Translating the neuroscience of adverse childhood experiences to inform policy and foster population-level resilience

A Functional Magnetic Resonance Imaging Meta-Analysis of Childhood Trauma

BACKGROUND

Traumatic experiences during childhood significantly impact the developing brain and contribute to the development of numerous physical and mental health problems. To date, however, a comprehensive understanding of the functional impairments within the brain associated with childhood trauma histories does not exist. Previous functional magnetic resonance imaging (fMRI) meta-analytical tools required homogeneity of task types and the clinical populations studied, thus preventing the comprehensive pooling of brain-based deficits present in children who have trauma histories. We hypothesized that the use of the novel, data-driven Bayesian author-topic model approach to fMRI meta-analyses would reveal deficits in brain networks that span fMRI task types in children with trauma histories.

METHODS

To our knowledge, this is the first study to use the Bayesian author-topic model approach to fMRI meta-analyses within a clinical population. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we present data-driven results obtained by combining activation patterns across heterogeneous tasks from 1428 initially screened studies and combining data from 14 studies that met study criteria (285 children with trauma histories, 297 healthy control children).

RESULTS

Altered brain activity was revealed within 2 clusters in children with trauma histories compared to control children: the default mode/affective network/posterior insula and the central executive network. Our identified clusters were associated with tasks pertaining to cognitive processing, emotional/social stress, self-referential thought, memory, unexpected stimuli, and avoidance behaviors in youths who have experienced childhood trauma.

CONCLUSIONS

Our results reveal disturbances in children with trauma histories within the modulation of the default mode and central executive networks-but not the salience network-regardless of whether children also presented with posttraumatic stress symptoms.

Program evaluation of a school-based mental health and wellness curriculum featuring yoga and mindfulness

BACKGROUND

Interest in the effectiveness of mindfulness-based interventions such as yoga in primary schools has grown. Evidence shows promise, as youth who engage in yoga to promote mindfulness show improved coping skills, increased socio-emotional competence and prosocial skills, academic performance, attention span, and ability to deal with stress.

OBJECTIVE

This study reports the results of a program evaluation of a universal health and wellness curriculum, Pure Power, designed to teach youth yoga techniques, mindfulness, and emotion regulation.

METHODS

A non-randomized comparison design examined outcomes among participants from schools that completed the intervention with highest fidelity of implementation (n = 461) and from students in matched comparison schools (n = 420). Standard measures of coping, emotion regulation and emotion dysregulation, spelling, and math achievement were collected.

RESULTS

Analyses suggest the youth in the intervention schools demonstrated relative improvement on measures of emotion regulation, spelling, and math.

CONCLUSIONS

Challenges in implementation in real-life settings are vital to identify. The data provide some real-world evidence for the effectiveness of a universal health and wellness curriculum on emotion regulation and positive academic outcomes. Training school staff to deliver the intervention may foster implementation. Future research should test the effectiveness of who delivers the intervention; for example, teacher-delivered groups vs. other wellness personnel.

Patient journey of civilian adults diagnosed with posttraumatic stress disorder-A chart review study

OBJECTIVE

To assess the journey of individuals from experiencing a traumatic event through onset of symptoms, diagnosis, and treatment of posttraumatic stress disorder (PTSD).

METHODS

Patient- and psychiatrist-level data was collected (02/2022-05/2022) from psychiatrists who treated ≥1 civilian adult diagnosed with PTSD. Eligible charts covered civilian adults diagnosed with PTSD (2016-2020), receiving ≥1 PTSD-related treatment (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], atypical antipsychotics [AAs]), and having ≥1 medical visit in the last 12 months. Collected information included clinical and treatment characteristics surrounding the PTSD diagnosis.

RESULTS

A total of 273 psychiatrists contributed data on 687 patients with PTSD (average age 36.1; 60.4% female). On average, the traumatic event and symptom onset occurred 8.7 years and 6.5 years prior to PTSD diagnosis, respectively. In the 6 months before diagnosis, 88.9% of patients had received a PTSD-related treatment. At time of diagnosis, 87.8% of patients had intrusion symptoms and 78.9% had alterations in cognition/mood; 41.2% had depressive disorder and 38.7% had anxiety. Diagnosis prompted treatment changes for 79.3% of patients, receiving treatment within 1.9 months on average, often with a first-line SSRI as either monotherapy (52.8%) or combination (24.9%). At the end of the 24-month study period, 34.4% of patients achieved psychiatrist-recorded remission. A total of 23.0% of psychiatrists expressed dissatisfaction with approved PTSD treatments, with 88.3% at least somewhat likely to prescribe AAs despite lack of FDA approval.

