Physiological and cognitive correlates of child abuse

Trauma-Informed Yoga: Investigating an Intervention for Mitigating Adverse Childhood Experiences in Rural Contexts

In a state ravaged by suicide and a mental health crisis, this study sought to mitigate impacts of adverse childhood experiences (ACEs) and depressive and anxiety symptomology in high school students in a rural Montana community. Through a seven-week, twice weekly intervention of trauma-informed yoga, participants experienced statistically significant reductions in anxiety (GAD-7) and increases in Strengths and Difficulties (SDQ-11) overall scores and some subscales; noteworthy improvements were also present in depressive symptomatology (PHQ-A), salivary cortisol levels, and sleep duration. Importantly, participant qualitative feedback indicated significant benefits in focus, relaxation, and overall well-being. Further research is needed to imply generalizability and should include a larger, more diverse sample as well as utilization of control groups and an examination of academic and behavioral impacts at the school level.

The neurophysiological embedding of child maltreatment

Maltreatment adversely impacts the development of children across a host of domains. One way in which maltreatment may exert its deleterious effects is by becoming embedded in the activity of neurophysiological systems that regulate metabolic function. This paper reviews the literature regarding the association between childhood maltreatment and the activity of three systems: the parasympathetic nervous system, the sympathetic nervous system, and the hypothalamic-pituitary-adrenal axis. A particular emphasis is placed on the extent to which the literature supports a common account of activity across these systems under conditions of homeostasis and stress. The paper concludes with an outline of directions for future research and the implications of the literature for policy and practice.

The neurocognitive profiles of children adopted from care and their emotional and behavioral problems at home and school

Adoptees' mental health problems in childhood and later life are well described, but little attention has been paid to domestically adopted children's emotional and behavioral problems and neurocognitive profiles. The aim of this study was to describe the neurocognitive profiles of domestically adopted children in the UK and their parent- and teacher-rated emotional and behavioral problems. Forty-five children (M age = 75.96 months, SD = 12.98; 51.1% female) who were placed for adoption from public care at a M age of 22.14 months (SD = 14.21) completed a battery of age standardized neurocognitive tests, and adoptive parents and school teachers rated their emotional and behavioral problems. Children had more emotional and behavioral problems than the general population and over a fifth scored low (> 1 SD below the expected range for their age) in 5/6 neurocognitive tasks. Children who scored low on the non-verbal reasoning task were more likely to have more parent- and teacher-rated behavioral problems, and children's performance on the inhibitory control and cognitive flexibility tasks were associated with parent-rated behavioral problems. Children's verbal reasoning scores were positively associated with both parent- and teacher-rated emotional problems. Children who were adopted later in childhood scored significantly lower in non-verbal reasoning. Although longitudinal studies are needed to clarify the nature of neurocognitive functioning as a marker for later mental health problems, our findings underscore the importance of using comprehensive assessments to better recognize adopted children's difficulties and inform appropriate intervention initiatives.

Autonomic nervous system activity and callous-unemotional traits in physically maltreated youth

BACKGROUND

Research into callous-unemotional (CU) traits often focuses exclusively on biological risk factors without integrating social factors. This gap exists despite a growing body of research showing that the social environment may actually impact physiological functioning, which could in turn affect behavior.

OBJECTIVE

The current study addresses this limitation by examining physical maltreatment and heart rate stress reactivity as potential risk factors for CU traits.

PARTICIPANTS AND SETTING

This research was conducted in a community sample of Chinese youth (mean age = 11.83 years, 44.3 % female).

METHODS

Each child separately reported frequency of physical maltreatment experiences by his or her mother and father over the past 12 months. Children completed a self-report measure of CU traits.

RESULTS

Frequency of maternal physical maltreatment was associated with uncaring traits in females, but not in males. Paternal physical maltreatment was associated with uncaring traits in both males and females and with callous traits in females only. While paternal physical maltreatment was associated with lower heart rate reactivity in females, maternal physical maltreatment was associated with higher heart rate reactivity in females.

CONCLUSION

Findings provide mixed support for a potential physiological pathway through which child maltreatment may impact callous traits and provide a multilevel, biosocial lens through which to understand CU traits.

Child Maltreatment, Autonomic Nervous System Responsivity, and Psychopathology: Current State of the Literature and Future Directions

Child maltreatment may affect autonomic nervous system (ANS) responsivity, and ANS responsivity may influence the impact of child maltreatment on later outcomes including long-term mental/physical health. This review systematically evaluated the evidence regarding effects of maltreatment on ANS responsivity in children and examined how ANS responsivity may influence the association between maltreatment and psychopathology, with attention to relevant developmental issues. We searched the literature for relevant studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched five electronic databases, performed key word searches in relevant journals, hand searched reference sections of relevant articles, and contacted experts in the field. Articles were extracted according to inclusion criteria and their quality assessed. The search produced 1,388 articles; 22 met inclusion criteria. Most of the studies suggested blunted cardiovascular responsivity generally and sympathetic activation specifically in response to stress in maltreated children compared to nonmaltreated children. Findings around vagal responsivity and skin conductance were mixed. Limited evidence was found for ANS responsivity as a moderator or mediator of psychopathology risk among maltreated children. Maltreatment may be associated with blunted sympathetic activation in stressful situations. Differences in ANS responsivity may influence psychopathology risk among maltreated children. Further research is needed to confirm the nature and magnitude of such effects.

Effects of an attachment-based intervention in infancy on children's autonomic regulation during middle childhood

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.

