The Complexity of Adaptation to Childhood Polyvictimization in Youth and Young Adults: Recommendations for Multidisciplinary Responders

Risk and Protective Factors for Sexual Exploitation in Male and Female Youth From a Cross-Cultural Perspective: A Systematic Review

Youth are at elevated risk of becoming victims of sexual exploitation, which has a detrimental impact on their physical and psychological well-being. Understanding factors associated with sexual exploitation is key for prevention efforts and adequate and timely treatment. This systematic review sheds more light on this by providing an overview of both risk and protective factors for sexual exploitation in male and female youth from a cross-cultural perspective. In all, 65 studies were selected meeting the inclusion criteria: qualitative or quantitative peer-reviewed studies in English, Dutch, or German with findings on risk and protective factors associated with sexual exploitation in youth aged up to 24 years. Results show that there are common risk factors in male and female youth worldwide (e.g., adverse childhood experiences, lack of a social network, substance use, and running away). Positive and supportive relationships are an important protective factor in mitigating the risk of sexual exploitation. Geographic differences were found. In non-Western continents, more environmental factors (e.g., economic vulnerabilities, residential instability) were cited. Research in countries outside the United States is limited and protective factors and males are underexamined. To fully understand vulnerabilities in youth, their interactions, and possible gender differences and to address the needs of diverse populations, more insight should be gained into the broader range of risk and protective factors worldwide. This systematic review has made a valuable contribution to this by providing practice, policy, and research guidance in the establishment of more targeted prevention efforts, adequate treatment, and areas to address in future research.

Peer Bullying Victimization Trajectories for Sexually and Gender Diverse Youth from Early Childhood to Late Adolescence

Sexually and gender diverse (SGD) youth experience more peer bullying victimization than heterosexual, cisgender youth during adolescence, yet the emergence and persistence of these disparities remain underexplored. Also, it is unclear which factors are associated with these disparities across development, and how these disparities are linked to late adolescent health discrepancies. This study utilized the sample from the Millennium Cohort Study in Britain (N = 10,080; 51.3% assigned female at birth; Mage = 2.28, SDage = 0.46 at Wave 2), in which 23.74% of youth reported non-heterosexual attraction, 21.59% reported non-heterosexual identity, and 1.08% reported gender identity not in line with the sex assigned at birth. Using latent class growth modeling, four peer bullying victimization trajectories were identified, with early peak (7.2%), late childhood peak (6.3%), adolescence onset (12.8%), and low (73.6%) rates of victimization. SGD youth, compared to heterosexual and cisgender youth, were found to have increased odds of being in the victimization-involved classes, especially the adolescence onset class. The study further revealed that SGD youth reported more mental health and relational difficulties in childhood, which were linked to their heightened risk of longer-lasting victimization. Further, long-term victimization was found to partially account for the disparities in health and well-being for SGD youth in late adolescence. In conclusion, SGD youth were more likely to experience longer-lasting bullying victimization during childhood and adolescence, its related mental and relational vulnerabilities were already established in childhood, and such victimization disparities were further linked to their detrimental health and well-being in late adolescence. The design, hypotheses, and target analyses of the current study were preregistered on 21st April 2023 at https://osf.io/f2zxy .

Childhood Trauma Questionnaire-Short Form: Evaluation of Factor Structure and Measurement Invariance

Childhood trauma is known to put individuals at risk for mental and physical challenges later in life. Retrospective assessment of early abuse and neglect is critical for prevention and intervention efforts targeted at reducing the negative impacts of childhood trauma. The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely used measure to assess trauma among adolescents and adults, though there are some inconsistencies with regard to its factor structure and psychometric properties. The purpose of the current study was twofold: (1) to evaluate the hypothesized five-factor structure of CTQ-SF and (2) to test measurement invariance (equivalence) of the instrument across gender and race in a large, nationally representative sample of US adults (N = 863). Confirmatory factor analysis results indicate that the five-factor model fit the data well. The results also show that the five-factor model is generally invariant by gender and racial/ethnic groups and that the form's subscales positively correlate with depression, anxiety, and abnormal inflammatory biomarker activity. Assessment is critical for the advocacy and treatment of individuals who have experienced abuse and neglect as children and adolescents. Our findings suggest that the CTQ-SF is a valuable tool for assessing childhood trauma and can be used in advocacy and treatment efforts.

