Childhood victimization and long-term intellectual and academic outcomes

Altered topological structure of the brain white matter in maltreated children through topological data analysis

Childhood maltreatment may adversely affect brain development and consequently influence behavioral, emotional, and psychological patterns during adulthood. In this study, we propose an analytical pipeline for modeling the altered topological structure of brain white matter in maltreated and typically developing children. We perform topological data analysis (TDA) to assess the alteration in the global topology of the brain white matter structural covariance network among children. We use persistent homology, an algebraic technique in TDA, to analyze topological features in the brain covariance networks constructed from structural magnetic resonance imaging and diffusion tensor imaging. We develop a novel framework for statistical inference based on the Wasserstein distance to assess the significance of the observed topological differences. Using these methods in comparing maltreated children with a typically developing control group, we find that maltreatment may increase homogeneity in white matter structures and thus induce higher correlations in the structural covariance; this is reflected in the topological profile. Our findings strongly suggest that TDA can be a valuable framework to model altered topological structures of the brain. The MATLAB codes and processed data used in this study can be found at https://github.com/laplcebeltrami/maltreated.

Association of childhood trauma with cognitive domains in adult patients with mental disorders and in non-clinical populations: a systematic review

Although the association between cognitive performances and the onset of psychiatric disorders has been widely investigated, limited research on the role of childhood trauma or early life stress (CT/ELS), and whether this role differs between clinical and non-clinical cohorts is available. This systematic review aims at filling this gap, testing whether the occurrence of CT/ELS and its subtypes are associated with cognitive domains (general cognitive ability, executive functions, working memory, attention, processing speed, verbal/visual memory) in patients with psychiatric disorders and in non-clinical populations. This study followed the PRISMA 2020 guidelines and the Newcastle-Ottawa scale for quality assessment. The search was performed until May 2022. Seventy-four studies were classified as eligible. The graphical representations of the results reported an association between exposure to CT/ELS and worse general cognitive ability, verbal/visual memory, processing speed and attention in patients affected by anxiety, mood and psychotic disorders, and that specific CT/ELS subtypes (physical neglect, physical/sexual abuse) can differentially influence specific cognitive abilities (executive functions, attention, working memory, verbal/visual memory). In non-clinical cohorts we found associations between CT/ELS exposure and impairments in executive functions, processing speed and working memory, while physical neglect was related to general cognitive ability and working memory. Concerning the emotional abuse/neglect subtypes in both populations, the results indicated their involvement in cognitive functioning; however, the few studies conducted are not enough to reach definitive conclusions. These findings suggest an association of CT/ELS with specific cognitive deficits and psychopathology.

Adversity, Engagement, and Later Achievement: The Role of Emotion Regulation and Parent-Child Relationship Quality

Background

Students who have experienced adversity tend to demonstrate poorer academic outcomes than their non-maltreated peers. Academic engagement, a multidimensional, motivational construct, associated with a myriad of positive academic outcomes is an important academically-related mechanism that can be leveraged to improve the outcomes of this population.

Objective

The present study aimed to better understanding of how engagement develops in the context of adversity by exploring the effects emotion regulation skills and parent-child relationships have on engagement development.

Participants and setting

Analyses were conducted on 795 participants in the NSCAW dataset.

Methods

Path analysis was used to estimate mediation and moderated mediation models.

Results

Emotion regulation skills significantly mediated the effect experiencing trauma symptoms had on engagement. Parent-child relationship quality moderated the mediation effect emotion regulation skills had on the relationship between experiencing trauma symptoms and engagement.

Conclusions

Emotion regulation skills and parent-child relationship quality are potential intervention targets to improve engagement for students who have experienced adversity.

Association of early life stress and cognitive performance in patients with schizophrenia and healthy controls

As core symptoms of schizophrenia, cognitive deficits contribute substantially to poor outcomes. Early life stress (ELS) can negatively affect cognition in patients with schizophrenia and healthy controls, but the exact nature of the mediating factors is unclear. Therefore, we investigated how ELS, education, and symptom burden are related to cognitive performance. The sample comprised 215 patients with schizophrenia (age, 42.9 ± 12.0 years; 66.0 % male) and 197 healthy controls (age, 38.5 ± 16.4 years; 39.3 % male) from the PsyCourse Study. ELS was assessed with the Childhood Trauma Screener (CTS). We used analyses of covariance and correlation analyses to investigate the association of total ELS load and ELS subtypes with cognitive performance. ELS was reported by 52.1 % of patients and 24.9 % of controls. Independent of ELS, cognitive performance on neuropsychological tests was lower in patients than controls (p < 0.001). ELS load was more closely associated with neurocognitive deficits (cognitive composite score) in controls (r = -0.305, p < 0.001) than in patients (r = -0.163, p = 0.033). Moreover, the higher the ELS load, the more cognitive deficits were found in controls (r = -0.200, p = 0.006), while in patients, this correlation was not significant after adjusting for PANSS. ELS load was more strongly associated with cognitive deficits in healthy controls than in patients. In patients, disease-related positive and negative symptoms may mask the effects of ELS-related cognitive deficits. ELS subtypes were associated with impairments in various cognitive domains. Cognitive deficits appear to be mediated through higher symptom burden and lower educational level.

State-level education policies: Opportunities for secondary prevention of child maltreatment

BACKGROUND

Exposure to child maltreatment creates risk for adverse social, health, and economic outcomes across generations. The socioecological model posits the well-being of individuals, including children and youth, is shaped by the larger systems they exist in. Employing state-level policies to position school settings to effectively identify and intervene in instances of child maltreatment is an important secondary prevention opportunity.

OBJECTIVE

This study examines the relationship between state-level policies that call for school based trainings to promote the recognition of and response to child maltreatment, and states' annual rates of substantiated child maltreatment reports.

METHODS

Relevant policies were identified and abstracted to generate measures of policy presence and comprehensiveness. The National Child Abuse and Neglect Data System was used to derive rates of substantiated child maltreatment reports by state and year. Child maltreatment rates were the dependent variable and policy measures were the primary explanatory variables in a difference-in-differences (DD) model series with state-level clustering and year-fixed effects.

RESULTS

The DD model series suggest significant, positive relationships between the presence of policies calling for school-based recognition and response training and child abuse (IRR 1.140, p = 0.04) as well as child physical abuse outcomes (IRR 1.150, p = 0.05). Sensitivity analyses suggest the relationships between policy presence and abuse outcomes were stronger for children than for adolescents.

CONCLUSION

These findings suggest that related policies may be effective secondary prevention tools for child maltreatment.

An Exploratory Investigation of Childhood Sexual Abuse and Other Theory-Driven Predictors of Sex Work Among Women with and without Childhood ADHD

Limited research has identified prospective risk factors for young-adult sex work or examined overlapping predictors concurrently. We investigated childhood sexual abuse (CSA), along with other theory-driven predictors of sex work, among a well-characterized sample of girls with and without childhood diagnoses of attention/deficit-hyperactivity disorder (ADHD).

METHODS

Participants were a racially and socioeconomically diverse sample of 140 girls with rigorously diagnosed ADHD (47 Inattentive [ADHD-I], 93 Combined [ADHD-C]), and 88 age- and ethnicity-matched comparison girls, all followed longitudinally into adulthood. Self-report data on young-adult occupations revealed a subsample of 7 participants reporting engagement in "sex work" or "prostitution." Logistic regressions tested whether CSA, measured both dichotomously and by discrete age ranges, predicted later sex work, accounting for other risk factors.

