Adverse behavioral and emotional outcomes from child abuse and witnessed violence

Maltreatment in Daycare Settings: A Review of Empirical Studies in the Field

Daycare maltreatment refers to abusive and/or neglectful acts perpetrated by teachers, directors, non-professionals or volunteers, family members of staff, and peers in a daycare setting. Despite growing evidence of its occurrence, the prevalence and consequences of daycare maltreatment for the child, the parent(s), and their dyad are largely unknown. This qualitative systematic literature review was conducted to synthesize the existing literature referring to daycare maltreatment, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In order to be included in the analysis, the manuscripts needed to report empirical findings regarding maltreatment in daycare settings, be written in English, be published in a peer-reviewed journal or a dissertation, and be accessible by our research team. In all, 25 manuscripts met the above criteria and were included in the review. Our results indicate that reports of daycare maltreatment are characterized by early age of abused children, inferring mainly to sexual, physical, and emotional abuse. The majority of these manuscripts reported caregivers' and teachers' abuse, while peer victimization was reported much less. In addition, the findings demonstrated a higher representation of female perpetrators compared to abuse in other scenarios. Although some indications of long-term implications are reported in the manuscripts, a well-validated measure for assessment of daycare maltreatment seems to be lacking. These findings contribute to a more nuanced understanding of the complex experience and ramifications of daycare maltreatment, providing insight into its multi-faceted implications.

Multi-level analysis of the determinants of physical domestic violence against children using longitudinal data from MINIMat mother-child cohort in Bangladesh

Objectives

Despite high levels of physical violence against children (VAC) globally (40-50%), the literature on the determinants of VAC remains inconclusive. Most of the literature on this topic is based on cross-sectional data, and the multi-level nature of the drivers of VAC is widely ignored. This leads to model specification problems and an inability to draw causal inferences. Moreover, despite the higher prevalence of VAC in low-and middle-income countries, studies from high income countries dominate the field. We examined the determinants of physical domestic VAC to address these gaps in the literature.

Methods

Data were collected between 2001 and 2020 from 762 mother-child dyads recruited in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study in Bangladesh. We conducted multi-level logistic regression analyses to identify the determinants of physical domestic VAC.

Results

Prevalence of physical domestic violence against girls (69%) and boys (62%) was extremely high. Community-level prevalence of physical domestic VAC increased the likelihood of physical domestic VAC at the individual level across gender (girls - OR-5.66; 95% CI- 3.11-10.32; boys - OR-7.67; CI- 3.95-14.91). While physical domestic violence against mothers was not associated with physical domestic violence against girls, it reduced the likelihood of such violence against boys by 47%. Having 3 or more siblings predicted physical domestic violence against girls (OR-1.97; 95% CI- 1.01-3.81 for 3 siblings; OR-4.58; 95% CI- 2.12-9.90 for 4 or more siblings), but not against boys. While girls in Hindu families were more likely to experience this violence, the boys were not. Mother's education, employment non-governmental organization (NGO) participation and, household wealth did not predict this violence against any gender.

Conclusion

We contend that physical domestic violence against mothers reflects an emphasized patriarchal culture in a family where a boy is less likely to experience physical domestic violence. Social norms and social learning theories explain the greater likelihood of a child experiencing physical domestic violence in a village with a higher level of such violence. We conclude that social norms around physical domestic VAC and patriarchal culture need to be changed to effectively address this violence.

Mental Health and Violence in Children and Adolescents

This article examines the complex interplay between mental health and violence among children. Although children with mental illness are more likely to be victims of violence than perpetrators, this article describes the few mental health conditions associated with increased violent behavior among children. Next, the authors examine the spectrum of mental health sequelae among children following exposure to various forms of violence. Lastly, the authors discuss the underutilization of mental health services in this population and highlight screening and intervention tools available to pediatric clinicians caring for children exposed to violence.

Validity and reliability of the 10-Item Adverse Childhood Experiences Questionnaire (ACE-10) among adolescents in the child welfare system

Introduction

Multiple evidence suggests that the vast majority of children in the Child Welfare System (CWS) are victims of early, chronic, and multiple adverse childhood experiences. However, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10) has never been tested in such a particularly vulnerable population as adolescents living in the CWS. We aimed to assess the psychometric properties of the ACE-10 in a community sample of 240 Hungarian adolescents placed in family style group care (FGC) setting.

Methods

Demographic data, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Bullying Measure were used.

Results

Our results showed acceptable internal consistency (α = 0.701) and item-total correlations (rpb = 0.25-0.65, p < 0.001). However, our results also reflect that item 6 ("Parental separation/divorce") is weakly correlated with both the cumulative ACE score and the rest of the questionnaire items. When item 6 is removed, the 9-item version of the ACE produces more favorable consistency results (α = 0.729). Strong and significant associations of the cumulative ACE score with emotional and behavioral symptoms and bully victimization confirm the concurrent criterion validity of both versions of the instrument.

Discussion

Our findings suggest that ACE-9 and ACE-10 are viable screening tools for adverse childhood experiences in the CWS contributing to the advancement of trauma-informed care. We recommend considering the use of either the 9-item or the 10- item version in the light of the characteristics of the surveyed population. The implications and limitations are discussed.

Adverse childhood experiences of emotional and physical abuse and emotional and behavioral problems: the mediating effects of family function and resilience

Adverse childhood experiences are a widespread phenomenon that can have a variety of negative effects on children. Emotional and behavioral problems (EBP) in children have been gaining interest in recent years. Therefore, this study aims to explore the association between emotional and physical abuse (EPA) and preschool children's EBP, as well as to assess the mediating effects of family function and resilience in this association. A cross-sectional study was conducted, and we recruited 3,636 participants from 26 kindergartens in three cities. Correlation analysis and regression analysis were used to test the relationships between EPA, mediators (family function and resilience), and EBP. Structural equation modeling was used to perform the mediation analyses. The results of this study showed that EPA predicted EBP in preschool children, family function, and resilience independently and in combination to mediate the relationship. Therefore, improving family function and increasing children's level of resilience are beneficial methods for the prevention and intervention of EBP in preschool children who experience EPA, but most fundamentally to avoid or reduce the occurrence of abuse. Further longitudinal studies are needed to confirm our findings and explore possible mediating mechanisms.

