The psychobiology of children exposed to marital violence

Stress-induced changes in autonomic reactivity vary with adolescent violence exposure and resting-state functional connectivity

Exposure to violence during childhood can lead to functional changes in brain regions that are important for emotion expression and regulation, which may increase susceptibility to internalizing disorders in adulthood. Specifically, childhood violence exposure can disrupt the functional connectivity among brain regions that include the prefrontal cortex (PFC), hippocampus, and amygdala. Together, these regions are important for modulating autonomic responses to stress. However, it is unclear to what extent changes in brain connectivity relate to autonomic stress reactivity and how the relationship between brain connectivity and autonomic responses to stress varies with childhood violence exposure. Thus, the present study examined whether stress-induced changes in autonomic responses (e.g., heart rate, skin conductance level (SCL)) varied with amygdala-, hippocampus-, and ventromedial prefrontal cortex (vmPFC)-whole brain resting-state functional connectivity (rsFC) as a function of violence exposure. Two hundred and ninety-seven participants completed two resting-state functional magnetic resonance imaging scans prior to (pre-stress) and after (post-stress) a psychosocial stress task. Heart rate and SCL were recorded during each scan. Post-stress heart rate varied negatively with post-stress amygdala-inferior parietal lobule rsFC and positively with post-stress hippocampus-anterior cingulate cortex rsFC among those exposed to high, but not low, levels of violence. Results from the present study suggest that post-stress fronto-limbic and parieto-limbic rsFC modulates heart rate and may underlie differences in the stress response among those exposed to high levels of violence.

Differentiated processing of emotional cues in adolescents and young adults with ICD-11 PTSD and complex PTSD after child abuse

BACKGROUND

The recent update of the International Classification of Diseases 11th revision (ICD-11) introduced the diagnosis of complex posttraumatic stress disorder (CPTSD) as a distinct entity from posttraumatic stress disorder (PTSD). Because psychophysiological alterations are a core diagnostic feature of PTSD and CPTSD, the aim of the current study was to examine potential distinctive patterns in cortical and cardiac responses to emotional words in adolescent and young adult patients with PTSD and CPTSD.

METHOD

Event-related potentials and heart rate responses were studied in 81 adolescent and young adult participants, of which 17 individuals were diagnosed with ICD-11 PTSD and 32 individuals with CPTSD, each after childhood sexual and/or physical abuse. Thirty-two individuals served as healthy controls. The paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening words.

RESULTS

Differentiated early processing of emotional words was indicated by differences on P1 and left EPN components. Additionally, PTSD and CPTSD patients presented with specific patterns of heart rate responses to emotional words. In CPTSD patients, heart rate reactions to emotional words were more variable than in PTSD patients.

CONCLUSIONS

These findings provide early evidence of differentiated cortical and cardiac response patterns in adolescent and young adult patients with CPTSD and PTSD, supporting a nosological distinction between PTSD and complex PTSD. However, due to small and unequal sample sizes, findings presented in the current study are preliminary and require future research.

Safeguarding Children Subjected to Violence in the Family: Child-Centered Risk Assessments

Assessing risk, planning for safety and security, and aiding recovery for children subjected to violence in a family setting is a complex process. The aim of the article is to synthesize the current research literature about risks for children subjected to violence in the family and outline an empirical base for a holistic and practically usable model of risk assessments placing the individual child at the center. Such assessments need to recognize four different areas of risk: (1) child safety, i.e., known risk factors for severe and dangerous violence aimed at both adults and children and how they play out in the individual case; (2) the child's response in situations with violence; (3) the child's perspective, especially fear and feelings of powerlessness in situations with violence; (4) developmental risks, e.g., instability in the child's situation and care arrangements, lack of a carer/parent as a "secure base" and "safe haven", the child developing difficulties due to the violence (e.g., PTSD), problems in parents' caring capacities in relation to a child with experiences of, and reactions to, violence, and lack of opportunities for the child to make sense of, and create meaning in relation to, experiences of violence. In addition to the four areas of risk, the article emphasizes the importance of assessing the need for immediate intervention and safety planning in the current situation as regards safety, the child's responses, the child's perspectives, and long-term developmental risks.

Health and Health Needs of Children of Women Seeking Services for and Safety From Intimate Partner Violence

Children exposed to intimate partner violence (IPV) are at increased risk for health problems. The moment that a mother seeks services for or safety from IPV may be a window of opportunity to offer needed health care for her children. The objective of the study is to describe the perceptions of child health conditions and needs among mothers seeking services for or safety from IPV, and to compare the results in shelter- versus community-based samples. A cross-sectional survey of women with at least one child of age 3 to 11 years seeking services at an urban YWCA, which supports a residential IPV shelter and a community-based family justice center, was done between fall 2013 and winter 2014. Child health conditions were captured using the Children With Special Health Care Needs survey and the Strengths and Difficulties Questionnaire. Prevalence of health conditions among IPV-exposed children was compared with population norms. Perceived child health and health needs in the residential versus community settings were compared. Women (n = 48) completed surveys related to 91 children. Special health care needs (25%) and behavioral health (52%) problems were significantly higher in our sample than in general populations. Almost one quarter (24%) of children had a current need for general medical care and almost one half (44%) had a current need for behavioral health care. No significant differences in child health conditions or needs between residential and community settings were observed. These findings extend prior research describing the health problems faced by children exposed to IPV by describing maternal perceptions of child health and need for health care in a critical moment of seeking help for IPV. Community agencies may use this window of opportunity to support child health and household safety.

A Longitudinal Examination of Heart-Rate and Heart Rate Variability as Risk Markers for Child Posttraumatic Stress Symptoms in an Acute Injury Sample

Heart rate (HR) alterations in the immediate aftermath of trauma-exposure have been proposed to be potentially useful markers for child and adolescent posttraumatic stress disorder (PTSD). However, it is not yet clear if this holds true for measures taken more distal to the trauma, and no studies have investigated the predictive validity of more sensitive HR variability (HRV) indices. We recruited 76 parent-child pairs (child age 6 to 13 years) after the child experienced a traumatic event leading to presentation at a hospital emergency department. At 1-month post trauma (T1), HR recordings were obtained at rest, and while children verbally recounted their traumatic experience, both alone and together with a parent. Child post-traumatic stress symptoms (PTSS) were assessed concurrently (T1), and at 3 (T2) and 6-month (T3) follow-ups. We found that for T1, elevated mean HR during trauma narratives, but not at baseline, was positively associated with PTSS, with some evidence that HRV-indices were negatively cross-sectionally associated with PTSS. Furthermore, T1 HR indices predicted PTSS at T2 and partially at T3, although these effects did not hold when T1 PTSS were added to the model. Findings suggest that, consistent with the adult literature, HR indices in children may be a concurrent marker of higher PTSS and may be predictive of longer term distress. The findings encourage further investigations that track child HR and HRV in relation to PTSS over time after trauma, in order to examine how biological profiles evolve in those with persistent symptoms.