RESULTS

A lifetime history of CSA was positively associated with sex work in initial analyses (β = 1.51, p = .045), but not after adjusting for additional risk factors. When examined by age ranges, only CSA occurring between ages 9-15 significantly predicted sex work (β = 2.84, p = .043), even after adjusting for additional risk factors. Childhood ADHD-C also emerged as a significant predictor (β = 4.94, p = .015). ADHD-related medication and years of education were protective factors only when CSA was considered dichotomously.

CONCLUSIONS

Findings from this exploratory study underscore the need for longitudinal research that (a) considers the developmental timing of CSA and (b) accounts for impulsivity and inattention as risk factors for sex work among young-adult women. Implications for clinical practice are briefly discussed.

Childhood maltreatment and cognitive functioning in middle adulthood

BACKGROUND

Childhood maltreatment (physical abuse, sexual abuse, and/or neglect) is associated with cognitive deficits in adulthood. Little is known about how childhood maltreatment affects the trajectory of cognitive functioning during early to middle adulthood.

OBJECTIVE

To explore the relationship between childhood maltreatment and change in cognitive functioning over a 10-year period in adulthood.

METHODS

Utilizing a prospective cohort design, a large group of court-substantiated cases of childhood maltreatment (ages 0-11) and demographically matched controls were followed into adulthood (N = 1196). Verbal intelligence and reading ability were assessed at age 29, and executive functioning was assessed at age 41. Linear, mixed-effects modeling was used to evaluate childhood maltreatment as a predictor of cognitive functioning and change in cognitive functioning over time.

RESULTS

Childhood maltreatment was associated with lower cognitive functioning at age 29 compared to controls (β = -0.28, p < .001), and this association was stronger for childhood neglect (β = -0.33, p < .001). Controls declined in cognitive functioning over the 10-year period (β = -0.12, p = .039), whereas childhood maltreatment overall was associated with no change. Adults with histories of neglect demonstrated an increase in cognitive functioning (β = 0.13, p = .021).

CONCLUSIONS

Our results demonstrate that childhood maltreatment is associated with cognitive functioning deficits in adulthood and suggest that cognitive change in adulthood may be differentially impacted by type of maltreatment. The initial deficit demonstrated by adults with childhood neglect was largely erased by a subsequent increase in cognitive functioning over 10 years.

The outcome of children placed in a welfare center or foster care before the age of 4: Prognostic factors

BACKGROUND

In child and adolescent psychiatry, many patients are placed in welfare institutions or foster care.

OBJECTIVE

It is important to study their progress in the long term and to examine the psychological and social care arrangements as well as their impacts.

POPULATION AND METHODS

This qualitative study designed to identify potential prognostic factors relating to the outcome of children placed in a welfare center or foster care before the age of 4 years was based on the analysis of 34 case histories of children placed in a welfare center or foster care in Angers. These records involved 129 cases collected for the "Saint Ex" study, a quantitative case study conducted from 1994 to 2001 designed to assess the outcome of children placed in a welfare center or foster care in Angers before the age of 4. The population sampling was purposive and was based on eight subgroups defined by three clinical criteria: Parent-Infant Relationship Global Scale assessment (PIR-GAS) at T1 (admission into welfare center or foster care), the status of a "infant at risk" at T1, and GAF (Global Assessment of Functioning) at T2 (exit from the welfare center or foster care).

RESULTS

The study population included 11 girls and 23 boys. Factors contributing to adverse progression included problems with interactions at a very early age, failure to listen or respond to a child's request regarding his or her placement, long delays between establishing facts and implementing social measures, discontinuity and/or inconsistency regarding the placement arrangements, and sexual abuse. On the other hand, factors contributing to positive progress included the diagnosis and adapted treatment of a mental disorder in the case of one or both parents, early placement in a foster family, considering the child's requests regarding the placement, responsiveness of social services, and psychological or psychiatric follow-up.

CONCLUSION

The analysis of these 34 cases sheds light on several prognostic elements, with the combination of all these factors as the background. Care based on prevention seems essential to protect early interactions and shorten the time that children are exposed to danger.

Longitudinal Association Between Child Psychological Abuse and Neglect and Academic Achievement in Chinese Primary School Children: A Moderated Mediation Model

To investigate the relationships among child psychological abuse and neglect (CPAN), children’s learning engagement, family socioeconomic status (family SES), and children’s academic achievement, 271 children (M_age = 9.41 ± 0.81 years old) and their parents participated in this study with a longitudinal design. Results revealed that learning engagement at T1 mediated the relationship between CPAN at T1 and academic achievement at T2 when gender, age, grade, and academic achievement at T1 were under control. Family SES at T1 moderated the relationship between children’s learning engagement at T1 and academic achievement at T2. The association between learning engagement and academic achievement was stronger among children from lower family SES. Our findings highlighted the negative impact of CPAN and the critical role of learning engagement in children’s academic achievement, especially for those from low SES families.

Electrophysiological Changes Related to Childhood Trauma in Patients with Major Depressive Disorder: An Event-related Potential Study

Objective

Methods

Results

Conclusion

An Examination of Downward Drift as an Explanation of the Relationship Between Childhood Maltreatment and Residence in Unhealthy Neighborhoods in Adulthood: The Role of Psychiatric Symptoms

This study sought to determine whether downward drift explains relationships among childhood maltreatment, psychiatric disorders, and residence in unhealthy neighborhoods. Using data from a prospective cohort design study, individuals with court substantiated cases of child abuse and/neglect (ages 0-11 during the years 1967-1971) and matched controls were followed up in adulthood. Mental health symptoms and neighborhood disadvantage were measured in young (M_age  = 29) and middle adulthood (M_age  = 40). Physical disorder and social cohesion were also measured in middle adulthood. Childhood maltreatment increased risk for more symptoms of depression, anxiety, and illicit drug use in young adulthood and depression and anxiety in middle adulthood. Childhood maltreatment negatively impacted neighborhood residence in young and middle adulthood, increasing a person's risk of living in neighborhoods with higher levels of physical disorder and economic disadvantage, and lower levels of social cohesion. Neighborhood disadvantage in young adulthood did not increase risk for psychiatric symptoms in middle adulthood. With one exception, neighborhood disadvantage earlier in life, not psychiatric symptoms, helped explain the relationship between childhood maltreatment and living in unhealthy neighborhoods. The negative impact of childhood maltreatment was evident earlier in life and continued into middle adulthood.

Child maltreatment and cognitive and academic functioning in two generations

BACKGROUND

Childhood maltreatment has been associated with deficits in cognitive functioning and poor academic performance. Not known is whether these characteristics are the direct consequence of the childhood maltreatment (that is, maltreatment plays a causal role) or whether other factors explain the relationship.

OBJECTIVES

To examine whether childhood maltreatment predicts cognitive and academic functioning and whether these relationships are explained by other factors (parent cognitive and academic functioning, family social class, or parent maltreatment).

PARTICIPANTS

Data are from a longitudinal study of previously maltreated children, matched controls, and a subset of their offspring (697 parent-offspring dyads) interviewed in 2009-2010.

METHOD

Cognitive and academic functioning were assessed in both parents and offspring with the same measures. Maltreatment was determined through official records. Hierarchical linear regressions were conducted to examine predictors of offspring cognitive and academic functioning.

RESULTS

Childhood maltreatment was associated with poorer cognitive functioning and worse academic performance in both generations. Controlling for age, sex, race, and whether the parent had more than one child in the study, offspring maltreatment predicted offspring cognitive functioning when it was the only predictor in the model. In a final model with all variables, only parent cognitive functioning predicted offspring cognitive functioning and parent academic functioning and parent history of maltreatment predicted offspring academic functioning.

