Promoting Resilience: Breaking the Intergenerational Cycle of Adverse Childhood Experiences

Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people

BACKGROUND

Clustering and co-occurring of family adversities, including mental health problems, substance use, domestic violence and abuse, as well as poverty can increase health and behavioural risks for children, which persist throughout the life course. Yet, interventions that acknowledge and account for the complex interactive nature of such risks are limited. This study aimed to develop intervention principles based on reflections from mothers, fathers, and young people who experience multiple and interacting adversities. These principles will show how family members perceive an intervention may bring about positive change and highlight key insights into design and delivery.

METHODS

A series of six co-design workshops with mothers, fathers, and young people who experienced multiple and interacting adversities (n = 41) were iteratively conducted across two regions in England (London and North-East) by four researchers. Workshop content and co-design activities were informed by advisory groups. Data from facilitator notes and activities were analysed thematically, resulting in a set of intervention principles.

RESULTS

The intervention principles highlighted that: (1) to reduce isolation and loneliness parents and young people wanted to be connected to services, resources, and peer support networks within their local community, particularly by a knowledgeable and friendly community worker; (2) to address feelings of being misunderstood, parents and young people wanted the development of specialised trauma informed training for practitioners and to have the space to build trusting, gradual, and non-stigmatising relationships with practitioners; and (3) to address the needs and strengths of individual family members, mothers, fathers, and young people wanted separate, tailored, and confidential support.

CONCLUSIONS

The current study has important implications for practice in supporting families that experience multiple and interacting adversities. The intervention principles from this study share common characteristics with other intervention models currently on offer in the United Kingdom, including social prescribing, but go beyond these to holistically consider the whole families' needs, environments, and circumstances. There should be particular focus on the child's as well as the mothers' and fathers' needs, independently of the family unit. Further refinement and piloting of the developing intervention are needed.

Childhood Traumatic Experiences and Happiness of Nursing Students: A Mixed Methods Study

The aim of this study was to examine the childhood trauma experiences and current happiness levels of nursing students. The quantitative part of the study was carried out with 349 student nurses and the qualitative part with 25 student nurses. An explanatory-sequential mixed methods design was used. Data were collected using Demographic Information Form, Childhood Trauma Questionnaire-Short Form, Oxford Happiness Questionnaire-Short Form and semi-structured Interview Form between November 2020 and September 2021. Quantitative data were analysed using descriptive statistics with the SAS 9.4 package program. Transcribed qualitative data were analysed using Braun and Clarke's six stage thematic analysis approach, and this was performed with the MAXQDA 2020 package program. In the quantitative section, it was determined that as the participants' childhood traumatic experiences increased, their happiness levels decreased. In the qualitative section six themes were formed (Childhood Trauma, Effects of Childhood Trauma, Coping with Childhood Trauma, Growing Up After Trauma, Perceptions of Future Parenting, Empowerment Through Nursing Education). It was determined that participants had various childhood traumatic experiences and mostly been exposed to emotional neglect. Some of the participants' childhood traumas continued to affect them in adulthood, and nursing education contributed to coping with trauma and raising awareness about it.

"They had clothes on their back and they had food in their stomach, but they didn't have me": The contribution of parental mental health problems, substance use, and domestic violence and abuse on young people and parents

BACKGROUND

The parental risk factors of mental health problems, substance use, and domestic violence and abuse each individually negatively impacts children's health and developmental outcomes. Few studies have considered the lived experience and support needs of parents and children in the real-world situation where these common risks cluster.

OBJECTIVE

This study explores parents' and young people's lived experiences of the clustering of parental mental health problems, parental substance use, and domestic violence and abuse.

METHODS

Semi-structured interviews were conducted with 18 mothers, 6 fathers, and 7 young people with experiences of these parental risk factors. Transcribed interviews were analysed using reflexive thematic analysis.

RESULTS

Four themes were developed, 1) cumulative adversity, 2) the impact of syndemic risk, 3) families navigating risk, and 4) family support. Parents and young people described family situations of stress wherein they experienced cumulative impact of multiple parental risk factors. Parents sought to navigate stressors and parent in positive ways under challenging conditions, often impeded by their own childhood trauma and diminished confidence. Parents and young people spoke of the need for, and benefits of having, support; both as a family and as individuals, to successfully address this trio of parental risks and the related impact.

CONCLUSIONS

This study highlights the high level of stress families experience and the efforts they go to mitigate risk. Services and interventions need to reflect the complexity of multiple needs and consider both the whole family and individuals when providing support.

Maternal childhood maltreatment: associations to offspring brain volume and white matter connectivity

The deleterious effects of adversity are likely intergenerational, such that one generation's adverse experiences can affect the next. Epidemiological studies link maternal adversity to offspring depression and anxiety, possibly via transmission mechanisms that influence offspring fronto-limbic connectivity. However, studies have not thoroughly disassociated postnatal exposure effects nor considered the role of offspring sex. We utilized infant neuroimaging to test the hypothesis that maternal childhood maltreatment (CM) would be associated with increased fronto-limbic connectivity in infancy and tested brain-behavior associations in childhood. Ninety-two dyads participated (32 mothers with CM, 60 without; 52 infant females, 40 infant males). Women reported on their experiences of CM and non-sedated sleeping infants underwent MRIs at 2.44 ± 2.74 weeks. Brain volumes were estimated via structural MRI and white matter structural connectivity (fiber counts) via diffusion MRI with probabilistic tractography. A subset of parents (n = 36) reported on children's behaviors at age 5.17 ± 1.73 years. Males in the maltreatment group demonstrated greater intra-hemispheric fronto-limbic connectivity (b = 0.96, p= 0.008, [95%CI 0.25, 1.66]), no differences emerged for females. Fronto-limbic connectivity was related to somatic complaints in childhood only for males (r = 0.673, p = 0.006). Our findings suggest that CM could have intergenerational associations to offspring brain development, yet mechanistic studies are needed.