Violence exposure, affective style, and stress-induced changes in resting state functional connectivity

Chronic childhood stress is linked to greater susceptibility to internalizing disorders in adulthood. Specifically, chronic stress leads to changes in brain connectivity patterns, and, in turn, affects psychological functioning. Violence exposure, a chronic stressor, increases stress reactivity and disrupts emotion regulation processes. However, it is unclear to what extent violence exposure affects the neural circuitry underlying emotion regulation. Individual differences in affective style also moderate the impact of stress on psychological function and can thus alter the relationship between violence exposure and brain function. Resting-state functional connectivity (rsFC) is an index of intrinsic brain activity. Stress-induced changes in rsFC between the amygdala, hippocampus, and prefrontal cortex (PFC) are associated with emotion dysregulation and may elucidate how affective style modulates the relationship between violence exposure and brain connectivity. Therefore, the present study examined the impact of violence exposure and affective style on stress-induced changes in rsFC. Participants (n = 233) completed two 6-minute resting-state functional magnetic resonance imaging scans, one before (pre-stress) and one after (post-stress) a psychosocial stress task. The bilateral amygdala, hippocampus, and ventromedial prefrontal cortex (vmPFC) were used as seed regions for rsFC analyses. Significant stress-induced changes in the prefrontal, fronto-limbic, and parieto-limbic rsFC were observed. Further, pre-stress to post-stress differences in rsFC varied with violence exposure and affective style. These findings suggest that prefrontal, fronto-limbic, and parieto-limbic connectivity is associated with the emotional response to stress and provide new insight into the neural mechanisms through which affective style moderates the impact violence exposure has on the brain.

Interparental conflict as a curvilinear risk factor of youth emotional and cortisol reactivity

This study examined interparental conflict as a linear and curvilinear predictor of subsequent changes in adolescents' negative emotional reactivity and cortisol functioning during family conflict and, in turn, their psychological difficulties. In addition, adolescents' negative emotional reactivity and cortisol functioning during family conflict were examined as subsequent predictors of their psychological difficulties. Participants included 258 adolescents (52% girls) and their parents and teachers who participated in 3 annual measurement occasions. Adolescents were 13 years old on average (standard deviation [SD] = .57) at the first measurement occasion, were generally from middle- and working-class backgrounds, and identified mostly as White (e.g., 74%). The results of latent-difference score analyses indicated that a multimethod and multiinformant assessment of interparental conflict linearly predicted subsequent changes in observational ratings of adolescent emotional reactivity and their overall cortisol output in response to family conflict over a 1-year period. These changes, in turn, predicted increases in multiinformant reports of adolescent psychological problems over a 2-year period. However, the linear association in the first link in the cascade was qualified by the quadratic effects of interparental conflict as a predictor. Consistent with risk-saturation models, the relatively strong associations among interparental conflict and youth emotional reactivity and cortisol output at mild and moderate exposure to conflict weakened as exposure to conflict reached higher levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Child Maltreatment, Autonomic Nervous System Responsivity, and Psychopathology: Current State of the Literature and Future Directions

Child maltreatment may affect autonomic nervous system (ANS) responsivity, and ANS responsivity may influence the impact of child maltreatment on later outcomes including long-term mental/physical health. This review systematically evaluated the evidence regarding effects of maltreatment on ANS responsivity in children and examined how ANS responsivity may influence the association between maltreatment and psychopathology, with attention to relevant developmental issues. We searched the literature for relevant studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched five electronic databases, performed key word searches in relevant journals, hand searched reference sections of relevant articles, and contacted experts in the field. Articles were extracted according to inclusion criteria and their quality assessed. The search produced 1,388 articles; 22 met inclusion criteria. Most of the studies suggested blunted cardiovascular responsivity generally and sympathetic activation specifically in response to stress in maltreated children compared to nonmaltreated children. Findings around vagal responsivity and skin conductance were mixed. Limited evidence was found for ANS responsivity as a moderator or mediator of psychopathology risk among maltreated children. Maltreatment may be associated with blunted sympathetic activation in stressful situations. Differences in ANS responsivity may influence psychopathology risk among maltreated children. Further research is needed to confirm the nature and magnitude of such effects.

Family Violence, Sibling, and Peer Aggression During Adolescence: Associations With Behavioral Health Outcomes

Bullying and sibling aggression can appear as similar behavior, though the latter is comparatively understudied. Aligned with the Theory of Intergenerational Transmission of Violence, research suggests that exposure to family violence increases an individual's risk for perpetrating violence in their own future relationships. Additionally, Problem Behavior Theory suggests that engaging in one problem behavior (e.g., bullying) increases the likelihood of engaging in other problem behavior (e.g., substance use). In Phase 1, this study of middle school students from the U.S. examined how exposure to family violence predicted membership in latent classes of bullying and sibling aggression perpetration (N = 894, sampled from four middle schools). In Phase 2, we used mixture modeling to understand how latent classes of family violence, sibling aggression, and bullying predict future substance use, mental health outcomes, and deviance behavior later in high school. Results yielded four profiles of peer and sibling aggression: high all, high sibling aggression, high peer aggression, and low all aggression. Youth who reported witnessing more family violence at home were significantly more likely to fall into the sibling aggression only and high all classes, compared to the low all class. Phase 2 results also yielded four classes: a high all class, a sibling aggression and family violence class, a peer aggression class, and a low all class. Individuals in the high all class were more likely to experience several unfavorable outcomes (substance use, depression, delinquency) compared to other classes. This study provides evidence for pathways from witnessing violence, to perpetrating aggression across multiple contexts, to developing other deleterious mental and behavioral health outcomes. These findings highlight the negative impact family violence can have on child development, providing support for a cross-contextual approach for programming aimed at developing relationships skills.

Interrelatedness of Children's Psychological and Physiological Responses to Interparental Conflict: A Moderating Role of Harsh Parenting

Children's psychological and physiological responses to interparental conflict have received considerable attention due to their implications for later adjustment, yet limited research has investigated the interplay between these two response systems. This study investigates patterns of association between children's psychological responses (e.g., emotional distress) and cortisol reactivity to interparental conflict, including possible moderations by negative caregiving environment. Participants included 193 families (mother, father, and child). Parents completed questionnaires relating to their caregiving behaviors toward the child (107 girls and 86 boys, M age = 7.99 years, SD = 0.53 years) and children's psychological responses to interparental conflict. Children provided three saliva samples over the course of watching videos depicting conflicts between two adults, whom children were asked to pretend were their parents. Based on a series of Latent Growth Curve Models, only children's emotional responses to interparental conflict (indicated by increased distress) were associated with greater cortisol reactivity. Additionally, fathers' harsh parenting behavior moderated the relation between children's emotional reactivity and cortisol reactivity, yet the moderation effect was not found for mothers' parenting. Findings are discussed in terms of the importance of exploring both psychological and physiological reactivity to conflict and the possible moderating role of harsh parenting.