Psychometric properties of the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) among Hungarian adolescents

Introduction

Although a number of studies have been conducted since the 1995 initiation of the ACE study to map the effects of adverse childhood experiences, few studies have examined the psychometric properties of the individual versions of the ACE questionnaire.

Aims

The Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) has only been tested in a single study in an adult population, while its applicability in a particularly vulnerable population, the adolescents, has not been investigated yet. Our present study aims to address this gap in an adolescent sample of 792 subjects from a non-representative general population.

Methods

Besides demographic data, the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Symptom Checklist (HBSC-SCL) were employed.

Results

Our results showed acceptable internal consistency (ɵ = 0.86, α = 0.64) and adequate internal validity (r = 0.28-0.70, p < 0.001). In addition, proper concurrent criterion validity of the questionnaire was found when tested along the SDQ and HBSC-SCL items.

Conclusion

Our results demonstrate that the ACE-10 is suitable for assessing intrafamilial adverse childhood experiences in adolescents.

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

Background

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

Objective

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

Participants and setting

Analyses were conducted on 795 participants in the NSCAW dataset.

Methods

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

Results

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

Conclusions

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

Violence Exposure and Mental Health Consequences Among Urban Youth

Urban residents are disproportionately affected by violence exposure and mental health consequences as compared to non-urban residents. The present study examined the prevalence of violence exposure and associated mental health consequences among urban and non-urban youth. Urban participants were drawn from Detroit, Michigan, a city that has led the nation for most of the last decade as one of the most violent big cities in the U.S. Participants included 32 Detroit youth and 32 youth recruited from the surrounding non-urban areas, matched on age (M=10.4±2.8 years) and sex (49% male). Youth completed validated measures of violence exposure, anxiety, and depression symptoms. Urban youth reported more violence exposures than their non-urban counterparts, including hearing gunshots (69% vs. 19%, respectively), witnessing a shooting (24% vs. 6%), and witnessing an arrest (58% vs. 27%). Overall, greater violence exposure was associated with more anxiety symptoms, particularly among urban youth. Although violence exposure was not associated with depressive symptoms overall, urban youth reported significantly higher depressive symptoms than non-urban youth. Exposure to specific violence types, particularly hearing gunshots, was associated with higher anxiety and depressive symptoms among urban but not non-urban youth. Being beat up predicted depressive symptoms among non-urban but not urban youth. Household income and community distress did not predict mental health outcomes. Taken together, urban youth have more exposure to violence, particularly firearm violence, and associated mental health problems than their non-urban counterparts. Targeted community-wide initiatives to prevent violence and identify exposed youth are needed to improve mental health in at-risk communities.

Child Maltreatment, Peer Victimization, and Mental Health: Neurocognitive Perspectives on the Cycle of Victimization

Children who experience maltreatment are at increased risk of revictimization across the life span. In childhood, this risk often manifests as peer victimization. Understanding the nature of this risk, and its impact on mental health, is critical if we are to provide effective support for those children who are most vulnerable. A systematic scoping review was conducted using Google Scholar and PsycINFO. Studies on adults, psychiatric, and/or inpatient populations were excluded. Included studies concerned all forms of child maltreatment and peer victimization. We found 28 studies about the association between maltreatment experience and peer victimization as well as peer rejection. We review the evidence documenting the relation between these adverse childhood experiences and mental health. The evidence suggests that maltreatment and peer victimization have additive effects on mental health outcomes. A number of theoretical developmental frameworks that delineate putative mechanisms that might account for an association are considered. Building on prior research, we then discuss the role of recent neurocognitive findings in providing a multilevel framework for conceptualizing mental health vulnerability following maltreatment. In addition, we consider how altered neurocognitive functioning following maltreatment may shed light on why affected children are more likely to be victimized by their peers. Specifically, we consider the threat, reward, and autobiographical memory systems and their role in relation to stress generation, stress susceptibility, and social thinning. Such a mechanistic understanding is necessary if we are to reduce the likelihood of peer victimization in children exposed to maltreatment, and move to a preventative model of mental health care.

Association between Child Abuse, Depression, and School Bullying among Chinese Secondary School Students

INTRODUCTION

School bullying is a serious social and public health problem. This article aims to explore the association between experiences of childhood abuse and involvement in school bullying, especially considering the mediating effects of depression.

METHODS

The sample of this study was 3059 students (1584 males and 1475 females) aged from 12 to 20, in eleven Chinese secondary schools, which included six middle schools, four high schools, and one vocational high school in both urban and rural areas. The multinomial logit regression and linear regression were conducted by the two gender groups, to determine the mediating effect of depression in the association between child abuse experiences and involvement in school bullying.

RESULTS

This study indicated that female students were less likely to be involved in school bullying. Male students were more represented in the bully-victim group and experienced more physical and mental abuse during childhood. Depression was a mediator between childhood abuse and involvement in school bullying. Nevertheless, there was a gender difference in that depression fully mediated the relationship between the two variables among female students, while it only partially meditated such a relationship for male students.

CONCLUSIONS

These findings indicate that more school-based service interventions and evidence-based research are needed to more thoroughly investigate school bullying and its predictors in China.

Anger and Attention Problems as Mechanisms Linking Maltreatment Subtypes and Witnessed Violence to Social Functioning Among Children in Out-of-Home Care

Research has consistently shown that child maltreatment and witnessed violence lead to disrupted patterns of social functioning, yet the mechanisms underlying these pathways remain unclear. This cross-sectional study evaluated whether anger and/or attention problems mediated the links from abuse, neglect, and witnessed violence to peer problems and aggressive behavior. Participants included a diverse sample of 470 children (ages 8-11; 52.1% boys) living in out-of-home care. Subtype and severity of maltreatment exposure were coded using Child Protection Services' intake reports and court records. Witnessed violence and anger were assessed using child-reports, and caregivers provided ratings of attention problems and social functioning. Indirect effects were tested using a series of structural equation path analysis models. Results indicated that anger fully mediated the links from witnessed violence to both peer problems and aggressive behavior. Further, attention problems fully mediated the links from physical abuse and physical neglect to both peer problems and aggressive behavior. These findings highlight the need for interventions to target anger regulation and attentional control among children in out-of-home care in order to mitigate their risk for social maladjustment.

