From mother to child: Maternal betrayal trauma and risk for maltreatment and psychopathology in the next generation

The objective of this study was to investigate whether experiences of high betrayal trauma (BT; maltreatment by a parent/caregiver) during mothers' own childhoods may influence the intergenerational transmission of maltreatment and its associated psychopathology from mothers to their children. A prospective, longitudinal design was utilized to assess maternal physical and sexual betrayal trauma in relation to children’s own maltreatment experiences, and child mood and behavioral symptoms during pre-adolescence. Data from 706 mothers and children who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) was analyzed, including: mothers’ physical and sexual maltreatment histories, child protective services’ documented physical and sexual maltreatment during children’s first twelve years of life, and mother- and child-reports of child internalizing and externalizing symptoms at age 12. Children of mothers who survived high BT (maltreatment by a caregiver) were 4.52 times more likely to experience maltreatment than children of no BT mothers (mothers whom were not maltreated), and 1.58 times more likely than children whose mothers survived low BT (maltreatment by a non-caregiver). Higher levels of maternal physical BT significantly predicted more internalizing and externalizing symptoms in children at age 12, according to both mother (CBCL) and child (YSR) reports. More incidents of child physical maltreatment partially mediated associations between maternal physical BT and child symptoms. Incidents of sexual maltreatment also partially mediated associations between maternal sexual BT and child internalizing and externalizing symptoms (CBCL only). These findings have implications for understanding the role of betrayal trauma in perpetuating the cycle of maltreatment across generations.     

Dissociation in maltreated versus nonmaltreated preschool-aged children.

OBJECTIVE: Dissociation is linked to the experience of child maltreatment for adults and for school-aged children. The goals of the current paper were: First, to extend existing research and examine the link between child maltreatment and preschool-aged children; and second, to examine which subgroups of maltreated preschoolers are most likely to evidence dissociation. METHOD: A well-validated measure of dissociation in children, The Child Dissociative Checklist (CDC; Putnam, Helmers, & Trickett, 1993), was utilized in a sample of low SES maltreated and nonmaltreated preschoolers (N = 198). A measure of internalizing and externalizing symptoms was also utilized. The maltreated children were assessed for sexual abuse, physical abuse, neglect, and also for severity, chronicity, and multiple subtypes of maltreatment. RESULTS: The sexually abused, physically abused, and neglected groups each demonstrated more dissociation than did the nonmaltreated group. Dissociation in the clinical (psychopathological) range was associated with physical abuse. Moreover, maltreatment severity, chronicity, multiple subtypes, and internalizing and externalizing symptomatology were each related to dissociation. CONCLUSIONS: Child maltreatment is a factor in dissociation in preschool-aged children as it is in older children and in adults. Sexual abuse, physical abuse, neglect, severity, and chronicity are all implicated. Developmentally sensitive interventions that look beyond comorbidity with behavioral symptoms for dissociative preschool-aged children are needed.     

Identifying maltreatment subgroups with patterns of maltreatment subtype and chronicity: A latent class analysis approach

Maltreatment experiences are complex, and it is difficult to characterize the heterogeneity in types of maltreatment. Subtypes, such as emotional maltreatment, sexual abuse, physical abuse, and neglect commonly co-occur and may persist across development. Therefore, treating individual maltreatment subtypes as independently occurring is not representative of the nature of maltreatment as it occurs in children’s lives. Latent class analysis (LCA) is employed herein to identify subgroups of maltreated children based on commonalities in maltreatment subtype and chronicity. In a sample of 674 low-income urban children, 51.6% of whom experienced officially documented maltreatment, our analyses identified four classes of children, with three distinct classes based on maltreatment subtypes and chronicity, and one group of children who did not experience maltreatment. The largest class of maltreated children identified was the chronic, multi-subtype maltreatment class (57% of maltreated children); a second class was characterized by only neglect in a single developmental period (31% of maltreated children), and the smallest class was characterized by a single subtype of maltreatment (emotional maltreatment, physical, or sexual abuse) occurring in a single developmental period (12% of maltreated children). Characterization of these groups confirms the overlapping nature of maltreatment subtypes. There were notable differences between latent classes on child behavioral and socio-emotional outcomes measured by child self-report and camp counselors report during a one-week summer camp. The largest differences were between the non-maltreated class and the chronic maltreatment class. Children who experienced chronic, multi-subtype maltreatment showed higher levels of externalizing behavior, emotion dysregulation, depression, and anxiety.     

