Trauma, mental representation, and the organization of memory for mother-referent material

The development of empathy in child maltreatment contexts

BACKGROUND

Despite robust associations between child maltreatment experiences and emotional development, a paucity of research examines the influence of child maltreatment on empathy development, and still fewer studies differentiate these effects across maltreatment subtypes.

OBJECTIVE

The present study examined the development of children's empathy from ages six to eight, as predicted by maltreatment, and as moderated by children's attachment representations.

PARTICIPANTS AND SETTING

Participants were a community sample of 250 children followed longitudinally and assessed in a laboratory setting with their primary caregivers.

METHOD

Child maltreatment experiences from birth to age six were assessed by semi-structured interviews with caregivers, which were rated according to widely-used child maltreatment coding protocols, and by caregiver and child self-report measures. Child empathy was assessed at ages six and eight by caregiver-report. Attachment representations were observed in children using the MacArthur Story Stem Battery.

RESULTS

Child emotional abuse (β = -0.150, p = .012) and child neglect (β = -0.137, p = .016) predicted decreased empathy at age eight, whereas child physical abuse (β = 0.132, p = .027) and child exposure to domestic violence (β = 0.164, p = .004) predicted increased empathy at age eight. Further, children's negative representations of mother figures moderated the positive association between child physical abuse and empathy (β = -0.177, p = .005), such that the association became weaker as negative representations increased.

CONCLUSIONS

These results highlight the nuanced ways in which child maltreatment experiences of different subtypes contribute to the development of empathy in school-aged children.

Community Violence, PTSD, Hopelessness, Substance Use, and Perpetuation of Violence in an Urban Environment

We investigated the relationships among chronic violence exposure, post-traumatic stress disorder (PTSD) symptom severity, hopelessness, substance use, and perpetuation of violence to facilitate the development of trauma-related interventions for residents of Newark, NJ. A convenience sample of Newark residents (N = 153) was recruited from community centers during various events in 2016-2017. Anonymous, self-report survey measures included a PTSD screen (PCL-C), Beck's Hopelessness Scale, the CAGE questionnaire, and a CDC Health Behavior Scale. Descriptive statistics, Pearson's correlations, Chi square analyses, logistic, and linear regressions were used for analysis. Thirty percent (95% CI [22.7, 37.4]) of our sample screened positive for PTSD. Drug and alcohol use, fighting, and hopelessness were related to severity of PTSD symptoms (p < 0.05). Female gender, CAGE scores, and hopelessness predicted the severity of PTSD symptoms (R² = 0.354, p < 0.05). Our data has informed the development of a resilience support group currently in the pilot stage for community members.

The latent structure of the adult attachment interview: Large sample evidence from the collaboration on attachment transmission synthesis

The Adult Attachment Interview (AAI) is a widely used measure in developmental science that assesses adults’ current states of mind regarding early attachment-related experiences with their primary caregivers. The standard system for coding the AAI recommends classifying individuals categorically as having an autonomous, dismissing, preoccupied, or unresolved attachment state of mind. However, previous factor and taxometric analyses suggest that: (a) adults’ attachment states of mind are captured by two weakly correlated factors reflecting adults’ dismissing and preoccupied states of mind and (b) individual differences on these factors are continuously rather than categorically distributed. The current study revisited these suggestions about the latent structure of AAI scales by leveraging individual participant data from 40 studies (N = 3,218), with a particular focus on the controversial observation from prior factor analytic work that indicators of preoccupied states of mind and indicators of unresolved states of mind about loss and trauma loaded on a common factor. Confirmatory factor analyses indicated that: (a) a 2-factor model with weakly correlated dismissing and preoccupied factors and (b) a 3-factor model that further distinguished unresolved from preoccupied states of mind were both compatible with the data. The preoccupied and unresolved factors in the 3-factor model were highly correlated. Taxometric analyses suggested that individual differences in dismissing, preoccupied, and unresolved states of mind were more consistent with a continuous than a categorical model. The importance of additional tests of predictive validity of the various models is emphasized.

