1
|
Minnis H. Abuse, neglect and neurodevelopment across the life course: what can paediatricians and child psychiatrists do about this together? The Illingworth-Rees keynote lecture 2023. Arch Dis Child 2024; 109:533-535. [PMID: 37788885 DOI: 10.1136/archdischild-2023-325942] [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] [Received: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023]
Abstract
Paediatricians and child psychiatrists share complex cases, often associated with abuse, neglect and other 'Adverse Childhood Experiences (ACEs)'. ACEs are associated in a dose-response relationship with both mental and physical health problems across the life span. We found that 9-year-old children who had been abused and neglected were much more likely to also have symptoms of heritable neurodevelopmental conditions (NDCs) such as ADHD, autism and intellectual disabilities. To our surprise, these were not caused by the abuse and neglect. Instead, both the NDCs and the abuse and neglect were being caused by additional genetic factors. We also found that children who have experienced abuse and neglect, and who also have NDCs, are at twice the risk of developing symptoms of severe mental illness in adolescence. This has caused us to develop our 'Double Jeopardy' hypothesis-that experiencing both abuse and neglect and NDCs in childhood might double the risk of a range of physical and mental health problems across the life span.Both paediatricians and child psychiatrists will be faced with children who have complex problems, and they will sometimes need to work together to solve these-whether or not abuse or neglect is in the mix.Dr Corinne Rees's words were prescient: 'The truth that psychological issues and behaviour are integral to all illness indicates the necessity for every doctor to feel competent in considering their relevance'. As paediatricians and child psychiatrists, let's move forward together to overcome the mind-body dichotomy for the benefit of our patients.
Collapse
Affiliation(s)
- Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
| |
Collapse
|
2
|
Uzun ME, Koşan Y, Şirin H. Abuse and Neglect of Children With Specific Learning Disorders in Türkiye: A Case-Control Study. Clin Psychol Psychother 2024; 31:e2986. [PMID: 38679965 DOI: 10.1002/cpp.2986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Although it is often stated that children with special needs are at risk of being abused and neglected, research conducted on the abuse of children with specific learning disorders (SLDs) is limited. METHODS This case-control study aims to compare exposure to neglect and abuse among children diagnosed with SLDs (case group) and children with typical development (control group). The study included children aged 6 to 12 years who were referred to the Child and Adolescent Psychiatry Outpatient Clinic and Pediatric Clinic of a hospital in Türkiye. The data collection process included 196 participants and lasted for 7 months in 2020. RESULTS Based on the analysis of the data collected with the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Turkish Version (K-SADS-PL-T) and the Abuse Assessment Questionnaire, we determined that children with SLDs were physically and emotionally abused more than the children of the control group. In addition, they witnessed violence between their parents more than the control group. Physical abuse, emotional abuse and witnessing family violence were identified as significant predictors for SLD. CONCLUSIONS The presence of SLDs is a significant risk factor for children to be exposed to abuse even in the absence of ADHD as a comorbidity.
Collapse
Affiliation(s)
- Mehmet Erdem Uzun
- Department of Child Psychiatry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye
| | - Yekta Koşan
- Department of Early Childhood Education, Ataturk University, Erzurum, Türkiye
| | - Hande Şirin
- Department of Child Psychiatry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye
| |
Collapse
|
3
|
Blair M, Tweedlie L, Minnis H, Cronin I, Turner F. Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy. PLoS One 2024; 19:e0301640. [PMID: 38626223 PMCID: PMC11020366 DOI: 10.1371/journal.pone.0301640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/19/2024] [Indexed: 04/18/2024] Open
Abstract
Dyadic Developmental Psychotherapy (DDP) is a family-based therapy for adopted children aiming to achieve secure attachment between the child and parent. Due to restrictions under the COVID-19 pandemic, delivery of DDP transitioned from face-to-face to online methods. This study aimed to explore families experience of online DDP compared to face-to-face DDP, looking at the advantages and disadvantages of remote delivery methods and the implications this has on future service delivery for clinicians. Semi-structured interviews with 6 families were conducted online. Analysis of transcripts using Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes: environment and child engagement, non-verbal communication, travel and familiarity with remote interactions. Parents recognised the influence the physical and online environment had on their child's engagement levels, however, varied in their experience and hence preference of delivery method. All families emphasised the importance of non-verbal communication within DDP sessions and majority highlighted this may be lost online. For families who travelled to face-to-face DDP, car journeys provided a unique opportunity to decompress and reflect after sessions. For families where travel is unfeasible, online DDP was a lifeline, demonstrating the ability of remote therapy to widen access to specialist healthcare. Familiarity with online work emerged as a strong indicator of positive attitudes towards remote DDP, especially if the previous experience is positive and the child is confident using technology. Overall, families differed greatly in their experience of remote and face-to-face DDP indicating a new approach must be undertaken with each family beginning therapy, ensuring it is unique and individual to their needs.
Collapse
Affiliation(s)
- Monica Blair
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Leigh Tweedlie
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Helen Minnis
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Irene Cronin
- Academic Child and Mental Health Services, University of Glasgow, Glasgow, United Kingdom
| | - Fiona Turner
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
4
|
Hamel C, Rodrigue C, Clermont C, Hébert M, Paquette L, Dion J. Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence. Sci Rep 2024; 14:6359. [PMID: 38493260 PMCID: PMC10944459 DOI: 10.1038/s41598-024-56909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Child maltreatment is a global concern that profoundly affects individuals throughout their lives. This study investigated the relationships between various forms of child maltreatment and behavior problems involving internalization and externalization during adolescence. Data obtained from a diverse sample of 1802 Canadians aged 14-18 years was used to examine the mediating role of alexithymia-a difficulty in recognizing and expressing emotions-in these associations. Results indicated that adolescents who experienced sexual abuse, emotional abuse, and exposure to intimate partner violence (IPV) in their childhood exhibited higher levels of alexithymia, which was correlated with elevated levels of both internalizing and externalizing problems. Physical abuse and parental neglect were only associated with externalizing problems. Gender differences also emerged, with gender-diverse adolescents reporting a higher prevalence of maltreatment, alexithymia, and behavior problems compared with their peers. However, alexithymia's mediating role was consistent across genders. Overall, this study highlights the intricate relationships between child maltreatment, alexithymia, and adolescent behavior problems. The findings of this study how different forms of child maltreatment significantly shape behavioral outcomes and indicate the importance of interventions in enhancing emotional awareness and expression in adolescents with a childhood history of maltreatment.
Collapse
Affiliation(s)
- Catherine Hamel
- Département de Psychologie, Université de Montréal, Montréal, H2V 2S9, Canada.
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada.
| | - Christopher Rodrigue
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- École de Psychologie, Université Laval, Québec, G1V 0A6, Canada
| | - Camille Clermont
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- École de Psychologie, Université Laval, Québec, G1V 0A6, Canada
| | - Martine Hébert
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- Département de Sexologie, Université du Québec À Montréal, Montréal, H2L 4Y2, Canada
| | - Linda Paquette
- Département Des Sciences de La Santé, Université du Québec À Chicoutimi, Chicoutimi, G7H 2B1, Canada
| | - Jacinthe Dion
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- Département de Psychologie, Université du Québec À Trois-Rivières, Trois-Rivières, G9A 5H7, Canada
| |
Collapse
|
5
|
Moran K, Dyas R, Kelly C, Young D, Minnis H. Reactive attachment disorder, disinhibited social engagement disorder, adverse childhood experiences, and mental health in an imprisoned young offender population. Psychiatry Res 2024; 332:115597. [PMID: 38194802 DOI: 10.1016/j.psychres.2023.115597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND A high proportion of young people in prison have a history of abuse and neglect, and/or of neurodevelopmental or psychiatric conditions. Despite this, the only two conditions specifically associated with abuse and neglect, Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), have never been included as part of a comprehensive prevalence study. METHODS A cross sectional study, in 110 male inmates aged 16 to 23, examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions, including RAD and DSED. OUTCOMES Virtually all of the young men (96 %) had one or more lifetime neurodevelopmental or mental health conditions, 85.5 % had a current condition, yet less than 3 % reported having received a mental health assessment in prison. High rates of RAD and/or DSED symptoms were found (53.6 %) and 74.5 % had experienced some form of abuse or neglect. INTERPRETATION There is a high prevalence of ACEs, RAD/DSED, neurodevelopmental and other mental health conditions within this population. Comprehensive clinical assessments are required to ensure appropriate support and staff training is needed to ensure that the full implications of the high prevalence of neurodevelopmental and mental health conditions are understood as part of trauma informed care.
Collapse
Affiliation(s)
- Kate Moran
- School of Psychology, Trinity College Dublin, Ireland.
| | - Rebecca Dyas
- University of Glasgow School of Health and Wellbeing, Glasgow, Scotland
| | | | - David Young
- Mathematics and Statistics, University of Strathclyde, Scotland.
| | - Helen Minnis
- University of Glasgow School of Health and Wellbeing, Glasgow, Scotland.
| |
Collapse
|
6
|
Rizeq J, Kennedy M, Kreppner J, Maughan B, Sonuga-Barke E. Understanding the prospective associations between neuro-developmental problems, bullying victimization, and mental health: Lessons from a longitudinal study of institutional deprivation. Dev Psychopathol 2024; 36:40-49. [PMID: 35983788 DOI: 10.1017/s095457942200089x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22-25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence.
