Polytraumatization and trauma symptoms in adolescent boys and girls: interpersonal and noninterpersonal events and moderating effects of adverse family circumstances

The Co-Occurrence of Child Maltreatment and Intimate Partner Violence in Families: Effects on Children's Externalizing Behavior Problems

Children exposed to maltreatment are at risk of experiencing intimate partner violence (IPV) and behavioral problems. This study examined different forms of family violence that co-occur and their relationship to children's externalizing behaviors across developmental stages (early childhood, middle childhood, adolescence). Longitudinal data (N = 1,987) at baseline and 18 months and 36 months post-baseline from the NSCAW II were used. Mixture modeling was employed in which latent class models estimated subgroups of children who experienced co-occurring forms of family violence; regression models estimated which subgroups of children were at risk of externalizing behaviors. Three latent classes were identified across developmental stages: high family violence, low family violence, and child physical abuse and psychological aggression. For children in early childhood, a fourth class was identified: partner and child physical abuse and child psychological aggression. Results from regression models revealed differences in externalizing scores by class membership across developmental age groups and over time. That distinct classes of child maltreatment and IPV co-occur and differentially impact children's behavior suggests a need for strong prevention and intervention responses to address children's dual maltreatment and IPV exposure.

Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre-trauma neurobiology in relation to posttraumatic stress symptoms

OBJECTIVE

Associations of neurobiological differences with posttraumatic stress disorder (PTSD) have generated interest in their temporal relation. Support has been voiced for the neurotoxic stress theory (NST) in which neurobiological differences develop following exposure and PTSD development. In contrast, the diathesis stress theory (DST) posits that neurobiological differences existed prior to exposure and may be vulnerability factors for PTSD. Studies in the first wave of neurobiological PTSD research were all cross sectional, but a second wave of research followed which used prospective repeated-measures designs that measured neurobiology prior to trauma exposure experiences, allowing greater causal inference.

METHODS

This study reviewed the second-wave studies in hopes of developing a preliminary consensus to support either the NST or the DST based on this more powerful prospective, repeated-measures study design.

RESULTS

Twenty-five second-wave studies were located that measured neurobiology prior to traumatic experiences. Nineteen studies supported the DST. Of 10 studies that were capable of testing the NST, only 3 were supportive.

CONCLUSION

The implications of the NST versus the DST have profound implications for understanding the fragility of the human brain and possible paths forward for future research on assessment, treatment, and social policy.

Bullying victimization in typically developing and clinical high risk (CHR) adolescents: A multimodal imaging study

BACKGROUND

Bullying has been shown to increase the risk of developing a psychotic disorder. To date, no studies have examined brain behavior relationships within the context of bullying victimization in clinical high-risk (CHR) youth, a group characterized by both gray and white matter abnormalities. The present study employed multimodal neuroimaging to examine possible neural mechanisms associated with bullying victimization.

METHODS

CHR and healthy volunteers underwent clinical interviews, parent reports and MRI scans. Regions of interest (ROIs) were picked based on sensitivity to environmental stress, including hippocampal, amygdala, and orbitofrontal cortex (OFC) structural ROIs, and uncinate fasciculus white matter integrity.

RESULTS

CHR individuals were more exposed to bullying victimization than healthy volunteers, and bullying was associated with depressive symptoms across the whole sample. CHR individuals exhibited smaller volumes in OFC, but not in other ROIs. Increased bullying exposure was associated with lower medial OFC volumes in CHR and HV groups independently. Results ought to be interpreted as preliminary, as they did not survive correction at the whole brain level.

DISCUSSION

Bullying victimization may affect or be affected by volumetric OFC differences in both healthy and CHR individuals. However, given CHR showed greater exposure to bullying as well as underlying vulnerability (e.g. lower volumes), results also point to etiological clues and novel intervention targets, though future replication is needed in better powered samples.

Development of a Brief Screen for Symptoms of Posttraumatic Stress Disorder in Young Children: The Young Child PTSD Screen

OBJECTIVE

The ability to reliably detect posttraumatic stress disorder (PTSD) symptoms that require treatment in young children through screening efforts is a critical step toward providing appropriate treatment. The developmental differences in this age group compared to older youths pose challenges for accurate detection. A brief age-appropriate screen has not yet been quantitatively validated. This study aimed to address that gap by creating a rapid and brief screen based on empirical data that focused on sensitivity and face validity for children aged 3 to 6 years.

