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Onyeka OC, Spencer SD, Salloum A, Jiannetto K, Storch EA. The role of family accommodation in child posttraumatic stress symptoms and functional impairment in the context of cognitive behavioral therapy. J Affect Disord 2024; 346:252-259. [PMID: 37924982 PMCID: PMC10843667 DOI: 10.1016/j.jad.2023.10.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Caregiver behaviors such as family accommodation (FA) are negatively reinforced by reduced distress in the short term, but ultimately maintain symptoms. It is important to explore the role of FA on symptoms and impairment. The current study examined the relationship among FA, posttraumatic stress symptoms (PTSS), and functional impairment in a sample of children and their caregivers who completed trauma treatment. METHOD Participants included 183 children and their caregivers (M age = 7.89; 55.19 % female; 73.22 % non-Hispanic; 51.37 % White). Data consisted of parent-reported measures collected at baseline, post-treatment, and 12-month follow-up from a randomized control trial (RCT) comparing Stepped Care CBT for Children after Trauma and Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Correlational, mediation, and hierarchical linear regression analyses were conducted to test the interrelationships among FA, child PTSS, and child functional impairment. RESULTS FA was significantly, positively associated with total PTSS and functional impairment at baseline. Baseline FA partially mediated the relationship between baseline total PTSS and baseline functional impairment. Lastly, greater pre- to post-treatment changes in FA were mostly associated with relevant outcome variables at post-treatment and 12-month follow-up. LIMITATIONS Study limitations include use of a single informant, cross-sectional data analysis, lack of differentiation among trauma types, concerns regarding generalizability. CONCLUSION Assessing FA may be a helpful tool in better understanding how child PTSS relates to functional impairment following exposure to trauma. This study is clinically relevant it offers insight on the relationship among FA, PTSS, and functional impairment for families involved in trauma treatment.
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Affiliation(s)
- Ogechi Cynthia Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Katie Jiannetto
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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2
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Leone C, Hawkins L, Geary M, Bolanos V. Sex Stereotypes and Child Physical Abuse: Mediating Effects of Attitudes on Beliefs about Consequences for Abusive Parents. Psychol Rep 2024:332941231225394. [PMID: 38206786 DOI: 10.1177/00332941231225394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
We hypothesized that (a) sex stereotypes would influence individuals' attitudes toward and beliefs about physically abusive parents and (b) these attitudes would mediate the connection between sex stereotypes and beliefs. Participants read one of four scenarios in which (a) sex of parents and sex of children were systematically varied while (b) holding constant the actions of parents and children as well as surrounding circumstances. Participants then expressed their attitudes about those parents and their beliefs about appropriate consequences for these parents. As expected, participants held more unfavorable attitudes about fathers than mothers and believed lenient consequences were more appropriate for mothers than fathers. Moreover, the linkage between parents' sex and participants' beliefs was mediated by participants' attitudes such that the effects of sex stereotypes on beliefs were all indirect rather than direct. Limitations (e.g., cross-sectional design, sample representativeness) and future directions (e.g., alternative parental and child behaviors, individual differences as moderators) are discussed.
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Affiliation(s)
- Christopher Leone
- Department of Psychology, University of North Florida, Jacksonville, FL, USA
| | - LouAnne Hawkins
- Department of Psychology, University of North Florida, Jacksonville, FL, USA
| | - Mary Geary
- Department of Psychology, University of North Florida, Jacksonville, FL, USA
| | - Valentina Bolanos
- Department of Psychology, University of North Florida, Jacksonville, FL, USA
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Morrison CA, Corbeil T, Kluisza L, Poku O, Liotta L, Attoh Okine ND, Dolezal C, Wiznia A, Abrams EJ, Robbins RN, Mellins CA. Identifying the Mental Health Effects of Cumulative Traumatic Exposure in HIV-Affected Youth: A Longitudinal Assessment. J Acquir Immune Defic Syndr 2024; 95:18-25. [PMID: 37820277 PMCID: PMC10841068 DOI: 10.1097/qai.0000000000003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Traumatic events (TEs) in early life can precede adult psychopathology. Limited research exists on this relationship in young adults with perinatally acquired HIV-infection (PHIV) or perinatal HIV-exposure without infection (PHEU), who often experience social and health disparities. This study examined TEs experienced in childhood/adolescence and their association with psychiatric and substance use disorders in young adults with PHIV and PHEU. METHODS Participants in a New York City-based longitudinal cohort study were assessed for TE exposure at enrollment (mean age = 12 years) and the first 2 follow-up interviews. Past-year psychiatric and substance use disorders were evaluated via psychiatric interview (DISC-IV) at the fifth follow-up interview (mean age = 22 years). Unadjusted and adjusted logistic regression models assessed associations between cumulative childhood/adolescence TEs and young adult psychiatric and substance use outcomes. Group differences were tested for PHIV and PHEU subgroups. RESULTS Among 236 participants (60% Black, 51% Latinx), mean cumulative traumatic event count was 3.09 (SD = 1.77); 26% had a past-year psychiatric diagnosis, and 28% had a past-year substance use diagnosis. Increased TEs were associated with past-year psychiatric diagnoses in young adulthood [average marginal effects (AME) 4.21, 95% confidence interval (CI): 0.83 to 7.58]; for PHEU participants, increased TEs were associated with a past-year substance use disorder (AME 15.67, 95% CI: 8.08 to 23.25). CONCLUSIONS High levels of TEs in childhood/adolescence may contribute to psychiatric and substance use disorders in young adults with PHIV or PHEU. Research exploring relationships between TE exposure and later psychiatric problems is needed to inform interventions for HIV-affected youth.
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Affiliation(s)
- Corey A Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Ohemaa Poku
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Lucy Liotta
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Naa-Djama Attoh Okine
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, NY; and
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
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Song J. Patterns of Adverse Childhood Experiences and Psychiatric Disorders Among Adolescents with ADHD: A Latent Class Analysis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01645-3. [PMID: 38110757 DOI: 10.1007/s10578-023-01645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023]
Abstract
There is limited existing research on whether specific combinations of Adverse Childhood Experiences (ACEs) are associated with different psychiatric disorders among adolescents with ADHD. This study aimed to address this gap by identifying classes of ACEs and examining their association with behavioral problems, anxiety, and depression in adolescents with ADHD aged 11-17 (n = 1,806), using data from the 2018 National Survey of Children's Health (NSCH). A latent class analysis revealed a four-class solution: (1) low-risk ACEs (61.6%), (2) moderate-risk ACEs (25.2%), (3) high discrimination and neighborhood violence exposure (7.6%), and (4) high-risk ACEs (5.6%). The "high-risk ACEs" and the "high discrimination and neighborhood violence exposure" class showed a higher likelihood of behavioral problems and depression, and anxiety and depression respectively. These findings provide some insight into the ACE patterns that are more likely to be associated with mental health problems among adolescents with ADHD.
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Affiliation(s)
- Jihee Song
- Florida Department of Children and Families, Tallahassee, FL, 32303, USA.
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL, 32611, USA.
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Salad AM, Malik SKMMR, Ndithia JM, Noor Z, Madeo M, Ibrahim M. Prevalence of mental disorders and psychological trauma among conflict- affected population in Somalia: a cross-sectional study. Front Public Health 2023; 11:1219992. [PMID: 37829096 PMCID: PMC10565346 DOI: 10.3389/fpubh.2023.1219992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023] Open
Abstract
Background Despite the longstanding psychosocial impact of the interactable conflict in Somalia for the last 30 years, there is lack of epidemiological studies of mental health conditions, especially at the population level. Objectives The aim of this study is to fill the epidemiological gap and provide population based data on mental health conditions in the South-Central region of Somalia. The specific objectives were: (1) To determine the epidemiological patterns of mental disorders in three sites; Baidoa, Dolow and Kismayo, (2) Understand the socio-demographic characteristics associated with mental health conditions in the study sites, and (3) To assess the correlates between psychological trauma and the mental wellbeing of the population. Methods This was a cross-sectional study of 713 respondents recruited from the three sites namely Dolow, Baidoa and Kismayo. Data on sociodemographic characteristics and mental disorders were collected using the MINI and sociodemographic questionnaire. Basic descriptive statistics were used to summarize sociodemographic characteristics. Univariable and multivariable logistic regressions were used to examine factors associated with common mental disorders. Statistical significance was considered at a value of p <0.05. Results Participants' mean age was 32.6 (±10.7) years. More than half (58.5%) of the respondents were male. The overall prevalence of common mental disorders was 557 (78.1%) with panic disorder (39.3%), generalized anxiety disorders (34.9%), major depressive episode current (32.1) and PTSD (29.9%). According to the multivariable logistic regression analysis, being male AOR = 1.74 (95%CI = 1.25, 2.42), having a family size of more than 10 members AOR =1.37 (95% CI = 1.00, 1.89), being unemployed AOR = 1.90 (95%CI = 1.18, 3.06), experienced starvation AOR =3.46 (95%CI = 2.23, 5.37), khat use AOR = 5.87 (955 CI, 1.75-19.65), were identified as predicting factors for the common mental disorders among the study participants. Conclusion There is a high prevalence of mental disorders with anxiety disorders being the commonest. Findings reflect earlier studies that showed higher rates in conflict and post-conflict settings. It also aligns with past studies in Somalia. As such, there is an urgent need to integrate mental health and psychosocial support within the primary healthcare and other service sectors such as education considering the vast majority of the population are young.