Cardiac reactions to emotional words in adolescents and young adults with PTSD after child abuse

Post-traumatic stress disorder (PTSD) is associated with alterations in cardiac reactivity to threat cues. Meta-analyses have summarized that adults with PTSD have increased heart rates in response to trauma-related stimuli. However, the opposite effect (i.e., cardiac hyporeactivity) has recently been reported in subgroups of PTSD patients. In children and adolescents with PTSD, reports of cardiac alterations are rare and ambiguous. So far, most studies in adolescents and young adults are restricted to victims of accidents, even though PTSD is highly prevalent in victims of child maltreatment. The present study aimed at investigating cardiac reactions in adolescents and young adults with PTSD after child abuse. Cardiac responses to standardized emotional words were studied in 39 adolescent and young adult PTSD patients after childhood sexual and/or physical abuse as compared to 39 healthy control subjects (age range: 15-20 years). The experimental paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening (swear) words. Results showed that cardiac reactions to negative stimuli, particularly physically threatening stimuli, were less pronounced in PTSD patients than in controls. Moreover, cardiac reactions in response to socially threatening words were less variable in the PTSD group. No differences between and within groups were present in reaction to neutral or positive stimuli. Findings suggest that a physiologically blunted subtype of PTSD may already manifest during adolescence and young adulthood. Moreover, the results of the present study emphasize the relevance of individual trauma history for physiological reactions.

Children's emotional and behavioral reactions to interparental aggression: The role of exposure to within-incident, cross-dyad aggression spillover

Despite children's frequent exposure to psychological and physical intimate partner aggression (IPA) and associated long-term consequences, little is known about children's immediate, within-incident reactions to IPA. Additionally, differences in reactions to IPA based on exposure to within-incident "spillover" of aggression across interparental and parent-child dyads have previously remained unexamined. Parents of children age 2.5 years at study commencement (N = 203 from 111 families) reported on incidents of family aggression four times for 1 year. Among select IPA incidents with the child present (n = 163 incidents from 73 families), IPA severity and children's exposure to aggression spillover were uniquely associated with children's expression of greater fear. Moreover, children unexposed to spillover experienced high fear only during relatively severe IPA incidents, whereas spillover-exposed children experienced high fear regardless of IPA severity (supporting observations of fear reactivity in response to low-level threats). Additionally, IPA severity positively predicted, and spillover exposure negatively predicted, children's attempts to make peace or solve the problem for their parents. Further, spillover-exposed children were more likely to withdraw or attempt to make peace during relatively more severe incidents of IPA. Thus, spillover-exposed children may manage their fear during relatively severe IPA incidents by withdrawing and/or engaging in active peacemaking behaviors but not by using other methods that may increase risk of aggression turning toward them. These results extend existing research, illustrate the unique predictive value of within-incident aggression spillover, and provide a foundation for understanding mechanisms through which IPA affects children in a diversity of ways. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding the Buffering Effects of Protective Factors on the Relationship between Adverse Childhood Experiences and Teen Dating Violence Perpetration

Prior research has demonstrated the scope and impact of adverse childhood experiences (ACEs) on health and wellbeing. Less is known about the trajectories from exposure to ACEs, such as witnessing family conflict and violence in the community, to teen dating violence perpetration, and the protective factors that buffer the association between early exposure to ACEs and later teen dating violence perpetration. Students (n = 1611) completed self-report surveys six times during middle and high school from 2008 to 2013. In early middle school, the sub-sample was 50.2% female and racially/ethnically diverse: 47.7% Black, 36.4% White, 3.4% Hispanic, 1.7% Asian/Pacific Islander, and 10.8% other. Youth were, on average, 12.7 years old. Latent transition analysis was used to assess how trajectories of exposure to parental conflict and community violence during middle school transition into classes of teen dating violence perpetration (e.g., sexual, physical, threatening, relational, and verbal) in high school. Protective factors were then analyzed as moderators of the transition probabilities. Three class trajectories of ACEs during middle school were identified: decreasing family conflict and increasing community violence (n = 103; 6.4%), stable low family conflict and stable low community violence (n = 1027; 63.7%), stable high family conflict and stable high community violence (n = 481; 29.9%). A three class solution for teen dating violence perpetration in high school was found: high all teen dating violence class (n = 113; 7.0%), physical and verbal only teen dating violence class (n = 335; 20.8%), and low all teen dating violence class (n = 1163; 72.2%). Social support, empathy, school belonging and parental monitoring buffered some transitions from ACEs exposure trajectory classes to teen dating violence perpetration classes. Comprehensive prevention strategies that address multiple forms of violence while bolstering protective factors across the social ecology may buffer negative effects of exposure to violence in adolescence.

Maternal witness to intimate partner violence during childhood and prenatal family functioning alter newborn cortisol reactivity

Witnessing intimate partner violence (IPV) during childhood is a risk factor for mental health problems across the lifespan. Less is known about the intergenerational consequences of witnessing IPV, and if the current family climate buffers intergenerational effects of witnessing violence. The mother's experience of witnessing IPV against her own mother during childhood, prenatal family dysfunction, and prenatal perceived stress were examined as predictors of offspring cortisol in the first month of life (N = 218 mother-infant dyads). Mothers reported on witnessing IPV in their childhoods, prenatal family dysfunction, and prenatal perceived stress in pregnancy. At 2 days and again at 1 month postpartum, infants engaged in a neurobehavioral exam to assess infant cortisol reactivity. Infants whose mothers witnessed IPV in childhood exhibited alterations in their baseline cortisol and their cortisol reactivity at 1 month of age, whereas family dysfunction during pregnancy was associated with baseline cortisol and cortisol reactivity at 2 days of age. Prenatal perceived stress was not associated with infant cortisol at 2 days or 1 month. Prenatal family dysfunction and perceived stress did not moderate effects of the mother's experience of witnessing IPV. Results support the view that maternal experiences in childhood and during pregnancy exert intergenerational effects on the HPA stress response system.

[Impact of Intimate Partner Violence on Child's Cognitive Development - Results from the Evaluation of the Home Visiting Program "Pro Kind"]

Impact of Intimate Partner Violence on Child's Cognitive Development - Results from the Evaluation of the Home Visiting Program "Pro Kind" Intimate partner violence (IVP) is a socially relevant problem area of high prevalence. Direct or indirect IVP leads to well documented problems in child socioemotional development. Longitudinal studies on influences of IVP on child's cognitive development are rare. The present study adds to close this gap. We analyze data from n = 535 families living under psychosocial risk conditions. All families took part in the evaluation of the home visiting program "Pro Kind". We administered one item of a parent questionnaire to assess the occurrence of IVP. The child's cognitive development is assessed at the ages of 6, 12, and 24 months of age with the Bayley Scales-II. We test the hypothesis that IVP to the mother causally affects early cognitive development of children in a structural equation model with Cross-Lagged-Panel design. The results show a causal influence of IVP on child's cognitive development during the period from t3 (12 months of child's age) to t4 (24 months of child's age). The explanatory power of results is limited by methodological problems, e. g. the operationalization of IVP with only one item and a high panel mortality. Implications for early prevention and intervention of IVP are derived.