Natural language model for automatic identification of Intimate Partner Violence reports from Twitter

Intimate partner violence (IPV) is a preventable public health problem that affects millions of people worldwide. Approximately one in four women are estimated to be or have been victims of severe violence at some point in their lives, irrespective of age, ethnicity, and economic status. Victims often report IPV experiences on social media, and automatic detection of such reports via machine learning may enable improved surveillance and targeted distribution of support and/or interventions for those in need. However, no artificial intelligence systems for automatic detection currently exists, and we attempted to address this research gap. We collected posts from Twitter using a list of IPV-related keywords, manually reviewed subsets of retrieved posts, and prepared annotation guidelines to categorize tweets into IPV-report or non-IPV-report. We annotated 6,348 tweets in total, with the inter-annotator agreement (IAA) of 0.86 (Cohen's kappa) among 1,834 double-annotated tweets. The class distribution in the annotated dataset was highly imbalanced, with only 668 posts (~11%) labeled as IPV-report. We then developed an effective natural language processing model to identify IPV-reporting tweets automatically. The developed model achieved classification F₁-scores of 0.76 for the IPV-report class and 0.97 for the non-IPV-report class. We conducted post-classification analyses to determine the causes of system errors and to ensure that the system did not exhibit biases in its decision making, particularly with respect to race and gender. Our automatic model can be an essential component for a proactive social media-based intervention and support framework, while also aiding population-level surveillance and large-scale cohort studies.

Understanding the Impact of Deviant Peer Association on Risk for Stimulant/Amphetamine Use: The Moderating Role of Exposure to Violence

Prior research has indicated that deviant peer association is associated with increased risk for stimulant/amphetamine use. However, there remain gaps in our understanding of the context under which this relationship occurs. This study examined two forms of exposure to violence (direct victimization, witnessed violence) as moderators of the relationship between deviant peer association and stimulant/amphetamine use risk. All 11 waves of the Pathways to Desistance longitudinal data were used in analyses. Mixed effects logistic regression models were used to estimate relationships of interest while accounting for repeated measures nested within individual participants across time. Findings indicated that greater deviant peer association was associated with greater odds of stimulant/amphetamine use. Experiencing direct victimization significantly moderated this relationship, but in the opposite of the hypothesized direction, with individuals reporting direct victimization also reporting less reactivity to deviant peer association as it pertained to stimulant/amphetamine use. Witnessed violence did not moderate this relationship.

Victimization history in female forensic psychiatric patients with intellectual disabilities: Results from a Dutch multicenter comparative study

BACKGROUND

Victimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care.

AIMS

The aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF.

METHODS

File data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF.

RESULTS

All forensic patients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men.

CONCLUSIONS

Victimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed.

Evaluating the Effect of Parent-Child Interactive Groups in a School-Based Parent Training Program: Parenting Behavior, Parenting Stress and Sense of Competence

The Exploring Together program is a group-based parent training program that comprises separate parent, child, and teacher components, and a combined parent-child interactive component. A cluster-randomized trial design was used to compare the Exploring Together program with (Exploring Together; ET) and without (Exploring Together-Adapted; ET-Adapted) the parent-child interactive component. One hundred and thirty-six parents and their children (aged 5-10 years) with externalizing and/or internalizing problems participated in the trial, recruited from primary schools. There was a significant reduction in negative parenting behavior across both treatment groups (ET and ET-Adapted) but no significant improvement in positive parenting behaviors. Parenting self-efficacy improved significantly across both treatment groups however there was no significant change in parenting satisfaction or parenting stress. There was no consistent evidence of superiority of one version of the Exploring Together program over the other. Further investigation regarding treatment dosage and mastery of parenting skills associated with the program is warranted.

Exploring the mediating effect of academic engagement on math and reading achievement for students who have experienced maltreatment

BACKGROUND

Students who experience maltreatment tend to underperform academically relative to their peers, requiring an understanding of academically-related mechanisms that are potential intervention targets. Academic engagement, a multidimensional construct that is influential in students' investment in learning and the school context, is one such mechanism that has been associated with positive academic outcomes and develops through interactions between students and their environment.

OBJECTIVE

The purpose of this study was to examine how maltreatment experiences and trauma symptoms were indirectly associated with academic achievement in adolescence through academic engagement.

PARTICIPANTS AND SETTING

The study was conducting on a subsample of 583 youths from the National Study of Child and Adolescent Wellbeing II (NSCAW II) cohort.

METHODS

Structural equation modeling was used to examine the indirect effect engagement on the relationship between maltreatment and trauma symptomology and academic achievement.

RESULTS

Academic engagement significantly mediated trauma symptoms and later standardized reading (β = -0.02; 95 % CI [-0.04, -0.0004]) and math (β = -0.02; 95 % CI [-0.05, -0.0003]) achievement test scores. However, similar mediating effects were not found for engagement on maltreatment and later standardized reading (β = -0.01; 95 % CI [-0.03, 0.01]) and math (β = -0.01; 95 % CI [-0.03, 0.01]) achievement test scores.

CONCLUSIONS

These findings suggest that variability in academic outcomes was indirectly associated with engagement but only for students who exhibited trauma symptoms rather than experiencing maltreatment alone. The findings suggest future researchers should consider engagement should as an academically-related mechanism to help students who were maltreated succeed academically.

