study used survival analysis to simultaneously examine the influence of maltreatment characteristics on the risk of receiving a PTSD diagnosis at any time in care following entry into care.

PARTICIPANTS/SETTING

291 youth (Mean age at entry = 9.71; 53 % female; 49 % Black) in foster care and their primary caregivers from a large, Midwestern county.

METHODS

Information on PTSD diagnosis was extracted from Medicaid records, and information on maltreatment and time in care was extracted from case files. Survival analysis was then used to determine the association between maltreatment and risk of PTSD diagnosis.

RESULTS

When examined independently, each dimension (frequency, severity) of the four maltreatment types was significantly associated with PTSD diagnosis risk (all hazard ratio's [HR] > 1.00), except sexual abuse frequency. In the comprehensive model with all dimensions examined simultaneously, only neglect frequency for youth entering care in adolescence (HR: 1.13[1.03-1.23]), and neglect severity (HR: 1.27[1.05-1.52]) and emotional abuse frequency (HR: 1.24[1.00-1.53]) for youth entering care pre-adolescence, were associated with PTSD diagnosis risk. Additionally, age of entry into care was associated with PTSD diagnosis risk (HR: 2.34[1.88-2.92]), as adolescents tended to spend fewer days in care before receiving a diagnosis.

CONCLUSIONS

Results suggest that researchers who study PTSD in youth in foster care should consider the entirety of youth's maltreatment exposure and the context of care to more accurately determine what aspects of youth's history contributes to receiving a PTSD diagnosis.

Threat-specific maltreatment exposure: Comparison of measurement models and associations with internalizing, externalizing, and PTSD symptoms

BACKGROUND

Child maltreatment is associated with short- and long-term mental health sequelae. Extant research has demonstrated that exposure characteristics (i.e., severity, frequency, duration, onset) are important in the measurement of maltreatment experiences. Emerging research has highlighted the contributions of these characteristics on symptom outcomes.

OBJECTIVE

The current study used multiple exposure characteristics of threat-specific types of maltreatment (i.e., physical abuse, sexual abuse, witnessing domestic violence) to examine three distinct measurement models of maltreatment and their relation to symptoms.

PARTICIPANTS AND SETTING

A racially and ethnically diverse sample of treatment-seeking youth (74 % female) ages 4-17 (N = 348) participated in the study. The majority of the youth (61 %) endorsed experiencing more than one type of threat-specific maltreatment.

METHOD

Using Structural Equation Modeling, we tested one-factor, three-factor, and bifactor models of maltreatment characteristics, and hypothesized that the bifactor model would yield the best fitting model based on prior studies supporting family violence as an underlying factor for child physical abuse and domestic violence.

RESULTS

The bifactor measurement model fit the data better than the three- and one-factor models. In the bifactor structural model that included symptom outcomes, physical abuse was significantly and positively associated with child internalizing and externalizing symptoms, whereas sexual abuse and witnessing domestic violence were associated with externalizing symptoms and PTSD.

CONCLUSION

Our findings support the inclusion of multiple exposure characteristics in the measurement of maltreatment and suggest that specific types of threat-specific maltreatment may have distinct associations with mental health sequelae.

The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda

BACKGROUND

Youth living in the slums of Kampala face many adversities, such as dire environmental conditions, poverty, and lack of government infrastructure.

OBJECTIVE

The purpose of this study is to examine the interplay of alcohol use and child maltreatment on suicidal ideation among youth living in the slums of Kampala, Uganda.

PARTICIPANTS AND SETTING

The study sample includes service-seeking youth who were attending Uganda Youth Development Link (UYDEL) drop-in centers in spring 2014 (n = 1134).

METHODS

Indicators of child maltreatment included parental physical abuse, parental neglect, and sexual abuse. Problematic alcohol use was specified using a hybrid structural equation mixture model that distinguished current drinking status with the frequency and intensity of use among current drinkers. This novel approach is more flexible than restricting our analysis to only drinkers or analyzing only current drinking status. The primary outcome of interest was suicidal ideation. All associations controlled for gender and age, and all associations were estimated simultaneously. All analyses were conducted in SAS 9.4 and Mplus 7.4.

