Psychosocial and cognitive functioning of children with specific profiles of maltreatment

Childhood adversity is associated with anxiety and depression in older adults: A cumulative risk and latent class analysis

BACKGROUND

The long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults.

METHODS

Data came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60-66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety.

RESULTS

Linear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model.

LIMITATIONS

There is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences.

CONCLUSION

Childhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship.

A Latent Class Analysis of Adverse Life Events for Kenyan Adolescents

Extant evidence indicates that exposure to adverse childhood experiences (ACE) tend to cluster among children and adolescents. Considering that adolescents from African countries present higher risk of being exposed to multiple ACE compared to other countries, the identification of victimization profiles in this population is clearly warranted. The aim of this study was to determine meaningful clusters of individuals with similar experiences of ACE in a sample of Kenyan adolescents. Latent class analysis (LCA) was conducted to identify latent classes of exposure to ACE. In addition, the relationships between the latent classes and gender, parental education, living arrangements and diagnosis of post-traumatic stress disorder (PTSD) were estimated. A three-class solution was found to be the best description of ACE, and the classes were labelled ''Low Risk'', ''Intermediate Risk'', and ''High Risk''. Compared with the Low-Risk class, the High-Risk class was found to be significantly more likely to have a diagnosis of PTSD and being a female may be an antecedent risk factor for high exposure to ACE. The Intermediate Risk class was significantly less likely to have parents with high school or college education. This paper indicates that Kenyan adolescents present higher risk of being exposed to multiple ACE and that trauma research may turn its focus on the individual as the unit of analysis rather than traumatic events.

Leveraging multivariate approaches to advance the science of early-life adversity

Since the landmark Adverse Childhood Experiences (ACEs) study, adversity research has expanded to more precisely account for the multifaceted nature of adverse experiences. The complex data structures and interrelated nature of adversity data require robust multivariate statistical methods, and recent methodological and statistical innovations have facilitated advancements in research on childhood adversity. Here, we provide an overview of a subset of multivariate methods that we believe hold particular promise for advancing the field's understanding of early-life adversity, and discuss how these approaches can be practically applied to explore different research questions. This review covers data-driven or unsupervised approaches (including dimensionality reduction and person-centered clustering/subtype identification) as well as supervised/prediction-based approaches (including linear and tree-based models and neural networks). For each, we highlight studies that have effectively applied the method to provide novel insight into early-life adversity. Taken together, we hope this review serves as a resource to adversity researchers looking to expand upon the cumulative approach described in the original ACEs study, thereby advancing the field's understanding of the complexity of adversity and related developmental consequences.

Emotion regulation as a mediator in the relationship between childhood maltreatment and symptoms of social anxiety among college students

OBJECTIVE

The current study explored emotion regulation strategies (ie, suppression, cognitive reappraisal, experiential avoidance) as mediators in the relationship between childhood maltreatment and social anxiety.

PARTICIPANTS

One hundred and ninety-three undergraduate students (Mage = 19.5 years; 83.9% female) were recruited from a public university in the northeastern United States.

METHODS

Participants completed measures assessing childhood maltreatment, emotion regulation strategies, and social anxiety.

RESULTS

Structural equation modeling was used to examine the mediation paths. Childhood maltreatment was negatively associated with cognitive reappraisal and experiential avoidance, and positively associated with suppression. Higher suppression was associated with higher social anxiety, and higher experiential avoidance was associated with lower social anxiety. The association between childhood maltreatment and symptoms of social anxiety was mediated by suppression and experiential avoidance, but not cognitive reappraisal. All other paths were nonsignificant.

CONCLUSIONS

Findings suggest that treatments for childhood maltreatment should aim to bolster experiential avoidance and minimize suppression to address social anxiety symptoms.

Childhood maltreatment and psychopathy in Chinese juvenile offenders: person-centered perspective

BACKGROUND

Childhood maltreatment stands as a salient risk factor in the etiology of juvenile delinquency, with a profound impact on the behavioral trajectories of young offenders. However, there is limited research on latent profile analysis to explore distinctive patterns of childhood maltreatment in Chinese juvenile offenders. Consequently, there is a lack of understanding regarding the associations between maltreatment profiles and relevant variables in this context. The present study aimed to explore meaningful subgroups of childhood maltreatment in juvenile offenders, and we further examined the associations between subgroups and multiple outcomes especially psychopathy.

METHODS

The data was obtained from a sample of Chinese juvenile offenders (N = 625, M age = 17.22, SD = 1.23). This study employed a latent profile analysis (LPA) based on factor scores of the Childhood Trauma Questionnaire-Short Form to identify the subgroups and examined the differences across subgroups using outcomes variables including psychopathy, callous-unemotional traits, aggression and anxiety. This study includes three self-report measures to evaluate psychopathy, with due regard for the nuanced considerations on the factor structure inherent in the conceptualization of psychopathy.

RESULTS

Two subgroups were identified, including the non-maltreatment subgroup (80.2%) and the maltreatment subgroup (19.8%). Maltreatment subgroup was characterized by a greater level of all types of maltreatment with particularly higher of emotion neglect. Besides, we found that maltreatment subgroup showed a significantly higher level of psychopathy across multiple self-report measures, and greater callous-unemotional traits, lack of empathy, aggression and anxiety. We found two subgroups of child maltreatment in Chinese juvenile offenders.

CONCLUSIONS

These findings may provide a further understanding of childhood maltreatment and the clinical intervention on psychopathy in the early period.

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.

Maternal Childhood Abuse Versus Neglect Associated with Differential Patterns of Infant Brain Development

Severity of maternal childhood maltreatment has been associated with lower infant grey matter volume and amygdala volume during the first two years of life. A developing literature argues that effects of threat (abuse) and of deprivation (neglect) should be assessed separately because these distinct aspects of adversity may have different impacts on developmental outcomes. However, distinct effects of threat versus deprivation have not been assessed in relation to intergenerational effects of child maltreatment. The objective of this study was to separately assess the links of maternal childhood abuse and neglect with infant grey matter volume (GMV), white matter volume (WMV), amygdala and hippocampal volume. Participants included 57 mother-infant dyads. Mothers were assessed for childhood abuse and neglect using the Adverse Childhood Experiences (ACE) questionnaire in a sample enriched for childhood maltreatment. Between 4 and 24 months (M age = 12.28 months, SD = 5.99), under natural sleep, infants completed an MRI using a 3.0 T Siemens scanner. GMV, WMV, amygdala and hippocampal volumes were extracted via automated segmentation. Maternal history of neglect, but not abuse, was associated with lower infant GMV. Maternal history of abuse, but not neglect, interacted with age such that abuse was associated with smaller infant amygdala volume at older ages. Results are consistent with a threat versus deprivation framework, in which threat impacts limbic regions central to the stress response, whereas deprivation impacts areas more central to cognitive function. Further studies are needed to identify mechanisms contributing to these differential intergenerational associations of threat versus deprivation.