Collapse
Affiliation(s)
- Jala Rizeq
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Kennedy
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jana Kreppner
- School of Psychology, University of Southampton, Southampton, UK
| | - Barbara Maughan
- Social, Developmental and Genetics Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Blair C, Leonard R, Linden M, Teggart T, Mooney S. Allied health professional support for children and young adults living in and leaving care: A systematic scoping review. Child Care Health Dev 2024; 50:e13140. [PMID: 37300280 DOI: 10.1111/cch.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/06/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Children and young people living in and leaving care are known to have experienced significant childhood adversity and trauma resulting in potentially deleterious impact on their health and well-being across the life course. Studies point to the complex needs of this population who may benefit from allied health professional (AHP)-related support with limited studies located. This review sought to address this gap by systematically scoping empirical literature focused on the provision of AHP support to this cohort of children and young adults to assist an understanding of the service needs for this vulnerable population. METHODS This scoping review followed Arskey and O'Malley's five steps framework (2005) to identify and review relevant literature. A focus on identifying the evidence, challenges and gaps in research relating to AHP support for children and young people living in and leaving care was initially agreed, followed by a systematic search using a combination of three key concepts to identify relevant studies in five AHP disciplinary areas to identify best evidence in the past decade (2011-2021). Study inclusion criteria were based on empirical studies of children and young people living in care (0-17 years) and leaving care (18-25 years). A data extraction table was formulated as a means of charting the data, aligned with the scope and objectives of this review. Finally, data were subsequently collated, synthesised and reported based on key thematic areas emerging from included studies regarding AHP support to children and young people living in and leaving care. RESULTS A total of 13 studies met the review inclusion criteria. Included studies reported specifically on speech and language therapist (SLT; n = 5), occupational therapist (OT; n = 3) and arts-based therapies (n = 5). No studies were identified with regard to the use of physiotherapy and dietetics with this population. Results indicated that children and young people living in and leaving care have high rates of speech, language, communication and sensory needs. More rigorous screening, assessment and early intervention were identified as essential for this vulnerable group. Increased multidisciplinary collaboration and OT support for young adults in preparation for transition to independent living was identified as an urgent requirement. Included studies indicate promising results in relation to access to arts-based therapies with particular reference to identity formation for children and young people living in and leaving care. CONCLUSIONS Although evidence of effectiveness remains limited, AHP service provision (specifically speech and language therapy, occupational therapy and arts-based therapies) has the potential to contribute positively to addressing the complex and interacting needs of this vulnerable population. As a result, it is recommended that AHP service provision is integrated into the collaborative, multidisciplinary care available to children living in and leaving care. More extensive, higher quality research related to the benefits of AHP provision for this population of children and young people is essential to provide a more robust evidence base across the various professional disciplines that constitute allied health provision.
Collapse
Affiliation(s)
- Carolyn Blair
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Rachel Leonard
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Suzanne Mooney
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| |
Collapse
|
8
|
Bali P, Sonuga‐Barke E, Mohr‐Jensen C, Demontis D, Minnis H. Is there evidence of a causal link between childhood maltreatment and attention deficit/hyperactivity disorder? A systematic review of prospective longitudinal studies using the Bradford-Hill criteria. JCPP ADVANCES 2023; 3:e12169. [PMID: 38054051 PMCID: PMC10694545 DOI: 10.1002/jcv2.12169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/24/2023] [Indexed: 12/07/2023] Open
Abstract
Background Studies report an elevated risk of maltreatment in children with attention deficit/hyperactivity disorder (ADHD), and elevated levels of ADHD in people who suffered childhood maltreatment (CM). However, the direction(s) of causality between CM and ADHD remain unclear-does ADHD create a context for CM, does CM cause ADHD, or both? Objective This study systematically reviews and qualitatively synthesizes the research evidence relating to this question using Bradford-Hill criteria for establishing causality-strength, temporality, dose-response and plausibility. Methods We conducted a systematic review, following PRISMA guidelines, of prospective longitudinal studies examining both CM and ADHD. We then used Bradford-Hill criteria to assess the quality of evidence for a causal link between CM and ADHD. Results All 11 included studies demonstrated an association between CM and ADHD. Seven included evidence for temporality: five suggesting that CM precedes ADHD in the lifespan; two suggesting ADHD precedes CM. Four studies demonstrated a dose response relationship in which greater CM exposure was associated with elevated risk of ADHD. Studies presented a range of plausible mechanisms, including CM causing ADHD through biological programming, versus ADHD causing CM through parental stress. Conclusions The high quality prospective longitudinal studies reviewed confirm the association between ADHD and CM, but present conflicting evidence about the direction of causality and mechanisms underpinning this association. To better understand the complex interplay between CM and ADHD, more studies using new research designs will be required that can partition effects by type of CM and account for bidirectional effects and other complexities.
Collapse
Affiliation(s)
- Paraskevi Bali
- University of GlasgowInstitute of Health and WellbeingGlasgowUK
| | - Edmund Sonuga‐Barke
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Christina Mohr‐Jensen
- Department of Child and Adolescent PsychiatryAalborg Psychiatric HospitalAalborg University HospitalAalborgDenmark
| | - Ditte Demontis
- Department of Biomedicine ‐ Human GeneticsAarhus UniversityAarhusDenmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric ResearchiPSYCHAarhusDenmark
| | - Helen Minnis
- University of GlasgowInstitute of Health and WellbeingGlasgowUK
| |
Collapse
|
9
|
Hammarlund M, Breitholtz M, Granqvist P, Forslund T. Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1206-1217. [PMID: 37194381 DOI: 10.1111/jar.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap. METHOD Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis. RESULTS Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability. CONCLUSIONS Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.
Collapse
Affiliation(s)
| | - Mia Breitholtz
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Pehr Granqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Tommie Forslund
- Department of Psychology, Stockholm University, Stockholm, Sweden
- SUF Resource Center, Region Uppsala, Uppsala, Sweden
| |
Collapse
|
10
|
Gibbs V, Hudson J, Pellicano E. The Extent and Nature of Autistic People's Violence Experiences During Adulthood: A Cross-sectional Study of Victimisation. J Autism Dev Disord 2023; 53:3509-3524. [PMID: 35821545 PMCID: PMC10465381 DOI: 10.1007/s10803-022-05647-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
Abstract
This study investigated the extent and nature of violence experiences reported by autistic adults. Autistic (n = 118) and non-autistic (n = 110) adults completed a questionnaire about their experiences of sexual harassment, stalking and harassment, sexual violence and physical violence since the age of 15. Autistic adults reported higher rates of all violence types, multiple forms of violence and repeated instances of the same type of violence. Typical gender differences in the patterns of violence (more physical violence reported by men and more sexual violence reported by women) were apparent in the non-autistic but not the autistic group. Findings add to the limited research in this area and highlight the need to identify risk and protective factors. Policy and practice implications are also discussed.
Collapse
Affiliation(s)
- Vicki Gibbs
- Macquarie School of Education, Macquarie University, Sydney, Australia.
| | | | | |
Collapse
|
11
|
Wolstencroft J, Mandy W, Brown-Wright L, Murin M, Skuse D, DeJong M. Can we distinguish the consequences of early maltreatment on child behaviour from idiopathic autism? Arch Dis Child 2023; 108:392-397. [PMID: 36609536 DOI: 10.1136/archdischild-2022-324156] [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] [Received: 04/11/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify clinical features that could distinguish children presenting with autistic-like features and a history of severe early maltreatment from children with idiopathic autism spectrum disorders (ASDs). DESIGN Matched-comparison study. SETTING Great Ormond Street Hospital, UK. PARTICIPANTS 46 children with a history of early maltreatment, mean (SD) age 10.6 (3.3) years and 47 children with an ASD, mean (SD) age 10.4 (2.9) years. MAIN OUTCOME MEASURES A range of standardised interview and observational measures that are designed to quantify autistic traits. Caregiver and teacher reports were obtained on broader aspects of behavioural and emotional adjustment. RESULTS Both groups had normal range IQ and were predominantly male. On the basis of autistic traits alone, caregiver interview and structured observation concurred that over 60% of the formerly maltreated children met criteria for an ASD. Autistic symptom profiles were very similar in both groups, although children with idiopathic ASD had significantly more marked repetitive and stereotyped behaviours. Teacher and caregiver reports indicated that children from both groups had an increased and broadly similar prevalence of emotional and behavioural disorders. CONCLUSION Children presenting with a history of early maltreatment, who show autistic traits of behaviour, have a high risk of meeting diagnostic criteria for ASD. Their symptom profiles are virtually indistinguishable from children with idiopathic autism.
Collapse
Affiliation(s)
- Jeanne Wolstencroft
- BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - William Mandy
- Psychology and Language Sciences, University College London, London, UK
| | - Lucy Brown-Wright
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marianna Murin
- Anna Freud Centre, University College London, London, UK
| | - David Skuse
- BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Margaret DeJong
- Psychological and Mental Health Services, Queen Anne Street Clinic, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Sonuga-Barke EJS, Becker SP, Bölte S, Castellanos FX, Franke B, Newcorn JH, Nigg JT, Rohde LA, Simonoff E. Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause. J Child Psychol Psychiatry 2023; 64:506-532. [PMID: 36220605 PMCID: PMC10023337 DOI: 10.1111/jcpp.13696] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.
