Childhood adversity increases the risk of onward transmission from perinatal HIV-infected adolescents and youth in South Africa

Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13–24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09–1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth.     

How Early Life Adversity Transforms the Learning Brain

For educators to help children exposed to adverse life experiences, it is necessary to understand how adversity impacts different mechanisms of learning, emotion, and planning as these capacities underpin success in schools and beyond. The goal of this paper is to review essential findings on how early life adversity transforms the brain which, in turn, impacts educational outcomes. Part 1 begins by discussing the species‐specific and expectant experiences that guide typical development, and then turns to early life adversities and their relationship to both physical and mental health outcomes. Part 2 summarizes four dimensions of adversity—type, timing, term, and toxicity—and how each differentially impacts the developing brain, including individual differences in psychopathology. Part 3 discusses the relevance of these findings for educators, highlighting how behavior can be modified to build resilience and greater academic and social–emotional competency.     

Resilience and coping: Implications for gifted children and youth at risk

The large body of literature on resilience and coping gives promise to finding specific ways in which teachers, counselors, and schools can enhance success among gifted and talented children and youth placed at risk. While high intelligence is not a requirement for resilient outcomes, cognitive ability appears to be a supporting factor, especially as it relates to problem solving and coping. To the extent that low‐income and culturally diverse children and youth have more experience overcoming adversity, they may possess a greater range of and flexibility in coping strategies that can be shared with others. This article summarizes findings from resilience literature relevant to the development of children and adolescents and derives specific strategies for enhancing outcomes for gifted children and youth most at risk for encountering adversity.     

Health effects of adverse childhood events: Identifying promising protective factors at the intersection of mental and physical well-being

Research documents how exposure to adversity in childhood leads to negative health outcomes across the lifespan. Less is known about protective factors – aspects of the individual, family, and community that promote good health despite exposure to adversity. Guided by the Resilience Portfolio Model, this study examined protective factors associated with physical health in a sample of adolescents and adults exposed to high levels of adversity including child abuse. A rural community sample of 2565 individuals with average age of 30 participated in surveys via computer assisted software. Participants completed self-report measures of physical health, adversity, and a range of protective factors drawn from research on resilience. Participants reporting a greater burden of childhood victimization and current financial strain (but not other adverse life events) had poorer physical health, but those with strengths in emotion regulation, meaning making, community support, social support, and practicing forgiveness reported better health. As hypothesized, strengths across resilience portfolio domains (regulatory, meaning making, and interpersonal) had independent, positive associations with health related quality of life after accounting for participants’ exposure to adversity. Prevention and intervention efforts for child maltreatment should focus on bolstering a portfolio of strengths. The foundation of the work needs to begin with families early in the lifespan.     

Biological Sensitivity to Context: The Interactive Effects of Stress Reactivity and Family Adversity on Socioemotional Behavior and School Readiness

This study examined the direct and interactive effects of stress reactivity and family adversity on socioemotional and cognitive development in three hundred and thirty-eight 5- to 6-year-old children. Neurobiological stress reactivity was measured as respiratory sinus arrhythmia and salivary cortisol responses to social, cognitive, sensory, and emotional challenges. Adaptation was assessed using child, parent, and teacher reports of externalizing symptoms, prosocial behaviors, school engagement, and academic competence. Results revealed significant interactions between reactivity and adversity. High stress reactivity was associated with more maladaptive outcomes in the context of high adversity but with better adaption in the context of low adversity. The findings corroborate a reconceptualization of stress reactivity as biological sensitivity to context by showing that high reactivity can both hinder and promote adaptive functioning.     