The protective effects of religiosity on maladjustment among maltreated and nonmaltreated children

OBJECTIVE: The aim of this study was to investigate the role of child religiosity in the development of maladaptation among maltreated children. METHODS: Data were collected on 188 maltreated and 196 nonmaltreated children from low-income families (ages 6-12 years). Children were assessed on religiosity and depressive symptoms, and were evaluated by camp counselors on internalizing symptomatology and externalizing symptomatology. RESULTS: Significant interactions indicated protective effects of religiosity. Child reports of the importance of faith were related to lower levels of internalizing symptomatology among maltreated girls (t=-2.81, p<.05). Child reports of attendance at religious services were associated with lower levels of externalizing symptomatology among nonmaltreated boys (t=1.94, p=.05). CONCLUSION: These results suggest that child religiosity may largely contribute to stress coping process among maltreated and nonmaltreated children from low-income families. The results also indicate that the protective roles of religiosity varied by risk status and gender. PRACTICAL IMPLICATIONS: The results indicate that a range of child religiosity behaviors and practices can be assessed in translational prevention research. It is recommended that healthcare professionals, psychologists, and social workers working with maltreated children and their families assess for salience of religiosity and may encourage them to consider the role religiosity plays in the development of prevention and intervention programs to alleviate distress and enhance stress coping.     

Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model

Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999–2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n = 280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.     

The relationship between protective factors and outcomes for children investigated for maltreatment

ObjectivesThis research explores the relationship between hypothesized protective factors and outcomes for children investigated for maltreatment.MethodsUsing data from the National Survey on Child and Adolescent Well-Being (NSCAW), we ran logistic regression models to examine the relationship between hypothesized protective factors (social competence, adaptive functioning skills, and peer relationships) and outcomes (externalizing behavior, internalizing behavior, reading competence).ResultsFor each hypothesized protective factor, we found variation in individual scores and sample mean scores at the lower end of the scales, indicating that these children fare worse than most children. However, many children experienced large changes in their individual scores over time suggesting that children can and do improve on these hypothesized protective factors. In examining the relationship between hypothesized protective factors and outcomes, children with higher levels of social competence were significantly more likely to be in the normal range for both externalizing and internalizing behaviors. Children with higher mean adaptive functioning skills were more likely to be in the normal range for both externalizing behavior and reading competence. The positive nature of the child's peer relationships was also related to externalizing behavior and reading competence.ConclusionsOverall, our analyses support the idea that social competence, adaptive functioning skills, and peer relationships are related to outcomes for children investigated for maltreatment. While further research is needed to establish a causal link, this work identifies three individual-level hypothesized protective factors as potential sources of variation in outcomes.Practice implicationsTo prevent or alleviate the harmful consequences maltreatment, it is necessary to understand factors that help children move beyond poor outcomes. Our analyses suggest that a strong relationship exists between a child's social competence, adaptive functioning skills and positive peer relationships and select outcomes three years after being investigated for maltreatment. With these individual-level protective factors related to more positive outcomes, it suggests that intervening to increase protective factors could improve outcomes for maltreated and at-risk children.     