Potentially Traumatic Events, Socioemotional and Adaptive Functioning: Associations with Self-Regulatory Skills in a Community Sample of Primarily Black and Latinx 3-5-year-olds

Early childhood is a heightened risk period for exposure to potentially traumatic events (PTEs) and a critical period for the development of foundational self-regulatory competencies that have potential cascading effects on future socioemotional functioning. This cross-sectional study examined associations between PTE exposure and socioemotional and adaptive functioning, and self-regulatory skills, in a community-based sample of 280 primarily Black and Latinx 3-5-year-olds. Results supported direct relations between PTE exposure and socioemotional and adaptive functioning. Attentional regulation was associated with PTEs and internalizing behaviors, externalizing behaviors, and adaptive behaviors. There was also a significant association of emotional regulation on the relationship between PTEs and internalizing and externalizing behaviors, but not adaptive functioning. Findings have implications for early intervention and educational and public policy, including the importance of scaffolding the development of self-regulatory skills among preschoolers with high PTE exposure.

Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder

Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.

Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

Sexual and Gender Minority Youth in Foster Care: An Evidence-Based Theoretical Conceptual Model of Disproportionality and Psychological Comorbidities

Sexual and gender minority youth (SGMY) are overrepresented in the foster care system and experience greater foster-care-related stressors than their non-SGM peers. These factors may further elevate their risk of anxiety/depressive, post-traumatic stress disorder, self-harm, and suicidality. The system currently produces unequal and disproportionate adverse mental health outcomes for SGMY and needs points of intervention to disrupt this status quo. This article provides an empirically grounded conceptual-theoretical model of disproportionate representation and burden of psychological comorbidities experienced by SGMY in the foster care system. We apply findings from an integrated literature review of empirical research on factors related to overrepresentation and mental health burden among SGMY to minority stress theory to explicate how and why the foster care system exacerbates mental health comorbidities for SGMY. Searches were conducted in June 2020 in PubMed using MeSH terms and title/abstract terms for foster care, sexual or gender minorities, and psychological comorbidities. Inclusion criteria are studies conducted in the United States, published in English, focused on mental illness, and published between June 2010 and 2020. Developmental/intellectual and eating disorders were excluded. The initial search returned 490 results. After applying inclusion criteria, 229 results remained and are utilized to build our conceptual-theoretical model. We assert that the phenomenon of disproportionate psychological comorbidities for SGMY in foster care is best represented as a complex and dynamic system with multiple feedback loops. Extant empirical and theoretical literature identifies three critical areas for intervention: family acceptance, community belonging and queer chosen/constructed family, and affirming and nondiscriminatory child welfare policy.

Applying shared decision-making to screening for trauma and adversity in youth

Youth who have experienced adverse childhood experiences (ACEs) or trauma are at risk for negative outcomes that may be lessened by adversity screening and prevention efforts. However, experts and consumers do not universally embrace adversity screening efforts. Despite significant support for widespread adversity screening, and many guidelines on how to conduct such screening, successful implementation has lagged behind enthusiasm. This paper outlines the challenges of adversity screening and then proposes applying the shared decision-making (SDM) model to improve adversity screening by increasing youths' 1) engagement in adversity screening if doing so is appropriate for them, and 2) disclosure of honest information during screens. Using an SDM approach honors youth preferences and perspectives, which simultaneously accomplishes a third overarching goal: aligning adversity screening with the principles of trauma-informed care.

Home, school, and community violence exposure and emotional and conduct problems among low-income adolescents: the moderating role of age and sex

PURPOSE

The purpose of this study is to assess whether violence exposure is associated with emotional/conduct problems, when adjusting for confounders/covariates and controlling for comorbidity, and to investigate interactions between violence exposure and sex and/or age.