Indigenous Cultural Identity Protects Against Intergenerational Transmission of ACEs Among Indigenous Caregivers and Their Children

A large body of empirical research has demonstrated that caregiver adverse childhood experiences (ACEs) predict ACEs in one's child, a phenomenon known as the intergenerational transmission of ACEs. Little of this empirical research, however, has focused specifically on Indigenous peoples despite a growing body of theoretical literature and the wisdom of Elders and Traditional Knowledge Keepers that speaks to the presence of this phenomenon within Indigenous communities as well as the protective role of Indigenous cultural identity in preventing the intergenerational transmission of ACEs. The purpose of the current study was to conduct an empirical evaluation of this hypothesis, specifically that Indigenous cultural identity and social support protects against the intergenerational transmission of ACEs among Indigenous peoples and their children in the USA. Participants were 106 Indigenous women caregivers of children ages 10 to 14 in South Dakota who completed surveys. Results showed that Indigenous cultural identity moderated the association between caregiver ACEs and child ACEs. At high levels of cultural identity, there was no association between caregiver ACEs and child ACEs. At low levels of Indigenous cultural identity, however, there was a strong and positive relationship between caregiver ACEs and child ACEs. Social support did not moderate the association between caregiver ACEs and child ACEs. These findings underscore the need for initiatives that enhance Indigenous cultural identity and social support among Indigenous caregivers to prevent the intergenerational transmission of ACEs.

Intergenerational Continuity of Childhood Adversity and Its Underlying Mechanisms Among Teen Mothers and Their Offspring

The present study investigates how parenting stress mediates the intergenerational continuity of childhood adversity in teenage mothers. Childhood adversity experiences of caregivers significantly affect their offspring's exposure to childhood adversity. However, little is known about the mechanisms linking childhood adversity across generations. The study measures how parental distress and parent-child dysfunctional interaction mediate the association between teen mothers' childhood adversity and their offspring's adversity, measuring when the offspring reached 11.5 years of age. The results revealed that parental distress, but not parent-child dysfunctional interaction, mediated the association between teen mothers' child abuse and their offspring's household dysfunction. This suggests that parental distress may be a crucial intervention target to prevent the intergenerational continuity of childhood adversity. The findings imply that efforts to prevent the intergenerational continuity of childhood adversity may be more successful if the public and professionals have a broader understanding of the associations between early adversity and parenting contexts. In conclusion, the study shed light on the potential mechanisms underlying the intergenerational continuity of childhood adversity and highlights the importance of targeting parenting stress, specifically parental distress, as an intervention strategy to prevent the perpetuation of childhood adversity across generations.

Negative and protective experiences influencing the well-being of refugee children resettling in Germany: a qualitative study

OBJECTIVE

Conflict, forced migration and searching for safety in a foreign land are all experiences common to refugee children. They experience potentially traumatic events that are distinct from the general population, yet current adverse childhood experience (ACE) studies do not cover these events. Studies that do examine refugee children's experiences typically focus on a single stage of migration or adversities from the community, offering insight into only a fraction of their realities. This study aimed to identify potentially traumatising and protective experiences subjectively perceived as influencing refugee children's well-being from all stages of migration and all socio-ecological levels.

DESIGN

Qualitative study with thematic analysis of semi-structured individual and group interviews. Themes were organised within a socio-ecological model.

SETTING

Non-profit organisations, youth welfare facilities and societies that organise civic engagement for refugee families in the Rhine-Neckar region in Germany provided rooms where interviews could be conducted.

PARTICIPANTS

Refugee parents and children who spoke one of the four most common languages of those seeking asylum in Germany in 2018 were included. This study excluded refugees who were not fleeing a conflict area. Forty-seven refugee parents and 11 children (aged 8-17 years) from Syria, Iraq, Palestine, Afghanistan and Eritrea participated.

RESULTS

Eight major themes emerged from interviews including six reflecting potentially negative experiences and two potentially protective themes. These themes evolved from experiences such as family dispersion, displacement, rigorous immigration and national policies, as well as constructive parenting and community support.

CONCLUSION

It is increasingly important to identify these diverse experiences as the refugee population continues to grow, and the increased prevalence of poor health outcomes in refugee children continues to be widely documented. Identifying ACEs specifically relevant to refugee children could contribute to understanding potential pathways and could further serve as a starting point for tailored interventions.

The effect of childhood maltreatment on adult survivors' parental reflective function, and attachment of their children: A systematic review

BACKGROUND

Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment.

METHODS

Ten databases were searched (from inception to 10^th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized.

RESULTS

One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results).

DISCUSSION

There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma.

OTHER

PROSPERO CRD42020223594.

"Going Forward Like a Grandmother in the Snow": Personal Survival Strategies, Motherhood, and Nature as Resources for Mothers Who Have Experienced Intimate Partner Violence

After suffering interpersonal violence (IPV), women survivors can access various interdisciplinary services and programmes to guide their recovery. Nevertheless, many vulnerable women postpone seeking help, sometimes indefinitely. Motherhood especially complicates help-seeking because mothers often want to protect both the perpetrator and their children. Understanding women's resilience, resources, and capacities in surviving IPV, however, could guide the development of helpful services that women actually access. Thus, in our study, we sought to explore the agency, resources, and reinforcing survival experiences of survivors of IPV. Our data, gathered in Finland during the COVID-19 pandemic, consisted of 12 narratives of mothers told in Clinical Ethnographic Narrative Interviews that were subsequently subjected to thematic analysis. Five themes describing personal resources, motherhood, and nature were identified under the overarching metaphor of "going forward like a grandmother in the snow". Recognising the agency, resources, capacities, and coping mechanisms of women who have suffered IPV can help in developing professional outreach programmes, promoting women's early access to useful resources, and, in turn, helping them to stop the possible intergenerational transmission of violence.

Adverse childhood experiences and early adolescent cyberbullying in the United States

INTRODUCTION

With the increasing use of social media and online platforms among adolescents, the relationship between traumatic life events and cyberbullying remains unclear. This study aimed to determine the associations between adverse childhood experiences (ACEs) and cyberbullying victimization among a racially/ethnically and socioeconomically diverse sample of early adolescents.

METHODS

We analyzed longitudinal data from 10,317 participants in the Adolescent Brain Cognitive Development (ABCD) study, baseline (2016-2018, ages 9-10 years) to Year 2. Logistic regression analyses were used to estimate associations between ACEs and cyberbullying victimization, adjusting for sex, race/ethnicity, country of birth, household income, parental education, and study site.