Factor analysis and predictive validity of the Early Risks of Physical Abuse and Neglect Scale (ERPANS): A prospective study in Dutch public youth healthcare

Early detection of child abuse risk factors in families of new-born babies is an important task of the public youth health care system in the Netherlands. The Early Risks of Physical Abuse and Neglect Scale (ERPANS) was originally developed in Belgium as an observation scale for public child healthcare nurses. The present longitudinal study is an independent prospective validation of the ERPANS in a Dutch community sample (N = 1257) of families with a new-born. Results showed a commonality of underlying subsets of items belonging to the 'Disturbed parent-child relationship' and 'Psychological problems' factors, but the factor 'Communication problems' of the original ERPANS could not be replicated. We found that parental psychological problems were a significant predictor of family problems, including involvement of child protection authorities, at an average follow-up of 22 months. Parents who reported feeling unloved by their own parents were at higher risk of reports of serious concern to child protection authorities at 22 months after birth. These findings support the utility of at least a subset of the ERPANS items as a screening tool for child abuse risk in preventive public youth health care for new-born babies. Our research adds to a growing body of evidence which points to the importance of parental mental health problems and adverse childhood experiences as precursors to child abuse risk.

Targeted Estimation of the Relationship Between Childhood Adversity and Fluid Intelligence in a US Population Sample of Adolescents

Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001-2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13-18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.

Altered fear processing in adolescents with a history of severe childhood maltreatment: an fMRI study

BACKGROUND

Children with a history of maltreatment suffer from altered emotion processing but the neural basis of this phenomenon is unknown. This pioneering functional magnetic resonance imaging (fMRI) study investigated the effects of severe childhood maltreatment on emotion processing while controlling for psychiatric conditions, medication and substance abuse.

METHOD

Twenty medication-naive, substance abuse-free adolescents with a history of childhood abuse, 20 psychiatric control adolescents matched on psychiatric diagnoses but with no maltreatment and 27 healthy controls underwent a fMRI emotion discrimination task comprising fearful, angry, sad happy and neutral dynamic facial expressions.

RESULTS

Maltreated participants responded faster to fearful expressions and demonstrated hyper-activation compared to healthy controls of classical fear-processing regions of ventromedial prefrontal cortex (vmPFC) and anterior cingulate cortex, which survived at a more lenient threshold relative to psychiatric controls. Functional connectivity analysis, furthermore, demonstrated reduced connectivity between left vmPFC and insula for fear in maltreated participants compared to both healthy and psychiatric controls.

CONCLUSIONS

The findings show that people who have experienced childhood maltreatment have enhanced fear perception, both at the behavioural and neurofunctional levels, associated with enhanced fear-related ventromedial fronto-cingulate activation and altered functional connectivity with associated limbic regions. Furthermore, the connectivity adaptations were specific to the maltreatment rather than to the developing psychiatric conditions, whilst the functional changes were only evident at trend level when compared to psychiatric controls, suggesting a continuum. The neurofunctional hypersensitivity of fear-processing networks may be due to childhood over-exposure to fear in people who have been abused.

Childhood Trauma Is Associated With Poorer Cognitive Performance in Older Adults

OBJECTIVE

Childhood trauma is common and associated with both worse cognitive performance and disruption to the hypothalamic-pituitary-adrenal axis in younger adults. The extent to which these associations persist into older adulthood remains unknown. The aim of this study was to investigate self-reported childhood trauma in relation to cognitive performance, and the extent to which cortisol explained this association, in 2 independent samples of older adults.

METHODS

In this cross-sectional study, participants in the discovery sample (N = 76) consisted of older adults with a DSM-IV diagnosis of generalized anxiety disorder (N = 57) and age-equated psychiatrically healthy comparison subjects (N = 19) who were referred largely through primary care clinics between 2004-2006. The replication sample (N = 48) consisted of older adults with DSM-IV anxiety or depressive disorders recruited between 2012-2013. Participants were administered the Early Trauma Inventory Self-Report-Short Form and a neuropsychological assessment (primary outcome).

RESULTS

Across both samples, childhood trauma was significantly associated with worse performance on measures of processing speed, attention, and executive functioning. The effect of trauma exposure was stronger when general, physical, and sexual traumatic events were examined specifically (all P < .05). Childhood trauma was not associated with cortisol levels, and cortisol did not explain the association between trauma and cognitive functioning.

CONCLUSIONS

Self-reported traumatic events experienced in childhood are associated with poorer cognitive performance in anxious and depressed older adults. Findings demonstrate a deleterious impact of childhood trauma on brain health in old age.

Childhood Maltreatment and Development of Substance Use Disorders: A Review and a Model of Cognitive Pathways

Exposure to childhood maltreatment (CM) is associated with increased risk for developing substance use disorders (SUDs). CM exerts negative effects on cognitive abilities including intellectual performance, memory, attention, and executive function. Parallel cognitive impairments have been observed in SUDs. Hence, limited studies have examined the mediating effect of cognitive impairments in the relationship between CM and SUDs. In addition, most studies used concurrent self-report assessments in adult populations. Longitudinal studies that investigated the long-term consequences of CM on psychopathology, including SUDs, throughout childhood, adolescence, and adulthood are rare. Thus, the underlying developmental pathways between CM and SUDs are not clearly understood. In this article, we review the evidence that cognitive impairments mediate, at least in part, the relationship between CM and development of SUDs and propose a model that explains how CM increases the risk for SUDs through the development of a cognitive framework of vulnerability.

A systematic review of physiological reactivity to stimuli in autism

OBJECTIVE

The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity (PR) is typical in this population. This article reviewed studies assessing PR to sensory, social and emotional, and stressor stimuli in individuals with autism.