Maternal experiences of intimate partner violence and C-reactive protein levels in young children in Tanzania

Intimate partner violence (IPV) is a critical public health issue that impacts women and children across the globe. Prior studies have documented that maternal experiences of IPV are associated with adverse psychological and physical health outcomes in children; however, research on the underlying physiological pathways linking IPV to these conditions is limited. Drawing on data from the 2010 Tanzania Demographic and Health Survey, we examined the relationship between maternal report of IPV in the past 12 months and inflammation among children ages 6 months to 5 years. Our study included 503 children who were randomly selected to provide a blood sample and had a mother who had ever been married and who had completed the Domestic Violence Module, which collected information on physical, sexual, and emotional violence. Analyses were stratified based on a threshold for acute immune activation status, defined by the threshold of CRP > 1.1 mg/L for young children in Tanzania. In bivariate analyses, healthy children whose mothers reported IPV showed a marginally elevated median CRP level compared to children whose mothers did not report IPV (0.35 vs. 0.41 mg/L; p = 0.13). Similarly, among children with active or recent infections, those whose mothers reported IPV had an elevated median CRP compared to children whose mothers did not (4.06 vs 3.09 mg/L; p = 0.03). In adjusted multiple variable regression models to account for child, mother, and household characteristics, maternal IPV was positively associated with (log) CRP in both healthy children and children with active or recent infection. Although longitudinal research with additional biomarkers of inflammation is needed, our results provide support for the hypothesis that inflammation may function as a biological pathway linking maternal IPV to poor psychological and physical health outcomes among children of mothers who are victimized-and this may extend to very young children and children in non-Western contexts.

Chronic Stress in Children and Adolescents: A Review of Biomarkers for Use in Pediatric Research

PROBLEM

Incorporating biomarkers of chronic stress into pediatric research studies may help to explicate the links between exposure to adversity and lifelong health, but there are currently very few parameters to guide nurse researchers in choosing appropriate biomarkers of chronic stress for use in research with children and adolescents.

METHODS

Biomarkers of chronic stress are described, including primary mediators (glucocorticoids, catecholamines, and cytokines) and secondary outcomes (neurologic, immune, metabolic, cardiovascular, respiratory, and anthropometric) of the chronic stress response.

RESULTS

Evidence of the use of each biomarker in pediatric research studies is reviewed. Recommendations for pediatric researchers, including selection of appropriate biomarkers, measurement considerations, potential moderators, and future directions for research, are presented.

DISCUSSION

A wide range of biomarkers is available for use in research studies with children. While primary mediators of chronic stress have been frequently measured in studies of children, measurement of secondary outcomes, particularly immune and metabolic biomarkers, has been limited. With thoughtful and theoretically based approaches to selection and measurement, these biomarkers present an important opportunity to further explore the physiologic pathways linking exposure to chronic stress with later health and disease.

CONCLUSION

The incorporation of chronic stress biomarkers into pediatric research studies may provide valuable insight into the mechanisms through which stressful environments "get under the skin" and ultimately inform efforts to promote health and reduce inequities among children exposed to adversity.

Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease

Childhood adversity has been repeatedly and robustly linked to physical and mental illness across the lifespan. Yet, the biological pathways through which this occurs remain unclear. Functioning of the inflammatory arm of the immune system and the hypothalamic-pituitary-adrenal (HPA)-axis are both hypothesized pathways through which childhood adversity leads to disease. This review provides a novel developmental framework for examining the role of adversity type and timing in inflammatory and HPA-axis functioning. In particular, we identify elements of childhood adversity that are salient to the developing organism: physical threat, disrupted caregiving, and unpredictable environmental conditions. We propose that existing, well-characterized animal models may be useful in differentiating the effects of these adversity elements and review both the animal and human literature that supports these ideas. To support these hypotheses, we also provide a detailed description of the development and structure of both the HPA-axis and the inflammatory arm of the immune system, as well as recent methodological advances in their measurement. Recommendations for future basic, developmental, translational, and clinical research are discussed.

Emotional Reactivity, Behavior Problems, and Social Adjustment at School Entry in a High-risk Sample

Prior research suggests that heightened emotional reactivity to emotionally distressing stimuli may be associated with elevated internalizing and externalizing behaviors, and contribute to impaired social functioning. These links were explored in a sample of 169 economically-disadvantaged kindergarteners (66 % male; 68 % African American, 22 % Hispanic, 10 % Caucasian) oversampled for elevated aggression. Physiological measures of emotional reactivity (respiratory sinus arrhythmia [RSA], heart rate [HR], and cardiac pre-ejection period [PEP]) were collected, and teachers and peers provided ratings of externalizing and internalizing behavior, prosocial competence, and peer rejection. RSA withdrawal, HR reactivity, and PEP shortening (indicating increased arousal) were correlated with reduced prosocial competence, and RSA withdrawal and HR reactivity were correlated with elevated internalizing problems. HR reactivity was also correlated with elevated externalizing problems and peer rejection. Linear regressions controlling for age, sex, race, verbal proficiency, and resting physiology showed that HR reactivity explained unique variance in both teacher-rated prosocial competence and peer rejection, and contributed indirectly to these outcomes through pathways mediated by internalizing and externalizing problems. A trend also emerged for the unique contribution of PEP reactivity to peer-rated prosocial competence. These findings support the contribution of emotional reactivity to behavior problems and social adjustment among children living in disadvantaged urban contexts, and further suggest that elevated reactivity may confer risk for social difficulties in ways that overlap only partially with internalizing and externalizing behavior problems.

Intimate partner violence is associated with increased maternal hair cortisol in mother-child dyads

BACKGROUND

The chronic consequences of intimate partner violence (IPV) on HPA activation are a topic of debate. The current study investigated hair cortisol concentrations in female victims of IPV and their children.

METHODS

A total of 52 mother-child dyads were divided into two groups depending on exposure to IPV: IPV group (n=27 dyads) and control group (n=25 dyads). Hair cortisol concentration was measured in 1-cm-long hair strands, representing 30days of exposure before assessment. PTSD and depression symptoms were assessed in the mother and child.

RESULTS

Women reporting IPV presented with higher hair cortisol levels, depression and PTSD symptoms severity in comparison to control women. Children who witnessed IPV reported more severe PTSD symptoms, but depressive symptoms and hair cortisol were not statistically different than those in control children. Correlation analyses revealed a positive association between the number of injury events and the level of hair cortisol in children. No associations between the hair cortisol levels in mothers and those in their children were found.

CONCLUSION

Higher hair cortisol levels detected in women exposed to IPV reflected long-lasting changes in HPA axis functioning associated with chronic stress exposure. Children whose parents recurrently engage in violent conflicts with intimate partners may often feel threatened and consequently reporting more PTSD-related symptoms. Given that experiencing and witnessing violence during childhood and adolescence are predictive of intimate partner violence in adulthood, the need of early interventions is crucial.

Cortisol, heart rate, and blood pressure as early markers of PTSD risk: A systematic review and meta-analysis

Individuals with posttraumatic stress disorder (PTSD) typically exhibit altered hypothalamic-pituitary-adrenal (HPA) function and sympathetic nervous system (SNS) activity. The goals of this study were to determine whether HPA and SNS alterations in the immediate aftermath of trauma predict subsequent PTSD symptom development and whether inconsistencies observed between studies can be explained by key demographic and methodological factors. This work informs secondary prevention of PTSD by identifying subgroups of trauma survivors at risk for PTSD. This meta-analysis (26 studies, N=5186 individuals) revealed that higher heart rate measured soon after trauma exposure was associated with higher PTSD symptoms subsequently (r=0.13). Neither cortisol (r=-0.07) nor blood pressure (diastolic: r=-0.01; systolic: r=0.02) were associated with PTSD symptoms which may be influenced by methodological limitations. Associations between risk markers (heart rate, cortisol, systolic blood pressure) and PTSD symptoms were in the positive direction for younger samples and negative direction for older samples. These findings extend developmental traumatology models of PTSD by revealing an age-related shift in the presentation of early risk markers. More work will be needed to identify risk markers and pathways to PTSD while addressing methodological limitations in order to shape and target preventive interventions.

