Trauma in early childhood: Empirical evidence and clinical implications

Childhood maltreatment and resting-state network connectivity: The risk-buffering role of positive parenting

Unraveling the neurobiological foundations of childhood maltreatment is important due to the persistent associations with adverse mental health outcomes. However, the mechanisms through which abuse and neglect disturb resting-state network connectivity remain elusive. Moreover, it remains unclear if positive parenting can mitigate the negative impact of childhood maltreatment on network connectivity. We analyzed a cohort of 194 adolescents and young adults (aged 14-25, 47.42% female) from the Neuroscience in Psychiatry Network (NSPN) to investigate the impact of childhood abuse and neglect on resting-state network connectivity. Specifically, we examined the SAN, DMN, FPN, DAN, and VAN over time. We also explored the moderating role of positive parenting. The results showed that childhood abuse was linked to stronger connectivity within the SAN and VAN, as well as between the DMN-DAN, DMN-VAN, DMN-SAN, SAN-DAN, FPN-DAN, SAN-VAN, and VAN-DAN networks about 18 months later. Positive parenting during childhood buffered the negative impact of childhood abuse on network connectivity. To our knowledge, this is the first study to demonstrate the protective effect of positive parenting on network connectivity following childhood abuse. These findings not only highlight the importance of positive parenting but also lead to a better understanding of the neurobiology and resilience mechanisms of childhood maltreatment.

Review of the Evidence for Neurofeedback Training for Children and Adolescents Who Have Experienced Traumatic Events

Neurofeedback training is an established treatment for children with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder and is an increasingly accepted modality of treatment in the context of child trauma. This treatment is typically delivered as a complement to more traditional talk therapy such as trauma-focused-cognitive behavioral therapy (TF-CBT). This review examined the evidence for the effectiveness of this intervention for children with trauma through a systematic search of the literature. A targeted search across databases identified 10 eligible studies that focused on children/young people who had experienced traumatic events and/or demonstrated symptoms of trauma, and which conducted a repeated measures study at a minimum. While the included studies suggest some benefits from neurofeedback training, the available studies, including randomized trials, have to date been relatively small, involve dramatically different treatment length and intensity, and show inconsistent benefits relative to usual treatment conditions. To advance knowledge of this intervention further research is needed with a clear best practice protocol and with a clearer target group.

Leveraging the developmental neuroscience of caregiving to promote resilience among youth exposed to adversity

Early adversity is a major risk factor for the emergence of psychopathology across development. Identifying mechanisms that support resilience, or favorable mental health outcomes despite exposure to adversity, is critical for informing clinical intervention and guiding policy to promote youth mental health. Here we propose that caregivers play a central role in fostering resilience among children exposed to adversity via caregiving influences on children's corticolimbic circuitry and emotional functioning. We first delineate the numerous ways that caregivers support youth emotional learning and regulation and describe how early attachment lays the foundation for optimal caregiver support of youth emotional functioning in a developmental stage-specific manner. Second, we outline neural mechanisms by which caregivers foster resilience-namely, by modulating offspring corticolimbic circuitry to support emotion regulation and buffer stress reactivity. Next, we highlight the importance of developmental timing and sensitive periods in understanding caregiving-related mechanisms of resilience. Finally, we discuss clinical implications of this line of research and how findings can be translated to guide policy that promotes the well-being of youth and families.

'Through the drawings…they are able to tell you straight': Using arts-based methods in violence research in South Africa

Arts-based methods are underutilized in violence research and may offer improved means of understanding these phenomena; but little is known about their value, especially in low-resource settings. A pilot study using a cross sectional sample was conducted in rural South Africa to determine the feasibility and acceptability of using arts-based methods in research with adults and children, in preparation for a longitudinal multigenerational cohort study on mechanisms that underly the intergenerational transmission of violence. Four arts-based methods were piloted with young adults aged 22-30 years (n = 29), children aged 4-7 years (n = 21) and former caregivers of the young adults aged 40-69 years (n = 11). A sample of qualitative interviews were audio recorded and transcribed (child n = 15, adults n = 19). Three focus group discussions (FGDs) were conducted to understand implementation and lessons learnt with the six interviewers on the study team, none of whom had used these methods in research before. Interviews and FGDs were audio recorded, transcribed and reviewed by the investigative team. Using a rapid analytical approach, our pilot study demonstrated that using arts and play-based methods in multigenerational violence research is feasible and acceptable to participants and interviewers. These methods worked well for nearly all participants regardless of age or ability and offered a comfortable and 'fun' way to engage in weighty conversations. They presented benefits in their capability to facilitate disclosure, expanding understanding, particularly around violence that is often a stigmatizing and sensitive experience. Interviewers required increased capacity and sensitivity in using the methods carefully, to maximize their full potential, and ongoing mentorship was indicated. Our study adds to the burgeoning evidence base of the effectiveness of the use of arts-based methods in health research.

Association between adverse childhood experiences and marital status among Japanese older adults

BACKGROUND

Marital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status.

OBJECTIVE

This study examined the association between ACEs and marital status among older Japanese adults.

PARTICIPANTS AND SETTING

This research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan.

METHODS

ACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression.

RESULTS

Three or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13-1.76) and females (RRR, 95%CI = 1.56, 1.28-1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02-1.53) and females (RRR, 95%CI = 1.41, 1.18-1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66-2.90; in females: 3.45, 2.71-4.38; p for interaction = 0.034).

CONCLUSIONS

ACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.

Exploring State Level Factors Associated with Short-Stays in Child Welfare: The Role of Systemic Risk and Surveillance

Growing attention has been directed toward children who are placed in out-of-home care by child welfare authorities for less than 30 days, deemed "short-stayers". This exploratory study uses multiple national child welfare and population data sources to identify macro level factors associated with short-stays. Two-level logistic regression modeling was conducted to explore how state-level factors were associated with risk of short-stays. Factors associated with lower odds of short-stays included living in a state with a centralized child welfare reporting structure and with greater food insecurity. Factors associated with greater odds included living in a state with a higher percentage of the state's population enrolled in the Supplemental Nutrition Assistance Program and states with more police per capita. Multiple state level factors were associated short-stay risk, which suggests broader systemic factors contribute to these brief removals. Findings suggest greater surveillance by police and social services increases risk of short-stays, which likely have implications for child welfare policy and practice.