METHODS

This cross-sectional study evaluated a community-based sample of 669 in-school 11-15-year-olds. A three-stage probabilistic sampling plan included a random selection of census units, eligible households, and target child. Multivariable logistic regression investigated the effect of severe physical punishment by parents, peer victimization at school, and community violence on the study outcomes (adolescent-reported emotional/conduct problems identified by the Strengths and Difficulties Questionnaire/SDQ) when controlling for confounders (resilience, parental emotional warmth, maternal education/unemployment/anxiety/depression) and covariates (age, sex, stressful life events, parental rejection).

RESULTS

Considering interactions, emotional problems were associated with community violence victimization among girls, while conduct problems were associated with severe physical punishment among the younger, suffering peer aggression among the oldest, bullying victimization among girls, and witnessing community violence among boys. Desensitization (less emotional problems with greater violence exposure) was noted among the youngest exposed to severe physical punishment and the oldest who witnessed community violence.

CONCLUSION

Age and sex are moderators of the association between violence exposure and emotional/conduct problems. Interventions at local health units, schools, and communities could reduce the use of harsh physical punishment as a parental educational method, help adolescents deal with peer aggression at school and keep them out of the streets by increasing the usual five hours in school per day and making free sports and cultural/leisure activities available near their homes.

Polyvictimization Among Russian Sex Workers: Intimate Partner, Police, and Pimp Violence Cluster With Client Violence

Female sex workers (FSW) are a key population in the HIV epidemic and face high levels of violence. While women globally are predominantly at risk of intimate partner violence (IPV), FSW are additionally vulnerable to violence from clients, police, and pimps associated with their occupation. FSW are therefore at risk of cumulative trauma from polyvictimization, or violence from multiple types of perpetrators. Polyvictimization is a driver of morbidity and mortality in numerous populations, but there has been little research on how multiple types of victimization are related to one another in FSW. A cross-sectional survey was conducted among 754 FSW from three cities in the Russian Federation. Surveys assessed lifetime experiences of client, police, intimate partner, and pimp violence. Multivariate log-binomial and Poisson regression were used to test associations between these types of violence. Forty-five percent experienced any type of violence, including 31.7% from clients, 16.0% from police, 15.7% from intimate partners, and 11.4% from pimps. One fifth (20.4%) experienced polyvictimization. Client violence was central to polyvictimization: Only 5.9% of polyvictimization occurs without client violence. When client violence was not present, police, pimp, or IPV co-occurred significantly less than would be expected under an assumption that these types of violence occur independently (p < .001). However, they co-occurred more than would be expected when client violence is present. After adjusting for other types of violence experienced and demographic factors, experiencing client violence was independently associated with police violence (adjusted relative risk [ARR] = 2.77, 95% confidence interval [CI] [1.67, 4.59]), IPV (ARR = 3.67, 95% CI [1.95, 6.89]), and pimp violence (ARR = 5.26, 95% CI [2.80, 9.86]). Client violence may drive exposure to other types of violence and enable polyvictimization in a way that other types of violence do not in this setting. Violence prevention interventions may achieve maximal effect in reducing multiple types of violence by focusing on client violence.

Sexual and Physical Violence in Childhood Is Associated With Adult Intimate Partner Violence and Nonpartner Sexual Violence in a Representative Sample of Rural South African Men and Women

Intimate partner violence, nonpartner sexual violence, and physical and sexual violence against children are significant public health issues in South Africa. Theory suggests that experiencing violence in childhood plays a role in propensity to perpetrate violence or vulnerability to violence in adulthood. Most research to date on this topic has been conducted in high-resource countries or within urban or high-risk populations. We explore the relationship between violence in childhood and violence in adulthood in a community-based sample of 18- to 49-year-old adults in rural South Africa using data from a population-based survey (N = 1,044) in North West province in 2014. We measured childhood violence before age 15 years, experience of nonpartner sexual violence in adulthood, and IPV victimization and perpetration in the last 12 months. We conducted multivariate logistic regression; gender was tested as an effect modifier. All estimates are weighted to the subdistrict population. More women (2.7%) than men (0.8%) reported childhood forced sex, whereas fewer women (2.0%) than men (7.9%) reported childhood physical violence. Women and men reported similar rates of IPV victimization (6.8% vs. 5.4%), IPV perpetration (3.3% vs. 4.8%), and forced sex by a nonpartner (1.6% vs. 1.2%). We found that men and women who experienced childhood violence (combined physical and/or sexual) were significantly more likely to experience forced sex by a nonpartner (men: adjusted odds ratio [aOR] = 5.53, 95% confidence interval [CI] = [1.27, 24.0], p < .05; women: aOR = 51.1, 95% CI = [10.58, 246.3], p < .01) compared with those who did not experience childhood violence. They were also 2.5 times as likely to perpetrate recent IPV (aOR = 2.5, 95% CI = [0.97, 6.7], p = .06) or experience recent IPV (aOR = 2.5, 95% CI = [0.9, 6.9], p = .07), although this finding was marginally significant. These results align with the literature from other settings and population groups.