CONCLUSION

These results challenge assumptions that childhood maltreatment directly causes deficits in cognitive and academic functioning. Policy makers and practitioners may need to rethink the design of interventions to improve the cognitive and academic functioning of maltreated children.

Patterning of individual variability in neurocognitive health among South African women exposed to childhood maltreatment

There are individual differences in health outcomes following exposure to childhood maltreatment, yet constant individual variance is often assumed in analyses. Among 286 Black, South African women, the association between childhood maltreatment and neurocognitive health, defined here as neurocognitive performance (NP), was first estimated assuming constant variance. Then, without assuming constant variance, we applied Goldstein's method (Encyclopedia of statistics in behavioral science, Wiley, 2005) to model "complex level-1 variation" in NP as a function of childhood maltreatment. Mean performance in some tests of information processing speed (Digit-symbol, Stroop Word, and Stroop Color) lowered with increasing severity of childhood maltreatment, without evidence of significant individual variation. Conversely, we found significant individual variation by severity of childhood maltreatment in tests of information processing speed (Trail Making Test) and executive function (Color Trails 2 and Stroop Color-Word), in the absence of mean differences. Exploratory results suggest that the presence of individual-level heterogeneity in neurocognitive performance among women exposed to childhood maltreatment warrants further exploration. The methods presented here may be used in a person-centered framework to better understand vulnerability to the toxic neurocognitive effects of childhood maltreatment at the individual level, ultimately informing personalized prevention and treatment.

Social determinants of health, personalized medicine, and child maltreatment

This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social determinants of health. Research on epigenetics related to child abuse and neglect is presented, followed by that pertaining to a few specific social factors, such as poverty, parental depression and substance use, and domestic (or intimate partner) violence. The review ends with a discussion of interventions to help address social determinants of health with brief descriptions of several model programs, and thoughts concerning the role of personalized medicine in addressing child maltreatment in the foreseeable future. IMPACT: This paper synthesizes knowledge on social determinants of health and advances in genetics and genomics related to the prevention of child maltreatment. It provides examples of model approaches to addressing the prevention of child maltreatment in primary care practices.

Childhood maltreatment and lead levels in middle adulthood: A prospective examination of the roles of individual socio-economic and neighborhood characteristics

BACKGROUND

Lead is a common environmental hazard because of its past use as an additive to gasoline and household paint. Some evidence suggests that children with histories of child abuse and neglect are at elevated risk for residence in communities and households with less desirable characteristics and high levels of exposure to environmental hazards and toxins.

OBJECTIVES

To understand whether childhood maltreatment leads to higher levels of household dust lead and blood lead in adulthood and the extent to which characteristics of a person's physical environment or individual level socio-economic status (SES) (based on unemployment, poverty, and receipt of public assistance) contribute to understanding the relationship.

METHODS

A large prospective cohort design study in which abused and neglected children (ages 0-11) were matched with non-maltreated children and assessed in adulthood. Objective and subjective neighborhood characteristics were assessed at approximate age 40 and household dust lead (cleaned and less often cleaned) and blood lead levels were measured at age 41. Blood was collected through venipuncture by a registered nurse as part of a medical status exam.

RESULTS

Childhood maltreatment predicted higher levels of dust lead in less often cleaned household places, residence in worse neighborhoods defined by objective (census tract data) and subjective (reports of physical disorder and lack of social cohesion and control), and higher levels of poverty, receiving public assistance, and unemployment. Only objective neighborhood characteristics mediated the relationship between childhood maltreatment and dust lead level in adulthood. There were also significant paths from objective neighborhood disadvantage and individual level SES to higher levels of blood lead.

DISCUSSION

Thirty years after their childhood experiences, individuals with documented histories of childhood maltreatment are at higher risk for living in environments as adults with elevated lead levels that may impact other aspects of their lives and compromise their health.

The role of psychiatric symptoms and environmental vulnerability factors in explaining the relationship between child maltreatment and suicidality: A prospective investigation

BACKGROUND

Childhood maltreatment has been associated with suicide thoughts and attempts; however, few longitudinal studies have assessed risk of suicidality into adulthood. Fewer have examined potential mediators (psychiatric symptoms and environmental vulnerability factors).

METHODS

Prospective cohort design. Children with documented cases of maltreatment (N = 495, ages 0-11) were matched with non-maltreated children (N = 395) and followed up into adulthood. Psychiatric symptoms (depression, anxiety, dysthymia, post-traumatic stress,antisocial personality,and substance use) and environmental vulnerability (social isolation, physical disability/illness, and homelessness) were assessed at mean age 29 and suicide thoughts and attempts at 39. Structural equation models tested for mediation, controlling for age, sex, race, and IQ.

RESULTS

Childhood maltreatment predicted suicide attempts (Beta = 0.44, p<0.001), but not suicide thoughts only.Individuals with only suicide thoughts differed significantly from those with suicide attempts in psychiatric symptoms, physical disability/ illness, and homelessness. There were significant paths from child maltreatment to suicide attempts through psychiatric symptoms (0.18, p<0.001), ASPD (0.13, p<0.001), substance use (0.07, p<0.01), and homelessness (0.10, p<0.05).

LIMITATIONS

Court cases of child maltreatment may not generalize to middle- or upper- class and non-reported cases.Effect sizes were small but significant.

CONCLUSIONS

Psychiatric risk factors for suicide are well recognized. These new results provide strong evidence that environmental vulnerability factors, particularly homelessness, are associated with increased risk for suicide attempts and warrant attention.Although many people report suicide thoughts, maltreated children with more psychiatric symptoms and experience homelessness are more likely to attempt suicide and warrant targeted interventions.

Accessing Alternative Response Payways: A Multi-Level Examination of Family and Community Factors on Race Equity

BACKGROUND

Although research has identified factors associated with child welfare involvement, less attention has been paid to how Black families are assigned to types of child welfare responses. The advent of alternative response pathways allows child protection workers to assign child abuse and neglect responses to families based on the type and seriousness of the maltreatment, history of prior reports and age of the child.

OBJECTIVE

The effects of family and community characteristics on alternative response pathways are examined by exploring decision-making at two points in the child welfare system: access to an alternative response child welfare system and assignment to either an investigative or alternative response pathway.

PARTICIPANTS AND SETTING

Black and White families reported for child abuse and neglect (N = 31,802) in New York State were studied.

METHODS

Using data from the National Child Abuse and Neglect Data System matched with New York State county socioeconomic indicators, logistic and multi-level analyses examined the effect of county-level variables on family characteristics.

RESULTS

The analysis determined that Black children and families were not assigned to alternative response pathways similarly to White families especially in counties where indication rates were higher.

CONCLUSION

Findings imply that Black families involved in the child welfare system may benefit from increased access to culturally responsive interventions that target neighborhoods with high indication rates.

Kindeswohlgefährdung – Ausweitung des Hellfeldes durch Neukonzeption der klinischen Kinderschutzarbeit

Hintergrund

Das Erkennen von Kindesmisshandlungen und der Umgang damit sind Herausforderungen im ärztlichen Alltag. Die Dunkelziffer bei Misshandlungen und Vernachlässigungen ist hoch.

Ziel der Arbeit

Das Ziel der Arbeit war, die Effektivität des neu strukturierten Kinderschutzprogrammes einer großen deutschen Kinderklinik zu untersuchen und durch die Präsentation der Vorteile der neuen Struktur die Verbesserung von Programmen für Kinder und Mediziner in anderen Kliniken anzuregen.

Methode

Es wurden retrospektiv alle Kinderschutzfälle im Altonaer Kinderkrankenhaus vor und nach Neukonzeption der Kinderschutzarbeit über einen Zeitraum von jeweils 2 Jahren untersucht und miteinander verglichen. Die Kinderschutzgruppe war neu strukturiert worden und wurde nachfolgend von einer hauptamtlichen Kinderschutzkoordinatorin geleitet.