METHODS

A trauma-exposed group (N = 284) and a non-trauma-exposed group (N = 46), aged 3 to 6 years, were assessed using a semistructured diagnostic interview with their primary caregivers.

RESULTS

One hundred twenty combinations of items were evaluated for sensitivity, specificity, positive predictive value, negative predictive value, associations with functional impairment, and frequency of false positives. Many combinations of items performed well on these psychometrics, and the final selection of a 6-item screener was influenced by considerations of face validity so that the screen would best reflect the unique symptoms of PTSD.

CONCLUSION

The screener proposed is a promising tool that will benefit from additional research to examine its psychometric properties as a stand-alone PTSD screen. Future research ought to include test-retest reliability and replication of these findings in other samples and settings. Eventual uses of a brief screen for PTSD in young children include screening during primary care visits and large-scale screening efforts following disasters, for which cost and time need to be considered.

School-Based Bullying and Teen Dating Violence Prevention Laws: Overlapping or Distinct?

The most recent legislative attempts to curb violence in schools have been school-based dating violence prevention laws. In the previous decade, there was an increase in legislation designed to prevent bullying in schools; these laws now exist in 50 states. However, most anti-bullying laws provide an expansive definition of bullying that includes any type of peer aggression, harassment, or teen dating violence (TDV). Having several different state and federal laws aimed at curtailing multiple forms of aggression may produce confusion about appropriate intervention and disciplinary responses, requiring school districts to develop parallel sets of policies, educational curricula, intervention approaches, and reporting requirements for overlapping behaviors that can be simultaneously peer aggression, bullying, harassment, and TDV. We conducted a systematic search of applicable laws and systematically coded those we identified for relevant content (i.e., definitions, covered locales, protected groups, and personnel, procedural, preventive, and disclosure elements). Anti-bullying laws were typically more detailed than dating violence laws. TDV laws were more likely to target TDV and control intimate behavior and to provide for education about healthy relationships. Both types of laws often mandated trainings; specified reportable behaviors; discussed sanctions, recommendations, and interventions; and mentioned counseling, specially trained staff persons, or designated specialists. Both anti-bullying and TDV laws also sometimes directed reporting of aggregate incident rates and impacts of prevention efforts. Neither type of law tended to specify school and community resources or prevention approaches. Results inform discussion of the merits of different approaches to school-based violence prevention laws.

Polyvictimization in childhood and its adverse impacts across the lifespan: Introduction to the special issue

Although much empirical work has focused on the adverse impact of specific types of childhood victimization (e.g., sexual, physical, or emotional abuse), researchers and clinicians increasingly are recognizing the prevalence of polyvictimization, or exposure to multiple types of victimization. Polyvictimization during formative developmental periods may have detrimental and potentially lifelong biopsychosocial impacts over and above the effects of exposure to specific types of adversity. In this guest editorial, we summarize the key questions and findings for six empirical studies on polyvictimization included in this Special Issue of the Journal of Trauma & Dissociation. These empirical studies further our understanding of the nature, consequences, and assessment of polyvictimization. We conclude with recommendations for continued scientific research and clinical inquiry on polyvictimization.

Secure Attachment Moderates the Relation of Sexual Trauma With Trauma Symptoms Among Adolescents From an Inpatient Psychiatric Facility

Experiencing sexual trauma has been linked to internalizing and externalizing psychopathologies. Insecure attachment has been shown to moderate the relation between sexual trauma and trauma symptoms among adults. However, few studies have explored relations among sexual trauma, attachment insecurity, and trauma symptoms in adolescence, and none have used developmentally appropriate measures. The present study sought to examine attachment security as a potential moderator of the relation between having a history of sexual trauma (HST) and trauma symptoms among adolescents at an inpatient psychiatric facility. Attachment to caregivers was measured by the Child Attachment Interview (CAI) and trauma symptoms by the Trauma Symptoms Checklist for Children (TSCC). HST was assessed with responses to two separate interviews that asked about traumatic experiences: the Computerized Diagnostic Interview Schedule for Children (C-DISC) and the CAI. Moderation analyses were conducted using univariate General Linear Modeling (GLM). Of the 229 study participants, 50 (21.8%) had a HST. The relation between HST and trauma symptoms was significantly moderated by insecure attachment with both mother, F(1, 228) = 4.818, p = .029, and father, F(1, 228) = 6.370, p = .012. Specifically, insecurely attached adolescents with a HST exhibited trauma symptoms at levels significantly greater than securely attached adolescents with a HST and adolescents with no HST. Results are consistent with previous research that suggests secure attachment may protect against the development of trauma symptoms among those who have experienced a sexual trauma.