Violence Against Female Adolescents in Low- and Middle-Income Countries: Evidence From 36 National Household Surveys

The goal of this article is to provide evidence on the past-year prevalence of violence against female adolescent children age 15 to 17 and test the hypothesis that higher socioeconomic status is associated with lower likelihoods of past-year violence. We used national household surveys from 36 low- and-middle-income countries to provide evidence on the prevalence of violence against 34,901 adolescents age 15 to 17 and logistic regression analysis to measure the association between socioeconomic status and past-year violence against adolescents. Among the sample population, prevalence of physical violence by nonpartners was 10.4% and by partners was 2.8%. Prevalence of sexual violence by nonpartners was 1.8% and by partners was 1.2%. Logistic regression analysis adjusted for country of residence, and demographic characteristics indicated that completing primary school was associated with higher likelihood of physical violence by nonpartner (odds ratio [OR] = 1.13, confidence interval [CI] [1.03, 1.24]) and lower likelihoods of sexual violence by nonpartner (OR = 0.66, CI [0.53, 0.83]), physical violence by partner (OR = 0.59, CI [0.49, 0.70]), and sexual violence by partner (OR = 0.48, CI [0.36, 0.63]). Total consumer durables owned was associated with reduced likelihoods of physical violence by nonpartner (OR = 0.96, CI [0.94, 0.98]), by partner (OR = 0.88, CI [0.84, 0.93]), and sexual violence by partner (OR = 0.91, CI [0.85, 0.99]). Overall, violence against adolescents as reported in the past-year experience of females age 15 to 17 is common. Primary school completion and household wealth may convey protective benefits against violence.

Lifetime Victimization in Children and Adolescents With ADHD

The objective of this study is to describe the frequency and type of victimization in a Spanish child and adolescent clinical ADHD sample and to analyze the association between the types of victimization and the severity of the symptoms. The sample is composed of 106 outpatients in treatment for ADHD, according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Symptom severity was measured by the Conners-3 scales. ADHD and comorbid diagnostics were evaluated with the Mini-Kid interview. The victimization experiences were studied using the Juvenile Victimization Questionnaire (JVQ). Children with child maltreatment history showed a greater intensity of hyperactivity/impulsivity, aggression and behavioral disorders as well as depression and anxiety disorders. The presence of peer victimization was associated with inattention, learning disorders, executive functioning, and relationship problems. Episodes of victimization should be considered in the treatment of the ADHD. Child maltreatment history is more associated with hyperactivity-impulsivity symptoms, while peer victimization is more associated with attentional symptoms.

Prevalence of violence by teachers and its association to students' emotional and behavioral problems and school performance: Findings from secondary school students and teachers in Turkey

BACKGROUND

Teacher violence toward students is a common public health risk associated with various negative outcomes. Though previous studies examined the prevalence of teacher violence toward students and its association with negative outcomes, little is known about the association between teacher violence and school performance, and the mediating role of students' emotional and behavioral problems, particularly in developing countries.

OBJECTIVE

This study sought to investigate the prevalence of teacher violence toward students, its association with school performance, and the mediating role of emotional and behavioral problems.

PARTICIPANTS AND SETTING

Data were collected from 293 students (M = 12.59, SD = 1.07) and 205 teachers (M = 37.20, SD = 8.41) using a structured sampling approach.

METHODS

Our cross-sectional study used a multi-informant approach: both teachers and students reported on violence by teachers. Students reported also on other types of violence, emotional and behavioral problems, and school performance.

RESULTS

Of all students, 55 % reported that they were exposed to teacher violence at least once in the past month, while 83 % of teachers reported having used any type of violence against students. Path analysis indicated direct associations between teacher violence toward students and students' behavioral and emotional problems (β = 0.21) and school performance (β = -0.15), and an indirect association between teacher violence and school performance (β = -0.05) via emotional and behavioral problems.

CONCLUSIONS

Teacher violence toward students was highly prevalent and associated with emotional and behavioral problems and lower school performance. Prevention programs and social policies aiming to reduce violence by teachers are urgently needed.

Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program

Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother-child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent-Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant-parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with relatively less adversity.

Mentalization-Based Training Program for Child Care Workers in Residential Settings

Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.

Associations between young children's exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.

Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model

INTRODUCTION

Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision.

METHODS

Self-report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one-year follow-up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection.

RESULTS

Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow-up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow-up via higher externalizing problems. Free schooling provision at baseline and follow-up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow-up through a direct negative effect on externalizing mental health distress.

CONCLUSIONS

Reducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.

Early Detection and Outcome in Borderline Personality Disorder

Borderline personality disorder (BPD) is a severe and heterogeneous mental disorder that is known to have the onset in young age, often in adolescence. For this reason, it is of fundamental importance to identify clinical conditions of childhood and adolescence that present a high risk to evolve in BPD. Investigations indicate that early borderline pathology (before 19 years) predict long-term deficits in functioning, and a higher percentage of these patients continue to present some BPD symptoms up to 20 years. There is a general accordance among investigators that good competence in both childhood and early adulthood is the main predictive factor of excellent recovery in BPD patients. Some authors suggest that specific childhood personality traits can to be considered precursors of adult BPD, as well as some clinical conditions: disruptive behaviours, disturbance in attention and emotional regulation, conduct disorders, substance use disorders, and attention-deficit-hyperactivity disorder. Unfortunately, diagnosis and treatment of BPD is usually delayed, also because some clinicians are reluctant to diagnose BPD in younger individuals. Instead, the early identification of BPD symptoms have important clinical implications in terms of precocious intervention programs, and guarantees that young people with personality disorders obtain appropriate treatments. This review is aimed to collect the current evidences on early risk and protective factors in young people that may predict BPD onset, course, and outcome.

Is There a Link Between Childhood Family Violence and Adult Health? Understanding Family Violence Amongst South Asian American Women

The devastating effects of experiencing violence in childhood has been particularly difficult to assess among South Asians (SA) living in the U.S. due to a lack of race specific data. A cross-sectional quantitative study of 535 SA adult women living in the U.S. was conducted to better understand the relationship between childhood exposure to violence and health behaviors in adulthood. Measures included socio-demographics, exposure to violence as a child via witnessing parental violence, and experience of childhood violence, adult IPV, suicide ideation and attempt, and body esteem and subjective well-being in adulthood. Significant associations were found between childhood verbal abuse and body esteem and subjective well-being in adulthood; childhood physical abuse and subjective well-being in adulthood; and having a battered mother and subjective well-being in adulthood. To date, this is the first study to examine childhood violence and its relationship to adult IPV and health among SA women in the U.S.

