Positive and negative effects of child's agency on trauma symptoms and psychological difficulties in war-like conditions. The mediating role of hope and life satisfaction

BACKGROUND

Children affected by war and political violence deploy agentic competencies to cope with trauma symptoms and psychological difficulties. However, it does not always act as a protective factor to help them adjust to potentially traumatic events.

AIMS

We expected to explore the association between agency, trauma symptoms and psychological difficulties and the mediating role of hope and life satisfaction in a group of child victims of military violence in Palestine.

METHODS

965 children aged 8 to 14 were assessed with self-reported measures, War Child Agency Assessment Scale, Children Revised Impact of events scale, Strengths and difficulties scale, Child Hope Scale and Brief Multidimensional Students Life Satisfaction Scale. Structural Equation Modelling was performed having Agency as a predictor, trauma symptoms, psychological difficulties as an outcome variable and life satisfaction and hope as a mediator.

RESULTS

We found a direct and positive effect of agency on trauma symptoms, psychological difficulties, and life satisfaction and hope on the two dependent variables. Life satisfaction and hope mediated the association between agency and the outcome variables.

CONCLUSION

Agency can help defend children from trauma and psychological maladaptation when it acts on life satisfaction and hope. At the same time, it might worsen psychological dysfunctions when working directly on trauma symptoms and difficulties. Clinical interventions must help children to foster agentic resources in activating hope and life satisfaction.

Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking

INTRODUCTION

This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females.

METHOD

Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests.

RESULTS

Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05).

DISCUSSION

Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.

Hope and life satisfaction in Palestinian children victim of military violence: The predictive role of agency, potentially traumatic experiences and symptoms of trauma

BACKGROUND

Children exposed political violence deploy resources to maintain functioning, hope and life satisfaction.

OBJECTIVE

We sought to explore whether or not children promote hope and life satisfaction trough agency, psychological difficulties, potentially traumatic experiences and symptoms in Palestine.

PARTICIPANTS AND SETTING

965 children (494 males and 471 females) in multiple geographical contexts, and areas were involved.

METHODS

We administered the War Child Agency Assessment Scale, Child Hope Scale, Multilevel Students'Life Satisfaction Scale-Bref, the Strength and difficulties scale, the Child Revised Impact of events Scale, and Trauma Checklist, and performed regression analysis; hope and life satisfaction were dependent and agency, strength and difficulties, trauma symptoms and traumatic events independent variables.

RESULTS

Specific forms of agency predicted life satisfaction (β = 0.219; ** p < .01, social agency; β = 0.11; ** p < .01, with agency in education) and hope (β = 0.07; ** p < .05, agency on free movement), while mental difficulties (conduct problems, β = -0.09; ** p < .01; hyperactivity, β = -0.07; ** p < .05; β = -0.15; ** p < .01 with life satisfaction) (conduct problems, β = -0.06; ** p < .05, and difficulties in pro-social behaviour, β = -0.21; ** p < .01 with hope), traumatic events (β = -0.16; ** p < .01, with life satisfaction; β = -0.15; ** p < .01, with hope) and trauma symptoms (β = -0.09; ** p < .05, with hope) were negatively associated with the dependents variables.

CONCLUSIONS

We found a positive role of social, educational, and freedom of movement agentic behaviours in fostering hope and life satisfaction.

Clinician-associated traumatization from difficult medical encounters: Results from a qualitative interview study on the Ehlers-Danlos Syndromes

Patients with hypermobile Ehlers Danlos Syndrome often experience psychological distress resulting from the perceived hostility and disinterest of their clinicians. We conducted 26 in-depth interviews with patients to understand the origins of this trauma and how it could be addressed in practice. We found that the cumulative effects of numerous negative encounters lead patients to lose trust in their healthcare providers and the healthcare system, and to develop acute anxiety about returning to clinic to seek further care. We describe this as clinician-associated traumatization. Ultimately, our interviewees described the result of this traumatization as worse - but preventable - health outcomes.

Parenting stress and children's trauma symptoms over the course of TF-CBT: Examining differences between relative and foster/adoptive caregivers

BACKGROUND

Through Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the gold standard in children's trauma treatment, caregivers participate in sessions parallel to the child. However, much of the research examining the impact of this caregiver involvement has focused on biological or relative caregivers, despite the high prevalence of trauma and trauma symptoms among youth in foster care and high rates of parenting stress among foster/adoptive caregivers.