Anger and aggression in children aged 6-12 in lockdowns during the COVID-19 pandemic in Turkey

Objective: This study investigated the relationship between parents’ emotional states and the anger and aggression levels of their children between the ages of 6-12 who were in social isolation during the coronavirus disease 2019 (COVID-19) pandemic in Turkey. Materials and Methods: The study adopted a cross-sectional and descriptive design. The sample consisted of 261 parents. Data were collected online during lockdowns between May and September 2020 due to the COVID-19 pandemic. Results: More than half of the participants reported that they were unhappy (53.2%), sad (63.2%), and worried about the future due to the COVID-19 pandemic (70.8%). Less than a quarter of the participants were angry (17.6%). Children living in districts had significantly higher verbal aggression scores than those living in city centers (p

Improving Functioning of Children Birth to Five with Emotional and Behavioral Problems: The Role of Comprehensive Mental Health Services and Supports

INTRODUCTION

Emotional and behavioral problems are growing among children ages birth to five, and racial/ethnic and socioeconomic disparities exist. Comprehensive, culturally responsive, family-driven systems of care, such as the one operated by California's diverse, urban Alameda County, offer one potential intervention.

METHODS

We used client-level service data (n = 496 children) to calculate descriptive statistics and regression analyses (including multilevel models to account for observations for the same client at multiple points in time). We estimated the prevalence of mental health issues and assessed the association between the length of time using services and emotional and behavioral functioning.

RESULTS

Comprehensive mental health services and supports were associated with improved emotional and behavioral functioning outcomes for children over time, even after controlling for other risk factors.

DISCUSSION

Systems of care appear to support the multidimensional functioning of children and their families.

Once upon a Pandemic: 'Online' Therapeutic Groupwork for Infants and Mothers Impacted by Family Violence

This case study describes the transition to an 'online' delivery of an evaluated infant mental health group work intervention for infants/mothers impacted by family violence during the COVID 19 pandemic. The imperative to provide early intervention to infants and their mother is outlined. The model and practice principles integral to this intervention are provided and described are four separate groups run online within two different Australian cities. Facilitators of the groups found that they were able to hold the infants and mothers safely in the online space despite the unexpected presence of others in the families' homes. The home-based nature of the work caused by lockdown restrictions revealed a transparency not found in office-based work, whilst simultaneously, evoking some discomfort. The ease with which infants and young children embraced technology worked in favor of using the online space. Playful, restorative, and creative ways of engaging with a highly vulnerable cohort of families were achieved; enhancing relational repair following both family violence and the isolation created by restrictions imposed by lockdowns. Despite an initial hesitancy to move online, the authors discovered meaningful ways through which to engage, treat and provide safe relational repair work with infants and their mothers impacted by family violence.

Young children's traumatic stress reactions to the COVID-19 pandemic: The long reach of mothers' adverse childhood experiences

BACKGROUND

The COVID-19 pandemic has negatively impacted parental and child mental health; however, it is critical to examine this impact in the context of parental histories of adversity. We hypothesized that maternal adverse childhood experiences (ACEs) and pandemic-related negative life events would predict child traumatic stress symptoms (TSS) and tested potential mediating pathways through maternal pandemic-related TSS and/or poorer maternal sensitivity during the pandemic.

METHODS

Data were collected from a longitudinal sample of low-income, racially/ethnically diverse mothers and their children. Between May and November 2020, mothers (n = 111) of young children (M age = 7.42 years, SD = 0.45) completed questionnaires to assess their own and their child's pandemic-related TSS, exposure to pandemic-related negative events, and parent-child relationship quality. Maternal ACEs, maternal depression, parent-child relationship quality, and child internalizing symptoms had been assessed approximately 1-3 years prior.

RESULTS

Structural equation analyses revealed that pandemic negative life events were indirectly associated with child TSS via greater maternal TSS. For mothers, recent pandemic-related negative events were associated with their own TSS, whereas maternal ACEs were not. Maternal ACEs directly predicted greater child TSS, with no evidence of mediation by either maternal TSS or maternal sensitivity.

LIMITATIONS

All measures were parent report, and pandemic-related measures were collected at the same time point.

CONCLUSIONS

Findings underscore the long reach of mothers' own adverse childhood experiences, highlighting the negative consequences of these prior traumatic exposures alongside current pandemic-related maternal trauma symptoms for children's adjustment during the pandemic.

Positive Caregiving Styles Attenuating Effects of Cumulative Trauma Among Youth Who Commit Sexual Crimes

Among youth who commit sexual crimes, childhood trauma experiences have been linked to a host of outcomes including trauma symptom expression. Furthermore, research has begun assessing differential rates of cumulative adverse childhood experiences (ACEs) between youth who commit sexual and non-sexual crimes. Yet, few studies have comparatively examined rates of cumulative traumatic events using more robust measures of adversity. There is scant research on outcomes associated cumulative trauma among youth who commit sexual crimes including linkages to trauma symptoms and how positive parenting styles (PCSs) can attenuate in this relationship. This study aims to compare cumulative trauma experiences between youth who commit sexual (n = 112) and non-sexual crimes (n = 224). Among youth who commit sexual crimes, we test how PCSs mitigate or moderate the effects of cumulative trauma on trauma symptoms. Results from independent samples t-tests revealed significant group differences on singular and cumulative traumatic experiences, and trauma symptomatology, where youth who commit sexual crimes had higher rates of all. Stepwise linear regressions revealed mitigating effects of maternal PCSs and tests of moderation revealed main and interaction effects, where intermediate positive maternal caregiving styles for youth with higher cumulative trauma were associated with greater trauma symptomatology. Implications and limitations are discussed.

Addressing challenges at the intersection of early intervention and child welfare

BACKGROUND

The Keep Children and Families Safe Act amendment to the Child Abuse Prevention and Treatment Act (CAPTA) of 2003 mandated children under age three who are involved with Child Welfare (CW) to receive a referral to the system for early intervention (EI). While there is strong rationale for providing developmental services to young children and families impacted by maltreatment, the early implementation of this policy brought about many challenges related to interagency coordination and readiness of providers to provide cross-systems care. Currently, as the system and providers within the system recover from the effects of Covid-19, a predicted increase in need of services may exacerbate historical gaps in the provision of services to families involved with CW.

PARTICIPANTS AND SETTING

This policy-focused paper explores issues impacting CW and EI providers who coordinate care between CW and EI services.

METHODS

This paper provides a historical examination of these challenges and proposes an approach for improving developmental services for families referred from CW, specifically through the lens of addressing resources and supports available to providers.

