Psychological distress as a mediator of the relationship between childhood maltreatment and sleep quality in adolescence: Results from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study

Childhood maltreatment represents an important public health concern, as it is often associated with a host of negative outcomes across development. In recent years, researchers have begun to examine the link between negative health-related behaviors and history of childhood maltreatment. The current study considers the relationship between history of childhood maltreatment and sleep disturbances in adolescence. Further, the role of psychological distress is considered as an explanatory link between childhood maltreatment and adolescent sleep disturbances. The current study is a secondary analysis using a subsample (N = 73) of child welfare-involved youth who participated in the initial and 2-year time-point of the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study on the variables of interest. Youth reported on lifetime maltreatment experiences, psychological distress, and sleep disturbances, in addition to the other measures administered as part of the larger MAP study protocol. More severe childhood maltreatment was related to increased sleep disturbances during adolescence, and psychological distress was a significant mediator of the childhood maltreatment-adolescent sleep disturbance association. The results demonstrate that a history of childhood maltreatment represents a risk factor for sleep disturbances in adolescence. The findings highlight the importance of inquiring about health-related behaviors in child welfare youth and the need to promote psychological well-being within this population.     

Prevalence of adverse childhood experiences (ACEs) among US children

ObjectiveThe purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs.MethodsData were drawn from the nationally representative 2016 National Survey of Children’s Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs.ResultsThe study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child’s age, family structure, poverty, type of health insurance, and SHCN status.ConclusionsWe found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.     

Trauma Response and Recovery Certificate Program: Preparing Students for Effective Practice

This paper describes an innovative approach to preparing MSW students for work with traumatized clients via a trauma certificate program. It explores conceptual and ethical principles of the program and presents results of the formative evaluation done with faculty, field instructors and students from the program's pilot year. Students reported gains in self-ratings of their efficacy in working with trauma in children, adults and communities, as well as articulating what parts of trauma theory were most useful to them in post-graduation. Field instructors were enthusiastic about the knowledge and skills students were building, and suggested further refinements to the program, including increased communication and networking on the topic of trauma.     

交通事故所致急性心理创伤症状与羞耻感的特点

目的：了解交通事故所致心理创伤症状与羞耻感的特点,为临床心理医疗提供理论基础。方法：对90例车祸伤的病人采用生活事件冲击量表修订版（ISE-R）、解离性体验量表（DES）和羞耻感量表等自陈式工具,于创伤后7天内进行评定。结果：个性羞耻与AI,侵袭性症状、回避症状与解离体验显著相关;行为羞耻与回避症状和解离体验显著相关;躯体羞耻与解离体验显著相关;家庭羞耻与解离体验显著相关。结论：交通事故所致急性心理创伤症状与非急性心理创伤组相比,心理创伤程度更严重,骨科医师在治疗骨科疾病的同时也应该重视PTSD的发生及其防治,以保证病人较快恢复健康,提高病人的生活质量。     

The role of complex posttraumatic stress symptoms in the association between exposure to traumatic events and severity of intimate partner violence

BackgroundSymptoms of both posttraumatic stress disorder (PTSD) and disturbances in self-organization (DSO) have been suggested to play a role in the association between an individual's childhood physical abuse and neglect and his/her perpetration of IPV in adulthood; however, the two have yet to be studied in one model. Thus, we aimed to examine the interrelations among childhood exposure to violence and physical neglect, exposure to trauma across one's lifetime, ICD-11 CPTSD symptoms (i.e., PTSD and DSO), and IPV severity.MethodsParticipants were 234 men drawn randomly from a national sample of 1600 mandated men receiving treatment for domestic violence in Israel. They completed measures of potentially traumatic exposure, symptoms of CPTSD, child abuse and neglect, and IPV. Structural equation modeling (SEM) was used to examine possible direct and indirect effects of the study variables.ResultsResults confirmed the indirect role of CPTSD symptoms in the association between the following types of traumatic exposure – childhood exposure to violence (B = .03, β = .05, SE = .01, p = .05, CI 90% [.041, .143]), childhood exposure to physical neglect (B = .04, β = .04, SE = .02, p < .01, CI 90% [.014, .092]), and lifetime exposure to potentially traumatic events, or PTEs (B = .04, β = .09, SE = .01, p < .001, CI 90% [.006, .074]) – and the perpetration of psychological IPV as an adult. No significant results were found in relation to the perpetration of physical IPV.ConclusionsThe current cross-sectional study findings suggest a preliminary direction regarding the possible direct and indirect effects of ICD-11CPTSD on the severity of IPV psychological perpetration. The clinical implications include the need to focus on both PTSD and DSO symptoms in order to help reduce these potential risk factors for psychological IPV perpetration.     