OBJECTIVE

The current study examined differences among relative and foster/adoptive caregivers' levels of parenting stress throughout the course of TF-CBT and how these differences were associated with child trauma symptoms throughout treatment.

PARTICIPANTS AND SETTING

Participants were 130 caregiver-child dyads (84 = foster/adoptive; 46 = biological/relative) who completed TF-CBT in either an academic-based clinic or an associated mental health agency. Providing clinicians were trained in TF-CBT, participated in case consultation, and received ongoing clinical supervision.

METHODS

Children and caregivers completed baseline measures prior to beginning treatment and termination measures at the completion of treatment.

RESULTS

Prior to treatment, foster/adoptive caregivers reported greater dysfunction in their parent-child interactions and relative caregivers reported greater personal stress. These differences were not seen at treatment termination, and significant reductions in child trauma symptoms and caregiver parenting stress were evidenced from pre to post treatment. Significant covariation between child trauma symptoms and relative caregiver parenting stress at termination was also found.

CONCLUSIONS

There were different profiles of parenting stress for relative versus foster/adoptive caregivers, but treatment completion attenuated group differences in parenting stress over the course of treatment.

A trauma-informed approach to understanding firearm decision-making among Black adolescents: Implications for prevention

Firearm violence remains a public health crisis in marginalized, urban communities, with Black adolescents bearing the burden of firearm homicides and injuries. As such, the prevention of firearm violence among adolescents has moved to a high priority of the U.S. public health agenda. The current paper reviews recent literature to highlight the heterogeneity in firearm behavior among Black adolescents and underscore the need for additional research on decision-making and firearm behavior to better understand how adolescents make decisions to acquire, carry, and use firearms. Through a discussion of the disproportionate levels of trauma exposure and trauma symptoms experienced by Black adolescents, the current paper also proposes a trauma-informed approach to understanding decision-making for risky firearm behavior. We discuss the broader impacts of this approach, including the development of a more comprehensive and contextually relevant understanding of the variability in risky firearm behavior and improvements in risk screening capabilities and preventive intervention strategies.

Non-supportive responses to adolescents who have experienced sexual abuse: Relations with self-blame and trauma symptoms

BACKGROUND

Youth who have experienced sexual abuse sometimes also experience non-supportive responses, such as accusations of lying, from people in their family and social environment. Little is known about how such responses from different sources (caregivers, friends, other adults) correlate with one another and operate together in the prediction of youth problematic thinking, such as self-blame, and trauma symptoms.

OBJECTIVE

To better understand how non-supportive responses from different sources relate to one another and contribute to youth problems following sexual abuse.

PARTICIPANTS AND SETTING

Participants were 475 youths (M_age = 13.57, SD = 1.77) brought to a children's advocacy center in the southern United States.

METHODS

Participants completed measures of non-supportive responses from caregivers, friends, and other adults. They also completed measures of abuse-specific self-blame and trauma symptoms.

RESULTS

Non-supportive responses from caregivers, friends, and other adults correlated with each other and with abuse-specific self-blame and trauma symptoms (correlations ranged from 0.12 to 0.18; all p values <.001). Results of regression analyses indicated that only non-supportive responses from caregivers contributed independently to abuse-specific self-blame, whereas non-supportive responses from caregivers and friends contributed to trauma symptoms.

CONCLUSIONS

In the aftermath of sexual abuse, non-supportive responses from caregivers and friends relate to youth trauma symptoms. Assessing non-supportive responses broadly across the social network can be useful in understanding youth adjustment following sexual abuse.

Exposure to IPV among Children in the Child Welfare System and an Emotional-Behavioral Disability: the Role of Maternal Depression and Social Support

This study examines the relationship between children's exposure to IPV and EBD among children involved in the child welfare system for suspected maltreatment (both substantiated and unsubstantiated). It specifically examines how children's trauma symptoms, maternal depression, and maternal social support may impact the relationship between exposure to IPV and EBD. This study uses structural equation modeling with data from the second National Survey of Child and Adolescent Wellbeing to examine the relationship between exposure to IPV and EBD among 989 children (ages 8-17) involved in the child welfare system. Moderated mediation was employed to examine whether children's trauma symptoms mediate the relationship between IPV exposure and EBD and whether differences in maternal depression and social support impact such mediation effect. Child trauma symptoms and maternal social support were significantly related to EBD. The current study highlights the relationship between children's trauma symptoms and EBD among children in the child welfare system. The study also provides preliminary evidence for maternal social support as a protective factor for children developing EBD. Implications of this research include providing interventions as well as increasing maternal social support to potentially reduce the likelihood of children developing EBD.

Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review

In 2019, more than 25.9 million children under 18 were displaced due to unending political conflicts. Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) has a high level of empirical evidence to support its efficacy in processing trauma and behavioral problems in non-refugee children. Yet, little is known about its long-term effectiveness in refugee children. This study conducted a systematic review that assessed the evidence of the effectiveness of TF-CBT in reducing trauma symptoms among refugee children under 18 years of age. A systematic review was conducted from peer-reviewed literature databases (12 databases): PsycINFO, PubMed, Scopus, Google Scholar, ProQuest Dissertations and Theses (PQDT), Cochrane Library, MEDLINE, PROSPERO, EBSCOHost, Campbell Collaboration Library of Systematic Reviews, Social Sciences Index, and grey literature sources published from 1990 to 2019. The search yielded 1650 articles, and 4 peer reviewed studies were identified that met inclusion criteria and yielded a sample size of 64 refugee children from 21 different countries. All 4 studies provided evidence that supported TF-CBT's effectiveness in decreasing trauma symptoms and sustainment during the follow-up assessment among refugee children participants. Despite TF-CBT effectiveness for trauma symptoms treatment, there is still limited evidence to suggest that TF-CBT is effective for all refugee children due to the pilot nature of the studies, and its underutilization in traumatized refugee children from different cultural backgrounds. Future studies should conduct more TF-CBT interventions with diverse refugee children to provide more empirical support for its effectiveness with that population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-021-00370-0.

Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children

BACKGROUND

There is increasing interest in routine screening for Adverse Childhood Experiences (ACEs) to help identify high-risk children who would benefit from interventions. However, there has not yet been sufficient research concerning which particular set of ACEs would be most predictive as a potential screening tool.

OBJECTIVE

This study compared 40 Adverse Childhood Experiences (ACEs), covering 11 different conceptual domains, in their ability to predict trauma symptoms in childhood.

PARTICIPANTS AND SETTING

The current study uses pooled data from three National Surveys of Children's Exposure to Violence (NatSCEV) conducted in 2008, 2011, and 2014. Each survey collected information on children aged one month to 17 years.

METHODS

Samples were obtained from a mix of random digit dialing and address based sampling methods. Telephone interviews were conducted with children 10 years and older and with caregivers, if the randomly selected child was under age 10.

RESULTS AND CONCLUSION

A different set of 15 items best predicted trauma symptoms for younger (2-9-year-old) compared to older (10-17-year-old) youth. Some conventional ACEs, like physical and emotional abuse, proved important for both age groups. However, family-related factors were more predictive for younger children, while community and peer violence exposures were more predictive for older children. Our new proposed measures explained substantially more variance in subsequent trauma symptoms than did the original ACE measure (R² = .31 vs .18 for 2-9 year olds; R² = .43 vs .26 for 10-17 year olds; p < .001 for all) and identified a larger percentage of children with high levels of trauma.

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors

The trauma symptoms of child sexual abuse (CSA) survivors don't end with the abuse, or even with the advent of adulthood. Instead, these symptoms can persist into all the realms of a survivor's life, including education, which sets the foundation for career advancement. This retrospective study of adult survivors of childhood sexual abuse (n=260) examined the relationships between trauma symptoms, dissociation, dissociative amnesia, anxiety, depression, sleep problems and higher education attainment. The purpose of this study was to determine if these factors are associated with higher education completion for childhood sexual abuse (CSA) survivors. Linear regressions and ANOVAs suggest that many of these variables are significantly associated with survivors' educational trajectory, and multiple linear regressions show that trauma symptoms (as measured by the Trauma Symptom Checklist-40), caregivers' education levels, and age at onset of abuse are significant predictors of decreased education levels. This information can provide insight into additional risk and protective factors for CSA survivors in order to enhance acute and long-term management of trauma symptoms to increase levels ofattainment of higher education.