RESULTS

The proposed approach includes an increase and reprioritization of resources to support provider readiness and well-being.

CONCLUSIONS

By focusing on support for providers, the authors propose a reduction of stress and improvement of services at each level of the "well-being" system.

Screening for PTSD and functional impairment in trauma-exposed young children: evaluation of alternative CBCL-PTSD subscales

The Child Behavior Checklist (CBCL 1.5–5 years) posttraumatic stress disorder (PTSD) subscale by Dehon & Scheeringa (2006) as a screener for PTSD in trauma-exposed young children has yielded inconsistent results so far. Therefore, the aim of this study was to create and examine the validity of alternative CBCL-PTSD subscales and compare them to the existing CBCL-PTSD subscale based on the DSM-5 PTSD diagnostic criteria for children 6 years and younger. Further, the CBCL-PTSD subscales were examined regarding their usefulness in screening for posttraumatic stress-related functional impairment. The sample comprised 116 trauma-exposed young children (Mage = 3.42 years, SDage = 1.21 years, female = 49.1%). The psychometric properties of the existing CBCL-PTSD subscale as well as the alternative subscales based on expert rating (CBCL-PTSD-17) and based on variable importance (CBCL-PTSD-6) were evaluated by means of receiver operating characteristic curves, sensitivity, specificity, positive predictive values, and negative predictive values. Area under the curves for all three investigated CBCL-PTSD subscales were good to excellent for PTSD and functional impairment. Further, all three CBCL-PTSD subscales showed high sensitivity for PTSD and functional impairment. Considering the length and the performance of the three investigated subscales, the CBCL-PTSD-6 appears to be a promising and clinically useful CBCL-PTSD subscale as a screener for PTSD and functional impairment due to the easiest and most practicable application. For purposes of discriminant validation of the CBCL-PTSD-6, young children without a history of trauma should be compared to young children with trauma history.

Trauma-informed care and ethics consultation in the NICU

Trauma-informed care responds to our current understanding of the ways in which people's traumatic life experiences influence both their health and their interactions with the health care system. Many ethics consults arise because those past traumatic life experiences are not recognized and addressed. In this paper, we present a NICU case that led to an ethics consultation about end-of-life decisions for a dying baby. We illustrate the ways in which a trauma-informed approach helped doctors, nurses and ethics consultants to better understand and care for the mother and baby.

Trauma-Informed Intervention with Children: Integrating the CANS Assessment with the ARC Framework in a Clinical Setting

Ongoing trauma-focused assessment is critical to developing trauma-informed treatment plans. The current study examines the clinical benefits of utilizing the Child and Adolescent Needs and Strengths (CANS) assessment to guide intervention based on the Attachment, Self-Regulation, and Competency (ARC) model to address children's trauma related symptoms in a rural state. WV CANS was developed by adapting the language of original CANS to be culturally specific to the state's unique situation and culture in consultation with the original CANS developer. This study included the data from children who received mental health services under WV CANS-ARC mapping from 2017 to 2019. Children's trauma-related symptoms are assessed using the WV CANS at intake and every 90 days to identify any changes in their symptoms. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three time points, with a total of 362 children used for the current analyses using Multilevel modeling with SAS PROC MIXED. The study found that children's trauma related symptoms significantly decreased in all ARC outcome domains over time after adjusting for basic demographic variables. The current study contributes to the evidence on treatment for children's trauma-related symptoms, especially with the application of the CANS-ARC mapping in a real-world clinical setting. The findings have significant implications for clinicians in integrating the assessment and treatment process using CANS-ARC mapping and for cross-system collaboration with continuity of care serving children who have experienced trauma.

Risks of major mental disorders after parental death in children, adolescents, and young adults and the role of premorbid mental comorbidities: a population-based cohort study

Previous studies have shown an association between early parental death and the risk of subsequent major mental disorders (MMDs) among the bereaved children and adolescents; however, it is unclear whether this risk exists in young adults and in individuals with premorbid mental comorbidities. We aimed to explore differences between children, adolescents, and young adults in the risk of MMDs after parental death. We analyzed data from the Taiwan National Health Research Database. The index cohort was offspring (divided into four groups: aged < 6, 6-11, 12-17, and 18-29 years) whose parents had died. The control cohort was demographically matched offspring whose parents were still alive. Cox regression with adjustments for demographics was used to estimate the risk of subsequent MMDs between the index and control cohorts, including schizophrenia, bipolar disorder, and depressive disorder. We included 202,837 cases and 2,028,370 matched controls. As with the bereaved children and adolescents, the bereaved young adults had a significantly higher risk of schizophrenia (hazard ratio with 95% confidence interval: 5.63; 5.01-6.33), bipolar disorder (3.37; 2.96-3.84), and depressive disorder (2.78; 2.68-2.90) than the control cohort. The risk of MMDs was similar for maternal death and paternal death. Among premorbid mental comorbidities, bereaved individuals with premorbid substance use disorder were associated with the highest risk of schizophrenia (10.43; 8.57-12.71), bipolar disorder (12.93; 10.59-15.79), and depressive disorder (10.97; 10.22-11.78). Healthcare workers should be aware that young adults and individuals with premorbid mental comorbidities are at a higher risk of subsequent MMDs than those without premorbid mental comorbidities after parental death.

The impact of the first wave of the Covid-19 pandemic on parents of children with externalising difficulties in ireland: A longitudinal cohort study

BACKGROUND

This longitudinal cohort study aimed to examine the impact of the first wave of the COVID-19 pandemic in Ireland on parents of children with externalising difficulties, in comparison to parents of children without such difficulties.

METHOD

Parents of 159 children completed online self-report measures at three time points during the first wave of the COVID-19 pandemic; (a) Delay and Mitigation Phase (March 2020 to May 2020), (b) Reopening of Society Phase (June 2020 to July 2020) and (c) Wave 2 Case Acceleration Phase (September 2020 to October 2020). Participants were allocated to the clinical group if they met the clinical cut off point on the Conduct or Hyperactivity/Inattention subscales of the Strengths and Difficulties Questionnaire at Time 1.

RESULTS

Parents of children with externalising difficulties experienced significantly higher levels of stress, lower levels of wellbeing and engaged in higher levels of avoidant-focused coping strategies longitudinally. There was a significant difference between outcomes at the different phases of the COVID-19 pandemic, for stress related to parenting, personal/family stress related to the impact of the COVID-19 and type of coping strategies employed. Children with externalising difficulties, in comparison to children without externalising difficulties, showed significantly greater adjustment over time for behavioural and emotional difficulties, as reported by their parents.