The impact of patterns of trauma exposure among low income children with and without histories of child maltreatment

Previous research has revealed a large prevalence of trauma experienced by children, creating high risk for the development of psychopathology. Research investigating the negative impacts of child maltreatment and other traumas has typically examined these experiences individually, controlling for co-occurring traumas, or has combined these experiences into a general variable of risk, thereby obscuring the complex relationships among environmental traumas and maltreatment. The current study expands on previous research by elucidating relationships between multiple contexts of overlapping traumas and maltreatment experienced by children, and by categorizing how these experiences join together to impact internalizing and externalizing symptomatology. Participants included 316 maltreated children and 269 nonmaltreated children (M age = 9.4, SD = 0.88) who attended a summer day camp research program for low-income children. Latent Class Analysis (LCA) identified three differential patterns of trauma exposure across children: 1) community violence and loss; 2) pervasive trauma; and 3) low trauma. Covariate analyses demonstrated that child maltreatment was significantly associated with class membership, suggesting that maltreated children were more likely to experience diverse traumas extending beyond their maltreatment experiences (pervasive trauma class). A two-way analysis of variance also demonstrated that trauma latent class membership and child maltreatment each represented unique predictors of internalizing and externalizing symptoms, with each having an independent effect on symptomatology. This investigation provides unique insight into the differential impact of patterns of trauma exposure and child maltreatment, providing support for further research and clinical practice addressing multiple levels of a child's ecology.

Direct protective and buffering protective factors in the development of youth violence

This article discusses conceptual issues and reviews knowledge about direct and buffering protective factors in the development of youth violence. Direct protective factors predict a low probability of violence, whereas buffering protective factors predict a low probability of violence in the presence of risk (and often interact with risk factors). Individual, family, school, peer, and neighborhood factors are reviewed. Heterogeneity of variables, measurement, contexts, study design, sample, and other characteristics limit generalizations. However, there were various evidence-based candidates for having a direct protective or buffering protective effect such as above-average intelligence, low impulsivity/easy temperament, enhanced anxiety, prosocial attitudes, high heart rate, close relationship to at least one parent, intensive parental supervision, medium SES of the family, sound academic achievement, strong school bonding, a positive school/class climate, nondeviant peers, and living in a nondeprived and nonviolent neighborhood. The probability of violence decreases as the number of protective factors increases (a dose-response relationship). Implications for future research and practice concern adequate research designs to detect nonlinear relationships; conceptually and methodologically homogeneous studies; differentiated analyses with regard to age, gender, and other characteristics; and greater integration of longitudinal correlational research with (quasi-)experimental intervention studies.

Can maltreated children inhibit true and false memories for emotional information?

The authors examined 284 maltreated and nonmaltreated children's (6- to 12-year-olds) ability to inhibit true and false memories for neutral and emotional information using the Deese/Roediger-McDermott (DRM) paradigm. Children studied either emotional or neutral DRM lists in a control condition or were given directed-remembering or directed-forgetting instructions. The findings indicated that children, regardless of age and maltreatment status, could inhibit the output of true and false emotional information, although they did so less effectively than when they were inhibiting the output of neutral material. Verbal IQ was related to memory, but dissociative symptoms were not related to children's recollective ability. These findings add to the growing literature that shows more similarities among, than differences between, maltreated and nonmaltreated children's basic memory processes.

Can maltreated children inhibit true and false memories for emotional information?

The authors examined 284 maltreated and nonmaltreated children's (6- to 12-year-olds) ability to inhibit true and false memories for neutral and emotional information using the Deese/Roediger-McDermott (DRM) paradigm. Children studied either emotional or neutral DRM lists in a control condition or were given directed-remembering or directed-forgetting instructions. The findings indicated that children, regardless of age and maltreatment status, could inhibit the output of true and false emotional information, although they did so less effectively than when they were inhibiting the output of neutral material. Verbal IQ was related to memory, but dissociative symptoms were not related to children's recollective ability. These findings add to the growing literature that shows more similarities among, than differences between, maltreated and nonmaltreated children's basic memory processes.

