Charting a Course towards Resilience Following Adverse Childhood Experiences: Addressing Intergenerational Trauma via Strengths-Based Intervention

The Intergenerational Transmission of Trauma, Adverse Childhood Experiences and Adverse Family Experiences: A Qualitative Exploration of Sibling Resilience

The Adverse Childhood Experiences (ACEs) and Adverse Family Experiences (AFEs) frameworks have been employed extensively in research. However, to date, no such studies have considered both frameworks concurrently, nor have they explored the similarities and differences in resilience between siblings with ACE- and AFE-exposed parent(s). Doing so could, perhaps, establish the ways in which adversity is transmitted through generations and subsequently identify what trajectories to address in potential interventions. Thus, the objectives of this study were to examine the experiences of families with intergenerational ACE and AFE trauma, and to ascertain what influences similarities and differences in sibling resilience. The thematic analysis of two family case studies (n = 6) proposed a narrative encompassing fear, relationships and challenging trauma. Findings demonstrated the influence of neighbourhood violence which appeared to initiate this narrative. The fear associated with neighbourhood violence and maltreatment in early childhood appeared to influence both the parent-child bond and intimate relationships. Finally, participants demonstrated the protective properties of dissociation and sibling parentification, exhibiting their relationship with resilience. Investigators suggested neighbourhood violence be considered in the ACE questionnaire to inform current and future policies, and to safeguard the needs of families affected by intergenerational trauma.

Effects of maternal separation on punishment-driven risky decision making in adolescence and adulthood

Early life adversity (ELA) is associated with a multitude of neural and behavioral aberrations. To develop treatments to mitigate the effects of ELA, it is critical to determine which aspects of cognition are affected and when these disturbances manifest across the lifespan. Here, we tested the effects of maternal separation, an established rodent model of ELA, on punishment-driven risky decision-making longitudinally in both adolescence (25-55 days old) and adulthood (80-100 days old). Risk-taking was assessed with the Risky Decision-making Task, wherein rats choose between a small, safe reward and a large reward accompanied by an escalating risk of punishment (foot shock). We observed that rats exposed to maternal separation were more prone to risk-taking than controls during adolescence, and demonstrated reduced latency to make both risky and safe decisions. Interestingly, this augmented risk-taking was no longer evident in adulthood. Males and females displayed comparable levels of risk-taking during adolescence then diverged in adulthood, with adult males displaying a sharp increase in risk-taking. Finally, we observed that risk-taking changed across the lifespan in rats exposed to maternal separation, but not in control rats. Collectively, these data reveal that ELA engenders risk-taking in adolescence but not adulthood, and that sex differences in risky decision-making are not evident until adulthood. This has important implications for the development of both behavioral and biological treatments to improve decision-making during the vulnerable adolescent period.

Primary healthcare practitioners' perspectives on trauma-informed primary care: a systematic review

BACKGROUND

Exposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners' perspectives on trauma-informed primary care.

METHODS

Eight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis.

RESULTS

13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment.

CONCLUSIONS

This review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses.

The experiences and perceptions of campus resource utilization by college students with childhood domestic violence exposure histories

Objective: The purpose of this study was to examine the campus resource utilization experiences of university students with childhood domestic violence exposure (CDV) histories. Participants: 368 students attending a large, flagship, land-grant, predominantly White university in the Southeastern United States. Methods: Participants completed a web-based survey with variables including CDV, campus resource utilization and perceptions of said resources, and participant resource suggestions. Results: Most students utilized at least one health-related campus resource, with the student health and counseling centers being the most common and helpful. Suggested areas for institutional and service provider growth include enhanced advertisement and accessibility for existing resources and added support groups. Conclusions: College campuses provide unique opportunities to support young adults with CDV histories. Tailoring programming to students with CDV histories has the potential to improve student's success in and beyond college.

Recalibration of the stress response system over adult development: Is there a perinatal recalibration period?

During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.

An Integrative Review of the Research on Teen Mothers' Resilience

Greater attention to teen mothers' strengths and aspirations has generated interest in their resilience. An integrative review of the research was undertaken to determine how teen mothers' resilience, risks, and protective factors are conceptualized across methodological approaches. In total, 10 databases were searched in 2021 to identify relevant studies. Of the 32 studies meeting criteria, the majority were conducted in the United States. Qualitative studies mined teen mothers' accounts for resilient processes, adversities, and protective factors while quantitative studies operationalized variables based on the resilience framework. The studies in this review present a more balanced and contextual perspective on teen mothers and suggest broader notions of their competence, success, and vulnerabilities. Several studies draw attention to the potential costs of resilience and the heterogeneity of teen mothers. Unfortunately, this research shows little cross-fertilization across methods. Implications of the findings for future research, policy, and practice are described.

Elucidating the relations between adverse childhood experiences, age of exposure to adversity, and adult posttraumatic stress symptom severity in pregnant women

BACKGROUND

Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities.

OBJECTIVE, PARTICIPANTS, AND SETTING

In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure.

METHODS

The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test.

RESULTS

The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t(134) = 2.69, p = .008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (ΔR² = 0.07, p = .290). Age of first exposure did not significantly moderate the effects of the CM (β = 0.12, p = .140) or HD (β = -0.10, p = .238) ACEs subscales on PTSS.

CONCLUSIONS

Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity.

Access to Public Support Systems Related to Severity of Adversities and Resilience among Adolescents

Access to support systems is crucial for providing immediate assistance and treatment to children to counteract the long-term detrimental effects of various forms of violence. This study examines how adversity such as victimization of violence and self-injury behaviors among young people with their individual resilience is related to their access to support systems. The data used in our analysis are from two national youth surveys carried out in Norway in 2007 and 2015. We ask: To what degree do young people with experiences of violence gain access to support systems such as child welfare services, mental health services for children and youth, and pedagogical psychology services? Our results show that although not all young people who need help have gained access to support systems, victimization of violence and self-injury behavior significantly increase the likelihood of accessing these support systems. Our results also reveal a persistent effect of young people’s home socio-economic background on their unequal access to system support. More future research is needed on the subtle mechanisms and social–emotional implications of individual accessing system support from the macro-societal level and meso-system/family level.