CONCLUSIONS

Results provide important information regarding the trajectory of psychological outcomes in parents of children with externalising difficulties over the first wave of the COVID-19 pandemic, highlighting the need for increased parental supports during, and after, the COVID-19 pandemic.

The Role of Acculturation and Intimate Partner Violence on Post-Traumatic Stress Symptoms Among Hispanic Youth With Child Welfare Contact

Research suggests that Hispanic youth with intimate partner violence (IPV) exposure report fewer trauma symptoms compared with youth from other racial/ethnic groups. However, no study has examined possible explanations for this finding. Our objective was to study the association between acculturation, IPV, and post-traumatic stress (PTS) symptoms among Hispanic youth and to test whether acculturation moderates the relationship between IPV and PTS symptoms. This analysis used data from 271 Hispanic youth aged 8 years or older participating in the second cohort of the National Survey of Child and Adolescent Well-being (NSCAW II). We conducted multiple linear regression analyses to achieve our study aims. We did not find a statistically significant relationship between IPV exposure and PTS symptoms among Hispanic youth (B = 0.21, 95% confidence interval [CI] = [-0.09, 0.52]), or that acculturation moderated this relationship (B = 0.04, 95% CI = [-0.23, 0.32]). However, we found a significant relationship between PTS symptoms and acculturation level. Specifically, higher levels of acculturation were associated with more reports of PTS symptoms (B = 1.03, 95% CI = [0.13, 1.93]). These study results highlight the need to consider the role of acculturation when working with Hispanic youth involved with child welfare.

Mothers' Experience of Intimate Partner Violence and Subsequent Offspring Attachment Security Ages 1-5 Years: A Meta-Analysis

Attachment status in early childhood is a key yet modifiable contributor to the development of social-emotional competence. The security and organization of the infant-mother attachment bond is particularly susceptible to stressors in the caregiving environment. While the impacts of normative interparental conflict on infant attachment are increasingly understood, the potentially unique place of intimate partner violence (IPV) in this pathway has been under-researched. This study surveyed all empirical work in this area, including unpublished literature (k = 6, N = 3,394), to examine meta-analytic associations between maternal experiences of IPV and offspring attachment security (ages 1-5 years) measured at least 6 months post-IPV exposure. Mothers' reports of IPV from pregnancy onward were inversely associated with offspring attachment security, r = -.23, CI [-0.42, -0.04], p = .02. Sample risk characteristics (e.g., clinical vs. community) moderated this association; child's age at attachment measurement and method of assessing child attachment (e.g., observational, representational, parent report) also moderated at a trend level. Implications for early screening, intervention, and future research are discussed.

Migration-related trauma and mental health among migrant children emigrating from Mexico and Central America to the United States: Effects on developmental neurobiology and implications for policy

Children make up over half of the world's migrants and refugees and face a multitude of traumatic experiences prior to, during, and following migration. Here, we focus on migrant children emigrating from Mexico and Central America to the United States and review trauma related to migration, as well as its implications for the mental health of migrant and refugee children. We then draw upon the early adversity literature to highlight potential behavioral and neurobiological sequalae of migration-related trauma exposure, focusing on attachment, emotion regulation, and fear learning and extinction as transdiagnostic mechanisms underlying the development of internalizing and externalizing symptomatology following early-life adversity. This review underscores the need for interdisciplinary efforts to both mitigate the effects of trauma faced by migrant and refugee youth emigrating from Mexico and Central America and, of primary importance, to prevent child exposure to trauma in the context of migration. Thus, we conclude by outlining policy recommendations aimed at improving the mental health of migrant and refugee youth.

Parental history of childhood maltreatment and child average RSA shape parent-child RSA synchrony

We examined whether dynamic parent-child RSA synchrony varied by individual differences in child average RSA and parental history of childhood maltreatment (CM), which has been linked to parental behavioral and physiological dysregulation. We also examined whether RSA synchrony was curvilinear, reflecting homeostatic regulation. Synchrony was defined as the dynamic association between parent and child RSA reactivity (change relative to their own mean) within epoch across a challenging task. Eighty-three mother-preschooler and 61 father-preschooler dyads participated. State-trait modeling showed that RSA synchrony was curvilinear such that significant relations were only found at lower and higher child reactivity. Children's higher task average RSA predicted maternal RSA augmentation and lower task average RSA predicted maternal RSA withdrawal, regardless of whether child reactivity in the moment was low or high, suggesting individual differences in child regulatory capacity were associated with dynamic maternal reactivity. When maternal CM history and child average RSA were both higher, mothers showed RSA augmentation. Father-child synchrony was not moderated by child average RSA but greater paternal CM history predicted fathers' greater RSA withdrawal regardless of whether child RSA reactivity was low or high. Findings offer novel insights into the nature and meaning of RSA synchrony with parents at risk.

The impact of adverse childhood experiences on healthcare utilization in children

BACKGROUND

Adverse childhood experiences (ACEs) are related to long-term negative outcomes. The impact of these experiences on healthcare utilization in children has been understudied.

OBJECTIVE

To examine the impact of ACEs on children's healthcare utilization, medical diagnoses, and pharmacological treatment.

PARTICIPANTS AND SETTING

Children aged 6 months to 17 years who were screened for ACEs in the Behavioral Health Department or in primary care locations as part of an initial consultation visit and who had at least one subsequent healthcare visit during the study period were included in the study.

METHODS

Adverse childhood experiences were measured using the ACE screening questionnaire designed by Felitti et al. (1998). Data from the year following administration of the ACE screening tool were retrospectively extracted from the electronic health record.

RESULTS

Overall, 1,183 children met study inclusion criteria. Children with any reported ACEs were more likely to no show appointments (1-3 ACEs incidence rate ratio (IRR) [95 % confidence interval (CI)]: 1.40 [1.11-1.77]; 4+ ACEs IRR [95 % CI]: 1.41 [1.08-1.84]) and to use emergency services (1-3 ACEs IRR [95 % CI]: 1.24 [1.00-1.53]; 4+ ACEs: IRR [95 % CI]: 1.42 [1.11-1.81) than children with no ACEs. Those with 4+ ACEs used the telephone nurse advisor less frequently (1-3 ACEs IRR [95 % CI]: 0.67 [0.53-0.84]; 4+ ACEs IRR [95 % CI]: 0.69 [0.53-0.90]). Although ACE scores were associated with healthcare utilization, insurance status was more robustly associated with healthcare utilization than ACE score.