Ergebnis

Die Prävalenz der Verdachtsfälle und der erhärteten Fälle von Kindeswohlgefährdung ist im Untersuchungszeitraum nach Neukonzeption hoch signifikant erhöht. Im Zeitraum vor der Neukonzeption wurden 24 Fälle mit dem Verdacht auf Kindswohlgefährdung untersucht, 23 erhärtet, danach 124 Fälle untersucht, 89 erhärtet. Eine Stigmatisierung der Familien bei der Abklärung wurde trotz des signifikanten Anstiegs falsch-positiver Verdachtsfälle durch sensibles Vorgehen und eine Konfrontation erst bei Erhärtung des Verdachtes vermieden.

Schlussfolgerung

Das vorgestellte Konzept zum medizinischen Kinderschutz in Kinderkliniken scheint das Hellfeld bei Kindeswohlgefährdung effektiv auszuweiten. Sowohl die Reduktion nichtdetektierter Fälle mit der Verhinderung potenzieller Eskalation mit prolongiertem Leidensweg als auch die Verminderung der immensen gesellschaftlichen Folgekosten rechtfertigen die personellen Investitionen.

Protocol for comparing two training approaches for primary care professionals implementing the Safe Environment for Every Kid (SEEK) model

BACKGROUND

Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents; promote children's health, development, and safety; help prevent CM; and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK's adoption, implementation, and sustainment, and its effectiveness in preventing CM.Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology-driven implementation strategies to scale-up SEEK-in pediatric and family medicine primary care settings. The aims are to (1) evaluate the effectiveness of training strategies on SEEK's implementation in primary care practices, (2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK, and (3) examine the model's effectiveness in preventing CM and the economic costs of implementing SEEK.

METHODS

This randomized type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK's adoption and implementation in pediatric and family medicine practices in different regions of the USA. These are independent online training and in-depth structured training via a quality improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a "Traditional" paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews, and data abstracted from electronic health records.

DISCUSSION

The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science and guide future interventions in primary care.

TRIAL REGISTRATION

NCT03642327, Clinical Trials, registered August 21, 2018.

Development and validation of a retrospective self-report measure of childhood neglect

BACKGROUND

Several measures are available to assess childhood physical and sexual abuse, but few measures focus specifically on neglect and little psychometric research on measures exists. This paper aims to fill a gap in the field by describing a new instrument to measure childhood neglect retrospectively and providing information about construct, predictive, and discriminant validity using adults with documented histories of childhood neglect.

METHODS

Data are from a large prospective, longitudinal study of abused and neglected children and matched controls followed up and assessed in adulthood. The current sample (N =717) includes 370 individuals with histories of childhood neglect and 347 demographically matched controls without those histories. Self-reports of childhood neglect were collected in in-person interviews at approximate age 40. Participants responded to a pool of items representing neglect. Missing responses were treated as substantive information in analyses. An optimal set of items was selected using Support Vector Machine (SVM) - a machine leaning algorithm. Neglect severity, diversity and SVM-based propensity scores were tested for predictive, construct and discriminant validity.

RESULTS

The optimal item subset included 10 items. The propensity scale measured with this optimal subset passed all validity tests, showing high predictive validity for neglect, discrimination between documented cases of neglect and abuse, and significant correlation with violence in adulthood (construct validity). The simple severity and diversity scores failed in at least one of the validity tests.

CONCLUSIONS

This new instrument shows promise in detecting experiences of childhood neglect retrospectively. Missing responses were found informative in recollections of childhood neglect.

A mother-child intervention program for adolescent mothers: Results from a randomized controlled trial (the TeeMo study)

Children of adolescent mothers are a high-risk group for negative child development. Previous findings suggest that early interventions may enhance child development by improving mother-child interaction. The purpose of the current study was to evaluate a mother-child intervention (STEEP-b) program in high-risk adolescent mother-infant dyads (N = 56) within a randomized controlled trial (RCT). Mother-child interaction was assessed at baseline (T1), postintervention (T2), and follow-up (T3). The primary outcome was the change in maternal sensitivity and child responsiveness from T1 to T2 that was measured by blinded ratings of videotaped mother-child-interaction with the Emotional Availability Scales. A modified intention-to-treat analysis was performed to examine the data. No intervention effect was found for maternal sensitivity, 95% CI [-0.59-0.60], p = .99, and child responsiveness, 95% CI [-0.51-0.62], p = .84. Maternal sensitivity and child responsiveness did not change over time in both groups (all ps > .05). A statistically nonsignificant, but potentially clinically meaningful difference emerged between rates of serious adverse events, SC: 4 (14.8%), STEEP-b: 1 (3.4%), possibly driven by different intensity of surveillance of dyads in the treatment groups. The current findings question the effectiveness of STEEP-b for high-risk adolescent mothers and do not justify the broad implementation of this approach.

The neurophysiological embedding of child maltreatment

Maltreatment adversely impacts the development of children across a host of domains. One way in which maltreatment may exert its deleterious effects is by becoming embedded in the activity of neurophysiological systems that regulate metabolic function. This paper reviews the literature regarding the association between childhood maltreatment and the activity of three systems: the parasympathetic nervous system, the sympathetic nervous system, and the hypothalamic-pituitary-adrenal axis. A particular emphasis is placed on the extent to which the literature supports a common account of activity across these systems under conditions of homeostasis and stress. The paper concludes with an outline of directions for future research and the implications of the literature for policy and practice.

The neurocognitive profiles of children adopted from care and their emotional and behavioral problems at home and school

Adoptees' mental health problems in childhood and later life are well described, but little attention has been paid to domestically adopted children's emotional and behavioral problems and neurocognitive profiles. The aim of this study was to describe the neurocognitive profiles of domestically adopted children in the UK and their parent- and teacher-rated emotional and behavioral problems. Forty-five children (M age = 75.96 months, SD = 12.98; 51.1% female) who were placed for adoption from public care at a M age of 22.14 months (SD = 14.21) completed a battery of age standardized neurocognitive tests, and adoptive parents and school teachers rated their emotional and behavioral problems. Children had more emotional and behavioral problems than the general population and over a fifth scored low (> 1 SD below the expected range for their age) in 5/6 neurocognitive tasks. Children who scored low on the non-verbal reasoning task were more likely to have more parent- and teacher-rated behavioral problems, and children's performance on the inhibitory control and cognitive flexibility tasks were associated with parent-rated behavioral problems. Children's verbal reasoning scores were positively associated with both parent- and teacher-rated emotional problems. Children who were adopted later in childhood scored significantly lower in non-verbal reasoning. Although longitudinal studies are needed to clarify the nature of neurocognitive functioning as a marker for later mental health problems, our findings underscore the importance of using comprehensive assessments to better recognize adopted children's difficulties and inform appropriate intervention initiatives.

Maternal Alcohol-Use Disorder and Child Outcomes

OBJECTIVES

Investigate the relationship between maternal alcohol-use disorder and multiple biological and social child outcomes, including birth outcomes, child protection, justice contact, and academic outcomes for both Indigenous and non-Indigenous children.

METHODS

Women with a birth recorded on the Western Australian Midwives Notification System (1983-2007) and their offspring were in scope. The exposed cohort were mothers with an alcohol-related diagnosis (International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision) recorded in an administrative data set and their offspring (non-Indigenous: n = 13 969; Indigenous: n = 9635). The exposed cohort was frequency matched with mothers with no record of an alcohol-related diagnosis and their offspring (comparison cohort; non-Indigenous: n = 40 302; Indigenous: n = 20 533).

