Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

PROTOCOL: Risk and protective factors for child sexual abuse and interventions against child sexual abuse: An umbrella review

This is the protocol for a Campbell Collaboration systematic review. Our objective is to conduct an umbrella review to synthesize published and unpublished systematic reviews focused on risk and protective factors for child sexual abuse and effectiveness of interventions against child sexual abuse perpetration and victimization. Specific research questions are: (i) what are the risk and protective factors for child sexual abuse victimization, and what are their relative strength and/or magnitude for predicting child sexual abuse victimization? (ii) what are the risk and protective factors for child sexual abuse perpetration, and what are their relative strength and/or magnitude for predicting child sexual abuse perpetration? (iii) are interventions aimed at reducing and/or preventing child sexual abuse effective? (iv) what are the moderators that increase or decrease effectiveness of the interventions? Efforts to decrease child sexual abuse need to be based on research, but more accessible evidence regarding the breadth of risk and protective factors and effectiveness of interventions to reduce child sexual abuse needs to be provided to policymakers. This will be the first umbrella review that comprehensively synthesizes findings of the previous systematic reviews that focus on risk and protective factors for child sexual abuse and interventions to prevent or reduce child sexual abuse. The results will be able to inform enhanced prevention policy and programs, and regulatory measures for specific contexts of child sexual abuse.

Dimensions of Child Maltreatment in Australians With a History of Out-of-Home Care

Research suggests that the dimensions of childhood maltreatment (type, age of onset, duration, frequency and perpetrator) play an important role in determining health and wellbeing outcomes, though little information is available on these dimensions for any care experienced cohorts. This study aimed to determine if any variation in maltreatment dimensions were experienced between two subsets of the nationally representative Australian Child Maltreatment Study, both of which reported childhood maltreatment histories: care-experienced (n = 358) and non-care-experienced (n = 4922). Using a series of independent t-tests and chi-square tests, we compared the two groups on seven dimensions (number of maltreatment types, range of maltreatment items, age of onset, duration, frequency, perpetrator number, and perpetrator type) for the five child maltreatment types (physical, emotional, sexual abuse, neglect, and exposure to domestic violence). Results showed that the care-experienced group reported a higher intensity of maltreatment, being younger when maltreatment first started, experiencing greater variety of maltreatment types, for longer periods, more times and by more perpetrators than maltreated people with no care experience. We conclude that children and young people in out-of-home care experience maltreatment at a higher intensity than the rest of the population, which has implications for effective treatment.

Prospective Association of Symptoms of Depression and Anxiety with Pornography Viewing Frequency Among Young Adults

Young adulthood is a critical development period when mental health problems such as anxiety and depression become more prevalent. Likewise, there is evidence to suggest that depression and anxiety may lead to increased pornography usage. We examined the association of depression and anxiety symptoms with pornography viewing frequency among a prospective cohort of young adults (n = 1864) from California. Multinomial logistic regression models estimated the association of depression symptoms only, anxiety symptoms only, and comorbid depression and anxiety with pornography viewing frequency (never, < 3 times/month, one to several times/week, one to several times/day) at a 6-month follow-up. Models adjusted for gender, sexual orientation, sexual satisfaction, and adverse childhood experiences. Participants with comorbid depression and anxiety (vs. no depression or anxiety symptoms) had 2.72 (95% CI: 1.66-4.46) times the odds of frequent pornography viewing (one to several times/day) compared to never watching pornography. There was an association of depression symptoms only with frequent pornography viewing but it did not reach statistical significance (OR: 1.95, 95% CI: 0.78-4.89). Anxiety symptoms alone (vs. no depression and anxiety symptoms) were not associated with pornography viewing at any frequency in the full sample. However, in gender-stratified models, anxiety symptoms alone were associated with pornography viewing among women (OR: 1.44. 95% CI: 1.00-2.07), but not men (1.12, 95% CI: 0.65-1.96). Findings suggest comorbid depression and anxiety symptoms are associated with frequent pornography viewing among young adults, and anxiety symptoms alone are associated with pornography viewing among women, but not men.

Global, regional, and national burden of major depressive disorder and alcohol use disorder attributed to childhood sexual abuse in 204 countries and territories, 1999-2019: An analysis for the global burden of disease study 2019

AIM

This study aims to elucidate the impact of childhood sexual abuse (CSA) on major depressive disorder (MDD) and alcohol use disorder (AUD) globally, regionally, and nationally, informing targeted public health interventions and policy.

METHODS

Using data from the Global Burden of Disease (GBD) Study 2019, we assessed the impact of CSA on MDD and AUD, analyzing disability-adjusted life years (DALYs) per 100,000 population. Our analysis included age, sex, geographic locations, temporal trends in age-standardized rates (ASR), and examined the relationship between the social development index (SDI) and the burden of these disorders.

RESULTS

From 1990 to 2019, the global ASR for MDD attributable to CSA increased by 1.9 %, while AUD decreased by 17.1 %. Significant gender disparities emerged, with females showing higher ASRs for MDD and males for AUD. The highest burden was observed in the 35-44 age group. Geographical analysis revealed the highest ASRs for MDD in Sub-Saharan Africa and for AUD in Eastern Europe, Central Europe, and High-income North America. A U-shaped relationship between SDI and disorder burdens was also identified.

CONCLUSIONS

Our findings indicate a slight increase in MDD and a significant decrease in AUD burdens globally due to CSA, underscoring the need for targeted interventions considering gender, geographical, and developmental differences. This calls for strategies tailored to each country's unique development, culture, and regional specifics.

Profiles of self-regulation and their association with behavior problems among sexually abused children

This study aimed to delineate profiles of self-regulation among sexually abused children and their association with behavior problems using a person-centered approach. A sample of 223 children aged six to 12, their parents, and teachers were recruited in specialized intervention centers. Latent profile analysis revealed four profiles: (1) Dysregulated, (2) Inhibited, (3) Flexibly Regulated, and (4) Parent Perceived Self-Regulation. Children from the Flexibly Regulated profile showed relatively low behavior problems, and those from the Dysregulated profile were characterized by high behavior problems. Children from the Parent Perceived Self-Regulation profile showed overall good adaptation, although teachers reported higher behavior problems than parents. Children from the Inhibited profile, characterized by the highest level of inhibition but low parent-rated emotion regulation competencies and executive functions, showed the highest level of internalizing behavior problems, indicating that high inhibition does not necessarily translate to better adaptation. Results also show a moderation effect of sex. Being assigned to the Inhibited profile was associated with decreased externalizing behaviors in boys and increased internalizing behaviors in girls. This study underscores the complexity of self-regulation in sexually abused children and supports the need to adopt a multi-method and multi-informant approach when assessing these children.

