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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Rosso AM. Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children's Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13015. [PMID: 36293590 PMCID: PMC9602324 DOI: 10.3390/ijerph192013015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child's safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child-parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents' narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent-child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent-child psychotherapy resulted, which proved to be the most effective.
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Affiliation(s)
- Anna Maria Rosso
- Department of Education, University of Genoa, 16128 Genoa, Italy
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Buchheim A, Ziegenhain U, Kindler H, Waller C, Gündel H, Karabatsiakis A, Fegert J. Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology. Front Hum Neurosci 2022; 16:890262. [PMID: 35923749 PMCID: PMC9341217 DOI: 10.3389/fnhum.2022.890262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach. Methods Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood. Results Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences. Conclusion We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.
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Affiliation(s)
- Anna Buchheim
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | | | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nürnberg, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Jörg Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
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Richters JE. Incredible Utility: The Lost Causes and Causal Debris of Psychological Science. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1080/01973533.2021.1979003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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Early life stress and neural development: Implications for understanding the developmental effects of COVID-19. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 22:643-654. [PMID: 33891280 PMCID: PMC8063781 DOI: 10.3758/s13415-021-00901-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 01/14/2023]
Abstract
Chronic and/or extreme stress in childhood, often referred to as early life stress, is associated with a wide range of long-term effects on development. Given this, the COVID-19 pandemic has led to concern about how stress due to the pandemic will affect children's development and mental health. Although early life stress has been linked to altered functioning of a number of neural and biological systems, there is a wide range of variability in children's outcomes. The mechanisms that influence these individual differences are still not well understood. In the past, studies of stress in childhood focused on the type of events that children encountered in their lives. We conducted a review of the literature to formulate a new perspective on the effects of early life stress on development. This new, topological model, may increase understanding of the potential effects of the COVID-19 pandemic on children's development. This model is oriented on children's perceptions of their environment and their social relationships, rather than specific events. These factors influence central and peripheral nervous system development, changing how children interpret, adapt, and respond to potentially stressful events, with implications for children's mental and physical health outcomes.
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Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up. Dev Psychopathol 2021; 33:554-564. [PMID: 33487189 DOI: 10.1017/s0954579420001765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluated whether Attachment and Biobehavioral Catch-up (ABC), a parenting intervention, altered the attachment representations of parents (average age of 34.2 years) who had been referred to Child Protective Services (CPS) due to risk for child maltreatment when their children were infants. Approximately 7 years after completing the intervention, parents who had been randomized to receive ABC (n = 43) exhibited greater secure base script knowledge than parents who had been randomized to receive a control intervention (n = 51). Low-risk parents (n = 79) exhibited greater secure base script knowledge than CPS-referred parents who had received a control intervention. However, levels of secure base script knowledge did not differ between low-risk parents and CPS-referred parents who had received the ABC intervention. In addition, secure base script knowledge was positively associated with parental sensitivity during interactions with their 8-year-old children among low-risk and CPS-referred parents. Mediational analyses supported the idea that the ABC intervention enhanced parents' sensitivity 7 years later indirectly via increases in parents' secure base script knowledge.
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8
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Greene CA, Haisley L, Wallace C, Ford JD. Intergenerational effects of childhood maltreatment: A systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence. Clin Psychol Rev 2020; 80:101891. [PMID: 32745835 PMCID: PMC7476782 DOI: 10.1016/j.cpr.2020.101891] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022]
Abstract
A history of maltreatment in childhood may influence adults' parenting practices, potentially affecting their children. This systematic review examines 97 studies investigating associations of parental childhood victimization with a range of parenting behaviors that may contribute to the intergenerational effects of abuse: abusive parenting, problematic parenting, positive parenting, and positive parental affect. Key findings include: (1) parents who report experiencing physical abuse or witnessing violence in the home during childhood are at increased risk for reporting that they engage in abusive or neglectful parenting; (2) a cumulative effect of maltreatment experiences, such that adults who report experiencing multiple types or repeated instances of victimization are at greatest risk for perpetrating child abuse; (3) associations between reported childhood maltreatment experiences and parents' problematic role reversal with, rejection of, and withdrawal from their children; (4) indirect effects between reported childhood maltreatment and abusive parenting via adult intimate partner violence; and (5) indirect effects between reported childhood maltreatment and lower levels of positive parenting behaviors and affect via mothers' mental health. Thus, childhood experiences of maltreatment may alter parents' ability to avoid negative and utilize positive parenting practices. Limitations of this body of literature include few prospective studies, an overreliance on adults' self-report of their childhood victimization and current parenting, and little examination of potentially differential associations for mothers and fathers.