The Children, Intimate Relationships, and Conflictual Life Events (CIRCLE) interview for simultaneous measurement of intimate partner and parent to child aggression

Despite substantial rates of parent to child aggression (PCA) and intimate partner aggression (IPA) co-occurrence within families, the co-occurrence of PCA and IPA within incidents of aggression has not previously been examined. To do so, we developed the Children, Intimate Relationships, and Conflictual Life Events (CIRCLE) interview to simultaneously measure incidents of psychological and physical PCA and IPA. The CIRCLE interview was administered quarterly for approximately 1 year to 109 women and 94 men from 111 couples with a first born child approximately 32 months of age at study initiation. Demonstrating the CIRCLE interview's ability to yield new knowledge about the nature of family aggression, we describe the frequency of aggressive incidents, the average number of aggressive behaviors within incidents, the daily occurrence of multiple aggressive incidents, and rates of within-incident PCA and IPA co-occurrence. With the exception of men's physical IPA, aggression scores derived from the CIRCLE interview exhibited a relatively high degree of interpartner reporting concordance, as well as structural validity and convergent validity with common aggression measures. Aggression reports via repeated testing were not influenced by social desirability or attempts to avoid aggression. Participants who perceived enhanced memory for aggression as a function of study participation reported increasing PCA and IPA frequencies over time. In the prediction of child conduct and emotional problems, the CIRCLE interview demonstrated predictive validity and incremental validity over traditional aggression measures. For the first time, within-incident co-occurrence of PCA and IPA was documented and shown to uniquely impact child outcomes. (PsycINFO Database Record

Childhood maltreatment and violence: mediation through psychiatric morbidity

Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21-34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.

Developmental variations in the impact of intimate partner violence exposure during childhood

BACKGROUND

Intimate partner violence (IPV) is a pervasive problem impacting individuals around the globe. The consequences of IPV extend beyond the adults in the relationship, as children witness a significant proportion of such violence. Exposure to IPV during childhood has devastating effects across multiple domains of functioning.

METHODS

This article reviews empirical studies of the effects of exposure to IPV by developmental stage.

RESULTS

The psychological, social, physical, and cognitive consequences of witnessing IPV are examined across development; from the impact of prenatal exposure to effects in infancy and toddlerhood, the preschool years, school-aged children, and adolescence.

CONCLUSIONS

The review concludes by providing suggestions for future research based on the identified developmental variations, recommendations for developmentally-sensitive interventions for children who have witnessed IPV, and directions for policy to address the issue of violence exposure early in the lives of children.

Intimate partner violence against women in Spain: A medico-legal and criminological study

Intimate partner violence (IPV) is a significant worldwide problem whose magnitude and risk factors vary across different settings and cultures. Nowadays, it is a priority to improve the knowledge on this issue in order to formulate better evidence-based policy responses. This study aims to contribute to a better understanding of non-fatal IPV against women in Spain. A retrospective analysis of IPV cases with a final judicial decision was carried out. The period under study extended from January 2005 to December 2012, with a total of 582 files included in the investigation. Most IPV victims were young adult women of Spanish origin, either married or single, with children, unemployed and with a low family income level. The majority of alleged perpetrators were young adults, employed, with a middle-low income level, a history of alcohol consumption/abuse, but no criminal records. Most victims had previous history of IPV, were engaged in a long-term relationship with their abuser and lived with him at the time of assault. The combination of psychological and physical abuse was the most frequent form of violence. The most common mechanisms of assault consisted in minor acts of physical violence, which resulted in mild injuries, most of them in the upper limbs and face. Nearly half of women sought medical care, but physician's injury report was only made in about a quarter of these cases, even though it is mandatory for health professionals. The majority of criminal proceedings were initiated by the victim's report and ended in conviction, most of them being considered occasional mistreatment. This study confirms the heterogeneity of the phenomenon of intimate partner violence. The importance of adopting standard IPV concepts and promoting the recognition and assessment of this form of violence amongst health care professionals, criminal investigators and forensic personnel is emphasized.

The influence of prenatal intimate partner violence exposure on hypothalamic–pituitary–adrenal axis reactivity and childhood internalizing and externalizing symptoms

This prospective longitudinal study examines the long-term influence of intimate partner violence (IPV) exposure in utero. We hypothesized that (a) prenatal IPV increases risk for internalizing and externalizing problems as well as for a profile of dysregulated cortisol reactivity, and (b) patterns of cortisol hyper- and hyporeactivity are differentially associated with internalizing and externalizing problems. The participants were 119 10-year-old children. Their mothers reported their IPV experiences and distress during pregnancy. Child and maternal reports of internalizing and externalizing problems as well as lifetime IPV exposure were obtained. Salivary cortisol was assessed at baseline, 20 min, and 40 min after challenge. The results partially supported our hypotheses: Exposure to IPV during pregnancy predicted child-reported internalizing and externalizing problems, mother ratings of child externalizing problems, and a profile of high cortisol secretion before and after stress challenge. The results were significant above and beyond the influence of maternal distress during pregnancy and IPV that occurred during the child's life. In addition, a profile of high cortisol secretion was associated with maternal reports of child internalizing behaviors. Findings support the growing consensus that prenatal stress can lead to lasting disruptions in adaptation and highlight the need for more longitudinal examinations of prenatal IPV exposure.

Differential associations between childhood trauma subtypes and adolescent HPA-axis functioning

Studies examining the association between childhood trauma exposure and neuroendocrine functioning have returned inconsistent findings. To date, few studies have accounted for the role exposure to different types of childhood trauma may have on different neuroendocrine adaptations, and no study has examined this association using multiple indices of hypothalamic-pituitary-adrenal axis (HPA-axis) functioning. The purpose of this study was to characterize the unique associations between exposure to physical abuse, emotional abuse, and non-intentional trauma, and multiple indices of HPA-axis functioning.

METHODS

A community sample of 138 youth (aged 9-16) completed the Socially Evaluated Cold Pressor Task (SE-CPT) while their parents completed the Early Trauma Inventory (ETI). All youth then collected 4 diurnal salivary cortisol samples at home across 2 consecutive weekdays.

RESULTS

High reported exposure to non-intentional trauma was associated with intact diurnal regulation but elevated cortisol at bedtime, physical abuse was associated with faster reactivity to acute stress, and emotional abuse was associated with delayed recovery of cortisol following acute stress. Taken together, there was a heterogeneous relationship among different indices of HPA-axis functioning and trauma subtype.

DISCUSSION

Different types of childhood trauma exposure are related to distinct anomalies in HPA-axis functioning. This study underscores the importance of research incorporating multiple indices of HPA-axis functioning to inform our understanding of the underlying neuroendocrine dysregulation that may later lead to stress-related psychopathology.

