Beyond abuse and neglect: validation of the childhood interpersonal trauma inventory in a community sample of adults

Introduction

Childhood trauma is not restricted to abuse or neglect and other potentially traumatic experiences need to be pondered in practice and research. The study aimed to collect validity evidence of a new measure of exposure to a broad range of potentially traumatic experiences, the Childhood Interpersonal Trauma Inventory (CITI), by evaluating whether the CITI provides important additional information compared to a gold standard measure of childhood trauma.

Methods

The sample consisted of 2,518 adults who completed the CITI and self-reported measures of trauma (Childhood Trauma Questionnaire; CTQ) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; Dissociative Experiences Scale).

Results

First, the sensitivity to properly detect participants having been exposed to childhood maltreatment, as measured by the CTQ (here used as the gold standard), ranged between 64.81% and 88.71%, and the specificity ranged between 68.55% and 89.54%. Second, hierarchical regressions showed that the CITI predicted between 5.6 and 14.0% of the variance in psychiatric symptoms while the CTQ only captured a very small additional part of variance (0.3 to 0.7%). Finally, 25% (n = 407) of CTQ-negative participants screened positive at the CITI. The latter reported higher severity of psychiatric symptoms than participants without trauma, suggesting that the CITI permits the identification of adults exposed to significant traumas that remain undetected using other well-validated measures.

Discussion

The findings underscore the utility of the CITI for research purposes and the latter's equivalence to a gold standard self-reported questionnaire to predict negative outcomes.

Association between childhood maltreatment and attachment disorganization in young adulthood: The protective role of early mother-child interactions

BACKGROUND

Individuals who experience chronic relational trauma within the parent-child relationship are at risk of developing disorganized representations of attachment relationships in the form of Hostile-Helpless (HH) states of mind. While this association is well recognized theoretically, few studies to date have empirically tested predictors of HH states of mind.

OBJECTIVE

The purpose of this study was to examine whether retrospective self-reports of maltreatment and the quality of mother-child affective communication assessed in childhood predict HH states of mind in young adulthood.

METHODS

The sample was composed of 66 young adults from a low-income community sample, who had been taking part in a longitudinal project since they were preschoolers.

RESULTS

Results indicate that childhood maltreatment experiences significantly predict HH states of mind and that the quality of mother-child affective communication serves a protective role in the association between childhood maltreatment severity and adult attachment disorganization.

CONCLUSION

This study is one of the first to prospectively examine how the quality of mother-child affective communication in childhood relates to attachment disorganization in young adulthood. Our results highlight the importance of providing support to families in which the child is at risk of experiencing relational trauma, with a particular focus on improving the quality of parent-child interactions.

Comparative efficacy of the Triple P program on parenting practices and family violence against children

BACKGROUND

The Triple P - Positive Parenting Program was rolled-out in two communities in Quebec, Canada, in order to prevent child maltreatment.

OBJECTIVES

(1) Evaluate the effects of Triple P versus care as usual on positive parenting practices, dysfunctional disciplinary practices, and family violence towards the child; (2) verify whether the observed changes persisted over time.

PARTICIPANTS AND SETTING

A quasi-experimental protocol with an active comparison group was used. Participants were 384 parents or parental figures of at least one 0-12-year-old child, assigned to one of two groups: Triple P (n = 291) and Care as usual (n = 93). We conducted a follow-up study with 164 parents from the Triple P group.

METHODS

We administered questionnaires at pretest, post-test, and follow-up. Standardized instruments measured positive parenting practices, dysfunctional disciplinary practices (overreactivity, laxness, hostility), and family violence towards the child (repeated psychological aggression, minor physical violence). The intervention dose received by each parent was calculated from data provided by practitioners.

RESULTS

Belonging to the Triple P group was associated with increased positive practices and decreased overreactive and hostile discipline. A higher dose of intervention was associated with a decrease in laxness. All observed changes were maintained at follow-up, with medium (η²_p = 0.073, hostility₎ to large (η²_p = 0.271, overreactivity) effect sizes. Also, Triple P was more effective in reducing minor physical violence, this effect persisting over time (from 36 % to 21 %).

CONCLUSIONS

This study supports the sustainable efficacy of the Triple P parenting program, except for repeated psychological aggression towards children.