METHODS

Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. Studies were analysed to determine: (a) participant characteristics; (b) physiological measures used; (c) PR to sensory, social and emotional or stressor stimuli; (d) the relation between PR and behavioural or psychological variables and (e) baseline physiological activity. A novel measure of methodological quality suitable for use with non-randomized, non-interventional, psychophysiological studies was also developed and applied.

RESULTS

Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. However, this extant literature is characterized by variable and inconsistent findings, which do not appear to be accounted for by varying methodological quality, making it difficult to determine what specific factors differentiate individuals with autism who present with atypical PR from those who do not.

CONCLUSIONS

Despite this uncertainty, individual differences in PR are clearly present in autism, suggesting additional research is needed to determine the variables relating to PR among those with ASD and to examine the possible existence of physiological subtype responders in the population.

A Comparison of Unresolved versus Resolved Status and its Relationship to Behaviour in Maltreated Adolescents

This exploratory investigation sought both to gain a better understanding of the mental representations of attachment in high-risk, maltreated adolescents and to explain how, if at all, unresolved attachment representations are related to behavioural maladjustment. Parent ratings, self-report ratings and attachment state of mind were obtained from 34 adolescents with a history of maltreatment. Results showed that maltreated adolescents with unresolved states of mind in regard to attachment were rated higher on maladaptive behaviour and lower on adaptive behaviour than maltreated adolescents who were resolved. Implications for school-based mental health intervention and future research are discussed.

Neurocognitive deficits in children and adolescents following maltreatment: Neurodevelopmental consequences and neuropsychological implications of traumatic stress

Childhood maltreatment is a significant risk factor for a host of psychiatric, developmental, medical, and neurocognitive conditions, often resulting in debilitating and long-term consequences. However, there is no available neuropsychological resource reviewing the literature on the associated neurocognitive deficits in children and adolescents. This review comprehensively examines the 23 prior studies that evaluated the intellectual, language, visual-spatial, memory, motor, and/or attention/executive functions in children and adolescents following an experience of childhood abuse and/or neglect. Neurocognitive impairments were frequently reported. Impairments in executive functions were the most frequent and severe reported impairments, although intelligence, language, visual-spatial skills, and memory are also at serious risk for compromised development following maltreatment. However, specific factors such as abuse/neglect duration, severity, type, and timing during development were all associated with neurocognition. This indicates that these factors are of greater importance than just the presence of abuse/neglect in identifying risk for neurocognitive compromise. Such neurocognitive deficits appear to be a consequence to the known neurobiological and brain development abnormalities of this population, suggesting traumatic stress can be a potential cause of neurodevelopmental disorders. These findings have critical implications for the clinical practice and research involving children following childhood maltreatment and other types of traumatic stress.

Methodological Issues in Assessing the Impact of Prenatal Drug Exposure

Prenatal drug exposure is a common public health concern that can result in perinatal complications, birth defects, and developmental disorders. The growing literature regarding the effects of prenatal exposure to specific drugs such as tobacco, alcohol, cocaine, and heroin is often conflicting and constantly changing. This review discusses several reasons why the effects of prenatal drug exposure are so difficult to determine, including variations in dose, timing, duration of exposure, polydrug use, unreliable measures of drug exposure, latent or “sleeper” effects, genetic factors, and socioenvironmental influences. In addition to providing research guidelines, this review also aims to help clinicians and policy makers to identify the strengths and weaknesses in studies investigating the effects of prenatal drug exposure. This knowledge may be used to make better informed decisions regarding the appropriate treatment for pregnant, drug-dependent women and their children.

Low-SES children's eyewitness memory: the effects of verbal labels and vocabulary skills

This study examined the effects of the verbal labels procedure and vocabulary skills on low-socioeconomic status (SES) preschool children's eyewitness memory. Children (N = 176) aged 3-5 years witnessed a conflict event and were then questioned about it in either a standard or a verbal labels interview. Findings revealed that children with higher rather than lower vocabulary skills produced more complete and accurate memories. Children who were given the verbal labels interview recalled more information, which included both correct and incorrect details. Overall, the verbal labels procedure did not improve children's performance on direct questions, but children with low vocabulary skills answered direct questions more accurately if they were given the verbal labels interview than when they were not. Implications of the findings for memory performance of low-SES children are discussed.

The biological effects of childhood trauma

Trauma in childhood is a psychosocial, medical, and public policy problem with serious consequences for its victims and for society. Chronic interpersonal violence in children is common worldwide. Developmental traumatology, the systemic investigation of the psychiatric and psychobiological effects of chronic overwhelming stress on the developing child, provides a framework and principles when empirically examining the neurobiological effects of pediatric trauma. This article focuses on peer-reviewed literature on the neurobiological sequelae of childhood trauma in children and in adults with histories of childhood trauma.

Psychiatric disorders and characteristics of abuse in sexually abused children and adolescents with and without intellectual disabilities

The purpose of this study was to compare sexually abused children and adolescents, with and without intellectual disabilities (ID), in terms of post-abuse psychiatric disorders, features of the sexual abuse, and sociodemographic characteristics. The study included sexually abused children aged 6-16 years, who were sent to three different child mental health units for forensic evaluation; there were 102 cases (69 girls and 33 boys) with ID and 154 cases (126 girls and 28 boys) without ID. Researchers retrospectively examined the files, social examination reports, and the judicial reports of the cases. It was determined that in the group with ID, sexual abuse types including penetration and contact had higher rates, they were exposed to more frequent repeated abuses, the abuses were revealed with their own reports at a later period and lower rates, and post-abuse pregnancies were more frequent. It was also determined that the abuser was a familiar person and a family member at lower rates and more than one abuser was encountered more frequently, compared to the group without ID. While no difference was determined between the two groups in terms of the frequency of post-abuse post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), conduct disorder (CD) was observed more frequently in the group with ID. This study emphasizes that sexual abuse, which is an important problem in individuals with ID, has different features and effects.