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Affiliation(s)
- Abdulwahab M Salad
- School of Public Health and Tropical Medicine, Somali National University, Mogadishu, Somalia
| | | | | | - Zeynab Noor
- Department of Mental Health and Substance Use, Federal Ministry of Health, Mogadishu, Somalia
| | | | - Mohamed Ibrahim
- WHO, Somalia Country Office, Mogadishu, Somalia
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
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Day A, Malvaso C, Boyd C, Hawkins K, Pilkington R. The effectiveness of trauma-informed youth justice: a discussion and review. Front Psychol 2023; 14:1157695. [PMID: 37744608 PMCID: PMC10514550 DOI: 10.3389/fpsyg.2023.1157695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Youth justice services around the world are under increasing pressure to find new and more effective ways of working with young people. One way forward is to implement a more compassionate approach to service delivery that embraces the idea of 'trauma-informed practice'. And yet, substantial variation has been observed in how a trauma-informed approach has been defined and understood by practitioners, with idiosyncratic implementation evident across different systems and only limited evidence that this results in reductions in subsequent re-offending. In this paper we argue that the success of efforts to work in more trauma-informed ways cannot be judged using recidivism data alone and that there is a need to identify key indicators of the effectiveness of any trauma- informed approach. We present the case for implementing trauma-informed youth justice and outline key features of the approach. We then present a logic model that articulates key components and identifies short- and longer-term outcomes that can be measured to assess the overall performance of a service. The article concludes with a discussion of the current evidential status of trauma-informed youth justice, identifying areas of current strength and those where further work is needed to develop the evidence base, including the need to demonstrate the hypothesized association between short-term trauma-informed practice outcomes and the longer-term goal of preventing re-offending.
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Affiliation(s)
- Andrew Day
- School of Social and Political Sciences, University of Melbourne, Parkville, VIC, Australia
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Catia Malvaso
- School of Psychology and the School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Carolyn Boyd
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Katherine Hawkins
- South Australian Department of Human Services, Adelaide, SA, Australia
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Yoon Y, Cederbaum JA, Duan L, Lee JO. Intergenerational Continuity of Childhood Adversity and Its Underlying Mechanisms Among Teen Mothers and Their Offspring. CHILD MALTREATMENT 2023:10775595231200145. [PMID: 37669686 DOI: 10.1177/10775595231200145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The present study investigates how parenting stress mediates the intergenerational continuity of childhood adversity in teenage mothers. Childhood adversity experiences of caregivers significantly affect their offspring's exposure to childhood adversity. However, little is known about the mechanisms linking childhood adversity across generations. The study measures how parental distress and parent-child dysfunctional interaction mediate the association between teen mothers' childhood adversity and their offspring's adversity, measuring when the offspring reached 11.5 years of age. The results revealed that parental distress, but not parent-child dysfunctional interaction, mediated the association between teen mothers' child abuse and their offspring's household dysfunction. This suggests that parental distress may be a crucial intervention target to prevent the intergenerational continuity of childhood adversity. The findings imply that efforts to prevent the intergenerational continuity of childhood adversity may be more successful if the public and professionals have a broader understanding of the associations between early adversity and parenting contexts. In conclusion, the study shed light on the potential mechanisms underlying the intergenerational continuity of childhood adversity and highlights the importance of targeting parenting stress, specifically parental distress, as an intervention strategy to prevent the perpetuation of childhood adversity across generations.
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Affiliation(s)
- Yoewon Yoon
- Department of Social Welfare, Dongguk University, Seoul, South Korea
| | - Julie A Cederbaum
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Lei Duan
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jungeun Olivia Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Ash MJ, Knutzen KE, Ogbeide I, Renfro TL, Ramirez MR, Woods-Jaeger B. Barriers and Facilitators to the Online Delivery of a School-Based Intervention to Reduce Racial Trauma. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:750-762. [PMID: 37332082 DOI: 10.1007/s10488-023-01281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
Students of color face disproportionate rates of adverse childhood experiences, including racial discrimination in school settings. Effective interventions strategies are needed to address school-based racial trauma. Link for Equity was designed to be a culturally-responsive trauma-informed intervention that includes universal cultural humility training for teachers. As a result of the COVID-19 pandemic, the in-person trauma-informed cultural humility training was adapted for online delivery. The purpose of this study was to assess barriers and facilitators that impacted online delivery of the training. We conducted semi-structured interviews with 25 high school teachers from three public school districts in the Midwestern United States who participated in the online training. Interview transcripts were coded by two team members, and thematic analysis was utilized. Barriers and facilitators to online delivery were identified across five domains: receptivity, logistics, engagement, comfort, and application. The implications of these barriers and facilitators are discussed and tailored recommendations for the virtual delivery of culturally-responsive trauma-informed interventions to reduce racial discrimination in schools are provided.
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Affiliation(s)
- Marcia J Ash
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
| | - Kristin E Knutzen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Ighedosa Ogbeide
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Tiffaney L Renfro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Marizen R Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
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Streicher A, Haselgruber A, Sölva K, Lueger-Schuster B. Co-development of traumatic stress symptoms and externalising behaviour problems among foster children and the effect of complex trauma: a latent growth curve model. BMJ Open 2023; 13:e067860. [PMID: 37527893 PMCID: PMC10394543 DOI: 10.1136/bmjopen-2022-067860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM). SETTING As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points. PARTICIPANTS Of, in total, 263 participating children, the data of 124 children aged 10-18 years (M=13.5, 28% female) could be analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates. RESULTS While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change. CONCLUSIONS Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.
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Affiliation(s)
- Alina Streicher
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | | | - Katharina Sölva
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
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Vieira A, Sheerin KM, Modrowski C, Kemp K. The intersection of adverse childhood experiences and mental health concerns for youth involved in the child welfare system. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2229-2245. [PMID: 36883424 DOI: 10.1002/jcop.23024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 02/18/2023] [Indexed: 06/14/2023]
Abstract
The present study sought to identify if there is distinct mental health symptomology among child welfare-involved youth depending on the category of adverse childhood experiences (ACEs) endorsed. A chart review of child welfare-involved youth (N = 129, ages 8-16) and caregiver reported ACEs and mental health/trauma symptoms was conducted. A K-means cluster analysis used ACE scores to identify groups of youth along two dimensions: household dysfunction and child abuse/neglect. The first cluster identified had low ACE scores outside of their system involvement (n = 62), the second predominantly endorsed household dysfunctions (n = 37), and the third predominantly endorsed abuse/neglect (n = 30). One-way analysis of variance tests revealed that youth in the systems-only cluster differed from youth in the other groups, while the two high ACE category groups did not differ from each other on mental health/trauma symptoms. These results have important implications for the screening and treatment referral processes in the child welfare system.
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Affiliation(s)
- Alyssa Vieira
- Department of Psychiatry, Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Kaitlin M Sheerin
- Department of Psychiatry, Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Crosby Modrowski
- Department of Psychiatry, Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Kathleen Kemp
- Department of Psychiatry, Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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11
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Tennity CL, Grassetti SN, Boniface RL, Charles NE, Paprzycki P. Do Externalizing Problems Impact Change in Post-Traumatic Stress Symptoms for Youth in a School-Based Group Intervention? SCHOOL MENTAL HEALTH 2023. [DOI: 10.1007/s12310-023-09583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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12
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Tabone JK, Rishel CW, Hartnett HP, Szafran KF, Royse R. Examining the Effects of Adverse Childhood Experiences and Gender on Trauma-Informed Intervention Outcomes. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:9-19. [PMID: 36776631 PMCID: PMC9908787 DOI: 10.1007/s40653-022-00456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 06/18/2023]
Abstract
Purpose The prevalence of Adverse Childhood Experiences (ACEs) and their link to negative behavioral and health outcomes is well documented, but very few studies have empirically examined the effect of ACEs on intervention outcomes. There is also emerging evidence of gender differences in vulnerability to developing traumatic symptoms, which relates to intervention outcomes. The current study examined the effects of ACEs and gender on trauma-informed intervention outcomes in a community-based clinical setting. Methods The study includes data from children who were treated with trauma-informed intervention services grounded in the Attachment, Self-Regulation, and Competency (ARC) framework from 2017 to 2019. ACE scores are measured as a total across 10 items and different types, maltreatment versus family dysfunction, at intake. Children's trauma-related symptoms are assessed at intake and every 90 days under the ARC framework. In order to examine the changes of traumatic symptoms over time, a total of 362 children with three time points are included for the current analyses using Multilevel modeling with SAS PROC MIXED. Results The study found that a trauma-informed intervention based on the ARC framework was effective in reducing children's trauma related symptoms until they experienced 6 or more ACEs. The intervention effect, however, did not hold when children's ACEs were cumulated to 7 or more. The study also revealed gender differences in intervention outcomes. Conclusions The finding has significant implications for early detection and preventative intervention efforts with children's ACEs before their ACEs further cumulate to a higher number. Gender difference should be considered in intervention planning and monitored during the intervention process.
