Childhood maltreatment,psychopathology and well-being: The mediator role of global self-esteem,attachment difficulties and substance use

Childhood maltreatment is known to be associated with a broad variety of psychopathology and deteriorated well-being in adolescent populations. In the present nationwide study, we aimed to explore global self-esteem, attachment difficulties and substance use as possible mediators of these associations in a high-risk adolescent population. We included 400 adolescents (aged 12–20 years) living in residential youth care in Norway (response rate 67%). The participants completed a semistructured psychiatric interview (Child and Adolescent Psychiatric Assessment (CAPA)), a study-specific questionnaire, a revised version of the Self-Perception Profile for Adolescents (SPPA) and the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). Information was also provided by the adolescent’s primary contact at the institution. Two models were tested using structural equation modelling; one assessed the association between childhood maltreatment and psychopathology, and one assessed the association between childhood maltreatment and well-being. Childhood maltreatment, psychopathology, well-being, global self-esteem and attachment difficulties were treated as latent variables, and substance use was added as an observed variable. The results of this study showed that global self-esteem was a mediator of paths in both models, whereas attachment difficulties and substance use were not. Preventing decline in health and well-being in high-risk adolescents is a main goal, and this study suggests that improving self-esteem, in addition to providing psychiatric health services, could be an important tool for achieving this goal.     

Attachment Disorganization in Infancy: A Developmental Precursor to Maladaptive Social Information Processing at Age 8

This study examined infant attachment as a predictor of social information processing (SIP) in middle childhood (n = 82) while controlling for parental sensitivity in middle childhood. Attachment quality was assessed using the Strange Situation. Although attachment insecurity did not predict SIP, attachment disorganization positively predicted the early SIP steps of hostile attributional bias and aggressive goals. Children with disorganized attachments interpreted ambiguous provocations more negatively (as indicating more hostility, rejection, and disrespect and as resulting in more anger) and endorsed significantly more revenge and dominance goals than children with organized attachments. In contrast, parental sensitivity negatively predicted the later SIP step of positive expectations for aggressive responses. Results further our understanding of the adverse outcomes associated with attachment disorganization.     

Attachment insecurity mediates the relationship between childhood trauma and eating disorder psychopathology in a clinical sample: A structural equation model

Objectives

Childhood maltreatment occurs often among those with an eating disorder and is considered a nonspecific risk factor. However, the mechanisms by which childhood maltreatment may lead to an eating disorder are not well understood. The current study tests a model in which attachment insecurity is hypothesized to mediate the relationship between childhood maltreatment and eating disorder psychopathology.

Method

Treatment seeking adults with eating disorders (N = 308) completed questionnaires about childhood maltreatment, eating disorder psychopathology, and adult attachment.

Results

Structural equation models indicated that childhood trauma had a direct effect on eating disorder symptoms. Also, attachment anxiety and avoidance each equally mediated the childhood maltreatment to eating disorder psychopathology relationship.

Conclusions

Attachment insecurity, characterized by affect dysregulation and interpersonal sensitivities may help to explain why eating disorder symptoms may be one consequence of childhood maltreatment in a clinical sample. Clinicians treating primarily those with trauma might assess for disordered eating as a potential manifestation of the sequelae of trauma and attachment insecurity.     

Neurobiological Processes of Risk and Resilience in Adolescence: Implications for Policy and Prevention Science

This article focuses on the concepts of risk and resilience and their potential to inform clinical interventions, school‐based prevention programs, and social policies. Research suggests that childhood adversity can trigger a cascade of psychological and neurobiological events that can lead to mental disorders in later life. Yet little is known about how these processes manifest in adolescence, a developmental window that is typically associated with an elevated risk for psychopathology and represents a period of neurological growth and reorganization that is second only to early childhood. A better understanding of adolescent brain development may provide an empirical grounding to improve the focus and timing of interventions, particularly those that target self‐regulation, meta‐cognition, and social supports. Finally, opportunities and challenges that emerge when bridging neuroscience and prevention science are discussed.     

Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample

OBJECTIVE: Child abuse is an important risk for adult psychiatric morbidity. However, not all maltreated children experience mental health problems as adults. The aims of the present study were to address the extent of resilience to adult psychopathology in a representative community sample, and to explore predictors of a good prognosis. METHODS: Data are drawn from a follow-up of the Isle of Wight study, an epidemiological sample assessed in adolescence and at midlife. Ratings of psychiatric disorder, peer relationships and family functioning were made in adolescence; adult assessments included a lifetime psychiatric history, personality and social functioning assessments, and retrospective reports of childhood sexual and physical abuse. RESULTS: Ten percent of individuals reported repeated or severe physical or sexual abuse in childhood. Prospective measures revealed increased rates of adolescent psychiatric disorders in this group. Rates of adult psychopathology were also high. A substantial minority of abused individuals reported no mental health problems in adult life. Resilience of this kind was related to perceived parental care, adolescent peer relationships, the quality of adult love relationships, and personality style. CONCLUSION: Good quality relationships across childhood, adolescence and adulthood appear especially important for adult psychological well being in the context of childhood abuse.     

Post-traumatic stress as a pathway to psychopathology among adolescents at high-risk for victimization

ObjectiveVictimization by violence elevates adolescents’ risk for developing internalizing and externalizing psychopathology. Recent findings suggest that disruptions in developmental processes associated with post-traumatic stress (PTS) reactions may partially account for the relationship between victimization and the subsequent development of psychopathology during adolescence. The present study tested the temporal sequencing of these associations using multi-informant measurements in a large, diverse sample of adolescents at high-risk for victimization.MethodData were collected from a multi-site consortium of prospective studies, the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Information about 833 youth’s victimization experiences (i.e., direct, indirect, familial, and non-familial violence), PTS, and affective, anxiety, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms were gathered from youth and their caregivers during biannual face-to-face interviews when youth were between the ages of 4 and 14 years, and continuously from official child protective services records.ResultsStructural equation modeling revealed that cumulative victimization contributed to elevations in youth and caregiver reported late childhood and early adolescent psychopathology. While PTS mediated the association between victimization and youth reported ADHD, ODD, CD, major depressive, and generalized anxiety symptoms during adolescence, it only mediated the association between victimization and caregiver reported affective symptoms.ConclusionsPTS reactions following childhood victimization partially accounted for escalations in psychopathology during the transition to adolescence. These findings underscore the importance of integrating trauma-informed assessment and intervention approaches with at-risk adolescents. Researchers should determine whether trauma-focused interventions sufficiently ameliorate other psychopathology among victimized adolescents or if additional interventions components are necessary.     

Mother–child attachment and cognitive performance in middle childhood: An examination of mediating mechanisms

Although mother–child attachment has been shown to predict cognitive performance, there has been a lack of attention to the mediating mechanisms that explain these associations. In the present study, we investigated relations of early mother–child attachment and cognitive performance in middle childhood (the latter in terms of both academic performance and IQ), and potential mediating mechanisms. Mother–child attachment was assessed at 15, 24, and 36-months, and child grades and IQ were assessed at grades 3 and 4. Attachment patterns at 15 months and avoidant attachment at 36-months were not related to school performance or IQ in middle childhood. Children more securely attached at 24 or 36-months had better school performance and higher IQs in middle childhood, and parental quality of assistance, encouragement of academics, children's social relationships, and children's regulatory characteristics significantly mediated these relationships. Both insecure-ambivalent attachment and disorganized attachment predicted later cognitive performance, and these associations were primarily mediated by the quality of parental assistance and child cooperation. This study advances our understanding of how and why early mother–child attachment is related to children's cognitive performance during middle childhood.     

Early Warning Signs of Functional Illiteracy: Predictors in Childhood and Adolescence

Early childhood, middle childhood, and early adolescence determinants of functional literacy in adulthood are investigated, using 20-year longitudinal data from a sample of black children of teenaged mothers from the Baltimore metropolitan area. Document literacy was assessed by a test that consisted of a subset of items of the National Assessment of Educational Progress (NAEP) adult literacy test. The Baltimore sample is compared to the NAEP sample. Family environmental factors, early childhood developmental level, and educational career factors were considered as predictors of young adulthood literacy. Preschool cognitive and behavioral functioning is highly predictive of literacy in young adulthood, even when the effects of family environmental characteristics, including living arrangements, the quality of the home environment, maternal education, and income, are controlled. Grade failure in elementary school is also associated with literacy, but this effect disappears when the measure of preschool abilities is controlled. Family environmental factors that are predictive of literacy include maternal education, family size in early childhood, maternal marital status, and income in middle childhood and early adolescence. Policy implications of these findings are discussed.     