Structural Validity and Internal Consistency of the Adolescents and Children Risk of Abuse and Maltreatment Parental Scale (ACRAM-PS)

There is a clear need for developing a comprehensive, unbiased, and psychometrically sound tool to assess child maltreatment. The aim of this study is to examine the structural validity, internal consistency, and convergent validity of a newly developed child maltreatment assessment instrument. A total of 286 professionals of the child protection system participated in the study, completing a total of 645 cases of children and adolescents. The Adolescents and Children Risk of Abuse and Maltreatment Parental Scale (ACRAM-PS), the Childhood Trauma Questionnaire Short Form (CTQ-SF) and other demographic variables were measured. Structural validity, internal consistency, and convergent validity of the ACRAM-PS were tested. This scale obtained good structural validity, internal consistency, and convergent validity as hypothesized patterns of correlations occurred as expected. This instrument implies a considerable improvement as it is comprehensive, psychometrically sound and, it has been articulated by its own users. It can significantly contribute to establish a common language among professionals, improve multidisciplinary communication, and optimize prevention, detection, and early intervention in child maltreatment.

Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample

BACKGROUND

Research has indicated that children with disabilities are at higher risk for victimization although the literature on this topic is limited.

OBJECTIVE

We examined rates of assault, sexual victimization, peer-sibling victimization, property crime, maltreatment, and poly-victimization among youth in the United States with and without disabilities. We examined these rates for three age groups (children ages 0-4 years, ages 5-11 years, and ages 12-17 years).

PARTICIPANTS AND SETTING

We use data from the National Survey of Children's Exposure to Violence (NatSCEV), waves I (2008), II (2011), and III (2014). These are cross-sectional nationally representative samples of children and youth ages one month to 17 years (N = 12,634).

RESULTS

Considering children of all ages together, children in all disability categories, except for physical disability, were at higher risk for poly-victimization. Victimization exposure overall is higher among older children (except for assault among very young children with developmental or learning disabilities), though the disparity between children with and without disabilities generally narrows as children get older. Age of the child impacted the relationships between disability and victimization. Very young children with physical disabilities were at heightened risk for most types of victimization while children with internalizing disabilities were at heightened risk for assault, property crime, and maltreatment in middle childhood and adolescence. Children with externalizing disabilities were at heightened risk for most types of victimization across all ages while developmental disabilities appeared to be risk factor for very young children and a potentially protective factor at later ages though these varied by type of victimization.

CONCLUSION

Victimization risk varied by victimization and disability types. This study demonstrates the importance of controlling for demographic characteristics, especially age of the child in estimating the prevalence of victimization among children with disabilities and establishes the importance of type-specific analyses by victimization type, disability type, and age of the child.

Adversity profiles of children receiving care and support from social services: A latent-class analysis of school-aged children in Wales

BACKGROUND

Children receive care and support from social services due to the risk of harm or impeded development or because of disability. This study aimed to identify typologies of adversity experienced by children receiving care and support from social services and to explore how typologies differ by sociodemographic characteristics.

METHODS

This is a cross-sectional study of 'Children Receiving Care and Support' (N = 12 792) during 2017/2018 in Wales, UK. We sought to (1) examine the prevalence of household adversities experienced by children in receipt of care and support from social services; (2) identify typologies of household adversities; and (3) explore how typologies of household adversities differ by family characteristics (demographics, measures of social disadvantage, perinatal and care factors).

RESULTS

We found evidence for multiple risk factor constellations. The four-class solution suggested four distinct classes of adversities: child disability (50.0%), low adversities (20.3%), family poor health (6.7%) and multiple risks (23.0%). Children in the 'multiple risk' class were significantly more likely to be younger, more deprived and 'looked after' by the local authority compared with those in the 'low adversities' class.

CONCLUSIONS

Given the presence of different constellations of household adversities, policies and interventions that address multiple risk factors simultaneously may be more effective and have longer-lasting benefits.

Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review

Background: Polyvictimization, the experience of multiple types of victimization, is associated with detrimental health outcomes. Despite extensive research on the health consequences of polyvictimization, one challenge in understanding this literature lies in the varied operationalized definitions of polyvictimization and health outcomes. This scoping review provides the volume of the current literature on this topic, documents the varied constructs of polyvictimization and associated health outcomes, identifies knowledge gaps, and guides future research directions. Method: A systematic search of English-language original articles that presented quantitative associations of childhood polyvictimization and health outcomes was performed through six-database searches, a gray literature search, and citation mining from June 2020 to January 2021. The varied constructs of polyvictimization, health outcomes, and other study characteristics were extracted. Results: A total of 96 studies were included. Two ways of creating continuous variables (30.21%) and four ways of constructing categorical variables (72.92%) were identified for operationalizing polyvictimization. The majority of health outcomes were mental, behavioral, or social (96.88%), while slightly more than 10% of studies examined physical health (11.46%) or general health conditions (10.42%), respectively. More than half of studies used U.S. samples (56.25%). Conclusions: The varied constructs of polyvictimization suggests that there is a need to establish a valid polyvictimization construct that is consistently agreed upon in the research community. Findings summarize the specific health outcomes that can be targeted for further investigation and prevention efforts. Findings also suggest that the study of resilience and coping education for childhood polyvictims is sorely needed.

The co-occurrence of potentially traumatic events (PTEs) and their associations with posttraumatic stress disorder (PTSD) in Indian and Malaysian adolescents

BACKGROUND

Although it is well-established that people can experience multiple traumatic events, there are few studies examining the co-occurrence of such experiences in non-Western nations. The current study sought to examine the occurrence of multiple potentially traumatic experiences (PTEs) and their associations with posttraumatic stress disorder (PTSD) among adolescents from two Asian nations.

METHODS

Latent class analysis (LCA) was employed to model the co-occurrence of PTEs in two school samples of adolescents from India (n = 411) and Malaysia (n = 469). Demographic correlates (i.e., sex, age, household composition, parent education) of the latent classes and the association between latent class membership and probable diagnosis of posttraumatic stress disorder (PTSD) were examined.

RESULTS

The LCA identified three latent classes for the Indian sample: 'Low Risk - moderate sexual trauma', 'Moderate Risk', and 'High Risk'. Similarly, three classes were also identified for the Malaysian sample: 'Low Risk', 'Moderate Risk', and 'High Risk'. Membership of 'Moderate Risk' was associated with male sex in both samples, and with older age and lower levels of parental education attainment in the Malaysian sample. No correlates of 'High Risk' class were identified in either sample. Membership of the 'High Risk' class was significantly associated with probable PTSD diagnosis in both samples, while membership of the 'Moderate Risk' class was associated with probable PTSD diagnosis in the Malaysian sample.

CONCLUSION

Findings from this study correspond with Western studies indicating co-occurrence of PTEs to be common and to represent a salient risk factor for the development of PTSD.

Can we distinguish the consequences of early maltreatment on child behaviour from idiopathic autism?

OBJECTIVE

To identify clinical features that could distinguish children presenting with autistic-like features and a history of severe early maltreatment from children with idiopathic autism spectrum disorders (ASDs).

DESIGN

Matched-comparison study.

SETTING

Great Ormond Street Hospital, UK.