Collapse
Affiliation(s)
- Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Sven Bölte
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Division of Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Sweden
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Emily Simonoff
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
| |
Collapse
|
13
|
Marchini S, Reis J, Ben-Shaool E, Delhaye M, Kornreich C, Nicolis H, Slama H, Leys C, Delvenne V. Dimensional model on how familial vulnerability and environmental factors impact transitional age youth psychopathology: The Transition_psy study. Front Psychiatry 2023; 14:1103030. [PMID: 37032919 PMCID: PMC10076738 DOI: 10.3389/fpsyt.2023.1103030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/20/2023] [Indexed: 04/11/2023] Open
Abstract
Background Understanding psychopathology in transitional age youth (TAY) requires a complex model, incorporating familial vulnerability and environmental factors. A trans-diagnostic and dimensional approach seems the most appropriate. Transition_psy study aims to assess factors playing a role in TAY psychopathology and to define predictors. Materials and methods This article presents part of the Transition_psy study results, a case-control observational study. Youth aged 17 years old were recruited between June 2020 and December 2021, from both clinical [clinical population (CP) group] and non-clinical settings [non-clinical population (NCP) group]. Participants completed self-report questionnaires. The primary outcome to assess TAY psychopathology was the Youth-Self Report (YSR). We evaluated care needs with the Health of The Nation Outcome Scales For Children And Adolescents (HoNOSCA-SR) and quality of life with the World Health Organization Quality of Life - BREF (WHOQoL-BREF). Exposure factors included familial vulnerability, childhood, and present environmental factors, such as first-degree family history of psychopathology, the Childhood Trauma Questionnaire (CTQ) and the Family Assessment Device (FAD). YSR scores were compared, between groups, according to exposure factors with ANOVA and linear regression. We performed best subsets selection of multivariable analyses based on the Akaike Information Criterion. This study was registered with ClinicalTrials.gov (Identifier: NCT04333797). Results A total of 220 TAY (CP = 106, NCP = 114) were included in the study. Participants were aged 17 years old. The majority were female (69.1%), single (96.8%), and born in Belgium (82.3%). Clinical data were all significantly different between CP and NCP groups. YSR scores were found statistically different according to group (p < 0.001), first-degree family history of psychopathology (p < 0.001), CTQ (p < 0.001), and FAD (p < 0.001). Predictive dimensional model suggested that TAY psychopathology can be predicted by group, CTQ and FAD. Significant positive correlation was found between YSR and HoNOSCA (rho = 0.81) and negative correlation between YSR and physical and psychological health (rho = -0.69 and -0.71, respectively). Conclusion This study findings allowed to present a predictive dimensional model on TAY psychopathology, including belonging to a clinical population at transitional age, childhood trauma, and family dysfunction. Further research is needed to replicate Transition_psy study results in other samples. The proposed model could be used in clinical practice to improve assessment of TAY psychopathology.
Collapse
Affiliation(s)
- Simone Marchini
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Psychiatry for Infant, Child, Adolescent and Youth, University Hospital Brussels (HUB), Brussels, Belgium
| | - Joana Reis
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Psychiatry for Infant, Child, Adolescent and Youth, University Hospital Brussels (HUB), Brussels, Belgium
| | - Ella Ben-Shaool
- Department of Psychiatry for Infant, Child, Adolescent and Youth, University Hospital Brussels (HUB), Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, University Hospital Brussels (HUB), Brussels, Belgium
| | - Marie Delhaye
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Psychiatry for Infant, Child, Adolescent and Youth, University Hospital Brussels (HUB), Brussels, Belgium
| | - Charles Kornreich
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Psychiatry, Brugmann University Hospital, Brussels, Belgium
| | - Hélène Nicolis
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Mental Health Service, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hichem Slama
- Department of Neuropsychology and Speech Therapy, University Hospital Brussels (HUB), Brussels, Belgium
- Faculty of Psychological Sciences and Education, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christophe Leys
- Faculty of Psychological Sciences and Education, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Véronique Delvenne
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Psychiatry for Infant, Child, Adolescent and Youth, University Hospital Brussels (HUB), Brussels, Belgium
| |
Collapse
|
14
|
Minnis H. Intergenerational links between childhood maltreatment and health outcomes in offspring. Lancet Public Health 2023; 8:e170-e171. [PMID: 36841557 DOI: 10.1016/s2468-2667(23)00035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Helen Minnis
- University of Glasgow School of Health and Wellbeing, West Glasgow Ambulatory Care Centre, Glasgow G3 8SJ, UK.
| |
Collapse
|
15
|
Davidson C, Turner F, Gillberg C, Campbell SL, Boyd S, Minnis H. Using the live assessment to discriminate between Autism Spectrum Disorder and Disinhibited Social Engagement Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 134:104415. [PMID: 36634523 DOI: 10.1016/j.ridd.2022.104415] [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: 08/29/2022] [Revised: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Children with Autism Spectrum Disorder (ASD) and children with Disinhibited Social Engagement Disorder (DSED) may present with similar social problems, despite differing aetiologies, resulting in diagnostic conundrums. METHODS Thirty children: 10 with ASD, no maltreatment history, 10 with DSED and 10 typically developing children were assessed via 'gold standard' ASD assessments, including the Autism Diagnostic Observational Schedule (ADOS) and a unique unstructured observation known as the Live assessment. Live utilises a triadic interaction (2 assessors and child), playful teasing and social 'stress' scenarios to increase the social challenge. RESULTS The ADOS supported discrimination of DSED from ASD to a degree. Where additional neurodevelopmental problems created ambiguity, the Live assessment was more supportive than the ADOS for unpicking the underlying nature of the social problems. CONCLUSION Live supported differentiation between ASD, DSED and other neurodevelopmental problems. The greater social challenge presented by Live exacerbated core problems of ASD and, in DSED, core social skills stood out.
Collapse
Affiliation(s)
- Claire Davidson
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Fiona Turner
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Christopher Gillberg
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom; Gillberg Neuropsychiatry Service, University of Gothenburg, Gothenburg, Sweden.
| | - Sharon L Campbell
- NHS Greater Glasgow and Clyde, SCA, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Sheila Boyd
- NHS Greater Glasgow and Clyde, SCA, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Helen Minnis
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| |
Collapse
|
16
|
Baldwin JR, Wang B, Karwatowska L, Schoeler T, Tsaligopoulou A, Munafò MR, Pingault JB. Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies. Am J Psychiatry 2023; 180:117-126. [PMID: 36628513 PMCID: PMC7614155 DOI: 10.1176/appi.ajp.20220174] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, the authors conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems. METHODS A search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed, English-language articles from database inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, children of twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting). RESULTS Thirty-four quasi-experimental studies were identified, comprising 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen's d=0.56, 95% CI=0.41, 0.71). After quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen's d=0.31, 95% CI=0.24, 0.37). This adjusted association between childhood maltreatment and mental health was consistent across different quasi-experimental methods, and generalized across different psychiatric disorders. CONCLUSIONS These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.
Collapse
Affiliation(s)
- Jessie R Baldwin
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| | - Biyao Wang
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| | - Lucy Karwatowska
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| | - Tabea Schoeler
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| | - Anna Tsaligopoulou
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| | - Marcus R Munafò
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| | - Jean-Baptiste Pingault
- Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò)
| |
Collapse
|
17
|
Islam S, Jaffee SR, Widom CS. Breaking the Cycle of Intergenerational Childhood Maltreatment: Effects on Offspring Mental Health. CHILD MALTREATMENT 2023; 28:119-129. [PMID: 35073784 DOI: 10.1177/10775595211067205] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study evaluated how continuities and discontinuities in the intergenerational transmission of maltreatment affect offspring psychopathology. Data from a multigenerational prospective, longitudinal study were used to compare the severity of offspring psychopathology in families with no history of maltreatment (controls) and those in which parents, offspring, or both experienced childhood maltreatment (cycle breakers, initiators, and maintainers, respectively). Participants included 454 parents (Mage = 47.1, SDage = 3.4) and their 697 offspring (Mage = 22.3, SDage = 6.3). Offspring of cycle breakers reported less psychopathology than offspring of cycle maintainers and did not report more psychopathology than offspring of controls. Offspring of cycle initiators and maintainers reported comparable levels of psychopathology. Results suggest that breaking the cycle of maltreatment buffers offspring from risk for psychopathology associated with parental maltreatment, with no enduring or additive effects of maltreatment across generations. Our findings highlight the need for maltreatment prevention programs and further research to identify conditions and characteristics that reduce the probability of intergenerational transmission.
Collapse
Affiliation(s)
- Samiha Islam
- Department of Psychology, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Sara R Jaffee
- Department of Psychology, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Cathy S Widom
- Psychology Department, John Jay College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| |
Collapse
|
18
|
Gillett G, Leeves L, Patel A, Prisecaru A, Spain D, Happé F. The prevalence of autism spectrum disorder traits and diagnosis in adults and young people with personality disorders: A systematic review. Aust N Z J Psychiatry 2023; 57:181-196. [PMID: 35986511 PMCID: PMC9896258 DOI: 10.1177/00048674221114603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Autism spectrum disorders and personality disorders are spectrum conditions with shared clinical features. Despite similarities, previous attempts to synthesise literature on co-existing prevalence and shared traits have employed a unidirectional focus, assessing personality characteristics of individuals with an autism spectrum disorder diagnosis. Here, we assess the prevalence of autism spectrum disorder diagnosis and/or traits among persons diagnosed with a personality disorder. METHODS We systematically reviewed the English-language literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, according to a pre-registered protocol (PROSPERO: CRD 42021264106). Peer-reviewed quantitative studies reporting the prevalence of autism spectrum disorder diagnosis or traits in persons with an established personality disorder diagnosis were included. Studies were critically appraised using the Appraisal tool for Cross-Sectional Studies. RESULTS Fifteen studies were identified, including 72,902 participants (median: 48, interquartile range: 30-77). Diagnoses included borderline, schizotypal and obsessive-compulsive personality disorders, and cohorts with unspecified personality disorder diagnoses. There was significant heterogeneity in diagnostic methodology and assessment tools used. We identified preliminary evidence of an increased prevalence of co-existing autism spectrum disorder diagnosis and traits among those diagnosed with a personality disorder, although significant limitations of the literature were identified. CONCLUSION Our research suggests clinicians should consider conducting a careful developmental assessment when assessing service-users with possible or confirmed personality disorder. Future research directions may include larger studies featuring clinical control groups, an exploration of shared and differentiating behavioural-cognitive features of the two conditions, and investigation into potentially shared aetiological factors. Research investigating demographic factors that may contribute to potential diagnostic overshadowing would also be welcomed.