RESULTS

The overall prevalence of suicidal ideation was 23.5 % (n = 266). Overall, current drinking status (OR: 1.80; 95 % CI: 1.31, 2.46), the child maltreatment sum score (OR: 1.88; 95 % CI: 1.48, 2.39), and sexual abuse (OR: 2.88; 95 % CI: 1.52, 5.47) were statistically significantly associated with reporting suicidal ideation.

CONCLUSIONS

This study highlights a population that would potentially benefit from prevention efforts not only aimed at suicide prevention but also harm reduction in terms of alcohol use and experiences of child maltreatment.

Maltreatment timing, HPA axis functioning, multigenic risk, and depressive symptoms in African American youth: Differential associations without moderated mediation

Utilizing a large (N = 739), ancestrally homogenous sample, the current study aimed to better understand biological risk processes involved in the development of depressive symptoms in maltreated, African American children age 8-12 years. Maltreatment was independently coded from Child Protective Services records and maternal report. Self-reported depressive symptoms were attained in the context of a week-long, summer research camp. DNA was acquired from buccal cell or saliva samples and genotyped for nine polymorphisms in four hypothalamic-pituitary-adrenal (HPA)-axis-related genes: FKBP5, NR3C1, NR3C2, and CRHR1. Salivary cortisol samples were collected each morning (9 a.m.) and late afternoon (4 p.m.) throughout the week to assess HPA functioning. Results revealed that experiences of maltreatment beginning prior to age 5 were most predictive of depressive symptoms, whereas maltreatment onset after age 5 was most predictive of HPA axis dysregulation (blunted daytime cortisol patterns). Multigenic risk did not relate to HPA functioning, nor did it moderate the relationship between maltreatment and HPA activity. There was no mediation of the relationship between maltreatment and depressive symptoms by HPA dysfunction. Results are interpreted through a developmental psychopathology lens, emphasizing the principle of equifinality while carefully appraising racial differences. Implications for future research, particularly the need for longitudinal studies, and important methodological considerations are discussed.

The Impact of Maltreatment on Internalizing Symptoms for Foster Youth: an Examination of Spirituality and Appraisals as Moderators

Research shows that exposure to child maltreatment increases the risk of internalizing symptoms for youth, and that youth in foster care are at a particularly high risk of symptoms. However, not all youth who experience maltreatment evidence maladjustment, making the link between exposure and mental health outcomes unclear and creating a need to examine what factors buffer against symptomatology. A sample of youth in foster care was used to provide a new examination of the relation between child maltreatment exposure and internalizing symptoms, to test the possible moderating effects of both appraisals and spirituality, and examine differences between children and adolescents. Participants were 486 youth in foster care (M age = 13; 204 children; 282 adolescents). Youth completed self-report measures through the SPARK project (Studying Pathways to Adjustment and Resilience in Kids). Although appraisals and spirituality were not significant moderators, significant main effects emerged. For children, regression analyses showed that maltreatment exposure and lower scores on spiritual prosocial attitudes accounted for the majority of the 21% of the variance in internalizing symptoms. For adolescents 28% of the variance in internalizing symptoms was accounted for by greater maltreatment exposure, lower scores on spiritual prosocial attitudes, higher scores on relationship with a God/Higher Power, and more negative appraisals of stressful life events. The current study provides support for cognitive-based interventions for adolescents aimed at increasing appraisal flexibility and suggests that both children and adolescents could benefit from the development of prosocial attitudes often tied to spirituality but could be reinforced in additional settings.