Epigenetic Vestiges of Early Developmental Adversity: Childhood Stress Exposure and DNA Methylation in Adolescence

Fifteen‐year‐old adolescents (N = 109) in a longitudinal study of child development were recruited to examine differences in DNA methylation in relation to parent reports of adversity during the adolescents’ infancy and preschool periods. Microarray technology applied to 28,000 cytosine–guanine dinucleotide sites within DNA derived from buccal epithelial cells showed differential methylation among adolescents whose parents reported high levels of stress during their children’s early lives. Maternal stressors in infancy and paternal stressors in the preschool years were most strongly predictive of differential methylation, and the patterning of such epigenetic marks varied by children’s gender. To the authors’ knowledge, this is the first report of prospective associations between adversities in early childhood and the epigenetic conformation of adolescents’ genomic DNA.     

Educational and emotional health outcomes in adolescence following maltreatment in early childhood: A population-based study of protective factors

Although childhood maltreatment is associated with long-term impairment, some children function well despite this adversity. This study aimed to identify the key protective factors for good educational attainment and positive emotional health in adolescents who experienced maltreatment in early childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children, a large UK prospective cohort study. The sample was defined by maternally reported exposure to physical or emotional maltreatment by a parent prior to 5 years. 1118 (8.0%) children were emotionally maltreated and 375 (2.7%) were physically maltreated before the age of 5. There were too few cases of sexual abuse to be considered. Positive outcomes were operationalized as achieving 5 or more grade A*-C GCSE exam grades at 16 years and scores above the cohort median on the self-report Warwick-Edinburgh Mental Wellbeing Scale and Bachmann Self-Esteem Scale at 17.5 years. The associations of individual, family and community covariates with successful adaptation to the adversity of maltreatment were investigated using logistic regression.School related factors, including engagement in extracurricular activities, satisfaction with school and not being bullied were the most important in facilitating resilience in educational attainment, self-esteem and wellbeing. Good communication and social skills was the most protective individual trait. There was insufficient evidence to suggest that family factors were associated with resilience to maltreatment. School-based interventions are recommended to promote positive adaptation following parental maltreatment. Future research should evaluate outcomes across the life-course to understand whether the protective influences of school persist into adulthood.     

The effects of classroom-based dynamic seating interventions on academic outcomes in youth: a systematic review

The purpose of this systematic review was to synthesise and evaluate the literature on the effects of classroom-based dynamic seating interventions on academic-related outcomes, among school-aged children and adolescents. A secondary aim was to examine the effects of interventions on students’ sedentary behaviour and physical activity levels. In September 2017, four electronic databases (PsycINFO, PubMed, SPORTDiscus, Web of Science) were searched and a total of 5138 titles and abstracts were reviewed. Studies that examined associations between a classroom-based dynamic seating intervention and at least one academic-related outcome in school-aged children or adolescents were included. A best-evidence synthesis and narrative approach was implemented to synthesise the evidence. Thirteen studies published between 2003 and 2017 were identified that met the inclusion criteria for the review. There is some evidence that classroom-based dynamic seating interventions could have positive effects on the in-seat behaviour, academic engagement and attention of school aged-children and adolescents, predominantly those with attention difficulties. It is currently unclear whether dynamic seating has positive effects on students’ on-task behaviour, disruptive behaviour, memory, concentration or academic achievement. No intervention was found to have a detrimental effect on academic-related outcomes. The findings come from low-quality to moderate-quality studies (M?=?60.62%; SD?=?10.44). Classroom-based dynamic seating could be a simple, effective health strategy to reduce students’ static sitting time without compromising student learning and academic performance. The current interventions need to be replicated with larger, adequately-powered RCT designs, valid and reliable outcome measures, and assessment of intervention fidelity.

     

Early Adverse Experiences and Repeated Wheezing From 6 to 30 Months of Age: Investigating the Roles of Hypothalamic–Pituitary–Adrenal Axis Functioning,Child Sex,and Caregiving Sensitivity

This study examined associations among early adversity, diurnal cortisol, child sex, and caregiver sensitivity at age 6 months in relation to wheezing in children (47% male) followed to 30 months. Analyses included 676 mother-child dyads, 393 of whom completed an observational caregiver sensitivity measure. Participants were primarily ethnic minorities (42.7% Black, 25.4% Hispanic); 22.1% of children had ≥ 1 wheezing episode. Higher adversity was associated with increased wheeze frequency and blunted diurnal cortisol slope. The indirect effect of adversity on wheezing through cortisol slope was significant for females, but not males. Higher caregiver sensitivity was protective against wheezing for males, but not females, with high cortisol. Findings suggest complex associations among adversity, cortisol, child sex, and caregiver sensitivity in predicting wheezing.     