A longitudinal investigation of protective factors for bereaved maltreated youth

BackgroundMaltreated youth are at an elevated risk for the development of problem behaviors. Coping with the death of a family member or close friend during adolescence, referred to as bereavement, is a stressful event that could potentiate risk linked to maltreatment. However, developmental research suggests that youth adjustment is a product of multiple risk and protective factors. Although maltreated youth who experience loss may be particularly vulnerable to behavior problems, personal and contextual factors may attenuate or exacerbate youths’ risk for internalizing and externalizing psychopathology.ObjectiveThe overarching goal of this study is to examine individual, family, and community-level protective factors for maltreated youth who experience bereavement. Specifically, we aim to examine the effect of age 12 bereavement on age 16 internalizing and externalizing psychopathology, and to investigate the moderating role of multi-level protective factors at ages 14 and 16.MethodsThe study consisted of a sample of 800 youth (52.4% female, 45.1% African-American) drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), collected from 1998 to 2011.ResultsMaltreated youth who experienced significant loss were at increased risk for externalizing symptoms, compared to non-bereaved maltreated youth (β = 0.085, p < .05). Individual future orientation (β = 0.103, p < .05) family future orientation (β = −0.120, p < .05), parental monitoring (β = −0.123, p< .01), and neighborhood collective efficacy (β = −0.126, p < .01) each significantly moderated the association between bereavement and externalizing symptoms.ConclusionsThese results have implications for future interventions aimed towards reducing problem behaviors in adolescents with a history of child maltreatment and who experience bereavement.     

A Longitudinal Study of Emotion Regulation,Emotion Lability‐Negativity,and Internalizing Symptomatology in Maltreated and Nonmaltreated Children

The longitudinal contributions of emotion regulation and emotion lability‐negativity to internalizing symptomatology were examined in a low‐income sample (171 maltreated and 151 nonmaltreated children, from age 7 to 10 years). Latent difference score models indicated that for both maltreated and nonmaltreated children, emotion regulation was a mediator between emotion lability‐negativity and internalizing symptomatology, whereas emotion lability‐negativity was not a mediator between emotion regulation and internalizing symptomatology. Early maltreatment was associated with high emotion lability‐negativity (age 7) that contributed to poor emotion regulation (age 8), which in turn was predictive of increases in internalizing symptomatology (from age 8 to 9). The results imply important roles of emotion regulation in the development of internalizing symptomatology, especially for children with high emotion lability‐negativity.     

The role of callous/unemotional traits in mediating the association between animal abuse exposure and behavior problems among children exposed to intimate partner violence

Children exposed to intimate partner violence are at increased risk for concomitant exposure to maltreatment of companion animals. There is emerging evidence that childhood exposure to maltreatment of companion animals is associated with psychopathology in childhood and adulthood. However, few studies have explored developmental factors that might help to explain pathways from animal maltreatment exposure to children’s maladjustment. The present study addresses this gap in the literature by examining relations between children’s exposure to animal maltreatment, callous/unemotional traits (i.e., callousness, uncaring traits, and unemotional traits), and externalizing and internalizing behavior problems. A sample of 291 ethnically diverse children (55% Latino or Hispanic) between the ages of 7 and 12 was recruited from community-based domestic violence services. A meditational path model indicated that child exposure to animal maltreatment was associated with callousness (β = 0.14), which in turn was associated with greater internalizing (β = 0.32) and externalizing problems (β = 0.47). The effect of animal maltreatment exposure on externalizing problems was mediated through callousness. Results suggest that callous/unemotional traits are a potential mechanism through which childhood exposure to animal maltreatment influences subsequent behavior problems. Future research is needed to evaluate the extent to which exposure to animal maltreatment affects children’s adjustment over time in the context of other co-occurring adverse childhood experiences.     