The effects of maltreatment and neuroendocrine regulation on memory performance

This investigation examined basic memory processes, cortisol, and dissociation in maltreated children. School-aged children (age range=6-13), 143 maltreated and 174 non-maltreated, were administered the California Verbal Learning Test-Children (D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1994) in a week-long camp setting, daily morning cortisol levels were assessed throughout the duration of camp, and behavioral symptoms were evaluated. Maltreatment and cortisol regulation were not related to short- or long-delay recall or recognition memory. However, children experiencing neglect and/or emotional maltreatment and low cortisol evinced heightened false recognition memory. Dissociative symptoms were higher in maltreated children; however, high dissociation was related to recognition inaccuracy only among non-maltreated children. Results highlight the interplay between maltreatment and hypocortisolism in children's recognition memory errors.

Community violence: a meta-analysis on the effect of exposure and mental health outcomes of children and adolescents

Meta-analytic techniques were used to estimate the effects of exposure to community violence on mental health outcomes across 114 studies. Community violence had its strongest effects on posttraumatic stress disorder (PTSD) and externalizing problems and smallest impact on other internalizing symptoms. Victimization by community violence most predicted symptomatology compared to witnessing or hearing about community violence. Witnessing community violence had a greater effect than hearing about violence on externalizing problems, but both types of exposure had an equal impact on other internalizing problems. PTSD symptoms were equally predicted by victimization, witnessing, or hearing about community violence. Compared to children, adolescents reported a stronger relationship between externalizing behaviors and exposure, whereas children exhibited greater internalizing problems than did adolescents.

Attachment and selective attention: Disorganization and emotional Stroop reaction time

Although central to attachment theory, internal working models remain a useful heuristic in need of concretization. We compared the selective attention of organized and disorganized mothers using the emotional Stroop task. Both disorganized attachment and emotional Stroop response involve the coordination of strongly conflicting motivations under conditions of emotional arousal. Furthermore, much is known about the cognitive and neuromodulatory correlates of the Stroop that may inform attempts to substantiate the internal working model construct. We assessed 47 community mothers with the Adult Attachment Interview and the Working Model of the Child Interview in the third trimester of pregnancy. At 6 and 12 months postpartum, we assessed mothers with emotional Stroop tasks involving neutral, attachment, and emotion conditions. At 12 months, we observed their infants in the Strange Situation. Results showed that: disorganized attachment is related to relative Stroop reaction time, that is, unlike organized mothers, disorganized mothers respond to negative attachment/emotion stimuli more slowly than to neutral stimuli; relative speed of response is positively related to number of times the dyad was classified disorganized, and change in relative Stroop response time from 6 to 12 months is related to the match-mismatch status of mother and infant attachment classifications. We discuss implications in terms of automatic and controlled processing and, more specifically, cognitive threat tags, parallel distributed processing, and neuromodulation through norepenephrine and dopamine.

Self-reported early trauma as a predictor of adult personality: a study in a military sample

Exposure to early trauma has frequently been linked to adult psychopathology, including personality disorders. This cross-sectional study explored the relationship between personality and retrospectively rated levels of early trauma in 242 soldiers. Multiple regression analyses showed a significant relationship between early trauma and adult personality as exposure to emotional trauma predicted levels of self-directedness and cooperativeness on the Temperament and Character Inventory (TCI; C. R. Cloninger, T. R. Przybeck, D. M. Svrakic, & R. D. Wetzel, 1994). Overall, these results suggest that early emotional trauma may be related to personality dimensions associated with poor impulse control and interpersonal behavior. These results are noteworthy considering that they were obtained in a healthy sample. They show that early trauma may become ingrained in personality and hamper the potential to effectively engage in social interactions, increasing the risk of emotional and cognitive problems.