Stress‐Induced Elevation of Oxytocin in Maltreated Children: Evolution,Neurodevelopment, and Social Behavior

Child maltreatment often has a negative impact on the development of social behavior and health. The biobehavioral mechanisms through which these adverse outcomes emerge, however, are not clear. To better understand the ways in which early life adversity affects subsequent social behavior, changes in the neuropeptide oxytocin (OT) in children (n = 73) aged 8.1–11.5 years following a laboratory stressor were examined. Girls with histories of physical abuse have higher levels of urinary OT and lower levels of salivary cortisol following the stressor when compared to controls. Abused and control boys, however, do not differ in their hormonal responses. These data suggest that early adversity may disrupt the development of the stress regulation system in girls by middle childhood.     

儿童青少年肥胖的干预研究评述

儿童青少年肥胖不断增加已成为全球关注的公共卫生问题,针对儿童青少年肥胖进行干预也成为一个热点话题。从干预理论、干预的内容及措施、干预的效果评价三个方面对国内外儿童青少年肥胖的干预研究进行了综述,在此基础上阐述了目前儿童青少年肥胖干预研究的不足并对未来的发展方向进行了展望。     

Long-term follow-up of children conceived through assisted reproductive technology

Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced.     

Occupational Therapy in Preschools: A Synthesis of Current Knowledge

This paper presents a synthesis of current knowledge about occupational therapy in preschools (for 3–6 year olds) in order to provide a better understanding of this field of practice and to guide the implementation or programming of this service. In the literature, occupational therapy in preschools has been documented mainly in the USA. Results revealed that this service helped all children, with and without difficulties, to improve their skills, especially fine motor and graphomotor skills, and their participation in educational and daily living activities. Occupational therapy also had positive effects on teachers, parents and services. A service delivery model based on Response-to-Intervention or collaborative model should guide the implementation or programming of occupational therapy in preschools, with the focus on prevention/health promotion, screening and early intervention as well as school inclusion and success. Future studies are needed to determine the best intervention approaches and methods to improve children’s motor skills and self-regulation in inclusive preschool settings.     

Two-Year Impacts of a Comprehensive Family Financial Rewards Program on Children's Academic Outcomes: Moderation by Likelihood of Earning Rewards

Abstract

This article examines the extent to which impacts of a conditional cash transfer (CCT) program on children's academic outcomes vary by key characteristics associated with families’ propensity to earn the rewards offered by the program. We utilize an experimental study of Opportunity NYC-Family Rewards, a comprehensive CCT program in New York City in which low-income families were offered rewards for outcomes in health, education, and work. Building from a technique in propensity score research but used here to assess subgroup impacts in experimental studies, we use multiple baseline characteristics to predict the amount of rewards earned as a means to identify theoretically important, multivariate-defined groups of children for whom program effects might be more concentrated. Fourth-grade children in families with higher likelihood to earn rewards experienced more positive impacts of the program on academic outcomes. By contrast, no program impacts were found among 7th- or 9th-graders whose families were most likely to earn rewards. Differences across age groups are discussed in terms of their different developmental periods and the differing way the children experienced the intervention.     