RESULTS

In the sample (48.7% female, 46.0% racial/ethnic minority), 81.3% of early adolescents reported at least one ACE, and 9.6% reported cyberbullying victimization. In general, there was a dose-response relationship between the number of ACEs and cyberbullying victimization, as two (adjusted odds ratio [AOR]: 1.45, 95% confidence interval [CI]: 1.13-1.85), three (AOR: 2.08, 95% CI: 1.57-2.74), and four or more (AOR: 2.37, 95% CI: 1.61-3.49) ACEs were associated with cyberbullying victimization in adjusted models. In models examining the specific type of ACE, sexual abuse (AOR: 2.27, 95% CI: 1.26-4.11), physical neglect (AOR: 1.61, 95% CI: 1.24-2.09), and household mental health problems (AOR: 1.39, 95% CI: 1.18-1.65) had the strongest associations with cyberbullying victimization.

CONCLUSION

Adolescents who have experienced ACEs are at greater risk for experiencing cyberbullying. Interventions to prevent cyberbullying could use a trauma-informed framework, including inter-peer interventions to break this cycle of trauma.

Applying the Integrative Model to Predict Intention to Use Corporal Punishment Among Low-income Parents

Child corporal punishment (CP) is associated with child physical abuse, which is a public health problem in the United States. Informed by the integrative model of behavioral prediction, this study surveyed low-income Black, Hispanic, and White parents who had children younger than 6 years old (N = 260) to identify major risk factors that determined intention to use CP to discipline children. Structural equation modeling revealed that attitudes, descriptive norms, and perceived efficacy of alternative discipline strategies were associated with intention to use CP. Additionally, parents' childhood CP frequency and past use of CP with their own children were influential distal variables that indirectly predicted CP intention. Results indicated the utility of the model in this behavioral context. Communication intervention programs targeting low-income parents should leverage perceived norms, perceived efficacy of alternative discipline strategies, and attitudes to change CP behavior.

Potential Points of Intervention to Minimize the Impact of Parents' Adverse Childhood Experiences on Child Mental Health

OBJECTIVE

Children of parents who experienced adverse childhood experiences (ACEs) are at elevated risk for mental health (MH) issues. The goal of this study was to explore the relationships between parent ACEs and child MH and to identify potential mediators and points of psychosocial intervention.

METHODS

Participants were 1307 children aged 5 to 9 years from diverse backgrounds and their primary caregivers. Using cross-sectional questionnaire data, we used structural equation modeling to examine the research questions.

RESULTS

Parent ACEs were directly related to child MH issues (β = 0.189, p < 0.001). This relationship was fully mediated by parent MH (β = 0.374, p < 0.001; β = 0.246, p < 0.001) and positive parenting behaviors (β = -0.237, p < 0.001; β = -0.556, p < 0.001). High parent ACEs were negatively associated with parent MH (β = 0.374, p < 0.001), which was then negatively associated with parenting behaviors (β = -0.500, p < 0.001), which was then negatively associated with child MH (β = -0.600, p < 0.001). Parent MH maintained a significant, though attenuated, direct relationship with child MH (β = 0.102, p < 0.05).

CONCLUSION

Parents with high ACEs but who have good mental health and positive parenting behaviors demonstrated no impact of their ACEs on their children's mental health. Providing MH care to parents and parenting programs may be strategies for improving children's MH. Parenting behavior assessment is recommended for clinicians when pediatric patients present with MH concerns.

Links between mothers' ACEs, their psychopathology and parenting, and their children's behavior problems-A mediation model

Introduction

Children of mothers with a history of adverse childhoods are at greater risk of behavior problems. However, the mechanisms through which a mother's early adverse experiences (ACEs) are transmitted to her children need further study. Our goal was to examine a conceptual mediational model linking mothers' ACEs, maternal psychopathology symptoms, and parenting behaviors with children's internalizing and externalizing behaviors sequentially.

Methods

A sample of 153 Israeli mothers of children ages 3-12 (52% girls) participated in the study, and most of the mothers (94.7%) were cohabiting with a spouse. Mothers completed online questionnaires about their early adverse experiences, psychopathology symptoms, parenting behavior, and their children's internalizing and externalizing behavior.

Results

Results showed that mothers with higher ACE scores reported more maternal psychopathology symptoms and more internalizing behavior in their children. The mother's psychopathology in and of itself mediated the link between her ACEs and her child's internalizing and externalizing behavior. Moreover, an indirect sequential path emerged linking ACEs with the mother's psychopathology symptoms, which, in return, were linked with hostile parenting. Hostile parenting, in turn, was linked with children's internalizing and externalizing behavior.

Discussion

These findings highlight the complicated and intertwined ways in which adverse experiences early in the mother's life might put her child's wellbeing at risk. The findings suggest that ACEs are linked to maternal affect dysregulation, which interferes with parenting, increasing the risk of behavior problems in children. The findings underscore the need to assess mothers' adverse history, psychological distress, and parenting behavior, and provide treatments that can reduce the intergenerational transmission of early adverse experiences.

Prevalence of Adverse Childhood Experiences (ACEs) among young adults of Kashmir

OBJECTIVE

Studies on the prevalence of adverse childhood experiences (ACEs) in Kashmir, India, are yet to be conducted. This study aims to estimate the prevalence of ACEs among young adults across all the ten districts of Kashmir Valley.

METHODS

A cross-sectional research strategy was used to assess the prevalence of ACEs by employing a multi-stage sampling method. Data were collected from 800 students studying in different colleges and universities in Kashmir with the help of the "Adverse Childhood Experiences" (ACEs) scale.

RESULTS

Findings disclosed that less than a quarter of the respondents reported high exposure to ACEs (15.4 %), more than one-tenth of the participants reported extremely high exposure to ACEs (13.4 %), over a quarter of the sample reported moderate exposure to ACEs (26.3 %), one-third of the youth reported low exposure to ACEs (33.0 %) and over one-tenth of the respondents reported no exposure to ACEs (11.8 %). The prevalence of ACEs was found to be 88.2 % (females: 82.7 % and males: 90.8 %) in Kashmir. The ACEs with the highest level of prevalence were "often or very often sworn at, insulted, or put down" (49.8 %), followed by "often or very often acted in a way that made them afraid that they would be physically hurt" (47.6 %), "often or very often pushed, grabbed, shoved, or slapped" (41.6 %), "often or very often hit so hard that they had marks or were injured" (28.3 %) and "touched or sexually fondled" (25.3 %). Thirteen out of 21 adverse events during childhood were significantly associated with gender.