Neuropsychological findings in pediatric maltreatment: relationship of PTSD, dissociative symptoms, and abuse/neglect indices to neurocognitive outcomes

Maltreated (n = 38), maltreated + posttraumatic stress disorder (PTSD; n = 60), and control youth (n = 104) underwent comprehensive neuropsychological testing. The two maltreated groups performed significantly lower on IQ, academic achievement, and nearly all of the neurocognitive domains than controls. Maltreated + PTSD performed significantly worse than maltreated youth without PTSD on a task in the visuospatial domain that assessed higher order visuoconstructive abilities. No group differences were evident on the fine motor domain. PTSD diagnosis duration negatively correlated with the visuospatial, and dissociation negatively correlated with the attention domain. Cumulative lifetime maltreatment types experienced negatively correlated with academic achievement. Sexual abuse negatively correlated with language and memory functions after controlling for other maltreatment types. These data support the adverse effects of maltreatment on neuropsychological functions in youth and suggest that all child protective services identified youth should be comprehensively examined for the integrity of their neuropsychological functioning and academic skills, regardless of the presence or absence of mental health symptoms.

Predicting the accuracy of facial affect recognition: the interaction of child maltreatment and intellectual functioning

Previous research demonstrates that both child maltreatment and intellectual performance contribute uniquely to the accurate identification of facial affect by children and adolescents. The purpose of this study was to extend this research by examining whether child maltreatment affects the accuracy of facial recognition differently at varying levels of intellectual functioning. A sample of maltreated (n=50) and nonmaltreated (n=56) adolescent females, 14 to 19 years of age, was recruited to participate in this study. Participants completed demographic and study-related questionnaires and interviews to control for potential psychological and psychiatric confounds such as symptoms of posttraumatic stress disorder, negative affect, and difficulties in emotion regulation. Participants also completed an experimental paradigm that recorded responses to facial affect displays starting in a neutral expression and changing into a full expression of one of six emotions: happiness, sadness, anger, disgust, fear, or surprise. Hierarchical multiple regression assessed the incremental advantage of evaluating the interaction between child maltreatment and intellectual functioning. Results indicated that the interaction term accounted for a significant amount of additional variance in the accurate identification of facial affect after controlling for relevant covariates and main effects. Specifically, maltreated females with lower levels of intellectual functioning were least accurate in identifying facial affect displays, whereas those with higher levels of intellectual functioning performed as well as nonmaltreated females. These results suggest that maltreatment and intellectual functioning interact to predict the recognition of facial affect, with potential long-term consequences for the interpersonal functioning of maltreated females.

Emerging adults' stress and health: the role of parent behaviors and cognitions

Although parent behaviors and cognitions are important for stress/health outcomes throughout development, little research examines whether cognitions mediate the relationship between parent behaviors and stress/health outcomes. As a result, the current study examined the reports of 160 emerging adults regarding their mothers' and fathers' behaviors (via the Parental Bonding Instrument and Alabama Parenting Questionnaire), their cognitions (via the Stress Appraisal Measure, Negative Mood Regulation Scale, Life Orientation Test-Revised, General Self-Efficacy Scale, and Ruminative Response Scale-Abbreviated), and their stress/health outcomes (via the Perceived Stress Scale and Short-Form Health Survey). Results of this study suggested that emerging adults' cognitions partially mediated the relationship between their mothers' behaviors and their stress/health outcomes and fully mediated the relationship between their fathers' behaviors and their stress/health outcomes. Future research should examine parent behaviors as important distal variables in emerging adults' stress/health outcomes but should examine cognitions as more salient, immediate predictors of their stress/health outcomes.

Neural correlates of socioeconomic status in the developing human brain

Socioeconomic disparities in childhood are associated with remarkable differences in cognitive and socio-emotional development during a time when dramatic changes are occurring in the brain. Yet, the neurobiological pathways through which socioeconomic status (SES) shapes development remain poorly understood. Behavioral evidence suggests that language, memory, social-emotional processing, and cognitive control exhibit relatively large differences across SES. Here we investigated whether volumetric differences could be observed across SES in several neural regions that support these skills. In a sample of 60 socioeconomically diverse children, highly significant SES differences in regional brain volume were observed in the hippocampus and the amygdala. In addition, SES × age interactions were observed in the left superior temporal gyrus and left inferior frontal gyrus, suggesting increasing SES differences with age in these regions. These results were not explained by differences in gender, race or IQ. Likely mechanisms include differences in the home linguistic environment and exposure to stress, which may serve as targets for intervention at a time of high neural plasticity.

Neuroimaging of child abuse: a critical review

Childhood maltreatment is a stressor that can lead to the development of behavior problems and affect brain structure and function. This review summarizes the current evidence for the effects of childhood maltreatment on behavior, cognition and the brain in adults and children. Neuropsychological studies suggest an association between child abuse and deficits in IQ, memory, working memory, attention, response inhibition and emotion discrimination. Structural neuroimaging studies provide evidence for deficits in brain volume, gray and white matter of several regions, most prominently the dorsolateral and ventromedial prefrontal cortex but also hippocampus, amygdala, and corpus callosum (CC). Diffusion tensor imaging (DTI) studies show evidence for deficits in structural interregional connectivity between these areas, suggesting neural network abnormalities. Functional imaging studies support this evidence by reporting atypical activation in the same brain regions during response inhibition, working memory, and emotion processing. There are, however, several limitations of the abuse research literature which are discussed, most prominently the lack of control for co-morbid psychiatric disorders, which make it difficult to disentangle which of the above effects are due to maltreatment, the associated psychiatric conditions or a combination or interaction between both. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavioral and affect control. Future, large scale multimodal neuroimaging studies in medication-naïve subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary co-morbid conditions.