CONCLUSION

PTSD presents heterogeneously, with an extensive journey from trauma to diagnosis with low remission rates and limited treatment options.

A Developmental Psychopathology Perspective on Adverse Childhood Experiences (ACEs): Introduction to the Special Issue

Adverse childhood experiences (ACEs), including child maltreatment and other adversities in the home context and beyond (e.g., witnessing domestic violence; parental mental illness; parental separation; living in a disadvantaged neighborhood) are prevalent in the population and often covary together. Research based on the construct of ACEs has transformed the field of adult mental health, yet child and adolescent mental health has often been overlooked in this work. This special issue of Research on Child and Adolescent Psychopathology focuses on the developmental science of ACEs and child psychopathology. The research presented here draws on the extensive evidence base that now exists regarding the co-occurrence of common childhood adversities, while informing the integration of theory and research on ACEs with that of developmental psychopathology at large. This Introduction provides an overview of ACEs and child mental health from a developmental psychopathology perspective, with an emphasis on key concepts and recent progress spanning the prenatal period through to adolescence and intergenerational pathways. Models of ACEs that emphasize the multi-dimensional nature of adversity and the importance of developmental timing to risk and protective pathways, have played a driving role in this progress. Methodological innovations in this work are highlighted, along with implications for prevention and intervention.

Using energy psychology to remediate emotional wounds rooted in childhood trauma: preliminary clinical guidelines

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood, such as violence, abuse, severe neglect, or mental health problems in caregivers. The negative physical and mental health consequences of severe or multiple ACEs provide a major challenge for the health care community. Psychotherapies that utilize a mind-body approach in treating ACE-related conditions are seen by their proponents as having advantages for bringing healing and restoration compared with talk, introspective, interpersonal, and exposure therapies that do not intervene at the body level, as famously encapsulated by Bessel van der Kolk's observation that "the body keeps the score." A mind-body approach whose use has been rapidly increasing in clinical settings as well as on a self-help basis is called "energy psychology." Energy psychology combines conventional therapeutic techniques such as cognitive restructuring and psychological exposure with the stimulation of acupuncture points (acupoints) by tapping on them. A review of the development, efficacy, and plausible mechanisms of energy psychology is presented, and several strengths are enumerated, such as how integrating acupoint tapping into conventional exposure methods enhances the speed and power of outcomes. The impact of energy psychology protocols on the three brain networks most centrally involved with ACEs is also examined. Finally, recommendations are offered for using an energy psychology approach at each stage of therapy with individuals who have endured severe or multiple ACES, from establishing a therapeutic alliance to assessment to treatment to follow-up.

Toward a Developmental Model of Continuity and Change in PTSD Symptoms following Exposure to Traumatic and Adverse Experiences

A developmental understanding of the expression of posttraumatic stress (PTS) symptoms following trauma in childhood requires identifying continuity and change in not just overall symptoms but in the individual symptoms as well. Such models of change also require understanding multiple dimensions of time. That is, longitudinal change-the passage of time-may have different effects on symptom expression depending on when in time an individual entered the study - such as what age they were when first assessed. This paper addresses these ideas with an overview of the developmental differences in the assessment of PTS from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), longitudinal research on posttraumatic stress disorder (PTSD) symptoms, and providing synthesis within a symptom network perspective. We then provide an illustration of how individual PTSD symptoms change over time at different ages (elementary versus middle school) with a secondary analysis of data from a previously reported study (n = 191 youth, aged 8-15, assessed at two time points six months apart). The reanalysis of the data suggests both continuity and change in symptoms over time (i.e., some symptoms were more stable than other symptoms) with differences in symptom rates and their longitudinal change as a function of age (i.e., some symptoms more common or more stable in younger versus older or older versus younger). We close with avenues for future research aimed at better understanding symptom cascades over time and at different ages and potential implications for future iterations of assessment/classification systems.