CONCLUSION

The findings suggest the need to advocate early targeted interventions, reduce ACEs and their impact, and design efficient measures to improve the health and well-being of young adults in Kashmir.

Impact of adverse childhood experiences on women's psychosocial and HIV-related outcomes and early child development in their offspring

Adverse childhood experiences (ACEs) may have a critical influence on adult outcomes and subsequent offspring development, but few data have explored the effects of ACEs in low-resource settings where the burdens of childhood adversity and HIV are high. Among mothers living with HIV in Cape Town, we examined the effects of ACEs on maternal psychosocial and HIV-related outcomes, as well as early child development in their offspring aged 36-60 months. The World Health Organization's Adverse Childhood Experiences International Questionnaire was used to measure maternal reports of ACEs, and the Ages & Stages Questionnaire to screen for developmental delays in their offspring. Among 353 women (median age: 32 years), 84% reported ≥1 ACEs. Increased report of ACEs was strongly associated with depressive symptoms, hazardous alcohol use, intimate partner violence and self-reported suboptimal adherence to antiretroviral therapy. These associations were driven by more severe childhood experiences, including abuse, neglect and exposure to collective violence. Among 255 women who reported on their child's development, maternal ACEs were associated with poorer socioemotional development. These data suggest that childhood adversity has long-term effects on maternal outcomes as well as their children's socioemotional development and point to ACEs that might be targeted for screening and intervention.

Coping with adverse childhood experiences during the COVID-19 pandemic: Perceptions of mental health service providers

Background

Adverse Childhood Experiences (ACEs) have been associated with long-term physical and mental health conditions, toxic stress levels, developing unstable interpersonal relationships, and substance use disorders due to unresolved childhood adversities.

Aims

This study assessed the perspectives of mental health providers (MHPs) regarding their adult patients’ coping with ACEs during COVID-19 in Houston, Texas. Specifically, we explored how individuals with ACEs are coping with the increased stresses of the pandemic, how MHPs may provide therapeutic support for individuals with ACEs during this pandemic, pandemic-related challenges of accessing and utilizing mental health services for individuals with ACEs, and the awareness and treatment of ACEs among MHPs.

Methods

Ten in-depth semi-structured virtual interviews were conducted with licensed MHPs from November 2021 to April 2022 in Houston, Texas. Interviews were coded and analyzed for emerging themes through an inductive open coding approach to discover insights regarding coping with ACEs during COVID-19.

Results

Four key themes experienced by individuals with ACEs emerged from the MHP interviews: (1) Maladaptive emotional dissonance and coping outlets during the pandemic, (2) Difficulties with social connectedness and significance of social support, (3) Heightened daily life stressors and coping with the ongoing disruption of the pandemic, and (4) Changing interactions with the mental health system. Themes from this study highlighted that resilience, seeking treatment, and strong social support can help develop healthy coping strategies among individuals with ACEs.

Conclusion

This study may help inform best clinical practices to develop interventions and policies regarding ACEs such as a resilience-promotion approach that targets all the socio-ecological levels. In addition, findings highlight the synergy of psychotherapeutic and pharmacological management via tele-health modalities, in helping individuals with ACEs continue receiving the care they deserve and need during a persistent pandemic and an uncertain future.

Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology

Introduction

Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach.

Methods

Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood.

Results

Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences.

Conclusion

We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.

The Potential for Teacher-Student Relationships and the Whole School, Whole Community, Whole Child Model to Mitigate Adverse Childhood Experiences

BACKGROUND

Adverse childhood experiences (ACEs) are associated with poorer health and educational outcomes. With over 20% of children experiencing multiple ACEs, interventions must target protective factors to improve outcomes among these students. Teacher-student relationships (TSRs) integrated with the Whole School, Whole Community, Whole Child (WSCC) are one promising approach to building resilience to overcome ACEs.

METHODS

A narrative literature review was conducted on ACEs, resilience, TSRs, and the WSCC model to explore the evidence and potential of TSR interventions integrated within the WSCC model to build resilience in students experiencing ACEs.

RESULTS

Supportive adult relationships are one of the strongest protective factors against ACEs. TSR interventions have improved student and relationship outcomes. Few studies have explored the relationship between TSRs and ACEs or TSR ACEs interventions. The WSCC model provides opportunities to integrate TSRs and other protective factors into a schoolwide health model to build resilience.

CONCLUSIONS

TSRs and the WSCC model are promising approaches to target protective factors to mitigate ACEs. Research is needed to further establish TSRs as a protective factor, explore TSR ACEs interventions, and determine best practices for integrating TSRs and resilience in the WSCC model.

A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development

Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.

Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting

Background

Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention.

Methods

Secondary analysis was carried out on anonymised cross-sectional data from health visiting services in south and west Wales that had previously captured information on mothers’ ACEs during routine contacts. Demographic data and information on mothers’ health were extracted from the Healthy Child Wales Programme.

Results

Half of all mothers sampled had experienced at least one ACE, with a history of ACEs more common among younger, white British mothers and those residing in deprived areas. Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83, 95% confidence interval [CI] = 1.19–12.32, p = 0.025), neglect (AOR = 7.60, 95%CI = 1.81–31.97, p = 0.006) and overall ACE exposure (AOR = 2.67, 95%CI = 1.14–6.23, p = 0.024), with one in ten mothers (10.0%) who experienced ≥4 ACEs having preterm birth. Sub-analyses revealed a more pronounced relationship among mothers with no known chronic health conditions, with those with ≥4 ACEs and no known chronic condition four times more likely to give birth preterm (AOR = 3.89, 95%CI = 1.40–10.80, p = 0.009).

Conclusions

Findings highlight the importance of the entire maternal experience. The experience of childhood adversity can have a lasting impact into and beyond the prenatal period, potentially increasing the risk of preterm birth, even among otherwise healthy women. Increasing our understanding of the potential perinatal outcomes associated with ACEs can help to inform how maternity services and partners offer trauma-sensitive support to mitigate some of the risks of early parturition, as well as target intergenerational cycles of adversity and poor health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04454-z.