Bringing War Down to Earth: The Dialectic of Pity and Compassion in Doonesbury's View of Combat Trauma

Post-traumatic stress disorder among returning veterans from the wars in Iraq and Afghanistan has invoked all manner of public responses, not least of which is a sense of pity that begins and ends with the moment of recognition. As such, the publicity of soldier sufferance ironically mitigates the need for a more complex socialization to the pain of war that might be animated by a more nuanced emotional response rooted in the disruption of common narratives about sacrifice, service, and heroism. This essay argues for the potential of Garry Trudeau's trilogy of cartoons, collected under the titles of The Long Road Home, The War Within, and Signature Wound, to depict a dialectic of pity and compassion while underscoring the inadequacies of discourses of trauma through the use of bathos—a verbal–visual descent that emphasizes the commonplace in the seemingly extraordinary through the trope of the ridiculous.     

Trauma appraisals,emotion regulation difficulties,and self-compassion predict posttraumatic stress symptoms following childhood abuse

Experiencing traumatic events and abuse is unfortunately common in general, non-clinical samples. Recent research indicates that the ways in which individuals interpret traumatic experiences, as well as the ways that they manage challenging emotions in general, may statistically predict post-traumatic stress disorder (PTSD) symptoms to a greater extent than does trauma itself. Negative trauma appraisals, generalized emotion regulation (ER) difficulties, and low levels of self-compassion have each been shown to influence the connection between trauma exposure and subsequent PTSD symptoms. However, little is known regarding how these processes interact, or their relative contributions to mental health after trauma. The current study analyzed data from 466 university students who completed self-report measures of childhood abuse, PTSD symptoms, trauma appraisals, ER difficulties, and self-compassion. Childhood abuse exposure and PTSD symptoms were positively associated with negative trauma appraisals and ER difficulties, and negatively associated with self-compassion. Self-compassion was inversely associated with negative trauma appraisals and ER difficulties. Multiple mediation analyses demonstrated that negative trauma appraisals, ER difficulties, and levels of self-compassion fully explained the link between abuse exposure and PTSD symptoms via several specific pathways. These findings suggest that researchers, clinicians, and abuse survivors can benefit from addressing these interconnected domains during treatment and recovery processes.     

Using the Trauma Symptom Checklist for Children-Short form (TSCC-SF) on abused children in South Africa: Confirmatory factor analysis and Rasch models

BackgroundWhile assessment measures of trauma-related symptoms in children exist, few of them are at once brief, self-reports, normed, comprehensive (i.e., cover both general and trauma-specific symptoms), and thus suitable for poorly resourced clinical contexts.ObjectiveThis study validated the short form of the Trauma Symptom Checklist for Children (TSCC-SF) in a sample of children and adolescents.Participants and settingsParticipants were school-age children and adolescents (N = 270; M_age = 12.55 yrs., SD = 1.19; 67% = Female) exposed to different types of abuse (i.e., sexual, physical, emotional and neglect) receiving counselling at a non-governmental organisation.MethodsThe TSCC-SF’s factor structure and Differential Item Functioning (DIF) across sexes were examined using confirmatory factor analysis and Rasch analysis.ResultsResults revealed a satisfactory construct validity of the scale, while internal consistency was also adequate. No DIF was found across the sexes.ConclusionsThe TSCC-SF appears to be a viable option for use with children exposed to different types of abuse, particularly in low resource clinical contexts.     

Cumulative trauma and symptom complexity in children: A path analysis

Multiple trauma exposures during childhood are associated with a range of psychological symptoms later in life. In this study, we examined whether the total number of different types of trauma experienced by children (cumulative trauma) is associated with the complexity of their subsequent symptomatology, where complexity is defined as the number of different symptom clusters simultaneously elevated into the clinical range. Children's symptoms in six different trauma-related areas (e.g., depression, anger, posttraumatic stress) were reported both by child clients and their caretakers in a clinical sample of 318 children. Path analysis revealed that accumulated exposure to multiple different trauma types predicts symptom complexity as reported by both children and their caretakers.     