Interactions of the CSF3R polymorphism and early stress on future orientation: evidence for the differential model of stress-related growth

AIMS

This study aims to explore the concept of future orientation, which encompasses individuals' thoughts about the future, goal-setting, planning, response to challenges and behavioural adjustments in evolving situations. Often viewed as a psychological resource, future orientation is believed to be developed from psychological resilience. The study investigates the curvilinear relationship between childhood maltreatment and future orientation while examining the moderating effects of genotype.

METHODS

A total of 14,675 Chinese adults self-reported their experiences of childhood maltreatment and their future orientation. The influence of genetic polymorphism was evaluated through genome-wide interaction studies (GWIS; genome-wide association study [GWAS] using gene × environment interaction) and a candidate genes approach.

RESULTS

Both GWAS and candidate genes analyses consistently indicated that rs4498771 and its linked single-nucleotide polymorphisms, located in the intergenic area surrounding CSF3R, significantly interacted with early trauma to influence future orientation. Nonlinear regression analyses identified a quadratic or cubic association between future orientation and childhood maltreatment across some genotypes. Specifically, as levels of childhood maltreatment increased, future orientation declined for all genotypes. However, upon reaching a certain threshold, future orientation exhibited a rebound in individuals with specific genotypes.

CONCLUSIONS

The findings suggest that individuals with certain genotypes exhibit greater resilience to childhood maltreatment. Based on these results, we propose a new threshold model of stress-related growth.

Maximizing the reach of universal child sexual abuse prevention: Protocol for an equivalence trial

Background

Child sexual abuse (CSA) affects 1 in 5 girls and 1 in 12 boys before age 18. Universal school-based prevention programs are an effective and cost-efficient method of teaching students an array of personal safety skills. However, the programmatic reach of universal school-based programs is limited by the inherent reliance on the school infrastructure and a dearth of available alternative delivery modalities.

Methods

The design for this study will use a rigorous cluster randomized design (N = 180 classrooms) to determine the equivalence of two delivery modalities of Safe Touches: as usual vs. modified. The as usual workshop will be delivered by two facilitators with live puppet skits (n = 90). Whereas, the modified workshop will be delivered by one facilitator using prerecorded skit videos (n = 90). We will determine the equivalence by measuring concept learning acquisition preworkshop to immediate postworkshop (Aim 1) and retention at 3-months postworkshop (Aim 2) among students in classrooms that receive the as usual or modified workshops. To conclude equivalence, it is imperative to also examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity between the two modalities (Aim 3).

Conclusion

Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within schools.

Clinical trial registration

NCT06195852.

Identifying PTSD and Complex PTSD Profiles in Child Victims of Sexual Abuse

Post-traumatic stress disorder (PTSD) symptoms are frequent in child victims of sexual abuse. Authors argued that early trauma could lead to alterations in development that go far beyond the primary symptoms of PTSD and have proposed that Complex PTSD (C-PTSD) involving alterations in attachment, biology, affect regulation, consciousness, behavioral regulation, cognition, and self-concept, may better describe children experiencing chronic trauma at an early developmental stage. The aim of the study was to disentangle the diversity of profiles in child victims of sexual abuse based on the C-PTSD framework. Latent profile analysis was used to identify distinct subgroups in a sample of 861 sexually abused children aged 6 to 12. Children and their non-offending parents completed questionnaires evaluating PTSD symptoms and measures documenting alterations in development characteristics of C-PTSD. Latent profile analysis identified a best-fitting model consisting of three profiles: PTSD (40.7% of children), Resilient (32.8% of children), and C-PTSD (26.5% of children). Compared to others, children in the C-PTSD profile were more likely to have experienced more forms of interpersonal trauma and showed impairments in several domains. Findings underscore the importance of tailoring interventions to efficiently address the needs of young victims of sexual trauma.

Role of Adverse Childhood Experiences in the Onset of Overweight/Obesity

PURPOSE OF REVIEW

The goal of this chapter was to summarize the literature on childhood adversity and obesity, discuss treatment implications with a case example, and provide recommendations for trauma-informed care for clinicians who work with individuals living with obesity.

RECENT FINDINGS

Adversity in childhood is related directly and indirectly to obesity development. Upstream contributors like adverse childhood experiences (ACEs) and other factors can lead to experiences of toxic stress and increased allostatic load, resulting in downstream effects of obesity and other chronic health conditions. A well-established literature has linked ACEs and obesity suggesting complex interactions between genetic, biological, behavioral, mental health, social, and environmental factors and obesity. Trauma-informed care strategies can be used to optimize care for individuals living with obesity. Care pathways should include individual (clinician) and systemic (organizational) evidence-based interventions.

Distinct characteristics of social anxiety among youths with childhood sexual abuse: A latent profile analysis

BACKGROUND

Childhood sexual abuse (CSA) is one type of childhood trauma that has long-term effects on physical and mental health, predisposing to social anxiety.

OBJECTIVE

This study attempted to investigate the characteristics of different subgroups of social anxiety among youths with CSA experiences.

PARTICIPANTS AND SETTING

83,219 participants were recruited in a cross-sectional study from 63 colleges and universities in Jilin Province, China.

METHODS

The main variables were measured by a series of self-report questionnaires. Latent profile analysis was used to classify different subgroups of social anxiety, and multiple logistic regression was employed to investigate factors influencing transitions between different subgroups.

RESULTS

3022 (3.63 %) youths who suffered from CSA (46.8 % were male, Mage = 19.57, SD = 1.76) could be divided into four subgroups of social anxiety: low-risk social anxiety (16.4 %), medium-risk social anxiety with high public speaking anxiety (30.3 %), medium-risk social anxiety with no prominent characteristics (22.9 %), and high-risk social anxiety (30.4 %). Shy bladder and bowel and virtual life orientation increased the level of social anxiety from low to medium and high risk. Smoking and drinking were more prevalent in the low- and medium-risk subgroups than in the high-risk subgroup.

CONCLUSIONS

There was heterogeneity in different subgroups of social anxiety among youths with CSA experiences. Potential targeted prevention and intervention suggestions could be beneficial in mitigating the risk of social anxiety and further preventing the aggravation of risk between subgroups.

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

COVID-19-related stress exacerbates the effect of child maltreatment on negative affect via increased identity confusion during adolescence

INTRODUCTION

Exposure to childhood maltreatment may undermine the crucial developmental task of identity formation in adolescence, placing them at risk for developing negative affect. The current study investigated whether COVID-19-related stress intensified the indirect link between child maltreatment and adolescents' negative affect through identity confusion.