Functional connectivity of hippocampal subregions in PTSD: relations with symptoms

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with abnormal hippocampal activity; however, the functional connectivity (FC) of the hippocampus with other brain regions in PTSD and its relations with symptoms warrants further attention. We investigated subregional hippocampal FC in PTSD during a resting state compared with a trauma-exposed control (TEC) group. Based on extant research, we targeted the FCs of the anterior and posterior hippocampal subregions with the amygdala, medial prefrontal cortex (mPFC), and the posterior cingulate (PCC).

METHODS

Resting-state functional magnetic resonance images were acquired from 11 individuals with PTSD and 13 trauma-exposed controls. Anterior and posterior hippocampal FC was compared between groups. Within the PTSD and TEC groups, subregional hippocampal FC was correlated with scores on the Clinician-Administered PTSD Scale (CAPS) at time of scan and 4 months post-scan.

RESULTS

Those with PTSD had significantly greater FC compared with the TEC group between the left posterior hippocampus and the bilateral PCC (g's > .96). Direct contrasts of the Fisher z-transformed coefficients indicated that the correlations between CAPS scores 4 months post scan and the FC between the left hippocampal head and the right PCC (z = - 2.07, p = .039) as well as the FC between the right hippocampal tail and the right mPFC (z = - 2.19, p = .029) were significantly greater in the PTSD group compared to the TEC group.

CONCLUSIONS

These results support between-group differences in posterior hippocampal FC and different relations with PTSD future symptoms, underscoring associations with the anterior and posterior hippocampus. These findings enrich our understanding of PTSD pathophysiology and provide support for future investigations of imaging biomarkers predictive of disease progression.

Victimization and adversity among children experiencing war-related parental absence or deployment in a nationally representative US sample

This study compares children and youth who have experienced lifetime war-related parental absence or deployment with those having no such history on a variety of victimization types, non-victimization adversity, trauma symptoms, and delinquency; and assesses whether cumulative adversity and victimization help to explain elevated emotional and behavioral problems among children of parents who have experienced war-related absence or deployment. The National Surveys of Children's Exposure to Violence (NatSCEV) are comprised of three cross-sectional telephone surveys conducted in 2008, 2011, and 2014. Data were collected on the experiences of children aged one month to seventeen years. In each survey, interviews were conducted with youth 10-17 years old and with caregivers of children 0-9 years old. The analyses use pooled data from all three U.S. nationally-representative samples (total sample size of 13,052). Lifetime parental war-related absence or deployment was a marker for elevated childhood exposure to a wide array of victimization and adversity types. Cumulative past year exposure to multiple forms of victimization and adversity fully explained elevated trauma symptoms and delinquency in this population of children. Given the breadth of victimization and adversity risk, children with histories of parental war-related absence or deployment, as well as their families, represent important target groups for broad-based prevention and interventions to reduce exposure and ameliorate consequences when it does occur.

Polyvictimization and Youth Violence Exposure Across Contexts

PURPOSE

The current research used latent class analysis to uncover groups of youth with specific victimization profiles and identify factors that are associated with membership in each victimization group.

METHODS

This study used data from National Survey of Children Exposure to Violence II. Random digit dialing and address-based sampling were used to obtain a nationally representative sample of 2,312 youth ages 10-17 years. Phone interviews, averaging 55 minutes in length, were conducted with caregivers to obtain both consent and background information and then with youths themselves.

RESULTS

Six groups of youth emerged: (1) nonvictims (26.4%), (2) home victims (8.4%), (3) school victims (20.8%), (4) home and school victims (21.3%), (5) community victims (5.4%), and (6) polyvictims (17.8%). Polyvictims were likely to have been victimized in multiple settings by multiple perpetrators and experienced the most serious aggravating characteristics, including incidents involving a weapon, injury, or a sexual component. Youth in the polyvictim class experienced the highest number of different victimizations types in the past year and had the most problematic profile in other ways, including greater likelihood of living in disordered communities, high probabilities of engaging in delinquency of all types, elevated lifetime adversity, low levels of family support, and the highest trauma symptom scores.