Posttraumatic cognitions,childhood sexual abuse characteristics,and posttraumatic stress disorder in men who have sex with men

BackgroundHigh rates of experience of childhood sexual abuse (CSA) among in men who have sex with men (MSM) place this population at increased risk for posttraumatic stress disorder (PTSD).ObjectiveThis study explores how specific characteristics of CSA relate to posttraumatic cognitions (PTCs) and explores the role that specific PTCs play in the relationship between CSA and PTSD in MSM.MethodsTwo-hundred and ninety MSM completed a CSA interview, the Davidson Trauma Scale, and the Posttraumatic Cognitions Inventory.ResultsControlling for sociodemographic factors, CSA involving physical injury and CSA with intense fear were associated with higher levels of PTCs about the self and world, but not with self-blame. We did not find significant associations for CSA involving a family member, CSA with penetration, or duration or frequency of CSA with any subscale on the PTCI. Experiencing CSA for the first time during adolescence was associated with higher self-blame. Analyses revealed that physical injury and intense fear each had indirect effects on PTSD symptoms through negative cognitions about the self and world. First CSA episode during adolescence had an indirect effect on PTSD symptoms through self-blame. CSAs accounted for 16.7% and PTCs accounted for 31.7% of the variance in PTSD, underlining the importance of PTCs.ConclusionsAssessing for physical injury, intense fear, and age at first CSA are particularly relevant to PTCs and of critical importance to advancing assessment and treatment strategies for PTSD in MSM.     

The intergenerational impact of trauma and family violence on parents and their children

BackgroundChildren who experience Child Abuse and Neglect (CAN) are at an increased risk of becoming a victim of Intimate Partner Violence (IPV) or a perpetrator of IPV or CAN. Moreover, maltreated children are at risk for developing long-lasting trauma symptoms, which can subsequently affect their own children’s lives. Understanding the mechanisms of the intergenerational transmission of violence and trauma is a prerequisite for the development of interventions.ObjectiveWe examine whether the relation between historical CAN and current trauma symptoms of mothers is mediated by current IPV. Furthermore, we investigate whether current CAN mediates the relation between current maternal trauma symptoms and child Post-Traumatic Stress Disorder (PTSD) symptoms. These mechanisms are compared for mothers and fathers.ParticipantsWe have recruited 101 fathers and 360 mothers (426 children, 50% boys, mean age 7 years) through child protection services.MethodsRespondents completed questionnaires about IPV, (historical) CAN and trauma symptoms.ResultsStructural equation models revealed that historical CAN of father and mothers was related to trauma symptoms. Only for mothers, this association was mediated by IPV. Trauma symptoms of both fathers and mothers were related to child PTSD symptoms. This effect was not mediated by current CAN.ConclusionIn violent families, maternal and paternal trauma can be transmitted over generations. However, intergenerational transmission of violence is found for mothers only. When family violence is reported, professionals should take the violence into account, as well as the history of parents and trauma symptoms of all family members.     

The association between maltreatment and obesity among preschool children

OBJECTIVE: To determine whether child maltreatment is associated with obesity in preschool children. METHODS: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities. At 3 years of age, 2412 of these children had their height and weight measured, and mothers answered items on the Parent-Child Conflict Tactics Scales about three types of child maltreatment--neglect, corporal punishment, and psychological aggression. The frequency of each type of maltreatment behavior in the prior year was analyzed using categories--ever/never for neglect and quintiles for the other two types of maltreatment. Child obesity was defined as measured body mass index (kg/m(2)) > or =95th percentile. RESULTS: Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment, and psychological aggression was 11%, 84%, and 93%, respectively. The odds of obesity were increased in children who had experienced neglect (odds ratio 1.56, 95% confidence interval, 1.14-2.14), after controlling for the income and number of children in the household, the mothers' race/ethnicity, education, marital status, body mass index, prenatal smoking, and age, and the children's sex and birth weight. Neither the frequency of corporal punishment nor psychological aggression was associated with an increased risk of obesity. CONCLUSIONS: In a sample of preschool children from 20 large US cities, maternal self-report of neglectful behavior was associated with an increased risk of childhood obesity, after controlling for birth weight, maternal obesity, and multiple socioeconomic factors.     

Maltreatment type,exposure characteristics,and mental health outcomes among clinic referred trauma-exposed youth

Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches.     

The intellectual profile of abused and neglected children in the Philippines: An analysis of SB5 IQ scores of sexually abused,physically abused and neglected children

Child abuse and neglect have been associated with cognitive deficits, among other effects on child development. This study explores the prediction that child abuse and neglect has an impact on Stanford-Binet Intelligence Scales 5th Edition (SB5) IQ scores, in relation to gender, age and type of abuse experienced. 300 children with experiences of abuse and neglect were included in the study, comprising 100 sexually abused, 100 physically abused and 100 neglected children. Overall, all scores on the SB5 were found to be significantly lower than the minimum average scores on the test. Verbal IQ (VIQ) scores were likewise found to be significantly lower than Nonverbal IQ (NVIQ) scores. Full Scale IQ (FSIQ) scores did not reveal heterogeneity when gender was factored in. Age and type of abuse (with a moderate effect size) on the other hand, showed significant differences among groups. Statistical analyses of SB5 Factor Index Scores revealed that abused children, in general, have significantly higher Visual-Spatial Processing (VS) and Quantitative Reasoning (QR) scores and lower scores in Knowledge (KN). There was a large effect size found in such an analysis. Age (with a large effect size), gender and type of abuse (with moderate effect sizes) give significant variations to this obtained profile.     

