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Knefel M, Karatzias T, Spinazzola J, Shevlin M, Ford JD. The relationship of posttraumatic stress disorder and developmental trauma disorder with childhood psychopathology: A network analysis. J Anxiety Disord 2023; 99:102766. [PMID: 37690357 DOI: 10.1016/j.janxdis.2023.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/25/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Potentially traumatic experiences are a major risk factor for mental disorders in children and adolescents. Posttraumatic psychopathology includes trauma-specific disorders such as posttraumatic stress disorder (PTSD) as well as other psychiatric disorders. Developmental Trauma Disorder (DTD) has been proposed as a developmentally sensitive diagnosis. We aimed to further illuminate the co-occurrence of psychiatric conditions with DTD and PTSD. METHOD In a convenience sample of families of 507 children and adolescents (mean age = 12.11 years old, SD = 2.92; 48.5% female), we assessed DTD, PTSD, and screened for psychiatric disorders. We estimated network models including DTD, PTSD and ten psychiatric conditions. RESULTS We found that DTD and PTSD share both common and differential comorbidity features on disorder-, domain-, and symptom-level. The differential comorbidity patterns of the DTD and PTSD domains placed DTD close to both externalizing and internalizing psychopathology while PTSD was primarily linked to internalizing conditions. CONCLUSIONS Our study provides evidence for the complex clinical presentation of posttraumatic psychopathology over and above PTSD in children. DTD and PTSD provide useful and distinct diagnostic categories for children who are also experiencing internalizing conditions, and DTD may be especially relevant for children who are experiencing externalizing psychopathology.
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Affiliation(s)
- Matthias Knefel
- Faculty of Psychology, University of Vienna, Vienna, Austria; Department of Internal Medicine, Landesklinikum Baden , Baden bei Wien, Austria.
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK; Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | | | - Mark Shevlin
- Ulster University, School of Psychology, Coleraine, UK
| | - Julian D Ford
- University of Connecticut School of Medicine, Farmington, CT, USA
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Ford JD. Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:403-418. [PMID: 37234835 PMCID: PMC10205922 DOI: 10.1007/s40653-021-00415-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 05/28/2023]
Abstract
Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.
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Affiliation(s)
- Julian D. Ford
- University of Connecticut School of Medicine, Farmington, USA
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Ford JD, Spinazzola J, van der Kolk B, Chan G. Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication. Acta Psychiatr Scand 2022; 145:628-639. [PMID: 35266162 DOI: 10.1111/acps.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. METHODS The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. RESULTS A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. CONCLUSION This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Medical School Psychiatry Department, Farmington, Connecticut, USA
| | | | | | - Grace Chan
- University of Connecticut Medical School Psychiatry Department, Farmington, Connecticut, USA
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Lenhart L, Gander M, Steiger R, Dabkowska‐Mika A, Mangesius S, Haid‐Stecher N, Fuchs M, Buchheim A, Sevecke K, Gizewski ER. Attachment status is associated with grey matter recovery in adolescent anorexia nervosa: Findings from a longitudinal study. Eur J Neurosci 2022; 55:1373-1387. [PMID: 35083790 PMCID: PMC9305298 DOI: 10.1111/ejn.15614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/02/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to investigate whether grey matter (GM) reductions in acute anorexia nervosa (AN) are (i) valid for adolescents (age 14-18 years), (ii) reversible following short-term psychotherapeutic and nutritional therapy and (iii) depend on psychological components like attachment trauma. 3T MRI including a high-resolution T1 MPRAGE was performed in 22 female adolescents in the acute state of AN (age: 15.2 ± 1.2 years) and after weight restoration (duration: 2.6 ± 1 months, n = 18) and compared with 18 gender-matched healthy controls. The Adult Attachment Projective Picture System was used to classify resolved and unresolved attachment patterns. GM decreases were localized in extensive cortical areas including the insula, prefrontal and cingulate cortices as well as subcortical regions during acute AN, which partially increased after therapy with a relative sparing of the hippocampus and parahippocampal gyrus. The resolved group showed more GM recovery in regions of the left hippocampus and parahippocampal gyrus, bilateral cerebellar regions, right precuneus and adjacent cingulate cortices relative to the unresolved pattern. Structural anomalies in adolescent AN that recovered after treatment may be primarily the consequence of malnutrition, whereas several regions did not display significant recovery. Attachment status seems to influence region-specific GM recovery.