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Affiliation(s)
- Jiyoung K. Tabone
- School of Social Work, West Virginia University, PO Box 6830, 26506 Morgantown, WV United States
| | - Carrie W. Rishel
- School of Social Work, West Virginia University, PO Box 6830, 26506 Morgantown, WV United States
| | - Helen P. Hartnett
- School of Social Work, West Virginia University, PO Box 6830, 26506 Morgantown, WV United States
| | - Kathy F. Szafran
- Crittenton Services of West Virginia, Inc, 2606 National Road, 26003 Wheeling, WV United States
| | - Richard Royse
- Crittenton Services of West Virginia, Inc, 2606 National Road, 26003 Wheeling, WV United States
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13
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Lopez-Tamayo R, Suarez L, Simpson D, Volpe K. The Impact of Adverse Childhood Experiences and Community Violence Exposure on a Sample of Anxious, Treatment-Seeking Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1081-1093. [PMID: 36439664 PMCID: PMC9684382 DOI: 10.1007/s40653-022-00447-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 06/16/2023]
Abstract
Screening for adverse childhood experiences (ACEs) can help prevent and reduce adverse outcomes on child development, including increased risk for anxiety disorders. Emerging studies strongly support the inclusion of community-level adversities in ACE screeners to consider diverse contexts and populations. Recent studies suggest that community violence exposure (CVE) may have a distinct impact on youth mental health. Although recent studies have examined the association between ACEs, CVE, and mental health in primary care settings, this association has not been examined on treatment-seeking children in urban mental health settings. The present study employs a mediation model using the PROCESS macro to examine community violence exposure mediating the effect on the association between ACEs and somatic symptoms (SS) on a sample of anxious treatment-seeking children. A total of 98 participants (Mage = 11.7, SD = 3.79, 51.6% males, 54.1% ethnic minority children) who sought services at a specialized anxiety clinic completed self-report measures. Results indicated that exposure to ACEs is associated with endorsement of somatic symptoms as a result of reporting hearing, witnessing, or experiencing CVE. Evidence of mediation was found in a statistically significant indirect effect of ACEs on SS through CREV (Effect = .17, 95% CI = .069-.294). These findings support recent evidence that CVE is a distinct ACE as it contributes to toxic stress similar to individual-level ACEs. The use of a comprehensive ACE screening that includes CVE is warranted, particularly when working with culturally and socioeconomically diverse populations, as it would better capture a broader range of adversities across demographic groups.
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Affiliation(s)
- Roberto Lopez-Tamayo
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois USA
| | - Liza Suarez
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois USA
| | | | - Kelley Volpe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois USA
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Adolescent Mental Health and Family Economic Hardships: The Roles of Adverse Childhood Experiences and Family Conflict. J Youth Adolesc 2022; 51:2294-2311. [PMID: 35997913 DOI: 10.1007/s10964-022-01671-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences (ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth psychopathology in previous studies, less is understood about how family environments might condition these pathways. Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6% Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study's findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between SES and youth psychopathology.
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15
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Yoon Y. Time Dimension of Childhood Adversities and Externalizing Behavior Among Children of Teen Mothers: Sensitive Period Hypothesis vs. Accumulation Hypothesis. CHILD MALTREATMENT 2022; 27:389-399. [PMID: 33371724 DOI: 10.1177/1077559520984249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Childhood adversities are associated with compromised behavioral health later in life. However, less attention has been paid to how time contributes to the damaging effects of adversity exposure. In addition, the differential impact of childhood maltreatment and household dysfunction has been understudied. The current study tested (a) the sensitive period hypothesis regarding timing of childhood adversity on externalizing behavior, (b) the accumulation hypothesis regarding the associations between the duration of childhood adversity and externalizing behavior, and (c) the domain-specific impact of childhood adversity on externalizing behavior. Data came from the Young Women and Child Development Study (N = 240). Childhood adversity was measured at seven periods (age range: 5.5-16), which were used to test the sensitive period hypothesis. Childhood adversity at each time period was summed across seven time periods to test the accumulation measure representing the duration of childhood adversity. Least angle and multiple regression analyses were conducted. Results supported the sensitive period hypothesis-the effect of childhood adversity was the most prominent at age 11.5, whereas the accumulation of childhood adversity time periods was not a significant predictor of later externalizing behavior. Probing childhood adversity by subdomains revealed maltreatment primarily accounted for externalizing behavior (p < .05). Findings suggest intervention efforts for children of teen mothers during early adolescence to prevent externalizing behavior in later adolescence. Unpacking childhood adversity may illuminate key areas of vulnerability to externalizing behavior.
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Affiliation(s)
- Yoewon Yoon
- Suzanne Dworak-Peck School of Social Work, 5116University of Southern California, Los Angeles, CA, USA
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16
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Grocott LR, Mair A, Galione JN, Armey MF, Huang J, Nugent NR. Days with and without self-injurious thoughts and behaviors: Impact of childhood maltreatment on adolescent online social networking. J Adolesc 2022; 94:748-762. [PMID: 35695124 DOI: 10.1002/jad.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Among adolescents, an increasing rate of interpersonal interactions occurs online. Previous research has shown that interpersonal context exerts a robust impact on suicidal thoughts or behaviors, yet little attention has focused on examining the content of online interactions surrounding self-injurious thoughts or behaviors. As such, the present study sought to compare online social networking behaviors among adolescents on days with and without experiencing self-injurious thoughts or behaviors, as influenced by childhood maltreatment history. METHOD Adolescents aged 13-18 hospitalized for self-injurious thoughts or behaviors were recruited as part of an ongoing longitudinal study. A subsample (N = 22) of adolescents provided data from their online social networking platforms (i.e., text messages, Facebook, Instagram, and Twitter). Using a mixed-methods approach, online social networking data on days of experiencing self-injurious thoughts or behaviors and days of not experiencing self-injurious thoughts or behaviors were compared. RESULTS Results indicate the frequency and content of online social networking messaging do not change by day of self-injurious thoughts or behaviors or history of childhood maltreatment. However, childhood maltreatment predicts received conflictual messages as well as sent symptomatic messages on days of experiencing self-injurious thoughts or behaviors. CONCLUSIONS Childhood maltreatment may play a role in the content of adolescent online behaviors, particularly on days when they experience self-injurious thoughts or behaviors. Implications for intervention are discussed.
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Affiliation(s)
- Lauren R Grocott
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anneliese Mair
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Janine N Galione
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jeff Huang
- Department of Computer Science, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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17
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Adolescents’ adverse family context and intimate partner violence: Mediating role of social media experience. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03160-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Thompson EL, Lever NA, Connors KM, Cloak CC, Reeves G, Chang L. Associations between potentially traumatic events and psychopathology among preadolescents in the Adolescent Brain and Cognitive Development Study ®. J Trauma Stress 2022; 35:852-867. [PMID: 35132700 PMCID: PMC9232853 DOI: 10.1002/jts.22793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/13/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022]
Abstract
The current cross-sectional study aimed to extend the literature on childhood adversity by examining the unique associations between potentially traumatic events (PTEs) and a range of mental health concerns, including domain-specific versus comorbid concerns. Participants were 11,877 preadolescents (47.8% female, 15.0% Black, 20.3% Hispanic/Latinx, Mage = 9.5 years) taking part in the Adolescent Brain and Cognitive Development (ABCD) Study® . The Kiddie Schedule for Affective Disorders and Schizophrenia was used to measure PTEs and caregiver- and child-reported mental health concerns. Adjusted odds ratios (aORs) were used for the outcomes of interest. Overall, PTEs were consistently associated with increased odds of experiencing comorbid posttraumatic stress disorder (PTSD), internalizing disorders, and externalizing disorders, significant AORs = 1.34-4.30, after accounting for children's experiences of other PTEs and polyvictimization. In contrast, PTEs were generally not associated with meeting the criteria for diagnoses within only one domain (i.e., internalizing-only or externalizing-only diagnoses). We also found PTEs to be differentially related to the various mental health outcomes. In particular, witnessing domestic violence was consistently associated with children's psychopathology. Other PTEs, such as witnessing community violence, were not associated with children's psychopathology in the final model. Associations between PTEs and mental health concerns did not differ as a function of sex. Overall, the results support the notion that PTEs are associated with comorbid concerns rather than individual disorders. These findings have important implications for the screening of PTEs, continued research on the conceptualization of traumatic stress, and the importance of accounting for comorbidities across mental health domains.
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Affiliation(s)
- Erin L. Thompson
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Nancy A. Lever
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kay M. Connors
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christine C. Cloak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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19
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Chen Y, Huang CC, Yang M, Wang J. Relationship Between Adverse Childhood Experiences and Resilience in College Students in China. JOURNAL OF FAMILY VIOLENCE 2022; 38:623-632. [PMID: 35368511 PMCID: PMC8961478 DOI: 10.1007/s10896-022-00388-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
A great body of literature has documented that adverse childhood experiences (ACEs) are related to individuals' psychological functioning and mental health. However, the majority of ACE studies focus on psychological dysfunction and less is known about how ACEs are associated with other positive psychological outcomes, including resilience. The current study assessed the relationship between ACEs and resilience, using a sample of college students in China. We hypothesized that college students who had ACEs would have lower levels of resilience. Data came from 1,871 college students from twelve colleges in China through an anonymous online survey between late September and early October 2020. Linear regression analyses were conducted. Aligned with our hypotheses, ACEs had a negative association with individuals' resilience. Despite several limitations, this study found a negative association between ACEs and college students' resilience. Preventive services and interventions are in need to protect individuals from ACEs.