Neurodevelopmental biology associated with childhood sexual abuse

Child maltreatment appears to be the single most preventable cause of mental illness and behavioral dysfunction in the United States. Few published studies examine the developmental and the psychobiological consequences of sexual abuse. There are multiple mechanisms through which sexual abuse can cause post-traumatic stress disorder, activate biological stress response systems, and contribute to adverse brain development. This article will critically review the psychiatric problems associated with maltreatment and the emerging biologic stress system research with a special emphasis on what is known about victimization by sexual abuse.

Early-life stress and cognitive outcome

RATIONALE

Early-life stress is associated with later neuropsychiatric illness. While the association between early-life stress and brain development is well recognized, relatively few studies have examined the association between exposure to early-life stress and cognitive outcome.

OBJECTIVES

The objective of this paper is to examine the association between early-life stress and cognitive outcome in animal models and humans.

METHODS

In this article, we review alterations in cognitive function associated with early-life stress in animals and then discuss the association of early-life stress and cognitive function in humans.

RESULTS

Findings suggest that early-life stress is associated with abnormal cognitive function in animals and humans. Furthermore, cognitive deficits associated with exposure to early-life stress in humans may persist into at least early adulthood, although animal models of enriched environments and studies of children adopted from institutionalized care into foster families suggest that certain social factors may at least partially reverse cognitive deficits following exposure to early-life stress.

CONCLUSIONS

Exposure to stress in early life may be associated with later deficits in cognitive function.

Neuropsychological findings in childhood neglect and their relationships to pediatric PTSD

Although child neglect is the most prevalent form of child maltreatment, the neurocognitive effects of neglect are understudied. We examined IQ, reading, mathematics, and neurocognitive domains of fine-motor skills, language, visual-spatial, memory/learning, and attention/executive functions in two groups of nonsexually abused medically healthy neglected children, one with DSM-IV posttraumatic stress disorder (PTSD) and one without, and a demographically similar healthy nonmaltreated control group. Significantly lower IQ, reading, mathematics, and selected differences in complex visual attention, visual memory, language, verbal memory and learning, planning, problem solving, and speeded naming were seen in Neglect Groups. The Neglect with PTSD Group performed worse than controls on NEPSY Design Copying, NEPSY Tower, and Mathematics; and performed worse than controls and Neglect without PTSD on NEPSY Memory for Faces-Delayed. Negative correlations were seen between PTSD symptoms, PTSD severity, and maltreatment variables, and IQ, Academic Achievement, and neurocognitive domains. Neglected children demonstrated significantly lower neurocognitive outcomes and academic achievement than controls. Lower IQ, neurocognitive functions, and achievement may be associated with more PTSD symptoms (particularly re-experiencing symptoms), greater PTSD severity, and a greater number of maltreatment experiences. Trauma experiences may additionally contribute to subsequent neurodevelopmental risk in neglected children. (JINS, 2009, 15, 868-878.).

Differential relationships between personal and community stressors and children's neurocognitive functioning

Early adversity can alter development of neurocognition, including executive cognitive and emotional regulatory functions. This is the first study to explore differential relationships between personal (physical and emotional abuse and neglect, school and parental stressors) and community (neighborhood problems and witnessing neighborhood violence) stressors and neurocognition. Predominantly Latino children (n = 553) aged 10 to 12 years completed tasks measuring intelligence, impulsivity, problem solving, cognitive flexibility, decision making, and emotion attributions. Adjusting for age and parent education, bivariate regression analyses found exposure to personal stressors to be associated with relative deficits in at least one neurocognitive function. Community stressors were related to relative deficits in emotion attributions and problem solving. In multivariate analyses, neglect was related to misattributions of emotion and IQ deficits, and physical abuse was related to problem solving. Community stressors were not correlated with neurocognition when viewed relative to personal stressors. Stressor types were differentially associated with performance on specific neurocognitive tasks.

Cognitive impairment and functioning in PTSD related to intimate partner violence

Posttraumatic stress disorder (PTSD) has been associated with neuropsychological impairments across multiple domains, but consensus regarding the cognitive profile of PTSD has not been reached. In this study of women with PTSD related to intimate partner violence (n = 55) and healthy, demographically similar comparison participants (NCs; n = 20), we attempted to control for many potential confounds in PTSD samples. All participants were assessed with a comprehensive neuropsychological battery emphasizing executive functioning, including inhibition, switching, and abstraction. NCs outperformed PTSD participants on most neuropsychological measures, but the differences were significant only on speeded tasks (with and without executive functioning components). The PTSD group's mean performance was within the average range on all neuropsychological tests. Within the PTSD group, more severe PTSD symptoms were associated with slower processing speed, and more severe dissociative symptoms were associated with poorer reasoning performance. These results suggest that women with PTSD related to intimate partner violence demonstrate slower than normal processing speed, which is associated with the severity of psychiatric symptoms. We speculate that the cognitive slowing seen in PTSD may be attributable to reduced attention due to a need to allocate resources to cope with psychological distress or unpleasant internal experiences.