PARTICIPANTS

46 children with a history of early maltreatment, mean (SD) age 10.6 (3.3) years and 47 children with an ASD, mean (SD) age 10.4 (2.9) years.

MAIN OUTCOME MEASURES

A range of standardised interview and observational measures that are designed to quantify autistic traits. Caregiver and teacher reports were obtained on broader aspects of behavioural and emotional adjustment.

RESULTS

Both groups had normal range IQ and were predominantly male. On the basis of autistic traits alone, caregiver interview and structured observation concurred that over 60% of the formerly maltreated children met criteria for an ASD. Autistic symptom profiles were very similar in both groups, although children with idiopathic ASD had significantly more marked repetitive and stereotyped behaviours. Teacher and caregiver reports indicated that children from both groups had an increased and broadly similar prevalence of emotional and behavioural disorders.

CONCLUSION

Children presenting with a history of early maltreatment, who show autistic traits of behaviour, have a high risk of meeting diagnostic criteria for ASD. Their symptom profiles are virtually indistinguishable from children with idiopathic autism.

Complex, Co-occurring Needs Patterns and Evidence-Based Service Planning for Families Involved in Foster Care: A Map for Research and Practice

This study described the complexity of service need co-occurrence among foster care-involved families and identified prevalent patterns of needs to inform future evidence-based service planning research. We utilized state administrative child maltreatment records, and restricted data to cases where the child entered foster care in 2019 and the caseworker indicated the presence of at least one need from the Family Assessment of Needs and Strengths (FANS; n = 1631). We extracted all unique combinations of needs (i.e., needs profiles), and we used association rule mining to identify patterns within these profiles. A total of 780 unique needs profiles emerged among the 1631 cases, which we condensed into 78 patterns. Although the variability and complexity of needs profiles makes evidence-based service planning difficult, the present analysis mapped prevalent needs patterns to guide future research intended to assist caseworkers in this task. Identification of maltreatment determinants among families involved in foster care, and future research into the needs within different needs patterns that might undermine treatment effectiveness, may result in a better balance between parsimonious service plans and a full consideration of co-occurring service needs.

Threat versus deprivation in mother's childhood: Differential relations to hair cortisol and psychopathology in pregnancy

BACKGROUND

The negative effects of childhood maltreatment can be intergenerational, and the prenatal period may play an important role in this intergenerational transmission. Maternal hypothalamic-pituitary-adrenal (HPA) axis dysfunction and maternal psychopathology represent two mechanisms through which the effects of childhood maltreatment are hypothesized to be transmitted across generations.

OBJECTIVE

This study first sought to extend prior research on pathways of intergenerational transmission by examining whether mothers' childhood experiences of abuse versus neglect differentially relate to maternal HPA activity and to maternal psychopathology during the prenatal period. Second, exploratory analyses examined the links between maternal variables and their State Protective Service involvement as a parent, as an indicator of maladaptive caregiving.

METHODS

During the third trimester of pregnancy, 51 women reported on experiences of childhood maltreatment, on State Protective Service involvement as an adult parent, and on current depressive and post-traumatic stress symptoms, and provided a hair sample for cortisol assay.

RESULTS

Regression analyses indicated that greater severity of abuse, but not neglect, in childhood was associated with higher maternal depressive symptoms (β = 0.488, p = .020). In contrast, greater severity of neglect, but not abuse, in mothers' childhood was associated with lower maternal hair cortisol concentration (β = -0.437, p = .031). Lower maternal hair cortisol concentration, but not maternal psychopathology or severity of childhood abuse or neglect, in turn, was associated with State Protective Service involvement (β = -0.785, p < .001).

CONCLUSIONS

Findings extend prior work by suggesting that childhood abuse and neglect may have different sequelae for mothers during pregnancy and that these sequelae may have different relations to parenting.

Latent profiles of childhood psychological maltreatment and their links to adult mental health in China and the UK

BACKGROUND

Though links between childhood maltreatment and mental health have been established, little known about how specific types of childhood maltreatment tend to cluster and how the resulting patterns of exposure impact mental health outcomes.

METHOD

The current study used latent profile analyses in Chinese (N = 544) and UK (N = 589) samples to identify childhood psychological maltreatment profiles (i.e., profiles of psychological abuse, psychological neglect, and psychological non-support) in different country contexts, and their associations with a range of mental health (i.e., depression, anxiety, anger, physical aggression, verbal aggression, and hostility), and broader well-being (i.e., self-esteem) outcomes. Unadjusted as well as analyses adjusted for adverse childhood experiences (ACEs) were conducted.

RESULTS

Four profiles were identified in both samples, but their nature differed between the Chinese sample ("Psychological Non-support", "Low-Maltreated", "High-Maltreated", and "Severe-Maltreated") and the UK sample ("Low-Maltreated", "Moderate-Maltreated", "High-Maltreated", and "Severe-Maltreated"). Individuals in the "Psychological Non-support" in China and "Low-Maltreated" class in the UK displayed better mental health outcomes-lower levels of depression, anxiety, and aggression, and higher self-esteem. In contrast, individuals in the "Severe-Maltreated" profiles in both the Chinese and UK samples displayed poorer mental health outcomes-higher depression, anxiety, and aggression, and lower self-esteem. Interventions and prevention efforts are needed for individuals categorized in profiles affected by psychological maltreatment.

CONCLUSION

This study highlights the importance of using targeted intervention or prevention to prevent psychological maltreatment, as well as improve mental health outcomes in individuals who have experienced psychological maltreatment.

A latent profile analysis of child maltreatment among at-risk youth gang members: Associations with violent delinquency, non-violent delinquency, and gang organizational structures

BACKGROUND

The relationship between child maltreatment and later delinquency is an enduring concern worldwide. However, the maltreatment-delinquency relationship is relatively underexplored in youth gang populations. Consequently, to date, studies have not examined typologies of maltreatment and their associations with violent delinquency, non-violent delinquency, and gang organizational structures.

OBJECTIVE

First, to identify the characteristics of subgroups of youth gang members who varied in abuse type and severity within type. Second, to determine in what ways the profiles differed in terms of gang organizational structures, violent delinquency, and non-violent delinquency.

PARTICIPANTS AND SETTINGS

A sample of 161 youth gang members (mean age: 16.8; range: 12-24) were recruited and surveyed by outreach social workers in Hong Kong.

METHODS

Latent profile analysis was first used to examine heterogeneity in victimization experiences (physical abuse, sexual abuse, emotional abuse, and neglect). Thereafter, non-parametric tests and post-hoc analyses were conducted to examine associations between the yielded typologies of maltreatment and gang organizational structures, violent delinquency, and non-violent delinquency.

RESULTS

Poly-victimization was prevalent in the sample, with 148 respondents (91.9 %) reporting at least two types of past abuses. Three profiles of maltreatment emerged, varying in abuse types and severity within types: 'Minimally maltreated', 'Moderately maltreated, except sexual abuse', and 'Severely maltreated'. In comparison to the 'Minimal' maltreatment profile, the 'Moderate' and 'Severe' profiles were associated with greater delinquent behaviors and being in gangs that encouraged congregate illegal behaviors.