Trajectories of child protective services contact among Alaska Native/American Indian and non-Native children

BackgroundContact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups.ObjectiveWe aimed to identify longitudinal trajectory classes of CPS contact among Alaska Native/American Indian (AN/AI) and non-Native children and examine preconception and prenatal risk factors associated with identified classes.Participants and settingWe used data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) births with administrative data including CPS records.MethodsWe conducted growth mixture modeling to identify trajectory classes of CPS contact from birth to age five years. We used Vermunt’s three-step approach to examine associations with preconception and prenatal risk factors.ResultsAmong AN/AI children, we identified three classes: 1) no/low CPS contact (75.4%); 2) continuous CPS contact (19.6%), and 3) early, decreasing CPS contact (5.0%). Among non-Native children, we identified four classes: 1) no CPS contact (81.3%); 2) low, increasing CPS contact (9.5%); 3) early, rapid decline CPS contact (5.8%); and 4) high, decreasing CPS contact (3.3%). Maternal substance use had the largest impact on probabilities of class membership, increasing the probability of membership in classes characterized by CPS contact, among both AN/AI and non-Native children.ConclusionsResults reveal heterogeneity in longitudinal patterns CPS contact across early childhood among Alaska children and identify maternal substance use as an important target for primary prevention.     

Effect of worker contacts on risk of child maltreatment recurrence among CPS-involved children and families

The mission and responsibility of child protective services (CPS) is to investigate maltreatment; intervene to protect children from harm; and promote safety, permanency, and well-being (DePanfilis & Salus, 2003; Goldman, Salus, Wolcott, & Kennedy, 2003). In 2015, approximately 7.2 million children in the United States were referred to CPS agencies, and 3.4 million children had an investigation or received an alternative response (US Department of Health & Human Services, 2017). Fluke, Shusterman, Hollinshead, and Yuan (2005) found that about one third of children with an allegation of maltreatment would have at least one re-report within a five-year period. Research indicates that the rates of child maltreatment or changes in indicators of child maltreatment have remained unchanged over time (Gilbert et al., 2012). Despite policies aimed at reducing or preventing maltreatment, the development of CPS systems across the United States, and a CPS workforce, the aggregate effects of the CPS system, services, and worker efforts are not well understood.     

Relations among home literacy environment,child characteristics and print knowledge for preschool children with language impairment

To contribute to the modest body of work examining the home literacy environment (HLE) and emergent literacy outcomes for children with disabilities, this study addressed two aims: (a) to determine the unique contributions of the HLE on print knowledge of preschool children with language impairment and (b) to identify whether specific child characteristics (oral language ability, print interest) moderated these relations. The sample consisted of 119 preschool children with language impairment. HLE was conceptualised as frequency of storybook reading and literacy teaching during book reading. Frequency of storybook reading was a unique predictor of print knowledge, which is consistent with research on children with typical language. Literacy teaching did not predict print knowledge, which diverges from research on children with typical language. No interactions between the HLE and child characteristics were significant, but language ability and print interest play a role in understanding individual differences in literacy development.     

The relationship between childhood emotional abuse and chronic pain among people who inject drugs in Vancouver,Canada

BackgroundPeople who inject drugs (PWID) often contend with chronic pain as a result of illness and trauma, and such pain is known to have significant impacts on mental health, quality of life, and substance use behaviours. Although PWID are also known to have high rates of childhood trauma, little is known about how childhood emotional abuse may be associated with chronic pain in this population.ObjectiveWe undertook this study to explore emotional abuse and chronic pain among PWID.Participants and settingThis study comprised a total of 1459 participants in Vancouver, Canada between June 2014 and November 2016.MethodsWe employed multivariable generalized estimating equations with data derived from two prospective cohort studies of community-recruited PWID to examine the relationship between childhood emotional abuse and chronic pain in the past six months.ResultsAmong eligible participants, 591 (40.5%) reported childhood emotional abuse, and 760 (52.1%) reported chronic pain in the previous six months. In a multivariable analysis, experiencing childhood emotional abuse remained independently associated with chronic pain (adjusted odds ratio: 1.25; 95% confidence interval: 1.01–1.53) after adjustment for a range of socio-demographic and drug use confounders.ConclusionsOur findings suggest that childhood emotional abuse may have lasting relationships with chronic pain among PWID, potentially through established physiological and psychological mechanisms. Current chronic pain treatment may benefit from the evaluation of life course vulnerabilities that may be amenable to earlier interventions. Further, increased availability of effective trauma-informed chronic pain treatment is needed among this vulnerable population.     

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.