Effects of an Early Family Intervention on Children's Memory: The Mediating Effects of Cortisol Levels

Developmental psychologists have long been concerned with the ways that early adversity influences children's long-term outcomes. In the current study, activity of the hypothalamic–pituitary–adrenal axis of medically at-risk (e.g., preterm) infants was measured as a result of maternal participation in a novel cognitively based home visitation program (versus a Healthy Start home visitation program). Maternal participation in the cognitive intervention predicted lower basal cortisol levels among infants—with reduced levels of maternal avoidance/withdrawal serving as a mediator of this relation. Lower cortisol levels in infancy, in turn, predicted higher verbal short-term memory (STM) at age 3. STM represents a cognitive ability that has importance for children's later educational outcomes. Findings provide experimental evidence concerning the pathway by which an early intervention may produce hormonal changes that can, in turn, influence children's learning outcomes.     

Intervention effects on negative affect of CPS-referred children: Results of a randomized clinical trial

Exposure to early adversity places young children at risk for behavioral, physiological, and emotional dysregulation, predisposing them to a range of long-term problematic outcomes. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention designed to enhance children's self-regulatory capabilities by helping parents to behave in nurturing, synchronous, and non-frightening ways. The effectiveness of the intervention was assessed in a randomized clinical trial, with parents who had been referred to Child Protective Services (CPS) for allegations of maltreatment. Parent–child dyads received either the ABC intervention or a control intervention. Following the intervention, children from the ABC intervention (n = 56) expressed lower levels of negative affect during a challenging task compared to children from the control intervention (n = 61).     

‘Push on through’: Children’s perspectives on the narratives of resilience in schools identified for intensive mental health promotion

Child mental health is a growing concern for policymakers across the global north. Schools have become a key site for mental health interventions, with new programmes aimed at promoting ‘resilience’, through which children may maintain or regain mental health during adversity. As one of the first studies to explore the early impact of intensive mental health promotion in schools from children’s perspectives, we adopt a governmentality approach to consider the logic and techniques of such programmes with a specific focus on England. An innovative visual methodology was used to focus on student perspectives of mental health interventions in school. Young peoples’ photo representations of mental health were collected and used to stimulate focus group discussions with 65 students aged 12–14, across seven schools. ‘Resilience’ was seen to be the key organising concept for mental health interventions in schools. The concept was viewed as narrowly focused on attitude towards—and performance in—school work, with individuals being encouraged to ‘push on through’ difficulties to achieve success. Young people were critical of this approach, suggesting several alternatives. These included increased access to independent mental health professionals, safe spaces within schools and mental health education that addressed the social and affective dimensions of mental health difficulties.     

Understanding Relations Among Early Family Environment, Cortisol Response, and Child Aggression via a Prevention Experiment

This study examined relations among family environment, cortisol response, and behavior in the context of a randomized controlled trial with 92 children ( M  =   48 months) at risk for antisocial behavior. Previously, researchers reported an intervention effect on cortisol response in anticipation of a social challenge. The current study examined whether changes in cortisol response were related to later child aggression. Among lower warmth families, the intervention effect on aggression was largely mediated by the intervention effect on cortisol response. Although the intervention also resulted in significant benefits on child engaging behavior, cortisol response did not mediate this effect. These findings demonstrate meaningful associations between cortisol response and aggression among children at familial risk for antisocial behavior.     

Role Fulfillment Mediates the Association Between Daily Family Assistance and Cortisol Awakening Response in Adolescents

Family assistance (helping the family) is associated with both positive and negative psychological and biological outcomes during adolescence. However, the association between family assistance and the hypothalamic–pituitary–adrenal (HPA) axis remains unstudied. Thus, we assess how helping the family relates to adolescents’ diurnal cortisol, an index of HPA activity, and psychological outcomes. Three hundred and seventy ethnically diverse adolescents (ages 11–18) reported daily helping behaviors and psychological experiences for 14 days and provided four saliva samples per day for 4 days. Multilevel modeling revealed that cortisol awakening response was lower the day after adolescents helped their families more. This association was explained, in part, by perceived role fulfillment (feeling like a good son, daughter, and sibling). Results highlight a possible psychological and biological benefit of assisting the family during adolescence.