Psychophysiological characteristics of pediatric posttraumatic stress disorder during script-driven traumatic imagery

BACKGROUND

Psychophysiological alterations such as elevated baseline levels and hyperresponsivity in cardiac, electrodermal, and facial muscle activity have been observed in adults with posttraumatic stress disorder (PTSD). There are only few, inconclusive studies investigating psychophysiological responses in children and adolescents with PTSD.

OBJECTIVE

This cross-sectional study sought to examine if autonomic variables, facial electromyography (EMG), and self-reported anxiety at baseline, while listening to neutral and idiosyncratic trauma scripts, differ between minors with a trauma history and PTSD, and a traumatized control (TC) group without PTSD. A better understanding of psychophysiological reactions in trauma-exposed children and adolescents could improve differential assessment and treatment decisions.

METHOD

PTSD was assessed using the Clinician Administered PTSD Scale for Children and Adolescents in 6- to 17-year-old trauma-exposed children, resulting in a group with PTSD according to DSM-IV (n=16) and a TC group without PTSD (n=18). Facial EMG, (para-)sympathetic measures (heart rate, electrodermal activity, respiratory sinus arrhythmia), and self-reported anxiety were measured during 5-min baseline, 3-min neutral script, and 3-min idiosyncratic trauma script. Baseline, reactivity (trauma minus baseline), and script contrast (trauma minus neutral) were analyzed by multivariate analyses of variance.

RESULTS

Children and adolescents with PTSD reported more anxiety compared to TC for baseline, reactivity, and script contrast (ps<0.021, ds>0.59), and showed elevated corrugator supercilii muscle activity for script contrast (p<0.05, d=0.79). No group differences emerged for sympathetic or parasympathetic measures.

CONCLUSIONS

Children and adolescents with PTSD experienced elevated anxiety at baseline and elevated anxiety and facial corrugator muscle response to an idiosyncratic trauma narrative. Autonomic hyperreactivity, typical for adult PTSD samples, did not figure prominently.

The dead end of domestic violence: spotlight on children's narratives during forensic investigations following domestic homicide

The current study provides an in-depth exploration of the narratives of children who witnessed their father killing their mother. This exploration was conducted using a thematic analysis of the children's forensic interviews based on seven investigative interviews that were conducted with children following the domestic homicide. Investigative interviews were selected for study only for substantiated cases and only if the children disclosed the domestic homicide. All of the investigative interviews were conducted within 24h of the domestic homicide. Thematic analysis revealed the following four key categories: the domestic homicide as the dead end of domestic violence, what I did when daddy killed mommy, that one time that daddy killed mommy, and mommy will feel better and will go back home. The discussion examines the multiple layers of this phenomenon as revealed in the children's narratives and its consequences for professionals within the legal and clinical contexts.

Emotional and physiological desensitization to real-life and movie violence

Youth are exposed to large amounts of violence in real life and media, which may lead to desensitization. Given evidence of curvilinear associations between exposure to violence and emotional distress, we examined linear and curvilinear associations of exposure to real-life and movie violence with PTSD symptoms, empathy, and physiological arousal, as well emotional and physiological reactivity to movie violence. College students (N = 209; mean age = 18.74) reported on their exposure to real-life and televised violence, PTSD symptoms, and empathy. Then, students were randomly assigned to view a series of violent or nonviolent high-action movie scenes, providing ratings of emotional distress after each clip. Blood pressure was measured at rest and during video viewing. Results showed that with increasing exposure to real-life violence, youth reported more PTSD symptoms and greater identification with fictional characters. Cognitive and emotional empathy increased from low to medium levels of exposure to violence, but declined at higher levels. For males, exposure to higher levels of real-life violence was associated with diminishing (vs. increasing) emotional distress when viewing violent videos. Exposure to televised violence was generally unrelated to emotional functioning. However, those with medium levels of exposure to TV/movie violence experienced lower elevations of blood pressure when viewing violent videos compared to those with low exposure, and those with higher levels of exposure evidenced rapid increase in blood pressure that quickly declined over time. The results point to diminished empathy and reduced emotional reactivity to violence as key aspects of desensitization to real-life violence, and more limited evidence of physiological desensitization to movie violence among those exposed to high levels of televised violence.

Preliminary findings on lifetime trauma prevalence and PTSD symptoms among adolescents in Sarawak Malaysia

OBJECTIVE

The objective of this study is to determine the prevalence of lifetime exposure to traumatic events and its relation to PTSD symptoms.

METHODS

Participants were randomly selected from several schools located in the city of Kuching. There were 85 adolescents participating in this study, with ages ranging from 13 to 14 years old, of whom 31% (n=26) were males and 69% (n=59) females. The Child Posttraumatic Stress Index-Revised, The Harvard Trauma Questionnaire and a lifetime trauma checklist were used in this study.

RESULTS

Results showed that 77.6% of participants were exposed to at least one lifetime trauma. The most frequently reported traumas were road accident (20.1%), death of a family member (19.7%), and almost drowning (10%). There was more indirect trauma than direct trauma exposure. Males were more likely to be involved in traumatic events than females. Results showed that 7.1% (6) exhibited PTSD symptoms. There was no significant difference in the mean score of CPTS-RI between genders and among ethnic groups. Total exposure to traumatic events was significantly correlated with PTSD symptoms.

CONCLUSION

Findings suggest that number of lifetime traumatic events was quite high and multiple exposures to traumatic events were significantly related to PTSD symptoms.

Exposure to maternal distress in childhood and cortisol activity in young adulthood

Dysregulated cortisol is a risk factor for poor health outcomes. Children of distressed mothers exhibit dysregulated cortisol, yet it is unclear whether maternal distress predicts cortisol activity in later developmental stages. This longitudinal study examined the prospective relation between maternal distress during late childhood (9–12 years) and adolescence (15–19 years) and cortisol response in offspring in young adulthood (24–28 years). Data were collected from 51 recently divorced mothers and their children across 15 years. Higher maternal distress during late childhood was associated with lower total cortisol independent of levels of maternal distress in adolescence or young adulthood. Maternal distress during adolescence marginally predicted blunted cortisol when distress in childhood was low. Findings suggest that blunted cortisol activity in young adulthood may be a long-term consequence of exposure to maternal distress earlier in development.

The relationship between adult health and childhood maltreatment, as moderated by anger and ethnic background

Childhood maltreatment, anger, and racial/ethnic background were examined in relation to physical health, psychological well-being, and blood pressure outcomes. This study used data from a diverse sample of African American, Latino, and Caucasian participants (N=198). Results from a series of multiple regressions indicated anger and total childhood maltreatment were robust predictors of poorer health. Although correlational analyses found maltreatment from the mother and father were associated with poorer health outcomes, when considered as part of the regression models, only a relationship between maltreatment from the mother and physical health was found. Greater anger scores were linked with lower blood pressure, particularly systolic blood pressure. Generally, more psychological and physical symptom reporting was found with greater anger scores, and higher levels of total maltreatment also predicted physical symptoms. The pattern of interactions indicated anger was more detrimental for African American participant's (and marginally so for Latino participant's) physical health. Interestingly, interactions also indicated total childhood maltreatment was related to fewer symptoms for Latino participants. Although child maltreatment may be viewed as a moral and/or human rights issue, this study provides evidence that it can also be viewed as a public health issue. Our study demonstrated that known health risk factors such as anger and maltreatment may operate in a different pattern dependent on ethnic/cultural background. The findings suggest health and health disparities research would benefit from greater exploration of the differential impact of certain moderating variables based on racial/ethnic background.

