Outcomes of child abuse

Validation of the "Darryl" PTSD Cartoon Test with Abused Children

Background

There is a lack of reliable and valid PTSD tests for young children that cannot read or are weak readers. The semi-projective cartoon test, "Darryl", which is read aloud, is a measure that appeals to this age group. The test has been applied in both clinical and epidemiological studies.

Objective

to validate a cartoon test, "Darryl", for children aged 6 or older in a population of children suspectedly sexually and/or physically abused.

Methods

In the Danish Child Centres, 327 children were screened with Darryl as part of an assessment for further intervention. The Bech Youth Inventory was filled out by 113 children, and 63 caregivers filled out the Strengths & Difficulties Questionnaire. Correlations were used to study the convergent validity between the scales and subscales and effect sizes were estimated. Reliability of the scales was investigated using Cronbach's alpha.

Results

Following the DSM-IV, 55.7% of the children (n = 182) had a possible PTSD diagnosis. More girls (n = 110, 62.9 %) than boys (n = 72, 47.4%) had PTSD. A total of 21.7 % (n = 71) had subclinical PTSD, lacking only one symptom of the full diagnosis. There was no significant difference in PTSD regarding physical or sexual abuse.

Clinical significance

The test allows clinicians in the pediatric field to screen for possible PTSD in a population where systematic self-report data have paramount importance.

Conclusions

Darryl appears to be a valid and reliable test for screening young children who have been physically or sexually abused. The test is helpful for clinician working with young children to identify those have developed trauma symptoms to secure them early treatment.

The Effects of Inattentiveness and Hyperactivity on Posttraumatic Stress Symptoms: Does a Diagnosis of Posttraumatic Stress Disorder Matter?

Objective: To address the nature of associations between ADHD symptoms and posttraumatic stress disorder (PTSD) psychopathology in adult military veterans. Method: Ninety-five combat veterans, with PTSD (n = 63) and without PTSD (n = 32), were recruited for this study. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS) and ADHD was assessed with Connors' Adult ADHD Rating Scale-Self-Report: Short Version (CAARS-S:S). Results: PTSD participants endorsed greater hyperactivity or restlessness, inattention or memory problems, and impulsivity or emotional lability scores than participants without PTSD. Among PTSD participants, inattention or memory problems and impulsivity or emotional lability were significant predictors of total PTSD symptoms, but only inattention or memory problems significantly predicted PTSD symptoms when other ADHD symptom clusters were considered simultaneously. Conclusion: Our data suggest that inattention may serve as a risk factor for posttraumatic stress symptoms following combat exposure.

Altered cortical functional network during behavioral inhibition in individuals with childhood trauma

Individuals who have prior history of childhood traumatic experiences are at a high risk for a variety of psychological and behavioral problems throughout their lifetime. This study aimed to investigate whether such individuals exhibit altered cortical functional networks during a behavioral inhibition task. One hundred fifty-three non-clinical individuals were recruited and instructed to perform a Go/NoGo task during an electroencephalograph. Source-level weighted functional networks based on the graph theory were analyzed for NoGo-P3 processing. Based on their total scores on the childhood trauma questionnaire (CTQ) participants were divided into three groups: low CTQ, middle CTQ, and high CTQ. Results at the global level indicated decreased strength, clustering coefficient, and efficiency for the low and gamma bands in the high CTQ group. In addition, the path length of the low beta band was observed to be longer in the high CTQ group than the low CTQ group. At the nodal level, the nodal clustering coefficient of high CTQ group was decreased in left primary somatosensory cortex and middle occipital gyrus for the low beta band, and in left superior temporal gyrus for the gamma band. The nodal clustering coefficient of the left primary somatosensory cortex showed a significant negative correlation with the total CTQ score for the low beta band. In addition, the nodal clustering coefficient of the left middle occipital gyrus for the low beta band and superior temporal gyrus for the gamma band showed significant negative correlations with the emotional neglect score. Our results demonstrate an altered cortical functional network in individuals who experienced childhood trauma. In particular, the left primary somatosensory cortex, middle occipital gyrus, and superior temporal gyrus were found to be vulnerable in individuals who experienced childhood trauma, especially emotional neglect.