METHOD

Using multidimensional assessments of child maltreatment (threat vs. deprivation), the study included a sample of 124 adolescents (Mage  = 12.89, SD = 0.79; 52% female) assessed before (January 2018 to March 2020) and during the pandemic (May to October 2020) in Georgia, United States. The majority of the participants were European American (78.8%), followed by African American (11.5%), Hispanic (3.8%), Asian/Pacific Islander (1.0%), and other (4.8%). We used structural equation modeling to test (a) the mediating role of identity confusion in the link between childhood maltreatment and negative affect and (b) whether COVID-19-related stress moderated these indirect effects. Simple slopes and Johnson-Neyman plots were generated to probe regions of significant interaction effects.

RESULTS

Threat and deprivation predicted an increase in adolescent identity confusion. Additionally, childhood threat and deprivation were indirectly linked to adolescents' negative affect through increased levels of identity confusion. COVID-19-related stress significantly exacerbated the link between identity confusion and negative affect.

CONCLUSION

Identity confusion is a mechanism underlying the link between child maltreatment and the development of negative affect in adolescence. Our results inform prevention and intervention programs that aim to reduce negative affect among adolescents who experience threatening and depriving rearing environments.

International guidelines for the prevention of sexual violence: A systematic review and perspective of WHO, UN Women, UNESCO, and UNICEF's publications

BACKGROUND

Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex, requiring not only evidence-based practices and high ethical standards, but also close collaboration with local governments and non-governmental organizations. In order to guide and support all stakeholders necessary to achieve large-scale prevention (e.g., politicians, decision-makers, in-field professionals), it is essential to establish international benchmarks for the prevention of sexual violence.

OBJECTIVE

The main goal of this collaborative study was to conduct a systematic review of the frameworks adopted by WHO, UN Women, UNESCO, and UNICEF to help prevent sexual violence worldwide, according to the PRISMA methodology. A secondary objective was to highlight the levels of prevention and determinants of health targeted by these organizations.

RESULTS

Overall, 1008 references were identified, of which 50 met the inclusion criteria. All international guidelines were limited to primary or tertiary prevention, and they were not specifically dedicated to sexual violence. In addition, each organization had developed idiosyncratic prevention strategies. Common primary prevention determinants of health were still found across organizations, including education, socio-economic inequalities, and life skills training. Tertiary prevention was poorly developed and polarized between victims and perpetrators. Secondary prevention was never addressed, however, despite the effectiveness of approaches such as helplines for people sexually attracted to children.

DISCUSSION

Given these results, an international French-speaking consortium of professional teams, all involved in the secondary prevention of sexual violence, was recently formed with a ratified charter presented here.

Individual and Social Risk and Protective Factors as Predictors of Trajectories of Post-traumatic Stress Symptoms in Adolescents

The present study elucidates heterogeneity in post-traumatic stress symptoms (PTSS) across adolescence in a sample of youth who have experienced myriad types and combinations of potentially traumatic events (PTEs), including substantiated physical abuse, sexual abuse, neglect and/or at least one other self-reported PTE. A machine learning technique was used to assess a multivariate set of variables (e.g., PTEs, individual risk and protective factors, social risk and protective factors, and racial and ethnic minority status) as predictors of PTSS trajectory group membership. The sample included 498 maltreated (n = 275) and comparison (n = 223) 14-19-year-old female adolescents (M = 15.27, SD = 1.06 at Time 1) assessed annually until age 19. 45.7% of participants were White, 45.3% Black, 0.4% Native American, 0.8% Hispanic, and 7.7% other. Growth mixture modeling identified three distinct trajectories of PTSS: (1) recovery (56%); (2) moderate, chronic (25%); and (3) high, chronic (19%). An elastic net model was used to test predictors of membership in the recovery versus the high, chronic PTSS trajectory groups. Results demonstrated that the recovery trajectory was characterized by the absence of sexual abuse, physical abuse, and other traumas, higher self-esteem, less affective dysregulation, less risky peers, lower levels of parent depression, and being of racial/ethnic minority status. Findings help to characterize individual variation in trajectories of PTSS following PTEs by underscoring the unique trauma responses of racial and ethnic minority youth and offering possible targets of interventions to promote recovery from PTSS.

Adverse childhood experiences on internet gaming disorder mediated through insomnia in Chinese young people

Background

Adverse childhood experiences (ACEs) have been associated with addictions such as substance use disorders. Few have examined ACEs on internet gaming disorder (IGD) as a newly established behavioral addiction, and the potential mediating role of insomnia remains unclear. We examined the associations between ACE number and types, IGD, and insomnia.

Methods

Participants included 1, 231 Chinese university students (54.5% male; 56.9% aged 18-20 years) who had played internet games at least once in the previous month. ACEs were measured using the 10-item ACE questionnaire (yes/no). Symptoms of insomnia and IGD were measured using the Insomnia Severity Index and the 9-item Internet Gaming Disorder Scale-Short-Form, respectively. Multivariable regressions examined the associations, adjusting for sex, age, maternal and paternal educational attainment, monthly household income, smoking, and alcohol drinking. The mediating role of insomnia symptoms was explored.

Results

The prevalence of ACEs≥1 was 40.0%. Childhood verbal abuse was the most prevalent (17.4%), followed by exposure to domestic violence (17.1%) and childhood physical abuse (15.5%). More ACE numbers showed an association with IGD symptoms (adjusted OR = 1.11, 95% CI 1.04, 1.17). Specifically, IGD symptoms were observed for childhood physical neglect, emotional neglect, sexual abuse, parental divorce or separation, and household substance abuse. Insomnia symptoms mediated the associations of ACE number and types with IGD symptoms (proportion of total effect mediated range 0.23-0.89).

Conclusion

The number and specific types of ACEs showed associations with IGD mediated through insomnia. Screening of ACEs is recommended in future studies on IGD. Longitudinal data are warranted to determine the causality of the observed associations.