Application of the Human Well-Being Index to Sensitive Population Divisions: A Children's Well-Being Index Development

The assessment of community well-being is critical as an end-point measure that will facilitate decision support and assist in the identification of sustainable solutions to address persistent problems. While the overall measure is important, it is equally vital to distinguish variations among groups within the population who may be impacted in a different manner. The U.S. Environmental Protection Agency (US EPA) developed the Human Well-Being Index (HWBI), as a way of measuring these outcomes and assessing community characteristics. The HWBI approach produces a suite of indicators, domains and a final composite index appropriate for characterizing well-being of a population. While generalized approaches are needed, it is important to also recognize variations in well-being across community enclaves. This paper presents an adaption of the HWBI for child populations to test the applicability of the index framework to specific community enclaves. First, an extensive literature review was completed to ensure the theoretical integrity of metric and indicator substitutions from the original HWBI framework. Metric data were then collected, refined, imputed where necessary and evaluated to confirm temporal and spatial availability. A Children's Well-Being Index (CWBI) value, representing the same indicators and domains of well-being as the original HWBI, was calculated for the population under age 18 across all US counties for 2011. Implications of this research point to an effective, holistic end-point measure that can be tracked over time. Similarly, there is great potential for the application of the original HWBI method to other statistical population segments within the greater US population. These adaptations could help identify and close gaps in equity of resource distribution among these groups.

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

Intimate partner violence victimization and parenting: A systematic review

Early studies examining parenting in the setting of intimate partner violence (IPV) often focus on abuse by the IPV perpetrator or effects of long term exposure. This review addresses how intimate partner violence impacts victim parenting. Seven databases were searched for the time period 1970-2015. Included were comparative studies involving children 11 years or younger. Quality ranking was based on: confirmation of victim status, consideration of co-perpetration, heterogeneity of the population, and standardization of measurements. Of 13,038 studies reviewed, 33 included studies showed that victimization is associated with negative parenting practices. Based on data presented within individual studies, 21 studies were eligible for meta-analysis which demonstrated modest effect sizes with high levels of heterogeneity. There was a negative correlation between IPV and positive parenting (r = -0.08; 95% CI: -.12, - .04); positive correlation between IPV and physical aggression (r = .17; 95% CI: .11, .23) and neglect (r = .12; 95% CI: .01, .23); and a trend toward positive correlation between IPV and psychological aggression (r = .23; 95% CI: -.94, .47). A synthesis of studies unsuitable for meta-analysis reinforced these findings. The review demonstrated ongoing methodological issues with extant literature.

The Interrelationship between Family Violence, Adolescent Violence, and Adolescent Violent Victimization: An Application and Extension of the Cultural Spillover Theory in China

The current study is the first study to emphasize family systems, violent norms, and violent peer association as three domains of the social environment that influence both adolescent violent offending and victimization among Chinese adolescents using a longitudinal sample. Under the framework of cultural spillover theory, the purpose of the current study was to explore how these three factors influenced adolescent violent offending and victimization. A total of 1192 middle and high school students were randomly selected from one of the largest cities in Southwest China. Structural equation model analysis was applied to investigate the direct and indirect effect of violence in the family system on violent offending and victimization. The results indicated that violent offending and victimization overlapped among Chinese adolescents. Violent peer association and acceptance of the violence norm fully mediated the effect of violence in the family system on violent offending, and partially mediated the effect of violence in the family system on violent victimization. In conclusion, adolescents who had experienced violence in their family system were more likely to be exposed to violent peer influences and to accept violent norms, which increased the likelihood of violence perpetration and victimization later in their life.

Lifetime and past-year prevalence of children's exposure to violence in 9 Balkan countries: the BECAN study

BACKGROUND

Children's exposure to violence is a major public health issue. The Balkan epidemiological study on Child Abuse and Neglect project aimed to collect internationally comparable data on violence exposures in childhood.

METHODS

A three stage stratified random sample of 42,194 school-attending children (response rate: 66.7%) in three grades (aged 11, 13 and 16 years) was drawn from schools in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Former Yugoslavian Republic of Macedonia (FYROM), Greece, Romania, Serbia and Turkey. Children completed the ICAST-C questionnaire, which measures children's exposure to violence by any perpetrator.

RESULTS

Exposure rates for psychological violence were between 64.6% (FYROM) and 83.2% (Greece) for lifetime and 59.62% (Serbia) and 70.0% (Greece) for past-year prevalence. Physical violence exposure varied between 50.6% (FYROM) and 76.3% (Greece) for lifetime and 42.5% (FYROM) and 51.0% (Bosnia) for past-year prevalence. Sexual violence figures were highest for lifetime prevalence in Bosnia (18.6%) and lowest in FYROM (7.6%). Lifetime contact sexual violence was highest in Bosnia (9.8%) and lowest in Romania (3.6%). Past-year sexual violence and contact sexual violence prevalence was lowest in Romania (5.0 and 2.1%) and highest in Bosnia (13.6 and 7.7% respectively). Self-reported neglect was highest for both past-year and lifetime prevalence in Bosnia (48.0 and 20.3%) and lowest in Romania (22.6 and 16.7%). Experiences of positive parental practices were reported by most participating children in all countries.

CONCLUSIONS

Where significant differences in violence exposure by sex were observed, males reported higher exposure to past-year and lifetime sexual violence and females higher exposure to neglect. Children in Balkan countries experience a high burden of violence victimization and national-level programming and child protection policy making is urgently needed to address this.