RESULTS

Over half of exposed non-Indigenous children (55%) and 84% of exposed Indigenous children experienced ≥1 negative outcome. The likelihood of any negative outcome was significantly higher for the exposed than the comparison cohort (non-Indigenous: odds ratio [OR] = 2.67 [95% confidence interval (CI) = 2.56-2.78]; Indigenous: OR = 2.67 [95% CI = 2.50-2.85]). The odds were greatest for children whose mothers received a diagnosis during pregnancy (non-Indigenous: OR = 4.65 [95% CI = 3.87-5.59]; Indigenous: OR = 5.18 [95% CI = 4.10-6.55]); however, numbers were small.

CONCLUSIONS

The effects of maternal alcohol-use disorder are experienced by the majority of exposed children rather than a vulnerable subgroup of this population. These findings highlight the need for universal prevention strategies to reduce harmful alcohol use and targeted interventions to support at-risk women and children.

Childhood Trauma Is Nominally Associated With Elevated Cortisol Metabolism in Severe Mental Disorder

OBJECTIVE

Individuals exposed to childhood trauma display longstanding modifications of the Hypothalamic-Pituitary-Adrenal (HPA) axis, as well as cognitive impairments. Schizophrenia spectrum disorder (SZ) and bipolar disorders (BD) are characterised by higher prevalence of childhood trauma, abnormal HPA axis, and cognitive dysfunction. Elevated cortisol metabolism was recently demonstrated in both disorders. However, it is yet to be established if childhood adversity is associated with cortisol metabolism in this population, and how this may be associated with cognitive function.

METHODS

One-hundred-and-fourteen participants with a DSM-IV SZ or BD diagnosis took part in the study. Diagnoses were evaluated by the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Estimated cortisol metabolizing activity (5α-reductase and 5β-reductase) was assessed by urinary free cortisol, and metabolites. All patients underwent cognitive assessment and completed the Childhood Trauma Questionnaire.

RESULTS

Estimated 5β-reductase activity was elevated in participant with childhood physical abuse (r = 0.26, p = 0.005). After adjusting for age, sex and diagnosis, physical abuse was still nominally associated with elevated 5β-reductase. Moreover, only high 5α-reductase activity was negatively correlated with working memory and executive performance (r = -0.23, p = 0.01; r = -0.19, p = 0.05, respectively), however this disappeared after adjusting for age, sex and diagnosis. Cortisol metabolism did not mediate the association between childhood trauma and cognitive function.

CONCLUSIONS

Our study indicates that childhood physical abuse is associated with elevated cortisol metabolism (5β-reductase) in adults with a SZ or BD disorder. However, our study did not support cortisol metabolism as a mediator between childhood trauma experiences and cognitive function within these disorders.

A Pilot Study of Neurocognitive Function and Brain Structures in Adolescents With Alcohol Use Disorders: Does Maltreatment History Matter?

Neurocognitive and brain structural differences are associated with adolescent onset alcohol use disorders (AUDs). Maltreatment histories may contribute to current results. To examine these issues, healthy adolescents (n = 31), adolescents without maltreatment and AUD (AUD - MAL, n = 28), and adolescents with AUDs with maltreatment (AUD + MAL, n = 17) underwent comprehensive neurocognitive assessments and MRI structural scans. Controls performed significantly better than the two AUD groups in math and language. The AUD + MAL group performed significantly lower in sustained attention compared to the AUD - MAL and control groups and lower in reading compared to controls. The AUD + MAL group had larger left pars triangularis, a region of the inferior frontal gyrus, compared to the AUD-MAL and control groups, and smaller anterior corpus callosum volumes versus the AUD - MAL group. There were no group differences in other prefrontal cortex, amygdala, hippocampus, and parahippocampal volumes. The AUD + MAL group showed an inverse correlation between hippocampal volumes and age. AUD variables were associated with lower performance in fine-motor and executive function. Cannabis use variables were associated with lower performance in fine-motor, language, visual-spatial, memory, and executive function. Parahippocampal volumes positively correlated with abstinence. The preliminary results suggest adolescent AUD studies should consider examinations of maltreatment history, comorbid substance use disorders, and recovery during abstinence in their analyses.

Current evidence of childhood traumatic experiences in psychosis - focus on gender differences

Childhood abuse is common among people with psychosis and it is associated with poor illness outcomes. Some forms of childhood abuse are more common in women, but the impact of gender and childhood abuse in psychosis has been little investigated and evidence has never been put into a congruent frame. Herein, we conducted a narrative review to assess the impact of gender and childhood abuse in psychosis. Research articles were identified (n = 44) using a comprehensive electronic search of PubMed, Web-of-Science, Scopus and Cochrane databases. Women appeared to be at greater risk of sexual abuse than men. Women with childhood abuse report more positive and mood symptoms, and more suicide attempts compared to men. In addition, women exposed to childhood abuse display an earlier age of onset compared to not exposed, but this association is not present in men. Conversely, men with childhood abuse show more negative symptoms, substance use and a poorer cognitive performance compared to women. It seems therefore confirmed that gender and childhood abuse may impact on the outcome of psychosis, since not all gender differences found in patients who had been abused in their childhood are accounted by the overall differences between men and women with psychosis.

Sexual minority status and child maltreatment: How do health outcomes among sexual minority young adults differ due to child maltreatment exposure?

BACKGROUND

Although prior studies indicate heightened health and well-being concerns for sexual minority (SM) youth, as well as for youth exposed to child maltreatment in the general population, it is unclear whether there are differences in these outcomes among SM youth that have and have not experienced maltreatment.

OBJECTIVE

Our aim was to investigate the unique associations between child maltreatment and emerging health outcomes beyond the impact of SM status. Data was drawn from a nationally representative sample of 648 SM youth in the U.S. in grades 7-12 during the 1994-1995 school year.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, descriptive statistics and ordinary least squares regression models were used to investigate differences in SM young adult outcomes by experiences of child maltreatment.

RESULTS

Maltreatment among SM individuals showed strong associations with poor adult mental health outcomes (e.g. depression, anxiety, isolation, and suicidal ideation) and fairly strong negative associations with general health outcomes (e.g., heart and lung problems) when compared to their non-maltreated peers. Associations with maltreatment and behavioral health and socioeconomic outcomes were not as strong for this population, which suggests the effects of maltreatment for SM youth are most salient in regards to mental and physical health.

CONCLUSIONS

Findings provide insight into what areas of health and well-being should be focused on when working with SM youth that have been maltreated, and offer evidence to encourage further exploration of the outcomes of SM maltreated individuals in young adulthood.

Severe childhood trauma and clinical and neurocognitive features in schizotypal personality disorder

OBJECTIVE

Literature suggests that childhood trauma increases vulnerability for schizophrenia-spectrum disorders, including schizotypal personality disorder (SPD). Yet, it remains unexplored whether childhood trauma predicts symptom load and the level of neurocognitive functioning in SPD.

METHOD

We included 225 individuals with SPD and 127 healthy controls. Childhood trauma was evaluated using the Childhood Trauma Questionnaire, and schizotypal traits were assessed using the Schizotypal Personality Questionnaire. Standard neurocognitive assessments covered six cognitive domains.

RESULTS

All types of reported childhood trauma were significantly associated with SPD, in a linear fashion. Severe sexual abuse showed the greatest magnitude of association with higher cognitive-perceptual load (e.g., ideas of reference, odd belief or magical thinking); severe emotional neglect was associated with interpersonal scores (e.g., excessive social anxiety, constricted affect) within the SPD group. SPD individuals who reported severe trauma showed worse cognitive functioning (i.e., working memory, verbal/visual learning and memory, as well as verbal fluency).