Understanding posttraumatic stress trajectories in adolescent females: A strength-based machine learning approach examining risk and protective factors including online behaviors

Heterogeneity in the course of posttraumatic stress symptoms (PTSS) following a major life trauma such as childhood sexual abuse (CSA) can be attributed to numerous contextual factors, psychosocial risk, and family/peer support. The present study investigates a comprehensive set of baseline psychosocial risk and protective factors including online behaviors predicting empirically derived PTSS trajectories over time. Females aged 12-16 years (N = 440); 156 with substantiated CSA; 284 matched comparisons with various self-reported potentially traumatic events (PTEs) were assessed at baseline and then annually for 2 subsequent years. Latent growth mixture modeling (LGMM) was used to derive PTSS trajectories, and least absolute shrinkage and selection operator (LASSO) logistic regression was used to investigate psychosocial predictors including online behaviors of trajectories. LGMM revealed four PTSS trajectories: resilient (52.1%), emerging (9.3%), recovering (19.3%), and chronic (19.4%). Of the 23 predictors considered, nine were retained in the LASSO model discriminating resilient versus chronic trajectories including the absence of CSA and other PTEs, low incidences of exposure to sexual content online, minority ethnicity status, and the presence of additional psychosocial protective factors. Results provide insights into possible intervention targets to promote resilience in adolescence following PTEs.

Infant epigenetic aging moderates the link between Black maternal childhood trauma and offspring symptoms of psychopathology

Although offspring of women exposed to childhood trauma exhibit elevated rates of psychopathology, many children demonstrate resilience to these intergenerational impacts. Among the variety of factors that likely contribute to resilience, epigenetic processes have been suggested to play an important role. The current study used a prospective design to test the novel hypothesis that offspring epigenetic aging - a measure of methylation differences that are associated with infant health outcomes - moderates the relationship between maternal exposure to childhood adversity and offspring symptomatology. Maternal childhood adversity was self-reported during pregnancy via the ACEs survey and the CTQ, which assessed total childhood trauma as well as maltreatment subtypes (i.e., emotional, physical, and sexual abuse). Offspring blood samples were collected at or shortly after birth and assayed on a DNA methylation microarray, and offspring symptomatology was assessed with the CBCL/1.5-5 when offspring were 2-4 years old. Results indicated that maternal childhood trauma, particularly sexual abuse, was predictive of offspring symptoms (ps = 0.003-0.03). However, the associations between maternal sexual abuse and offspring symptomatology were significantly attenuated in offspring with accelerated epigenetic aging. These findings further our understanding of how epigenetic processes may contribute to and attenuate the intergenerational link between stress and psychopathology.

The effect of childhood trauma and resilience on psychopathology in adulthood: Does bullying moderate the associations?

BACKGROUND

Exposure to traumatic events in childhood, including bullying, can negatively affect physical and mental health in adulthood. The aim of the present study was to determine the prevalence of bullying in different sociodemographic groups of the Slovak Republic and to assess the moderating effect of bullying on the associations between childhood trauma, resilience, and the later occurrence of psychopathology.

METHODS

For the analyses, a representative sample of the population of the Slovak Republic was used (N = 1018, mean age 46.24 years, 48.7% of men). Multivariate linear regression models were used to investigate the predictive ability of childhood trauma (The Childhood Trauma Questionnaire, CTQ) and resilience (The Brief Resilience Scale, BRS) to explain psychopathology (The Brief Symptom Inventory, BSI-53). Bullying (The Adverse Childhood Experiences - International Questionnaire, ACE-IQ) was used as a moderator.

RESULTS

In total, 13.5% of respondents have experienced bullying. The most common form of bullying was making fun of someone because of how their body or face looked (46.7%) and excluding someone from activities or ignoring them (36.5%). Higher scores in all types of psychopathology and the Global Severity Index (GSI) were significantly associated with higher scores of emotional and sexual abuse, and some of them with physical neglect. The protective effect of resilience was moderated by bullying in several types of psychopathology, specifically in somatization, obsessive-compulsive, interpersonal sensitivity, depression, psychoticism, and the GSI.

CONCLUSION

Understanding the links between childhood trauma, bullying, and later psychopathology can help professionals target policies, resources, and interventions to support children and families at risk. Every child should feel accepted and safe at home and school.

Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children's knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

A person-centered data analytic approach to dopaminergic polygenic moderation of child maltreatment exposure

The present study illustrates the utility of latent class analysis, a person-centered data analytic approach, as an innovative method for identifying naturally occurring patterns of polygenic risk, specifically within the dopaminergic system. Moreover, this study tests whether latent classes of polygenic variation moderate the effect of child maltreatment exposure on internalizing symptoms among African ancestry youth. African ancestry youth were selected for this study because youth of color are overrepresented in the child welfare system and because African ancestry individuals are significantly underrepresented in genomics research. Results identified three latent classes of dopaminergic gene variation. Class 1 was marked predominately by homozygous minor alleles, Class 2 was characterized by homozygous major and heterozygous presentations, and Class 3 was marked by heterozygous alleles on the DAT-1 single-nucleotide polymorphisms (SNPs) and a combination of homozygous major and minor alleles on the other SNPs. Results indicated that a greater number of maltreatment subtypes experienced were associated with higher internalizing symptoms only for children with the latent polygenic Class 2 pattern. This latent class was distinctly characterized by more homozygous major or heterozygous allelic presentations along all three DAT-1 SNPs. This significant latent polygenic class by environment interaction was replicated in an independent replication sample. Together, findings suggest that African ancestry children with a pattern of dopaminergic variation characterized by this specific combination of polygenic variation are more vulnerable to developing internalizing symptoms following maltreatment exposure, relative to their peers with other dopamine-related polygenic patterns.

Knowledge Gains from the Implementation of a Child Sexual Abuse Prevention Program and the Future of School-Based Prevention Education

School-based child sexual abuse (CSA) programs effectively increase students' CSA-related knowledge. This study focuses on an implementation trial of Safe Touches, an empirically supported, school-based CSA prevention program, that was disrupted by the COVID-19 pandemic. We sought to demonstrate gains in CSA-related knowledge following Safe Touches but were limited to a pre-post design. A total of 2,210 students across five counties in a Mid-Atlantic state received the Safe Touches workshop between September 2019 and March 2020. McNemar's chi-square test was used to assess changes in the proportion of correct responses pre-workshop (Time 1) and one-week post-workshop (Time 2). Students' CSA-related knowledge increased significantly based on changes in mean CSA knowledge scores and the number of correct item-level responses assessed at Time 1 and Time 2 (p < .000). Leveraging the experience of the facilitators' who delivered these workshops prior to the disruption of implementation, we gathered facilitators' perspectives to explore the viability of offering Safe Touches virtually. In July 2020, 16 facilitators completed an electronic survey designed to understand the viability of a virtual Safe Touches workshop. Three themes emerged from facilitator feedback on virtual programming: student engagement concerns, handling disclosures, and technology access to a virtual program. The findings of this study indicate that the Safe Touches workshop significantly increased CSA-related knowledge and, overall, facilitators supported further exploration and development of a virtual Safe Touches workshop. The transition of empirically supported school-based CSA prevention programs to a virtual delivery modality is necessary to maintain an effective means of primary prevention and opportunity for disclosure.