Child maltreatment characteristics as predictors of heterogeneity in internalizing symptom trajectories among children in the child welfare system

This study investigated heterogeneity in the developmental trajectories of internalizing symptoms among 541 children who were involved with the child welfare system and examined child maltreatment characteristics, including types, level of harm, and timing, as predictors of internalizing trajectory patterns. Secondary longitudinal research was conducted using data from the National Survey of Child and Adolescent Well-Being-I, collected from 1999 to 2007 in the United States. Three distinct trajectory groups were identified: high–decreasing; low–increasing; and low–stable Sexual abuse, emotional abuse, neglect, and more severe levels of harm from maltreatment predicted membership in two maladaptive groups compared to the low–stable group. The findings of the study suggest the importance of providing a thorough assessment of the type and severity of maltreatment experiences and continued monitoring of internalizing symptoms for children with child welfare involvement.     

The relation between dimensions of maltreatment,placement instability,and mental health among youth in foster care

Youth in foster care with maltreatment experiences often demonstrate higher rates of mental and behavioral health problems compared to youth in the general population as well as maltreated youth who remain at home. Previous research has demonstrated that dimensions of maltreatment (type, frequency, and severity) and placement instability are two prominent factors that account for high rates of psychopathology (e.g., depression, anxiety, and disruptive behavior disorders). The present study sought to clarify the relation between maltreatment and mental health among youth in foster care by studying both the isolated dimensions of maltreatment and cumulative maltreatment, and to determine whether the effects of maltreatment on mental health operated indirectly through placement instability. Information on youth in foster care’s (N = 496, M_age = 13.14) mental and behavioral health, maltreatment history, and placement changes were obtained from state records and primary caregivers. Using a SEM framework, the results suggest that maltreatment and placement instability each independently relate to mental and behavioral health problems. Further, none of the maltreatment types predicted greater placement instability in the current models. These findings suggest that placement stability is critical for mental health for youth in foster care, regardless of the type, severity, or frequency of their maltreatment experiences. Results also indicated that, although cumulative maltreatment predicted both internalizing and externalizing symptoms, maltreatment frequency and severity had direct relations to externalizing symptoms only. These findings underscore the utility of comprehensive maltreatment assessment, encouraging researchers and clinicians to assess and carefully consider the relation between maltreatment dimensions and outcomes.     

What do we know about child abuse and neglect patterns of co-occurrence? A systematic review of profiling studies and recommendations for future research

Latent class (LCA) and latent profile (LPA) analysis represent methodological approaches to identify subgroups of maltreated individuals. Although research examining child abuse and neglect (CAN) profiles is still rare, the application of person-centered techniques to clarify CAN types co-occurrence has substantially increased in recent years. Therefore, the aim of the present study was to provide a summary and critical evaluation of the findings of LCA/LPA child maltreatment research to: (a) systemize the current understanding of patterns of maltreatment across populations and (b) elucidate interactive effects of CAN types on psychosocial functioning. A search in PsychInfo, Eric, PubMed, Scopus, and Science Direct, and Google Scholar was performed. Sixteen studies examining the co-occurrence between child physical abuse, emotional abuse, sexual abuse, neglect, and/or exposure to domestic violence were identified. A critical review of the studies revealed inconsistent findings as to the number of CAN classes, but most research uncovered a poly-victimized and a low abuse group. Further, multiple victimization was associated with most adverse internalizing and externalizing outcomes, especially when sexual abuse was present. Exposure to physical and emotional abuse was frequently reported to lead to behavioural problems. Based on the present study results, we provide a set of recommendations for surpassing the current methodological and conceptual limitations in future research.     

Variations in emotional abuse experiences among multiply maltreated young adolescents and relations with developmental outcomes

Objective

Based on the data obtained through Child Protective Services (CPS) case records abstraction, this study aimed to explore patterns of overlapping types of child maltreatment in a sample of urban, ethnically diverse male and female youth (n= 303) identified as maltreated by a large public child welfare agency.

Methods

A cluster analysis was conducted on data for 303 maltreated youth. The overall categorization of four types of abuse (i.e., physical, sexual, emotional abuse and neglect) was used to provide a starting point for clustering of the 303 cases and then the subtypes of emotional abuse were broken down in the clusters. The different clusters of child maltreatment were compared on the multiple outcomes such as mental health, behavior problems, self-perception, and cognitive development.