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Affiliation(s)
- Lukas Lenhart
- Department of RadiologyMedical University of InnsbruckInnsbruckAustria
- Department of NeuroradiologyMedical University of InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University of InnsbruckInnsbruckAustria
| | - Manuela Gander
- Department of Child and Adolescent PsychiatryMedical University of InnsbruckInnsbruckAustria
- Department of Child and Adolescent PsychiatryTirol KlinikenHall in TirolAustria
| | - Ruth Steiger
- Department of NeuroradiologyMedical University of InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University of InnsbruckInnsbruckAustria
| | - Angieszka Dabkowska‐Mika
- Department of NeuroradiologyMedical University of InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University of InnsbruckInnsbruckAustria
| | - Stephanie Mangesius
- Department of NeuroradiologyMedical University of InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University of InnsbruckInnsbruckAustria
| | - Nina Haid‐Stecher
- Department of Child and Adolescent PsychiatryTirol KlinikenHall in TirolAustria
| | - Martin Fuchs
- Department of Child and Adolescent PsychiatryTirol KlinikenHall in TirolAustria
| | - Anna Buchheim
- Institute of PsychologyUniversity of InnsbruckInnsbruckAustria
| | - Kathrin Sevecke
- Department of Child and Adolescent PsychiatryMedical University of InnsbruckInnsbruckAustria
| | - Elke Ruth Gizewski
- Department of NeuroradiologyMedical University of InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University of InnsbruckInnsbruckAustria
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Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders. Compr Psychiatry 2021; 111:152273. [PMID: 34555553 DOI: 10.1016/j.comppsych.2021.152273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/31/2021] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, Mage = 15.09, SD = 1.44; 27% male, Mage = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.
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Enlander A, Simonds L, Hanna P. Using the power threat meaning framework to explore birth parents' experiences of compulsory child removal. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abi Enlander
- School of Psychology University of Surrey Guildford UK
| | - Laura Simonds
- School of Psychology University of Surrey Guildford UK
| | - Paul Hanna
- School of Psychology University of Surrey Guildford UK
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Duffee J, Szilagyi M, Forkey H, Kelly ET. Trauma-Informed Care in Child Health Systems. Pediatrics 2021; 148:peds.2021-052579. [PMID: 34312294 DOI: 10.1542/peds.2021-052579] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- James Duffee
- Departments of Pediatrics and Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Moira Szilagyi
- Divisions of General and Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Heather Forkey
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
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Ford JD, Spinazzola J, van der Kolk B. Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R). Eur J Psychotraumatol 2021; 12:1929028. [PMID: 34249242 PMCID: PMC8245086 DOI: 10.1080/20008198.2021.1929028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.
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Affiliation(s)
- Julian D Ford
- University of Connecticut School of Medicine, Farmington, CT, USA
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Love B, Vetere A, Davis P. Understanding addiction, relapse and recovery amongst substance using offenders – a qualitative study informed by developmental psychological theories. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-04-2020-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Psychological developmental informed theories imply that addiction is not exclusively due to the addictive properties of the substance but that early psycho-social experiences are influential on later life. The purpose of this paper is to understand substance dependency, relapse and recovery amongst community-based substance using offenders in relation to their childhoods, relationships and significant life events, from their perspective. A key aim was to help better inform policy and practice.
Design/methodology/approach
A qualitative study (interpretative phenomenological analysis) was used to understand the impact of childhood, relationships and significant life events amongst (N = 17) adult ex/offenders with substance use dependency problems, (who were part of the UK Government rehabilitation programme), to understand their substance use and recovery from their own perspectives.
Findings
Four main superordinate themes were developed illustrating participants extremely adverse childhoods. Substance use was a means to cope with current and past trauma and crises and to help manage the emotions and mental health which could accompany these difficulties. Managing recovery was about learning to manage life itself, including emotions, mental health problems, trauma/responses, relationships and everyday life.
Originality/value
This group is under researched where qualitative methods have been used. The study focussed on early-psycho-social experiences and relationships and the influence of these throughout the life cycle, in relation to their substance use. The study was informed by theories often used in therapeutic settings but rarely in research, (Orford, 2008; Khantzian, 2012; Flores, 2012, Van Der Kolk, 2014).
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Gander M, Buchheim A, Bock A, Steppan M, Sevecke K, Goth K. Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence. J Pers Disord 2020; 34:84-103. [PMID: 31990614 DOI: 10.1521/pedi_2020_34_468] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.