Childhood Trauma Associated with Enhanced High Frequency Band Powers and Induced Subjective Inattention of Adults

Childhood trauma can lead to various psychological and cognitive symptoms. It has been demonstrated that high frequency electroencephalogram (EEG) powers could be closely correlated with inattention. In this study, we explored the relationship between high frequency EEG powers, inattention, symptoms of adult attention deficit hyperactivity disorder (ADHD), and childhood traumatic experiences. A total of 157 healthy Korean adult volunteers were included and divided into two groups using the Childhood Trauma Questionnaire (CTQ) score. The subjective inattention scores, ADHD scale, and anxiety and depression symptom were evaluated. EEG was recorded and quantitative band powers were analyzed. The results were as follows: (1) the high CTQ group showed significantly increased delta, beta1, beta2, beta3 and gamma, and significantly decreased low alpha power compared to the low CTQ group; (2) the high CTQ group had higher inattention score compared to the low CTQ group; (3) the high CTQ group had higher adult ADHD scores; (4) CTQ scores showed significant positive correlations with inattention scores, and adult ADHD scores; (5) unexpectedly, the inattention scores showed significant positive correlations with beta powers and a negative correlation with low alpha power; and (6) the moderated mediation model was confirmed: the depression fully mediated the path from state anxiety to inattention, and the CTQ significantly moderated the pathway between anxiety and depression. Our results show the possibility that childhood adversity may cause subjective inattention and adult ADHD symptoms. Depressive symptoms fully mediated the path from anxiety to inattention, especially in those who report severe childhood traumatic experiences.

Does pediatric post-traumatic stress disorder alter the brain? Systematic review and meta-analysis of structural and functional magnetic resonance imaging studies

Several studies have recently demonstrated that the volumes of specific brain regions are reduced in children and adolescents with post-traumatic stress disorder (PTSD) compared with those of healthy controls. Our study investigated the potential association between early traumatic experiences and altered brain regions and functions. We conducted a systematic review of the scientific literature regarding functional magnetic resonance imaging and a meta-analysis of structural magnetic resonance imaging studies that investigated cerebral region volumes in pediatric patients with PTSD. We searched for articles from 2000 to 2014 in the PsycINFO, PubMed, Medline, Lilacs, and ISI (Web of Knowledge) databases. All data regarding the amygdala, hippocampus, corpus callosum, brain, and intracranial volumes that fit the inclusion criteria were extracted and combined in a meta-analysis that assessed differences between groups. The meta-analysis found reduced total corpus callosum areas and reduced total cerebral and intracranial volumes in the patients with PTSD. The total hippocampus (left and right hippocampus) and gray matter volumes of the amygdala and frontal lobe were also reduced, but these differences were not significant. The functional studies revealed differences in brain region activation in response to stimuli in the post-traumatic stress symptoms/PTSD group. Our results confirmed that the pediatric patients with PTSD exhibited structural and functional brain abnormalities and that some of the abnormalities occurred in different brain regions than those observed in adults.

Child maltreatment, callous-unemotional traits, and defensive responding in high-risk children: An investigation of emotion-modulated startle response

Child maltreatment is associated with disruptions in physiological arousal, emotion regulation, and defensive responses to cues of threat and distress, as well as increased risk for callous unemotional (CU) traits and externalizing behavior. Developmental models of CU traits have focused on biological and genetic risk factors that contribute to hypoarousal and antisocial behavior, but have focused less on environmental influences (Blair, 2004; Daversa, 2010; Hare, Frazell, & Cox, 1978; Krueger, 2000; Shirtcliff et al., 2009; Viding, Fontaine, & McCrory, 2012). The aim of the present investigation was to measure the independent and combined effects of child maltreatment and high CU traits on emotion-modulated startle response in children. Participants consisted of 132 low-income maltreated (n = 60) and nonmaltreated (n = 72) children between 8 and 12 years old who attended a summer camp program. Acoustic startle response (ASR) was elicited in response to a 110-dB 50-ms probe while children viewed a slideshow of pleasant, neutral, and unpleasant IAPS images. Maltreatment status was assessed through examination of Department of Human Services records. CU traits were measured using counselor reports from the Inventory of Callous and Unemotional Traits (Frick, 2004), and conduct problems were measured using counselor and child self-report. We found no significant differences in emotion-modulated startle in the overall sample. However, significant differences in ASR by maltreatment status, maltreatment subtype, and level of CU traits were apparent. Results indicated differential physiological responses for maltreated and nonmaltreated children based on CU traits, including a pathway of hypoarousal for nonmaltreated/high CU children that differed markedly from a more normative physiological trajectory for maltreated/high CU children. Further, we found heightened ASR for emotionally and physically neglected children with high CU and elevated antisocial behavior in these children. Results provide further support for differential trajectories by which experience and biology may influence the development of antisocial behavior in youth and highlight potential avenues for intervention.