Maltreatment exposure across childhood and low-grade inflammation: Considerations of exposure type, timing, and sex differences

Links between child maltreatment and low-grade inflammation in adulthood are well documented, but these studies often rely on adults to report retrospectively on experiences of childhood abuse. Furthermore, these findings raise questions about whether exposure to childhood maltreatment needs time to "incubate," only giving rise to nonresolving inflammation in adulthood, or whether heightened inflammation may be observable in childhood, closer in time to the maltreatment exposure. The present study examined this question in a sample of 155 low-income children (ages 8-12), half of whom had been exposed to maltreatment. Trained coders evaluated case reports to classify maltreatment based on timing and exposure type. Blood samples from children assessed C-reactive protein and cytokines, which were used to form a composite of low-grade inflammation. Analyses revealed a marginally significant Maltreatment Exposure × Sex interaction, which suggested that maltreatment exposure was associated with higher inflammation for girls but not boys. Additionally, analyses focused on the accumulation of maltreatment experiences (through multiple forms of maltreatment or across multiple time points) revealed that girls with greater diversity in their maltreatment experiences and those who experienced maltreatment at multiple time points were at greatest risk. Finally, examination of timing of first onset of maltreatment suggested that girls whose exposures occurred before the age of 5 had the highest low-grade inflammation. These findings add new evidence linking maltreatment to inflammation in childhood, which could increase the risk for mental and physical health problems across the lifespan.

Measuring self-reported polyvictimization in foster youth research: A systematic review

BACKGROUND

Youth who are or have been in foster care (foster youth) are at higher risk for adverse outcomes in early adulthood. As the importance and complexity of victimization experiences, including types, timing, and perpetrators, is better understood it is unclear whether or to what extent the research on foster youth assesses polyvictimization. Because many types of victimization, such as community violence, are under-reported or absent in the administrative data typically used for research with foster care populations, self-reports of victimization experiences are necessary to comprehensively assess polyvictimization. Polyvictimization places youth at increased risk for adverse outcomes, and yet is not widely measured in the foster youth population. This is likely in part due to the wide-use of administrative reports to assess maltreatment among research on foster youth which does not capture a full range of victimization experiences.

OBJECTIVE

The aim of the present study was to systematically review and evaluate the measurement of self-reported polyvictimization with foster youth samples.

METHODS

A search in Academic Search Premier, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Social Work Abstracts, SociINDEX, and Scopus was conducted. Articles included peer-reviewed, quantitative research studies that measured self-reported victimization (including violence exposure and/or maltreatment) with foster youth samples between 1997-2017. In total, 1887 studies were identified and reviewed by two raters and of those 18 met the study criteria.

RESULTS

Almost all of the included studies (n = 16) measured multiple types of victimization through self-report. The most common types of victimization measured were sexual abuse (n = 15), physical abuse (n = 14), and physical neglect (n = 11). Half of studies (n = 9) measured at least one non-maltreatment victimization experience, such as community violence exposure and/or dating violence. However, included studies rarely measured other aspects of victimization, such as timing of exposure (e.g., pre or during foster care), which research has identified as relevant to outcomes.

CONCLUSIONS

This is the first systematic review to assess the measurement of self-reported polyvictimization in research with current or former foster youth. Given the limited comprehensive assessment of victimization, these findings support strong recommendations for developing or adapting polyvictimization measures specifically for foster youth so that the measures include child welfare-specific factors such as the timing and perpetration of victimization experiences.

Developmental pathways from child maltreatment to adolescent suicide-related behaviors: The internalizing and externalizing comorbidity hypothesis

Child maltreatment is a robust risk factor for suicidal ideation and behaviors during adolescence. Elevations in internalizing and externalizing symptomology have been identified as two distinct developmental pathways linking child maltreatment and adolescent risk for suicide. However, recent research suggests that the co-occurrence of internalizing and externalizing symptomology may form a distinct etiological pathway for adolescent risk behaviors. Using the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) sample (N = 1,314), the present study employed a person-centered approach to identify patterns of concurrent change in internalizing and externalizing psychopathology over five time points from early childhood to adolescence in relation to previous experiences of child maltreatment and subsequent suicidal ideation and behaviors. Results indicated four distinct bivariate externalizing and internalizing growth trajectories. Group membership in a heightened comorbid internalizing and externalizing symptom trajectory mediated the association between childhood abuse and adolescent suicidal ideation and suicidal behaviors. These findings suggest that the concurrent development of externalizing and internalizing symptoms in childhood and adolescence may constitute a unique developmental trajectory that confers risk for suicide-related outcomes.