Hostile-helpless states of mind: A scoping review of risk factors, correlates, and consequences

Chronic relational trauma can lead to the formation of pervasively unintegrated attachment representations in adulthood, referred to as Hostile-Helpless (HH) states of mind. Individuals with this type of attachment disorganization evidence conflicting evaluations of caregivers and have difficulty reflecting on their traumatic childhood experiences. This scoping review is the first to systematically integrate the results of all empirical studies on HH states of mind in an effort to highlight the scientific and clinical contributions of the concept and guide future research. Following Arksey and O'Malley's (2005) Methodological Framework, cross-reference keywords were searched in three databases (PsycArticles, Psychology and Behavioral Sciences Collection, ProQuest). In total, 19 studies met inclusion criteria and were included in the synthesis. Results suggest that prevalence rates of HH states of mind increase as a function of adults' psychosocial risk status. Findings also reveal that the long-term consequences of early trauma are greater in the presence of a HH state of mind, whereas the absence of a HH state of mind acts as a protective factor against the intergenerational transmission of maladaptation. Finally, results support the discriminant validity of the HH classification against other forms of attachment disorganization in adulthood. Research gaps and future research directions are discussed.

Child Psychological Functioning During the COVID-19 Lockdown: An Ecological, Family-Centered Approach

OBJECTIVE

To evaluate how sociodemographic characteristics and various aspects of parent well-being, family functioning, parent-child relationship, and child characteristics are related to psychological functioning in children aged 9 to 12 years during the COVID-19 lockdown.

METHOD

Participants included 144 children aged 9 to 12 years and their parents who lived in the province of Quebec, Canada, during the COVID-19 mandatory lockdown. Parents and children were administered a phone-based survey in which various child, parent, parent-child, and family characteristics were assessed.

RESULTS

Results showed that higher internalizing problems in children were related to greater depressive symptoms in parents, lower attachment security to parents, and greater aversion to aloneness in children. Results on externalizing behavior problems showed that more problems were associated with more family dysfunction and chaos and lower attachment security to parents. Finally, results on children's anxiety toward COVID-19 showed that more anxiety was associated with greater parental anxiety toward COVID-19 and more child aversion to aloneness.

CONCLUSION

Our findings showed that even during an unusual and stressful context such as a pandemic, proximal variables such as the attachment relationship that have been known to be closely associated with adaptation are significantly related to child psychological functioning. Such observations are important because they highlight factors that may accentuate child vulnerability in times of a pandemic and shed light on potential intervention targets.

Relations between Child and Parent Fears and Changes in Family Functioning Related to COVID-19

In adults, higher anxiety level related to COVID-19 has been associated with having a pre-existing medical or mental health condition and poor sleep quality. However, no study yet has looked at these links in children. The present study's main aim was to assess family changes associated with child and parent fears and concerns about COVID-19. We conducted a cross-sectional study among 144 families with children aged 9-12 years during the COVID-19 lockdown period. Families came from Quebec, Canada, and the survey was done in the early stages of the lockdown (April-May 2020). A phone-based survey assessed parent and child COVID-19-related fears and concerns, family-related changes and health issues. Results showed the more fears parents have about COVID-19, the more fears their child also has. Moreover, changes in family sleep habits were associated with parental and child fears and concerns about COVID-19. Reduced access to health services was associated with parental concerns about COVID-19. If another lockdown was to be put in place in the future, it would be important to inform families on the importance of sleep schedules and to maintain or increase health appointments when possible.

Hostile-Helpless state of mind as further evidence of adult disorganized states of mind in neglecting families

This study aimed to assess disorganized states of mind in a sample of neglecting and at-risk of neglecting mothers using the recently developed Hostile-Helpless (HH) coding system (Lyons-Ruth et al., 2006) for the Adult Attachment Interview (Main & Goldwyn, 1998). The relation between HH states of mind and mothers' childhood traumas was also examined. Participants were 70 neglecting mothers and at-risk of neglecting mothers. Childhood traumas were assessed using the Childhood Trauma Questionnaire. HH states of mind were coded from Adult Attachment Interview transcripts by two reliable coders. Results revealed a high prevalence of disorganized states of mind in this sample. Forty-five mothers were classified HH, representing 64% of the entire sample. Most mothers reported at least one form of childhood trauma, with a mean of 2.9 different forms of trauma. Mothers classified HH reported having been emotionally abused, sexually abused and physically neglected more frequently than non-HH mothers. There was no difference between neglecting and at-risk of neglect mothers on HH states of mind and childhood experiences of trauma. These findings are in line with theorization on maltreating mothers' psychological background and they provide further empirical support to the validation of the HH classification system with at-risk populations.