CONCLUSIONS

There was a relationship between typologies of maltreatment and gang organizational structures, violent delinquency, and non-violent delinquency in the sample of youth gang members. Implications for practice and future research are discussed.

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.

Profiles of family maltreatment and peer victimization: Associations with psychosocial adjustment in Chinese children

BACKGROUND

Although the family and peer systems are both important for children's development, few studies have simultaneously considered the impact of adversity experienced in these systems on children.

OBJECTIVE

The first purpose of this study was using latent profile analysis (LPA) to identify profiles of family maltreatment (i.e., physical abuse, emotional abuse, and neglect) and peer victimization (i.e., physical victimization and relational victimization) among Chinese elementary school children. The second purpose was to examine associations between the identified profiles and short-term psychosocial adjustment (i.e., self-esteem, depression symptoms, prosocial behavior, and externalizing behavior).

PARTICIPANTS AND SETTING

The sample included 4313 children (45.6 % girls) with an average age of 10.9 years (SD = 0.49) from a large city in China.

METHOD

Assessments were conducted on two occasions six months apart. Family maltreatment and peer victimization were assessed at Time 1. Psychosocial adjustment was assessed at Time 2.

RESULTS

The potential complexity of children's adversity experiences was revealed in that six profiles of family maltreatment and peer victimization in children were identified: (a) Low-risk; (b) Slight peer victimization; (c) Severe peer victimization; (d) Serious neglect; (e) Severe maltreatment; (f) Doubly disadvantaged. Children in the low-risk profile showed the best psychosocial adjustment whereas children in the doubly disadvantaged profile showed the worst psychosocial adjustment. The findings revealed additional differences in the subsequent psychosocial adjustment of the children in the six profiles.

CONCLUSIONS

The identification of multiple profiles and differing relations to psychosocial adjustment implies that interventions should be tailored to members of specific profiles.

Role of Risk Taking and Inhibitory Control in Alcohol Use Among Maltreated Adolescents and Nonmaltreated Adolescents

Exposure to childhood maltreatment is a significant risk factor for the development and persistence of problematic alcohol use. The present study examined the role of risk taking and inhibitory control, key cognitive processes believed to govern behavioral regulation, as mechanisms that underlie the association between childhood maltreatment and the early stages of alcohol use. A sample of 129 maltreated adolescents and 102 socioeconomic status-matched, nonmaltreated adolescents and their parents completed three annual assessments, including computer-administered tasks and adolescent- and parent-report questionnaires, across ages 12-13 through 14-15 years. Childhood maltreatment was not directly associated with alcohol use in middle adolescence but was significantly associated with deficits in inhibitory control in early adolescence, which, in turn, led to significantly increased alcohol use in middle adolescence. Indeed, decreased inhibitory control was significant as a mediator, highlighting the salient role of this cognitive process in the early stages of alcohol use among maltreated adolescents.

Behavioral Parent Training for Preschool ADHD: Family-Centered Profiles Predict Changes in Parenting and Child Outcomes

OBJECTIVE

Behavioral parent training (BPT) is the first line of treatment for preschool-aged children with attention-deficit hyperactivity disorder (ADHD); however, clinically significant improvements are not universal. In the current study, we employ a person-centered approach to create subgroups of families based on the intersection of multiple parent, child, and family pre-treatment factors. Further, we explore the utility of pre-treatment family profiles in predicting post-treatment differences in observed parenting behavior (i.e., behavioral control, parental warmth) and clinically significant change in child ADHD and oppositional symptoms.

METHOD

Longitudinal data were collected using observational and parent-, teacher- and clinician-reported assessments from 130 parent-child dyads (Mage= 3.57, range = 3.0- 4.11, 73.8% male, 69.2% White, 25.6% Hispanic) participating in BPT.

RESULTS

Findings from the current study suggest three distinct family profiles, which consisted of one profile with high family stress (HFS) as evidenced by elevated symptomatology across parent, child, and family-level domains, a second profile with elevated parental anxiety (PA), and a final profile with elevated parental depression (PD). These family-centered profiles were differentially associated with changes in observed parenting practices. Specifically, the PD profile (39%) demonstrated minimal improvements in behavioral control and warmth following treatment. In contrast, the HFS profile (30%) only improved in behavioral control and the PA profile (31%) improved in both parenting domains following treatment. In addition, marginally significant differences in child oppositional and ADHD symptoms were observed across profiles.

CONCLUSIONS

Family-centered approaches may be useful for selecting and implementing interventions.

Patterns of adversity and post-traumatic stress among children adopted from care

BACKGROUND

Children adopted from care are more likely to have experienced early adversity, but little is known about the impact of early adversity on later post-traumatic stress (PTS) symptoms.

OBJECTIVE

To investigate sub-groups of adversity in a sample of adopted children and examine the association with later PTS symptoms.

PARTICIPANTS AND SETTING

A study of British children adopted from care using social worker records (N = 374) and questionnaire-based longitudinal study of n = 58 children over 4-years post adoptive placement.

METHODS

We used latent class analysis to identify subgroups of children based on commonalities in perinatal and postnatal adversity experienced prior to adoption and examined differences in PTS symptoms at 4-years post-placement between subgroups.

RESULTS

Nearly one in five (19 %) children were in the clinical or borderline ranges for symptoms of PTS arousal, 14 % for PTS avoidance and 8 % for PTS intrusion. The 5-class solution fitted the data best, with one class characterized by children with a low probability of experiencing any adversity, one perinatal adversity class and three classes capturing different patterns of adversity. The multiple complex adversity class involving both perinatal and postnatal adversity had significantly higher symptoms of PTS avoidance and arousal than other sub-groups.

CONCLUSIONS

The prevalence and complexity of PTS symptoms among adoptive children highlights the need for effective interventions considering different profiles of early adversity.

Heterogeneity in caregiving-related early adversity: Creating stable dimensions and subtypes

Early psychosocial adversities exist at many levels, including caregiving-related, extrafamilial, and sociodemographic, which despite their high interrelatedness may have unique impacts on development. In this paper, we focus on caregiving-related early adversities (crEAs) and parse the heterogeneity of crEAs via data reduction techniques that identify experiential cooccurrences. Using network science, we characterized crEA cooccurrences to represent the comorbidity of crEA experiences across a sample of school-age children (n = 258; 6-12 years old) with a history of crEAs. crEA dimensions (variable level) and crEA subtypes (subject level) were identified using parallel factor analysis/principal component analysis and graph-based Louvain community detection. Bagging enhancement with cross-validation provided estimates of robustness. These data-driven dimensions/subtypes showed evidence of stability, transcended traditional sociolegally defined groups, were more homogenous than sociolegally defined groups, and reduced statistical correlations with sociodemographic factors. Finally, random forests showed both unique and common predictive importance of the crEA dimensions/subtypes for childhood mental health symptoms and academic skills. These data-driven outcomes provide additional tools and recommendations for crEA data reduction to inform precision medicine efforts in this area.