CONCLUSIONS

Particular severe childhood trauma types were associated with higher cognitive-perceptual and interpersonal symptoms in SPD, along with worse cognitive functioning. These findings highlight the need for clinicians to enquire about childhood trauma in SPD patients, since unaddressed early adverse experiences may carry long-term negative consequences.

The reproduction of child maltreatment: An examination of adolescent problem behavior, substance use, and precocious transitions in the link between victimization and perpetration

Growing evidence suggests that maltreatment is reproduced across generations as victims of maltreatment are at an increased risk for maltreatment perpetration. Unfortunately, little information about mediating pathways exists to provide an explanation for why maltreatment begets maltreatment. We use the number of types of maltreatment experienced to predict later maltreatment perpetration and then examine two developmental pathways that may serve as bridges between maltreatment victimization and perpetration: adolescent problem behaviors and precocious transitions to adulthood. With prospective, longitudinal data from the Rochester Youth Development Study, we assess the relevance of these pathways for the number of maltreatment experiences as well as the number of maltreatment victimization experiences by developmental period (i.e., childhood and adolescence). Our results demonstrate a significant relationship between maltreatment victimization and maltreatment perpetration. Adolescent delinquency and two precocious transitions, dropping out of school and independent living, as well as the accumulation of precocious transitions and problem behaviors, serve as mediators of this intergenerational relationship. Furthermore, the relationship between the number of types of maltreatment and subsequent perpetration is primarily driven by experiences of maltreatment during adolescence. We discuss the implications of these results and set an agenda for the development of programs and policies to interrupt the cycle of maltreatment.

The Childhood Maltreatment Modulates the Impact of Negative Emotional Stimuli on Conflict Resolution

It has been reported that negative emotional stimuli could facilitate conflict resolution. However, it remains unclear about whether and how the impact of negative emotional stimuli on conflict resolution varies depending on childhood maltreatment. To clarify this issue, seventy-nine subjects were required to perform an arrow Eriksen Flanker Task which was presented in the center of emotional pictures. The present study found a significant interaction effect of childhood maltreatment and emotion on executive attention scores in reaction times (RTs) that reflect conflict resolution speed. For subjects in high childhood maltreatment, negative pictures elicited smaller executive attention scores in RTs than neutral and positive pictures, while neutral and positive pictures elicited similar executive attention scores in RTs. By contrast, for subjects in low childhood maltreatment, executive attention scores in RTs were similar across three conditions. These results suggest that the speed of conflict resolution is enhanced in high, instead of low, childhood maltreatment in situations of negative stimuli. This finding extends our understanding of the interaction among emotion, childhood maltreatment and conflict resolution.

Ongoing Pediatric Health Care for the Child Who Has Been Maltreated

Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician's role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences.

Childhood trauma interacts with ApoE to influence neurocognitive function in women living with HIV

HIV-associated neurocognitive disorder (HAND) describes a spectrum of behavioural, motor and cognitive disturbances that can occur secondary to HIV infection. Less severe forms of the disorder persist despite advances in antiretroviral medication efficacy and availability. Childhood trauma (CT) may predispose individuals to developing HAND. As genetic variation in human apolipoprotein E (ApoE) has been implicated in cognitive decline and may mediate the development of long-term health outcomes following CT, we investigated the influence of ApoE and CT on cognitive function in the context of HIV. One hundred twenty-eight HIV-positive Xhosa women completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF) as well as the HIV Neurobehavioural Research Center neurocognitive test battery. rs7412 and rs429358 were genotyped using KASP assays, and this data was used to determine the ApoE isoform. Baseline differences in demographic and clinical variables according to CT exposure were calculated. Analysis of covariance was used to assess the contributions of CT and ApoE variants, as well as their interaction, to cognitive function. Eighty-eight participants reported experiencing CT. The rs7412 C allele protected against the harmful effect of CT on motor scores using an additive model. The interaction of ApoE ε4 and CT was associated with worse attention/working memory scores. ApoE ε4, alone and in combination with CT, is associated with poorer cognitive function. Further research into this gene-environment interaction may assist in identifying at-risk individuals for targeted interventions.

Cognitive and educational outcomes of maltreated and non-maltreated youth: A birth cohort study

OBJECTIVES

Previous research suggests that child maltreatment is associated with adverse outcomes, but the potential impact on cognitive and educational outcomes into adulthood has rarely been studied using a birth cohort design. The aim of this study is to investigate whether child maltreatment is associated with adverse outcomes in cognitive function, high school completion and employment by the age of 21.

METHODS

Longitudinal birth cohort study commencing in the prenatal period, with mothers and infants followed up to age 21. Of the original birth cohort of 7223, 3778 (52.3%) young people participated at age 21. Child maltreatment was identified by linkage with prospectively collected data from the relevant government agency. Associations between child maltreatment (abuse and neglect) and the outcomes were adjusted for relevant sociodemographic and perinatal variables.

RESULTS

After full adjustment, young people who had been notified as cases of child maltreatment had reduced performance on the Peabody Picture Vocabulary Test by over a quarter of a standard deviation (coefficient = -2.85, p = 0.004). Maltreated young people also had three times the odds of failing to complete high school (odds ratio = 3.12, p < 0.001) and more than twice the odds of not being engaged in either study or employment at age 21 (odds ratio = 2.38, p < 0.001). Both abuse and neglect were similarly associated with adverse outcomes.

CONCLUSION

Child maltreatment, including both abuse and neglect, is associated with adverse cognitive, educational and employment outcomes in young adulthood. This adds further impetus to efforts to prevent child maltreatment and assist young people who have experienced it.

Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study

BACKGROUND

We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood.

METHODS

Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria.

RESULTS

There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age.

LIMITATIONS

Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years.

CONCLUSIONS

Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations.

Higher Levels of Intelligence and Executive Functioning Protect Maltreated Children Against Adult Arrests: A Prospective Study

Research shows that maltreated children are at elevated risk of arrest as adults and that higher verbal intelligence, reading ability, and executive functioning (abstract reasoning and cognitive flexibility) may be protective against criminal behavior. The current study examines this hypothesis using data from court-substantiated cases of child abuse and neglect and demographically matched controls followed prospectively into middle adulthood ( N = 1,196). At age 29, verbal intelligence was assessed with the Quick Test and reading ability with the Wide Range Achievement Test-Revised. At age 41, abstract reasoning was assessed with the Matrix Reasoning Test and cognitive flexibility with the Trail Making Test-B. Arrest records were gathered from law enforcement agencies through mean age 51. Data were analyzed with binomial logistic regressions. The results indicated that maltreated children were at increased risk of arrest for nonviolent and violent crime. Higher verbal intelligence, reading ability, nonverbal reasoning, and cognitive flexibility were protective against arrest for violent crime. The protective effects of neuropsychological functions were more pronounced for violent than nonviolent crime, for the control than maltreated children, and differed by gender and race. These results suggest that interventions targeting improved cognitive and neuropsychological functions may serve an important role in reducing risk of crime.

The effects of childhood maltreatment and anxiety proneness on neuropsychological test performance in non-clinical older adolescents

BACKGROUND

The effect of childhood maltreatment (CM) on neuropsychological performance is well established, but the effect of anxiety proneness (AP) on such performance has been underexplored. We assessed the predictive ability of CM and AP, and their interaction, in non-clinical adolescents, for a range of previously documented neuropsychological deficits.

METHODS

Multiple linear regression models were used to assess the unique and combined influences of CM and AP on neuropsychological performance in 104 non-clinical adolescents, who underwent both neuropsychiatric and neuropsychological assessment.