Family Violence and Other Potentially Traumatic Interpersonal Events Among 9- to 17-Year-Old Children Attending an Outpatient Psychiatric Clinic

Among children visiting child and adolescent mental health care (CAM), the prevalence of exposure to family violence (FV) is reported to exceed prevalence in community samples, as are potentially traumatic interpersonal events (IPE) outside the family. The aim of the study was to relate CAM patients' self-reported experiences of violence exposure to their current psychiatric symptoms and to compare patients exposed to violence with patients who reported no exposure. We asked 305 consecutive 9- to 17-year-old patients in CAM about their current and previous exposure to violence in and outside of the family. Prevalence of exposure to any kind of violence was 67%. Reported exposures were 19% to IPE, 21% to FV, and 27% to both. Children exposed to both FV and IPE were more negatively affected by the events than children exposed to FV or IPE only. Children in the FV + IPE group reported more mental health symptoms than those in the no violence (33%) group. In general, IPE was related to the outcome measures only in combination with FV. Degree of violence exposure seemed to have a dose-response relationship with the diagnosis of post-traumatic stress disorder.

The lifetime experience of traumatic events is associated with hair cortisol concentrations in community-based children

Adversity early in life can disrupt the functioning of the hypothalamic-pituitary-adrenal axis (HPAA) and increase risk for negative health outcomes. Recent research suggests that cortisol in scalp hair represents a promising measure of HPAA function. However, little is known about the relationship between early exposure to traumatic events and hair cortisol concentrations (HCC) in childhood, a critical period of HPAA development. The current study measured HCC in scalp hair samples collected from 70 community-based children (14 males, mean age=9.50) participating in the Imaging Brain Development in the Childhood to Adolescence Transition Study (iCATS). Data were also collected on lifetime exposure to traumatic events and current depressive symptoms. Lifetime exposure to trauma was associated with elevated HCC; however, HCC was not associated with current depressive symptoms. Consistent with some prior work, males were found to have higher HCC than females, although results should be treated with caution due to the small number of males who took part. Our findings suggest that hair cortisol may represent a biomarker of exposure to trauma in this age group; however, further study is necessary with a particular focus on the characterization of trauma and other forms of adversity.

Untangling Psychiatric Comorbidity in Young Children Who Experienced Single, Repeated, or Hurricane Katrina Traumatic Events

BACKGROUND

In individuals with posttraumatic stress disorder (PTSD), 70%-90% have at least one comorbid non-PTSD disorder.

OBJECTIVE

This study tested several hypotheses to untangle comorbidity issues. Following McMillen et al. (2002), we hypothesized that few non-PTSD disorders would arise following traumatic events in children with substantial PTSD symptoms. Second, Repeated Events victims would show more internalizing and externalizing problems compared to Single Event and Hurricane Katrina victims. Third, we aimed to replicate in young children the finding from older populations that exposure to multiple events, not the type of event, would predict severity of symptoms. These results would inform speculations that repeated and prolonged traumas produce greater symptom complexity.

METHODS

Children 3-6 years of age were recruited for three types of trauma: Single (n=62), Hurricane Katrina (n=85), and Repeated Events (n=137), and assessed with caregiver reports from a diagnostic interview.

RESULTS

Overall, 95% of children who developed new non-PTSD disorders following traumas also had substantial PTSD symptoms. The Katrina and Repeated Events groups showed more diagnoses of oppositional defiant disorder compared to the Single Event group, but groups did not differ on PTSD, depression, anxiety, or attention-deficit/hyperactivity disorder. Cumulative number of events was the only significant predictor of PTSD symptoms, while type of trauma and total occurrences of traumas did not predict additional variance.

CONCLUSION

These data provide empirical support for targeting interventions on PTSD following traumas and disasters. The homogeneity of outcomes across types of traumas provides little empirical support for speculations that repeated and prolonged traumas produce greater symptom complexity.