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Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Anna Buchheim
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria.,Institute of Psychology, University of Innsbruck.,Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Austria
| | - Astrid Bock
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Martin Steppan
- Institute of Psychology, University of Basel, Switzerland
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinics, Basel, Switzerland
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Latrèche C, Brodard F. Diagnostiquer le trouble de stress post-traumatique chez l’enfant : le passage du DSM-IV-TR au DSM-5. PSYCHOLOGIE FRANCAISE 2020. [DOI: 10.1016/j.psfr.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Gubi AA, Strait J, Wycoff K, Vega V, Brauser B, Osman Y. Trauma-Informed Knowledge and Practices in School Psychology: A Pilot Study and Review. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2019. [DOI: 10.1080/15377903.2018.1549174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Aaron A. Gubi
- Department of Advanced Studies in Psychology, Kean University, Union, New Jersey, USA
| | - Julia Strait
- Department of Clinical, Health and Applied Sciences, University of Houston-Clear Lakes, Houston, Texas, USA
| | - Kirby Wycoff
- Department of Education, Eastern University, St. Davids, Pennsylvania, USA
| | - Vanessa Vega
- Department of Advanced Studies in Psychology, Kean University, Union, New Jersey, USA
| | - Bracha Brauser
- Department of Advanced Studies in Psychology, Kean University, Union, New Jersey, USA
| | - Yael Osman
- Department of Advanced Studies in Psychology, Kean University, Union, New Jersey, USA
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Gander M, Diamond D, Buchheim A, Sevecke K. Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD. J Trauma Dissociation 2018; 19:572-595. [PMID: 29547072 DOI: 10.1080/15299732.2018.1451803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.
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Affiliation(s)
- Manuela Gander
- a Department of Child and Adolescent Psychiatry , Medical University of Innsbruck , Innsbruck, Austria
| | - Diana Diamond
- b The Graduate Center , City College of the City University of New York , New York, USA
| | - Anna Buchheim
- c Institute of Psychology , University of Innsbruck , Innsbruck, Austria
| | - Kathrin Sevecke
- a Department of Child and Adolescent Psychiatry , Medical University of Innsbruck , Innsbruck, Austria
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Kozak RS, Gushwa M, Cadet TJ. Victimization and Violence: An Exploration of the Relationship Between Child Sexual Abuse, Violence, and Delinquency. JOURNAL OF CHILD SEXUAL ABUSE 2018; 27:699-717. [PMID: 29792581 DOI: 10.1080/10538712.2018.1474412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Child sexual abuse (CSA) continues to be a major public health issue with significant short- and long-term consequences. However, little contemporary research has examined the relationship between CSA and delinquent and violent behavior in adolescence. Children who have been sexually abused experience a unique form of victimization compared to children who have endured other forms of maltreatment, as CSA can result in feelings of shame, powerlessness and boundary violations. The purpose of this study was to examine the effect of CSA on delinquent and violent behavior in adolescence. We examined self-report data at the age 18 interview from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) on measures of sexual abuse experience, and engagement in delinquent and violent behavior in the past year. All participants reported either a history of maltreatment or were identified at-risk based on demographic risk factors. Participants included 368 males and 445 females who self-reported experiences of CSA and delinquent and violent behavior (N = 813). Findings indicated that, when controlling for gender and race, the odds of engagement in delinquent and violent behavior for those who have experienced CSA are 1.7 times higher than for those who have not. Additionally, female victims of CSA were .52 times less likely to engage in violent and delinquent behavior compared to their male counterparts. Further efforts are needed to examine the effects of CSA on violent and delinquent behavior to better guide treatment efforts that prevent juvenile justice involvement.
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Affiliation(s)
| | - Melinda Gushwa
- a School of Social Work, Simmons College , Boston , MA , USA
| | - Tamara J Cadet
- a School of Social Work, Simmons College , Boston , MA , USA
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Abstract
The present study investigated differences in various aspects of facial behavior among female patients with complicated grief (CG; n = 18) and healthy controls (n = 18) during the assessment of their attachment representation using the Adult Attachment Projective Picture System. All patients were classified with an unresolved attachment status. On a behavioral level, they demonstrated longer gazing behavior away from the interviewer and the picture stimuli, more speech pauses, less smiling toward the interviewer, and more crying, especially in response to stimuli portraying the theme of loss. Focusing on the in-depth analysis of death-related stimuli using the Facial Action Coding System, patients demonstrated less facial affective behavior, less disgust, and less smiling in response to these stimuli compared with the healthy controls. The impaired capacity of patients with CG responding in an affective appropriate manner regarding bereavement might be interpreted as a specific emotion dysregulation when their attachment and mourning system is activated.