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.

Diverse trauma profiles of youth in group care settings: A cluster analysis

BACKGROUND

Many adolescents in group care have experienced higher rates of traumatic event exposure, behavior problems, and severe trauma sequelae compared to those outside of group care. Yet, little research has examined from a person-centered perspective their diverse trauma profiles and corresponding service needs.

OBJECTIVE

This exploratory study aimed to examine the heterogeneity of trauma-related profiles among youth in group care to highlight potential distinct service needs among subgroups.

METHOD

Data from the Maltreatment and Adolescent Pathways Study identified 96 randomly selected youth (14-17 years) in Canadian group care settings who completed a battery of self-report measures. Cluster analysis was employed to reveal common patterns of maltreatment and trauma symptoms among subgroups, further described and validated by externalizing behaviors (substance use, risky sexual behavior), internalizing symptoms (global mental health, anger), and personal/parental demographic factors.

RESULTS

Four distinct clusters emerged: (1) no/low maltreatment, low trauma; (2) moderate physical and emotional abuse, moderate trauma; (3) moderate-severe maltreatment, low trauma; and (4) severe maltreatment, high trauma. Clusters 1, 2, and 4 reflected 'dose-response' relationships between maltreatment and trauma symptoms; Cluster 3 was characterized as 'resilient'. Females were highly over-represented in Cluster 4, echoing previous research.

CONCLUSIONS

Findings align with previous research confirming high incidence of maltreatment, internalizing, and externalizing problems among youth in group care, but extends to emphasize the importance of providing trauma-informed services tailored to their variable, complex presentations. Limitations and suggestions for group care settings to provide this wide range of services at program and individual levels are discussed.

The longitudinal effects of maltreatment class membership on post-traumatic stress & depression

BACKGROUND

While the link between maltreatment and mental illness has been largely established, there is a need to better understand how certain types or profiles of maltreatment place youth at heightened risk for depression and traumatic stress, and when the risk of developing symptoms may be greatest.

OBJECTIVE

We examined the extent to which youth experiences of maltreatment co-occur and how certain combinations of maltreatment work to influence the subsequent development of depression and post-traumatic stress over time.

PARTICIPANTS & SETTING

Data were drawn from NSCAW-II, a nationally representative longitudinal sample of 5872 child welfare involved youth, aged 0-18.

METHODS

Latent Class Analysis was used to investigate profiles of child maltreatment. We then used a longitudinal three-wave panel design to examine whether membership in various maltreatment classes predicted development of depression and post-traumatic stress measured at two future time points.

RESULTS

Three classes emerged: Class 1 (68 %) the "Neglect and Adverse Parental Behaviors Class", Class 2 (20 %) the "Physical Abuse Class", and Class 3 (12 %) the "Sexual Abuse Class". Membership in Class 2 increased depression and trauma symptoms at Wave 2, compared to Class 1 (b = 1.8 and 1.4, respectively; p < 0.05). Membership in Class 3 increased trauma symptoms at Wave 3, compared to Class 1 and Class 2 (b = 2.3 and 2.7, respectively; p < 0.01).

IMPLICATIONS

Child welfare involved youth need to be appropriately screened for psychiatric health annually and provided with services that correspond with their level of need.

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.

A latent profile analysis of adverse childhood experiences and adult health in a community sample

BACKGROUND

Childhood adversity is generally associated with adult mental health problems, but most studies have an insufficient sample size to examine relationships among various aspects of childhood adversity and adult mental health outcomes. Further, past research has predominantly been restricted to a single or limited types of adverse events, which ignores the inherent interdependence among childhood adversity indicators.

OBJECTIVE

The current study explored various configurations of adverse childhood experiences (ACEs) and then examined the relationships among these configurations and various mental health constructs with a person-centered analytic framework.

PARTICIPANTS AND SETTING

A sample of 3, 932 adult outpatients was recruited in primary care settings, during regular physician visits.

METHODS

Participants provided informed consent, demographic information, and then completed validated measure of ACEs (emotional abuse, physical abuse, sexual abuse, physical neglect, emotional neglect, family dysfunction), and a series of validated mental health measures.

RESULTS

Latent profile analyses revealed four configurations (or profiles) of ACEs, which were analysed for their relationships with mental health outcomes. The profile with a dominance of physical neglect was associated with the highest levels of anxiety and depression. The profiles with high levels of sexual abuse, either alone or combined with general adversity, had more emotional problems than the profile with low levels of adversity. The profiles characterizing mistreatment did not consistently differ from each other on the mental health outcomes.

CONCLUSIONS

It is critical to consider ACEs in their complex relationship with each other. Different patterns of ACEs are associated with differential health outcomes in adults.

How Does Exposure to Violence Affect School Delay and Academic Motivation for Adolescents Living in Socioeconomically Disadvantaged Communities in South Africa?

To date, little is known about the effects of violence on the educational outcomes of adolescents in disadvantaged communities in South Africa. In response, self-report data were collected from a socioeconomically disadvantaged sample of 503 adolescents aged 10 to 18 participating in a child abuse prevention trial in the Eastern Cape. Adolescents were purposively selected in the trial. This study applies Latent Profile Analysis (LPA) to examine relationships between past-month exposure to violence, school delay, and academic motivation. About 93.8% of adolescents in the sample experienced poly-violence-exposure to at least two forms of violence in the past month. Results identified two distinct profiles in the socioeconomically disadvantaged sample: Profile 1, adolescents exposed to more frequent poly-violence, and Profile 2, adolescents exposed to less frequent poly-violence. Being exposed to more frequent poly-violence was associated with greater risk of school delay-based on age-appropriate grade in South Africa. However, being exposed to more frequent poly-violence was not associated with lower academic motivation-adolescents showed high rates of wanting to achieve. Our findings suggest that exposure to more frequent poly-violence increases risk of school delay among adolescents from disadvantaged communities, while not affecting their academic motivation. Thus, although adolescents maintained aspirations and goals to do well at school, exposure to high frequency of violence affected their capacity to fulfill these aims.

Foster Parents' Parenting and the Social-Emotional Development and Adaptive Functioning of Children in Foster Care: A PRISMA-Guided Literature Review and Meta-Analysis

Children in foster care (CFC) are at increased risk for negative developmental outcomes. Given the potential influence of foster parents' parenting on the development of CFC, this literature review and meta-analysis provide an initial overview of how parenting factors in foster families relate to CFC's developmental outcomes. We aimed to explore (1) whether foster parents' parenting conceptualizations are related differently to various CFC developmental outcome variables and (2) how characteristics of foster parents and CFC moderate these associations. Following the recommendations of the PRISMA statement, we searched four databases in 2017 (with an update in May 2020). Forty-three primary studies were coded manually. The interrater agreement was 92.1%. Parenting variables were specified as parenting behavior, style, and goals and were distinguished further into functional and dysfunctional parenting. CFC development was divided into adaptive (including cognitive) development and maladaptive development. Meta-analyses could be performed for foster parenting behavior and developmental outcomes, as well as for functional parenting goals and maladaptive socioemotional outcomes in CFC. Associations between functional parenting behavior and adaptive child development were positive and negative for maladaptive child development, respectively. For dysfunctional, parenting effects were in the opposite direction. All effects were small to moderate. Similar results were found descriptively in the associations of parenting style and child developmental outcomes. We found similar effect sizes and directions of the associations between parenting behavior in foster families and the child's developmental outcomes as those previously reported for biological families. These findings provide strong support for the significant role of parenting in foster families regarding children's development in foster care.