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Affiliation(s)
- Yafan Chen
- School of Social Work, Rutgers University, 390 George St, New Brunswick, NJ 08901 USA
| | - Chien-Chung Huang
- School of Social Work, Rutgers University, 390 George St, New Brunswick, NJ 08901 USA
| | - Meifen Yang
- School of Public Administration, Guangdong University of Foreign Studies, Guangzhou, China
| | - Jianfeng Wang
- School of Education, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016 USA
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20
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Tabone JK, Rishel CW, Hartnett HP, Szafran KF. Trauma-Informed Intervention with Children: Integrating the CANS Assessment with the ARC Framework in a Clinical Setting. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:65-74. [PMID: 35222776 PMCID: PMC8837714 DOI: 10.1007/s40653-021-00357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 06/14/2023]
Abstract
Ongoing trauma-focused assessment is critical to developing trauma-informed treatment plans. The current study examines the clinical benefits of utilizing the Child and Adolescent Needs and Strengths (CANS) assessment to guide intervention based on the Attachment, Self-Regulation, and Competency (ARC) model to address children's trauma related symptoms in a rural state. WV CANS was developed by adapting the language of original CANS to be culturally specific to the state's unique situation and culture in consultation with the original CANS developer. This study included the data from children who received mental health services under WV CANS-ARC mapping from 2017 to 2019. Children's trauma-related symptoms are assessed using the WV CANS at intake and every 90 days to identify any changes in their symptoms. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three time points, with a total of 362 children used for the current analyses using Multilevel modeling with SAS PROC MIXED. The study found that children's trauma related symptoms significantly decreased in all ARC outcome domains over time after adjusting for basic demographic variables. The current study contributes to the evidence on treatment for children's trauma-related symptoms, especially with the application of the CANS-ARC mapping in a real-world clinical setting. The findings have significant implications for clinicians in integrating the assessment and treatment process using CANS-ARC mapping and for cross-system collaboration with continuity of care serving children who have experienced trauma.
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Affiliation(s)
- Jiyoung K. Tabone
- School of Social Work, West Virginia University, PO Box 6830, Morgantown, WV 26506 USA
| | - Carrie W. Rishel
- School of Social Work, West Virginia University, PO Box 6830, Morgantown, WV 26506 USA
| | - Helen P. Hartnett
- School of Social Work, West Virginia University, PO Box 6830, Morgantown, WV 26506 USA
| | - Kathy F. Szafran
- Crittenton Services of West Virginia, Inc, 2606 National Road, Wheeling, WV 26003 USA
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21
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Lord KA, Suvak MK, Hodgdon HB. Temporal Relationships between PTSD Symptoms and Social Functioning among Adolescents in Residential Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021:1-12. [PMID: 34936524 DOI: 10.1080/15374416.2021.2007486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Theoretical and conceptual models of posttraumatic stress disorder (PTSD) symptom progression in youth have identified social functioning as having a central influence. Yet a dearth of research has examined the bidirectional temporal associations between PTSD symptoms and social functioning. METHOD This study is the first to investigate these temporal dynamics in a sample of adolescents in trauma-informed residential treatment (N= 453; M age = 15.77 [range = 12.12-18.95], SD = 1.55; 57.2% female). The UCLA PTSD Reaction Index for DSM-5 was analyzed as a measure of youth-reported PTSD symptoms and the Interpersonal Problems subscale of the Children's Depression Inventory, 2nd edition was analyzed as a measure of youth-reported social functioning issues. The Social Problems subscale from the Child Behavior Checklist was analyzed as a measure of clinician-reported social functioning difficulties. Measures were completed at baseline and then approximately every three months for the duration of treatment. Multivariate lagged analyses were used to examine the temporal, bidirectional associations between PTSD symptoms and social functioning. RESULTS Results indicated that while controlling for length of stay, trauma exposure, age, and gender, reductions in PTSD symptoms predicted subsequent reductions in social functioning problems across both measures (prs = .12-.16), and that improvement in interpersonal relationships predicted subsequent decreases in PTSD symptoms (pr = .12). CONCLUSIONS Taken together, these findings highlight the importance of healthy social relationships for decreasing adolescent's psychological distress. Treatments that include components that target social functioning in addition to symptom reduction may maximally benefit youth with trauma-related psychopathology.
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22
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Song J, Fogarty K, Suk R, Gillen M. Behavioral and mental health problems in adolescents with ADHD: Exploring the role of family resilience. J Affect Disord 2021; 294:450-458. [PMID: 34325164 DOI: 10.1016/j.jad.2021.07.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Family resilience and its role in behavioral and mental health problems has not been well documented among U.S. adolescents, especially those with ADHD. METHODS Using data from the 2016 and 2017 National Survey of Children's Health (NSCH), we examined associations between family resilience connection index (FRCI) and conduct problems, depression, anxiety, and substance abuse in adolescents with ADHD aged 11-17 (n=4,169). Data were analyzed using multivariate logistic regression and chi-square tests. RESULTS Adolescents with ADHD who had a lower FRCI score were more likely to have conduct problems (OR:1.64, CI:1.13-2.38) and depression (OR: 3.08, CI: 2.12-4.49). There were small differences between adjusted and unadjusted odds after controlling for adverse childhood experience and other covariates. LIMITATION We could not assert prediction or causation, only associations among variables, due to the cross-sectional design of the 2016-2017 NSCH; however, a major advantage of the NSCH is that it includes a nationally representative sample of children and allows inferences to be made for understanding of the adolescents with ADHD in the U.S. CONCLUSION Findings suggest that family resilience may serve as a protective factor that leads to decreasing conduct problems, despite experiencing adversity in childhood. Targeting family resilience, in terms of teaching families ways to cope with adversities such as: a child's diagnosis of ADHD; behavioral problems, and/or other adverse experiences in children's environments, has great potential to reduce adolescents' conduct and mental health problems.
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Affiliation(s)
- Jihee Song
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL, United States.
| | - Kate Fogarty
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL, United States
| | - Ryan Suk
- Center for Health Services Research, Department of Management, Policy and Community Health, UT Health School of Public Health, Huston, TX, United States
| | - Martie Gillen
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL, United States
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23
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Hughesdon KA, Ford JD, Briggs EC, Seng JS, Miller AL, Stoddard SA. Interpersonal Trauma Exposure and Interpersonal Problems in Adolescent Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:733-743. [PMID: 34021624 DOI: 10.1002/jts.22687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022]
Abstract
Traumatic experiences have been differentiated as interpersonal (i.e., the direct result of actions by other people) or noninterpersonal (i.e., other life-threatening events, such as severe accidents). Interpersonal trauma exposure generally has been shown to be associated with more severe posttraumatic stress disorder (PTSD) symptoms than noninterpersonal trauma exposure. Interpersonal problems also tend to be associated with trauma exposure and PTSD symptoms, but it is unclear whether a mediating association exists between trauma type, interpersonal problems, and PTSD symptoms. A clinical sample of 4,275 adolescents (age range: 12-18 years) from the National Child Traumatic Stress Network Core Data Set were classified as having experienced interpersonal trauma, noninterpersonal trauma, or both. Interpersonal problems were operationalized by social problem behaviors (e.g., immature and dependent behaviors) and aggressive behaviors on the Child Behavior Checklist. The results of path analyses showed that cumulative interpersonal trauma exposure was both directly and indirectly associated with PTSD symptoms via social problem behaviors but not aggressive behaviors, total effect β = .20, 95% CI [.17, .23]. In a second model, path analyses showed that cumulative interpersonal trauma exposure was associated directly and indirectly via PTSD symptoms with social problem behaviors, total effect β = .15, 95% CI [.11, .18], and aggressive behaviors, total effect β = .13, 95% CI [.09, .17]. These findings suggest that during adolescence, interpersonal problems play an important role in the association between interpersonal trauma exposure and PTSD symptoms.
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Affiliation(s)
| | - Julian D Ford
- Department of Psychology, University of Connecticut, Farmington, Connecticut, USA
| | | | - Julia S Seng
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison L Miller
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah A Stoddard
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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Berman IS, Petretric P, Bridges AJ. Beyond child maltreatment: The incremental value of household dysfunction in the prediction of negative beliefs and internalizing symptoms in women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:537-545. [PMID: 31765292 DOI: 10.1080/07448481.2019.1687483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 09/23/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Child maltreatment is associated with negative mental health outcomes including depression, posttraumatic stress disorder (PTSD), and anxiety. Maltreatment experiences can result in negative beliefs about safety and wellbeing, which may maintain negative mental health symptoms. Household dysfunction (eg, impaired caregiver) is considered less severe than maltreatment but more problematic than well-functioning family environments. Objective: This study investigates the incremental value household dysfunction contributes, above effects of maltreatment, to the prediction of internalizing symptoms (PTSD, depression, anxiety), and the extent to which negative beliefs might maintain these symptoms. Participants/methods: Female college students (N = 252; Mage = 19.2) electronically reported childhood exposure to maltreatment and household dysfunction, current maladaptive beliefs and internalizing symptoms. Results: Structural equation modeling showed household dysfunction significantly predicted internalizing symptoms after controlling for maltreatment experiences; this association was mediated through negative beliefs. Conclusions: Results suggest the additional importance of considering elements of household dysfunction when exploring traumatic histories.