Results

In this study, we identified four clusters of child maltreatment experiences. Three patterns involved emotional abuse. One cluster of children experienced all four types. Different clusters were differentially associated with multiple outcome measures. In general, multiply-maltreated youth fared worst, especially when the cluster involved sexual abuse. Also, sex differences were found in these associations. Boys who experienced multiple types of maltreatment showed more difficulties than girls.

Conclusion and practice implications

These results reiterate the importance of creating more complex models of child maltreatment. Children who have experienced various types of maltreatment are especially in need of more attention from professionals and resources should be allocated accordingly.     

The whole picture: Child maltreatment experiences of youths who were physically abused

The purpose of the current study was to describe the maltreatment experiences of a sample of urban youths identified as physically abused using the Maltreatment Case Record Abstraction Instrument (MCRAI). The sample (n = 303) of 9–12 year old youths was recruited from active child protective services (CPS) cases in 2002–2005, and five years of child protective service records were reviewed. The demographic and maltreatment experiences of MCRAI-identified youths with physical abuse were compared to maltreated youths who were not physically abused and youths who were identified as physically abused by CPS when they entered this longitudinal study. T-tests and chi-square tests were used to compare the demographics and maltreatment experiences of the sample MCRAI-identified physically abused to the sample MCRAI-identified as nonphysically abused maltreated by gender. Of the total sample, 156 (51%) were identified by MCRAI as physically abused and 96.8% of these youth also experienced other types of maltreatment. Whereas youth with the initial CPS identification of physical abuse showed little co-occurrence (37.7%) with other forms of maltreatment. The MCRAI-identified physically abused youths had a significantly higher mean number of CPS reports and higher mean number of incidents of maltreatment than MCRAI-identified nonphysically maltreated youths. Lifeline plots of case record history from the time of first report to CPS to entry into the study found substantial individual variability in maltreatment experiences for both boys and girls. Thus, obtaining maltreatment information from a single report vastly underestimates the prevalence of physical abuse and the co-occurrence of other maltreatment types.     

Maltreatment in multiple-birth children

ObjectiveThe rate of multiple births has increased over the last two decades. In 1982, an increased frequency of injuries among this patient population was noted, but few studies have evaluated the increased incidence of maltreatment in twins. The study aim was to evaluate the features of all multiple-birth children with substantiated physical abuse and/or neglect over a four-year period at a major children's hospital.Study design and methodsA Retrospective chart review was conducted of multiple-gestation children in which at least one child in the multiple set experienced child maltreatment from January 2006 to December 2009. Data regarding the child, injuries, family, and perpetrators were abstracted. We evaluated whether family and child characteristics were associated with maltreatment, and whether types of injuries were similar within multiple sets. For comparison, data from the same time period for single-birth maltreated children also were abstracted, including child age, gestational age at birth, and injury type.ResultsThere were 19 sets of multiple births in which at least one child had abusive injuries and/or neglect. In 10 of 19 sets (53%), all multiples were found to have a form of maltreatment, and all children in these multiple sets shared at least one injury type. Parents lived together in 63% of cases. Fathers and mothers were the alleged perpetrator in 42% of the cases. Multiple-gestation-birth maltreated children were significantly more likely than single-birth maltreated children to have abdominal trauma (13% vs. 1%, respectively; p < .01), fractures (83% vs. 39%; p < .01), and to be injured at a younger mean age (12.8 months vs. 34.8 months; p < .01).ConclusionsSiblings of maltreated, multiple-gestation children often, but not always, were abused. In sets with two maltreated children, children usually shared the same modes of maltreatment. Multiples are significantly more likely than singletons to be younger and experience fractures and abdominal trauma. The findings support the current standard practice of evaluating all children in a multiple set when one is found to be abused or neglected.     

