Quantifying Severity of Maltreatment, Adversity, and Trauma From Child Protective Services Case Record Files

Caregiver Report of Children's Exposure to Adverse Life Events: Concordance Between Questionnaire and Interview Approaches

Assessment practices for measuring adverse life events (ALEs) are often characterized by considerable variability, which is associated with inconsistency and reproducibility issues when conducting research on children with ALE exposure. One aspect of assessment variability for caregiver report of children's ALE history that has received minimal attention is assessment format. To address this issue, the current study evaluated concordance between two main ALE assessment formats: interviews and questionnaires. This involved examining overall endorsement of ALEs and concordance among multiple characteristics of ALE exposure, including type, polyvictimization, frequency, severity, and age of onset. Fifty-eight caregivers (Mage = 33.72; 60% Black; 55% below the federal poverty line) of preschool and school-age children were administered an ALE assessment in both a questionnaire and interview format across two sessions. The sum scores and concordance rates between format responses were compared based on ALE type, polyvictimization, frequency, severity, and age of onset of exposure. Results indicated that most total or sum scores were similar between formats, with the exception of ALE severity scores. However, there was most often low-to-moderate concordance across the 50 types of ALEs examined in the current study, suggesting that a different constellation of events comprised each sum or total score. This was also the case across all characteristics of the ALEs and most notably for the severity of ALE. Based on these findings, the format of assessment may be associated with inconsistent reporting of children's ALE exposure across multiple characteristics of ALE. Researchers may need to utilize multiple types of ALE assessments when relying on caregiver report of a child's ALEs.

Reducing Family Violence Through Child Welfare Intervention: A Propensity Score-Matched Study of Fathers for Change

Intimate partner violence (IPV) is prevalent, costly, and detrimental to children's health and development. It often co-occurs with child abuse and neglect. Most children referred to child protective services (CPS) have witnessed IPV and are at increased risk for subsequent exposure, as well as repeat maltreatment. For CPS referred children, there is often a missed opportunity to interrupt family violence and prevent future occurrences. Fathers for Change (F4C) is a family level intervention designed to reduce IPV by improving emotion regulation and reflective functioning in fathers. To date, no study has examined whether F4C is associated with reduced recidivism in families referred to CPS. Using propensity score matching (PSM) to simulate an experimental design, the current study tests the hypothesis that families with fathers who completed F4C will have significantly lower rates of new CPS reports over a 12-month period compared to a PSM sample of families of fathers not referred to F4C. Data were extracted from a state CPS electronic case records system on all accepted child maltreatment reports received between January 1, 2015, and April 30, 2020. PSM was successful in balancing potential confounders (e.g., race, number of prior maltreatment reports, risk level, date of report), resulting in a comparison group approximate to one that could be achieved via a randomized control trial. Logistic regression analyses of 1:1 PSM pairs revealed that control fathers were 2.4 times more likely to have a repeat maltreatment report during the 12-month follow-up period than F4C fathers. These findings suggest that F4C may provide an effective approach for reducing risk of repeat maltreatment among CPS referred children with identified IPV exposure.

Prospective Associations Between Early Childhood Intimate Partner Violence Exposure and Middle Childhood Internalizing and Externalizing Psychopathology

Co-occurring adversities are common for young children with child protective services (CPS) involvement, with high rates of intimate partner violence (IPV) exposure in this population. Despite extensive research linking childhood IPV exposure to later psychopathology, fewer studies have examined the prospective associations between IPV exposure and psychopathology using a dimensional approach. Here, we conducted secondary analyses of data from a randomized controlled trial of a parenting intervention for CPS-involved children, examining the associations between early childhood IPV exposure (i.e., threat), co-occurring deprivation, and middle childhood internalizing and externalizing symptoms. Adversity variables were coded from data collected when children were infants (N = 249, M_age = 7.97 months) through 48-month assessments; internalizing and externalizing psychopathology were modeled as latent variables reflecting the mean of data from yearly assessments between ages 8 to 10. Results of our structural equation model demonstrated that, accounting for the effects of co-occurring deprivation, IPV exposure was significantly associated with both internalizing, β = .38, p = .001, and externalizing, β = .26, p = .019, symptoms. Results suggest links between early childhood IPV exposure (i.e., threat) and later psychopathology. Findings support screening and intervention efforts to mitigate the developmental sequelae of IPV exposure among CPS-involved children.

Do Trajectories of Sensation Seeking Vary by Sex and Child Maltreatment Subtypes?