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Affiliation(s)
- Ilana S Berman
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Patricia Petretric
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Ana J Bridges
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
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Adverse childhood experiences: Mechanisms of risk and resilience in a longitudinal urban cohort. Dev Psychopathol 2021; 32:1418-1439. [PMID: 31663487 DOI: 10.1017/s095457941900138x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is an extensive literature describing the detrimental effects of adverse childhood experiences (ACE; e.g., abuse, neglect, and household dysfunction) on physical and mental health. However, few large-scale studies have explored these associations longitudinally in urban minority cohorts or assessed links to broader measures of well-being such as educational attainment, occupation, and crime. Although adversity and resilience have long been of interest in developmental psychology, protective and promotive factors have been understudied in the ACE literature. This paper investigates the psychosocial processes through which ACEs contribute to outcomes, in addition to exploring ways to promote resilience to ACEs in vulnerable populations. Follow-up data were analyzed for 87% of the original 1,539 participants in the Chicago Longitudinal Study (N = 1,341), a prospective investigation of the impact of an Early Childhood Education program and early experiences on life-course well-being. Findings suggest that ACEs impact well-being in low-socioeconomic status participants above and beyond the effects of demographic risk and poverty, and point to possible mechanisms of transmission of ACE effects. Results also identify key areas across the ecological system that may promote resilience to ACEs, and speak to the need to continue to support underserved communities in active ways.
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Negriff S. Expanding our Understanding of Intergenerational Exposure to Adversity. CHILDREN AND YOUTH SERVICES REVIEW 2020; 118:105369. [PMID: 33132471 PMCID: PMC7592700 DOI: 10.1016/j.childyouth.2020.105369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The present study examined the intergenerational continuity of adverse childhood experiences (ACEs) for parents and their adolescent offspring. Data were from a longitudinal study of the effects of maltreatment on adolescent development. Only biological parents (n=185) and one adolescent per parent (n=164) were included in the analytic sample. Self-reported retrospective data on childhood adversities was obtained at the 3rd wave for parents and the 4th wave for adolescents (M age=18.16). For siblings in the study, one was randomly chosen to be included. Latent class analysis was used to examine 1-4 class solutions for parents and adolescents separately and crosstabs were used to show the concordance between assignment to similar classes for the parent and child. Results indicated 2 class solutions for both the parent and child: a high ACEs class characterized by witnessing intimate partner violence and all maltreatment types and a low ACES class characterized by no adversities. Concordance was highest for both parent and child being assigned to the low ACEs class (52% of the dyads). There were 9% of the dyads who were concordant for being assigned to the high ACEs class, indicating less continuity of adversity than expected. Overall the findings show some intergenerational continuity of adversity, but further work should be done to characterize the different patterns of concordance/discordance between parent and child ACEs.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, United States
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Whitson ML, Champine RB, Griffin A, Corto-Mergins C, Lusa J, Jaffe J, Hemmelgarn A, Bryden E, Clark K, Kaufman JS. Impact of an Integrated EMDR Treatment Program for Children and Youth Exposed to Potentially Traumatic Events: The Village Collaborative Trauma Center. JOURNAL OF EMDR PRACTICE AND RESEARCH 2020. [DOI: 10.1891/emdr-d-20-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exposure to adverse events during childhood and adolescence is associated with problematic outcomes across the life span, including the development of posttraumatic stress disorder (PTSD). A growing body of research examining the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in treating PTSD among young people has yielded mixed findings. More work is needed that elucidates whether EMDR is linked to positive and sustained reductions in symptoms among youth who experience potentially traumatic events. For this open trial, we analyzed data from 143 youth (Mage = 12.9, standard deviation [SD] = 3.4, Range = 6–18) who received outpatient behavioral health clinic services, including EMDR. We assessed whether the number of types of exposure to family-related and non-family-related traumatic events, as well as differences in severity of PTSD symptomatology, was associated with changes in internalizing and externalizing problem behaviors from intake to 6 months. Results indicated that youth with (a) fewer exposures to non-family-related potentially traumatic events and (b) more severe PTSD symptoms, showed greater improvements in externalizing problem behaviors. We discuss limitations of the present study and implications for future research.
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28
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Kovács G, van Dijke A, Enders-Slegers MJ. Psychodynamic Based Equine-Assisted Psychotherapy in Adults with Intertwined Personality Problems and Traumatization: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165661. [PMID: 32764468 PMCID: PMC7460234 DOI: 10.3390/ijerph17165661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/01/2020] [Accepted: 07/31/2020] [Indexed: 06/01/2023]
Abstract
The growing field of equine-assisted psychotherapy (EAP), a subfield of animal-assisted psychotherapy (AAP), needs theoretically-based clinical studies. This systematic review examines the existing clinical studies in adult populations on psychodynamic psychotherapy combined with equine-assisted psychotherapy. An electronic database search was divided in two studies to identify publications on 1) EAP combined with psychodynamic psychotherapy and 2) EAP combined to personality problems and traumatization in order to compile studies by population, intervention, outcome and therapeutic assets. Study 1 revealed no relevant clinical studies on EAP with a psychodynamic background with an adult population. Study 2 revealed 12 publications to review predominantly addressing veterans with PTSD. The methodological limitations of most of the studies restrain the overall findings on outcome. However, overall positive effects for EAP, specifically on its experiential features and on finding interpersonal trust for patients, can be discerned. There is an apparent need for clinical studies meeting methodological standards on psychodynamic underpinned EAP methodologies in adults with intertwined personality problems and traumatization.
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Affiliation(s)
- Géza Kovács
- Faculty of Psychology, Open University, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands;
- SPEL Psychologen Putten, Garderenseweg 158, 3881 NE Putten, The Netherlands
| | - Annemiek van Dijke
- Online poli’s I-psy psyQ Brijder, Parnassia Group, Schipholpoort 20, 2034 MA Haarlem, The Netherlands;
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Putnam FW, Amaya-Jackson L, Putnam KT, Briggs EC. Synergistic adversities and behavioral problems in traumatized children and adolescents. CHILD ABUSE & NEGLECT 2020; 106:104492. [PMID: 32447141 DOI: 10.1016/j.chiabu.2020.104492] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically reactive. METHODS A sample of 10,355 clinic-referred youth (1.5-18 years) from the National Child Traumatic Stress Network Core Data Set was divided by gender and categorized into salient age groups (1.5-5 years, 6-12 years, and 13-18 years). Attributable Proportion (AP), a biomedically relevant metric, was calculated to assess additive synergy for behavior problems on the CBCL. RESULTS Overall, only four pairs of adversities were synergistic. Three involved sexual abuse with physical abuse, parental loss, and domestic violence. When the sample was analyzed by Gender X Age group, however, a more complicated picture emerges. Twelve of the twenty-one possible pairings (57 %) show additive synergy in one or more categories. The mean AP accounted for approximately 40 % of outcome variance. Males had more synergistic pairings (16) than females (7). The average synergistic effect was higher for males (42 % of variance) than females (36 % of variance). The vast majority of synergy occurs in the 6-12 and 13-18 age groups. Sexual abuse was the most synergistically reactive trauma, pairing most frequently (16) followed by physical abuse (10) or neglect (9). CONCLUSION Sexual abuse was malignantly synergistic, frequently pairing with other adversities, followed by physical abuse, neglect, and domestic violence. The findings underscore that all ACEs are not equal in their contributions to commonly assessed outcomes. The findings also have considerable implications for prevention, intervention, and future research.
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Affiliation(s)
- Frank W Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, United States
| | - Lisa Amaya-Jackson
- UCLA/Duke University National Center for Child Traumatic Stress, Duke University School of Medicine, Durham, NC, United States
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, United States
| | - Ernestine C Briggs
- UCLA/Duke University National Center for Child Traumatic Stress, Duke University School of Medicine, Durham, NC, United States.
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Specific adverse childhood experiences and their association with other adverse childhood experiences, asthma and emotional, developmental and behavioral problems in childhood. Pediatr Res 2020; 88:100-109. [PMID: 32051534 PMCID: PMC8104128 DOI: 10.1038/s41390-020-0784-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/19/2019] [Accepted: 11/23/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have lifelong health consequences, yet screening remains challenging. Particularly in clinical settings, brief screeners that could lead to comprehensive assessments may be more feasible. We explore how two ACEs (economic hardship, parental/caregiver divorce/separation) are associated with other ACEs, asthma, and emotional, developmental, or behavioral (EDB) problems. METHODS Using the 2016 National Survey of Children's Health, we assessed the associations between ACEs and asthma and EDB problems and calculated sensitivities, specificities and predictive values. RESULTS Parents frequently reported 1+ ACEs for their child (50.3%). Individual ACE frequency ranged from 4.2 to 29.6%; all were significantly associated with EDB problems (adjusted odds ratios (aORs): 2.2-5.1) and more ACEs confirmed higher odds. Two ACES (economic hardship, parental/caregiver divorce/separation) co-occurred frequently with other ACEs, having either predicted EDB problems similarly to other ACEs (aORs 1.8; 95% CI 1.4, 2.3) and having both greatly increased odds (aOR 3.8; 95% CI 2.8, 5.2). The negative predictive value of EDB problems associated with citing neither ACE was high (95.7%). Similar trends with asthma were observed. CONCLUSIONS Economic hardship and caregiver separation are strongly associated with other ACEs, EDB problems and asthma. A brief screener including these ACEs may reduce clinical barriers to broader ACEs screening.