[Personality disorders in adolescence: conceptual issues and treatment approaches]

Objective of this paper is to search for answers for the question if it is justified to use the diagnosis of personality disorder already in adolescence. Recent research data confirm that the stability of basic personality traits is only gradually lower in adolescence compared to adulthood. Using the diagnostic criteria of adults there is not much of a difference concerning prevalence rate and stability in adolescence and adulthood. Meta-analyses reveal that patients with personality disorders can successfully be treated with specalized treatment programs so that personality disorders should not be viewed as life-course persistent. It is argued that an early assessment with standardized procedures can help to identify adolescents with personality disorders so that specialized treatment approaches can be started. In adulthood there is empirical evidence for the use of Dialectical-Behavior Therapy DBT, Transference Focused Psychotherapy TFP, Mentalization-based Therapy MBT and Schema-focused Psychotherapy SFT for the use in patients with personality disorders. These treatment approaches have to be adapted to the special situation of adolescents so that their use can help to prevent these early developing disorders to become chronic.

CONFOUNDING VARIABLES WITHIN “REFERRAL CONTROLS” FOR CHILDREN WITH HISTORIES OF SEXUAL STIMULATION BY ADULTS: IMPLICATIONS FOR ERRONEOUS ATTRIBUTIONS FROM “CHILDHOOD SEXUAL ABUSE”

Verbal and performance scores from a standardized intelligence battery for age-matched children from four groups (n = 67) were compared to discern if the depressed scores for verbal intelligence displayed by children with histories of verified sexual stimulation by adults were epiphenomenal. The children had been referred to a psychiatric facility because of early sexual stimulation by adults, from a children's mental health service because of family problems, or from a school board for conduct disorders. The fourth group was hospital controls for the first group. The children with nonculturally approved sexual activity with adults and those from the mental health service displayed verbal intelligence scores that were about one SD below the scores for children referred by the school board and for the control group. These results suggest that psychological variables may not reflect a causal relationship and hence group differences should not be attributed exclusively to the diagnosis of sexual abuse.

Similar autonomic responsivity in boys with conduct disorder and their fathers

OBJECTIVE

Antisocial behavior frequently occurs in families. This study investigated whether autonomic hypoarousal and hyporesponsivity, which have been observed in antisocial individuals of all ages, are passed from fathers to male offspring.

METHOD

The study included 44 boys with early-onset conduct disorder and 36 healthy controls (8 to 13 years old) together with their biological fathers. Resting heart rate and nonspecific skin conductance fluctuations were assessed as arousal measurements, with electrodermal responses and heart rate changes to pictorial stimuli serving as response measurements. In addition, boys and fathers were subjected to psychometric measurements of antisocial behavior.

RESULTS

The fathers of boys with CD showed significantly lower electrodermal responses to pictures of either emotional quality than the fathers of controls (p between.015 and < .001), and they revealed fewer nonspecific skin conductance fluctuations (p = .001). In addition, they reported a more aggressive, hostile, and impulsive behavioral style. Psychophysiological measurements were highly correlated between fathers and sons (p between .007 and < .001), and fathers' autonomic responses accounted for group differences in electrodermal responses between boys (p < .001).

CONCLUSIONS

The fathers of boys with conduct disorder exhibited an abnormal psychophysiological response pattern similar to that of their sons. High father-son correlations in psychophysiological measures raise the question of whether autonomic abnormalities may constitute a biological mediator through which the disposition for antisocial behavior is transmitted within families.

[The influence of cognitive abilities, age and characteristics of their sexual abuse experience on the statement of the presumed victims]

OBJECTIVE

The goal of the present study was to examine the effects of children's age, cognitive abilities and the characteristics of their sexual abuse experience on the quantity of details revealed about the sexual abuse in an investigative interview as a function of the type of questions asked. METHOD VERSION: Transcripts of 37 investigative interviews conducted with children between 6 and 12 years of age were analyzed according to the type of interviewer questions used and the quantity of details given by the child. The children's cognitive abilities were measured using the vocabulary, information and block design subtests of the WISC-III.

RESULTS

Results of multiple regression analyses indicate that children's age and verbal abilities as well as their relationship with the perpetrator explain 50% of the variance of the mean number of details obtained from the child following open-ended interviewer questions.

CONCLUSION

The results of this study suggest that the quantity of details obtained during an investigative interview is influenced not only by children's age but also by their verbal skills and the child-perpetrator relationship.

The development of psychopathy

The current review focuses on the construct of psychopathy, conceptualized as a clinical entity that is fundamentally distinct from a heterogeneous collection of syndromes encompassed by the term 'conduct disorder'. We will provide an account of the development of psychopathy at multiple levels: ultimate causal (the genetic or social primary cause), molecular, neural, cognitive and behavioral. The following main claims will be made: (1) that there is a stronger genetic as opposed to social ultimate cause to this disorder. The types of social causes proposed (e.g., childhood sexual/physical abuse) should elevate emotional responsiveness, not lead to the specific form of reduced responsiveness seen in psychopathy; (2) The genetic influence leads to the emotional dysfunction that is the core of psychopathy; (3) The genetic influence at the molecular level remains unknown. However, it appears to impact the functional integrity of the amygdala and orbital/ventrolateral frontal cortex (and possibly additional systems); (4) Disruption within these two neural systems leads to impairment in the ability to form stimulus-reinforcement associations and to alter stimulus-response associations as a function of contingency change. These impairments disrupt the impact of standard socialization techniques and increase the risk for frustration-induced reactive aggression respectively.

Neurobehavioral sequelae of child sexual abuse

This study examined intellectual and memory functioning in a sample of sexually abused children compared to demographically and age-matched controls. The severity of abuse and other pertinent factors were also examined in relation to cognitive performance. Elevated levels of psychopathology were present in the abused children, as well as diminished performance on tasks influenced by attention/concentration. However, after controlling for differences in IQ and socioeconomic status (SES), significant differences in memory function were not found. Results are discussed in the context of stress effects on cognition and the potential resiliency of cognitive function in children undergoing treatment for sexual abuse.

Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits

A number of studies have demonstrated an increased rate of histories of childhood maltreatment among adults with serious mental illness. The present investigation documented the presence of childhood maltreatment in a sample of 40 psychiatric inpatients with schizophrenia spectrum disorders. The type (neglect, physical abuse, sexual abuse), duration, and severity of childhood maltreatment was examined along with measures of premorbid functioning, current symptomatology, and cognitive functioning. Participants with histories of maltreatment were significantly more likely to have poorer peer relationships in childhood, more difficulty in school, an earlier age at first hospitalization, more previous hospitalizations, elevated symptoms of anxiety, depression, and suicidality on the Brief Psychiatric Rating Scale (BPRS), and more impaired performance on a task of visual-perceptual organization. Severity and frequency of childhood maltreatment were both positively correlated with hallucinations and delusions on the BPRS. Linear trend analysis indicated a pattern of more severe impairment as the number of types of maltreatment increased. No relationships were found between maltreatment and measures of executive functioning, verbal fluency, or verbal processing speed. A history of childhood maltreatment appears to be a significant determinant of premorbid functioning, illness-related symptom expression, and specific forms of cognitive dysfunction.

The psychobiology of children exposed to marital violence

We examined the psychological and physiological functioning of a community sample of children exposed to marital violence, comparing them to a clinical comparison group without marital violence exposure. Results replicated past findings of elevated levels of trauma symptomatology in this population. Further, children exposed to marital violence differed significantly from comparison children with respect to sympathetic nervous system functioning and hypothalamic-pituitary-adrenal (HPA) axis functioning. Specifically, elevations were seen in heart rate and salivary cortisol levels, but not in orthostatic challenge response or blood pressure. These results indicate that children exposed to marital violence have a different physiological presentation than controls and may be physiologically "traumatized" by virtue of marital violence exposure.

Exposure of mice to a predator odor increases acoustic startle but does not disrupt the rewarding properties of VTA intracranial self-stimulation

The present investigation assessed the propensity of an acute psychogenic stressor exposure to induce behavioral change in paradigms assessing fear/anxiety (acoustic startle) and motivation/anhedonia (intracranial self-stimulation) in CD-1 mice. In the acoustic startle paradigm, a 10-min exposure of 2-4 month old mice (young adult mice) to fox odor (2,5-dihydro-2,4,5-trimethylthiazoline; TMT) was associated with decreased acoustic startle relative to mice exposed to the control odor, butyric acid (BA), immediately and relative to both saline and BA exposure 24 h following odor exposure in the home cage. In contrast, a 2-min exposure of young adult mice to TMT was associated with an increase in startle relative to saline and BA during the immediate post-odor test session only. In young adult mice a 2-min and a 10-min exposure to BA resulted in a startle profile of mice reminiscent of saline-treated mice. In comparison to young adult mice, a 2-min exposure of mature adult mice (5-7 months old) to TMT enhanced startle for up to 48 h relative to both saline and BA, while a 10-min exposure of mature adult mice to TMT enhanced startle for 168 h post-odor exposure relative to saline-exposed mice only. However, the greatest increase in startle amplitude (i.e. 48 h) was acquired following the 2-min exposure of mature mice to TMT. Among mature adult mice, a 10-min exposure to BA in the home cage eventuated in enhanced startle relative to saline-exposed animals 168 h following odor exposure. In comparison, exposure of mice to 10 min of TMT depressed responding for VTA brain stimulation at the initial 80 Hz frequency, but was ineffective in elevating reward thresholds relative to mice merely exposed to saline. Mice assessed in the ICSS paradigm were approximately 2-4 months old at the time of surgery and 5-7 months old at the completion of testing. These data suggest that acute odor exposure may induce a fear gradient dependent upon the perceived stressor severity and that the resultant anxiety-like effects are dependent on the duration of odor exposure, age of the animals and the temporal interval between odor presentation and behavioral testing. Moreover, the anxiogenic properties of psychogenic stressors can be separated from their anhedonic effects. The implications of these data for clinical psychopathology are discussed.

Community violence exposure in young adults

The United States is one of the most violent countries in the world, and this is being reflected in rates of young adults' lifetime exposure ranging from 76% to 82% for victimization and 93% to 96% for witnessing. These high rates are found despite these studies being conducted on relatively low-risk samples from rural areas, and the majority of violent acts reported being less life threatening than those reported by high-risk urban adolescents. Nonetheless, young adults with high levels of exposure report more psychological maladjustment including depressed mood, aggressive behavior, posttraumatic stress disorder symptomatology, and interpersonal problems. The cycle from exposure to later perpetration of aggression is discussed in terms of psychophysiological processes that may emerge from chronic violence exposure or interact with victimization to increase risk. Last, theoretical, clinical, and policy implications are suggested that include intervention and prevention programs targeting all forms of violence in urban and rural areas.

Somatoform dissociation in eating-disordered patients

This study investigated the role of somatoform dissociation in eating disorders and pathological eating behaviour, relative to the established association of eating pathology with psychological dissociation. The participants were 131 women with DSM-IV diagnoses of anorexic or bulimic disorders and 75 women who had no such disorder. Each woman completed measures of psychological and somatoform dissociation, as well as a measure of bulimic attitudes. The current presence or absence of specific bulimic behaviours was identified during the clinical interview. Levels of both forms of dissociation were higher in the women who had diagnoses of disorders with a bulimic component (bulimia nervosa; anorexia nervosa of the binge/purge subtype) than in the non-clinical or restrictive anorexic women. Somatoform dissociation showed particularly strong links with the presence of bulimic behavioural features (excessive exercise, laxative abuse, diet pill abuse, diuretic abuse) and with bulimic attitudes. The formulation and treatment of cases where there are bulimic features is likely to be enhanced by the assessment of somatoform dissociation.