Does the impact of child sexual abuse differ from maltreated but non-sexually abused children? A prospective examination of the impact of child sexual abuse on internalizing and externalizing behavior problems

Child sexual abuse (CSA) continues to be a significant problem with significant short and long term consequences. However, extant literature is limited by the reliance on retrospective recall of adult samples, single-time assessments, and lack of longitudinal data during the childhood and adolescent years. The purpose of this study was to compare internalizing and externalizing behavior problems of those with a history of sexual abuse to those with a history of maltreatment, but not sexual abuse. We examined whether gender moderated problems over time. Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 6, 8, 10, 12, 14, and 16 (N = 977). The Child Behavior Checklist was used to assess internalizing and externalizing problems. Maltreatment history and types were obtained from official Child Protective Services (CPS) records. Generalized Estimating Equations (GEE) were used to assess behavior problems over time by maltreatment group. Findings indicated significantly more problems in the CSA group than the maltreated group without CSA over time. Internalizing problems were higher for sexually abused boys compared to girls. For sexually abused girls internalizing problems, but not externalizing problems increased with age relative to boys. This pattern was similar among maltreated but not sexually abused youth. Further efforts are needed to examine the psychological effects of maltreatment, particularly CSA longitudinally as well as better understand possible gender differences in order to best guide treatment efforts.     

The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers,children and young people and young adults

Objectives

To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health.

Methods

A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health.

Results

2.5% of children aged under 11 years and 6% of young people aged 11–17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11–17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11–17 and 18.6% of females aged 18–24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms.

Conclusions

The past year maltreatment rates for children under age 18 were 7–17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.     

The unique relation of childhood emotional maltreatment with mental health problems among detained male and female adolescents

Mounting evidence indicates that emotional maltreatment is at least as harmful as physical and sexual abuse. Notwithstanding their high occurrence among detained adolescents, the link between emotional maltreatment and mental health problems in these youths is not well researched. This study, therefore, was designed to examine the unique link between emotional maltreatment and mental health problems, with particular attention to gender differences. Well validated self-report measures of maltreatment experiences (Childhood Trauma Questionnaire) and mental health problems (Youth Self Report) were completed by 341 detained adolescents (156 boys, 185 girls) aged 12 to 18 years. As expected, girls reported higher levels of maltreatment experiences and internalizing and externalizing mental health problems than boys. Blockwise multiple linear regression analyses indicated that in both genders emotional abuse was uniquely and positively associated with internalizing and externalizing mental health problems, over and above the influence of other types of maltreatment. Furthermore, sexual abuse was uniquely related with internalizing problems in girls only, whereas only in boys this type of abuse was uniquely related with externalizing problems. Detained adolescents who have been the victim of emotional abuse in combination with another type of maltreatment may be the worst subgroup in terms of mental health problems. Therefore, emotional maltreatment experiences in adolescents who offend should receive more research and clinical attention.     

Cumulative childhood trauma and psychological maladjustment of sexually abused children in Korea: Mediating effects of emotion regulation

The purpose of the present study was to identify the mediating effects of emotion regulation on the association between cumulative childhood trauma and behavior problems in sexually abused children in Korea, using structural equation modeling (SEM). Data were collected on 171 children (ages 6–13 years) referred to a public counseling center for sexual abuse in Seoul, Korea. Cumulative childhood traumas were defined on the basis of number of traumas (physical abuse, witnessing domestic violence, neglect, traumatic separation from parent, and sexual abuse) and the severity and duration of traumas. Children were evaluated by their parents on emotion regulation using the Emotion Regulation Checklist and internalizing and externalizing behavior problems using the Korean-Child Behavior Checklist. SEM analyses confirmed the complete mediation model, in which emotion dysregulation fully mediates the relationship between cumulative childhood traumas and internalizing/externalizing behavior problems. These findings indicate that emotion regulation is an important mechanism that can explain the negative effects of cumulative childhood traumas and that there is a need to focus on emotion regulation in sexually abused children exposed to cumulative trauma.