Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program

Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.

Recognizing Suicidal Risk in Very Young Children

Suicidal thought and behavior (STB) in preschool and kindergarten-age children is an alarming event. Until recently, these young children's experiences have been under recognized, in part due to an under appreciation for their awareness of the finality of death. Although rare, serious suicide attempts and death by suicide among preschool and kindergarten-age children are well documented. There is limited research on the risk factors that contribute to STB in very young children. We present de-identified case descriptions of very young children seen for psychiatric treatment at a day hospital program who presented with self-injurious behavior and suicidal ideation (SI). The patients described have common risk factors, including exposure to trauma, family conflict and family history of suicidal behavior. It is critical that children presenting with STB be assessed and offered services to mitigate these risks.

Partial hospitalization treatment for preschoolers with severe behavior problems: child age and maternal functioning as predictors of outcome

BACKGROUND

This study focused on the behavioral functioning and treatment outcomes of preschool-aged children who attended a specialized, family focused psychiatric partial hospitalization program.

METHOD

Study data were collected between 2002 and 2007. Maternal reports of child behavioral functioning were obtained at program admission and discharge. Maternal parenting stress and psychiatric impairment were assessed at admission.

RESULTS

Children's symptom severity decreased from admission to discharge, particularly with respect to externalizing symptoms. Both child age and maternal functioning emerged as predictors of treatment outcome.

CONCLUSIONS

Specialized partial hospitalization may be an effective approach to treatment for preschool children with severe psychopathology.

Anger and sadness perception in clinically referred preschoolers: emotion processes and externalizing behavior symptoms

This study examined emotion perception processes in preschool aged children presenting with clinically significant emotional and behavior problems, with emphasis on sadness perception accuracy (i.e., the ability to correctly identify sadness from expressive and situational cues) and anger perception bias (i.e., the tendency to perceive anger in the absence of concordant cues) as related to children's externalizing symptoms. Participants were 82 children (3-5 years of age) admitted to a psychiatric day treatment program. Children participated in a structured puppet play activity to assess emotion understanding. Mothers reported on children's externalizing symptoms and program staff reported on children's emotion regulation and negative emotional lability. Young children in this clinical sample demonstrated generally age-appropriate ability to identify basic emotions as expressed within prototypical social situations. Most emotion perception errors involved the over-identification of sadness. Children's decreased accuracy in sadness perception was associated with increased externalizing symptoms. Children's negative emotional lability contributed unique variance to the prediction of externalizing symptoms, with more labile children also demonstrating increased symptoms. Results underscore the role of emotion processes in early childhood mental health problems, with implications for emotion-based treatments of early externalizing behavior symptoms.

Depression following a spinal cord injury

OBJECT

Depression is a common problem following a spinal cord injury (SCI) and can greatly interfere with the rehabilitation process because of reduced energy, negative expectations, and social withdrawal. Understanding various factors which influence a vulnerability to depression may improve the diagnosis and treatment of depressive disorders and can improve rehabilitation outcome.

METHOD

A thorough literature search was conducted using Medline, PsychLit, Pyschinfo, and Social Science Citation Index to identify relevant articles published between 1967 and 1995.

RESULTS

A diathesis-stress model is proposed to explain the increased risk of depressive symptoms after a SCI. Biological changes associated with SCI and pre-existing cognitive biases may influence the individual's vulnerability to stressful life events following the injury. The nature and frequency of stressful life events following the injury can tax the individual's coping resources. Furthermore, the perceived quality of social support and the severity of conflict within the family can influence the individual's adaptation.

CONCLUSIONS

Social support and recent stressors should be assessed to identify patients at high risk for depression. Patients are less likely to become depressed if their independence is fostered and they are encouraged to develop new sources of self-esteem. Relatives can be counseled to help maintain supportive relationships within the family.

Estimating premorbid intelligence in African-American and white elderly veterans using the American version of the National Adult Reading Test

Knowledge of earlier intellectual functioning can be very helpful in the diagnosis of neurocognitive disorders. The National Adult Reading Test (Nelson, 1982), based on the observation that reading irregularly spelled words remains intact in mild dementia, may be useful for this purpose. A version for speakers of American English (AMNART) was recently published (Grober & Sliwinski, 1991). The present study evaluated the validity of the AMNART with demented and nondemented African-American and White elderly veterans. The average differences between African-American and White participants on the AMNART and WAIS-R were similar. The differences between demented and nondemented patients were greater on the WAIS-R than on the AMNART, as expected. Paradoxically, the AMNART appears to over-estimate IQ among nondemented individuals with lower WAIS-R scores, but underestimate IQ among more impaired demented patients. Using Grober and Sliwinski's (1991) 10-point discrepancy rule between AMNART and WAIS-R VIQ scores, 70% of demented and nondemented veterans were successfully classified. No discontinuation rule for the AMNART could be established because word difficulty order varies across samples.