The Efficacy of Two Group Interventions on Mental Representations, Attachment Security, and Trauma Symptoms in Ethnically and Socioeconomically Minoritized Young Adolescents in an Urban Middle School

Symptoms resulting from childhood trauma can negatively impact socioemotional well-being and school performance during early adolescence unless positive changes in attachment security and mental representations of significant relationships occur. A sample of 109 eighth grade urban students were randomly assigned to one of two weekly, one-hour, school-based group interventions-Storytelling/Story-Acting for Adolescents (STSA-A) or Mentalization-Based Treatment Group Intervention (MBT-G). The Object Relations Inventory (ORI), Adolescent Attachment Questionnaire (AAQ) and Child PSTD Stress Scale (CPSS) were administered to students and their primary group leaders at the beginning (October) and end (May) of the intervention protocol as outcome variables. Participants in both the STSA-A and MBT-G intervention conditions experienced significant increases in attachment security and decreases in trauma symptoms. Over the course of eight months of group intervention, affective valence of paternal mental representations significantly decreased for boys and for participants in the STSA-A condition, while affective valence of primary group leader mental representations significantly decreased for participants in the MBT-G condition. STSA-A and MBT-G were found to be efficacious at improving attachment security and reducing trauma symptoms in young adolescents. The strengths of each group intervention for addressing interpersonal issues unique to specific types of adolescents are discussed.

The Restorative Integral Support (RIS) Model: Community-Based Integration of Trauma-Informed Approaches to Advance Equity and Resilience for Boys and Men of Color

Mental health and health promotion research and practice have consistently revealed the social and structural inequities that boys and men of color (BMoC) face. Moreover, scholarship highlights the importance of gender, especially the concepts of masculinity and manhood, in understanding inequities that are experienced. Providers and community leaders are finding culturally relevant ways to foster healing and restoration while addressing racial trauma and the adverse community environments tied to adverse childhood experiences (ACEs). This article introduces the restorative integral support (RIS) model to promote connectivity through networks and to acknowledge the contextual differences BMoC experience when suffering from trauma and adversities. RIS is a framework used to address adversities and trauma while increasing societal awareness and advancing equity. This community-based, multidimensional approach is offered to enhance individual, agency, community, and policymaking leadership, raising awareness of mental health concerns and trauma while offering a flexible guide to developing safe spaces and support for recovery from ACEs and trauma. This article offers an in-depth appreciation of the real-life contexts within which BMoC overcome histories of adversity and trauma, demonstrating how the RIS model is applied to advance structural transformation while fostering community resilience.

Towards assessing subcortical "deep brain" biomarkers of PTSD with functional near-infrared spectroscopy

Assessment of brain function with functional near-infrared spectroscopy (fNIRS) is limited to the outer regions of the cortex. Previously, we demonstrated the feasibility of inferring activity in subcortical "deep brain" regions using cortical functional magnetic resonance imaging (fMRI) and fNIRS activity in healthy adults. Access to subcortical regions subserving emotion and arousal using affordable and portable fNIRS is likely to be transformative for clinical diagnostic and treatment planning. Here, we validate the feasibility of inferring activity in subcortical regions that are central to the pathophysiology of posttraumatic stress disorder (PTSD; i.e. amygdala and hippocampus) using cortical fMRI and simulated fNIRS activity in a sample of adolescents diagnosed with PTSD (N = 20, mean age = 15.3 ± 1.9 years) and age-matched healthy controls (N = 20, mean age = 14.5 ± 2.0 years) as they performed a facial expression task. We tested different prediction models, including linear regression, a multilayer perceptron neural network, and a k-nearest neighbors model. Inference of subcortical fMRI activity with cortical fMRI showed high prediction performance for the amygdala (r > 0.91) and hippocampus (r > 0.95) in both groups. Using fNIRS simulated data, relatively high prediction performance for deep brain regions was maintained in healthy controls (r > 0.79), as well as in youths with PTSD (r > 0.75). The linear regression and neural network models provided the best predictions.