Preventive Education Outreach on Social Media: The Quest to Enroll Community Members in a Child Sexual Prevention Workshop

Social media is a frequently used tool in health promotion efforts although less so for the prevention of child sexual abuse (CSA). This is due, in part, to the lack of standardized branding guides for community-based efforts in how to craft messages related to CSA prevention. This study examined the use of Twitter (now "X") as a means of promoting participation in the adult-focused Stewards of Children CSA prevention workshop, prior to and following the implementation of a standardized branding guide. The exposure, reach, and engagement of the top tweets and top media tweets were examined over 24-months pre- and post-implementation of a five-point branding guide. Engagement was descriptively compared to the number of adults who enrolled in the Stewards of Children workshop. As evidenced by the increase in tweet impressions and the number of adults trained, it is likely the implementation of the branding guide was beneficial in promoting participation in the Stewards of Children workshop. Though participation in a program does not inherently suggest behavior change, getting participants to enroll is a crucial first step. The findings emphasize the potential of using social media to ultimately promote behavior change in the field of CSA prevention and beyond.

The Consequences of Child Abuse

This review provides an overview of the consequences of early adverse experiences across various domains of life. Drawing on the Adverse Childhood Experiences (ACEs) conceptual framework, we discuss the ACE pyramid and the varying degrees of consequences that ACE exposure may elicit. Using online search engines such as Google Scholar, the authors sifted through empirical research to locate relevant articles and research to help prepare this review. This article sheds light on the implications of ACEs for health, socio-emotional and psychosocial well-being, relationships, personality, and cognitive functioning.

Predictors of Online Child Sexual Abuse in a U.S. National Sample

As technology has become increasingly integrated into the everyday lives of young people and social interactions have moved online, so too have the opportunities for child sexual abuse. However, the risk factors for online sexual abuse, and their similarities or differences with those of offline sexual abuse have not been clarified, making it difficult to design prevention strategies. Using a nationally representative online survey panel of young adults ages 18 to 28, the current study sought to identify risk factors for online childhood sexual abuse and compare their relevance and strength in predicting offline sexual abuse. The 2,639 participants, ages 18 to 28, were sampled from the Ipsos KnowledgePanel and were asked questions about 11 different kinds of technology-facilitated online sexual abuse that occurred in childhood, follow-up questions about their dynamics and offenders, and a variety of potential risk factors. Results indicated that: (1) being cisgender female, nonheterosexual, and having parents with less than a high school education emerged as important demographic predictors of online child sexual abuse (OCSA); and (2) early offline sexual abuse was the strongest predictor of OCSA, when considering both its direct and indirect effects through online risky behavior. Findings suggest that prevention programs directed at reducing risk of sexual abuse, in general, are likely to be effective against online sexual abuse, provided they also incorporate efforts to educate youth on the need to avoid risky online behaviors.

The Flexible Regulation of Emotional Expression Scale for Youth (FREE-Y): Adaptation and Validation Across a Varied Sample of Children and Adolescents

Flexible self-regulation has been shown to be an adaptive ability. This study adapted and validated the adult Flexible Regulation of Emotional Expression (FREE) Scale for use with youth (FREE-Y) in community and maltreatment samples. The FREE-Y measures the ability to flexibly enhance and suppress emotion expression across an array of hypothetical social scenarios. Participants (N = 654, 8-19 years) were included from three studies. Confirmatory factor analysis (CFA) confirmed a theoretically appropriate higher order factor structure. Using multiple-group CFAs, measurement invariance was achieved across maltreatment status, age, and gender. Reliabilities were adequate and construct validity was demonstrated through associations with measures of emotion regulation, psychopathology, IQ, and executive functioning. Group comparisons indicated lower Suppression and Flexibility scores for maltreated versus comparison participants. Findings suggest that the FREE-Y is a valid measure of expressive regulation ability in youth that can be applied across a range of populations.

Introduction to the Special Section: Developmental Perspectives on Trauma Exposure and Posttraumatic Stress

This article provides an introduction and overview of the current special section devoted to developmental perspectives on trauma exposure and posttraumatic stress reactions. Although there have been many revisions to the posttraumatic stress disorder (PTSD) diagnosis in the four decades that have ensued since its inclusion in our diagnostic systems, and many decades of empirical and clinical work investigating the differential effects of traumatic stress on children and adolescents, a truly developmental perspective is still lacking in the diagnosis. In a call to address this gap, this article outlines principles of developmental psychopathology as applied to the phenomenology of trauma and points to potential developmental transformations in the expression of posttraumatic stress across developmental epochs. The introduction then goes on to describe the valuable contributions to the literature represented by the six teams of contributing authors to this present special section, in which they discuss stability and change in posttraumatic symptom expression across development, the current state of validation research on the proposed diagnosis of Developmental Trauma Disorder, complex symptom arrays in children who have been complexly traumatized, distinctions between Complex PTSD and emerging personality pathology, developmental perspectives on prolonged grief, and developmental considerations for understanding the intersection between trauma and moral injury. It is hoped that this collection of articles will serve to stimulate new research and inform effective interventions for young persons affected by traumatic stress.

Dimensions of Early Adversity and Sexual Behavior in a US Population-Based Adolescent Sample

PURPOSE

Early life adversity (ELA) is associated with sexual risk, but ELA dimensions-and potential mechanisms-have been less examined. We evaluated associations between threat and deprivation-two key ELA dimensions-and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway.

METHODS

Data were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat- or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency ("always" vs. "not always" used). Girls reported age at menarche.

RESULTS

Threat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62-1.92]) and deprivation (OR = 1.51 [95% CI, 1.24-1.83]) were each linked with engagement in sex, ps<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for deprivation: earlier age at first sex (b = -0.20 [95% CI, -0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10-0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64-0.80]), ps <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no significant indirect effects through age at menarche.

DISCUSSION

Although threat and deprivation were related to engagement in sexual activity, threat-related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health.