Mental models of attachment as a part of kindergarten student teachers' practical knowledge about caregiving

The present study investigated beginning kindergarten student teachers' mental models of attachment as a part of their practical knowledge about caregiving. Mental models of attachment (i.e. how students construct their own attachment-related childhood experiences and relationships from their current perspective) were assessed with an Adult Attachment Interview. The participants were 82 female first-year students in the University of Helsinki. Forty-four per cent of the students were classified as dismissive of attachment, 43% as secure/autonomous, and 13% as preoccupied. The study also investigated student teachers' motives for entering kindergarten teacher education, and the possible relationship between students' mental models of attachment and their motives for entering the field. Participants' attachment status was significantly associated with their career preference, and the expression and complexity of their motives. Students with a secure/autonomous mental model of attachment were the most certain students concerning career choice, and they were the most likely to express both child-centred and self-centred motives for entering the education.     

Population attributable fractions of psychopathology and suicidal behaviour associated with childhood adversities in Northern Ireland

Childhood adversities are strong predictors of psychopathology and suicidality. However, specific adversities are associated with different outcomes, with cross-national variations reported. The current study examined rates of adversities reported in Northern Ireland (NI), and associations between adverse childhood experiences and psychopathology and suicidal behaviour were explored. Data was obtained from the Northern Ireland Study of Health and Stress (NISHS), conducted as part of the World Mental Health (WMH) survey initiative (2004–2008); response rate 68.4% (n = 1,986). The on-line survey used, the WHO Composite International Diagnostic Interview (CIDI) to examine psychopathology and associated risk factors in the NI population. Prevalence rates of retrospectively reported childhood adversities were calculated, with gender and age variations explored. Females were more likely to experience sexual abuse. Individuals who grew up during the worst years of the civil conflict in NI experienced elevated levels of childhood adversities. Participants who endured childhood adversities were more likely to have mental health problems but variations in risk factors were found for different disorders. Parental mental illness was associated with all disorders however, with ORs ranging from 2.20 for mood disorders to 4.07 for anxiety disorders. Population attributable fractions (PAF) estimated the reduction in psychopathology and suicidal behaviour in the population if exposure to adverse childhood events had not occurred. The highest PAF values were revealed for parental mental illness and sexual abuse. The findings indicate that a substantial proportion of psychopathology and suicide risk in NI are attributable to childhood adversities, providing support for early intervention and prevention initiatives.     

The importance of shared environment in mother-infant attachment security: a behavioral genetic study

In a sample of 157 monozygotic and dizygotic twins, genetic and environmental influences on infant attachment and temperament were quantified. Only unique environmental or error components could explain the variance in disorganized versus organized attachment as assessed in the Ainsworth Strange Situation Procedure. For secure versus nonsecure attachment, 52% of the variance in attachment security was explained by shared environment, and 48% of the variance was explained by unique environmental factors and measurement error. The role of genetic factors in attachment disorganization and attachment security was negligible. Genetic factors explained 77% of the variance in temperamental reactivity, and unique environmental factors and measurement error explained 23%. Differences in temperamental reactivity were not associated with attachment concordance.     

Childhood emotional abuse characteristics moderate associations with adult psychopathology and caregiving

As the consequences of childhood maltreatment for adult adjustment become increasingly established in the literature, investigations of individual differences in these effects must evolve to examine more nuanced components of the maltreatment experience. This is particularly true for studies of childhood emotional abuse (CEA), which represents an umbrella label for numerous qualitatively different experiences. The present study examined the distinct contributions and potential interactive effects of CEA frequency and intensity on adult psychopathology, caregiving behaviors, and caregivers’ representations of the caregiver-child relationship in a diverse sample of 62 female caregivers of 4-year-old children, all of whom had experienced CEA. Frequency and intensity emerged as orthogonal characteristics of CEA with differential effects on adult adaptation. Higher CEA frequency predicted increased adult psychopathology, whereas higher CEA intensity predicted increased boundary dissolution in caregivers’ representations. Further, an interaction between frequency and intensity predicted negativity in caregivers’ representations, such that higher frequency of high intensity, but not low intensity, CEA predicted decreased negativity. Neither frequency nor intensity of CEA predicted observed caregiving behaviors. These results provide evidence that characteristics of CEA signal important differences in its experience, with differential implications for later adjustment. The specific differences in caregiving representations associated with high vs. low intensity CEA suggest that diverging mechanisms by which these experiences eventuate in adult outcomes should also be investigated. Above all, this study suggests that the measurement of CEA, and childhood maltreatment broadly, will benefit from enhanced attention to specific characteristics of individuals' experiences.     