Child abuse: A social evil in Indian perspective

Child abuse is a social evil which has existed in our society since a long time. The awareness regarding the same has been minimal in developing countries. Many a times, punitive measures taken by parents to discipline their children turn out to be painful scars in their childhood resulting in stunting of their mental and social growth. Doctors and other health care workers have a very important role in identifying and reporting such issues. Law has also evolved over the recent past in safeguarding the future of our children. However, awareness regarding this issue has remained to be the same as before. During the current era of COVID, parents and children have been restricted to their homes. Livelihood of many families have been at risk. These issues have burdened the caretakers at home and absence of teachers who were otherwise their guardian angels have impacted the minds of these children adversely. Hence in this article we intend to provide good clarity about this social evil, and the rights of our children. We also wish to stress upon the duties of parents, doctors, teachers in molding these tender minds so as to get the best out of them.

Comparison of three models of adverse childhood experiences: Associations with child and adolescent internalizing and externalizing symptoms

Exposure to adverse childhood experiences (ACEs) is prevalent and confers risk for psychopathology later in life. Approaches to understanding the impact of ACEs on development include the independent risk approach, the Dimensional Model of Adversity and Psychopathology (DMAP) distinguishing between threat and deprivation events, and the cumulative risk approach. The present research provides an empirical confirmation of DMAP and a comparison of these three approaches in predicting internalizing and externalizing symptoms in youth. In Study 1, mental health professionals (N = 57) rated ACEs as threat or deprivation events. These ratings were used to create composites to represent the DMAP approach in Study 2. With cross-sectional and longitudinal data from children and adolescents in state custody (N = 23,850), hierarchical linear regression analyses examined independent risk, DMAP, and cumulative risk models in predicting internalizing symptoms, disinhibited externalizing symptoms, and antagonistic externalizing symptoms. All three approaches produced significant models and revealed associations between exposure to ACEs and symptoms. Individual risk accounted for significantly more variance in symptoms than cumulative risk and DMAP. Cumulative risk masked differential associations between ACEs and psychological symptoms found in the individual risk and DMAP approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Latent classes of childhood maltreatment in children and adolescents in foster care: associations with ICD-11 PTSD and complex PTSD

Background: Children and adolescents in foster care often experience many co-occurring subtypes of maltreatment. However, little is known about different combinations of maltreatment subtypes, referred to as maltreatment classes. Furthermore, the association between those maltreatment classes and ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has not been investigated in children and adolescents. In previous studies, classes characterized by cumulative maltreatment were associated with severe psychopathological symptoms. So far, no study investigated ICD-11 PTSD and CPTSD. Objective: The first aim of this study was the detection of distinct maltreatment classes by examining frequently co-occurring maltreatment subtypes. The second aim was the examination of the association between those maltreatment classes and ICD-11 PTSD and CPTSD. Method: Participants were 147 children and adolescents currently living in foster care institutions in Lower Austria. Maltreatment history, ICD-11 PTSD and CPTSD were assessed using standardized self-report questionnaires. Latent class analysis was applied to examine maltreatment subtypes. χ2 difference testing was used to examine class associations with PTSD and CPTSD. Results: Three latent classes that comprised different subtypes of maltreatment were identified (limited maltreatment, n = 49; high neglect, n = 53; cumulative maltreatment, n = 45). Cumulative maltreatment was associated with higher symptom severity of PTSD and CPTSD than the limited maltreatment and the high neglect class, with effect sizes ranging from 0.62 to 0.93. Conclusions: The association of the cumulative maltreatment class with the highest symptom severity of PTSD and CPTSD highlights the detrimental effect of cumulative maltreatment. The detection of a high neglect class identifies children and adolescents, who are at high-risk of experiencing future maltreatment because of their previous experiences of neglect and the associated lack of protection. The examination of the association of distinct maltreatment classes with ICD-11 PTSD and CPTSD might provide implications for targeted prevention, assessment and treatment.

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.

A Narrative Review of the Needs of Children in Foster and Kinship Care: Informing a Research Agenda

As a result of maltreatment, children in care can present with a range of complex needs and challenges. In addition to direct clinical care commonly provided by paediatricians, psychiatrists, and clinical psychologists, the provision of knowledge and skills to foster and kinship carers have become modes of support common in responding to these needs and challenges. A narrative review of key systematic reviews and empirical research was conducted to assess the effectiveness of existing foster carer interventions. Results indicated a range of methodological characteristics that limit our ability to develop a sound, research-driven, evidence base. As a result, we remain limited in our knowledge about which treatments are effective, for which symptoms they are effective, and for which population subgroups they are most likely to be effective. This review provides a summary of identified needs and challenges in the delivery of foster carer interventions. It provides an account of current treatment components and offers a platform for the development and progression of a programme of research in an effort to advance knowledge in the area.

Atuação de Psicólogos em Alegações de Violência Sexual: Boas Práticas nas Entrevistas de Crianças e Adolescentes

Resumo Discussões sobre o papel de profissionais da Psicologia na escuta de alegações de violência sexual contra crianças e adolescentes têm emergido em todo país. Escuta especializada, depoimento especial e perícia psicológica são procedimentos previstos na legislação brasileira em diferentes momentos de uma alegação de violência sexual, dentro do Sistema de Garantia de Direitos. Enquanto os dois primeiros podem contar com profissionais de outras áreas, a perícia psicológica é atribuição privativa dos psicólogos. Tendo em vista que a principal fonte de informações sobre os eventos alegados é a criança, este artigo de revisão narrativa tem como objetivo discutir a escuta do psicólogo/a sobre alegações de violência sexual nos contextos da escuta especializada, do depoimento especial e da perícia psicológica. O artigo também tem como objetivo apresentar diretrizes gerais para entrevistas com crianças e adolescentes, consideradas na literatura como boas práticas nesse campo de atuação. Considerando a entrevista como o ponto comum entre esses três procedimentos, recomenda-se o uso de questões abertas, preparação do local em que a entrevista será conduzida e o uso de protocolos empiricamente validados para obtenção do relato sobre o evento alegado. Observou-se que tanto na literatura especializada como na legislação brasileira ainda se faz necessário esclarecer a operacionalização de “escuta especializada”, pois pode dificultar a atuação efetiva dos profissionais que atuam em serviços de proteção e atendimento a crianças e adolescentes.

Investigating the causal relationship between maltreatment and cognition in children: A systematic review

BACKGROUND

Cognitive impairment (i.e. lower IQ/cognitive development) in individuals who have experienced childhood maltreatment is well documented in the literature. It is not yet clear whether maltreatment itself causes cognitive impairment, or whether reduced cognitive functioning pre-dates maltreatment exposure and places children at risk of maltreatment.