The enhancing connections program: pilot study of a cognitive-behavioral intervention for mothers and children affected by breast cancer

In 2005, approximately 211,240 women in the US will be diagnosed with early stage breast cancer and an estimated 22% will be child rearing. Research reveals that both mothers and children have elevated distress attributed to the cancer; struggle with how to talk about and deal with the impact of the cancer; and both fear the mother will die. The Enhancing Connections Program (EC) was developed to reduce this cancer-related distress and morbidity. The program involves five, 1-hour educational counseling sessions delivered at 2-week intervals by specially trained clinicians. This study reports on the program's short-term impact on mothers' and children's adjustment. Thirteen households were recruited within 7.5 months of the mother's diagnosis with early stage breast cancer. Impact was evaluated within a single group design using data obtained from standardized questionnaires with established reliability and validity. Results revealed significant improvements in the mother's depressed mood, anxiety, and self-confidence to assist her child (mother report). There were also significant decreases in the child's behavioral problems (mother and father report); the child's cancer-related worries (child report); and the child's anxiety/depressed mood (mother and father report). Further evaluation is warranted within a clinical trial.

The Construction of Experience: A Longitudinal Study of Representation and Behavior

Continuity in relationship representation and developmental links between relationship representation and behavior from infancy to late adolescence were examined using longitudinal data from a risk sample (N = 185). Significant correlations were found among diverse representational assessments (e.g., interview, drawing, projective narrative) and between representational and concurrent observational measures of relationship functioning. Structural equation models were analyzed to investigate the relations among caregiving experience in infancy; relationship representation and experience in early childhood, middle childhood, and early adolescence; and socioemotional functioning in adolescence. A model representing interactive contributions of representational and behavioral experience represented the data significantly better than a model representing noninteractive contributions. Findings support an organizational developmental view that socioemotional adaptation arises from the progressive construction of mutually informing expectations and experience.

Protection, Dissociation, and Internal Roles: Modeling and Treating the Effects of Child Abuse

This article presents a theory of the long-term effects of child abuse that emphasizes the development of internal working models of protection. The theory proposes that abused children do not receive adequate caregiver protection and do not form internal representations of an effective protector. As a result, they have ongoing difficulty defending themselves against interpersonal aggression and internal self-criticism. The model integrates current research and theory in attachment behavior, developmental psychopathology, trauma, dissociation, and experiential psychotherapy. It accounts for many of the clinical symptoms presented by adult survivors of child abuse and suggests specific strategies for treatment. The author provides 3 examples of psychotherapy interventions derived from the model, distinguishes protection and “rescuing,” and suggests directions for future research.

Associations between psychological profiles and diseases: examining hemispheric dominance and autonomic activation as underlying regulators

Personality profiles are often typical for specific illnesses, e.g., the type A personality and heart disease. We hypothesize that many more such patterns exist, and have developed a scheme in which many diseases can be classified, depending on hemispheric dominance (i.e., integrated, intellectualising or emotional) and type of autonomic control (i.e., dominance of either sympathetic or parasympathetic system, or an increase in both types of autonomic outflow). Our hypothesis is based on recent findings in neurophysiology, involving the early rearing environmental effects on the developing orbitofrontal cortex, and attachment theory. We conclude with implications for therapy, and a discussion of the limitations of our hypothesis.