Family risk and early attachment development: The differential role of parental sensitivity

Family risks are known to be detrimental to children's attachment development. This study investigated whether parental sensitivity plays different roles in early attachment development in the context of risk: Sensitivity was hypothesized to mediate risk effects on attachment, as well as a moderator that shapes the relation between risk and attachment. Multiple family risks, parental sensitivity (defined as responsivity and supportive presence), and children's attachment security of 197 infants and toddlers (M_age  = 15.25 months) and their caregivers were assessed in a prospective study with a cohort-sequential-design in Germany. Caregivers' sensitivity served as a mediator of risk effects on attachment as well as a moderator that buffers adverse consequences of risk. Early sensitivity might be relevant in setting the stage for attachment development supporting resilience.

Cingulo-opercular and Cingulo-parietal Brain Networks Functional Connectivity in Pre-adolescents: Multiplicative Effects of Race, Ethnicity, and Parental Education

Introduction

A growing body of research has shown a diminished association between socioeconomic status (SES) indicators and a wide range of neuroimaging indicators for racial and ethnic minorities compared to majority groups. However, less is known about these effects for resting-state functional connectivity between various brain networks.

Purpose

This study investigated racial and ethnic variation in the correlation between parental education and resting-state functional connectivity between the cingulo-opercular (CO) and cingulo-parietal (CP) networks in children.

Methods

This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study; we analyzed the resting-state functional Magnetic Resonance Imaging (rsfMRI) data of 8,464 American pre-adolescents between the ages of 9 and 10. The main outcome measured was resting-state functional connectivity between the CO and CP networks calculated using rsfMRI. The independent variable was parental education, which was treated as a nominal variable. Age, sex, and family marital status were the study covariates. Race and ethnicity were the moderators. Mixed-effects regression models were used for data analysis, with and without interaction terms between parental education and race and ethnicity.

Results

Higher parental education was associated with higher resting-state functional connectivity between the CO and CP networks. Race and ethnicity both showed statistically significant interactions with parental education on children's resting-state functional connectivity between CO and CP networks, suggesting that the correlation between parental education and the resting-state functional connectivity was significantly weaker for Black and Hispanic pre-adolescents compared to White and non-Hispanic pre-adolescents.

Conclusions

In line with the Minorities' Diminished Returns theory, the association between parental education and pre-adolescents resting-state functional connectivity between CO and CP networks may be weaker in Black and Hispanic children than in White and non-Hispanic children. The weaker link between parental education and brain functional connectivity for Blacks and Hispanics than for Whites and non-Hispanics may reflect racism, racialization, and social stratification that collectively minimize the returns of SES indicators, such as parental education for non-Whites, who become others in the US.

Childhood adversity and mental health among Chinese young adults: The protective role of resilience

AIM

The aims of this study were to examine the prevalence of adverse childhood experiences (ACEs) among health science students in China; associations between the number of ACE exposures and severity of depressive and anxiety symptoms; and the extent to which resilience moderates the effect of ACEs on mental health outcomes.

DESIGN

This descriptive, cross-sectional study was conducted May-August 2020.

METHODS

Five hundred and sixty-six health science students (18-38 years) from China completed online surveys measuring ACEs using the Simplified Chinese version of the ACE-International Questionnaire, depressive and anxiety symptoms and resilience. Descriptive statistical analysis, ANOVA with Tukey HSD post hoc tests and multiple regression analysis were performed using SPSS 27.

RESULTS

88.5% of participants reported at least one ACE; 42.6% reported four or more ACEs. Higher number of ACEs was associated with more symptoms of depression and anxiety. Four or more ACEs were associated with significantly worse mental health outcomes than those with no ACEs and those with one to three ACEs. Greater resilience significantly attenuated the effects of ACEs on mental health symptoms.

CONCLUSIONS

ACEs are highly prevalent among Chinese health science students but their impact on mental health can be buffered by higher levels of resilience.

IMPACT

Screening for ACEs and strength-based, trauma-informed interventions on fostering resilience is needed to promote mental health among Chinese young adults.

Applications of psychoneuroimmunology models of toxic stress in prevention and intervention efforts across early development

Although evidence supporting psychoneuroimmunology (PNI) models of toxic stress have emerged over the past decade, the PNI field has struggled to integrate these important findings into real-world practical applications. There is great potential for these models to reduce the societal burden of childhood adversity by facilitating early detection and prevention with those children and adolescents at greatest risk for stress-related physical and psychological disorders. But further research is needed to validate and scale developmentally appropriate interventions with specific immune and endocrine mechanism-based targets that are developmentally sensitive. The allostatic load and additive PNI models of toxic stress exposure in youth are summarized. These models highlight the importance of integrating a standardized screening of environmental and interpersonal risk factors with stable and scalable cognitive and biological markers of risk. PNI models of toxic stress illustrate the need for intervention delivery as early as possible to prevent negative health outcomes in youth and comprehensive screening efforts would facilitate the deployment of community and family level interventions. This review discusses practical applications of toxic stress models that are currently under investigation, clarifies key obstacles, such as research gaps and scalability, and provides potential solutions, including cross-disciplinary partnerships.

The association between elder abuse and childhood adversity: A study of older adults in Malaysia

OBJECTIVES

Childhood adversity has been linked with later victimization of young and middle-aged adults, but few studies have shown persistence of this effect among elders, especially outside of North America. This research examined the association between adverse childhood experiences (ACEs) and elder abuse among older adults aged 60 years and over in Malaysia.

DESIGN

Cross sectional data were collected via face-to-face interview from June to August 2019.

SETTING

Eight government community health clinics in Kuala Pilah, a district in Negeri Sembilan state approximately 100km from Malaysian capital city Kuala Lumpur.

PARTICIPANTS

Older adults aged 60 years and above (N = 1984; Mean age 69.2, range 60-93 years) attending all eight government health clinics in the district were recruited for a face-to-face interview about health and well-being.

MEASUREMENT

The Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Revised Conflict Tactics Scale (CTS) were utilized to estimate childhood adversity and elder abuse respectively.