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Affiliation(s)
- Carolyn A Greene
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | | | - Cara Wallace
- University of Hartford, 200 Bloomfield Avenue, West, Hartford, CT 06117, USA
| | - Julian D Ford
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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Smith KE, Pollak SD. Rethinking Concepts and Categories for Understanding the Neurodevelopmental Effects of Childhood Adversity. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 16:67-93. [PMID: 32668190 PMCID: PMC7809338 DOI: 10.1177/1745691620920725] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Discovering the processes through which early adverse experiences affect children’s nervous-system development, health, and behavior is critically important for developing effective interventions. However, advances in our understanding of these processes have been constrained by conceptualizations that rely on categories of adversity that are overlapping, have vague boundaries, and lack consistent biological evidence. Here, we discuss central problems in understanding the link between early-life adversity and children’s brain development. We conclude by suggesting alternative formulations that hold promise for advancing knowledge about the neurobiological mechanisms through which adversity affects human development.
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Affiliation(s)
- Karen E Smith
- Department of Psychology and Waisman Center, University of Wisconsin-Madison
| | - Seth D Pollak
- Department of Psychology and Waisman Center, University of Wisconsin-Madison
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Aspects of Parent-Child Interaction from Infancy to Late Adolescence Are Associated with Severity of Childhood Maltreatment through Age 18. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113749. [PMID: 32466383 PMCID: PMC7312453 DOI: 10.3390/ijerph17113749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
Abstract
Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent-child interaction that indicate risk for CM and that can instigate strategically targeted family supports. The aim of this longitudinal study was to assess multiple aspects of observed mother-child interaction from infancy to late adolescence as risk indicators of the overall severity of CM by age 18. Mother-child dyads were assessed in infancy (N = 56), at age 7 years (N = 56), and at age 19 years (N = 56/110). Severity of CM through age 18 was indexed by combined prospective and retrospective assessments. Interactions associated with severity of CM by age 18 included maternal hostility in infancy, maternal withdrawal in infancy and middle childhood, child disorganized attachment behavior in middle childhood and late adolescence, as well as hostile and role-confused interactions in late adolescence. This study identifies new indices of maternal and child behavior as important risk indicators for the severity of CM. These indices could be used to improve early identification and tailor preventive interventions for families at risk for CM.
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11
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Cooke JE, Racine N, Plamondon A, Tough S, Madigan S. Maternal adverse childhood experiences, attachment style, and mental health: Pathways of transmission to child behavior problems. CHILD ABUSE & NEGLECT 2019; 93:27-37. [PMID: 31048134 DOI: 10.1016/j.chiabu.2019.04.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Investigations have found mothers' adverse childhood experiences (ACEs) confer an intergenerational risk to their children's outcomes. However, mechanisms underlying this transmission have only been partially explained by maternal mental health. Adult attachment insecurity has been shown to mediate the association of ACEs and mental health outcomes, yet an extension of this research to children's behavioral problems has not been examined. OBJECTIVE To examine the cascade from maternal ACEs to risk for child behavioral problems at five years of age, via mothers' attachment insecurity and mental health. PARTICIPANTS AND SETTING Participants in the current study were 1994 mother-child dyads from a prospective longitudinal cohort collected from January 2011 to October 2014. METHODS Mothers retrospectively reported their ACEs when children were 36 months of age. When children were 60 months of age, mothers completed measures of their attachment style, depression and anxiety symptoms, and their children's behavior problems. RESULTS Path analysis demonstrated maternal ACEs were associated with children's internalizing problems indirectly via maternal attachment avoidance, attachment anxiety, and depression symptoms, but not directly (β = .05, 95% CI [-.001, .10]). Maternal ACEs indirectly predicted children's externalizing problems via maternal attachment avoidance, attachment anxiety, and depression. A direct effect was also observed from maternal ACEs to child externalizing problems (β = .06, 95% CI [.01, .11]). CONCLUSIONS Maternal ACEs influenced children's risk for poor behavioral outcomes via direct and indirect intermediary pathways. Addressing maternal insecure attachment style and depression symptoms as intervention targets for mothers with histories of ACEs may help to mitigate the intergenerational transmission of risk.
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Affiliation(s)
- Jessica E Cooke
- University of Calgary, Canada; Alberta Children's Hospital Research Institute, Canada
| | - Nicole Racine
- University of Calgary, Canada; Alberta Children's Hospital Research Institute, Canada
| | | | - Suzanne Tough
- University of Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Cumming School of Medicine, Canada
| | - Sheri Madigan
- University of Calgary, Canada; Alberta Children's Hospital Research Institute, Canada.