Psychometric properties of the Adverse Childhood Experiences Abuse Short Form (ACE-ASF) among Romanian high school students

Child abuse is a major public health problem. In order to establish the prevalence of abuse exposure among children, measures need to be age-appropriate, sensitive, reliable and valid. This study aimed to investigate the psychometric properties of the Adverse Childhood Experiences Questionnaire Abuse Short Form (ACE-ASF). The ACE-ASF is an 8-item, retrospective self-report questionnaire measuring lifetime physical, emotional and sexual abuse. Data from a nationally representative sample of 15-year-old, school-going adolescents (n=1733, 55.5% female) from the Romanian Health Behavior in School-Based Children Study 2014 (HBSC) were analyzed. The factorial structure of the ACE-ASF was tested with Exploratory Factor Analysis (EFA) and confirmed using Confirmatory Factor Analysis (CFA). Measurement invariance was examined across sex, and internal reliability and concurrent criterion validity were established. Violence exposure was high: 39.7% physical, 32.2% emotional and 13.1% sexual abuse. EFA established a two-factor structure: physical/emotional abuse and sexual abuse. CFA confirmed this model fitted the data well [χ2(df)=60.526(19); RMSEA=0.036; CFI/TLI=0.990/0.986]. Metric invariance was supported across sexes. Internal consistency was good (0.83) for the sexual abuse scale and poor (0.57) for the physical/emotional abuse scale. Concurrent criterion validity confirmed hypothesized relationships between childhood abuse and health-related quality of life, life satisfaction, self-perceived health, bullying victimization and perpetration, externalizing and internalizing behaviors, and multiple health complaints. Results support the ACE-ASF as a valid measure of physical, emotional and sexual abuse in school-aged adolescents. However, the ACE-ASF combines spanking with other types of physical abuse when this should be assessed separately instead. Future research is needed to replicate findings in different youth populations and across age groups.

Incorporating Child Maltreatment Training into Medical School Curricula

The Child Advocacy Studies Training (CAST) program has been implemented at the graduate and undergraduate levels, but has not been incorporated in medical school training. This study examines the efficacy of a modified version of the CAST program that is tailored to meet the educational needs of medical students. A total sample of 75 first year medical students (57 at 6 month follow-up) participated in the study and completed analogue vignettes depicting cases of maltreatment. It was hypothesized that, relative to the comparison group, students who completed CAST training would demonstrate better accuracy at identifying and reporting maltreatment. Results indicated that CAST students demonstrated improved accuracy at the conclusion of the CAST program and 6 months later.

An Ecodevelopmental Exploration of Mediators Between Maltreatment in Childhood and Drug use During Pregnancy

Child maltreatment is associated with increased risk of substance abuse in adulthood. However, prior investigations have not examined substance use specifically in pregnancy, and have relied on self-report of substance use. The present study addresses these gaps via secondary analysis of 295 primarily low-income, Black postpartum women who agreed to complete a brief questionnaire and subsequently provided urine and hair samples. A clear relationship emerged between self-reported maltreatment and positive toxicology (with drug use present in 37.2% of maltreated participants and 17.1% of non-maltreated participants; p < .001). Depression and violence exposure were positively associated with maltreatment and with drug use. The combined effect of violence exposure and depression mediated the association between maltreatment and drug use during pregnancy (the bootstrapped 95% confidence interval of total indirect effect ranged from .17-.86). This investigation is the first to show an association between childhood maltreatment and toxicological evidence of drug use in pregnancy.

[The protection of children exposed to intimate partner violence]

Intimate partner violence is one of the most serious forms of abuse inflicted on children. It poses a challenge for professional practices. The protection of the child cannot be separated from that of the parent suffering the abuse, and their safety cannot be assured without an adapted arrangement of the conditions of parental authority.

Physical, emotional and sexual adolescent abuse victimisation in South Africa: prevalence, incidence, perpetrators and locations

BACKGROUND

Physical, emotional and sexual abuse of children is a major problem in South Africa, with severe negative outcomes for survivors. To date, no known studies have used data directly obtained from community-based samples of children to investigate prevalence, incidence, locations and perpetrators of child abuse victimisation. This study aims to investigate prevalence and incidence, perpetrators, and locations of child abuse victimisation in South Africa using a multicommunity sample.

METHODS

3515 children aged 10-17 years (56.6% female) were interviewed from all households in randomly selected census enumeration areas in two South African provinces. Child self-report questionnaires were completed at baseline and at 1-year follow-up (96.7% retention).

RESULTS

Prevalence was 56.3% for lifetime physical abuse (18.2% past-year incidence), 35.5% for lifetime emotional abuse (12.1% incidence) and 9% for lifetime sexual abuse (5.3% incidence). 68.9% of children reported any type of lifetime victimisation and 27.1% reported lifetime multiple abuse victimisation. Main perpetrators of abuse were reported: for physical abuse, primary caregivers and teachers; for emotional abuse, primary caregivers and relatives; and for sexual abuse, girlfriend/boyfriends or other peers.

CONCLUSIONS

This is the first study assessing current self-reported child abuse through a large, community-based sample in South Africa. Findings of high rates of physical, emotional and sexual abuse demonstrate the need for targeted and effective interventions to prevent incidence and re-victimisation.

Dissociation in patients with schizophrenia spectrum disorders: What is the role of different types of childhood adversity?

AIMS

Our study aimed to explore the effects of different types of adverse childhood experiences (e.g. domestic violence, early loss, parental dysfunction, sexual and physical abuse) as well as experiences of sexual and physical abuse in adulthood on dissociative symptoms in adult patients with schizophrenia-spectrum disorders.

METHODS

145 patients were examined for psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), for dissociative symptoms with the German version of the Dissociative Experiences Scale (DES) and for adverse experiences in childhood and adulthood with the Structured Trauma Interview (STI).

RESULTS

Childhood physical abuse was reported by 32%, childhood sexual abuse by 17% of the patients. Other forms of childhood adversity were also quite common; 18% had witnessed domestic violence, 26% reported early loss, and nearly half of patients reported at least one condition potentially related to parental dysfunction. The DES total score was significantly associated with childhood sexual abuse, witnessing of domestic violence and paternal dysfunction, as well as with physical violence in adulthood. In the final regression model, reports of paternal dysfunction and sexual abuse in childhood were independently associated with adult dissociation. Variance in dissociative symptoms was mainly explained by paternal dysfunction (18%).

CONCLUSION

Substantial rates of childhood adversity were found and specific associations were evident with adult dissociation amongst psychosis patients who reported sexual abuse or paternal dysfunction in childhood. Therefore, it is important that patients with schizophrenia-spectrum disorders are routinely asked about a broad range of possible adverse childhood experiences in order to provide appropriate interventions.