Childhood Bereavement, Adverse and Positive Childhood Experiences, and Flourishing among Chinese Young Adults

Childhood bereavement (CB) resulting from a parent or primary caregiver death is associated with a range of adverse outcomes. Little is known about the association between CB and adult flourishing in the context of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs). In a cross-sectional observational study, we examined how ACEs, PCEs, and adult flourishing differs by self-reported CB history among 9468 Chinese young adults (18-35 years), of which 4.3% experienced CB (n = 409). Data collection included convenience sampling among university students in Mainland China. Respondents voluntarily completed an online survey between August and November 2020. Descriptive statistics, chi-square tests, and logistic regressions examined frequencies and differences in ACEs, PCEs, and flourishing by the history of CB controlling for a few demographic covariates. Bereaved individuals reported significantly higher ACEs and lower PCEs. The odds of experiencing emotional, physical, and sexual abuse as well as household substance abuse, parental mental illness, and parental incarceration ranged from 2.0-5.2 times higher for bereaved individuals. Bereaved participants also reported significant negative relationships with Flourishing Index (β = -0.35, t = -4.19, p < 0.001) and Secure Flourishing Index (β = -0.40, t = -4.96, p < 0.001). Consistent with previous research, our findings demonstrate the lasting effects of CB on well-being. We discuss study implications for ACEs and PCEs screening and surveillance as well as grief counseling to promote flourishing among bereaved youth in China and beyond.

Child Maltreatment and Long-Term Physical and Mental Health Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention

Child maltreatment rates remain unacceptably high and rates are likely to escalate as COVID-related economic problems continue. A comprehensive and evidence-building approach is needed to prevent, detect and intervene where child maltreatment occurs. This review identifies key challenges in definitions, overviews the latest data on prevalence rates, reviews risk and protective factors, and examines common long-term mental health outcomes for children who experience maltreatment. The review takes a systems approach to child maltreatment outcomes through its focus on the overall burden of disease, gene-environment interactions, neurobiological mechanisms and social ecologies linking maltreatment to mental ill-health. Five recommendations relating to the accurate measurement of trends, research on brain structures and processes, improving the reach and impact of teleservices for detecting, preventing and treating child maladjustment, community-based approaches, and building population-focused multidisciplinary alliances and think tanks are presented.

Roper and Race: the Nature and Effects of Death Penalty Exclusions for Juveniles and the “Late Adolescent Class”

In Roper v. Simmons (2005), the US Supreme Court raised the minimum age at which someone could be subjected to capital punishment, ruling that no one under the age of 18 at the time of their crime could be sentenced to death. The present article discusses the legal context and rationale by which the Court established the current age-based limit on death penalty eligibility as well as the scientific basis for a recent American Psychological Association Resolution that recommended extending that limit to include members of the “late adolescent class” (i.e., persons from 18 to 20 years old). In addition, we present new data that address the little-discussed but important racial/ethnic implications of these age-based limits to capital punishment, both for the already established Roper exclusion and the APA-proposed exclusion for the late adolescent class. In fact, a much higher percentage of persons in the late adolescent class who were sentenced to death in the post-Roper era were non-White, suggesting that their age-based exclusion would help to remedy this problematic pattern.

Cortical activation predicts posttraumatic improvement in youth treated with TF-CBT or CCT

BACKGROUND

Identifying neural activation patterns that predict youths' treatment response may aid in the development of imaging-based assessment of emotion dysregulation following trauma and foster tailored intervention. Changes in cortical hemodynamic activity measured with functional near-infrared spectroscopy (fNIRS) may provide a time and cost-effective option for such work. We examined youths' PTSD symptom change following treatment and tested if previously identified activation patterns would predict treatment response.

METHODS

Youth (N = 73, mean age = 12.97, SD = 3.09 years) were randomly assigned to trauma-focused cognitive behavioral therapy (TF-CBT), cue-centered therapy (CCT), or treatment as usual (TAU). Parents and youth reported on youth's PTSD symptoms at pre-intervention, post-intervention, and follow-up. Neuroimaging data (N = 31) assessed at pre-intervention were obtained while youth engaged in an emotion expression task. Treatment response slopes were calculated for youth's PTSD symptoms.

RESULTS

Overall, PTSD symptoms decreased from pre-intervention through follow-up across conditions, with some evidence of relative benefit of TF-CBT and CCT over TAU but significant individual variation in treatment response. Cortical activation patterns were correlated with PTSD symptom improvement slopes (r = 0.53). In particular, cortical responses to fearful and neutral facial stimuli in six fNIRS channels in the bilateral dlPFC were important predictors of PTSD symptom improvement.