Collapse
Affiliation(s)
- George Gillett
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,George Gillett, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AB, UK.
| | | | | | | | - Debbie Spain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| |
Collapse
|
19
|
Turner F, Kainth G, MacDonald S, O'Connor R, Crawford K, Minnis H. "I will commit to this child as much as I can for the time that they are with me:" A qualitative examination of how foster carer commitment relates to short-term foster care for young children following abuse and neglect. CHILD ABUSE & NEGLECT 2023; 135:105983. [PMID: 36525826 DOI: 10.1016/j.chiabu.2022.105983] [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: 03/31/2022] [Revised: 09/27/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Foster carer commitment to the child has been shown to be of paramount importance in young children's recovery and development following abuse and neglect. In Dozier's definition of commitment in the US, there is a focus on both emotional investment in the child and committing to an enduring relationship with the child. How this relates to the routine practice of short-term, temporary, foster care has not been studied. OBJECTIVE This is the first qualitative study to explore the drivers of, and barriers to, commitment in short-term foster care within the broader aim of examining whether short-term care is meeting the needs of maltreated young children. PARTICIPANTS & SETTING Fourteen foster carers took part in research interviews and five focus groups were conducted with infant mental health professionals. METHODS Interviews and focus group data were subject to qualitative thematic analysis in order to identify patterns of commonality in relation to our research questions. RESULTS Three broad themes pertain to commitment and the meeting of young children's needs in short-term foster care: Influence, Timescales and Choice in the fostering role. These themes were found to house both drivers of, and barriers to, commitment in short-term care, which are influenced by systemic normalisations of fostering practices. CONCLUSIONS The emotional investment facet of commitment is more alive in the 'psyche' of short-term foster care than commitment to an enduring relationship. A long-term outlook for the child may be an undefined facet of commitment that is more akin with short-term placements.
Collapse
Affiliation(s)
- Fiona Turner
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Gary Kainth
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Sara MacDonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Rory O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Karen Crawford
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Helen Minnis
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| |
Collapse
|
20
|
Gajwani R, Minnis H. Double jeopardy: implications of neurodevelopmental conditions and adverse childhood experiences for child health. Eur Child Adolesc Psychiatry 2023; 32:1-4. [PMID: 36156745 PMCID: PMC9908716 DOI: 10.1007/s00787-022-02081-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ruchika Gajwani
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, Academic CAMHS, West Glasgow Ambulatory Care Hospital, University of Glasgow, Glasgow, G3 8SJ UK ,grid.413301.40000 0001 0523 9342NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, Academic CAMHS, West Glasgow Ambulatory Care Hospital, University of Glasgow, Glasgow, G3 8SJ, UK. .,NHS Greater Glasgow and Clyde, Glasgow, UK.
| |
Collapse
|
21
|
Thapar A, Livingston LA, Eyre O, Riglin L. Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression. J Child Psychol Psychiatry 2023; 64:4-15. [PMID: 35972029 PMCID: PMC10087979 DOI: 10.1111/jcpp.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.
Collapse
Affiliation(s)
- Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy A Livingston
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olga Eyre
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| |
Collapse
|
22
|
Cooke EM, Connolly EJ, Boisvert DL, Hayes BE. A Systematic Review of the Biological Correlates and Consequences of Childhood Maltreatment and Adverse Childhood Experiences. TRAUMA, VIOLENCE & ABUSE 2023; 24:156-173. [PMID: 34105421 DOI: 10.1177/15248380211021613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Childhood maltreatment (CM) and adverse childhood experiences (ACEs) are two primary forms of interpersonal victimization that have been associated with a host of deleterious health outcomes. Studies over the past decade have begun to use a range of biologically informed methods to better understand the role biology plays in the relationship between CM, ACEs, and later life outcomes. This line of research has shown that both forms of victimization occur at sensitive periods of development, which can increase the likelihood of "getting under the skin" and influence health and behavior across the life course. This review examines the current state of knowledge on this hypothesis. One hundred and ninety-nine studies are included in this systematic review based on criteria that they be written in English, use a biologically informed method, and be conducted on samples of humans. Results reveal that latent additive genetic influences, biological system functioning captured by biomarkers, polygenic risk scores, and neurobiological factors are commonly associated with exposure and response to CM and ACEs. The implication of these findings for the existing body of research on early life victimization and recommendations for future research and policy are discussed.
Collapse
Affiliation(s)
- Eric M Cooke
- Department of Criminal Justice and Criminology, 4038Sam Houston State University, Huntsville, TX, USA
| | - Eric J Connolly
- Department of Criminal Justice and Criminology, 4038Sam Houston State University, Huntsville, TX, USA
| | - Danielle L Boisvert
- Department of Criminal Justice and Criminology, 4038Sam Houston State University, Huntsville, TX, USA
| | - Brittany E Hayes
- School of Criminal Justice, 2514University of Cincinnati, OH, USA
| |
Collapse
|
23
|
Wilkinson S, Evans S, DeJong M. Assessing autism spectrum disorder in children with a background of maltreatment: challenges and guidance. Arch Dis Child 2022:archdischild-2022-323986. [PMID: 36385007 DOI: 10.1136/archdischild-2022-323986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 10/22/2022] [Indexed: 11/17/2022]
Abstract
There may be some similarities in the presentation of children who have autism spectrum disorder (ASD) and those exposed to maltreatment affecting assessment and diagnosis. Overlapping characteristics include difficulties understanding and maintaining relationships, sensitivity to routine and hyper-reactivity to sensory inputs. Children who have been maltreated are at increased risk of various developmental vulnerabilities with both environmental and genetic factors being relevant. The existing epidemiological evidence has found that looked-after children are more likely to screen positively for neurodevelopmental disorders and there are smaller scale studies in adoptive children finding higher rates of ASD than would be expected in the general population. Other research suggests a predominantly genetic basis for this increased risk in keeping with what is generally understood about the aetiology of autism. Children exposed to profound deprivation in Romanian orphanages were found to be at higher risk of a pattern of traits termed 'quasi autistic' which tended to reduce following adoption, but these findings have not been replicated in children experiencing maltreatment in birth families. Reactive attachment disorder (RAD) has some overlapping criteria with ASD, but its prevalence is unknown and children with RAD should be more socially reciprocal and not have the same repetitive and restricted behaviours and interests. We recommend experienced multidisciplinary assessment that considers both the possibility of maltreatment in children with ASD and neurodevelopmental vulnerabilities in children who have been maltreated and advise on assessment and management strategies.
Collapse
Affiliation(s)
- Simon Wilkinson
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sacha Evans
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Margaret DeJong
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
24
|
Tobarra‐Sanchez E, Riglin L, Agha SS, Stergiakouli E, Thapar A, Langley K. Preschool development, temperament and genetic liability as early markers of childhood ADHD: A cohort study. JCPP ADVANCES 2022; 2:e12099. [PMID: 36478889 PMCID: PMC9716640 DOI: 10.1002/jcv2.12099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Background ADHD is associated with multiple adverse outcomes and early identification is important. The present study sets out to identify early markers and developmental characteristics during the first 30 months of life that are associated with ADHD 6 years later. Methods 9201 participants from the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were included. Outcome measures were parent-rated ADHD symptom scores (Strengths and Difficulties Questionnaire, SDQ) and ADHD diagnosis (Development and Wellbeing Assessment, DAWBA) at age 7. Seventeen putative markers were identified from previous literature and included: pre- and peri-natal risk factors, genetic liability (ADHD polygenic risk scores, PRS), early development, temperament scores and regulatory problems. Associations were examined using regression analysis. Results Univariable regression analysis showed that multiple early life factors were associated with future ADHD outcomes, even after controlling for sex and socio-economic status. In a multivariable linear regression model; temperament activity scores (B = 0.107, CI = 0.083-0.132), vocabulary delay (B = 0.605, CI = 0.211-0.988), fine motor delay (B = 0.693, CI = 0.360-1.025) and ADHD PRS (B = 0.184, CI = 0.074-0.294) were associated with future symptoms (R 2 = 10.7%). In a multivariable logistic regression model, ADHD PRS (OR = 1.39, CI = 1.10-1.77) and temperament activity scores (OR = 1.09, CI = 1.04-1.16) showed association with ADHD diagnosis. Conclusion As well as male sex and lower socio-economic status, high temperament activity levels and motor and speech delays in the first 30 months of life, are associated with childhood ADHD. Intriguingly, given that genetic risk scores are known to explain little of the variance of ADHD outcomes, we found that ADHD PRS added useful predictive information. Future research needs to test whether predictive models incorporating aspects of early development and genetic risk scores are useful for predicting ADHD in clinical practice.
Collapse
Affiliation(s)
- Esther Tobarra‐Sanchez
- Child and Adolescent Psychiatry SectionDivision of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and GenomicsSchool of MedicineCardiff UniversityCardiffUK,Cwm Taf Morgannwg University Health BoardCardiffUK
| | - Lucy Riglin
- Child and Adolescent Psychiatry SectionDivision of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and GenomicsSchool of MedicineCardiff UniversityCardiffUK
| | - Sharifah S. Agha
- Child and Adolescent Psychiatry SectionDivision of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and GenomicsSchool of MedicineCardiff UniversityCardiffUK,Cwm Taf Morgannwg University Health BoardCardiffUK
| | - Evie Stergiakouli
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK,Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Anita Thapar
- Child and Adolescent Psychiatry SectionDivision of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and GenomicsSchool of MedicineCardiff UniversityCardiffUK
| | - Kate Langley
- Child and Adolescent Psychiatry SectionDivision of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and GenomicsSchool of MedicineCardiff UniversityCardiffUK,School of PsychologyCardiff UniversityCardiffUK
| |
Collapse
|
25
|
Göransson L, Ekermann S, Dovik C, Klingberg G, Ridell K, Laurell L. Children's advocacy centre fails to respond to dental, mental and physical ill-health in abused children. Acta Paediatr 2022; 111:1186-1193. [PMID: 35279867 PMCID: PMC9314582 DOI: 10.1111/apa.16328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/29/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
Aim Sweden´s first multidisciplinary children's advocacy centre (CAC) was founded in 2005 as a collaborative practice between child protection services, the legal system and health care in response to police‐reported child abuse. CACs were introduced in the county of Skåne in 2007. The aim of the study was to describe the health of children investigated at the CAC in Lund, and to examine whether the CAC model of collaboration responded to the healthcare needs of these children. Methods All children aged 0–17 years investigated at the CAC in 2015 were included in this retrospective study. We reviewed the CAC files and the children's medical and dental records from one year prior to, until one year after their assessment at the CAC. Results Our review of the medical and dental records (n = 298) showed a high prevalence of mental, dental and physical ill‐health. After the CAC joint meeting, only 1% of the children were referred for a medical examination and 4% for a focused forensic evaluation. Conclusion Our study demonstrates limitations in the CAC process in responding to extensive health issues of the young victims of crime. We suggest mental, dental and physical health assessments to be statutory in CACs.