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Adverse Childhood Experiences and Addictive Behaviors in Adolescence: the Moderating Effect of Internalizing and Externalizing Symptoms. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Kovensky R, Anderson D, Leve LD. Early Adversity and Sexual Risk in Adolescence: Externalizing Behaviors as a Mediator. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:173-184. [PMID: 32549929 PMCID: PMC7289910 DOI: 10.1007/s40653-019-00278-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual risk behavior in adolescence can result in serious health consequences that persist across the lifespan, particularly for female youth. While adverse childhood experiences (ACEs) are linked to engagement in sexual risk behavior later in life, little research has examined pathways that may help explain this association. To address this gap, the present study examined whether internalizing and externalizing behaviors mediated the link between (ACEs) and sexual risk behavior in female youth. We examined data from 122 adolescent girls, ages 13-18, who were involved in the juvenile justice system or receiving social supports from local agencies and schools. Girls were asked to report their exposure to ACEs and engagement in sexual risk behavior and caregivers were asked to report on girls' internalizing and externalizing behaviors. Regression analyses indicated that girls who experienced more ACEs and exhibited more externalizing behaviors demonstrated higher rates of sexual risk. Further, externalizing behaviors partially mediated the association between ACEs and sexual risk behavior. Findings suggest that increased exposure to ACEs and higher incidence of externalizing behaviors may place girls at heightened risk for sexual risk behavior. Interventions aimed at decreasing externalizing behaviors may be particularly important in reducing sexual risk behavior among at-risk female youth.
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Affiliation(s)
- Rachel Kovensky
- Department of Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403-1215 USA
| | - Daniel Anderson
- Behavioral Research and Teaching, University of Oregon, Eugene, OR USA
| | - Leslie D. Leve
- Department of Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403-1215 USA
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The UCLA PTSD Reaction Index for DSM-5 Brief Form: A Screening Tool for Trauma-Exposed Youths. J Am Acad Child Adolesc Psychiatry 2020; 59:434-443. [PMID: 31376502 DOI: 10.1016/j.jaac.2019.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/22/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Children and adolescents who experience potentially traumatic events are at risk for developing posttraumatic stress disorder (PTSD). Although psychometrically sound measures are now available to assess these youths, brief tools are currently needed for screening purposes. Two studies were conducted to develop and validate the UCLA PTSD Reaction Index for DSM-5-Brief Form (RI-5-BF). METHOD Study 1 used item response theory models to derive the RI-5-BF from the UCLA PTSD Reaction Index for DSM-5 and assess its internal consistency using a sample of 486 trauma-exposed youths (mean age = 13.32 years, SD = 2.90) recruited through a practice research network. Study 2 used receiver operating characteristic analyses and diagnostic efficiency statistics to assess the discriminant-groups validity and clinical utility of the RI-5-BF in identifying children at different levels of PTSD risk using a sample of 41 treatment-seeking youths (mean age = 12.44 years, SD = 2.99). RESULTS In study 1, item response theory models identified the 11 most informative items across their respective subscales. The RI-5-BF exhibited excellent internal consistency in both studies (α > .93). In study 2, receiver operating characteristic analyses indicated that an RI-5-BF score of 21 maximized sensitivity and specificity. Moreover, diagnostic likelihood ratios across multiple levels of scores provided support for the measure's clinical utility in identifying different levels of PTSD risk. CONCLUSION These findings provide support for both the psychometric properties of the RI-5-BF as a brief screening measure for PTSD in children and adolescents and its utility for identifying youths meriting further assessment and consideration for treatment.
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Bifulco A, Schimmenti A. Assessing child abuse: "We need to talk!". CHILD ABUSE & NEGLECT 2019; 98:104236. [PMID: 31683250 DOI: 10.1016/j.chiabu.2019.104236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This discussion paper adds to the recent critical debate concerning retrospective measurement of childhood abuse and adverse experiences. A series of recent articles found only modest overlap of prospective informant-based records with retrospective self-report questionnaires, with biases evident in the latter. However, this literature has omitted the use of investigator-based interviews as an alternative retrospective tool for triangulation of measurement. Validated interview approaches can ascertain accurate data using expert scoring that can be used to test both dose-effect and specificity analyses for further research and treatment purposes. OBJECTIVE Arguments for the retention and further promotion of intensive interview measures for retrospective assessment of childhood neglect and abuse in relation to lifetime clinical outcomes are presented, with illustrative analyses. METHOD AND RESULTS A network analytic approach is outlined, with six types of childhood abuse or neglect experiences scored via a well-validated interview (the Childhood Experiences of Care and Abuse). This indicates distinct pathways between types of neglect and abuse, but also from more common emotional abuse (antipathy, critical parenting) through to more pernicious psychological abuse (coercive, sadistic control) involving physical abuse or sexual abuse pathways. This is supplemented by a case vignette to illustrate the different pathways indicated. CONCLUSIONS The interview approach gives victims a voice with their narrative (chance to talk) needed for better understanding of the specific dynamics of child abuse and neglect and for an entry into psychotherapeutic work. We need to ensure that such methods are retained in the research and practitioner portfolio of measurement tools.
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Affiliation(s)
- Antonia Bifulco
- Department of Psychology, Middlesex University, The Burroughs, Hendon, London, UK.
| | - Adriano Schimmenti
- Facuty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, snc D6, Enna, Italy.
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Negriff S. ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence. Soc Sci Med 2019; 245:112696. [PMID: 31785426 DOI: 10.1016/j.socscimed.2019.112696] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Abstract
RATIONALE Adverse Childhood Experiences (ACEs) have shown substantial effects on health across the lifespan. However, many studies on this topic discount the individual items as well as the distinction between household dysfunction and maltreatment experiences. OBJECTIVE The current study examined individual ACEs items as well as the relative contribution of the household dysfunction scale versus the childhood maltreatment scale for predicting mental health outcomes in adolescence. Lastly, we examined the utility of a cut-off score for ACEs in predicting mental health. METHODS Data were from Time 4 of a longitudinal study of the effects of maltreatment on adolescent development (n = 352; Mean age = 18). Self reported ACEs were assessed via structured interview and mapped onto the original ACEs questionnaire (Kaiser-CDC). Mental health outcomes were symptoms of depression, anxiety, trauma, and externalizing behavior. RESULTS MANCOVA showed few mean differences between those endorsing 'yes' versus 'no' for the household dysfunction items, with the exception of witnessing parental Intimate Partner Violence (IPV). Those who endorsed witnessign IPV reported more symptoms of depression, anxiety, and trauma. On the other hand, all of the maltreatment items were asscociated with significantly higher scores on at least three of the four outcomes for those endorsing versus not. Sexual abuse and physical abuse were associated with symptoms of depression, trauma, and externalizing behavior. Neglect was associated with depressive, trauma, and anxiety symptoms. Emotional abuse and emotional neglect were both associated with all four mental health outcomes. When household dysfunction and maltreatment sum scores were entered into the model together, maltreatment primarily accounted for mental health symptoms. Finally, our results did not indicate a meaningful cutoff for the number of ACEs needed to predict mental health outcomes. CONCLUSIONS Our findings support the assessment of maltreatment events as more salient than household dysfunction in mental health treatment and caution health providers against only using the total ACEs score in clinical decision-making.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA 91101, United States.
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McWhorter KL, Parks CG, D’Aloisio AA, Rojo-Wissar DM, Sandler DP, Jackson CL. Traumatic childhood experiences and multiple dimensions of poor sleep among adult women. Sleep 2019; 42:zsz108. [PMID: 31260523 PMCID: PMC6941710 DOI: 10.1093/sleep/zsz108] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 03/29/2019] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Exposure to traumatic childhood experiences (TCEs) may contribute to poor sleep in adulthood. Previous studies have been limited to mainly investigating physical and sexual abuse and did not consider betrayal trauma, or whether the victim regarded the perpetrator as someone socially close to them, the age group at occurrence, and trauma-related distress/anxiety. METHODS We used a large cohort of US women, 35-74 years old, enrolled in the Sister Study from 2003 to 2009. Self-reports of specific TCEs occurring before the age of 18 years included sexual, physical, and psychological/emotional trauma; natural disasters; major accidents; and household dysfunction. Participants self-reported average sleep duration (short: <7 hours vs recommended: 7-9 hours), sleep onset latency (SOL) at least 30 vs less than 30 minutes, at least 3 night awakenings once asleep at least 3 times/week (Night awakenings [NA], yes vs no), and napping at least 3 vs less than 3 times/week. RESULTS Among 40 082 women, 55% reported a TCE, with 82% reporting betrayal trauma. Compared to women reporting no TCE, women with any TCE were more likely to report short sleep (prevalence ratio [PR] = 1.08, [95% confidence interval (CI) = 1.04 to 1.11]), longer SOL (1.11, [1.06 to 1.16]), frequent NAs (1.06, [1.00 to 1.11]), and frequent napping (1.05, [0.99 to 1.12]). The relationship between experiencing any TCE and short sleep was stronger for TCEs by a perpetrator considered socially close vs not close (1.12, [1.09 to 1.16]), SOL (1.27, [1.22 to 1.33]), NA (1.20, [1.14 to 1.27]), and napping (1.24, [1.17 to 1.32]). CONCLUSIONS TCEs were associated with poor sleep in women with greater impact when the perpetrator was regarded as close. More research is warranted to better understand pathways between childhood trauma and sleep health in adulthood to develop effective interventions.