Short-Term and Long-Term Resilience Among At-Risk Adolescents: The Role of Family and Community Settings

Objective: Given the severe consequences associated with maltreatment, establishing an understanding of pathways to resilience among trauma-exposed youth is a critical public health aim. Longitudinal research has either examined short-term or long-term responses to traumatic events, which prevents testing for a) individual differences between resilience subtypes and b) consistency of short-term, resilient responses over time. Additionally, post-traumatic stress and depression represent the two most common symptom patterns in youth exposed to maltreatment, however few studies have simultaneously investigated resilience to these outcomes. In response, the current study employs a dimensional analytic approach to distinguish between short-term (the ability to demonstrate adaptive responses to ongoing adversities) and long-term (lack of distress over several years in response to a prior adversity) resilience. Consistent with an ecological perspective, the study examines whether family- and community-level protective factors are similarly or uniquely associated with different resilience subtypes.Method: Participants included 943 individuals (469 male, 474 female) from a nationally-representative, at-risk sample of adolescents who completed self-report measures of maltreatment exposure, depressive symptoms and post-traumatic stress symptoms at ages 12, 16, and 18. During the age 12 visit, participants' caregivers completed self-report measures of family routines and neighborhood social cohesion.Results: Overall, we found that family routines uniquely buffered against trauma-related distress across resilience conceptualizations, while social cohesion played a role in short-term resilience to depressive symptoms (p <.05). Participant gender did not moderate these results (p > .05).Conclusion: These findings highlight the importance of understanding resilience dimensionally for adolescents exposed to maltreatment.

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.

It's not "Just poverty": Educational, social, and economic functioning among young adults exposed to childhood neglect, abuse, and poverty

BACKGROUND

Neglect is the most common allegation in Child Protective Services (CPS) investigations. Researchers and media have questioned whether and how CPS-investigated neglect differs from poverty. Prior studies are limited by self-reported or cross-sectional measures, small samples, and short observation periods.

OBJECTIVE

(1) To estimate the "added harm" of CPS-investigated neglect, net of poverty exposure (depth and duration), on high school completion, employment and earnings, incarceration, and teen parenthood; (2) To assess whether abuse is a stronger risk factor for adverse outcomes than neglect.

PARTICIPANTS AND SETTING

29,154 individuals born in 1993-1996 from Milwaukee County, WI, who either received food assistance or were reported to CPS before age 16.

METHOD

Using logistic regression with a rich set of social and demographic controls, we compared individuals with CPS-investigated neglect, abuse, or both abuse and neglect in early childhood or adolescence to those who experienced poverty but not CPS involvement. We calculated cumulative measures of poverty duration and poverty depth between ages 0 and 16 for the full sample using public benefit records.

RESULTS

Outcomes among children with alleged or confirmed neglect were statistically significantly worse in all domains than impoverished children without maltreatment allegations, and similar to children with alleged or confirmed abuse. Effect sizes varied by outcome.

CONCLUSIONS

Overall, this study suggests that CPS allegations of neglect are distinct from poverty and an important risk factor for adverse outcomes in adulthood.

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.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Antecedents of attachment states of mind in normative-risk and high-risk caregiving: cross-race and cross-sex generalizability in two longitudinal studies

BACKGROUND

Longitudinal investigations of relatively large typical-risk (e.g., Booth-LaForce & Roisman, 2014) and higher-risk samples (e.g., Raby et al., 2017; Roisman et al., 2017) have produced evidence consistent with the claim that attachment states of mind in adolescence and young adulthood, as measured by the Adult Attachment Interview (AAI), are associated with the quality of caregiving experienced during childhood. None of these studies, however, has examined whether such associations are consistent across sex and/or race, as would be expected in light of the sensitivity hypothesis of attachment theory.

