Adverse childhood experiences and residential care environment: The mediating role of trauma-related symptoms and psychological maladjustment in adolescents

BACKGROUND

Research has consistently found poorer outcomes in adolescents who have been exposed to early interpersonal adversities, especially those in out-of-home placements. The presence of mental health problems also contributes to the perception of a more negative group climate and peer interactions through cascading effects.

OBJECTIVE

To analyze the sequential relationships between exposure to adverse childhood experiences (ACEs), trauma-related symptoms, psychological maladjustment, and the perception of group climate and peer interactions. In addition, the study analyzes the mediating role of trauma-related symptoms and psychological maladjustment.

PARTICIPANTS AND SETTING

The sample comprised 161 adolescents in out-of-home care (46.6 % males, 49.7 % females, 3.7 % non-binary), aged 12-18 (M = 15.22, SD = 1.59) from 24 residential facilities in Spain.

METHODS

This study is part of the VRINEP project. Group care workers reported about ACEs and trauma-related symptoms through online questionnaires, whereas adolescents self-reported about psychological maladjustment, group climate, and peer interactions.

RESULTS

Differential associations between ACEs with trauma-related symptoms and internalizing problems were found. The relationship between certain ACEs and externalizing problems was fully mediated by trauma-related symptoms. Likewise, psychological maladjustment was related to a more negative perception of the group climate and peer interactions. Although trauma-related symptoms were not directly associated with the perception of the residential environment, they were indirectly associated with peer relational aggression through externalizing problems.

CONCLUSIONS

Mental health has a significant impact on the perception of the group climate and peer interactions among adolescents in residential care who have been exposed to ACEs.

The Achieved Capabilities Questionnaire for Community Mental Health (ACQ-CMH): A consumer-based measure for the evaluation of community mental health interventions

The capabilities approach offers a multidimensional, ecological, and agent-centered framework that may inspire models of intervention and evaluation. A growing number of measures grounded on the capabilities approach for outcome measurement are appearing. Regarding community mental health, new consumer-valued measures-constructed in collaboration with consumers-are here considered crucial for a transformative shift. Meanwhile, new measurements need to provide psychometric evidence to enable proper choice and application. The Achieved Capabilities Questionnaire for Community Mental Health (ACQ-CMH) was developed in collaboration with consumers of community mental health services. It aims to assess consumers' capabilities achieved through program support. The present paper shows advancements in the measure validation through a confirmatory factor analysis within a sample of community mental health consumers (N = 225). Reliability and construct-related validity were also observed. A structural solution composed of five factors and 43 items revealed a better model fit than that obtained in a previous exploratory study. Findings support the reliability, sensibility, and both convergent and discriminant validity of using the ACQ-CMH in the evaluation of community mental health interventions. The ACQ-CMH offers a consumer-valued framework with specific dimensions and indicators of capabilities for use in a routine service evaluation setting.

"(I Think) My Mother Thinks I Am, Therefore I Am." The Looking-glass Self in Maltreated Children and Adolescents

Children and adolescents with maltreatment experiences show worse representations of themselves, as compared to their nonmaltreated counterparts. According to the looking-glass self hypothesis (LGSH), individuals' self-representations (SR) stem from interactions with significant others, reflecting associations between what significant others think of them (i.e., actual appraisals), individuals' perceptions of significant others' appraisals of them (i.e., reflected appraisals), and SR. However, little is known about the looking-glass self process in maltreated children and adolescents. This multi-informant study aimed to test the LGSH within the mother-child relationship with children and adolescents with maltreatment experiences. Specifically, including maltreatment experiences as co-predictors, this study analyzed the mediating role of mothers' reflected appraisals (MRA) in associations between mothers' actual appraisals (MAA) and children/adolescents' SR. Participants were 203 children/adolescents (52.5% boys), 8-16 years old (M = 12.6; SD = 2.49), assisted by children and youth protection committees (CYPC), their mother, and their CYPC case workers. Case workers reported on child/adolescent maltreatment, children/adolescents reported on SR and MRA, and mothers reported on MAA. A multiple mediation path analysis revealed significant mediation effects of MRA between MAA and child/adolescent SR in instrumental, social, emotional, intelligence, and opposition SR, thus supporting the LGSH in the context of child/adolescent maltreatment. Also, psychological neglect was associated to worse intelligence SR, mediated by intelligence reflected appraisals. Findings emphasize the importance of the role of MRA on maltreated children and adolescents' SR construction process, and provide useful clues to incorporate in prevention and intervention strategies targeting maltreated children and adolescents.