Childhood trauma predicts blunted error monitoring in adulthood: An event-related potential study

Abuse and neglect have detrimental consequences on emotional and cognitive functioning during childhood and adolescence, including error monitoring, which is a critical aspect of cognition that has been implicated in certain internalizing and externalizing psychopathologies. It is unclear, however, whether (a) childhood trauma has effects on error monitoring and, furthermore whether, (b) error monitoring mediates the relation between childhood trauma and psychopathology in adulthood. To this end, in a large sample of young adults (ages 18-30) who were oversampled for psychopathology (N = 390), the present study assessed relations between childhood trauma and error-related negativity (ERN), which is a widely used neurophysiological indicator of error monitoring. Cumulative childhood trauma predicted ERN blunting, as did two specific types of traumas: sexual abuse and emotional neglect. Furthermore, the ERN partially mediated the effects of cumulative childhood trauma and emotional neglect on externalizing-related symptoms. Future studies should further examine the relations between childhood trauma and error monitoring in adulthood, which can help to inform intervention approaches.

Is the Risk for Sexual Revictimization Cumulative? A Prospective Examination

INTRODUCTION

Sexual abuse during childhood is associated with risk for sexual assault as an adult, known as revictimization. Although multiple experiences of sexual assault in adulthood are also common, it is unclear how risk trajectories might continue to evolve in emerging adulthood, defined as ages 18-25. Clarifying risk trajectories is important to inform the development of targeted risk reduction interventions. To fill this gap, we examined cumulative risk for sexual assault in emerging adult women following multiple experiences of childhood sexual abuse (CSA) and adulthood sexual assault (ASA).

METHODS

Women (n = 447; aged 18-25 years at enrollment) completed behaviorally specific assessments of unwanted sexual experiences at up to 9 time points across 3 years. Logistic regression was used to predict any sexual assault during the 3-year period as a function of victimization history at baseline. A multilevel logistic regression analysis among ASA survivors was then used to determine whether each successive ASA increased risk for further victimization.

RESULTS

Extending prior research, findings revealed that the risk for sexual assault during the 3-year study was greater for women reporting more prior experiences of CSA and ASA. Unexpectedly, each ASA increased the risk for a subsequent ASA to a lesser extent among women with more experiences of CSA.

CONCLUSIONS

Findings suggest that the risk for sexual revictimization can be cumulative, but that risk does not increase indefinitely. Future research should investigate the points at which survivors of multiple assaults may begin to experience a decreased risk for later assaults, as well as the factors associated with change in risk status (e.g., removal from violent environments or relationships, changes in institutional policies). Such research could inform intervention targets.

Developmental pathways from child maltreatment to adolescent pregnancy: A multiple mediational model

Adolescent pregnancy (AP) is a significant public health issue. Child maltreatment (CM) represents an established risk factor, yet little is known about the explanatory mechanisms linking the phenomena. Informed by developmental theory, this study prospectively tested seven multi-level, indirect pathways that could plausibly explain the relationship between CM and AP: (1) substance use (polysubstance use and frequency); (2) sexual risk behavior; (3) depressive symptoms; (4) posttraumatic stress disorder symptoms; (5) cognitive dysregulation; (6) pregnancy desire and difficulty expectancies; and (7) age at menarche. Data came from a prospective, longitudinal cohort study of 469 ethnically diverse, nulliparous adolescent females, designed to examine the impact of substantiated CM on reproductive outcomes such as pregnancy and childbirth (265 maltreated and 204 demographically matched comparison adolescents). A multiple-mediator structural equation model was conducted to simultaneously test multiple indirect effects while accounting for confounding variables. Maltreatment had an indirect effect on pregnancy via substance use and higher pregnancy desire/lower perceived difficulty. Findings represent a step towards elucidating pathways linking CM with AP. Recommendations are offered to prevent pregnancy by addressing the pregnancy-specific mechanisms that are part of the maltreatment sequelae.

Intergenerational Continuity of Child Sexual Abuse: Comparison of Mother and Emerging Adult Dyads

Sexual abuse trauma can have long-term implications for individuals in terms of psychological functioning, relationships, and socio-environmental circumstances, all of which are elements that could explain the CSA intergenerational continuity phenomenon. There are few empirical studies drawing comparisons between families to identify factors associated with the intergenerational (dis)continuity of CSA. The objectives of this study are to compare mother and emerging adult dyads to determine differences between cycle maintainers, cycle breakers, cycle initiators, and a control group in terms of maternal maltreatment histories, mental health, attachment, and socio-environmental characteristics. A sample of 186 dyads was recruited across Canada to participate in an online study. The study represents a cross-sectional design and bivariate and multivariate analyses were used. The results support prior research that there is a higher risk of CSA in dyads where the mother experienced CSA (OR = 1.38). Compared to cycle initiators, maintainers reported greater psychological distress (M = 27.23; 35.18), and lower mother-rated parent-child attachment (M = 115.83; 111.43). Maintainers reported more post-traumatic stress symptoms only in comparison to the control group (M = 24.82; 10.13). Mothers in cycle maintaining dyads were exposed to more acts of domestic violence than those in cycle breaking dyads (OR = 2.43). No group differences were observed for intimate partner attachment. Findings should be replicated using robust methodological designs (e.g., longitudinal, mixed methods). Preventative efforts should target at-risk families to reduce the chance of intergenerational CSA.

Empirically-derived dimensions of childhood adversity and cumulative risk: associations with measures of depression, anxiety, and psychosis-spectrum psychopathology

Background: Investigating different approaches to operationalizing childhood adversity and how they relate to transdiagnostic psychopathology is relevant to advance research on mechanistic processes and to inform intervention efforts. To our knowledge, previous studies have not used questionnaire and interview measures of childhood adversity to examine factor-analytic and cumulative-risk approaches in a complementary manner.Objective: The first aim of this study was to identify the dimensions underlying multiple subscales from three well-established childhood adversity measures (the Childhood Trauma Questionnaire, the Childhood Experience of Care and Abuse Interview, and the Interview for Traumatic Events in Childhood) and to create a cumulative risk index based on the resulting dimensions. The second aim of the study was to examine the childhood adversity dimensions and the cumulative risk index as predictors of measures of depression, anxiety, and psychosis-spectrum psychopathology.Method: Participants were 214 nonclinically ascertained young adults who were administered questionnaire and interview measures of depression, anxiety, psychosis-spectrum phenomena, and childhood adversity.Results: Four childhood adversity dimensions were identified that captured experiences in the domains of Intrafamilial Adversity, Deprivation, Threat, and Sexual Abuse. As hypothesized, the adversity dimensions demonstrated some specificity in their associations with psychopathology symptoms. Deprivation was uniquely associated with the negative symptom dimension of psychosis (negative schizotypy and schizoid symptoms), Intrafamilial Adversity with schizotypal symptoms, and Threat with depression, anxiety, and psychosis-spectrum symptoms. No associations were found with the Sexual Abuse dimension. Finally, the cumulative risk index was associated with all the outcome measures.Conclusions: The findings support the use of both the empirically-derived adversity dimensions and the cumulative risk index and suggest that these approaches may facilitate different research objectives. This study contributes to our understanding of the complexity of childhood adversity and its links to different expressions of psychopathology.

