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Frost A, Collins A, Chung EO, Escobar Carias MS, Hagaman A, Gupta S, Bibi A, Sikander S, Maselko J. Trauma exposure among young children in rural Pakistan: Associations with gender, mental health, and cognitive skills. BMC Psychol 2024; 12:454. [PMID: 39183356 PMCID: PMC11346172 DOI: 10.1186/s40359-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The burden of childhood trauma (violence, injury/illness, loss) in low-resource settings is high, although the effect of trauma on children's mental and cognitive health is under-researched. Child gender may moderate the association between trauma and outcomes; boys are more likely to experience trauma, but girls are more likely to show distress following trauma. METHODS We draw on data from the Bachpan cohort (n = 888), a sample of mother-child dyads in rural Pakistan, to investigate these associations among 6-year-old children in a South Asian, low-resource setting. Mothers reported on children's lifetime exposure to 15 possible traumas and their current mental health. In addition, children were assessed for their verbal skills, working memory, and inhibitory control. We estimated trauma prevalence and used generalized estimating equations to test the association between number of traumatic events and child mental health and cognitive skills in the overall sample and by gender. RESULTS 90.5% of children experienced at least one trauma. The most common traumas were death of a loved one (47%) and hearing about war/terrorism on the TV/radio (48%). On average, boys experienced more traumas (M = 3.00) than girls (M = 2.67). Specifically, boys were more likely than girls to experience an injury or hospitalization (30% vs. 21%, p < .05) and to hear about war/terrorism on the TV/radio (52% vs. 43%, p < .05). Trauma was associated with increased mental health difficulties and increased anxiety scores. There was little evidence that trauma exposure was associated with child cognitive skills. The strength of association between trauma and outcomes was similar for boys and girls. CONCLUSIONS Findings show that childhood trauma exposure is common in this setting and associated with worse mental health problems among young boys and girls. Results suggest that trauma-informed interventions are important for supporting child mental health in South Asia.
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Affiliation(s)
- Allison Frost
- Carolina Population Center, University of North Carolina, Chapel Hill, USA.
| | - Amanda Collins
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | | | | | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sugandh Gupta
- Department of Anthropology, University of North Carolina, Chapel Hill, USA
| | - Amina Bibi
- Human Development Research Foundation, Islamabad, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Siham Sikander
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Joanna Maselko
- Carolina Population Center, University of North Carolina, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Huffhines L, Parade SH, Martin SE, Gottipaty A, Kavanaugh B, Spirito A, Boekamp JR. Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program. Dev Psychopathol 2024:1-17. [PMID: 38711378 DOI: 10.1017/s0954579424000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.
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Affiliation(s)
- Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, E. P Bradley Hospital, Riverside, RI, USA
| | - Stephanie H Parade
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, E. P Bradley Hospital, Riverside, RI, USA
| | - Sarah E Martin
- Department of Psychology, Simmons University, Boston, MA, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anjali Gottipaty
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Brian Kavanaugh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John R Boekamp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
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Young G. Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:911-923. [PMID: 35958715 PMCID: PMC9360301 DOI: 10.1007/s40653-022-00438-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 05/07/2023]
Abstract
The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.
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Affiliation(s)
- Gerald Young
- Glendon College, York University, Toronto, Canada
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Zhou Y, Wang J, Zhou N, Zhan J, Sun L, Xing C, Liu N, Wang X, Liu W. The Hidden Factors Affecting Academic Performance Among Chinese Middle School Students: Traumatic Experience and Posttraumatic Stress Symptoms. Psychol Res Behav Manag 2022; 15:111-121. [PMID: 35046737 PMCID: PMC8761031 DOI: 10.2147/prbm.s343452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose The role of posttraumatic stress disorder (PTSD) in the path from traumatic exposure (TE) to academic performance (AP) is still not explicitly illustrated. The current study aimed to examine the moderator role of PTSD on the relationship between TE and AP, and then to investigate whether this moderator role is influenced by gender. Participants and Methods A sample of Chinese students (n=235) who had experienced the major earthquake of Wenchuan was chosen. PTSD and TE were measured by the Impact of Event Scale – Revised (IES-R) and an earthquake-related experience questionnaire, respectively. AP was collected from their up-to-date general examination. Data for 221 participants (53.4% female; mean age=14.03 years, SD=0.824) were finally included in the analysis. Parsimonious latent-variable interaction analysis and hierarchical regression analysis were adopted to examine the moderator role of PTSD. Results The average IES-R score was 27.57 (SD=13.265, range 0–67). The average score for earthquake exposure was 5.86 (SD=2.069, range 1–12). The results showed that both TE and the interaction term of PTSD*TE had significant negative correlations with AP, while PTSD was not associated with AP. Subsequent hierarchical regression analysis found that the relationship of the interaction term and AP was only significant in female students, and a simple slope plot showed a distinct pattern of the moderating effect of PTSD in both genders. Conclusion This study supported that PTSD moderated the connection between TE and AP in middle school students who had undergone a major earthquake trauma, which was influenced by gender. Students who experienced major trauma with drastic exposure history and manifested PTSD symptoms need specified intervention to avoid further deterioration in performance in school.
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Affiliation(s)
- Yaoguang Zhou
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China.,Lab for Post-Traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Jing Wang
- Department of Sports and Health, Shanghai Lixin University of Accounting and Finance, Shanghai, 201620, People's Republic of China
| | - Na Zhou
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Jingye Zhan
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China.,Lab for Post-Traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Luna Sun
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China.,Lab for Post-Traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Chenqi Xing
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China.,Lab for Post-Traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Nianqi Liu
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China.,Lab for Post-Traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Xing Wang
- Shanghai University of Sport, Shanghai, 200438, People's Republic of China
| | - Weizhi Liu
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China.,Lab for Post-Traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
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Developmental Consequences of Early Life Stress on Risk for Psychopathology: Longitudinal Associations with Children's Multisystem Physiological Regulation and Executive Functioning. Dev Psychopathol 2021; 33:1759-1773. [PMID: 34949903 DOI: 10.1017/s0954579421000730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The etiology of psychopathology is multifaceted and warrants consideration of factors at multiple levels and across developmental time. Although experiences of adversity in early life have been associated with increased risk of developing psychopathology, pathways toward maladaptation or resilience are complex and depend upon a variety of factors, including individuals' physiological regulation and cognitive functioning. Therefore, in a longitudinal cohort of 113 mother-child dyads, we explored associations from early adverse experiences to physiological co-regulation across multiple systems and subsequent variations in executive functioning. Latent profile analysis derived multisystem profiles based on children's heart rate, respiratory sinus arrhythmia, pre-ejection period, and cortisol measured during periods of rest and reactivity throughout a developmentally challenging protocol. Three distinct profiles of multisystem regulation emerged: heightened multisystem baseline activity (Anticipatory Arousal/ANS Responder), typically adaptive patterns across all systems (Active Copers/Mobilizers) and heightened HPA axis activity (HPA Axis Responders). Path models revealed that children exposed to adversity before 18-months were more likely to evidence an Anticipatory Arousal/ANS Responders response at 36-months, and children in this profile had lower executive functioning scores than the Active Copers/Mobilizers. In sum, these findings provide important information about potential physiological associations linking early adversity to variations in children's task-based executive functioning.
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