CONCLUSIONS

The use of fNIRS provides a method of monitoring and assessing cortical activation patterns in a relatively inexpensive and portable manner. Associations between functional activation and youths' PTSD symptoms improvement may be a promising avenue for understanding emotion dysregulation in clinical populations.

Positive Childhood Experiences Associate with Adult Flourishing Amidst Adversity: A Cross Sectional Survey Study with a National Sample of Young Adults

The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we used convenience and snowball sampling to recruit 9468 young adults, ages 18-35, enrolled in undergraduate or graduate programs at universities in Mainland China to participate in a survey, which included measures on flourishing, exposure to ACEs and PCEs, and demographic characteristics. Approximately 92% of participants reported experiencing seven to nine PCEs, with harmonious family relationships (96.9%), feeling supported by friends (96.8%) and being treated fairly at school (96.3%) being the most common PCEs reported. Results of the multiple regression indicated that the cumulative number of PCEs statistically significantly moderated the relation between the cumulative number of ACEs and flourishing (interaction term b = -0.060 [-0.071, -0.049], p < 0.001, adjusted R² = 0.183); as the number of ACEs increased up through eight ACEs, decreases in flourishing were smaller among those with higher numbers of PCEs. PCEs are common among young adults from Mainland China and serve a potential buffering effect against exposure to ACEs.

Adverse childhood experiences, adult anxiety and social capital among women in rural Kenya

Hundreds of millions of people suffer anxiety disorders globally, demonstrating need for scalable and effective interventions. Adverse childhood experiences contribute to this mental health burden. The stress-buffering hypothesis, which posits social factors moderate prior adversity and subsequent mental health outcomes, provides one theoretical avenue to consider observations that group-based microfinance programs improve social capital. We investigate associations between adverse childhood experiences, generalized anxiety among adults and social capital associated with participation in a group-based microfinance program in rural Kenya. Adult participants (n = 400 women) responded to standardized measures of childhood adversity in June 2018, group-affiliated social capital and generalized anxiety in June 2019. Cumulative adverse childhood experiences predicted higher anxiety, which was statistically moderated by the presence of group-affiliated interpersonal trust. This study is the first to find social capital associated with participation in a group-based microfinance program statistically moderates expected associations between adverse childhood experiences and adult generalized anxiety. Future study should be conducted using a cluster-randomized control design to further assess the potential of this intervention method to ameliorate associations between past adversity and current mental health.

Prevalence of meditation-related adverse effects in a population-based sample in the United States

OBJECTIVE

Meditation practice and meditation-based psychotherapies have become increasingly popular. Although psychological benefits associated with meditation are well-documented, potential risks are unclear.

METHOD

We conducted a population-based survey to evaluate the occurrence of a broad range of meditation-related adverse effects (MRAE).

RESULTS

Nine hundred and fifty three participants completed our screening survey, 470 endorsed lifetime exposure to meditation practice, and 434 completed a follow-up survey assessing MRAE (92.3% response rate). A higher proportion than hypothesized reported occurrence of MRAE (general item = 32.3%, 1+ specific item = 50.0%) and MRAE duration ≥1 month (10.4%). Anxiety, traumatic re-experiencing, and emotional sensitivity were the most common MRAE. Some degree of functional impairment was reported by 10.6% of participants, with impairment lasting ≥1 month for 1.2%. Childhood adversity was associated with elevated risk for MRAE. Participants reporting MRAE were equally glad to have practiced meditation as those not reporting MRAE. Additional correlates of MRAE were identified in exploratory analyses.

CONCLUSION

MRAE are common, even in a sample with relatively modest amounts of experience. Identifying individuals at elevated risk for MRAE, being transparent and realistic about the possible range of effects, and increasing trauma-sensitivity are warranted to maximize benefits and minimize risks of meditation.