Child maltreatment and elevated sensation seeking are associated with a wide range of negative outcomes. Longitudinal data from a study of Puerto Ricans living in two sociocultural contexts were used to determine whether child maltreatment subtypes, sex, or sociocultural context relate to trajectories of sensation seeking. Participants were 2,489 individuals from the Boricua Youth Study (48.5% girls) living in New York and in Puerto Rico (PR; 5-15 years old at Wave 1). Subtypes of child maltreatment were measured using child report on the Parent-Child Conflict Tactics Scale and the Sexual Victimization Scale at Wave 1. The association between child maltreatment subtypes, sex, sociocultural context, and previously established sensation-seeking trajectories across three waves of data collection was probed using multinomial logistic regression. Girls, but not boys, who experienced neglect (adjusted odds ratio; AOR; 95% confidence interval [95% CI] = 5.33 [1.35, 21.03]), or physical abuse (AOR [95% CI] = 3.66 [1.07, 12.54]), were more likely to have an elevated sensation-seeking trajectory than a normative trajectory. For boys, none of the maltreatment subtypes were linked to the elevated sensation-seeking class. Girls exposed to verbal abuse (AOR [95% CI] = 0.33 [0.15, 0.75]) and boys exposed to physical abuse (AOR [95% CI] = 0.39 [0.16, 0.97]) were less likely to belong to the low sensation-seeking class. No significant interactions between sociocultural context (i.e., PR vs. New York) and maltreatment subtype on the development of sensation seeking were found. This research suggests sensation-seeking levels vary by experiences of childhood maltreatment, and that sex moderates the relationship between child maltreatment experiences and sensation seeking, with an association between some maltreatment subtypes and elevated sensation-seeking trajectories found in girls, but not boys. These results underline the importance of considering sex when examining how child maltreatment relates to outcomes.

A Trauma-Informed Approach to Assessment, Case Conceptualization, and Treatment Planning for Youth Exposed to Intimate Partner Violence

Children’s exposure to intimate partner violence (IPV) is a prevalent public health problem that can result in serious mental health impairments, including traumatic stress. These can emerge early and persist across development. IPV early in life has also been described as a “gateway exposure” to other forms of adversity and trauma. Children and families impacted by IPV have complex needs that complicate assessment and intervention. This paper highlights these issues and reviews best practices in assessment, case conceptualization, and treatment planning as they pertain to the treatment of IPV-exposed children. A case vignette illustrates the complex nature of IPV and application of best practices by telling the story of Isaiah, a 13-year-old boy with an extensive history of IPV exposure and co-occurring adversity and trauma.

A multi-method and multi-informant approach to assessing post-traumatic stress disorder (PTSD) in children

Trauma exposure is highly prevalent among children globally, and is associated with elevated rates of PTSD. The goal of this study was to systematically evaluate the effects of multiple informants and multiple screening measures on the identification of specific PTSD symptoms and rates of PTSD diagnoses. Participants in this study included 350 maltreated children from two cohorts, one recruited from Connecticut (n = 130), and the other from Vermont (n = 220). Both cohorts completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED) before a PTSD self-report measure. The KSADS psychiatric interview was also completed with the Connecticut cohort, with best-estimate ratings generated using parent and child interview, child self-report, and teacher questionnaire data. In addition to the SCARED and PTSD self-report scale, parents of the Vermont cohort completed the Child Behavioural Checklist. Significant differences emerged between parent and child report of sleep, nightmares, concentration, and irritability problems, suggesting the need for multiple informants in PTSD screening. Children also under-reported nightmares when asked in the context of a trauma-specific screening tool. As child trauma is associated with a broad range of psychiatric sequelae, comprehensive assessment using both general symptomatology and trauma-specific measures is recommended, since children often shut down when completing trauma measures.

Social supports moderate the effects of child adversity on neural correlates of threat processing

BACKGROUND

Child abuse and other forms of adversity are associated with alterations in threat processing and emotion regulation brain circuits.

OBJECTIVE

The goal of the current investigation is to determine if the availability of positive social support can ameliorate the negative impact of adversity on these brain systems.

PARTICIPANTS AND SETTING

Subjects included 55 children ages 7-16 (X = 11.8, SD = 2.0). Approximately one-third of the cohort had no significant history of adversity, one-third had a history of moderate adversity, and one-third had a history of severe adversity. Brain imaging was conducted at the University of Vermont using a 3.0 T Philips scanner.

METHODS

The Emotional Go-NoGo task with fearful and calm facial stimuli was used to assess the neural correlates of threat processing and emotion regulation in children during functional magnetic resonance imaging (fMRI). Dimensional measures of anxiety, social supports, and children's adverse experiences were also obtained.

RESULTS

A conjunction analysis was used to test if trauma-related brain activation in responding to fearful vs. calm targets was impacted by social support. This approach identified multiple activation foci, including a cluster extending from the left amygdala to several other key brain regions involved in emotion regulation, including the orbitofrontal cortex, anterior cingulate cortex (ACC), anterior insula, nucleus accumbens, and frontal pole (Family Wise Error (FWE) correction, p < 0.05).

CONCLUSIONS

Greater social support may reduce the effect that adversity has on neural processing of threat stimuli, consistent with the protective role of positive supports in promoting resilience and recovery demonstrated in the literature.