Measuring self-reported polyvictimization in foster youth research: A systematic review

BACKGROUND

Youth who are or have been in foster care (foster youth) are at higher risk for adverse outcomes in early adulthood. As the importance and complexity of victimization experiences, including types, timing, and perpetrators, is better understood it is unclear whether or to what extent the research on foster youth assesses polyvictimization. Because many types of victimization, such as community violence, are under-reported or absent in the administrative data typically used for research with foster care populations, self-reports of victimization experiences are necessary to comprehensively assess polyvictimization. Polyvictimization places youth at increased risk for adverse outcomes, and yet is not widely measured in the foster youth population. This is likely in part due to the wide-use of administrative reports to assess maltreatment among research on foster youth which does not capture a full range of victimization experiences.

OBJECTIVE

The aim of the present study was to systematically review and evaluate the measurement of self-reported polyvictimization with foster youth samples.

METHODS

A search in Academic Search Premier, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Social Work Abstracts, SociINDEX, and Scopus was conducted. Articles included peer-reviewed, quantitative research studies that measured self-reported victimization (including violence exposure and/or maltreatment) with foster youth samples between 1997-2017. In total, 1887 studies were identified and reviewed by two raters and of those 18 met the study criteria.

RESULTS

Almost all of the included studies (n = 16) measured multiple types of victimization through self-report. The most common types of victimization measured were sexual abuse (n = 15), physical abuse (n = 14), and physical neglect (n = 11). Half of studies (n = 9) measured at least one non-maltreatment victimization experience, such as community violence exposure and/or dating violence. However, included studies rarely measured other aspects of victimization, such as timing of exposure (e.g., pre or during foster care), which research has identified as relevant to outcomes.

CONCLUSIONS

This is the first systematic review to assess the measurement of self-reported polyvictimization in research with current or former foster youth. Given the limited comprehensive assessment of victimization, these findings support strong recommendations for developing or adapting polyvictimization measures specifically for foster youth so that the measures include child welfare-specific factors such as the timing and perpetration of victimization experiences.

Sluggish cognitive tempo and exposure to interpersonal trauma in children

Background: Childhood adversity has been suggested, but not yet empirically examined, as a factor in sluggish cognitive tempo (SCT) in childhood.Objective: This study was an examination of SCT in relation to childhood adversity, and its association with exposure to non-interpersonal and interpersonal trauma.Method: Caregivers (N = 161) and a sub-sample of children, 8-17 years old, were recruited from mental health and pediatric practices/programs and interviewed.Results: SCT was positively associated with interpersonal trauma but not non-interpersonal trauma. Two hierarchical regression analyses revealed that interpersonal trauma exposure was associated with SCT score over and above symptoms of other psychopathologies.Conclusion: Results suggest that SCT is associated with interpersonal trauma exposure in children. Further research is needed to examine the association between SCT and interpersonal trauma exposure, and trauma-related biopsychosocial impairments.

Moral Disengagement as an Explanatory Factor of the Polyivictimization of Bullying and Cyberbullying

BACKGROUND

The present study's objectives were to: (1) Identify and analyze the prevalence of poly-victims, and (2) determine how the levels of moral disengagement and the various defence mechanisms that victims use to explain abusive behavior might function as predictors of poly-bullying.