CONCLUSIONS

Healthcare systems may employ results from this study to adopt trauma-informed care initiatives. Ensuring that all patients have insurance may be a first step toward improving healthcare utilization.

Age-related similarities and differences in networks of acute trauma-related stress symptoms in younger and older preschool children

BACKGROUND

Prior research on trauma-exposed preschool children has found various levels of trauma-related stress symptoms depending on age, which might be explained by developmental factors.

OBJECTIVE

This study uses network analysis to extend prior research and compare symptom presentation in younger and older preschoolers in the acute phase (first 4 weeks) following a potentially traumatic event.

METHOD

Parent-reported trauma-related acute stress symptoms were assessed using the Pediatric Emotional Distress Scale - Early Screener via www.kidtrauma.com. First, the overall symptom severity and symptom levels were compared between younger (1-3 years) and older (4-6 years) preschoolers. Further, two Gaussian graphical models of stress symptoms in younger (n = 242; M_age = 2.3 years; SD_age = 0.6 years) and older preschoolers (n = 299; M_age = 4.8 years; SD_age = 0.7 years) were modelled and compared.

RESULTS

Overall symptom severity did not differ between the groups. Symptom levels for developmental regression and avoidance of talking about the event were higher in older preschoolers. The network structures of the younger and the older preschoolers were largely similar. Highly central symptoms in both networks were trauma-unrelated fear and anger. The connections between fear of reminders and clinginess and trauma-unrelated fear and clinginess were stronger in the older preschoolers' network. The connections between worry and sadness and withdrawal; fear of reminders and creation of games, stories, and pictures; and whininess and clinginess were all stronger in the younger preschoolers' network.

CONCLUSIONS

Trauma-related stress symptomatology of younger and older preschoolers may not differ greatly in the acute phase. Trauma-unrelated fear and anger seem to be central symptoms in both groups. However, examining symptom-level associations across age groups revealed differential connections that might arise from developmental differences. If replicated in longitudinal and within-subject studies, these findings could help tailor interventions for trauma-exposed preschoolers in the acute phase.

The Experience of the Infant Entering Refuge (Shelter) Setting with Their Mothers After Fleeing Family Violence

Almost nothing is known about how the infant may experience being in a women's Refuge (Shelter) setting with their mother after fleeing family violence, despite the high numbers of infants and young children in Refuges or Shelters. This research was concerned with exploring how the infant experienced refuge within a Refuge setting post family violence. Using a non-intrusive, ethically informed, 'infant led' approach, this research involved ten infants (aged 3 weeks to 16 months), ten mothers, and 13 staff in eight Refuges from three countries: Australia, Scotland and England. Data was collected through infant observation, interviews with mothers and then staff. Presented is a synthesis of a research methodology which was led by the infant, drew on concepts of 'inter-subjectivity' and used a constructivist grounded theory method. Infants were often lost from view within the Refuge setting. The mother, herself traumatised, was expected to be the refuge for her infant. Only the obviously distressed infant was assisted, and where available, from outside specialist workers. It was often too painful for the adults, both mothers and staff, to see or reflect on the infant's possible trauma. Significantly, in all cases the motivation for each mother to enter Refuge was ensuring their infant's safety. Concern for their infant or young child can be a powerful catalyst for women leaving a violent relationship. Refuges (Shelters) are in a unique position to respond to the infant in their own right whilst helping to heal and grow the infant/mother relationship.

Examination of the associations between young children's trauma exposure, trauma-symptomatology, and executive function

The present study used a bioecological framework to examine associations between trauma exposure, trauma-related symptomatology, and executive function (EF) in an urban sample of 88 predominantly ethnic-minority, low-income preschoolers (age 2-5) exposed to interpersonal trauma. Contrary to hypotheses based on past literature documenting associations between trauma exposure and EF deficits in childhood, in regressions adjusting for child gender, family income, and caregiver education, neither trauma exposure or trauma-related symptoms (post-traumatic stress symptoms, internalizing behaviors, or externalizing behaviors) were significantly associated with children's EF performance. Associations between child trauma exposure, symptomatology, and executive function were not moderated by parental PTSD symptomatology; and EF was not differentially predicted by type of trauma. Results suggest that, within an ethnically-diverse sample of preschool-aged children exposed to multiple traumas, associations between trauma exposure, symptomatology, and EF may be particularly nuanced. Keywords: child trauma, posttraumatic stress, executive function, preschool-age children, child mental health.

Adverse caregiving in early life: The trauma and deprivation distinction in young children

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move beyond broad indices of risk and toward more specific and individualized understanding of how risk exposures are linked to clinical outcomes in young children. Within infant and early childhood mental health, there is a need for greater specificity in linking adverse caregiving experiences in early life to psychopathology in children. We highlight a framework distinguishing experiences of trauma from experiences of deprivation and use the examples of posttraumatic stress disorder and reactive attachment disorder to demonstrate how greater specificity in our understanding of early adverse caregiving can lead to more accurate and targeted diagnosis and treatment for young children. Both researchers and clinicians benefit from an approach to gain a greater appreciation of the links between specific types of experiences and outcomes in the children that we serve.

The hypothalamic-pituitary-adrenal axis in the perinatal period: Its relationship with major depressive disorder and early life adversity

Objectives: Effects of major depressive disorder and early life adversity (ELA) on the maternal HPA axis in the perinatal period were examined.Methods: Four groups of women (n = 127) were recruited, with the perinatal groups being compared during pregnancy (Preg) and at two months postpartum (PP) - [1] Depressed during pregnancy (Depressed-Preg/PP), [2] Prior history of depression but euthymic during pregnancy (History-Preg/PP), [3] Healthy pregnant women (Control-Preg/PP), and [4] Healthy non-pregnant women (Non-pregnant Control). Serial saliva samples were collected over the course of a day and waking and evening cortisol, total cortisol output and the cortisol awakening response were examined.Results: There were no HPA axis differences among the three groups during pregnancy. A history of ELA, regardless of comorbid depression, was associated with higher evening cortisol levels during pregnancy (p = 0.015). Women in the Depressed-PP group had had higher evening cortisol levels compared to the History-PP group (p < 0.017).Conclusions: Evening cortisol measures are a potential marker for both ELA and depression, with higher levels during pregnancy being associated with ELA and higher levels postpartum being associated with antenatal depression.

Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa

BACKGROUND

While intimate partner violence (IPV) has well documented impact on women and children, few interventions have been tested for mothers and children in the domestic violence shelter system.

OBJECTIVE

We used mixed methods to explore effects of a pilot intervention combining trauma focused cognitive behavior therapy (TF-CBT) (verbal therapy method) with art and play therapy (non-verbal therapy methods) in New York City and Johannesburg, to compare efficacy between high and low-middle income contexts.

PARTICIPANTS AND SETTING

School-aged children and their mothers from one domestic violence shelter in each city were invited to participate.

METHODS

Children were screened for depression and post-traumatic stress disorder (PTSD). Children participated in a weekly group session lasting 1-2 hours over 12 weeks and mothers received 3 group sessions. Quantitative data comprised pre-and post-intervention child self-reports (n = 21) and mother's report (n = 16) of child depressive and PTSD symptoms. Qualitative in-depth interviews were conducted with children (n = 11) and mothers (n = 8) who completed the intervention.

RESULTS

At baseline, children showed high rates of symptoms of probable depression and probable PTSD (33 % and 66 % respectively). By endline, depressive symptoms significantly reduced (mean of 13.7-8.3,p = 0.01) and there was a non-significant trend towards PTSD improvement (40.0-34.4, p = 0.21). Children revealed the art helped them express difficult emotions and experiences with their mothers. Multiple children felt it assisted in managing challenging behaviours.

CONCLUSION

This pilot trauma-informed art and play therapy group intervention holds promise in mitigating the effects of IPV for children and mothers in domestic violence shelters.

Early Childhood Education Programs as Protective Experiences for Low-Income Latino Children and Their Families

Research is accelerating toward a deeper understanding of early childhood education (ECE) environments as protective experiences for Latino children; however, more work remains. This paper provides a review of the evidence that ECE environments benefit Latino children and mitigate the impact of adverse childhood experiences (ACEs) and other poverty-related risks; however, Latino families face numerous barriers to accessing ECE opportunities for their children. While enrollment by Latino children in ECE programs has grown in prior decades, further increases in access to ECE are needed to benefit Latino children, who are disproportionately impacted by poverty. In addition, ECE programs, especially high-quality and dual generation-focused programs like Early Head Start and Head Start, are in a strong position to help offset the risk for poor educational and mental health outcomes due to Latino's children's exposure to stressors such as discrimination and ACEs. Gaps remain in how well ECE is serving Latino families due to a combination of factors including parental work schedules, heritage language and cultural factors, and the lack of affordable and available ECE programs in Latino communities. To remedy these gaps, researchers must continue to further elucidate the needs, preferences, and gaps regarding access to early care and education opportunities for Latino children. For those studying trauma and ACEs among low-income children, greater attention to how preventative interventions or treatments that are embedded in ECE settings serve Latino populations is warranted, as this has the tremendous potential to mitigate the long-term impact of ACEs on Latino children. The paper concludes with a set of early childhood practice and policy recommendations for enhancing protective experiences for low-income Latino children.

Self-harm and violent criminality linked with parental death during childhood

BACKGROUND

Adverse health and social outcomes are known to occur more frequently following parental death during childhood, but evidence is lacking for comparing long-term risks of internalised v. externalised harm.

METHODS

This national register-based cohort study consisted of Danish persons born 1970-2000. The Civil Registration System and National Causes of Death Register were linked to ascertain parental deaths by cause before cohort members' 15th birthdays. From age 15 years, hospital-treated self-harm episodes were ascertained through linkage to the National Patient Register and the Psychiatric Central Research Register, and violent crimes were identified via linkage to the National Crime Register. Hazard ratio and cumulative incidence values were estimated.

RESULTS

Self-harm and violent criminality risks were elevated following parental death during childhood. Covariate adjustment for gender, birth year and first-degree relatives' mental illnesses attenuated these associations, although significantly heightened risks persisted. The estimated hazard ratios did not differ greatly according to which parent died, but losing both parents conferred particularly large risk increases. Risks for both adverse outcomes were higher in relation to unnatural v. natural parental death; violent criminality risk was especially raised among individuals exposed to parental death by unnatural causes other than suicide. The association was strongest when pre-school age children experienced parental death.

CONCLUSIONS

Effective early intervention is needed to help youngsters who have experienced the death of one or both parents to develop immediate and sustained coping strategies. Enhanced cooperation between health and social services and criminal justice agencies may mitigate risks for these two destructive behaviours.

Toward fostering resilience on a large scale: Connecting communities of caregivers

In interventions for at-risk children, Tom Dishion strongly exhorted programs that are short term, cost-effective, and delivered in families' own communities, just as resilience researchers underscore the need for programs that provide ongoing support for children's primary caregivers, and are implementable on a large scale. Presented here are preliminary results on a short-term intervention for mothers, the Authentic Connections Virtual Groups. A previous randomized trial of the in-person version of this program, conducted with mothers at high risk for stress and burnout, showed significant benefits. There had been zero dropouts across the 3-month program, and participants showed significant improvements on psychological indices as well as cortisol, even 3 months after the program ended. In the present study, virtual groups were conducted with five sets of women, all white-collar professionals with highly stressful, exacting careers, and most also primary caregivers of their children. Again, there were zero dropouts. Mean satisfaction ratings were 9.6 of 10, and the Net Promoter Score (promoters vs. detractors) fell in the "world class" range. To illuminate mechanisms of change, participants' responses to open-ended questions on the groups' value are presented verbatim. Recurrently mentioned were the development of new, authentic connections and invaluable ongoing support. These results, with the low costs and ease of women's attendance, attest to the value of expanding offerings such as these, toward benefiting even more highly stressed mothers themselves as well as the children for whose care they are responsible.

Patterns of exposure to adverse childhood experiences and their associations with mental health: a survey of 1346 university students in East Asia

INTRODUCTION

Adverse childhood experiences (ACEs) constitute a significant global mental health burden. Prior studies typically investigated the impact of ACEs on mental health using a cumulative risk approach; most ACEs studies were also conducted in Western settings.

PURPOSE

This study aimed to examine ACEs using a pattern-based approach and assess their associations with mental health outcomes by early adulthood in East Asia.

METHODS

The present study included measures of exposure to 13 categories of ACEs, depression, anxiety, maladjustment, and posttraumatic stress in a sample of 1346 university students from Hong Kong, China, Taiwan, and Japan.