Collapse
Affiliation(s)
- Linn Göransson
- Department of Gynaecology and Obstetrics Eksjö Hospital Eksjö Sweden
| | | | - Christoffer Dovik
- Department of Internal Medicine and Emergency Care Skåne University Hospital Lund Sweden
| | | | - Karin Ridell
- Faculty of Odontology Malmö University Malmö Sweden
| | - Louise Laurell
- Department of Paediatrics Skåne University Hospital Lund University, Faculty of Medicine, Department of Clinical Sciences Lund Sweden
| |
Collapse
|
26
|
The Lancet Psychiatry Commission on intimate partner violence and mental health: advancing mental health services, research, and policy. Lancet Psychiatry 2022; 9:487-524. [PMID: 35569504 DOI: 10.1016/s2215-0366(22)00008-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023]
|
27
|
Nemmezi Karaca S, Uzun Cicek A, Mercan Isik C, Kanak M, Demirel G. Evidence of the relationship between attention deficit/hyperactivity disorder (ADHD) and emotional abuse in a sample of preschool children. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2072311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sanem Nemmezi Karaca
- Department of Family Medicine, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ayla Uzun Cicek
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Cansu Mercan Isik
- Department of Preschool Education, Faculty of Education, Cumhuriyet University, Sivas, Turkey
| | - Mehmet Kanak
- SBU Diyarbakir Gazi Yaşargil Education Research Hospital, Child and Adolescent Psychiatry Outpatient Clinic, Diyarbakir, Turkey
| | - Gulbahtiyar Demirel
- Department of Midwifery, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
28
|
Turner F, Venturini E, Kainth G, Crawford K, O'Connor R, Balestrieri M, MacDonald S, Minnis H. The expected and the unexpected in recovery and development after abuse and neglect: The role of early foster carer commitment on young children's symptoms of attachment disorders and mental health problems over time. CHILD ABUSE & NEGLECT 2022; 127:105585. [PMID: 35279447 DOI: 10.1016/j.chiabu.2022.105585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Whilst we know that foster care is better than institutional care for abused and neglected children, we know less about the specific qualities of foster care that are important for their development and recovery from maltreatment effects. OBJECTIVE This is the first study to investigate the effects of foster carer commitment on symptoms of Attachment Disorders (AD) and mental health problems in young children post-maltreatment. PARTICIPANTS & SETTING 144 children, age 0-5, recently accommodated into foster care as part of an ongoing Randomised Controlled Trial. METHODS Children were assessed using the Disturbances of Attachment Interview and the Strengths and Difficulties Questionnaire, then followed up 15 months and 2.5 years thereafter. Commitment of the foster carer was measured by 'This Is My Baby' interview. Multiple regression was used to analyse the data. RESULTS Higher initial foster carer commitment, measured shortly after entry to care, was associated with a reduction in Reactive Attachment Disorder symptoms 15 months after placement, with a modest (non-significant) association persisting 2.5 years later. Initial commitment was not associated with symptoms of Disinhibited Social Engagement Disorder at any follow-up time point, nor with symptoms of mental health problems at 15 months. However, higher initial commitment was unexpectedly associated with higher mental health symptom scores at 2.5 years post-accommodation. CONCLUSIONS This study highlights the complex and non-linear development of children in committed foster care, underscoring the need to examine multiple time-points and to consider symptoms of Attachment Disorders separately from those of other mental health problems.
Collapse
Affiliation(s)
- Fiona Turner
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | | | - Gary Kainth
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Karen Crawford
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Rory O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | | | - Sara MacDonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Helen Minnis
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| |
Collapse
|
29
|
Davidson C, Moran H, Minnis H. Autism and attachment disorders – how do we tell the difference? BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SUMMARY
Clinicians assessing children with autism are sometimes faced with a dilemma, especially if there is a definite or suspected history of abuse or neglect: is this autism or attachment disorder? This is important because the attachment disorders (reactive attachment disorder and disinhibited social engagement disorder) are thought to be caused by abuse or neglect, whereas autism is not. We discuss the Coventry Grid, a clinical tool aiming to aid differentiation between autism and attachment disorders. We examine the small body of empirical studies focusing on this differential diagnosis and find that the Coventry Grid can be regarded as an evidence-based tool. We also discuss preliminary findings regarding a relatively unstructured observational method involving two assessors who engage the child in jokes and playful social dilemmas, which might help clinicians elicit the information required to complete the Coventry Grid.
Collapse
|
30
|
Abstract
Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.
Collapse
Affiliation(s)
- Sarah A Font
- Pennsylvania State University, Department of Sociology and Criminology, 612 Oswald Tower, University Park, PA 16802
| | - Reeve Kennedy
- Pennsylvania State University, Department of Sociology and Criminology
| |
Collapse
|
31
|
Marshall JJ, Sörman K, Durbeej N, Thompson L, Lundström S, Minnis H, Hellner C, Gillberg C. Interpersonal trauma and its relation to childhood psychopathic traits: what does ADHD and ODD add to the equation? BMC Psychiatry 2021; 21:630. [PMID: 34922499 PMCID: PMC8684186 DOI: 10.1186/s12888-021-03610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/22/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Childhood trauma has demonstrated associations with callous-unemotional traits (e.g., reflecting lack of remorse and guilt, unconcern about own performance). Less is known about associations between trauma and multiple domains of child psychopathic traits. There has also been limited focus on the role of co-occurring disorders to psychopathy traits among children, namely, attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) and how they interact with childhood trauma. METHODS We examined to what degree childhood interpersonal trauma can predict parent-rated psychopathic traits in a large population based Swedish twin sample (N = 5057), using a stringent definition of interpersonal trauma occurring before age 10. Two hundred and fifty-one participants met the interpersonal trauma criteria for analysis. The study explored the additional impact of traits of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). RESULTS Linear regressions demonstrated statistically significant but clinically negligible effects of interpersonal trauma on total and subscale scores of parent-rated psychopathic traits. When exploring interaction effects of ADHD and ODD into the model, the effect increased. There were interaction effects between ODD and trauma in relation to psychopathic traits, suggesting a moderating role of ODD. Having been exposed to trauma before age 10 was significantly associated with higher parent rated psychopathy traits as measured by The Child Problematic Traits Inventory-Short Version (CPTI-SV), however the explained variance was small (0.3-0.9%). CONCLUSIONS The results challenge the notion of association between interpersonal trauma and youth psychopathic traits. They also highlight the need to gain an improved understanding of overlap between psychopathic traits, ADHD and ODD for clinical screening purposes and the underlying developmental mechanisms.
Collapse
Affiliation(s)
- John J. Marshall
- Institute of Health and WellbeingUniversity of Glasgow, Glasgow, UK
| | - Karolina Sörman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Durbeej
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Stockholm, Sweden
| | - L. Thompson
- Institute of Health and WellbeingUniversity of Glasgow, Glasgow, UK
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Glasgow, UK
| | - Sebastian Lundström
- Institute of Neuroscience and Physiology, Gillberg Neuropsychiatry Centre, Centre of Ethics Law and Mental Health, Gothenburg University, Gothenburg, Sweden
| | - Helen Minnis
- Institute of Health and WellbeingUniversity of Glasgow, Glasgow, UK
| | - Clara Hellner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Institute of Health and WellbeingUniversity of Glasgow, Glasgow, UK
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Glasgow, UK
| |
Collapse
|
32
|
Abstract
In the last 40 years, there has been a huge increase in autism genetics research and a rapidly growing number of discoveries. We now know autism is one of the most highly heritable disorders with negligible shared environmental contributions. Recent discoveries also show that rare variants of large effect size as well as small effect common gene variants all contribute to autism risk. These discoveries challenge traditional diagnostic boundaries and highlight huge heterogeneity in autism. In this review, we consider some of the key findings that are shaping current understanding of autism and what these discoveries mean for clinicians.
Collapse
Affiliation(s)
- Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Hadyn Ellis Building, Cardiff, Maindy Road, Wales, CF24 4HQ, UK.
| | - Michael Rutter
- Social, Genetic and Developmental Psychiatry Centre, Kings College London, London, UK
| |
Collapse
|
33
|
Fleming M, McLay JS, Clark D, King A, Mackay DF, Minnis H, Pell JP. Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study. PLoS Med 2021; 18:e1003832. [PMID: 34767555 PMCID: PMC8589203 DOI: 10.1371/journal.pmed.1003832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. METHODS AND FINDINGS Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. CONCLUSIONS Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.
Collapse
Affiliation(s)
- Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - James S. McLay
- Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - David Clark
- Public Health Scotland, Edinburgh, United Kingdom
| | - Albert King
- ScotXed, Scottish Government, Edinburgh, United Kingdom
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
34
|
Baldwin JR, Ayorech Z, Rijsdijk FV, Schoeler T, Pingault JB. Cyber-victimisation and mental health in young people: a co-twin control study. Psychol Med 2021; 51:2620-2630. [PMID: 32364102 DOI: 10.1017/s0033291720001178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The rise of social media use in young people has sparked concern about the impact of cyber-victimisation on mental health. Although cyber-victimisation is associated with mental health problems, it is not known whether such associations reflect genetic and environmental confounding. METHODS We used the co-twin control design to test the direct association between cyber-victimisation and multiple domains of mental health in young people. Participants were 7708 twins drawn from the Twins Early Development Study, a UK-based population cohort followed from birth to age 22. RESULTS Monozygotic twins exposed to greater levels of cyber-victimisation had more symptoms of internalising, externalising and psychotic disorders than their less victimised co-twins at age 22, even after accounting for face-to-face peer victimisation and prior mental health. However, effect sizes from the most stringent monozygotic co-twin control analyses were decreased by two thirds from associations at the individual level [pooled β across all mental health problems = 0.06 (95% CI 0.03-0.10) v. 0.17 (95% CI 0.15-0.19) in individual-level analyses]. CONCLUSIONS Cyber-victimisation has a small direct association with multiple mental health problems in young people. However, a large part of the association between cyber-victimisation and mental health is due to pre-existing genetic and environmental vulnerabilities and co-occurring face-to-face victimisation. Therefore, preventative interventions should target cyber-victimisation in conjunction with pre-existing mental health vulnerabilities and other forms of victimisation.