OBJECTIVE

This systematic review critically evaluated the evidence for a causal association between child maltreatment and impaired cognition in children under 12 years.

METHODS

Following PRISMA guidelines, databases were searched and articles extracted according to inclusion criteria. Quality rating of articles was conducted independently by two reviewers and the evidence for a causal association was evaluated using guidelines based on the Hill criteria for causation in epidemiological and public health research.

RESULTS

31 articles were included in the review, with results that suggested lower IQ/cognitive development in maltreated children compared to controls, and a dose-response relationship between timing and duration of maltreatment and impaired cognition. Assessment of causality indicated strong evidence for a causal association between maltreatment and reduced overall cognitive performance in institutionalised children. Findings were less robust for non-institutionalised samples. Evidence regarding specific cognitive functions was mixed.

CONCLUSIONS

Extreme maltreatment may lead to reduced cognitive functioning in children under 12 years. More research is required to determine the impact of the nature and timing of maltreatment, as well as additional heritable and social factors, on specific profiles of cognition in this population.

Adverse childhood experiences and domain-specific cognitive function in a population-based study of older adults in rural South Africa

Research on early life adversity and later-life cognitive function is conflicting, with little evidence from low-income settings. We investigated associations between adverse childhood experiences and cognitive function in an older population who grew up under racial segregation during South African apartheid. Data were from 1,871 adults aged 40-79 in the population-representative "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" in 2015. The adverse childhood experiences were having a parent unemployed for > 6 months; having parents who argued or fought often; having a parent who drank excessively, used drugs, or had mental health problems; and physical abuse from parents. Executive function, language, visuospatial ability, and memory were assessed with the Oxford Cognitive Screen-Plus, a validated cognitive assessment designed for low-income, low-literacy settings. We estimated associations between adverse childhood experiences and latent cognitive domain z-scores using multiple-indicator, multiple-cause structural equation models. Childhood adversities were reported by 15% (parental unemployment for > 6 months), 25% (parents argued or fought often), 25% (a parent drank excessively, used drugs, or had mental health problems), and 35% (physical abuse from parent) of respondents. They were not associated with cognition, except that having a parent who drank excessively, used drugs, or had mental health problems was associated with lower memory z-scores (-0.07; 95% CI [-0.13, -0.01]). This is one of the first investigations into later-life cognitive outcomes associated with early adversity in a population with a historical context of pervasive trauma, and suggests that later-life memory may be vulnerable to early adversity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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.

Intergenerational maltreatment and child emotion dysregulation

BACKGROUND

Childhood maltreatment has been related to adverse outcomes on social, cognitive, and biological development with sequelae present throughout the lifespan. As such, caregivers maltreated in childhood may face a different set of challenges and interpersonal stressors in rearing their children. Parental history of maltreatment has the potential to increase the risk of parental depression and exposure to maltreatment in the next generation, both of which can have a negative effect on children's development.

OBJECTIVE

The purpose of this study is to investigate maternal depression and child experiences of maltreatment as mediators of the relationship between mothers' own maltreatment experiences and child emotion dysregulation in children aged 10-12.

PARTICIPANTS AND SETTING

378 low-income mothers and their children were recruited to participate in a research summer camp from 2004-2007.

METHOD

Mothers self-reported on their experiences of maltreatment in childhood and current depressive symptoms. Current generation child maltreatment information was coded from Child Protective Services records. Child emotion dysregulation (rated by camp counselors) was the outcome measure in this study. Structural equation modeling was employed to test associations between maternal maltreatment and child emotion dysregulation.

RESULTS

Maternal history of maltreatment related to both child maltreatment (β = .24, SE = .052, p < .001) and greater maternal depressive symptoms (β = .28, SE = .049, p < .001). Only child maltreatment mediated the effect of mothers' maltreatment on child emotion dysregulation (95 %CI: .005-.023).

CONCLUSIONS

In this low-income sample, the rate of intergenerational maltreatment is high and represents a pathway of influence that increases risk for maladaptive socioemotional child development.

Child Maltreatment and Disordered Eating in Adulthood: a Mediating Role of PTSD and Self-Esteem?

The current study investigated relationships between different experiences of child maltreatment (CM) and disordered eating (DE) in a large population-based sample of Danish young adults. Participants completed a structured interview comprising socio-demographic, psychological and physical domains. Questions regarding CM, DE, PTSD symptoms and self-esteem were analyzed using chi-square-tests, ANOVAs, hierarchical regression, and multiple mediation analyses. Participants with a history of CM experienced higher levels of DE than non-abused individuals. PTSD symptoms and self-esteem appeared to differentially mediate the relationship between three classes of CM and DE. Whereas the relation between emotional and sexual abuse with DE was partially mediated via participants' level of PTSD symptoms and self-esteem with emotional abuse having a stronger impact on self-esteem and sexual abuse more strongly influencing PTSD symptoms, the relation between polyvictimization and DE was fully mediated by PTSD and self-esteem, mainly due to the indirect effect via PTSD.

Diversity of adverse childhood experiences among adolescent mothers and the intergenerational transmission of risk to children's behavior problems

RATIONALE

It is important to investigate the diversity and variability among adverse childhood experiences (ACEs) in young mothers because they are likely to experience considerable adverse exposures during childhood as well as challenging environments following childbirth.

OBJECTIVE

The current study used latent class analysis with a diverse sample of young mothers to identify subgroups of mothers based on their adverse childhood experiences (ACEs). Subsequent analyses were conducted to examine class specific differences in maternal mental health postpartum and their children's socio-emotional functioning at eight years of age.

RESULTS

Four classes of participants were identified based on mothers' ACEs, including a high, multiple-risk class, a low-risk class, a high-risk for abuse class, and a high-risk for household dysfunction class. These classes were associated with differences in maternal and child functioning. The low-risk class showed significantly better maternal and child health and well-being than the high-risk class. However, nuanced differences were seen for mothers and their children across all classes; for example, children of mothers in the high-risk for abuse class scored significantly better on internalizing behaviors than children from the high, multiple-risk class, but not better on externalizing behaviors. Further, children of mothers in the high-risk for household dysfunction class scored better than the high, multiple-risk class on externalizing behaviors but not better on scores of internalizing behaviors.

CONCLUSION

Understanding the differences in how certain types of childhood adversity are associated with mothers' and their children's later health and well-being will bolster the use of only a sum score of ACEs for both how we research risk and in supporting clinicians to provide targeted care.

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.

Associations between childhood maltreatment latent classes and eating disorder symptoms in a nationally representative sample of young adults in the United States

BACKGROUND

Childhood maltreatment is associated with eating disorders, but types of childhood maltreatment often co-occur.

OBJECTIVE

To examine associations between childhood maltreatment patterns and eating disorder symptoms in young adulthood.

PARTICIPANTS AND SETTING

Data came from the National Longitudinal Study of Adolescent to Adult Health (N = 14,322).