Prevalence of different forms of child maltreatment among Taiwanese adolescents: a population-based study

Reported cases of child maltreatment are increasing in Taiwan. Yet, comprehensive epidemiological characteristics of adolescents' exposure over the wide spectrum of violence are still lacking. The purpose of this study was to estimate the prevalence and magnitude of child maltreatment among Taiwanese adolescents. A population-based study was conducted with 5,276 adolescents aged 12-18 from 35 schools in 17 cities and townships to determine the prevalence of five forms of child maltreatment in Taiwan. A total of 5,236 adolescents completed anonymous, self-report, structured questionnaires. Most adolescents (91%, n=4,788) experienced at least one form of maltreatment with 83% (n=4,347) exposed during the previous year. Violence exposure was the most common type of child maltreatment experienced, followed by psychological abuse, physical abuse, neglect, and sexual abuse. Adolescents reported an average of 7.4 (SD=5.87) victimizations over their lifetime and 4.8 (SD=4.82) victimizations during the past year. Females reported a higher rate of neglect, while males reported a higher rate of sexual abuse. Most of the sexual abuse perpetrators were known by their victims. Adolescents' victimization and polyvictimization from child maltreatment in Taiwan deserves a review and modification of national control and prevention policies.

Reliability, factor structure, and validity of the German version of the Trauma Symptom Checklist for Children in a sample of adolescents

BACKGROUND

The Trauma Symptom Checklist for Children (TSC-C) is the most widely used self-report scale to assess trauma-related symptoms in children and adolescents on six clinical scales. The purpose of the present study was to develop a German version of the TSC-C and to investigate its psychometric properties, such as factor structure, reliability, and validity, in a sample of German adolescents.

METHOD

A normative sample of N=583 and a clinical sample of N=41 adolescents with a history of physical or sexual abuse aged between 13 and 21 years participated in the study.

RESULTS

The Confirmatory Factor Analysis on the six-factor model (anger, anxiety, depression, dissociation, posttraumatic stress, and sexual concerns with the subdimensions preoccupation and distress) revealed acceptable to good fit statistics in the normative sample. One item had to be excluded from the German version of the TSC-C because the factor loading was too low. All clinical scales presented acceptable to good reliability, with Cronbach's α's ranging from .80 to .86 in the normative sample and from .72 to .87 in the clinical sample. Concurrent validity was also demonstrated by the high correlations between the TSC-C scales and instruments measuring similar psychopathology. TSC-C scores reliably differentiated between adolescents with trauma history and those without trauma history, indicating discriminative validity.

CONCLUSIONS

In conclusion, the German version of the TSC-C is a reliable and valid instrument for assessing trauma-related symptoms on six different scales in adolescents aged between 13 and 21 years.

A comparison of adolescents engaging in self-injurious behaviors with and without suicidal intent: self-reported experiences of adverse life events and trauma symptoms

Research comparing adolescents engaging in suicidal and non-suicidal self-injury (NSSI), both separately and in combination, is still at an early stage. The purpose of the present study was to examine overlapping and distinguishable features in groups with different types of self-injurious behaviors, using a large community sample of 2,964 (50.6% female) Swedish adolescents aged 15-17 years. Adolescents were grouped into six categories based on self-reported lifetime prevalence of self-injurious behaviors. Of the total sample, 1,651 (55.7%) adolescents reported no self-injurious behavior, 630 (21.2%) reported NSSI 1-4 times, 177 (6.0%) reported NSSI 5-10 times, 311 (10.5%) reported NSSI ≥ 11 times, 26 (0.9%) reported lifetime prevalence of suicide attempt and 169 (5.7%) adolescents reported both NSSI and suicide attempt. After controlling for gender, parental occupation and living conditions, there were significant differences between groups. Pairwise comparisons showed that adolescents with both NSSI and suicide attempt reported significantly more adverse life events and trauma symptoms than adolescents with only NSSI, regardless of NSSI frequency. The largest differences (effect sizes) were found for interpersonal negative events and for symptoms of depression and posttraumatic stress. Adolescents with frequent NSSI reported more adversities and trauma symptoms than those with less frequent NSSI. There were also significant differences between all the NSSI groups and adolescents without any self-injurious behavior. These findings draw attention to the importance of considering the cumulative exposure of different types of adversities and trauma symptoms when describing self-injurious behaviors, with and without suicidal intent.