Collapse
Affiliation(s)
- Jessie R Baldwin
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ziada Ayorech
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fruhling V Rijsdijk
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tabea Schoeler
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jean-Baptiste Pingault
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
35
|
Reuben KE, Stanzione CM, Singleton JL. Interpersonal Trauma and Posttraumatic Stress in Autistic Adults. AUTISM IN ADULTHOOD 2021; 3:247-256. [PMID: 36605371 PMCID: PMC8992908 DOI: 10.1089/aut.2020.0073] [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: 01/07/2023]
Abstract
Background Many autistic adults report interpersonal traumas (IPTs) such as physical or sexual assault, which are often associated with posttraumatic stress and dissociation. Factors such as gender might make autistic individuals particularly vulnerable to experiencing IPT and negative posttraumatic symptoms. Methods In this study, 687 self-identified autistic adults completed an online survey on their traumatic experiences and mental health symptoms. Results Seventy-two percent of participants reported experiencing sexual assault, other unwanted or uncomfortable sexual experiences, or physical assault. Forty-four percent of participants met the criteria for posttraumatic stress disorder (PTSD), including 50% of those who had experienced IPT and 28% of those who had not (odds ratio = 2.50; 95% confidence interval 1.74-3.60). IPT was also significantly associated with higher levels of psychoform (p < 0.001) and somatoform (p < 0.001) dissociation. Autistic cisgender women and gender minorities experienced a significantly higher number of traumas (p = 0.004) and were significantly more likely than cisgender men to experience sexual IPT (p < 0.001) and meet the criteria for PTSD (p < 0.001). There were no significant differences between autistic individuals with and without a professional autism spectrum disorder (ASD) diagnosis. Conclusions IPT is associated with potentially severe mental health outcomes for autistic adults. Autistic women and gender minorities may be particularly vulnerable to sexual IPT and adverse outcomes. Increased screening for a history of IPT and posttraumatic symptoms is recommended for all autistic adults regardless of ASD diagnosis status. Lay summary Why was this study done?: Many autistic people experience interpersonal traumas (IPTs) such as sexual or physical assault. These can lead to mental health challenges such as posttraumatic stress disorder (PTSD) or dissociation (a disconnection between individuals and aspects of their perceptions or sense of self). We wanted to better understand what might make autistic adults more likely to experience trauma and how it affects them.What was the purpose of this study?: The purpose was to understand what might make autistic people more at risk of experiencing IPT and PTSD. We also wanted to know if IPT is associated with a higher risk of PTSD or dissociation.What did the researchers do?: Six hundred eighty-seven autistic adults filled out an online survey about their traumatic experiences, PTSD symptoms, and dissociation symptoms. We analyzed their responses to see how often participants reported experiencing different types of trauma and whether they met the criteria for PTSD and clinical dissociation. We then compared trauma experiences and PTSD rates across genders and those with and without a professional autism spectrum disorder (ASD) diagnosis and compared PTSD rates and dissociation rates across participants who had versus had not experienced IPT.What were the results of the study?: Seventy-two percent of autistic adults in this study reported having experienced sexual assault, another unwanted sexual experience, or physical assault. Almost half (44%) met the criteria for PTSD. Most participants (93%) also reported high levels of mind-based dissociation, and 32% reported high levels of body-based dissociation (dissociation that causes negative emotions to be experienced as physical problems such as headaches or trouble moving). Participants who had experienced IPT were almost twice as likely to meet the criteria for PTSD and scored higher on both measures of dissociation. Cisgender women and gender minorities were more likely to experience IPT and meet the criteria for PTSD than cisgender men. Participants with and without a professional ASD diagnosis did not differ.What do these findings add to what was already known?: Most previous research on trauma and PTSD for autistic people was done on children and did not look at IPT specifically or compare people based on their gender or ASD diagnosis. As far as we know, this is the first study on posttraumatic dissociation in autistic adults.What are potential weaknesses in the study?: The findings of this study may not apply to autistic adults as a whole. People who could have participated may not have been interested in the topic, may not have seen study advertisements and so been unaware of the study, or may not have had the time or energy to participate. Findings might have been different if different groups of autistic people participated more.How will these findings help autistic adults now or in the future?: If professionals who help autistic people do not talk to them about trauma, traumatized autistic adults may not get the right support. This study could encourage professionals to screen more autistic people, especially women and gender minorities, for trauma.
Collapse
Affiliation(s)
- Katherine E. Reuben
- Center for Research on Interpersonal Violence, School of Public Health, Georgia State University, Atlanta, Georgia, USA.,Address correspondence to: Katherine E. Reuben, BS, Center for Research on Interpersonal Violence, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, USA.
| | | | - Jenny L. Singleton
- Department of Linguistics, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
36
|
Lewis SJ, Koenen KC, Ambler A, Arseneault L, Caspi A, Fisher HL, Moffitt TE, Danese A. Unravelling the contribution of complex trauma to psychopathology and cognitive deficits: a cohort study. Br J Psychiatry 2021; 219:448-455. [PMID: 34538875 PMCID: PMC7611677 DOI: 10.1192/bjp.2021.57] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Complex traumas are traumatic experiences that involve multiple interpersonal threats during childhood or adolescence, such as repeated abuse. Complex traumas are hypothesized to lead to more severe psychopathology and poorer cognitive function than other non-complex traumas. However, empirical testing of this hypothesis has been limited to clinical/convenience samples and cross-sectional designs. AIMS To investigate psychopathology and cognitive function in young people exposed to complex, non-complex, or no trauma from a population-representative longitudinal cohort, and to consider the role of pre-existing vulnerabilities. METHOD Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative birth-cohort of 2,232 British children. At age 18 years (93% participation), we assessed lifetime exposure to complex and non-complex trauma, past-year psychopathology, and current cognitive function. We also prospectively assessed early childhood vulnerabilities: internalizing and externalizing symptoms at age 5, IQ at age 5, family history of mental illness, family socioeconomic status, and sex. RESULTS Participants exposed to complex trauma had more severe psychopathology and poorer cognitive function at age 18 compared to both trauma-unexposed participants and those exposed to non-complex trauma. Early childhood vulnerabilities predicted risk of later complex trauma exposure, and largely explained associations of complex trauma with cognitive deficits, but not with psychopathology. CONCLUSIONS By conflating complex and non-complex traumas, current research and clinical practice under-estimate the severity of psychopathology, cognitive deficits, and pre-existing vulnerabilities linked with complex trauma. A better understanding of the mental health needs of people exposed to complex trauma could inform the development of new effective interventions.
Collapse
Affiliation(s)
- Stephanie J Lewis
- King’s College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, USA
| | - Antony Ambler
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Louise Arseneault
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Avshalom Caspi
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; Duke University, Department of Psychology and Neuroscience, USA; Duke University, Department of Psychiatry and Behavioral Sciences, USA; Duke University, Center for Genomic and Computational Biology, USA
| | - Helen L Fisher
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; King’s College London, ESRC Centre for Society & Mental Health, UK
| | - Terrie E Moffitt
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; Duke University, Department of Psychology and Neuroscience, USA; Duke University, Department of Psychiatry and Behavioral Sciences, USA; Duke University, Center for Genomic and Computational Biology, USA
| | - Andrea Danese
- King’s College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, UK; King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; South London and Maudsley NHS Foundation Trust, National and Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, UK
| |
Collapse
|
37
|
Fisher JH, Widom CS. Child maltreatment and cognitive and academic functioning in two generations. CHILD ABUSE & NEGLECT 2021; 115:105011. [PMID: 33636490 DOI: 10.1016/j.chiabu.2021.105011] [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: 10/20/2020] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Childhood maltreatment has been associated with deficits in cognitive functioning and poor academic performance. Not known is whether these characteristics are the direct consequence of the childhood maltreatment (that is, maltreatment plays a causal role) or whether other factors explain the relationship. OBJECTIVES To examine whether childhood maltreatment predicts cognitive and academic functioning and whether these relationships are explained by other factors (parent cognitive and academic functioning, family social class, or parent maltreatment). PARTICIPANTS Data are from a longitudinal study of previously maltreated children, matched controls, and a subset of their offspring (697 parent-offspring dyads) interviewed in 2009-2010. METHOD Cognitive and academic functioning were assessed in both parents and offspring with the same measures. Maltreatment was determined through official records. Hierarchical linear regressions were conducted to examine predictors of offspring cognitive and academic functioning. RESULTS Childhood maltreatment was associated with poorer cognitive functioning and worse academic performance in both generations. Controlling for age, sex, race, and whether the parent had more than one child in the study, offspring maltreatment predicted offspring cognitive functioning when it was the only predictor in the model. In a final model with all variables, only parent cognitive functioning predicted offspring cognitive functioning and parent academic functioning and parent history of maltreatment predicted offspring academic functioning. CONCLUSION These results challenge assumptions that childhood maltreatment directly causes deficits in cognitive and academic functioning. Policy makers and practitioners may need to rethink the design of interventions to improve the cognitive and academic functioning of maltreated children.