Parental Attitudes in Child Maltreatment

An information-processing approach to maladaptive parenting suggests that high-risk and maltreating parents are likely to hold inaccurate and biased preexisting cognitive schemata about child development and child rearing. Importantly, these schemas, which may include values, beliefs, expectations, and attitudes, are known to influence the way parents perceive and subsequently act toward their children. However, the few studies specifically addressing parental attitudes only considered global maltreatment, not distinguishing abuse from neglect. Moreover, few have considered dual-process models of cognition, relying mostly on the explicit level of parental attitudes that can be prone to various biases. Based on the Social Information Processing (SIP) model of child abuse and neglect, this study examines the association of parents preexisting cognitive schemata, namely explicit and implicit parental attitudes, and child abuse and neglect. A convenience sample of 201 mothers (half with at least one child referred to child protection services) completed a measure of explicit parental attitudes and a speed-accuracy task related to parenting. Abuse and neglect were measured with self-report and professionals-report instruments. Overall, the results support the hypothesis that maladaptive parenting is related with more biased preexisting cognitive schemas, namely attitudes related to parenting, but only for neglect and particularly when reported by professionals. Moreover, the results observed with both the explicit and implicit measures of attitudes were convergent, with mothers presenting more inadequate explicit attitudes also exhibiting an overall lower performance in the implicit attitudes task. This study is likely to contribute to the SIP framework of child abuse and neglect, particularly for the elucidation of the sociocognitive factors underlying maladaptive parenting, while also providing relevant cues for prevention and intervention programs.

Youth in Residential Care: A Cross-Sectional Mediation Analysis of Youth’s Perceptions of Their Social Images, Self-Representations, and Adjustment Outcomes

Individuals’ perceptions of their social images [i.e., meta-representations (MR)] and perceived stereotyping threat create involuntary stress responses that may affect important outcomes, such as self-esteem, academic achievement, and mental health. This study aimed to (1) analyze the indirect associations between residential care youth’s MR and their psychological adjustment (i.e., externalizing and internalizing problems) through their self-representations (SR) and (2) test the moderating role of youth’s age and residential unit size in those associations. A sample of 926 youth aged between 12 and 25years old filled out self-report questionnaires regarding their representations about how people in general perceive them (i.e., MR) and their SR. Residential care professionals filled in the socio-demographic questionnaires and the Child Behavior Checklist. Data were analyzed through multiple mediation models and moderated mediation models. Results showed that (1) youth’s behavioral MR were indirectly associated with higher internalizing and externalizing behavior through higher levels of behavioral SR and (2) youth’s emotional MR were associated with higher internalizing problems through higher emotional SR, but also with lower internalizing problems through lower levels of behavioral SR. These results emphasize the importance of stimulating positive SR, by showing that they can be a protective factor for youth in residential care.

Recognizing children's emotions in child abuse and neglect

Past research has suggested that parents' ability to recognize their children's emotions is associated with an enhanced quality of parent-child interactions and appropriateness of parental caregiving behavior. Although this association has also been examined in abusive and neglectful parents, the results are mixed and do not adequately address child neglect. Based on the Social Information Processing model of child abuse and neglect, we examined the association between mothers' ability to recognize children's emotions and self- and professionals-reported child abuse and neglect. The ability to recognize children's emotions was assessed with an implicit valence classification task and an emotion labeling task. A convenience sample of 166 mothers (78 with at least one child referred to Child Protection Services) completed the tasks. Child abuse and neglect were measured with self-report and professionals-report instruments. The moderating role of mothers' intellectual functioning and socioeconomic status were also examined. Results revealed that abusive mothers performed more poorly on the negative emotions recognition task, while neglectful mothers demonstrated a lower overall ability in recognizing children's emotions. When classifying the valence of emotions, mothers who obtained higher scores on child neglect presented a higher positivity bias particularly when their scores in measures of intellectual functioning were low. There was no moderation effect for socioeconomic status. Moreover, the results for child abuse were mainly observed with self-report measures, while for child neglect, they predominantly emerged with professionals-report. Our findings highlight the important contribution of the social information processing model in the context of child maltreatment, with implications for prevention and intervention addressed.