Different paths to death row: a comparison of men who committed heinous and less heinous crimes

Part of the answer to violent crime prevention is to understand the route that those who have committed violent crimes have traveled in order to find ways to guide others from the road leading to such violence. An investigation of the lifelong personal and environmental factors affecting 37 men who were executed in 1997 focuses on distinctions between men in two categories based on heinousness of violent crime. The study aimed to identify risk factors and events that preceded the violent event and to compare the constellation of variables of the men who committed particularly heinous murders characterized by extreme rage and brutality with those whose crimes and criminal histories were characterized mostly by property crimes without intentional harm to people. Descriptive results suggest differences between the two groups of men related to 19 variables and the emergence of two diverse profiles of risk factors and life experiences.

Neuropsychological function in female victims of intimate partner violence with and without posttraumatic stress disorder

BACKGROUND

Various aspects of neuropsychologic function have been reported to be abnormal in patients with posttraumatic stress disorder (PTSD); however, the majority of these data come from studies of seriously ill, treatment-seeking samples with substantial substance use comorbidity. Few studies have included similarly trauma-exposed subjects without PTSD, and fewer still have focused on women.

METHODS

Thirty-nine female victims of intimate partner violence (IPV; 22 without lifetime PTSD and 17 with current PTSD), and 22 nonvictimized comparison (NC) subjects were administered tests of attention, working memory, visuoconstruction, language ability, learning and memory, and executive functioning.

RESULTS

The IPV and NC subjects did not demonstrate statistically significant differences on most neuropsychologic tests, with the exception of those in the realm of working memory, visuoconstruction, and executive functioning. The IPV subjects, regardless of PTSD status, had poorer performance on tasks of speeded, sustained auditory attention and working memory (Paced Auditory Serial Addition Test) and response inhibition (Stroop). The IPV subjects with PTSD performed worse than NCs on a set-shifting task (Trail Making Test, Part B). No consistent relationships were noted between neuropsychologic functioning and severity of childhood abuse or domestic violence experiences.

CONCLUSIONS

Cognitive deficits in IPV subjects were confined to measures of working memory, visuoconstruction, and executive function; were subtle; and were not uniformly worse among those with current PTSD. This pattern, however, is consistent with frontal-subcortical dysfunction in traumatized women. The clinical significance of these findings deserves further study.

Brain structures in pediatric maltreatment-related posttraumatic stress disorder: a sociodemographically matched study

BACKGROUND

Previous investigations suggest that maltreated children evidence alterations of chemical mediators of stress and adverse brain development. Previous anatomical magnetic resonance imaging (MRI) brain studies have not controlled for socioeconomic status.

METHODS

In this study, 28 psychotropic naïve children and adolescents with maltreatment-related posttraumatic stress disorder (PTSD) and 66 sociodemographically similar healthy control subjects underwent comprehensive clinical assessments and anatomical MRI brain scans.

RESULTS

Compared with control subjects, subjects with PTSD had smaller intracranial, cerebral, and prefrontal cortex, prefrontal cortical white matter, and right temporal lobe volumes and areas of the corpus callosum and its subregions (2, 4, 5, 6, and 7), and larger frontal lobe cerebrospinal fluid (CSF) volumes than control subjects. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller in subjects with PTSD, whereas right, left, and total lateral ventricles and frontal lobe CSF were proportionally larger than in control subjects, after adjustment for cerebral volume. Brain volumes positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Significant gender x group effect demonstrated greater lateral ventricular volume increases in maltreated male subjects with PTSD than maltreated female subjects with PTSD. No hippocampal differences were seen.

CONCLUSIONS

These data provide further evidence to suggest that maltreatment-related PTSD is associated with adverse brain development. These data also suggest that male children may be more vulnerable to these effects.

Brain morphometry in female victims of intimate partner violence with and without posttraumatic stress disorder

BACKGROUND

To examine neuroanatomical morphometry in adult female victims of intimate partner violence with and without posttraumatic stress disorder.

METHODS

Seventeen nonvictimized comparison subjects and 22 victims of intimate partner violence, 11 with and 11 without posttraumatic stress disorder, were studied. Using quantitative magnetic resonance imaging, three mesial temporal lobe areas were measured: hippocampus, amygdala, and parahippocampal gyrus. Additionally, whole brain morphometry provided fluid, gray, and white matter volumes of the cortex and cerebellum for exploratory analyses. Relationships of morphometric measures to symptoms, abuse history, and neuropsychological function were examined.

RESULTS

Intimate partner violence subjects with posttraumatic stress disorder did not demonstrate significantly smaller hippocampal or other mesial temporal lobe volumes. Overall, intimate partner violence subjects had smaller supratentorial cranial vaults and smaller frontal and occipital gray matter volumes relative to nonvictimized comparison subjects. Supratentorial cranial vault volume was negatively correlated with severity of childhood physical abuse, but not with intimate partner violence or posttraumatic stress disorder severity. Trails B performance was negatively correlated with frontal gray matter volume.

CONCLUSIONS

These findings are inconsistent with prior reports of smaller hippocampal volumes in patients with posttraumatic stress disorder. Rather, the findings point to cerebral abnormalities that may reflect the influence of early trauma on neurodevelopmental processes or denote brain morphometric characteristics of persons at increased risk for serious psychosocial adversity.