Collapse
Affiliation(s)
- Jacqueline Horan Fisher
- Psychology Department, SUNY Purchase College, 735 Anderson Hill Road, Purchase, NY, 10577, USA; Psychology Department, John Jay College, City University of New York, 524 West 59th Street, New York, NY, 10019, USA.
| | - Cathy Spatz Widom
- Psychology Department, John Jay College, City University of New York, 524 West 59th Street, New York, NY, 10019, USA; Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA.
| |
Collapse
|
38
|
The association of child maltreatment and systemic inflammation in adulthood: A systematic review. PLoS One 2021; 16:e0243685. [PMID: 33831008 PMCID: PMC8031439 DOI: 10.1371/journal.pone.0243685] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Child maltreatment (CM) is associated with mental and physical health disorders in adulthood. Some studies have identified elevated markers of systemic inflammation in adult survivors of CM, and inflammation may mediate the association between CM and later health problems. However, there are methodological inconsistencies in studies of the association between CM and systemic inflammation and findings are conflicting. We performed a systematic review to examine the association of CM with systemic inflammation in adults. Methods A pre-registered systematic review was performed following PRISMA guidelines. Medline, Embase, Scopus and PsychInfo were searched for studies of the association of CM with blood markers of inflammation in adults. Quality was assessed using the Crowe Critical Appraisal Tool. We had intended to perform a meta-analysis, but this was not possible due to variation in study design and reporting. Results Forty-four articles met criteria for inclusion in the review. The most widely reported biomarkers were C-Reactive Protein (CRP) (n = 27), interleukin-6 (IL-6) (n = 24) and Tumour Necrosis Factor-alpha (TNF-a) (n = 17). Three studies were prospective (all relating to CRP) and the remainder were retrospective. 86% of studies were based in high income countries. In the prospective studies, CM was associated with elevated CRP in adulthood. Results of retrospective studies were conflicting. Methodological issues relating to the construct of CM, methods of analysis, and accounting for confounding or mediating variables (particularly Body Mass Index) may contribute to the uncertainty in the field. Conclusions There is some robust evidence from prospective studies that CM is associated with elevated CRP in adulthood. We have identified significant methodological inconsistencies in the literature and have proposed measures that future researchers could employ to improve consistency across studies. Further prospective, longitudinal, research using robust and comparable measures of CM with careful consideration of confounding and mediating variables is required to bring clarity to this field.
Collapse
|
39
|
Gajwani R, Dinkler L, Lundström S, Lichtenstein P, Gillberg C, Minnis H. Mania symptoms in a Swedish longitudinal population study: The roles of childhood trauma and neurodevelopmental disorders. J Affect Disord 2021; 280:450-456. [PMID: 33242716 DOI: 10.1016/j.jad.2020.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/13/2020] [Accepted: 10/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adult psychiatric disorders are associated with both childhood traumatic experiences (CTEs) and neurodevelopmental disorders (NDDs). CTEs and NDDs frequently co-occur in childhood, but their combined risk effect on the emergence of juvenile mania symptoms has not yet been examined. METHODS In a population-representative Swedish twin study, CTEs and NDDs were assessed in 3,348 nine-year old twins born between 1998 and 2001, and treated as dichotomous predictors (any CTEs, any NDDs). Follow-up data were gathered at age 15 through parental reports of mania symptoms, yielding a symptom count score. RESULTS Both CTEs and NDDs at age 9 contributed uniquely to an increase in mania symptoms at age 15. Children with both risk factors had 1.6 times the rate of mania symptoms as children with CTEs-only (Incidence rate ratio [IRR] 1.63, 95% CI 1.37-1.93), and 1.3 times the rate of mania symptoms as children with NDDs-only (IRR 1.26, 95% CI 1.06-1.50). There was no evidence for an interactive effect of CTEs and NDDs. NDDs showed a trend towards having a larger effect on mania symptoms than CTEs (NDDs-only vs. CTEs-only: IRR 1.29, 95% CI 0.99-1.68). LIMITATIONS Although it is a strength of the study that the data on exposures and outcome were collected prospectively, parental recall of CTEs was required and CTEs may be under-reported. CONCLUSIONS NDDs are at least as important as CTEs in the development of mania symptoms, and their risk is additive. Those with a history of both CTEs and NDDs should be monitored closely for the development of more severe psychiatric presentations.
Collapse
Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Christopher Gillberg
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
40
|
Johansson A, Rötkönen N, Jern P. Is the association between childhood maltreatment and aggressive behavior mediated by hostile attribution bias in women? A discordant twin and sibling study. Aggress Behav 2021; 47:28-37. [PMID: 32853475 PMCID: PMC7754152 DOI: 10.1002/ab.21928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022]
Abstract
Understanding the mechanisms behind aggressive behavior (AGG) is vital so that effective prevention and intervention strategies can be developed. Maltreated children are hypothesized to be prone to social information processing biases, such as hostile attribution bias (HAB), which, in turn, may increase the likelihood of behaving aggressively. The first aim of the present study was to replicate findings regarding associations between childhood maltreatment (CM), HAB, and aggression in a population-based sample of Finnish female twins and their sisters (N = 2,167). However, these associations might not be causal but instead confounded by familial factors, shared between the variables. The second aim was, thus, to test the associations when potential confounding by familial (genetic or common environmental) effects were controlled for using a multilevel discordant twin and sibling design within (a) 379 pairs of twins (npairs = 239) or siblings (npairs = 140), and (b) within the 131 monozygotic (MZ) twin pairs. Consistent with previous studies, HAB mediated the association between CM and AGG when familial confounding was uncontrolled. No support was found for the mediation when controlling for familial confounding. Between-pair associations were found between CM and AGG, and between CM and HAB. In addition, within-pair associations were found between HAB and AGG, and between CM and AGG, however, these were nonsignificant in the discordant MZ analysis, offering the most stringent control of familial confounding. The results indicate the necessity of taking familial confounding into account when investigating the development of AGG.
Collapse
Affiliation(s)
- Ada Johansson
- Department of Psychology, Faculty of Arts, Psychology and Theology Åbo Akademi University Turku Finland
| | - Nicola Rötkönen
- Department of Psychology, Faculty of Arts, Psychology and Theology Åbo Akademi University Turku Finland
| | - Patrick Jern
- Department of Psychology, Faculty of Arts, Psychology and Theology Åbo Akademi University Turku Finland
| |
Collapse
|
41
|
Kandaswamy R, Hannon E, Arseneault L, Mansell G, Sugden K, Williams B, Burrage J, Staley JR, Pishva E, Dahir A, Roberts S, Danese A, Mill J, Fisher HL, Wong CCY. DNA methylation signatures of adolescent victimization: analysis of a longitudinal monozygotic twin sample. Epigenetics 2020; 16:1169-1186. [PMID: 33371772 PMCID: PMC8813077 DOI: 10.1080/15592294.2020.1853317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Accumulating evidence suggests that individuals exposed to victimization at key developmental stages may have different epigenetic fingerprints compared to those exposed to no/minimal stressful events, however results are inconclusive. This study aimed to strengthen causal inference regarding the impact of adolescent victimization on the epigenome by controlling for genetic variation, age, gender, and shared environmental exposures. We conducted longitudinal epigenome-wide association analyses (EWAS) on DNA methylation (DNAm) profiles of 118 monozygotic (MZ) twin pairs from the Environmental Risk study with and without severe adolescent victimization generated using buccal DNA collected at ages 5, 10 and 18, and the Illumina EPIC array. Additionally, we performed cross-sectional EWAS on age-18 blood and buccal DNA from the same individuals to elucidate tissue-specific signatures of severe adolescent victimization. Our analyses identified 20 suggestive differentially methylated positions (DMPs) (P < 5e-05), with altered DNAm trajectories between ages 10–18 associated with severe adolescent victimization (∆Beta range = −5.5%−5.3%). Age-18 cross-sectional analyses revealed 72 blood (∆Beta range = −2.2%−3.4%) and 42 buccal (∆Beta range = −3.6%−4.6%) suggestive severe adolescent victimization-associated DMPs, with some evidence of convergent signals between these two tissue types. Downstream regional analysis identified significant differentially methylated regions (DMRs) in LGR6 and ANK3 (Šidák P = 5e-09 and 4.07e-06), and one upstream of CCL27 (Šidák P = 2.80e-06) in age-18 blood and buccal EWAS, respectively. Our study represents the first longitudinal MZ twin analysis of DNAm and severe adolescent victimization, providing initial evidence for altered DNA methylomic signatures in individuals exposed to adolescent victimization.
Collapse
Affiliation(s)
- Radhika Kandaswamy
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Eilis Hannon
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Louise Arseneault
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,ESRC Centre for Society & Mental Health, King's College London, London, UK
| | - Georgina Mansell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Benjamin Williams
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Joe Burrage
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - James R Staley
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ehsan Pishva
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Aisha Dahir
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Susanna Roberts
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London UK
| | - Andrea Danese
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,King's College London, Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London UK.,National & Specialist CAMHS Clinic for Trauma, Anxiety and Depression, South London & Maudsley NHS Foundation Trust, London, UK
| | - Jonathan Mill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,ESRC Centre for Society & Mental Health, King's College London, London, UK
| | - Chloe C Y Wong
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| |
Collapse
|
42
|
Lang J, Kerr DM, Petri-Romão P, McKee T, Smith H, Wilson N, Zavrou M, Shiels P, Minnis H. The hallmarks of childhood abuse and neglect: A systematic review. PLoS One 2020; 15:e0243639. [PMID: 33290423 PMCID: PMC7723263 DOI: 10.1371/journal.pone.0243639] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Studies on the impacts of child maltreatment (CM) have been conducted in diverse areas. Mechanistic understanding of the complex interplay between factors is lacking. Hallmarking is an approach which identifies common factors across studies and highlights the most robust findings. OBJECTIVES In a review of systematic reviews and meta-analyses, we addressed the following questions: 1) What are the hallmarks associated with exposure to CM across the bio-ecological spectrum? 2) What is the strength of evidence to support each hallmark? 3) What are the gaps that future research should address? METHODS A comprehensive literature search was carried out to find relevant systematic reviews or meta-analyses. 269 articles were read in full and 178 articles, encompassing more than 6000 original papers, were included in the final synthesis. All reviews were independently rated for quality by at least 2 reviewers using AMSTAR-2. RESULTS Of 178 review articles, 6 were rated as high quality (all meta-analyses) and 46 were rated as medium quality. Most were from high income countries. CONCLUSIONS Based on the most commonly reported high-quality research findings we propose that the hallmarks of exposure to child maltreatment are: Increased risk of psychopathology; Increased risk of obesity; Increased risk of high- risk sexual behaviours, Increased risk of smoking; and Increased risk of child maltreatment in children with disabilities. Research gaps include a lack of focus on complexity and resilience. Little can be concluded about directions of causality or mechanisms. Adequately powered prospective studies are required to move the field forward.