CONCLUSIONS

The study supports the contention that a core basis of the particularly damaging effects of polyvictimization is the experience of victimization across multiple domains of the child's life.

Polyvictimization and Youth Violence Exposure Across Contexts

PURPOSE

The current research used latent class analysis to uncover groups of youth with specific victimization profiles and identify factors that are associated with membership in each victimization group.

METHODS

This study used data from National Survey of Children Exposure to Violence II. Random digit dialing and address-based sampling were used to obtain a nationally representative sample of 2,312 youth ages 10-17 years. Phone interviews, averaging 55 minutes in length, were conducted with caregivers to obtain both consent and background information and then with youths themselves.

RESULTS

Six groups of youth emerged: (1) nonvictims (26.4%), (2) home victims (8.4%), (3) school victims (20.8%), (4) home and school victims (21.3%), (5) community victims (5.4%), and (6) polyvictims (17.8%). Polyvictims were likely to have been victimized in multiple settings by multiple perpetrators and experienced the most serious aggravating characteristics, including incidents involving a weapon, injury, or a sexual component. Youth in the polyvictim class experienced the highest number of different victimizations types in the past year and had the most problematic profile in other ways, including greater likelihood of living in disordered communities, high probabilities of engaging in delinquency of all types, elevated lifetime adversity, low levels of family support, and the highest trauma symptom scores.

CONCLUSIONS

The study supports the contention that a core basis of the particularly damaging effects of polyvictimization is the experience of victimization across multiple domains of the child's life.

Decrease in Behavioral Problems and Trauma Symptoms Among At-Risk Adopted Children Following Trauma-Informed Parent Training Intervention

Children who have experienced early adversities are at risk for behavioral problems and trauma symptoms. Using a two-group, pre-post intervention design, the current study evaluated the effectiveness of a parent training utilizing Trust-Based Relational Intervention, a trauma-informed, attachment-based intervention, in reducing behavioral problems and trauma symptoms in at-risk adopted children. Children of parents in the treatment group (n = 48) demonstrated significant decreases in behavioral problems on the Strengths and Difficulties Questionnaire and significant decreases in trauma symptoms on the Trauma Symptoms Checklist for Young Children after intervention. Scores for children in a matched-sample control group did not change. Findings suggest that Trust-Based Relational Intervention is effective at addressing many behavioral problems and trauma symptoms in children with histories of adversities.

A cross-sectional study of adolescent non-suicidal self-injury: support for a specific distress-function relationship

BACKGROUND

This study has investigated the specific relationship between childhood adversities, individual trauma symptoms and the functions of non-suicidal self-injury (NSSI). The aim was to examine whether different self-reported adverse experiences and trauma symptoms predict the need to engage in NSSI, either to regulate emotions or to communicate with and influence others.

METHOD

The participants were a community sample of 816 adolescents aged 15-17 years with NSSI. Hierarchical multiple regression was used, controlling for NSSI frequency and gender. The dependent variables were the automatic and social functions of NSSI, respectively. The predictors entered in the model were several different maltreatment and adversity experiences as well as individual trauma symptoms. Mediation analyses were also performed using the bootstrapping method with bias-corrected confidence estimates.

RESULTS

Frequency of NSSI, gender (female), emotional abuse, prolonged illness or handicap during upbringing and symptoms of depression uniquely predicted the automatic functions of NSSI in the final regression model, but not the social functions. Symptoms of anxiety uniquely predicted social but not automatic functions. Having experienced physical abuse, having made a suicide attempt and symptoms of dissociation were significant predictors in both final models. The model for automatic functions explained more of the variance (62%) than the social model (28%). The relationship between childhood emotional, physical and sexual abuse and performing NSSI for automatic reasons was mediated by symptoms of depression and dissociation. The relationship between physical abuse and the social functions of NSSI was mediated by symptoms of anxiety and dissociation.

CONCLUSIONS

It is important to understand the specific context in which NSSI has developed and is maintained. Experiences of emotional abuse and symptoms of depression could guide clinical work in the direction of emotion regulation skills since in this study these variables were uniquely associated with the need to engage in NSSI to regulate emotions, to self-punish or to generate feelings. The presence of physical abuse, a suicide attempt and symptoms of dissociation could alert clinicians to a broad treatment approach since they were associated with performing NSSI to regulate both social and automatic experiences.