RESULTS

Multiple logistic regression analysis revealed a significant relationship between the number of cumulative ACEs and elder abuse. Compared to older adults with no self-reported adversity, those reporting three ACEs (OR 2.67, 95% CI 1.84,3.87) or four or more ACEs (OR 1.7, 95% CI 1.16, 2.48) had higher risk of any elder abuse occurrence since age 60 years. The effect was most prominent for financial and psychological elder abuse. The associations persisted in multivariate logistic regression models after adjusting for sociodemographic and health factors.

CONCLUSION

Early life adversities were significantly associated with victimization of older adults. Social and emotional support to address elder abuse should recognize that, for some men and women, there is a possibility that vulnerability to maltreatment persisted throughout their life course.

Prevalence of and relationship between adverse childhood experiences and family context risk factors among children with intellectual disabilities and borderline intellectual functioning

BACKGROUND

Adverse Childhood Experiences (ACEs) are an overlooked risk factor for behavioural, mental and physical health disparities in children with intellectual disabilities (ID) and borderline intellectual functioning (BIF).

AIMS

To gain insight into the presence of the 10 original Wave II ACEs and family context risk variables in a convenience sample of children with ID and BIF in Dutch residential care.

METHODS AND PROCEDURES

134 case-files of children with ID (n = 82) and BIF (n = 52) were analysed quantitatively.

OUTCOMES AND RESULTS

81.7 % of the children with ID experienced at least 1 ACE, as did 92.3 % of the children with BIF. The average number of ACEs in children with ID was 2.02 (range 0-8) and in children with BIF 2.88 (range 0-7). About 20 % of the children with moderate and mild ID experienced 4 ACEs or more. Many of their families faced multiple and complex problems (ID: 69.5 %; BIF 86.5 %). Multiple regression analysis indicated an association between family context risk variables and the number of ACEs in children.

CONCLUSIONS AND IMPLICATIONS

The prevalence of ACEs in children with ID and BIF appears to be considerably high. ACEs awareness in clinical practice is vital to help mitigate negative outcomes.

The Performance of Resilient Supply Chain Sustainability in Covid-19 by Sourcing Technological Integration

The present study describes technological integration as source of the sustainable supply chain resilience. The implementation of sustainable supply chain resilience has recently played a vital role, owing to its substantial factors which influence the business continuity. The influence of sustainable supply chain resilience is greatly varying, to embrace companies’ efficiency during a crisis such as COVID-19. In the present study, systematic model-based integration of sustainable supply chain resilience is developed, which can benefit the companies’ profile of work normalcy during the pandemic situation by managing the associated risks. Different variable factors are considered, to assess their impact on the sustainable supply chain. These factors are environmental regulatory system, customer response monitoring system, environmental uncertainty, interoperability and operational integration. Data were collected by questionnaire and analyzed with statistical tools of interpretation. This research is concluded with the assessment that there is a significant correlation between technological integration and the resilient supply chain’s sustainability. The business organizations need to understand the current COVID-19 situation, the supply chain issues, and their impact on the other factors. Business organizations need to implement international quality standards through the use of technology. This study highlights the critical components of technological advancement, which can uplift the existing standards. Overall, the study portrays the recent sustainable supply chain resilience-based orientation to cope with the current pandemic situation.

Relationship of childhood trauma, psychological resilience, and family resilience among undergraduate nursing students: A cross-sectional study

PURPOSE

To analyze how family resilience mediates the relationship between childhood trauma and psychological resilience in undergraduate nursing students.

DESIGN AND METHODS

A cross-sectional survey design was used to investigate 698 nursing undergraduate students (mean age: 18.77 ± 0.86 years) using the Childhood Trauma Questionnaire, Family Resilience Assessment Scale, and Connor-Davidson Resilience Scale. The mediating effect of family resilience was estimated using structural equation modeling and the bootstrap method.

FINDINGS

Both childhood trauma and family resilience were associated with psychological resilience. Family resilience showed a partial mediating effect between childhood trauma and psychological resilience, accounting for 21.5% of the total effect.

PRACTICE IMPLICATION

Our findings may help inform family interventions to improve the psychological resilience of nursing students, especially for those with childhood trauma experience.

Race, Socioeconomic Status, and Cerebellum Cortex Fractional Anisotropy in Pre-Adolescents

Introduction

Cerebellum cortex fractional anisotropy is a proxy of the integrity of the cerebellum cortex. However, less is known about how it is shaped by race and socioeconomic status (SES) indicators such as parental education and household income.

Purpose

In a national sample of American pre-adolescents, this study had two aims: to test the effects of two SES indicators, namely parental education and household income, on cerebellum cortex fractional anisotropy, and to explore racial differences in these effects.

Methods

Using data from the Adolescent Brain Cognitive Development (ABCD) study, we analyzed the diffusion Magnetic Resonance Imaging (dMRI) data of 9565, 9-10-year-old pre-adolescents. The main outcomes were cerebellum cortex fractional anisotropy separately calculated for right and left hemispheres using dMRI. The independent variables were parental education and household income; both treated as categorical variables. Age, sex, ethnicity, and family marital status were the covariates. Race was the moderator. To analyze the data, we used mixed-effects regression models without and with interaction terms. We controlled for propensity score and MRI device.

Results

High parental education and household income were associated with lower right and left cerebellum cortex fractional anisotropy. In the pooled sample, we found significant interactions between race and parental education and household income, suggesting that the effects of parental education and household income on the right and left cerebellum cortex fractional anisotropy are all significantly larger for White than for Black pre-adolescents.

Conclusions

The effects of SES indicators, namely parental education and household income, on pre-adolescents' cerebellum cortex microstructure and integrity are weaker in Black than in White families. This finding is in line with the Marginalization-related Diminished Returns (MDRs), defined as weaker effects of SES indicators for Blacks and other racial and minority groups than for Whites.

Exploring maternal adversity and childhood outcomes among low-income rural families

BACKGROUND

Research has linked adversity among mothers to poorer outcomes among their offspring. However, additional inquiry is warranted particularly in rural communities where risk factors for adversity are prevalent.

OBJECTIVE

This study had two objectives: (1) to describe and compare relationships between individual and cumulative maternal adversity with childhood outcomes; and, (2) to determine if mother-child attachment mediated the relationship between maternal adversity and childhood outcomes.

PARTICIPANTS AND SETTING

A convenient sample of 140 women with low socio-economic status (SES) were recruited through Head Start programs in the rural Midwest.