RESULTS

Latent class analysis indicated three distinct patterns of ACE exposure: Class 1: Low ACEs (76.0%); Class 2: Household Violence (20.6%); and Class 3: Household Dysfunction (3.4%). Those representing Class 3 had significantly more ACEs compared with those in Classes 1 or 2. Controlling for age and sex, those in Class 2 reported significantly higher depression and maladjustment symptoms compared with those in Class 1; both Classes 2 and 3 had significantly higher anxiety symptoms and odds for meeting diagnostic criteria for posttraumatic stress disorders compared with those in Class 1.

CONCLUSIONS

Study findings suggest that young adults' mental health, at least under certain contexts, is more closely linked with the nature and pattern of ACE co-occurrence, rather than the number of ACEs.

Study of the Differential Consequences of Neglect and Poverty on Adaptive and Maladaptive Behavior in Children

The consequences of physical neglect on retardation in the development of adaptive behaviors and the increased risk of poor physical and mental health are well documented. As physical neglect is a phenomenon found almost exclusively among socially deprived people, it is important to distinguish the health effects caused by neglect from those caused by poverty. The objective of this study was to compare the effects of poverty and physical neglect on the development of problematic externalizing and internalizing behaviors, adaptive skills, and school problems among school children between the ages of 3 and 12. A group of 157 children were chosen from 28 Andalusian schools and classified in three homogeneous groups. Children in group 1 (n = 53) had two target conditions: living in slums (poverty) and suffering from neglect. Children in group 2 (n = 52) had one target condition: living in the same slums as the children in group 1, but not suffering from neglect. Group 3 (n = 52) consisted of children from other (non-slum) neighborhoods who did not suffer from neglect. Adaptive and maladaptive behaviors were evaluated with the Behavior Assessment System for Children (BASC). Significant differences were found between group 1 and group 2, but there were no important differences between group 2 and group 3. The conclusion was that externalizing and internalizing problems, school problems, and low adaptive skills found in neglected children were associated with neglect rather than with poverty or socially deprived environments.

The role of early care and education in addressing early childhood trauma

Young children's experience of trauma is associated with a wide range of adverse events and circumstances, including abuse and neglect, domestic violence, loss of a parent, and community violence. Policymakers and practitioners are increasingly aware that trauma during the first few years of life is especially widespread, and there is growing interest in new ways to support these young children and their families. Many young children who experience trauma attend early care and education (ECE) programs, and these settings offer important opportunities to promote their well-being. This paper examines strategies currently being implemented in ECE to address early childhood trauma. The paper first examines research on how trauma affects young children's development, ECE environments, and society. We then describe the unique needs of young, traumatized children and features of trauma-informed care that can address their needs, along with emerging interventions and supports that can be incorporated into or linked with ECE settings as part of a trauma-informed approach. We conclude with a discussion of future directions for ECE and trauma research, policy, and practice, bearing in mind both the promise of new approaches and a limited evidence base to date.

Screening for Trauma Symptoms in Child Welfare-Involved Young Children: Findings from a Statewide Trauma-Informed Care Initiative

Young children who experience abuse, neglect, domestic violence, and other interpersonal forms of trauma are at risk for developing complex psychological trauma. Timely referrals by child welfare services for trauma evaluation and intervention is critical, particularly during the developmentally-sensitive period of birth to three. However, few screening instruments exist that are feasible for implementation in child welfare services and none have reported psychometric data for children under three. The aim of this exploratory, retrospective study was to examine developmental differences in detection rates of two brief trauma screening scales, comparing outcomes for toddlers (age 1 and 2 years) and preschoolers (age 3 to 6 years), using the evaluation data from a statewide child welfare demonstration project. The sample included 151 children ages 1 to 6 participating in evidence-based trauma treatment with their caregivers. More than 80% of children, regardless of age group, met the cut-off on one of the screeners; children who met the cut-off on either screener were significantly more likely to have experienced domestic violence, physical abuse or poly-victimization. Implications for future research are discussed.

Healing the Past by Nurturing the Future-co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study

INTRODUCTION

Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal parents experiencing complex trauma.

METHODS AND ANALYSIS

This formative research project is being conducted in three Australian jurisdictions (Northern Territory, South Australia and Victoria) with key stakeholders from all national jurisdictions. Four action research cycles incorporate mixed methods research activities including evidence reviews, parent and service provider discussion groups, development and psychometric evaluation of a recognition and assessment process and drafting proposals for pilot, implementation and evaluation. Reflection and planning stages of four action research cycles will be undertaken in four key stakeholder workshops aligned with the first four Intervention Mapping steps to prepare programme plans.

ETHICS AND DISSEMINATION

Ethics and dissemination protocols are consistent with the National Health and Medical Research Council Indigenous Research Excellence criteria of engagement, benefit, transferability and capacity-building. A conceptual framework has been developed to promote the application of core values of safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. These include related principles and accompanying reflective questions to guide research decisions.

Parenting after a history of childhood maltreatment: A scoping review and map of evidence in the perinatal period

Background and aims

Child maltreatment is a global health priority affecting up to half of all children worldwide, with profound and ongoing impacts on physical, social and emotional wellbeing. The perinatal period (pregnancy to two years postpartum) is critical for parents with a history of childhood maltreatment. Parents may experience ‘triggering’ of trauma responses during perinatal care or caring for their distressed infant. The long-lasting relational effects may impede the capacity of parents to nurture their children and lead to intergenerational cycles of trauma. Conversely, the perinatal period offers a unique life-course opportunity for parental healing and prevention of child maltreatment. This scoping review aims to map perinatal evidence regarding theories, intergenerational pathways, parents’ views, interventions and measurement tools involving parents with a history of maltreatment in their own childhoods.

Methods and results

We searched Medline, Psychinfo, Cinahl and Embase to 30/11/2016. We screened 6701 articles and included 55 studies (74 articles) involving more than 20,000 parents. Most studies were conducted in the United States (42/55) and involved mothers only (43/55). Theoretical constructs include: attachment, social learning, relational-developmental systems, family-systems and anger theories; ‘hidden trauma’, resilience, post-traumatic growth; and ‘Child Sexual Assault Healing’ and socioecological models. Observational studies illustrate sociodemographic and mental health protective and risk factors that mediate/moderate intergenerational pathways to parental and child wellbeing. Qualitative studies provide rich descriptions of parental experiences and views about healing strategies and support. We found no specific perinatal interventions for parents with childhood maltreatment histories. However, several parenting interventions included elements which address parental history, and these reported positive effects on parent wellbeing. We found twenty-two assessment tools for identifying parental childhood maltreatment history or impact.