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Affiliation(s)
- Ketrell L McWhorter
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | | | - Darlynn M Rojo-Wissar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
- Intramural Program, National Institute on Minority Health and Health Disparities, Department of Health and Human Services, Bethesda, MD
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Weiss MD, McBride NM, Brandt T, Esmaeilpour D, Jensen P. Symptom Profiles Specific to Trauma in a Child Inpatient Unit. J Am Acad Child Adolesc Psychiatry 2019; 58:818-820.e1. [PMID: 30953733 DOI: 10.1016/j.jaac.2019.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/10/2019] [Accepted: 03/28/2019] [Indexed: 11/25/2022]
Abstract
Adverse childhood experiences (ACE) score showing 4 or more types of trauma have been shown to be a strong predictor of deleterious outcomes.1 We report here on the relationship between ACE or number of trauma types, and symptom profile as measured by the Child Behavior Checklist (CBCL) of children on an inpatient unit. Previous work has been limited to samples preselected for trauma, thus limiting the ability to identify whether the clinical presentation of trauma has unique attributes when compared to a clinical sample of comparable severity.
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Affiliation(s)
| | - Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Tiffany Brandt
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Dianna Esmaeilpour
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock
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Choi KR, Ford JD, Briggs EC, Munro-Kramer ML, Graham-Bermann SA, Seng JS. Relationships Between Maltreatment, Posttraumatic Symptomatology, and the Dissociative Subtype of PTSD Among Adolescents. J Trauma Dissociation 2019; 20:212-227. [PMID: 30714854 PMCID: PMC6407637 DOI: 10.1080/15299732.2019.1572043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to explore relationships between maltreatment, posttraumatic stress disorder, and the dissociative subtype of posttraumatic stress disorder among adolescents. This descriptive study used secondary data from the National Child Traumatic Stress Network Core Data Set. A clinical sample of adolescents exposed to potentially traumatizing events ages 12 to 16 was selected (N = 3081) to explore associations between trauma history characteristics, sociodemographic factors, posttraumatic stress disorder, and the dissociative subtype of PTSD which includes depersonalization and derealization. More than half of adolescents who met criteria for posttraumatic stress disorder also met criteria for the posttraumatic stress disorder dissociative subtype with significant depersonalization/derealization symptoms. No particular maltreatment type was associated with increased odds of posttraumatic stress disorder, with or without the dissociative subtype. All posttraumatic stress disorder-affected adolescents, with or without the dissociative subtype, experienced more overall potentially traumatizing events and maltreatment events than those without a posttraumatic stress disorder diagnosis. Girls and adolescents in residential treatment were more likely to have posttraumatic stress disorder with the dissociative subtype. This study provides evidence about the dissociative subtype of posttraumatic stress disorder among adolescents and provides new directions for research on trauma and dissociation. Future research studies should explore the co-occurrence of posttraumatic stress disorder and dissociation with broader range of dissociative symptoms than only depersonalization/derealization to further understand how to diagnose and treat traumatic stress disorders among adolescents.
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Affiliation(s)
- Kristen R Choi
- a Division of General Internal Medicine & Health Services Research , University of California Los Angeles , Los Angeles , California , USA
| | - Julian D Ford
- b University of Connecticut , Farmington , Connecticut , USA
| | | | | | | | - Julia S Seng
- d University of Michigan , Ann Arbor , Michigan , USA
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Hodgdon HB, Spinazzola J, Briggs EC, Liang LJ, Steinberg AM, Layne CM. Maltreatment type, exposure characteristics, and mental health outcomes among clinic referred trauma-exposed youth. CHILD ABUSE & NEGLECT 2018; 82:12-22. [PMID: 29852362 DOI: 10.1016/j.chiabu.2018.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches.
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Affiliation(s)
- Hilary B Hodgdon
- The Trauma Center at Justice Resource Institute, Brookline, MA, United States; Suffolk University, Department of Psychology, Boston, MA, United States.
| | | | - Ernestine C Briggs
- UCLA-Duke University National Center for Child Traumatic Stress, Durham, NC, United States; Duke University School of Medicine, United States
| | - Li-Jung Liang
- University of California, Los Angeles School of Medicine, United States
| | - Alan M Steinberg
- UCLA-Duke University National Center for Child Traumatic Stress, University of California, Los Angles, United States
| | - Christopher M Layne
- UCLA-Duke University National Center for Child Traumatic Stress, University of California, Los Angles, United States
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Barnett ER, Jankowski MK, Butcher RL, Meister C, Parton RR, Drake RE. Foster and Adoptive Parent Perspectives on Needs and Services: a Mixed Methods Study. J Behav Health Serv Res 2018; 45:74-89. [PMID: 28852992 DOI: 10.1007/s11414-017-9569-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Caring for children with complex needs severely stresses foster and adoptive parents, but few studies have examined their perspectives on needs and services. To examine parental views, the authors analyzed four focus groups (n = 27 participants) and one state-wide survey (n = 512 respondents, 42% of 1206 contacted) of foster and adoptive parents in one state. Results highlighted inadequate communication between providers and families, cultural and legal barriers, needs for parent training and preparation, the importance of several types of parent supports, and needs for specialized mental health treatment for the children. Surveyed parents identified children's behavior problems as their top challenge, and over half rated the availability of mental health providers who treat attachment and family as insufficient. The findings suggest specific areas in which state leaders could enhance training and supports for child welfare staff and foster and adoptive parents and improve mental health services for children in foster and adoptive care.
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Affiliation(s)
- Erin R Barnett
- Department of Psychiatry, Dartmouth Trauma Interventions Research Center, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Mary K Jankowski
- Department of Psychiatry, Dartmouth Trauma Interventions Research Center, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Rebecca L Butcher
- Center for Program Design and Evaluation at Dartmouth, 21 Lafayette #373, Lebanon, NH, 03756, USA
| | - Catherine Meister
- New Hampshire Division of Children Youth and Families, 129 Pleasant St, Concord, NH, 03301, USA
| | - Rebecca R Parton
- Department of Psychiatry, Dartmouth Trauma Interventions Research Center, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Robert E Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH, 03766, USA
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Using an adoption-biological family design to examine associations between maternal trauma, maternal depressive symptoms, and child internalizing and externalizing behaviors. Dev Psychopathol 2018; 29:1707-1720. [PMID: 29162177 DOI: 10.1017/s0954579417001341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Maternal trauma is a complex risk factor that has been linked to adverse child outcomes, yet the mechanisms underlying this association are not well understood. This study, which included adoptive and biological families, examined the heritable and environmental mechanisms by which maternal trauma and associated depressive symptoms are linked to child internalizing and externalizing behaviors. Path analyses were used to analyze data from 541 adoptive mother-adopted child (AM-AC) dyads and 126 biological mother-biological child (BM-BC) dyads; the two family types were linked through the same biological mother. Rearing mother's trauma was associated with child internalizing and externalizing behaviors in AM-AC and BM-BC dyads, and this association was mediated by rearing mothers' depressive symptoms, with the exception of biological child externalizing behavior, for which biological mother trauma had a direct influence only. Significant associations between maternal trauma and child behavior in dyads that share only environment (i.e., AM-AC dyads) suggest an environmental mechanism of influence for maternal trauma. Significant associations were also observed between maternal depressive symptoms and child internalizing and externalizing behavior in dyads that were only genetically related, with no shared environment (i.e., BM-AC dyads), suggesting a heritable pathway of influence via maternal depressive symptoms.
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Darnell D, Flaster A, Hendricks K, Kerbrat A, Comtois KA. Adolescent clinical populations and associations between trauma and behavioral and emotional problems. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:266-273. [PMID: 29723033 DOI: 10.1037/tra0000371] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Trauma exposure is common during childhood and adolescence and is associated with youth emotional and behavioral problems. The present study adds to the current literature on trauma exposure among adolescent clinical populations by examining the association between trauma exposure and adolescent self-report of emotional and behavioral problems broadly, including internalizing and externalizing symptoms, in addition to the trauma-specific symptoms of posttraumatic stress disorder (PTSD). METHOD This study included 94 female (64%) and male (36%) adolescents, ages 13-19, representing 4 clinical populations: those seeking inpatient psychiatry, outpatient psychiatry, residential substance abuse, and outpatient medical services. Adolescents self-reported trauma history and internalizing, externalizing, and PTSD symptoms. RESULTS Most adolescents reported experiencing at least 1 traumatic event (83%; M = 2.28, SD = 1.83). Multiple regression analyses controlling for age, race/ethnicity, gender, and treatment setting indicated a greater number of types of trauma are associated with externalizing symptoms (β = .31, p < .01) and PTSD symptoms (β = .35, p < .01). CONCLUSION Trauma is a common experience among adolescents, particularly those presenting for behavioral health services, making trauma-informed care essential in these service delivery settings. Treatment that addresses adolescent risk behaviors and prevents recurrent trauma may be particularly important given the negative impact of multiple traumatic events on developing adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Doyanne Darnell
- Department of Psychiatry & Behavioral Sciences, University of Washington
| | - Aaron Flaster
- Department of Psychiatry & Behavioral Sciences, University of Washington
| | - Karin Hendricks
- Department of Psychiatry & Behavioral Sciences, University of Washington
| | - Amanda Kerbrat
- Department of Psychiatry & Behavioral Sciences, University of Washington
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Garrido EF, Weiler LM, Taussig HN. Adverse Childhood Experiences and Health-Risk Behaviors in Vulnerable Early Adolescents. THE JOURNAL OF EARLY ADOLESCENCE 2018; 38:661-680. [PMID: 29861530 PMCID: PMC5976451 DOI: 10.1177/0272431616687671] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Adverse childhood experiences (ACEs) are associated with health-risk behaviors in general samples of adults and adolescents. The current study examined the association between ACEs and these behaviors among a high-risk sample of early adolescents. Five hundred and fifteen 9-11-year-old children placed in foster care due to maltreatment were interviewed about their engagement in violence, substance use, and delinquency. A multi-informant ACEs score was derived based on exposure to six adverse experiences. Regression analyses examined the relationship between ACEs and risk behaviors and the potential moderating effects of age, sex, and minority status. ACE scores were predictive of risk behaviors after controlling for age, sex, and minority status. Although males and older youth were more likely to engage in risk behaviors, none of the demographic characteristics moderated the ACE-risk behavior association. This study extends previous research by demonstrating an association between ACEs and risk behaviors in extremely vulnerable early adolescents.