A Relação entre as Representações acerca das Figuras Parentais e as Competências Sociais em Crianças Maltratadas e não Maltratadas

RESUMO Assumindo a centralidade das representações acerca das figuras parentais na trajetória desenvolvimental, este estudo teve como objetivo analisar a relação destas representações com as competências sociais de crianças maltratadas e não maltratadas. Participaram, nesta investigação, 62 crianças em idade escolar (22 maltratadas e 40 não maltratadas). As representações acerca das figuras parentais foram avaliadas com a Entrevista de Avaliação das Representações acerca das Figuras Parentais e as competências sociais com a adaptação portuguesa da Social Skills Rating System - Form for Teachers. Nas crianças maltratadas, não se verifica a associação entre as representações das figuras parentais e as competências sociais, observada em amostras normativas. Os resultados sugerem que os dois grupos atribuem significados distintos aos comportamentos parentais.

Developmental variations in the impact of intimate partner violence exposure during childhood

BACKGROUND

Intimate partner violence (IPV) is a pervasive problem impacting individuals around the globe. The consequences of IPV extend beyond the adults in the relationship, as children witness a significant proportion of such violence. Exposure to IPV during childhood has devastating effects across multiple domains of functioning.

METHODS

This article reviews empirical studies of the effects of exposure to IPV by developmental stage.

RESULTS

The psychological, social, physical, and cognitive consequences of witnessing IPV are examined across development; from the impact of prenatal exposure to effects in infancy and toddlerhood, the preschool years, school-aged children, and adolescence.

CONCLUSIONS

The review concludes by providing suggestions for future research based on the identified developmental variations, recommendations for developmentally-sensitive interventions for children who have witnessed IPV, and directions for policy to address the issue of violence exposure early in the lives of children.

Family Violence and Child Sexual Abuse Among South Asians in the US

Family violence, including child sexual abuse (CSA), is a significant public health problem in the United States. It is particularly difficult to assess family violence and CSA among South Asians because it is often hidden due to cultural and familial stigma. A web-based survey was administered to a convenience sample (n = 368) of South Asian adults in the US. One-fourth (25.2 %) of the sample reported CSA; 13.8 % reported abuse involving exposure; 21.5 % reported abuse involving touching; 4.5 % reported attempted sexual intercourse; and 3.5 % reported forced sexual intercourse. Adjusted odds ratios found that participants who reported any relationship violence were significantly more likely to have experienced CSA (OR 2.28; 95 % CI 1.26-4.13); and suicide attempt was significantly associated with CSA (OR 3.96; 95 % CI 1.27-12.3). The findings presented in this formative study will assist in guiding future studies and interventions for South Asians in the United States.

Childhood Maltreatment, Depression, and Suicidal Ideation: Critical Importance of Parental and Peer Emotional Abuse during Developmental Sensitive Periods in Males and Females

BACKGROUND

The adverse childhood experience (ACE) study found that risk for depression increased as a function of number of types of childhood maltreatment, and interpret this as a result of cumulative stress. An alternative hypothesis is that risk depends on type and timing of maltreatment. This will also present as a linear increase, since exposure to more types of abuse increases likelihood of experiencing a critical type of abuse at a critical age.

METHODS

560 (223M/337F) young adults (18-25 years) were recruited from the community without regard to diagnosis and balanced to have equal exposure to 0-4 plus types of maltreatment. The Maltreatment and Abuse Chronology of Exposure Scale assessed severity of exposure to 10 types of maltreatment across each year of childhood. Major depressive disorder (MDD) and current symptoms were evaluated by SCID, interview, and self-report. Predictive analytics assessed importance of exposure at each age and evaluated whether exposure at one or two ages was a more important predictor than number, severity, or duration of maltreatment across childhood.

RESULTS

The most important predictors of lifetime history of MDD were non-verbal emotional abuse in males and peer emotional abuse (EA) in females at 14 years of age, and these were more important predictors across models than number of types of maltreatment (males: t 9 = 16.39, p < 10(-7); females t 9 = 5.78, p < 10(-4)). Suicidal ideation was predicted, in part, by NVEA and peer EA at age 14, but most importantly by parental verbal abuse at age 5 in males and sexual abuse at age 18 in females.

CONCLUSION

This study provides evidence for sensitive exposure periods when maltreatment maximally impacts risk for depression, and provides an alternative interpretation of the ACE study results. These findings fit with emerging neuroimaging evidence for regional sensitivity periods. The presence of sensitive exposure periods has important implications for prevention, preemption, and treatment of MDD.

Posttraumatic stress symptom trajectories among children exposed to violence

Little research has examined the developmental course of posttraumatic stress symptoms (PTSS) in children. The current study aimed to identify developmental trajectories of PTSS in childhood and to examine predictors of symptom presentation in 1,178 children from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a consortium of studies focusing on the causes and effects of child maltreatment. Most children had a history of documented reports with Child Protective Services (CPS) and all were identified as living in high-risk environments. Using group-based trajectory modeling, 3 unique developmental trajectories were identified: Resilient, Clinical-Improving (PTSS in the clinical range at baseline then declining over time), and Borderline-Stable (chronically subclinical PTSS). Children in the Clinical-Improving group were more likely than children in the Resilient group to have reports of physical abuse (RRR = 1.76), emotional abuse (RRR = 2.55), neglect (RRR = 1.57), and exposure to violence at home and in the community (RRR = 1.04). Children in the Borderline-Stable group were more likely than children in the Resilient group to have a CPS history of neglect (RRR = 2.44) and exposure to violence at home and in the community (RRR = 1.04). Many children living in high-risk environments exhibit resilience to PTSS, but exposure to witnessed violence and neglect appear to put children at chronic risk for poor adjustment. These children may require more intensive, integrated clinical services that attend to multiple adverse experiences.