Auditory hallucinations, childhood sexual abuse, and limbic gray matter volume in a transdiagnostic sample of people with psychosis

Childhood sexual abuse (CSA) is a potentially unique risk factor for auditory hallucinations (AH), but few studies have examined the moderating effects of sex or the association of CSA with limbic gray matter volume (GMV) in transdiagnostic samples of people with psychotic disorders. Here we found that people with psychotic disorders reported higher levels of all surveyed maltreatment types (e.g., physical abuse) than healthy controls, but people with psychotic disorders with AH (n = 41) reported greater CSA compared to both those without AH (n = 37; t = -2.21, p = .03) and controls (n = 37; t = -3.90, p < .001). Among people with psychosis, elevated CSA was most pronounced among females with AH (sex × AH status: F = 4.91, p = .009), held controlling for diagnosis, medications, and other maltreatment (F = 3.88, p = .02), and correlated with the current severity of AH (r = .26, p = .03) but not other symptoms (p's > .16). Greater CSA among patients related to larger GMV of the left amygdala accounting for AH status, diagnosis, medications, and other maltreatment (t = 2.12, p = .04). Among people with psychosis, females with AH may represent a unique subgroup with greater CSA. Prospective high-risk studies integrating multiple measures of maltreatment and brain structure/function may help elucidate the mechanisms linking CSA with amygdala alterations and AH.

Adverse childhood experiences and child behavioral health trajectory from early childhood to adolescence: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) profoundly influence child development. Different patterns of ACEs among boys and girls may be associated with different developmental trajectories.

OBJECTIVE

This study aimed to identify patterns of ACEs at age three and tested the associations of these patterns with child behavioral health problems from age three to age fifteen.

PARTICIPANTS AND SETTING

This study used data (N = 4898) from the Fragile Families Child Wellbeing Study.

METHODS

First, this study conducted latent class analysis (LCA) across ten indicators of ACEs at age 3. LCA was conducted separately for boys and girls. Second, class membership was tested for associations with child internalizing symptoms and externalizing behaviors (ages three, five, nine, and fifteen years).

RESULTS

LCA identified five classes of ACEs for girls: low ACEs, parental separation, financial difficulty, chaotic home, and child maltreatment. LCA for boys, however, identified a six-class solution, in which there was a physical abuse-only class, while also a sixth high ACEs class that included both physical and emotional abuse. Classes with the most ACEs often had the highest symptomology (internalizing symptoms ranging from 0.24 to 0.56; externalizing ranging from 0.36 to 1.00; ps < .05). However, differences in behavioral health were detected depending on the patterns of ACES. At ages nine and fifteen, the financial difficulty group also had high symptomatology (internalizing symptoms ranging from 0.23 to 0.43; externalizing from 0.23 to 0.46; ps < .05).

CONCLUSIONS

Findings provide implications including the need to examine ACEs heterogeneity and address financial difficulty as a substantial ACE.

Taking a School-Based Child Sexual Abuse Prevention Program to Scale: a Cost Analysis

Cost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child sexual abuse (CSA), regularly viewed as a human rights violation, is also a public health concern estimated to impact 27% of females and 5% of males by age 18. Universal, school-based CSA programs are one prevailing prevention strategy. However, there are no known cost analyses of school-based CSA prevention programming, thereby limiting potential scalability. Using the ingredients method, this cost analysis presents the findings of implementing Safe Touches, an evidence-based universal prevention program, across four sites (i.e., counties) in one mid-Atlantic state. Reaching a total of 14,235 s grade students, results indicate an average cost of $43 per student, an average classroom cost of $859, an average district cost of $10,637, and an average site cost of $154,243. There was a noted decrease in costs when more students were reached, suggesting a need to focus efforts on bolstering the reach of implementation efforts. Sensitivity analyses explored variations in implementation constraints such as personnel and facilities suggesting a range of per-student costs (lower-bound per-student cost = $34; upper-bound per-student cost = $64). Findings presented herein may be used to inform future universal CSA prevention efforts by providing detailed information about the costs of large-scale implementation of an evidence-based program among elementary-aged children.

Childhood Sexual Abuse and Exposure to Peer Bullying Victimization

Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing further victimization in adolescence. Associations between CSA and several forms of cyber and in-person peer bullying victimization were assessed in a prospective, longitudinal study. Females exposed to substantiated CSA and a matched comparison group (N = 422) were followed over a two-year period. Bullying experiences were assessed in both survey and qualitative interviews. Qualitative data were coded and used to describe the types (e.g., cyber, physical, verbal), and foci (e.g., threats, physical appearance) of bullying victimization. Logistic regression was used to assess the odds that CSA was associated with subsequent bullying victimization, adjusted for demographics, social networking use, and prior bullying. CSA-exposed females were at an increased risk of multiple forms of bullying victimization with a persistent risk of bullying victimization over time. Specifically, they had 2.6 times higher odds of experiencing any bullying at follow-up, 2.9 times higher odds of experiencing cyberbullying at follow-up, and 2 times higher odds of experiencing combined cyber/in-person bullying at follow-up. CSA-exposed females were more likely than comparison females to experience bullying regarding their appearance/weight and dating relationships. Findings provide further insight into the unique circumstances of the cyberbullying and in-person bullying experienced by CSA-exposed females. Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing bullying victimization, specifically cyberbullying and combined cyber/in-person bullying, as well as bullying about their appearance and dating relationships. These findings indicate that bullying prevention needs to include trauma-focused components to target these uniquely vulnerable females.