Validity of CBCL-derived PTSD and dissociation scales: further evidence in a sample of neglected children and adolescents

There is growing evidence that child neglect is an important risk factor for posttraumatic stress disorder (PTSD) and dissociation. Considering that the Child Behavior Checklist (CBCL) is a widely used measure, the possibility of using validated CBCL-derived trauma symptoms scales could be particularly useful to better understand how trauma symptoms develop among neglected children and adolescents. This study examined the factor structure of three CBCL-derived measures of PTSD and dissociation (namely, PTSD scale, Dissociation scale, and PTSD/Dissociation scale) in a sample of 239 neglected children and adolescents aged 6 to 18 years using the latest version of CBCL (CBCL 6-18). Evidence of convergent validity of these scales was also examined for participants aged 12 and under using two well-validated measures of PTSD and Dissociation: the Trauma Symptoms Checklist for Young Children and the Child Dissociation Checklist. Findings suggest that CBCL-derived measures of trauma symptoms, especially PTSD and Dissociations scales, may be of heuristic value in the study of trauma symptomatology in neglected samples. Factor structure and evidence of convergent validity were supported for these two scales. Results also provide further support to the well-established assumption that PTSD and dissociation are two related but different constructs.

Trauma-related symptoms in neglected preschoolers and affective quality of mother-child communication

This study (a) assessed whether child neglect is associated with posttraumatic stress disorder (PTSD) and dissociative symptoms in the preschool period and (b) examined the role of quality of mother-child affective communication in the development of trauma-related symptoms among neglected children. Participants were 33 neglected and 72 non-neglected preschoolers (mean age = 60 months). Neglected children were recruited from the Child Protection Agencies. Neglected and non-neglected children victims of other form of abuse were excluded from the study. Trauma symptoms were evaluated through mother and preschool teacher reports. Quality of mother-child affective communication was assessed in a lab visit during an unstructured task. According to teachers, neglected children displayed more PTSD and dissociative symptoms than non-neglected children. Quality of mother-child communication was lower in neglected dyads. Mother-child affective communication predicted teacher-reported child trauma symptomatology, over and above child neglect. Discussion focuses on the traumatic nature of child neglect and the underlying parent-child relational processes.

The role of trauma symptoms in the development of behavioral problems in maltreated preschoolers

OBJECTIVE

This study assessed the mediating role of trauma symptoms in the relation between child maltreatment and behavioral problems. It is based on the postulate that child maltreatment is a severe form of chronic relational trauma that has damaging consequences on the development of children's behavioral regulation.

METHOD

Participants were 34 maltreated and 64 non-maltreated children (mean age=60 months; range: 46 to 72 months), all from economically disadvantaged families. Maltreated children were recruited from the Child Protection Agencies. Behavioral problems and trauma symptoms were evaluated by the preschool teacher with the Internalizing and the Externalizing scales of the Child Behavior Checklist-Teacher Report Form (CBCL-TRF) and the posttraumatic stress score of the Trauma Symptoms Checklist for Young Children respectively (TSCYC).

RESULTS

Baron and Kenny's mediational procedure was conducted using structural equation modeling. Mediational analyses revealed that trauma symptoms fully mediated the association between maltreatment and both internalizing and externalizing behaviors.

CONCLUSIONS

Results were consistent with the literature on developmental trauma research and provide empirical support to the idea that trauma-related symptoms resulting from early maltreatment may constitute a mechanism in the development of psychosocial problems in preschoolers.

PRACTICE IMPLICATIONS

These findings underline the importance of understanding psychosocial maladjustment of maltreated children not only from the perspective of problematic behavior, but also by taking into account the traumatic reactions that might develop in response to chronic and intense stress associated with abuse and neglect.