METHODS

Data was gathered using a survey comprised of multiple measures to assess maternal adversity and childhood outcomes (i.e. behavior and attachment). Data were analyzed in SPSS using bivariate and multivariate analyses, including stepwise regression.

RESULTS

Nearly 80 % of respondents experienced at least one adverse childhood experience (ACE) and 48 % reported having one or more traumatic experiences. Higher levels of adversity were associated with increased attention problems, increased emotional reactivity, and decreased harmonious attachment (p < .05, d = 0.37-0.38). Maternal experiences of childhood physical abuse and sexual abuse, as well as witnessing trauma, significantly predicted childhood outcomes, however, the variance accounted for by each type of adversity was small (4%-6%). Maternal adversity was unrelated to mother-child attachment.

CONCLUSIONS

Low-SES mothers in rural communities have significant histories of adversity. It is important to consider individual and cumulative adverse experiences, as well as the mother's perception of events as traumatic. Factors associated with rural communities and Head Start programming, as well as implications for research and practice surrounding maternal adversity and childhood outcomes, are discussed.

Adverse Childhood Experiences and Psychological Well-Being in Chinese College Students: Moderated Mediation by Gender and Resilience

Adverse childhood experiences (ACEs), including child abuse/neglect and household challenges, are a prevalent social issue that impacts individuals' well-being worldwide. Relatively few ACEs studies orient to the presence of psychological wellness, especially in ethnically Chinese populations. Furthermore, less is known about resilience as a mechanism between ACEs and psychological well-being, in addition to the moderating effect of gender. This study examined the relationship between ACEs and psychological well-being among Chinese college students and the potential mediating and moderating effects of resilience and gender, respectively. A total of 1,871 college students studying social science from 12 Chinese colleges completed an anonymous online survey between late September and early October 2020. Multiple-group path analyses were conducted to examine whether the relationships among ACEs, resilience, and psychological well-being differed as a function of gender. Results suggested that gender moderated the relationships studied. For female students, resilience mediated the association between abuse/neglect and psychological well-being, where abuse/neglect was negatively associated with resilience, which in turn had a negative relationship with psychological well-being. For male students, household challenges were negatively related to psychological well-being through reduced resilience. Based on the findings, various ACE-informed initiatives may be essential to prevent and protect individuals from ACEs. We also call for resilience-based interventions to enhance individuals' resilience and thus strengthen their psychological well-being.

Race, Ethnicity, Family Socioeconomic Status, and Children's Hippocampus Volume

Introduction

The hippocampus has a significant role in memory, learning, and cognition. Although hippocampal size is highly susceptible to family socioeconomic status (SES) and associated stress, very little is known on racial and ethnic group differences in the effects of SES indicators on hippocampus volume among American children.

Purpose

This study explored the multiplicative effects of race, ethnicity, and family SES on hippocampus volume among American children.

Methods

Using data from the Adolescent Brain Cognitive Development (ABCD), we analyzed the functional Magnetic Resonance Imaging (fMRI) data of 9390 9-10 years old children. The main outcome was hippocampus volume. The predictor was parental education. Subjective family SES was the independent variable. Age, sex, and marital status were the covariates. Racial and ethnic group membership were the moderators. To analyze the data, we used regression models.

Results

High subjective family SES was associated with larger hippocampus volume. This effect was significantly larger for Whites than Black families.

Conclusions

The effect of subjective family SES on children's hippocampus volume is weaker in Black than White families.

A Qualitative Metasynthesis of Mothers' Adverse Childhood Experiences and Parenting Practices

INTRODUCTION

Despite the known prevalence and detrimental health outcomes associated with adverse childhood experiences (ACEs), extant literature has rarely focused on the impact of ACEs on mothers' parenting practices. The purpose of this metasynthesis was to synthesize qualitative studies to understand how mothers with a history of ACEs parent their children.

METHOD

A systematic search was conducted across five databases with 11 studies meeting eligibilty criteria. Relevant data were extracted and analyzed with qualitative description.

RESULTS

Six subthemes and three themes emerged from the data. Themes included breaking the cycle, parent and child well-being, and supporting mothers. All mothers described strategies to protect their children, with some describing hypervigilant parenting practices. Mothers discussed worries about appropriate discipline and a pervasive fear of community-based services for fear of removal of the child. Across studies, mothers described their current support system and offered several suggestions for formal support services.

DISCUSSION

This metasynthesis provides the synthesized perspectives of traumatized mothers' parenting practices, which may inform future interventions.

Resilience Protective Factors Checklist (RPFC): Buffering Childhood Adversity and Promoting Positive Outcomes

While research tends to focus on understanding risk factors associated with adverse childhood and adolescent experiences, there is growing empirical support within the field of human services to also focus on strengths and protective factors that bolster resilience in life. This study investigated the psychometrics of the Resilience Protective Factors Checklist (RPFC), which is a questionnaire that assists in the identification of protective factors empirically linked to resilience and positive outcomes. In addition, associations between protective factors, childhood adversity, and quality of life outcomes were examined. Participants were undergraduate college students (n = 1,256). The results revealed good psychometric properties for the RPFC and the factor analysis supported the resilience structural model of three interrelated areas of protective factors - Individual, Family, and Community influences. All three areas of protection were positively correlated with all four domains of positive life outcomes (physical health, psychological health, social relationships, and a healthy environment) and negatively correlated with adverse childhood experiences. RPFC's individual protective factors positively predicted physical health and psychological health outcomes, while the community protective factors positively predicted environmental health outcomes. In addition, the RPFC's family protective factors moderated the path between adverse childhood experiences and social relationships. That is, for individuals who have experienced more adverse childhood experiences, those with higher levels of RPFC family protective factors had positive social relationship outcomes, while those with lower levels of family protective factors had negative social relationship outcomes. These findings lend support for the utilization of assessment measures for identifying and promoting protective factors that can buffer life adversity and heighten resilient positive outcomes.