Cumulative adversity in childhood and emergent risk factors for long-term health

OBJECTIVE

To examine whether and when effects of cumulative adversity in the first 7 years of life are evident in relation to 3 childhood markers of risk for poor adult physical health.

STUDY DESIGN

The study data are from an English birth cohort. Parental reports of 8 social risk factors were obtained during the child's first 7 years, and scores were created to reflect cumulative adversity at 4 developmental periods. At age 7 and 11 years, weight, height, and blood pressure (BP) were measured by clinic staff, and caregivers reported behavior problems. Linear regression was used to estimate associations of cumulative adversity with each outcome (n = 4361) and changes in these outcomes between 7 and 11 years (n = 3348).

RESULTS

At age 7 years, mean adversity and chronic exposure to high adversity were associated with elevated body mass index (BMI) and internalizing and externalizing symptoms (P < .05), but not elevated BP. Adversity in all developmental periods was associated with elevated numbers of internalizing and externalizing symptoms (P < .0001), but associations were less robust for BMI. Adversity did not predict change in BMI or BP between age 7 and 11 years, however, it predicted increases in internalizing and externalizing symptoms (P < .0001).

CONCLUSION

Cumulative adversity was associated with BMI and behavior problems at age 7 years, and our data indicate that timing and chronicity of exposure to adversity differentially influence diverse indicators of long-term health risk commonly measured in childhood. This research suggests the hypothesis that interventions to address adversity could reduce the development of multiple chronic disease risk factors and limit their effects on health.

Interparental aggression, attention skills, and early childhood behavior problems

The current study explored longitudinal associations between interparental aggression, the development of child attention skills, and early childhood behavior problems in a diverse sample of 636 families living in predominately low-income, nonmetropolitan communities. The results of latent-variable, cross-lagged longitudinal models revealed that maternal-reported interparental aggression in infancy predicted reduced observed attention skills in toddlerhood; no association was observed, however, between attention in infancy and interparental aggression during the toddler years. Further, reduced toddler attention and high interparental aggression were both associated with increased risk for attention-deficit/hyperactivity disorder symptoms and conduct problems at 3 years of age. Processes largely operated in similar ways regardless of child gender or low-income status, although a few differences were observed. Overall, the results suggest that interparental aggression undermines attention development, putting children's early behavioral adjustment at risk.

Adequate endocrine and cardiovascular response to social stress in survivors of childhood acute lymphoblastic leukemia

Survivors of childhood ALL have been demonstrated to have increased morning cortisol levels compared to healthy controls. Information regarding the response of the HPA axis and the sympathetic nervous system to stress in childhood ALL survivors is not available. The present study aimed at assessing the endocrine and cardiovascular stress response in childhood ALL survivors and healthy controls by evaluating perceived stress on visual analog scales, by determining saliva cortisol, blood pressure and heart rate in response to the Trier Social Stress Test for Children (TSST-C). Fifty survivors who had completed their treatment for childhood ALL 57 (IQR 47.0-72.3) months before and 50 healthy age and sex matched controls were included. Exposure to the TSST-C induced a significant response of perceived stress, saliva cortisol and cardiovascular outcome variables in the total study group. These responses did not significantly differ between survivors of childhood ALL and healthy controls. We conclude that the endocrine and cardiovascular response to social stress are intact in survivors of childhood ALL.

Marital conflict, allostatic load, and the development of children's fluid cognitive performance

Relations between marital conflict, children's respiratory sinus arrhythmia (RSA), and fluid cognitive performance were examined over 3 years to assess allostatic processes. Participants were 251 children reporting on marital conflict, baseline RSA, and RSA reactivity (RSA-R) to a lab challenge were recorded, and fluid cognitive performance was measured using the Woodcock-Johnson III. A cross-lagged model showed that higher levels of marital conflict at age 8 predicted weaker RSA-R at age 9 for children with lower baseline RSA. A growth model showed that lower baseline RSA in conjunction with weaker RSA-R predicted the slowest development of fluid cognitive performance. Findings suggest that stress may affect development of physiological systems regulating attention, which are tied to the development of fluid cognitive performance.

Psychobiology of PTSD in the acute aftermath of trauma: Integrating research on coping, HPA function and sympathetic nervous system activity

Research on the psychobiological sequelae of trauma has typically focused on long-term alterations in individuals with chronic posttraumatic stress disorder (PTSD). Far less is known about the nature and course of psychobiological risk factors for PTSD during the acute aftermath of trauma. In this review, we summarize data from prospective studies focusing on the relationships among sympathetic nervous system activity, hypothalamic-pituitary-adrenal function, coping strategies and PTSD symptoms during the early recovery (or non-recovery) phase. Findings from pertinent studies are integrated to inform psychobiological profiles of PTSD-risk in children and adults in the context of existing models of PTSD-onset and maintenance. Data regarding bidirectional relations between coping strategies and stress hormones is reviewed. Limitations of existing literature and recommendations for future research are discussed.

Trauma sequelae and cortisol levels in women exposed to intimate partner violence

Intimate partner violence (IPV) is often a chronic form of trauma with deleterious mental health problems. Furthermore, IPV survivors have also often experienced trauma in childhood. Consequently, by examining a sample of IPV survivors, this study sought to assess typical trauma sequelae--Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), or dissociative symptoms-and trauma-related characteristics consistent with Herman's Trauma theory (1992; i.e., chronicity of trauma, age of first trauma exposure, and social support), in relation to hypothalamic-pituitary-adrenal axis function. The study compared basal and diurnal cortisol in women (n = 88) based on diagnostic status and symptom severity (PTSD [n = 14], PTSD and comorbid MDD [n = 43], subthreshold symptoms of PTSD and MDD [n = 19]), dissociative symptoms, and the aforementioned trauma-related characteristics to a matched control group (n = 12) without any lifetime history of mental health diagnoses or exposure to interpersonal trauma. Regardless of their diagnostic status and trauma-related characteristics, trauma-exposed women had higher levels of dissociative symptoms relative to women in the control group, and these dissociative symptoms were inversely related to awakening cortisol levels. Findings suggest that low cortisol levels may not be a diagnostic marker, but instead may be associated with a dissociative coping style developed in the context of trauma exposure, consistent with mechanisms posited by Trauma theory.