Early childhood maltreatment and trajectories of behavioral problems: exploring gender and racial differences

The current study aimed to examine the trajectory of child behavior problems over time as a function of early maltreatment. We anticipated that early alleged maltreatment would have a substantial impact on both internalizing and externalizing behaviors. The impact of gender and racial differences in the trajectories were also examined. Using the LONGSCAN archived data, a total of 484 children were selected for the study from varying sites. Two groups were formed: children with early allegations of maltreatment from birth to age 4 and children without any report. Children included did not have further allegations of maltreatment from ages 4 to 12. Additionally, they must have completed a behavioral assessment using the Child Behavior Checklist at the age 4 baseline interview. Multilevel modeling using the SAS PROC MIXED procedure was used to examine the effects of early allegations of maltreatment on the trajectories of both internalizing and externalizing problems. Although race was not significant, gender was found to differ in trajectory of behavioral problems among children with early allegations of maltreatment. For boys, the impact of early maltreatment was strongest at the most proximal assessment of behavioral outcomes and then decreased gradually over the course of subsequent periods. For girls, although no significant impact was observed at each measurement point, the impact of early maltreatment increased and became pronounced over time. Findings support the importance of early intervention/prevention to decrease the likelihood of presenting behavioral problems in later childhood years with consideration to gender.

Social work and adverse childhood experiences research: implications for practice and health policy

Medical research on "adverse childhood experiences" (ACEs) reveals a compelling relationship between the extent of childhood adversity, adult health risk behaviors, and principal causes of death in the United States. This article provides a selective review of the ACE Study and related social science research to describe how effective social work practice that prevents ACEs and mobilizes resilience and recovery from childhood adversity could support the achievement of national health policy goals. This article applies a biopsychosocial perspective, with an emphasis on mind-body coping processes to demonstrate that social work responses to adverse childhood experiences may contribute to improvement in overall health. Consistent with this framework, the article sets forth prevention and intervention response strategies with individuals, families, communities, and the larger society. Economic research on human capital development is reviewed that suggests significant cost savings may result from effective implementation of these strategies.

Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort

BACKGROUND

Several large population-based studies have demonstrated associations between adverse childhood experiences and later development of psychotic symptoms. However, little attention has been paid to the mechanisms involved in this pathway and the few existing studies have relied on cross-sectional assessments.

METHODS

Prospective data on 6692 children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) were used to address this issue. Mothers reported on children's exposure to harsh parenting and domestic violence in early childhood, and children self-reported on bullying victimization prior to 8.5 years. Presence of children's anxiety at 10 years and their depressive symptoms at 9 and 11 years were ascertained from mothers, and children completed assessments of self-esteem and locus of control at 8.5 years. Children were interviewed regarding psychotic symptoms at a mean age of 12.9 years. Multiple mediation analysis was performed to examine direct and indirect effects of each childhood adversity on psychotic symptoms.

RESULTS

The association between harsh parenting and psychotic symptoms was fully mediated by anxiety, depressive symptoms, external locus of control, and low self-esteem. Bullying victimization and exposure to domestic violence had their associations with psychotic symptoms partially mediated by anxiety, depression, locus of control, and self-esteem. Similar results were obtained following adjustment for a range of confounders and when analyses were conducted for boys and girls separately.

CONCLUSIONS

These findings tentatively suggest that specific cognitive and affective difficulties in childhood could be targeted to minimize the likelihood of adolescents exposed to early trauma from developing psychotic symptoms.

Parental competence and maltreatment: the curvilinear influence of plan complexity

A parent's ability to plan for child behavior problems was proposed to influence the relationship between parental competence and attitudes/beliefs about parenting behaviors. One hundred and one parents from three community sites completed questionnaires measuring parental competence, plan complexity, and attitudes/beliefs about parenting. Results indicated that plan complexity significantly influenced the relationship between parental competence and judgments about corporal punishment. The same influence existed between parental competence and power independence. We discuss these results with regard to forwarding theoretical work on planning processes, as well as practical implications for enhancing parent education curricula to better address the constructive management of difficult child behaviors.

Psychosocial stressors in inter-human relationships and health at each life stage: A review

Currently, psychosocial stressors' impacts on health are increasing. Among these stressors, this review focused on inter-human relationships. Since social supports could be protective against ill health, consequences contributing to psychosocial stressors are discussed here in relation to social supports for each stage of childhood, adulthood and elderly status.For childhood, parental divorce/isolation, and child abuse/neglect appeared to be determinants of healthy development at either the initial or later stages. According to prospective studies, such stressors, especially those occurring until around 3 years of age, were associated with later adverse life quality in adulthood. Therefore, nationwide preventive strategies were developed in each country to monitor protective social programs.For adulthood, job strain was focused on Karasek's job strain model, effort-reward imbalance, employment grade and working hours. These psychosocial stressors were shown to affect not only the physical health but also the mental health of working people. These days, since Karoshi and even suicide related to excessive workloads are taking a toll on workplace organization, stress-coping abilities such as a sense of coherence were introduced from the individual-social interaction aspect.For elderly status, retirement, caring for the elderly, and spouse bereavement were discussed as psychosocial stressors. Some evidence indicates that these stressors could be determiants of health. Finally, social supports have been demonstrated to promote health and protect the elderly against diseases and death.

Polytraumatization and trauma symptoms in adolescent boys and girls: interpersonal and noninterpersonal events and moderating effects of adverse family circumstances

The objective of this study was to investigate the cumulative effect of interpersonal and noninterpersonal traumatic life events (IPEs and nIPEs, respectively) on the mental health of adolescents and to determine if the adverse impacts of trauma were moderated by adverse family circumstances (AFC). Adolescents (mean age 16.7 years) from the normative population (n = 462) completed the questionnaire, the Linköping Youth Life Experience Scale (LYLES), together with Trauma Symptom Checklist for Children (TSCC). The lifetime accumulation of interpersonal, noninterpersonal, and AFC was independently related to trauma-related symptoms in both boys and girls. The number of AFCs moderated the mental health impact of both IPEs and nIPEs in boys but not in girls. Cumulative exposure to both interpersonal and noninterpersonal traumatic events is important for the mental health of adolescents, and, at least for boys, family circumstances seem to be relevant for the impact of trauma. Our results suggest that broader approaches to the study, prevention, and treatment of trauma, including consideration of cumulative exposure, different types of trauma, and additional social risk factors, could be fruitful.