Family Income Mediates the Effect of Parental Education on Adolescents' Hippocampus Activation During an N-Back Memory Task

Introduction: Hippocampus, a medial temporal lobe structure, has significant implications in memory formation and learning. Although hippocampus activity is believed to be affected by socioeconomic status (SES), limited knowledge exists on which SES indicators influence hippocampus function. Purpose: This study explored the separate and combined effects of three SES indicators, namely parental education, family income, and neighborhood income, on adolescents’ hippocampus activation during an N-Back memory task. As some of the effects of parental education may be through income, we also tested if the effect of parental education on hippocampus activation during our N-Back memory task is mediated by family or neighborhood income. Methods: The Adolescent Brain Cognitive Development (ABCD) study is a national multi-center investigation of American adolescents’ brain development. Functional magnetic resonance imaging (fMRI) data of a total sample of 3067 9–10-year-old adolescents were used. The primary outcome was left- hippocampus activation during the N-Back memory task (mean beta weight for N-Back run 1 2 back versus 0 back contrast in left hippocampus). The independent variable was parental education. Family income and neighborhood income were two possible mediators. Age, sex, and marital status were the covariates. To test mediation, we used hierarchical linear regression models first without and then with our mediators. Full mediation was defined according to Kenny. The Sobel test was used to confirm statistical mediation. Results: In the absence of family and neighborhood income in the model, higher parental educational attainment was associated with lower level of left hippocampus activation during the N-Back memory task. This effect was significant while age, sex, and marital status were controlled. The association between parental educational attainment and hippocampus activation during the N-Back memory task was no more significant when we controlled for family and neighborhood income. Instead, family income was associated with hippocampus activation during the N-Back memory task. These findings suggested that family income fully mediates the effect of parental educational attainment on left hippocampus activation during the N-Back memory task. Conclusions: The effect of parental educational attainment on adolescents’ hippocampus activation during an N-Back memory task is fully explained by family income. That means low family income is why adolescents with low-educated parents show highlighted hippocampus activation during an N-Back memory task. Given the central role of the hippocampus in learning and memory and as income is a modifiable factor by tax and economic policies, income-redistribution policies, fair taxation, and higher minimum wage may have implications for promotion of adolescent equality and social justice. There is a need to focus on family-level economic needs across all levels of neighborhood income.

What's Love Got to do with it: Role of oxytocin in trauma, attachment and resilience

Oxytocin (OT) is a neurohypophysial hormone and neuropeptide produced by the hypothalamus and released by the pituitary gland. It has multiple physiological roles including stimulation of parturition and lactation, and promotion of pro-adaptive social behaviors necessary for mammalian survival. OT interacts with one receptor subtype: the OT receptor (OTR) which, upon stimulation, triggers different intracellular signal transduction cascades to mediate its physiological actions. Preclinical studies show that OT regulates social behaviors such as pair bonding, recognition and social interaction. It also coordinates the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the release of corticotrophin-releasing hormone. Further evidence suggests that OT plays an important role in regulating caloric intake and metabolism, and in maintaining electrolyte and cardiovascular homeostasis. OT is also involved in attenuating the neurophysiological and neurochemical effects of trauma on the brain and body by facilitating both physical attachment such as wound healing, and psychological/social attachment, thereby increasing resilience to subsequent traumatic events. Clinical trials have reported that intranasal administration of OT provides therapeutic benefits for patients diagnosed with traumatic stress-related diseases such as major depressive disorders and post-traumatic stress disorder. OT's therapeutic benefits may result from context-dependent interactions with key neural pathways (social, cognitive, and reward), neurotransmitters (dopamine, norepinephrine, serotonin, and endogenous opioids), and biomarkers (adrenocorticotropic hormone, cortisol, and dehydroepiandrosterone sulfate), that lead to a decrease in stress -associated behaviors, and facilitate post-traumatic growth, ultimately leading to increased resilience, through improved social cohesion and attachment. OT induced-augmentation of physical and cognitive resilience may play a significant role in both the prevention of, and improved clinical outcomes for, traumatic stress-related disorders following either acute or enduring traumatic experiences.

Maternal Adverse Childhood Experiences, Family Strengths, and Chronic Stress in Children

BACKGROUND

Researchers have demonstrated that maternal adverse childhood experiences (ACEs), such as abuse and neglect, are associated with prenatal risk factors and poor infant development. However, associations with child physiologic and health outcomes, including biomarkers of chronic or "toxic" stress, have not yet been explored.

OBJECTIVES

The purpose of this study was to examine the associations among past maternal experiences, current maternal posttraumatic stress disorder (PTSD) symptoms, and children's indicators of exposure to chronic stress in a multiethnic sample of mothers and children at early school age (4 to 9 years).

METHODS

This cross-sectional study included maternal-child dyads (N = 54) recruited from urban community health centers in New Haven, Connecticut. Mothers reported history of ACEs, family strengths, and current PTSD symptoms. Child measures included biomarkers and health and developmental outcomes associated with chronic stress. Correlational and regression analyses were conducted.

RESULTS

Childhood trauma in mothers was associated with higher systolic blood pressure percentile (ρ = .29, p = .03) and behavioral problems (ρ = .47, p = .001) in children, while maternal history of family strengths was associated with lower salivary interleukin (IL)-1β (ρ = -.27, p = .055), salivary IL-6 (ρ = -.27, p = .054), and body mass index z-scores (ρ = -.29, p = .03) in children. Maternal PTSD symptoms were associated with more child behavioral problems (ρ = .57, p < .001) and higher odds of asthma history (ρ = .30, p = .03).

DISCUSSION

Results indicate that past maternal experiences may have important influences on a child's health and affect his or her risk for experiencing toxic stress.

Addressing Adverse Childhood Experiences: It’s All about Relationships

Recognition that economic, environmental, and social adversity affects health is not new; adversity may result from social determinants such as poverty, community violence, or poor nutrition; from within the family/caregiving environment; or interactions between these complex environs. However, compelling new research demonstrating the profound impact of cumulative early adversity and toxic stress on development and adult health is leading to the mobilization of global prevention and intervention efforts to attain and assure better health for populations across the world. In this paper, we begin with a global population perspective on adversity and discuss priorities for global health. We then turn to studies of adverse childhood experiences to consider current understanding of how early experiences impact brain development and short- and long-term health. Factors that build resilience and buffer the effects of toxic stress and adversity are described, with emphasis on the foundationally protective role of safe and nurturing caregiving relationships. We discuss the implications of these findings in terms of community health and present a participatory research paradigm as a relationship-based method to improve community engagement in identifying and mitigating the impact of adverse childhood experiences on health.