METHODS

The sample consisted of 1328 participants of from 9 to 14 years old. The instruments used were two questionnaires. One allows the prevalence of bullying and cyberbullying victims to be identified and analyzed. The other analyses the level of moral disengagement and the defence mechanisms to which the victims resort.

RESULTS

The results showed there to be a continuity of the role of victim in off-line and on-line contexts, turning those who are subject to these situations into poly-victims. The moral disengagement of these victims was found basically to be centered at two levels-a locus of behavior, and a locus of outcomes.

CONCLUSIONS

Exposure to abuse that is continuous, of different types, and coming from different contexts must be perceived as a public health problem given the lack of effective tools to combat the situations of helplessness that the polyvictims experience.

Resilience and Poly-Victimization among Two Cohorts of Norwegian Youth

Previous research shows that there is a significant and positive relationship between being a victim of violence and experiencing high levels of psychological problems among young people. Conversely, resilience is negatively associated with psychological problems among young people in general, and this negative association is particularly strong among victims of violence. Our study examines resilience among young people (aged ≥ 18 years) who reported being victims of multiple forms of violence during childhood and adolescence using data from two national youth surveys administered in Norway in 2007 (N = 7033) and 2015 (N = 4531), respectively. We first compared the score of resilience, as measured by the Resilience Scale for Adolescents (READ), and the prevalence of poly-victimization, as identified by the number of young people in our study who were exposed to three of the four forms of violence (i.e., non-physical violence, witnessing violence against parents, physical violence, and sexual abuse). Second, we tested our hypothesis using our data and found that resilience-individuals' capacity to handle adversity, as well as their use of social and cultural resources when facing adversity-moderates the association between poly-victimization and the onset of psychological problems.

Polyvictimization and Sexual Risk Behaviors in College-Aged Women

Current research suggests a link between childhood sexual abuse and risky sexual behaviors (RSBs) in emerging adults. However, previous studies neglect evaluating the influence of high levels of cumulative childhood victimization. The present study examined the relationships among polyvictimization, six aggregate categories of childhood victimization, and RSB in college women. This study first examined the relative contributions of polyvictimization and individual categories of childhood victimization in predicting RSB and then tested whether polyvictimization contributes any unique variance, beyond that accounted for by the combination of all six aggregate categories in a sample of 321 college women in a Southern state. Regression analyses reveal that (a) polyvictimization accounts for a significant proportion of variability in scores for RSB, beyond that accounted for by any of the six categories of childhood victimization alone; (b) the categories of childhood victimization contribute little to no variability beyond that accounted for by polyvictimization; and (c) polyvictimization accounts for a significant proportion of variability in RSB, beyond that already accounted for by the simultaneous entry of all six categories as predictor variables. Results suggest treatment providers working with college students should assess polyvictimization in relation to RSB and inform their prevention efforts given this link.

Poly-victimization in a Norwegian adolescent population: Prevalence, social and psychological profile, and detrimental effects

Background

This study focuses on poly-victimization, with the aim of providing a realistic estimation of the prevalence of lifetime victimization in a Norwegian adolescent population (ages 18–19 years).

Methods

Based upon the concept from previous research, we applied measures of child poly-victimization on Norwegian data obtained from a national youth survey in 2015 (N = 4,531) to arrive at an estimation of its prevalence. We used variables that measure individual characteristics such as gender and educational aspiration and socio-economic factors such as parents’ education level and home economic situation to derive a social and psychological profile of victimization and poly-victimization among young people. Finally, we estimated the effects of poly-victimization on mental health such as symptoms of depression, anxiety and trauma.

Results

Our study identified a poly-victimization prevalence of 8.6% among young people, i.e. they were exposed to three of all four forms of violence investigated by our study: non-physical violence, witnessing violence against parents, physical violence and sexual abuse. Adolescents of poly-victimization are six times more likely to report depression and anxiety and trauma when compared with those without victimization.

Conclusions

Poly-victimization is a phenomenon that heavily burdens many young people across many national contexts. Poly-victims clearly tend to develop depression, anxiety, and posttraumatic stress symptoms. The early detection of sexual abuse, physical violence, and bullying victimization is of critical importance and preventive measures could consider addressing family factors through parental educational programs.