METHODS

We examine whether sex or race moderates previously reported links between caregiving and AAI states of mind in two longitudinal studies (pooled N = 1,058) in which caregiving was measured either within (i.e., observed [in]sensitive care) or outside (i.e., childhood maltreatment) of the normative range of caregiving experiences.

RESULTS

Hierarchical moderated regression analyses in both longitudinal cohorts provided evidence that maternal insensitivity and experiences of maltreatment were prospectively associated with dismissing and preoccupied states of mind in adolescence, as hypothesized. Moreover, these associations were generally comparable in magnitude for African American and White/non-Hispanic participants and were not conditional on participants' biological sex.

CONCLUSIONS

Both maternal insensitivity and the experience of maltreatment increased risk for insecure attachment states of mind in adolescence. Moreover, our analyses provided little evidence that either participant race or participant sex assigned at birth moderated these nontrivial associations between measures of the quality of experienced caregiving and insecure attachment states of mind in adolescence. These findings provide support for the sensitivity hypothesis of attachment theory and inform the cultural universality hypothesis of attachment processes.

A longitudinal investigation of protective factors for bereaved maltreated youth

BACKGROUND

Maltreated youth are at an elevated risk for the development of problem behaviors. Coping with the death of a family member or close friend during adolescence, referred to as bereavement, is a stressful event that could potentiate risk linked to maltreatment. However, developmental research suggests that youth adjustment is a product of multiple risk and protective factors. Although maltreated youth who experience loss may be particularly vulnerable to behavior problems, personal and contextual factors may attenuate or exacerbate youths' risk for internalizing and externalizing psychopathology.

OBJECTIVE

The overarching goal of this study is to examine individual, family, and community-level protective factors for maltreated youth who experience bereavement. Specifically, we aim to examine the effect of age 12 bereavement on age 16 internalizing and externalizing psychopathology, and to investigate the moderating role of multi-level protective factors at ages 14 and 16.

METHODS

The study consisted of a sample of 800 youth (52.4% female, 45.1% African-American) drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), collected from 1998 to 2011.

RESULTS

Maltreated youth who experienced significant loss were at increased risk for externalizing symptoms, compared to non-bereaved maltreated youth (β = 0.085, p < .05). Individual future orientation (β = 0.103, p < .05) family future orientation (β = -0.120, p < .05), parental monitoring (β = -0.123, p< .01), and neighborhood collective efficacy (β = -0.126, p < .01) each significantly moderated the association between bereavement and externalizing symptoms.

CONCLUSIONS

These results have implications for future interventions aimed towards reducing problem behaviors in adolescents with a history of child maltreatment and who experience bereavement.

Experiences of (young) women after out of home placement: An examination of personality disorder symptoms through the lens of child maltreatment

BACKGROUND

Child maltreatment has been associated with the development of various mental health problems, including the development of personality disorders.

OBJECTIVE

This study investigated the association between child maltreatment and personality disorder symptoms in 125 women who transitioned out of residential care.

METHOD

The Child Trauma Questionnaire was used for the measurement of child maltreatment, and Personality disorder symptoms were measured using the Personality Diagnostic Questionnaire 4 + . The Psychological Distress Index was used to control for symptoms of distress.

RESULTS

A Stepwise regression analysis showed that the majority of the associations were found between self-reported emotional abuse, neglect and personality disorder symptoms. Emotional abuse was significantly related to the Paranoid (β = .42, p<0.001), Schizoid (β = .18, p <0.05), Schizotypal (β = .18, p<0.05), Histrionic (β = .22, p<0.05), Avoidant (β = .31, p <  .001), Dependent (β = 0.31, p <  .001), Obsessive Compulsive (β = 0.29, p = .001), Passive Aggressive (β = 0.23, p<0.01) and the Depressive personality disorder (β = .38, p <  .001). Emotional neglect was significantly associated to the Borderline Personality Disorder (β = .32, p<0.001) and the Paranoid Personality Disorder (β =-0.22, p<0.05).