Links between community violence and the family system: evidence from children's feelings of relatedness and perceptions of parent behavior

In this study, we examined some of the ways in which broader ecological systems may influence the organization of behavior within the family system. Specifically, links between exposure to community violence and children's relationships with maternal caregivers were investigated in a sample of 127 urban children between the ages of 7 and 13 years. Children were asked to indicate whether they had been exposed to a wide variety of violent events. In addition, their feelings of relatedness and separation anxiety, and their perceptions of maternal behavior were assessed. It was expected that exposure to community violence would be associated with feeling less secure with caregivers. Consistent with predictions from ecological-transactional theory, data supported this hypothesis. Children who reported that they had been exposed to high levels of community violence also indicated that they felt less positive affect when with their caregiver, were dissatisfied with how close they felt to her, felt more separation anxiety, and reported more negative maternal behavior than children exposed to less violence. Findings are discussed in terms of how violence may affect the family system and the protective function of human attachment.

Effects of marital conflict on children: recent advances and emerging themes in process-oriented research

BACKGROUND

The effects of marital conflict on children's adjustment are well documented. For the past decade research has increasingly focused on advancing a process-level understanding of these effects, that is, accounting for the particular responses and patterns embedded within specific contexts, histories, and developmental periods that account for children's outcomes over time.

METHODS

As a vehicle for presenting an update, this review follows the framework for process-oriented research initially proposed by Cummings and Cummings (1988), concentrating on recent research developments, and also considering new and emerging themes in this area of research.

RESULTS

In this regard, areas of advancement include (a) greater articulation of the effects of specific context/stimulus characteristics of marital conflict, (b) progress in identifying the psychological response processes in children (e.g., cognitive, emotional, social, physiological) that are affected and their possible role in accounting for relations between marital conflict and child outcomes, (c) greater understanding of the role of child characteristics, family history, and other contextual factors, including effects on children due to interrelations between marital conflict and parenting, and (d) advances in the conceptualization of children's outcomes, including that effects may be more productively viewed as dynamic processes of functioning rather than simply clinical diagnoses.

CONCLUSIONS

Understanding of the impact of marital conflict on children as a function of time-related processes remains a gap in a process-oriented conceptualization of effects. Based on this review, a revised model for a process-oriented approach on the effects of marital discord on children is proposed and suggestions are made for future research directions.

Possible role of cortisol and dehydroepiandrosterone in human development and psychopathology

BACKGROUND

The characteristics of adrenal hormone secretion change markedly during infancy. Disturbances in basal levels may precipitate psychological dysfunction and are associated with psychopathology in young people.

AIMS

To relate three aspects of behavioural endocrinology: developmental changes in cortisol and dehydroepiandrosterone (DHEA), the role of these hormones in the psychopathology of young people, and the action of these steroids in the brain.

METHOD

A selective review from the human developmental, psychiatric and neurosciences literature.

RESULTS

There are developmentally mediated changes in brain sensitivity following excess exposure to cortisol. This may result in impairments of mental and behavioural function. DHEA and gonadal steroids may modulate the actions of cortisol.

CONCLUSIONS

Steroid hormones contribute to shaping behavioural function during early development and act as risk factors for psychopathology.

Down will come baby, cradle and all: diagnostic and therapeutic implications of chronic trauma on child development

OBJECTIVE

This review examines the clinical outcomes associated with exposure to chronic intrafamilial trauma and explores the treatment of the psychological, biological and cognitive sequelae.

METHOD

The existing research literature on the subject was collected, using Index Medicus/MEDLINE, Psychological Abstracts and the PILOTS database. The research findings were supplemented with clinical observations by the authors and other clinical writings on this topic.

RESULTS

Children with histories of exposure to multiple traumatic experiences within their families or in medical settings usually meet criteria for numerous clinical diagnoses, none of which capture the complexity of their biological, emotional and cognitive problems. These are expressed in a multitude of psychological, cognitive, somatic and behavioural problems, ranging from learning disabilities to aggression against self and others.

CONCLUSIONS

Exposure to intrafamilial violence and other chronic trauma results in pervasive psychological and biological deficits. Treatment needs to address issues of safety, stabilise impulsive aggression against self and others, promote mastery experiences, compensate for specific developmental deficits, and judiciously process both the traumatic memories and trauma-related expectations.