Pathways and processes of risk in associations among maternal antisocial personality symptoms, interparental aggression, and preschooler's psychopathology

Two studies examined the nature and processes underlying the joint role of interparental aggression and maternal antisocial personality as predictors of children's disruptive behavior problems. Participants for both studies included a high-risk sample of 201 mothers and their 2-year-old children in a longitudinal, multimethod design. Addressing the form of the interplay between interparental aggression and maternal antisocial personality as risk factors for concurrent and prospective levels of child disruptive problems, the Study 1 findings indicated that maternal antisocial personality was a predictor of the initial levels of preschooler's disruptive problems independent of the effects of interparental violence, comorbid forms of maternal psychopathology, and socioeconomic factors. In attesting to the salience of interparental aggression in the lives of young children, latent difference score analyses further revealed that interparental aggression mediated the link between maternal antisocial personality and subsequent changes in child disruptive problems over a 1-year period. To identify the family mechanisms that account for the two forms of intergenerational transmission of disruptive problems identified in Study 1, Study 2 explored the role of children's difficult temperament, emotional reactivity to interparental conflict, adrenocortical reactivity in a challenging parent-child task, and experiences with maternal parenting as mediating processes. Analyses identified child emotional reactivity to conflict and maternal unresponsiveness as mediators in pathways between interparental aggression and preschooler's disruptive problems. The findings further supported the role of blunted adrenocortical reactivity as an allostatic mediator of the associations between parental unresponsiveness and child disruptive problems.

Interparental aggression and infant patterns of adrenocortical and behavioral stress responses

Drawing on emotional security theory, this study examined linkages between interparental aggression, infant self-regulatory behaviors, and patterns of physiological and behavioral stress responses in a diverse sample of 735 infants residing in predominately low-income, non-metropolitan communities. Latent profile analysis revealed four classes of adrenocortical and behavioral stress-response patterns at 7 months of age, using assessments of behavioral and cortisol reactivity to an emotion eliciting challenge, as well as global ratings of the child's negative affect and basal cortisol levels. The addition of covariates within the latent profile model suggested that children with more violence in the home and children who used less caregiver-oriented regulation strategies were more likely to exhibit a pattern of high cortisol reactivity with moderate signs of distress rather than the average stress response, suggesting possible patterns of adaptation in violent households.

Hypothalamic-pituitary-adrenal axis function in survivors of childhood acute lymphoblastic leukemia and healthy controls

Of all malignancies in children, acute lymphoblastic leukemia (ALL) is the most common type. Since survival significantly improves over time, treatment-related side effects become increasingly important. Glucocorticoids play an important role in the treatment of ALL, but they may suppress the hypothalamic-pituitary-adrenal (HPA) axis. The duration of HPA axis suppression is not yet well defined. The present study aimed at assessing the function of the HPA axis by determining the cortisol awakening response (CAR) and the dexamethasone (DEX) suppression test in children that were treated for childhood ALL, compared to a healthy age and sex matched reference group. In addition, questionnaires regarding sleep, fatigue, depression and quality of life were completed by the children and their parents. Fourty-three survivors who finished their treatment for childhood ALL 37 (interquartile range 22-75) months before and 57 healthy controls were included. No differences in CAR were observed between ALL survivors and the reference group, but survivors of ALL had higher morning cortisol levels and an increased cortisol suppression in response to oral dexamethasone. Higher cortisol levels in childhood ALL survivors were associated with more fatigue and poorer quality of life. We conclude that the experience of a stressful life event in the past may have caused a long-term dysregulation of the HPA axis in childhood ALL survivors, as reflected in an increased cortisol production and an enhanced negative feedback mechanism.

Patterns of children's adrenocortical reactivity to interparental conflict and associations with child adjustment: a growth mixture modeling approach

Examining children's physiological functioning is an important direction for understanding the links between interparental conflict and child adjustment. Utilizing growth mixture modeling, the present study examined children's cortisol reactivity patterns in response to a marital dispute. Analyses revealed three different patterns of cortisol responses, consistent with both a sensitization and an attenuation hypothesis. Child-rearing disagreements and perceived threat were associated with children exhibiting a rising cortisol pattern, whereas destructive conflict was related to children displaying a flat pattern. Physiologically rising patterns were also linked with emotional insecurity and internalizing and externalizing behaviors. Results supported a sensitization pattern of responses as maladaptive for children in response to marital conflict, with evidence also linking an attenuation pattern with increased family risk. The findings of the present study support children's adrenocortical functioning as one mechanism through which interparental conflict is related to children's coping responses and psychological adjustment.

The Combined and Independent Impact of Witnessed Intimate Partner Violence and Child Maltreatment

Intimate partner violence (IPV) is a pervasive issue, generating startling facts regarding its detrimental societal effects. There is also considerable overlap between witnessing IPV and experiencing childhood maltreatment. The current article reviews the state of the knowledge about the short- and long-term impact of witnessing IPV as well as a review of the literature exploring the unique impact of experiencing both IPV and maltreatment compared to witnessing only. Seventy-three articles were included in the present review. Negative outcomes in youth have been reported in both the internalizing and externalizing domains of functioning, in health and cognitive domains, as well as in youth’s relationships with family, peers, and romantic partners. The current literature suggests that these negative impacts persist into adulthood. Mixed results, whether there are significant additive effects of witnessing IPV and child maltreatment compared to witnessing IPV only, were found in youth and again into adulthood. Policy implications and recommendations for future research are suggested.

Interparental aggression and children's adrenocortical reactivity: testing an evolutionary model of allostatic load

Guided by an evolutionary model of allostatic load, this study examined the hypothesis that the association between interparental aggression and subsequent changes in children's cortisol reactivity to interparental conflict is moderated by their temperamental dispositions. Participants of the multimethod, longitudinal study included 201 2-year-old toddlers and their mothers. These children experienced elevated levels of aggression between parents. Consistent with the theory, the results indicated that interparental aggression predicted greater cortisol reactivity over a 1-year period for children who exhibited high levels of temperamental inhibition and vigilance. Conversely, for children with bold, aggressive temperamental characteristics, interparental aggression was marginally associated with diminished cortisol reactivity. Further underscoring its implications for allostatic load, increasing cortisol reactivity over the one year span was related to concomitant increases in internalizing symptoms but decreases in attention and hyperactivity difficulties. In supporting the evolutionary conceptualization, these results further supported the relative developmental advantages and costs associated with escalating and dampened cortisol reactivity to interparental conflict.

Interparental violence, maternal emotional unavailability and children's cortisol functioning in family contexts

Our goal in the present study was to examine the specificity of pathways among interparental violence, maternal emotional unavailability, and children's cortisol reactivity to emotional stressors within interparental and parent-child relationships. The study also tested whether detrimental family contexts were associated, on average, with hypocortisolism or hypercortisolism responses to stressful family interactions in young children. Participants included 201 toddlers and their mothers who were from impoverished backgrounds and who experienced disproportionate levels of family violence. Assessments of interparental violence were derived from maternal surveys and interviews, whereas maternal emotional unavailability was assessed through maternal reports and observer ratings of caregiving. Salivary cortisol levels were sampled at 3 time points before and after laboratory paradigms designed to elicit children's reactivity to stressful interparental and parent-child contexts. Results indicated that interparental violence and the mother's emotional unavailability were differentially associated with children's adrenocorticol stress reactivity. Furthermore, these family risk contexts predicted lower cortisol change in response to distress. The results are interpreted in the context of risky family and emotional security theory conceptualizations that underscore how family contexts differentially impact children's physiological regulatory capacities.