RESULTS

The interaction of CM and AP was associated with poorer performance in executive functioning skills, processing speed, and estimated IQ. CM and AP were uniquely associated with verbal working memory performance, while verbal and visual memory performance and learning, and visuo-spatial ability, were not associated with either CM, AP or the interaction of CM and AP.

LIMITATIONS

The use of self-report measures to determine participants' levels of CM, AP, and depression. The CTQ-SF, a retrospective self-report measure, may have introduced recall bias. The neuropsychological evaluation was not conducted in the Xhosa language, the first language of most African participants. Most instruments utilized have not been validated in a South African adolescent sample. The impact of important moderator variables (e.g., age of onset of maltreatment) was not assessed.

CONCLUSIONS

Increased levels of CM and AP may be risk markers for poor performance in several key neuropsychological domains. Our findings underscore the importance of assessing the impact of both CM and anxiety-related temperamental traits on neuropsychological performance.

Mediating effect of emotional/behavioral problems and academic competence between parental abuse/neglect and school adjustment

The current study examined the mediating effects of emotional/behavioral problems and academic competence between parental abuse/neglect and a child's school adjustment by investigating 2070 student surveys from the Korean Child Youth Panel Study (KCYPS). A path analysis yielded the following key findings. Firstly, childhood abuse and neglect showed a significant negative and direct effect on school adjustment. It is particularly important to note that the effect of neglect was bigger than that of abuse in this study. Secondly, emotional/behavioral problems were found to partially mediate between abuse/neglect and school adjustment. Thirdly, academic competence partially mediated the effect of neglect on school adjustment, while it did not mediate the effect of abuse on school adjustment. The indirect effect of parental neglect via emotional/behavioral problems and academic competence was stronger than that of parental abuse. The influence of parental abuse and neglect on children's school adjustments was discussed in terms of emotional/behavioral problems and academic competence considering unique Korean cultural context.

Childhood adversity and cognitive function in schizophrenia spectrum disorders and healthy controls: evidence for an association between neglect and social cognition

BACKGROUND

Childhood adversity is associated with cognitive impairments in schizophrenia. However, findings to date are inconsistent and little is known about the relationship between social cognition and childhood trauma. We investigated the relationship between childhood abuse and neglect and cognitive function in patients with a first-episode of schizophrenia or schizophreniform disorder (n = 56) and matched healthy controls (n = 52). To the best of our knowledge, this is the first study assessing this relationship in patients and controls exposed to similarly high levels of trauma.

METHODS

Pearson correlational coefficients were used to assess correlations between Childhood Trauma Questionnaire abuse and neglect scores and cognition. For the MCCB domains displaying significant (p < 0.05) correlations, within group hierarchical linear regression, was done to assess whether abuse and neglect were significant predictors of cognition after controlling for the effect of education.

RESULTS

Patients and controls reported similarly high levels of abuse and neglect. Cognitive performance was poorer for patients compared with controls for all cognitive domains except working memory and social cognition. After controlling for education, exposure to childhood neglect remained a significant predictor of impairment in social cognition in both patients and controls. Neglect was also a significant predictor of poorer verbal learning in patients and of attention/vigilance in controls. However, childhood abuse did not significantly predict cognitive impairments in either patients or controls.

CONCLUSION

These findings are cross sectional and do not infer causality. Nonetheless, they indicate that associations between one type of childhood adversity (i.e. neglect) and social cognition are present and are not illness-specific.

Longitudinal association of child maltreatment and cognitive functioning: Implications for child development

Although research investigating associations among child maltreatment, cognitive functioning, and academic achievement has grown in recent years, important questions remain. In particular, assessing the influence of maltreatment apart from that of other co-occurring and confounding factors remains difficult. This study was developed to further the field's understanding by investigating cognitive functioning in association with time-variant maltreatment patterns. Using multiple time-variant linear mixed models, we investigated the relationships between maltreatment timing and three domains of cognitive functioning (i.e., knowledge, comprehension, and analysis). In general, the cognitive functioning of students who experienced maltreatment was lower than that of their peers who had yet to experience maltreatment at the time of testing. Results of LMM indicated that the cognitive functioning of students who experienced maltreatment concurrent with the testing year fluctuated over time whereas the cognitive functioning of students who experienced maltreatment prior to or after the testing year remained stable. Students who experienced concurrent maltreatment showed the lowest functioning of any group. While maltreatment timing was a significant predictor of cognitive functioning over time, the addition of poverty into the model resulted in a non-significant effect of maltreatment timing. Additional research is needed to disentangle the longitudinal effect of maltreatment on cognitive functioning and address the interacting role of poverty and chronic maltreatment.

A Bibliometric Analysis of the Global Research Trend in Child Maltreatment

Child maltreatment remains a major health threat globally that requires the understanding of socioeconomic and cultural contexts to craft effective interventions. However, little is known about research agendas globally and the development of knowledge-producing networks in this field of study. This study aims to explore the bibliometric overview on child maltreatment publications to understand their growth from 1916 to 2018. Data from the Web of Science Core Collection were collected in May 2018. Only research articles and reviews written in the English language were included, with no restrictions by publication date. We analyzed publication years, number of papers, journals, authors, keywords and countries, and presented the countries collaboration and co-occurrence keywords analysis. From 1916 to 2018, 47,090 papers (53.0% in 2010⁻2018) were published in 9442 journals. Child Abuse &amp; Neglect (2576 papers; 5.5%); Children and Youth Services Review (1130 papers; 2.4%) and Pediatrics (793 papers, 1.7%) published the most papers. The most common research areas were Psychology (16,049 papers, 34.1%), Family Studies (8225 papers, 17.5%), and Social Work (7367 papers, 15.6%). Among 192 countries with research publications, the most prolific countries were the United States (26,367 papers), England (4676 papers), Canada (3282 papers) and Australia (2664 papers). We identified 17 authors who had more than 60 scientific items. The most cited papers (with at least 600 citations) were published in 29 journals, headed by the Journal of the American Medical Association (JAMA) (7 papers) and the Lancet (5 papers). This overview of global research in child maltreatment indicated an increasing trend in this topic, with the world&rsquo;s leading centers located in the Western countries led by the United States. We called for interdisciplinary research approaches to evaluating and intervening on child maltreatment, with a focus on low-middle income countries (LMICs) settings and specific contexts.

Altered cortical functional network during behavioral inhibition in individuals with childhood trauma

Individuals who have prior history of childhood traumatic experiences are at a high risk for a variety of psychological and behavioral problems throughout their lifetime. This study aimed to investigate whether such individuals exhibit altered cortical functional networks during a behavioral inhibition task. One hundred fifty-three non-clinical individuals were recruited and instructed to perform a Go/NoGo task during an electroencephalograph. Source-level weighted functional networks based on the graph theory were analyzed for NoGo-P3 processing. Based on their total scores on the childhood trauma questionnaire (CTQ) participants were divided into three groups: low CTQ, middle CTQ, and high CTQ. Results at the global level indicated decreased strength, clustering coefficient, and efficiency for the low and gamma bands in the high CTQ group. In addition, the path length of the low beta band was observed to be longer in the high CTQ group than the low CTQ group. At the nodal level, the nodal clustering coefficient of high CTQ group was decreased in left primary somatosensory cortex and middle occipital gyrus for the low beta band, and in left superior temporal gyrus for the gamma band. The nodal clustering coefficient of the left primary somatosensory cortex showed a significant negative correlation with the total CTQ score for the low beta band. In addition, the nodal clustering coefficient of the left middle occipital gyrus for the low beta band and superior temporal gyrus for the gamma band showed significant negative correlations with the emotional neglect score. Our results demonstrate an altered cortical functional network in individuals who experienced childhood trauma. In particular, the left primary somatosensory cortex, middle occipital gyrus, and superior temporal gyrus were found to be vulnerable in individuals who experienced childhood trauma, especially emotional neglect.