Functional near-infrared spectroscopy brain imaging predicts symptom severity in youth exposed to traumatic stress

Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with the potential to enable the assessment of posttraumatic stress disorder (PTSD) brain biomarkers in an affordable and portable manner. Consistent with biological models of PTSD, functional magnetic resonance imaging (fMRI) and fNIRS studies of adults with trauma exposure and PTSD symptoms suggest increased activation in the dorsolateral prefrontal cortex (dlPFC) and ventrolateral PFC (vlPFC) in response to negative emotion stimuli. We tested this theory with fNIRS assessment among youth exposed to traumatic stress and experiencing PTSD symptoms (PTSS). A portable fNIRS system collected hemodynamic responses from (N = 57) youth with PTSS when engaging in a classic emotion expression task that included fearful and neutral faces stimuli. The General Linear Model was applied to identify cortical activations associated with the facial stimuli. Subsequently, a prediction model was established via a Support Vector Regression to determine whether PTSS severity could be predicted based on fNIRS-derived cortical response measures and individual demographic information. Results were consistent with findings from adult fMRI and fNIRS studies of PTSS showing increased activation in the dlPFC and vlPFC in response to negative emotion stimuli. Subsequent prediction analysis revealed ten features (i.e., cortical responses from eight frontocortical fNIRS channels, age and sex) strongly correlated with PTSS severity (r = 0.65, p < .001). Our findings suggest the potential utility of fNIRS as a portable tool for the detection of putative PTSS brain biomarkers.

Applications of psychoneuroimmunology models of toxic stress in prevention and intervention efforts across early development

Although evidence supporting psychoneuroimmunology (PNI) models of toxic stress have emerged over the past decade, the PNI field has struggled to integrate these important findings into real-world practical applications. There is great potential for these models to reduce the societal burden of childhood adversity by facilitating early detection and prevention with those children and adolescents at greatest risk for stress-related physical and psychological disorders. But further research is needed to validate and scale developmentally appropriate interventions with specific immune and endocrine mechanism-based targets that are developmentally sensitive. The allostatic load and additive PNI models of toxic stress exposure in youth are summarized. These models highlight the importance of integrating a standardized screening of environmental and interpersonal risk factors with stable and scalable cognitive and biological markers of risk. PNI models of toxic stress illustrate the need for intervention delivery as early as possible to prevent negative health outcomes in youth and comprehensive screening efforts would facilitate the deployment of community and family level interventions. This review discusses practical applications of toxic stress models that are currently under investigation, clarifies key obstacles, such as research gaps and scalability, and provides potential solutions, including cross-disciplinary partnerships.

Forgotten Variables and Older Men in Custody: Negative Childhood Events, Forgiveness, and Religiosity

The study tested a mediational model linking negative childhood events through forgiveness of self and social support to religiosity using data from a convenience sample of 261 men aged 45-82 years residing behind prison walls. The Developmental Model of Adaptation provided the study's conceptual model for investigating the associations among the study variables. The study tested a mediational model linking the distal past (negative childhood events) to the outcome, religiosity, through forgiveness, and social support. The final model demonstrated the association of negative childhood events with religiosity through forgiveness of self (not forgiveness of others or situation) and social support. The study's findings suggest that at intake and during time in confinement, middle-aged and older men in prison should be assessed for and offered interventions aimed at helping them cope with the trauma of childhood events, achieve self-forgiveness, seek social support, and express religiosity as important for sustaining their well-being.

Thought Problems and Aggression Over Time Among Youth in Foster Care

Background

Youth in foster care may demonstrate high levels of aggression and thought problems. There is a growing trend to consider mental health symptoms of youth involved with the foster care system from a developmental trauma perspective.

Objective

The aim of this study was to test if trauma, race, age, and gender predicted variability in thought problems and aggression for youth in foster care.

Method

The sample (n = 303) included youth in out-of-home placements with a mean age of 14 years, a diverse racial demographic, and almost an equal percentage of males and females. Participants were assessed over three waves using a series of multilevel growth curve models.

Results

Results indicated significant decreases in thought problems and aggression and youth with higher levels of trauma reported higher initial levels and swifter decreases of both thought problems and aggression over time.

Conclusions

While trauma was associated with aggression and thought problems, results found that youth demonstrated significant decreases in aggression and thought problems over time. A better understanding of the long-term effects of trauma on thought problems and aggression of youth in foster care is needed. While our findings suggest foster care may be protective in fostering resilience, additional research on the nature of potential positive effects of foster care on aggression and thought problems is suggested.