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Affiliation(s)
- Edward F. Garrido
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, 13123 E 16 Ave, B390, Aurora, CO 80045, United States of America
| | - Lindsey M. Weiler
- Department of Family Social Science, University of Minnesota, 1985 Buford Ave #290, St Paul, MN 55108, United States of America
| | - Heather N. Taussig
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, 13123 E 16 Ave, B390, Aurora, CO 80045, United States of America
- Graduate School of Social Work, University of Denver, 2148 S High St., Denver, CO 80208, United States of America
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44
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Cummings JA. Transformational change in parenting practices after child interpersonal trauma: A grounded theory examination of parental response. CHILD ABUSE & NEGLECT 2018; 76:117-128. [PMID: 29101832 DOI: 10.1016/j.chiabu.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Child interpersonal trauma is associated with a host of negative outcomes, both concurrently and in adulthood. Parental responses following trauma can play an important role in modulating child responses, symptoms, and post-trauma functioning. However, parents themselves are also impacted after their child experiences trauma, reporting distress, psychopathology, concerns about the child's safety, changes in discipline and protectiveness, and feelings of blame. Most of this previous research, however, suffers from methodological limitations such as focusing on description and correlations, providing static "one shot" assessments of parenting after trauma, and relying mainly on results related to child sexual abuse. This project developed a comprehensive, explanatory theory of the dynamic process by which parenting changes in response to a range of child trauma, using a sample of parents whose children had experienced a range of interpersonal trauma types. Grounded theory analyses revealed a three-phase dynamic model of discontinuous transformation, in which parents experienced destabilization, recalibration, and re-stabilization of parenting practices in response to child trauma. Parents were focused on Protecting and Healing the child victim, often at the expense of their own needs. Most parents reached a phase of posttraumatic growth, labelled Thriving Recovery, but processes that hindered this recovery are also discussed. This study provides the first evidence that dynamic systems of change as well as vicarious posttraumatic growth can apply to parents of child trauma victims. Generating an explanatory theory provides important avenues for future research as well as interventions and services aimed at families who have experienced child trauma.
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Affiliation(s)
- Jorden A Cummings
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK, Canada.
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45
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Choi KR, Seng JS, Briggs EC, Munro-Kramer ML, Graham-Bermann SA, Lee RC, Ford JD. The Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) Among Adolescents: Co-Occurring PTSD, Depersonalization/Derealization, and Other Dissociation Symptoms. J Am Acad Child Adolesc Psychiatry 2017; 56:1062-1072. [PMID: 29173740 PMCID: PMC5726572 DOI: 10.1016/j.jaac.2017.09.425] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/08/2017] [Accepted: 09/26/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms. METHOD A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology. RESULTS Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal. CONCLUSION These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses.
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46
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Gomez B, Peh CX, Cheok C, Guo S. Adverse childhood experiences and illicit drug use in adolescents: Findings from a national addictions treatment population in Singapore. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1348558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Brenda Gomez
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Chao Xu Peh
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Christopher Cheok
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Song Guo
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
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47
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Garcia AR, Gupta M, Greeson JKP, Thompson A, DeNard C. Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing. CHILD ABUSE & NEGLECT 2017; 70:292-302. [PMID: 28668759 DOI: 10.1016/j.chiabu.2017.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.
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Affiliation(s)
- Antonio R Garcia
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States.
| | - Meera Gupta
- Division of Transplant Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA 19104, United States
| | - Johanna K P Greeson
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
| | - Allison Thompson
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
| | - Christina DeNard
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
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48
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Kinner SA, Borschmann R. Inequality and intergenerational transmission of complex adversity. LANCET PUBLIC HEALTH 2017; 2:e342-e343. [PMID: 29253468 DOI: 10.1016/s2468-2667(17)30139-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Stuart A Kinner
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Melbourne, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Mater Research Institute-UQ, University of Queensland, QLD, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Griffith Criminology Institute, Griffith University, QLD, Australia.
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Melbourne, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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49
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Bryson SA, Gauvin E, Jamieson A, Rathgeber M, Faulkner-Gibson L, Bell S, Davidson J, Russel J, Burke S. What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. Int J Ment Health Syst 2017; 11:36. [PMID: 28503194 PMCID: PMC5425975 DOI: 10.1186/s13033-017-0137-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate trauma sequelae. Common practices, such as seclusion and restraint, put young people at risk of retraumatization, development of comorbid psychopathology, injury, and even death. In response, psychiatric and residential facilities have embraced trauma-informed care (TIC), an organizational change strategy which aligns service delivery with treatment principles and discrete interventions designed to reduce rates of retraumatization through responsive and non-coercive staff-client interactions. After more than two decades, a number of TIC frameworks and approaches have shown favorable results. Largely unexamined, however, are the features that lead to successful implementation of TIC, especially in child and adolescent inpatient psychiatric and residential settings. METHODS Using methods proposed by Pawson et al. (J Health Serv Res Policy 10:21-34, 2005), we conducted a modified five-stage realist systematic review of peer-reviewed TIC literature. We rigorously searched ten electronic databases for peer reviewed publications appearing between 2000 and 2015 linking terms "trauma-informed" and "child*" or "youth," plus "inpatient" or "residential" plus "psych*" or "mental." After screening 693 unique abstracts, we selected 13 articles which described TIC interventions in youth psychiatric or residential settings. We designed a theoretically-based evaluative framework using the active implementation cycles of the National Implementation Research Network (NIRN) to discern which foci were associated with effective TIC implementation. Excluded were statewide mental health initiatives and TIC implementations in outpatient mental health, child welfare, and education settings. Interventions examined included: Attachment, Self-Regulation, and Competency Framework; Six Core Strategies; Collaborative Problem Solving; Sanctuary Model; Risking Connection; and the Fairy Tale Model. RESULTS Five factors were instrumental in implementing trauma informed care across a spectrum of initiatives: senior leadership commitment, sufficient staff support, amplifying the voices of patients and families, aligning policy and programming with trauma informed principles, and using data to help motivate change. CONCLUSIONS Reduction or elimination of coercive measures may be achieved by explicitly targeting specific coercive measures or by implementing broader therapeutic models. Additional research is needed to evaluate the efficacy of both approaches.
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Affiliation(s)
- Stephanie A. Bryson
- Portland State University, School of Social Work, 1800 SW 6th, Building ASRC 620G, Portland, OR 97207-0751 USA
| | - Emma Gauvin
- University of British Columbia, School of Social Work, 2080 West Mall, Vancouver, BC V6T 1Z2 Canada
| | - Ally Jamieson
- University of British Columbia, School of Social Work, 2080 West Mall, Vancouver, BC V6T 1Z2 Canada
| | - Melanie Rathgeber
- Mental Health, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Lorelei Faulkner-Gibson
- Children’s & Women’s Hospitals and Health Centre, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Sarah Bell
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Jana Davidson
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Jennifer Russel
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Sharlynne Burke
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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50
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Sege RD, Amaya-Jackson L, Flaherty EG, Idzerda SM, Legano LA, Leventhal JM, Lukefahr JL, Sege RD. Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment. Pediatrics 2017; 139:peds.2017-0100. [PMID: 28320870 DOI: 10.1542/peds.2017-0100] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children who have suffered early abuse or neglect may later present with significant health and behavior problems that may persist long after the abusive or neglectful environment has been remediated. Neurobiological research suggests that early maltreatment may result in an altered psychological and physiologic response to stressful stimuli, a response that deleteriously affects the child's subsequent development. Pediatricians can assist caregivers by helping them recognize the abused or neglected child's emotional and behavioral responses associated with child maltreatment and guide them in the use of positive parenting strategies, referring the children and families to evidence-based therapeutic treatment and mobilizing available community resources.
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Affiliation(s)
- Robert D. Sege
- Health Resources in Action, Boston, Massachusetts
- Center for the Study of Social Policy, Washington District of Columbia; and
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, UCLA-Duke National Center for Child Traumatic Stress, Center for Child & Family Health, Duke University School of Medicine, Durham, North Carolina
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