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Bethell CD, Carle A, Hudziak J, Gombojav N, Powers K, Wade R, Braveman P. Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice. Acad Pediatr 2017; 17:S51-S69. [PMID: 28865661 PMCID: PMC6035880 DOI: 10.1016/j.acap.2017.04.161] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/21/2017] [Accepted: 04/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children's Health (NSCH) now measures ACEs for children, but requires further assessment and validation. METHODS We identified and compared methods to assess ACEs among children and families, evaluated the acceptability and validity of the new NSCH-ACEs measure, and identified implications for assessing ACEs in research and practice. RESULTS Of 14 ACEs assessment methods identified, 5 have been used in clinical settings (vs public health assessment or research) and all but 1 require self or parent report (3 allow child report). Across methods, 6 to 20 constructs are assessed, 4 of which are common to all: parental incarceration, domestic violence, household mental illness/suicide, household alcohol or substance abuse. Common additional content includes assessing exposure to neighborhood violence, bullying, discrimination, or parental death. All methods use a numeric, cumulative risk scoring methodology. The NSCH-ACEs measure was acceptable to respondents as evidenced by few missing values and no reduction in response rate attributable to asking about children's ACEs. The 9 ACEs assessed in the NSCH co-occur, with most children with 1 ACE having additional ACEs. This measure showed efficiency and confirmatory factor analysis as well as latent class analysis supported a cumulative risk scoring method. Formative as well as reflective measurement models further support cumulative risk scoring and provide evidence of predictive validity of the NSCH-ACEs. Common effects of ACEs across household income groups confirm information distinct from economic status is provided and suggest use of population-wide versus high-risk approaches to assessing ACEs. CONCLUSIONS Although important variations exist, available ACEs measurement methods are similar and show consistent associations with poorer health outcomes in absence of protective factors and resilience. All methods reviewed appear to coincide with broader goals to facilitate health education, promote health and, where needed, to mitigate the trauma, chronic stress, and behavioral and emotional sequelae that can arise with exposure to ACEs. Assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical research contexts. Although research to date and neurobiological findings compel early identification and health education about ACEs in clinical settings, further research to guide use in pediatric practice is required, especially as it relates to distinguishing ACEs assessment from identifying current family psychosocial risks and child abuse. The reflective as well as formative psychometric analyses conducted in this study confirm use of cumulative risk scoring for the NSCH-ACEs measure. Even if children have not been exposed to ACEs, assessing ACEs has value as an educational tool for engaging and educating families and children about the importance of SSNRs and how to recognize and manage stress and learn resilience.
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Bethell C, Gombojav N, Solloway M, Wissow L. Adverse Childhood Experiences, Resilience and Mindfulness-Based Approaches: Common Denominator Issues for Children with Emotional, Mental, or Behavioral Problems. Child Adolesc Psychiatr Clin N Am 2016; 25:139-56. [PMID: 26980120 PMCID: PMC4863233 DOI: 10.1016/j.chc.2015.12.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
US children with emotional, mental, or behavioral conditions (EMB) have disproportionate exposure to adverse childhood experiences (ACEs). There are theoretic and empirical explanations for early and lifelong physical, mental, emotional, educational, and social impacts of the resultant trauma and chronic stress. Using mindfulness-based, mind-body approaches (MBMB) may strengthen families and promote child resilience and success. This paper examines associations between EMB, ACEs, and protective factors, such as child resilience, parental coping/stress, and parent-child engagement. Findings encourage family-centered and mindfulness-based approaches to address social and emotional trauma and potentially interrupt cycles of ACEs and prevalence of EMB.
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Affiliation(s)
- Christina Bethell
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Narangerel Gombojav
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Michele Solloway
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Lawrence Wissow
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
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Rosenthal MN, Reinhardt KM, Birrell PJ. Guest editorial: Deconstructing disorder: An ordered reaction to a disordered environment. J Trauma Dissociation 2016; 17:131-7. [PMID: 26979580 DOI: 10.1080/15299732.2016.1103103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Pamela J Birrell
- a Department of Psychology , University of Oregon , Oregon , USA
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