METHODS

Latent class analysis was conducted, using childhood physical neglect, physical abuse, and sexual abuse as model indicators. Logistic regression models adjusted for demographic covariates were conducted to examine associations between childhood maltreatment latent classes and eating disorder symptoms.

RESULTS

In this nationally representative sample of U.S. young adults (mean age = 21.82 years), 7.3% of participants reported binge eating-related concerns, 3.8% reported compensatory behaviors, and 8.6% reported fasting/skipping meals. Five childhood maltreatment latent classes emerged: "no/low maltreatment" (78.5% of the sample), "physical abuse only" (11.0% of the sample), "multi-type maltreatment" (7.8% of the sample), "physical neglect only" (2.1% of the sample), and "sexual abuse only" (0.6% of the sample). Compared to participants assigned to the "no/low maltreatment" class, participants assigned to the "multi-type maltreatment" class were more likely to report binge eating-related concerns (odds ratio = 1.97; 95% confidence interval [CI]: 1.52, 2.56) and fasting/skipping meals (OR = 1.85; 95% CI: 1.46, 2.34), and participants assigned to the "physical abuse only" class were more likely to report fasting/skipping meals (OR = 1.35; 95% CI: 1.04, 1.76).

CONCLUSIONS

This study provides evidence that distinct childhood maltreatment profiles are differentially associated with eating disorder symptoms. Individuals exposed to multi-type childhood maltreatment may be at particularly high risk for eating disorders.

First-onset and persistence of suicidal ideation in university students: A one-year follow-up study

BACKGROUND

Longitudinal evidence about risk and protective factors for suicidal ideation among university students is limited.

METHODS

12-month first-onset and persistence of suicidal ideation (SI) among Spanish first-year university students were estimated using baseline (T1) and 12-month follow-up (T2) online surveys. Information about STBs, childhood/adolescence adversities, positive relationships, mental disorders, recent stressful experiences, and university sense of membership was assessed. Logistic regression analysis was used to study risk/protective factors of first-onset and persistence of suicidal ideation (SI).

RESULTS

A total of 1,248 respondents (58.9% response) were included. Mean age at baseline was 18.7 (SD = 1.3) and 56.0% were female. 7.3% reported 12-month SI at T2. Incidence of new SI cases was 3.4% and, among students with SI at T1, 21.2% also reported SI at T2 (persistence). Risk factors of T2 SI included 12-month mood disorder at T2 both without (aOR = 12.08 95% CI 5.45-26.80) or with (aOR = 7.2 95% CI 2.91-17.80) lifetime mood at T1, past lifetime suicide attempt (aOR = 8.79 95% CI 2.37-32.64) and plan without attempt (aOR = 4.72 95% CI 2.32-9.61), and 12-month physical or sexual assault (aOR = 3.28 95% CI 1.13-9.46). Twelve-month mood at T2 withoutT1 lifetime mood (aOR = 11.27 95% CI 3.02-42.14) and childhood/adolescence emotional abuse or neglect (aOR = 3.41 95% CI 1.10-10.57) or having been bullied (aOR = 3.2 95% CI 1.08-9.53) were associated with first-onset of SI. Twelve-month mood at T2 either without (aOR = 13.92 95% CI 3.76-51.59) or with (aOR = 8.03 95% CI 2.13-30.29) were associated to T2 SI persistence. University sense of membership was protective for overall 12-month SI at T2 (aOR = 0.25 95% CI 0.12-0.53 for middle tertile), first-onset SI (aOR = 0.1 95% 0.02-0.55 for middle tertile) and persistence (aOR = 0.3 95% CI 0.11-0.81 for middle tertile).

LIMITATIONS

Analysis was based on self-report data focusing on SI only, and conclusions about the direction of the associations are limited.

CONCLUSIONS

High proportion of SI suggests the need of suicide prevention strategies. The potential role of university sense of membership in reducing suicidal behaviour among university students deserves further investigation.

Assessment of Trauma Symptoms in Toddlers and Preschoolers Living in Poverty

A first-line screening instrument, the Preschool Inventory of Trauma Symptoms (PITS), was developed to assess trauma symptoms with a diverse sample of 150 toddlers and preschoolers (M = 2.49 years; SD = 1.12). Items reflected the current trauma literature, assessment measures, and diagnostic criteria for very young children. A principal component analysis produced a 34-item, four-factor model: Arousal and Hyper-Reactivity, Fearful Attachment, Intrusion and Re-Experiencing, and Avoidance and Negative Cognition and Mood. One validity scale, Response Style, was also developed. All scales significantly correlated (r = .45 to .81; p < .01) with preestablished trauma measures and demonstrated adequate internal consistency (α = .68 - .87). A receiver operating characteristics curve analysis identified a cut-score with good discrimination ability (.88), sensitivity (.81), and specificity (.81). In a preliminary pilot study, PITS also was found to be sensitive to trauma symptom change following participation in an evidence-based trauma informed treatment program. A copy of the PITS is included in the Appendix for free use by qualified professionals.

Comparison of Institutionally Reared and Maltreated Children on Socioemotional and Biological Functioning

The current study compared behavioral and adrenocortical functioning of maltreated (N = 91) and comparably aged (1.5-3 years) institutionally-reared children soon after (1.5-2.5 months) placement in foster care or adoptive homes, respectively. Foster and adoptive parents reported on the children's socioemotional competence and behavior problems, experimenters scored fear and positive affect to laboratory tasks, and diurnal cortisol measures were obtained. We sought to address whether these early contexts, characterized by different types of neglect and deprivation, have differential effects on young children's development. We found little support for the argument that either context results in uniformly poorer functioning soon after removal from adversity. Maltreated children were less fearful and more positive when exposed to both positive and novel events than institutionally-reared children. However, maltreated children were reported to have more behavior problems than did institutionally-reared children, and institutionally-reared children showed more typical declines in cortisol throughout the day than the maltreated children. These findings increase our ability to construct more targeted and effective interventions for these populations.

Associations Between Maternal Caregiving and Child Indicators of Toxic Stress Among Multiethnic, Urban Families

INTRODUCTION

Our purpose was to examine associations between maternal caregiving and child indicators of toxic stress among multiethnic, urban families with children of early school age.

METHOD

We conducted an exploratory cross-sectional analysis of 54 maternal-child dyads. Mothers reported on parenting behaviors and parental reflective functioning (PRF). Child indicators of toxic stress included hair/salivary biomarkers, anthropometric characteristics, and maternally reported health and behavior.

RESULTS

Hostile/coercive parenting behaviors were associated with child externalizing behavioral problems (r = 0.43, p = .001, but lower interleukin (IL) 6 levels (r = 0.31, p = .03). High PRF was associated with fewer child emergency department visits (ρ = -0.43, p = .009), whereas impaired PRF was associated with more behavioral problems (ρ = 0.52, p < .0001).

DISCUSSION

PRF and supportive parenting behaviors may protect against toxic stress among vulnerable families, but additional research is needed to better understand these relationships. Resources are available to help clinicians screen for family risk factors and model responsive caregiving in pediatric settings.