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12
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Robinson-Drummer PA, Opendak M, Blomkvist A, Chan S, Tan S, Delmer C, Wood K, Sloan A, Jacobs L, Fine E, Chopra D, Sandler C, Kamenetzky G, Sullivan RM. Infant Trauma Alters Social Buffering of Threat Learning: Emerging Role of Prefrontal Cortex in Preadolescence. Front Behav Neurosci 2019; 13:132. [PMID: 31293398 PMCID: PMC6598593 DOI: 10.3389/fnbeh.2019.00132] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
Within the infant-caregiver attachment system, the primary caregiver holds potent reward value to the infant, exhibited by infants' strong preference for approach responses and proximity-seeking towards the mother. A less well-understood feature of the attachment figure is the caregiver's ability to reduce fear via social buffering, commonly associated with the notion of a "safe haven" in the developmental literature. Evidence suggests this infant system overlaps with the neural network supporting social buffering (attenuation) of fear in the adults of many species, a network known to involve the prefrontal cortex (PFC). Here, using odor-shock conditioning in young developing rats, we assessed when the infant system transitions to the adult-like PFC-dependent social buffering of threat system. Rat pups were odor-shock conditioned (0.55 mA-0.6 mA) at either postnatal day (PN18; dependent on mother) or 28 (newly independent, weaned at PN23). Within each age group, the mother was present or absent during conditioning, with PFC assessment following acquisition using 14C 2-DG autoradiography and cue testing the following day. Since the human literature suggests poor attachment attenuates the mother's ability to socially buffer the infants, half of the pups at each age were reared with an abusive mother from PN8-12. The results showed that for typical control rearing, the mother attenuated fear in both PN18 and PN28 pups, although the PFC [infralimbic (IL) and ventral prelimbic (vPL) cortices] was only engaged at PN28. Abuse rearing completely disrupted social buffering of pups by the mother at PN18. The results from PN28 pups showed that while the mother modulated learning in both control and abuse-reared pups, the behavioral and PFC effects were attenuated after maltreatment. Our data suggest that pups transition to the adult-like PFC social support circuit after independence from the mother (PN28), and this circuit remains functional after early-life trauma, although its effectiveness appears reduced. This is in sharp contrast to the effects of early life trauma during infancy, where social buffering of the infant is more robustly impacted. We suggest that the infant social buffering circuit is disengaged by early-life trauma, while the adolescent PFC-dependent social buffering circuit may use a safety signal with unreliable safety value.
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Affiliation(s)
- Patrese A. Robinson-Drummer
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
| | - Maya Opendak
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
| | - Anna Blomkvist
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Stephanie Chan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Stephen Tan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Cecilia Delmer
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Kira Wood
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Aliza Sloan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, United States
| | - Lily Jacobs
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Biology, Yeshiva University, New York, NY, United States
| | - Eliana Fine
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Biology, Yeshiva University, New York, NY, United States
| | - Divija Chopra
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Chaim Sandler
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Biology, Yeshiva University, New York, NY, United States
| | - Giselle Kamenetzky
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Instituto de Investigaciones Médicas A Lanari, IDIM-CONICET, Universidad de Buenos Aires, Combatientes de Malvinas 3150 (CP 1427), Buenos Aires, Argentina
| | - Regina M. Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
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Effects of an attachment-based intervention in infancy on children's autonomic regulation during middle childhood. Biol Psychol 2019; 143:22-31. [PMID: 30772404 DOI: 10.1016/j.biopsycho.2019.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/22/2018] [Accepted: 01/12/2019] [Indexed: 11/21/2022]
Abstract
The present study used a longitudinal randomized clinical trial to test whether an early intervention has causal effects on children's autonomic nervous system regulation. When children were infants, parents involved with Child Protective Services received Attachment and Biobehavioral Catch-up (ABC; N = 43), an intervention that promotes sensitive parenting, or a control intervention (N = 53). When children were 9 years old, children whose parents had received ABC exhibited higher respiratory sinus arrhythmia and lower heart rate at rest and during a parent-child interaction than children in the control group. Intervention effects were not detected for children's average skin conductance levels or for indices of autonomic reactivity. Results suggest that a parenting-focused early intervention impacted the development of children's autonomic regulation.
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14
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The effect of maltreatment experiences on maltreating and dysfunctional parenting: A search for mechanisms. Dev Psychopathol 2019. [DOI: 10.1017/s0954579418001517] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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