Perinatal programming of emotional brain circuits: an integrative view from systems to molecules

Environmental influences such as perinatal stress have been shown to program the developing organism to adapt brain and behavioral functions to cope with daily life challenges. Evidence is now accumulating that the specific and individual effects of early life adversity on the functional development of brain and behavior emerge as a function of the type, intensity, timing and the duration of the adverse environment, and that early life stress (ELS) is a major risk factor for developing behavioral dysfunctions and mental disorders. Results from clinical as well as experimental studies in animal models support the hypothesis that ELS can induce functional “scars” in prefrontal and limbic brain areas, regions that are essential for emotional control, learning and memory functions. On the other hand, the concept of “stress inoculation” is emerging from more recent research, which revealed positive functional adaptations in response to ELS resulting in resilience against stress and other adversities later in life. Moreover, recent studies indicate that early life experiences and the resulting behavioral consequences can be transmitted to the next generation, leading to a transgenerational cycle of adverse or positive adaptations of brain function and behavior. In this review we propose a unifying view of stress vulnerability and resilience by connecting genetic predisposition and programming sensitivity to the context of experience-expectancy and transgenerational epigenetic traits. The adaptive maturation of stress responsive neural and endocrine systems requires environmental challenges to optimize their functions. Repeated environmental challenges can be viewed within the framework of the match/mismatch hypothesis, the outcome, psychopathology or resilience, depends on the respective predisposition and on the context later in life.

Using neuropsychological profiles to classify neglected children with or without physical abuse

OBJECTIVE

The aim of this study is twofold: First, to investigate whether cognitive functions can contribute to differentiating neglected children with or without physical abuse compared to comparison participants; second, to demonstrate the detrimental impact of children being victimized by a combination of different types of maltreatment.

METHODOLOGY

Seventy-nine children aged 6-12 years and currently receiving Child Protection Services because of one of two types of maltreatment (neglect with physical abuse, n=56; neglect without physical abuse, n=28) were compared with a control group of 53 children matched for age, gender, and annual family income. The neuropsychological assessment focused on motor performance, attention, memory and learning, visual-motor integration, language, frontal/executive functions, and intelligence.

RESULTS

Discriminant analysis identified auditory attention and response set, and visual-motor integration (Function 1), and problem solving, abstraction, and planning (Function 2) as the two sets of variables that most distinguished the groups. Discriminant analysis predicted group membership in 80% of the cases. Children who were neglected with physical abuse showed cognitive deficits in auditory attention and response set, and visual-motor integration (Function 1) and problem solving, abstraction, and planning (Function 2). Children who were neglected without physical abuse differed from the control group in that they obtained lower scores in auditory attention and response set, and visual-motor integration (Function 1). Surprisingly, these same children demonstrated a greater capacity for problem solving, abstraction, and planning (Function 2) than the physically abused neglected and control children.

CONCLUSION

The present study underscores the relevance of neuropsychology to maltreatment research. The results support the heterogeneity of cognitive deficits in children based on different types of maltreatment and the fact that neglect with physical abuse is more harmful than neglect alone.

Children's basic memory processes, stress, and maltreatment

Building upon methods and research utilized with normative populations, we examine extant assumptions regarding the effects of child maltreatment on memory. The effects of stress on basic memory processes is examined, and potential neurobiological changes relevant to memory development are examined. The impact of maltreatment-related sequelae (including dissociation and depression) on basic memory processes as well as false memories and suggestibility are also outlined. Although there is a clear need for additional research, the investigations that do exist reveal that maltreated children's basic memory processes are not reliably different from that of other, nonmaltreated children.