Targeted Estimation of the Relationship Between Childhood Adversity and Fluid Intelligence in a US Population Sample of Adolescents

Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001-2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13-18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.

Relationship between executive function, attachment style, and psychotic like experiences in typically developing youth

Psychotic like experiences (PLE's) are common in the general population, particularly during adolescence, which has generated interest in how PLE's emerge, and the extent to which they reflect either risk for, or resilience to, psychosis. The "attachment-developmental-cognitive" (ADC) model is one effort to model the effect of risk factors on PLEs. The ADC model proposes attachment insecurity as an early environmental insult that can contribute to altered neurodevelopment, increasing the likelihood of PLE's and psychosis. In particular, early-life attachment disruptions may negatively impact numerous aspects of executive function (EF), including behavioral inhibition and emotion regulation. Yet despite the relationship of disrupted attachment to EF impairments, no studies have examined how these factors may combine to contribute to PLE's in adolescents. Here, we examined the relative contributions of daily-life EF and attachment difficulties (avoidance and anxiety) to PLEs in typically developing youth (N=52; ages 10-21). We found that EF deficits and high attachment insecurity both accounted for a significant proportion of the variance in PLE's, and interacted to predict PLE manifestation. Specifically, positive PLEs were predicted by greater trouble monitoring behavioral impact, less difficulty completing tasks, greater difficulty regulating emotional reactions, greater difficulty controlling impulses and higher attachment anxiety. Negative PLEs were predicted by greater difficulty in alternating attention, transitioning across situations, and regulating emotional reactions as well as higher attachment anxiety. These results are consistent with the ADC model, providing evidence that early-life attachment disruptions may impact behavioral regulation and emotional control, which together may contribute to PLEs.

Educational attainment for youth who were maltreated in adolescence: Investigating the influence of maltreatment type and foster care placement

Decades of research have consistently shown a link between foster care and low rates of high school completion. Despite the overwhelming knowledge surrounding this association, it remains unclear whether the low rates of high school completion are due to placement in foster care or the maltreatment and other contextual factors that foster care youth have experienced. This study examined the extent to which (a) maltreatment type and (b) foster care placement were associated with the educational attainment of 337 maltreated adolescents. Logistic regression analyses were conducted using two waves of data and the ACR dataset of the National Survey of Child and Adolescent Well-Being (NSCAW). After controlling for academic risk factors related to the adolescents (age, race, and gender), their family (household poverty and parental education), and their environment (community environment), neither maltreatment type nor foster care placement status were associated with subsequent high school completion. Overall, only 58% of the maltreated adolescents reported completing their education. That is about 15% less than the national average at the time data were collected for this study. Results, overall, suggest a need for educational supports and interventions for youth who experience maltreatment during their adolescent years, regardless of maltreatment type and foster care placement.

Brain structural covariance network centrality in maltreated youth with PTSD and in maltreated youth resilient to PTSD

Child maltreatment is a major cause of pediatric posttraumatic stress disorder (PTSD). Previous studies have not investigated potential differences in network architecture in maltreated youth with PTSD and those resilient to PTSD. High-resolution magnetic resonance imaging brain scans at 3 T were completed in maltreated youth with PTSD (n = 31), without PTSD (n = 32), and nonmaltreated controls (n = 57). Structural covariance network architecture was derived from between-subject intraregional correlations in measures of cortical thickness in 148 cortical regions (nodes). Interregional positive partial correlations controlling for demographic variables were assessed, and those correlations that exceeded specified thresholds constituted connections in cortical brain networks. Four measures of network centrality characterized topology, and the importance of cortical regions (nodes) within the network architecture were calculated for each group. Permutation testing and principle component analysis method were employed to calculate between-group differences. Principle component analysis is a methodological improvement to methods used in previous brain structural covariance network studies. Differences in centrality were observed between groups. Larger centrality was found in maltreated youth with PTSD in the right posterior cingulate cortex; smaller centrality was detected in the right inferior frontal cortex compared to youth resilient to PTSD and controls, demonstrating network characteristics unique to pediatric maltreatment-related PTSD. Larger centrality was detected in right frontal pole in maltreated youth resilient to PTSD compared to youth with PTSD and controls, demonstrating structural covariance network differences in youth resilience to PTSD following maltreatment. Smaller centrality was found in the left posterior cingulate cortex and in the right inferior frontal cortex in maltreated youth compared to controls, demonstrating attributes of structural covariance network topology that is unique to experiencing maltreatment. This work is the first to identify cortical thickness-based structural covariance network differences between maltreated youth with and without PTSD. We demonstrated network differences in both networks unique to maltreated youth with PTSD and those resilient to PTSD. The networks identified are important for the successful attainment of age-appropriate social cognition, attention, emotional processing, and inhibitory control. Our findings in maltreated youth with PTSD versus those without PTSD suggest vulnerability mechanisms for developing PTSD.

Medical and Legal Aspects of Child Sexual Abuse: A Population-Based Study in a Hungarian County

Background: Very few studies focus on childhood sexual abuse in middle European countries. Aim: The purpose of our study is to describe the medical and legal characteristics of children who experience sexual abuse and explore common features that may result in strategies for prevention. Methods: Between 2000 and 2015, 400 girls and 26 boys under the age of 18, suspected of being sexually abused, visited one of the four hospitals in a Hungarian county. Results: Mean age at onset was 10.81 years for boys, 13.46 years for girls. In 278 cases (65.3%), the perpetrator was known to the victim, and a stranger was suspected in 148 cases (34.7%). In 79 cases (30.7% of boys and 17.7% of girls), a family member was the accused perpetrator. In more than one-third (boys) and in one-fifth (girls) of cases, sexual abuse had occurred on multiple occasions. In the case of boys, child and adolescent sexual abuse (CSA) included oral genital, genital touching and genital to genital contact in 14 cases (53.8%) and anal intercourse in 12 (46.2%) cases. In case of girls, sexual abuse included coitus in 219 (54.8%), oral genital, genital touching, genital to genital contact in 164 (41.0%), anal abuse in 14 (3.5%) cases, physical injury was incurred in 15 cases. Legal proceedings followed the CSA in 205 (48.1%) cases. Conclusion: The results highlight the urgent need to address the issue of sexual abuse in Hungary and minimize its impact. Prevention requires a systematic and lifelong approach to educating children about personal space safety and privacy to reduce vulnerability and is the responsibility of parents and professionals.

Dimensions of physical punishment and their associations with children's cognitive performance and school adjustment

This study examined how a range of physical punishment measures, ranging from mild corporal punishment to physical abuse, are associated with cognitive performance, school engagement, and peer isolation over a 3- year span among 658 children initially observed between the ages of 8 and 14. Physical punishment was captured in three groups: mild corporal punishment, harsh corporal punishment, and physical abuse, and both caregiver- and child-reported punishment measures were considered. After accounting for socioeconomic and demographic characteristics, only Ninitial exposure to physical abuse was significantly associated with declines in cognitive performance. However, all forms of physical punishment were associated with declines in school engagement, and harsh corporal punishment was associated with increased peer isolation. Our findings were relatively consistent regardless of whether physical punishment was reported by the child or caregiver. Overall, our findings suggest that the prevention of physical abuse may enhance children's cognitive performance, but that alone may not be sufficient to ensure children are engaged and well-adjusted in school.