CONCLUSIONS

The current study underlines the detrimental effects of childhood maltreatment, and in particular the effects of emotional abuse and neglect.

The reproduction of child maltreatment: An examination of adolescent problem behavior, substance use, and precocious transitions in the link between victimization and perpetration

Growing evidence suggests that maltreatment is reproduced across generations as victims of maltreatment are at an increased risk for maltreatment perpetration. Unfortunately, little information about mediating pathways exists to provide an explanation for why maltreatment begets maltreatment. We use the number of types of maltreatment experienced to predict later maltreatment perpetration and then examine two developmental pathways that may serve as bridges between maltreatment victimization and perpetration: adolescent problem behaviors and precocious transitions to adulthood. With prospective, longitudinal data from the Rochester Youth Development Study, we assess the relevance of these pathways for the number of maltreatment experiences as well as the number of maltreatment victimization experiences by developmental period (i.e., childhood and adolescence). Our results demonstrate a significant relationship between maltreatment victimization and maltreatment perpetration. Adolescent delinquency and two precocious transitions, dropping out of school and independent living, as well as the accumulation of precocious transitions and problem behaviors, serve as mediators of this intergenerational relationship. Furthermore, the relationship between the number of types of maltreatment and subsequent perpetration is primarily driven by experiences of maltreatment during adolescence. We discuss the implications of these results and set an agenda for the development of programs and policies to interrupt the cycle of maltreatment.

Maternal and Child Sexual Abuse History: An Intergenerational Exploration of Children's Adjustment and Maternal Trauma-Reflective Functioning

Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with a lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers).

Methods: One hundred and eleven children (M_age = 9.53 years; 43 sexual abuse victims) and their mothers (M_age = 37.99; 63 sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms.

Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children.

Conclusion: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing T-RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk.

Course of disinhibited social engagement behavior in clinically referred home-reared preschool children

BACKGROUND

Evidence supporting clinical relevance and persistence of disinhibited social engagement behavior (DSEB) pertains mostly to children reared in institutions and foster care. This study examined the course of DSEB in clinically referred home-reared children from early into middle childhood, and associations with neglect/emotional maltreatment, effortful control, Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Autism Spectrum Disorder.

METHODS

Disinhibited social engagement behavior was examined in 124 children (82% boys, M = 4.06 years, SD = 0.89), referred for treatment of emotional and behavioral problems, by use of the Disturbances of Attachment Interview (DAI) with biological parents. Neglect and emotional maltreatment were assessed from case records and effortful control by use of the Child Behavior Questionnaire. At follow-up, on average 4 years later, DSEB was examined by use of DAI as well as two observational ratings: the Stranger at the Door procedure (SatD) and a structured home observation of stranger approach. Psychiatric disorders were assessed by means of the Kiddie-Schedule for Affective Disorders and Schizophrenia.

RESULTS

Persistence of parent-reported DSEB was found in 57% (n = 27) of the children with DSEB at baseline (n = 47). Parent-reported DSEB at follow-up was significantly related to DSEB observed in the SatD (rpb  = .31, p = .001) and to observed stranger approach (rs  = .41, p < .001), but only stranger approach was associated with baseline DSEB. The course of DSEB was not related to neglect/emotional maltreatment, nor to the level of effortful control. There was no association between DSEB and Autism Spectrum Disorder, but course of DSEB was associated with Attention Deficit/Hyperactivity Disorder/Oppositional Defiant Disorder at follow-up (χ2  = 13.08, p = .004).

CONCLUSIONS

Although explanations for the onset and course of DSEB in home-reared children remain elusive, findings suggest that DSEB is part of a complex of clinically significant problem behaviors in referred home-reared preschool children.