Trauma Chronicity and the Long-Term Needs of Childhood Sexual Trauma Survivors

Research has linked childhood sexual trauma (CST) with adverse adult outcomes (AAOs) that span physical, psychological, and social domains of functioning. Differences in conceptualizing and measuring CST, however, have inhibited the examination of trauma-related variables hypothesized to impact adult outcomes. We used National Sexual Health Survey (NSHS; 1995–1996) data to examine trauma chronicity (i.e., duration) and AAOs (domains: physical and mental health, close relationships, and achievement). The NSHS (N = 6537, 18–70 years) assessed duration using perpetrator-specific CST reports. Adjusting for background characteristics, we examined CST duration in relation to AAOs and CST-related help-seeking. Approximately 8% of participants reported CST. Chronic (vs. single-exposure) CST survivors were at substantially higher risk of experiencing AAOs [i.e., mean AAOs and specific AAOs (e.g., physical and emotional health problems, divorce/separation, and poverty)]. CST had direct effects on sexual dysfunction and satisfaction, and on relationship stressors which may impact sexual relationship quality. Although 62% of CST survivors did not seek help, those with more chronic CST histories reported a higher prevalence of trauma-related help-seeking. Our work underscores the importance of examining CST chronicity in relation to long-term developmental outcomes. Chronicity assessment may be an important screening tool in the therapeutic context and in broader community screening efforts.

Virtual Delivery of A School-Based Child Sexual Abuse Prevention Program: A Pilot Study

Universal child sexual abuse (CSA) prevention is a public health priority. The prevailing prevention strategy is school-based CSA prevention programming. School closures during the COVID-19 pandemic highlighted the need for flexible modes of delivery, including virtual programs. This pilot examined the virtual delivery of an evidence-based, school-based CSA prevention program, Safe Touches, designed to teach CSA-related knowledge and concepts. Using mixed methods, the pilot sought to determine the feasibility of the virtually delivered CSA prevention program. One school district that had previously received Safe Touches in-person participated. A total of 176 second grade students participated in the virtual workshop. Post-workshop survey responses from virtual (N = 37) and in-person workshops (N = 60) were compared descriptively. Mean item scores and response patterns from students who received the virtual workshop were nominally comparable to the student scores from the in-person workshop. Following the virtual workshop, one teacher notified the research team of a disclosure of CSA. Qualitative input from the facilitator and school staff was positive, indicating high student engagement. Results suggest the viability and feasibility of virtual school-based CSA preventive programs. Investment in virtual modes of delivery would ensure all students have access to CSA prevention programming in the future.

Racial differences in early adolescent substance use: Child abuse types and family/peer substance use as predictors

This study examined the associations among child abuse types, family/peer substance use, and adolescent substance use, as well as testing whether these associations vary by race. The sample was derived from the Longitudinal Studies of Child Abuse and Neglect (N = 562). Child sexual abuse, family substance use, and peer substance use were associated with a higher likelihood of adolescent substance use. Sexual abuse was more strongly associated with substance use in Black youth than in White youth. Conversely, greater peer substance use had a stronger association with substance use in White youth than in Black youth.

Linking Salience Signaling With Early Adversity and Affective Distress in Individuals at Clinical High Risk for Psychosis: Results From an Event-Related fMRI Study

Evidence suggests dysregulation of the salience network in individuals with psychosis, but few studies have examined the intersection of stress exposure and affective distress with prediction error (PE) signals among youth at clinical high-risk (CHR). Here, 26 individuals at CHR and 19 healthy volunteers (HVs) completed a monetary incentive delay task in conjunction with fMRI. We compared these groups on the amplitudes of neural responses to surprising outcomes-PEs without respect to their valence-across the whole brain and in two regions of interest, the anterior insula and amygdala. We then examined relations of these signals to the severity of depression, anxiety, and trauma histories in the CHR group. Relative to HV, youth at CHR presented with aberrant PE-evoked activation of the temporoparietal junction and weaker deactivation of the precentral gyrus, posterior insula, and associative striatum. No between-group differences were observed in the amygdala or anterior insula. Among youth at CHR, greater trauma histories were correlated with stronger PE-evoked amygdala activation. No associations were found between affective symptoms and the neural responses to PE. Our results suggest that unvalenced PE signals may provide unique information about the neurobiology of CHR syndromes and that early adversity exposure may contribute to neurobiological heterogeneity in this group. Longitudinal studies of young people with a range of risk syndromes are needed to further disentangle the contributions of distinct aspects of salience signaling to the development of psychopathology.

The Centrality of Child Maltreatment to Criminology

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.

An observational study of Internet behaviours for adolescent females following sexual abuse

Child sexual abuse (CSA) is associated with revictimization and sexual risk-taking behaviours. The Internet has increased the opportunities for teens to access sexually explicit imagery and has provided new avenues for victimization and exploitation. Online URL activity and offline psychosocial factors were assessed for 460 females aged 12-16 (CSA = 156; comparisons = 304) with sexual behaviours and Internet-initiated victimization assessed 2 years later. Females who experienced CSA did not use more pornography than comparisons but were at increased odds of being cyberbullied (odds ratio = 2.84, 95% confidence interval = 1.67-4.81). These females were also more likely to be represented in a high-risk latent profile characterized by heightened URL activity coupled with problematic psychosocial factors, which showed increased odds of being cyberbullied, receiving online sexual solicitations and heightened sexual activity. While Internet activity alone may not confer risk, results indicate a subset of teens who have experienced CSA for whom both online and offline factors contribute to problematic outcomes.

Hypothalamic-pituitary-adrenal axis attenuation and obesity risk in sexually abused females

BACKGROUND

Childhood sexual abuse (CSA) confers elevated risks for obesity in females. Mechanisms that explain this link remain unclear. This study tracked serum basal cortisol levels with body mass index (BMI) from childhood into adulthood to test whether hypothalamic-pituitary-adrenal (HPA) axis attenuation accounts for elevated obesity risks for sexually abused females.

METHODS

Data drew from six timepoints of a longitudinal study of the impact of CSA on development. Participants were females aged 6-16 years at time of study enrollment with substantiated CSA and demographically matched non-abused peers. Analyses included only participants who did not have obesity at study enrollment. Main outcomes were BMI growth trajectories across ages 6-27 (n = 150; 66 abused, 84 comparisons) and early adulthood obesity status (ages 20-27; n = 133; 62 abused, 71 comparison). HPA axis functioning indicators were intercept and linear slope parameters extracted from multilevel growth trajectories of serum basal cortisol levels across development. Racial-ethnic minority status, parity, steroid medication use, depression history and disordered eating history were covaried.

RESULTS

While controlling for covariates, multilevel modeling indicated that high initial serum basal cortisol levels in childhood and attenuated cortisol growth rate over time (i.e., HPA axis attenuation) were associated with accelerated BMI accumulation (p < .01). Attenuated cortisol growth rate mediated the effect of CSA on accelerated BMI accumulation and on elevated adulthood obesity rates (p < .05).

CONCLUSION

This work establishes a mechanistic association between HPA axis attenuation and obesity, suggesting that trauma treatments for abuse survivors should include interventions that reduce health consequences associated with dysregulated stress physiology.