Collapse
Affiliation(s)
- Jason Lang
- University of Glasgow, Glasgow, United Kingdom
- NHS Lanarkshire, Lanarkshire, United Kingdom
| | | | | | - Tracey McKee
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Helen Smith
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Naomi Wilson
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Paul Shiels
- University of Glasgow, Glasgow, United Kingdom
| | | |
Collapse
|
43
|
Seleem MA, Amer RA. Parenting discipline styles and child psychopathology in a clinical sample of Egyptian children in the Nile Delta region. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00063-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Few, if any, studies evaluated the effect of violent parenting discipline on children’s psychological well-being in the Nile Delta region. The current study aimed to explore the spectrum of violent versus non-violent parenting discipline styles practiced by a sample of Egyptian families who came for psychiatric advice in Tanta Psychiatry and Neurology Center and the effects of such styles on youth’s problem behavior and psychiatric diagnoses. Two hundred and seven families were recruited and interviewed using the Kiddie Schedule of affective disorders and schizophrenia-present and life-time version “K-SADS-PL.” Arabic translated and validated versions of the conflict tactics scale–parent child version (CTS-PC) and the child behavioral checklist questionnaire (CBCL) for ages 6–18 years were used to evaluate parenting discipline styles and child psychopathology, respectively.
Results
Youth (n = 207) had an average age of 10.8 ± 2.8 years and 30% were females. A significant association was noted between all forms of psychological and physical violence against children, in addition to neglectful parenting, and both internalizing and externalizing problems in offspring with no significant differences between mild and severe forms of violence. Parents who were sexually abused as children had more tendency to practice violent discipline strategies on their own children.
Conclusions
All forms of child maltreatment, even mild forms, have a considerable effect on the child psychological development. National policies and legalization should be implemented to decrease child maltreatment and protect children from all forms of physical and sexual abuse.
Collapse
|
44
|
Kildahl AN, Oddli HW, Helverschou SB. Potentially traumatic experiences and behavioural symptoms in adults with autism and intellectual disability referred for psychiatric assessment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 107:103788. [PMID: 33091711 DOI: 10.1016/j.ridd.2020.103788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) more frequently experience potentially traumatic events (PTEs), and may be more vulnerable to trauma-related symptoms. However, it is unclear how such symptoms are captured on tools used for behavioural and psychiatric assessment in this population. AIMS To explore whether and how PTEs are associated with symptom reports in adults with ASD and ID. METHODS AND PROCEDURES Associations and group differences for death of a close relative and serious disease/injury in a close relative/caregiver/friend were explored in a clinical sample of 171 adults with ASD and ID referred for psychiatric assessment. Symptoms were measured using Aberrant Behavior Checklist (ABC) and Psychopathology in Autism Checklist (PAC). OUTCOMES AND RESULTS Disease/injury was associated with higher scores on ABC irritability, ABC hyperactivity and self-injurious behaviour. Death was associated with lower scores on ABC lethargy and ABC stereotypic behaviour. Some associations reached significance only when controlling for ASD, ID, or verbal language skills, but the identified associations were not robust. No associations were found for PAC. CONCLUSIONS AND IMPLICATIONS There is a risk of under-appreciating the impact of PTEs in this population unless ASD, ID and verbal language skills are taken into account.
Collapse
Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway; NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway.
| | | | - Sissel Berge Helverschou
- NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
45
|
Craig SG, Bondi BC, O'Donnell KA, Pepler DJ, Weiss MD. ADHD and Exposure to Maltreatment in Children and Youth: a Systematic Review of the Past 10 Years. Curr Psychiatry Rep 2020; 22:79. [PMID: 33161561 DOI: 10.1007/s11920-020-01193-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW The purpose of the current paper was to review and summarize the literature on ADHD and maltreatment over the past 10 years. RECENT FINDINGS The majority of research on ADHD and exposure to maltreatment focuses on the high rates of comorbidity, including international studies from Asia, South America, North America, and Europe. Longitudinal studies showed that early exposure to maltreatment is a risk factor for ADHD symptoms later in development; however, this finding was not consistent. There were some preliminary studies on the neurological and genetic mechanisms underlying the link between ADHD and exposure to maltreatment. Finally, ADHD and exposure to maltreatment were found to have an additive effect on clinically salient outcomes (e.g., aggression, suicide attempts). Results from the review have direct clinical and future implications, including the need to understand the effect of comorbid ADHD and exposure to maltreatment in treatment studies.
Collapse
Affiliation(s)
- Stephanie G Craig
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada.
| | - Bianca C Bondi
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada
| | | | - Debra J Pepler
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada
| | | |
Collapse
|
46
|
Ogundele M. Profile of neurodevelopmental and behavioural problems and associated psychosocial factors among a cohort of newly looked after children in an English local authority. ADOPTION & FOSTERING 2020; 44:255-271. [DOI: 10.1177/0308575920945187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Limited research has been undertaken into the neurodevelopmental profile of looked after children and young people who are known to be highly vulnerable to mental and physical health morbidities. This study seeks to assess the prevalence of childhood neurodisabilities and related neurodevelopmental, emotional, behavioural and intellectual problems (NDEBIPs) among a cohort of children coming into care in an English local authority. A retrospective review of all referrals to a local authority health team between January and December 2018 was carried out as part of its clinical governance strategies. No identifiable patient record was used and no research ethical approval was required. A total of 56 out of 80 (70%) children had at least one or more NDEBIPs (average of two), including behavioural (32.5%) and emotional problems (16%), attachment difficulties (14%) and speech/language delay (12.5%). This compares with a prevalence of up to 15% reported in normal childhood populations. Fifty-one (91%) of the looked after children and young people with NDEBIPs experienced at least one or more psychosocial adversities/trauma (average of five). Each of them received help from an average of four multidisciplinary professionals including social workers, dentists, opticians and health visitors and had an average of three physical/mental health diagnoses. The implications of this high prevalence are discussed together with recommendations arising from clinical experience. Particularly salient is the need for planning future integrated multi-agency services to meet children’s complex needs.
Collapse
|
47
|
Social-relational exposures and well-being: Using multivariate twin data to rule-out heritable and shared environmental confounds. JOURNAL OF RESEARCH IN PERSONALITY 2020; 83. [PMID: 32317811 DOI: 10.1016/j.jrp.2019.103880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aims of the present study were as follows: (1) Using a large sample of adults, estimate overlap between social-relational exposures measured at midlife and well-being measured at midlife and approximately 9-years later. (2) Using a subsample of twins, test for heritable variation in social-relational exposures, and (3) controlling for heritable and shared environmental variation, estimate overlap between social-relational exposures and well-being, both concurrently and approximately 9-years later. Results indicated small-to-moderate overlap between exposures and well-being (mean r = .29, range = .05 to .54). There was also evidence for heritable variation in exposures, and after accounting for these genetic factors, the degree of overlap between social-relational exposures and well-being decreased (mean r = .09, range = -.07 to .33).
Collapse
|
48
|
Kildahl AN, Helverschou SB, Bakken TL, Oddli HW. "If we do not look for it, we do not see it": Clinicians' experiences and understanding of identifying post-traumatic stress disorder in adults with autism and intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1119-1132. [PMID: 32285568 DOI: 10.1111/jar.12734] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co-occurring ASD and ID. METHOD Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. RESULTS Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. CONCLUSIONS Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population.
Collapse
Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway.,NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Sissel Berge Helverschou
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Trine Lise Bakken
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
| | | |
Collapse
|
49
|
Lehmann S, Breivik K, Monette S, Minnis H. Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms. CHILD ABUSE & NEGLECT 2020; 101:104374. [PMID: 31982843 DOI: 10.1016/j.chiabu.2020.104374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown. OBJECTIVE We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B). PARTICIPANTS, SETTING AND METHODS Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview. RESULTS Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort). CONCLUSIONS These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.
Collapse
Affiliation(s)
- Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, NORCE Norwegian Research Centre, Bergen, Norway; Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Norway.
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sebastien Monette
- Department of Psychology, Université Du Québec à Montréal (UQAM), Canada
| | - Helen Minnis
- Adverse Childhood Experiences Clinical and Research Centre, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
| |
Collapse
|
50
|
Danese A. Annual Research Review: Rethinking childhood trauma-new research directions for measurement, study design and analytical strategies. J Child Psychol Psychiatry 2020; 61:236-250. [PMID: 31762042 DOI: 10.1111/jcpp.13160] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
Abstract
Childhood trauma is a key modifiable risk factor for psychopathology. Despite significant scientific advances, traumatised children still have poorer long-term outcomes than nontraumatised children. New research paradigms are, thus, needed. To this end, the review examines three dominant assumptions about measurement, design and analytical strategies. Current research warns against using prospective and retrospective measures of childhood trauma interchangeably; against interpreting cross-sectional differences in putative mediating mechanisms between adults with or without a history of childhood trauma as evidence of longitudinal changes from pre-trauma conditions; and against directly applying explanatory models of resilience or vulnerability to psychopathology in traumatised children to forecast individual risk in unseen cases. The warnings equally apply to research on broader measures of adverse childhood experiences (ACEs). Further research examining these assumptions can generate new insights on how to prevent childhood trauma and its detrimental effects.
Collapse
Affiliation(s)
- Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National and Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|