Conclusions

Perinatal evidence is available to inform development of strategies to support parents with a history of child maltreatment. However, there is a paucity of applied evidence and evidence involving fathers and Indigenous parents.

Mothers and Toddlers Exposed to Political Violence: Severity of Exposure, Emotional Availability, Parenting Stress, and Toddlers' Behavior Problems

This study examined the potential risks of maternal and child exposure to traumatic events resulting from political violence, specifically those related to emotional availability, parenting stress and children's behavioral problems. It also evaluated the feasibility of mitigating these effects through a play-based group intervention for conjoint dyads of mothers and toddlers. Results from 54 dyads show that the higher maternal and especially child exposure to political violence and other trauma, the lower their emotional availability in dyadic interactions (r = .40, p < .01). Emotional availability was associated with the mother's parenting stress, and both parenting stress and emotional availability were associated with the mother's perceptions of her child's behavior problems. Comparisons of observed emotional availability, child behavior problems as perceived by the mother, and reported stress in 28 dyads before and after participating in the intervention suggest that it may be possible to bolster emotional availability and to reduce child's behavior problems.

Home-Based Parent Child Therapy for Young Traumatized Children Living In Poverty: A Randomized Controlled Trial

A randomized control trial was used to evaluate the effectiveness of a home-based, parent-and-child therapy program specifically developed for toddlers and preschoolers living in poverty with trauma symptoms. Sixty-four children 5-years of age and younger were referred to a community-based clinic for behavior problems and emotional difficulties. All children had experienced one or more potentially traumatic events and met the DSM-5's criteria for Post-Traumatic Stress Disorder in Children Six Years of Age and Younger. All families received government assistance indicating that their income met the federal definition for poverty. Participants were randomly assigned to either immediate treatment or wait list control groups. Significant between-group differences on all post-treatment measures were found. After the waitlist group completed treatment, significant improvements for both groups were found on all measures at six-weeks follow-up. Outcomes included reductions in challenging behaviors and emotional symptoms of trauma, improved caregiver-child relationships, and increased caregiver adherence to treatment strategies. This study offers support for early intervention of children with trauma symptoms and identifies the clinical challenges and advantages of providing therapy services in a home setting for very young children in poverty.

Profiles of adverse childhood experiences and impulsivity

The influence of adverse childhood experiences (ACEs), which often include childhood exposure to maltreatment and household dysfunction, on health risk behaviors during young adulthood has been widely documented. A vulnerability marker for the increased risky behaviors among young ACEs victims such as impulsivity remains to be explored. The present study investigated how different profiles of ACEs influence impulsivity in young adulthood. Respondents were young people (N = 336; ages 18-25) who were recruited from the community. Latent class analysis (LCA) was used to identify subpopulations of individuals based on varying exposure to 13 types of ACEs, including childhood maltreatment, household dysfunction, and community violence. Four distinct classes emerged: Low ACEs (56%), Household Dysfunction/Community Violence (14%), Emotional ACEs (14%), and High/Multiple ACEs (16%). Multiple regression analyses found that compared to those in the Low ACEs class, young adults in the Emotional ACEs and High/Multiple ACEs respectively, reported increased levels of negative urgency, controlling for sociodemographic characteristics and other impulsivity traits. This result suggests that childhood exposure to multiple ACEs at high levels is particularly related to impulsive self-control in the context of intense negative emotionality.

Trauma and resilient functioning among Syrian refugee children

Following the civil war in Syria, there has been a growing interest in the impact of war, violent conflict, and refuge on the development and mental health of refugee children in general and Syrian refugee children in particular. The objective of this paper is threefold: (a) to critically review the existing literature on the psychological functioning of Syrian refugee children, with a particular focus on those residing in the urban areas or camps in Turkey; (b) to identify the main theoretical and methodological problems of this emerging literature; and (c) to suggest guidelines for how to improve research and practice in this field. The reviewed literature predominantly focuses on psychological trauma, trauma-related symptomatology or other maladaptive functioning in children, and psychosocial interventions conducted toward alleviating these issues. This paper will summarize the research findings in the above-mentioned topics to discern what can be known from the existing literature on Syrian refugee children.

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.

Early life experiences and social cognition in major psychiatric disorders: A systematic review

Objective:

To present a systematic review of the literature on the associations between early social environment, early life adversity, and social cognition in major psychiatric disorders, including schizophrenia, bipolar disorder, borderline personality disorder, major depressive disorder and posttraumatic stress disorder.

Method:

Relevant studies were identified via electronic and manual searches of the literature and included articles written in English and published in peer-reviewed journals up to May 2018. Quality assessment was performed using the quality evaluation scale employed in previous systematic reviews.

Results:

A total of 25 studies were included in the systematic review with the quality assessment scores ranging from 3 to 6 (out of 6). The vast majority of the studies reviewed showed a significant association between early childhood social experience, including both insecure attachment and adversity relating to neglect or abuse, and poorer social cognitive performance.

Conclusion:

We discuss these findings in the context of an attachment model, suggesting that childhood social adversity may result in poor internal working models, selective attention toward emotional stimuli and greater difficulties with emotional self-regulation. We outline some of the steps required to translate this understanding of social cognitive dysfunction in major psychiatric disorders into a target for interventions that mitigate the adverse effects of childhood maltreatment and poor parental attachment on social cognition.

Intergenerational Transmission of Trauma: Maternal Trauma-Related Cognitions and Toddler Symptoms

The purpose of this study was to elucidate possible cognitive mechanisms involved in the intergenerational transmission of trauma from maltreatment-survivor mothers to their toddler/preschool-aged children. This study investigated whether maternal trauma-related cognitions-posttrauma appraisals and disorganized memory for maltreatment-were associated with higher levels of toddler internalizing and externalizing symptoms and more dysfunction in the mother-child relationship. A community sample of mothers with histories of maltreatment and a child between the ages of 2 and 5 years was recruited for a study on maternal attachment, coping, and health ( N = 113). Path analysis results showed that posttrauma appraisals and disorganized memory were significantly related to toddler internalizing symptoms, even with maternal trauma symptoms included in the model. Maternal posttrauma appraisals and disorganized memory were also linked to more dysfunction in the mother-child relationship. These findings provide preliminary evidence in support of maternal trauma-related cognitions as potential mechanisms for the intergenerational transmission of trauma.