Associations Among Infant Iron Deficiency,Childhood Emotion and Attention Regulation,and Adolescent Problem Behaviors

This study examined whether iron deficiency (ID) in infancy contributes to problem behaviors in adolescence through its influence on poor regulatory abilities in childhood. Chilean infants (N = 1,116) were studied when there was no national program for iron fortification (1991–1996), resulting in high rates of ID (28%) and iron‐deficiency anemia (IDA, 17%). Infants (54% male) were studied at childhood (M_age = 10 years) and adolescence (M_age = 14 years). IDA in infancy was related to excessive alcohol use and risky sexual behavior in adolescence through its effect on poor emotion regulation in childhood. Attentional control deficits at age 10 were also related to both infant IDA and heightened risk taking in adolescence. Findings elucidate how poor childhood regulatory abilities associated with infant IDA compromise adjustment in adolescence.     

No Such Thing as a Baby: Responses to Infant Cry Paradigms Are Primarily Influenced by Parents’ Experiences and Behavior

SYNOPSIS

This article builds on our previous work demonstrating that, when exposed to work–family conflict, parents with high levels of attachment anxiety exhibit greater work–family guilt and less tolerance of infant distress. We respond to commentaries suggesting that the theoretical model could be enhanced by better accounting for innate infant differences and parent psychopathology, arguing that it is possible that parents’ experiences of work–family conflict and attachment anxiety precede the development of psychopathology and may influence the development of infant temperament and behavior. We further explore clinical implications of our findings and identify key suggestions for future work, with an emphasis on the roles of parental experiences of childhood maltreatment and insensitive caregiving.     

Social support, attachment, and psychopathology in high risk formerly maltreated adults

OBJECTIVE: The aim of this study was to examine the relationships among social support, attachment security, and psychopathology in an adult sample of high risk abuse survivors. Attachment security was conceptualized in terms of two underlying dimensions, the working models of self and other. METHOD: Sixty-six participants (24 men and 42 women) who met conditions for physical or sexual abuse were recruited from the greater Boston area. They completed the "Record of Maltreatment Experiences." the "Relationship Scales Questionnaire," the "Norbeck Social Support Questionnaire," and multiple measures of psychopathology. RESULTS: When multiple risk and protective factors were examined concurrently (e.g., social support, attachment, abuse history, IQ, SES), a negative view of self (one of the attachment poles) was the strongest predictor of overall psychopathology. Social support did not emerge as a significant direct predictor of psychopathology, once the effects of negative view of self were accounted for. However, among participants low on social support, in comparison to those who are high, a negative view of self was more highly correlated with some psychopathology measures. CONCLUSIONS: These findings indicate that among maltreatment survivors, negative view of self emerges as the most substantial predictor of psychopathology when examined in combination with other relevant risk factors.     

Parental reactions to children's negative emotions: longitudinal relations to quality of children's social functioning

Relations between self-reported parental reactions to children's negative emotions (PNRs) and children's socially appropriate/problem behavior and negative emotionality were examined longitudinally. Evidence was consistent with the conclusion that relations between children's externalizing (but not internalizing) emotion and parental punitive reactions to children's negative emotions are bidirectional. Reports of PNRs generally were correlated with low quality of social functioning. In structural models, mother-reported problem behavior at ages 10-12 was at least marginally predicted from mother-reported problem behavior, children's regulation, and parental punitive or distress reactions. Moreover, parental distress and punitive reactions at ages 6-8 predicted reports of children's regulation at ages 8-10, and regulation predicted parental punitive reactions at ages 10-12. Father reports of problem behavior at ages 10-12 were predicted by earlier problem behavior and parental distress or punitive reactions; some of the relations between regulation and parental reactions were similar to those in the models for mother-reported problem behavior. Parental perceptions of their reactions were substantially correlated over 6 years. Some nonsupportive reactions declined in the early to mid-school years, but all increased into late childhood/early adolescence.     

The construction of experience: a longitudinal study of representation and behavior

Continuity in relationship representation and developmental links between relationship representation and behavior from infancy to late adolescence were examined using longitudinal data from a risk sample (N = 185). Significant correlations were found among diverse representational assessments (e.g., interview, drawing, projective narrative) and between representational and concurrent observational measures of relationship functioning. Structural equation models were analyzed to investigate the relations among caregiving experience in infancy; relationship representation and experience in early childhood, middle childhood, and early adolescence; and socioemotional functioning in adolescence. A model representing interactive contributions of representational and behavioral experience represented the data significantly better than a model representing noninteractive contributions. Findings support an organizational developmental view that socioemotional adaptation arises from the progressive construction of mutually informing expectations and experience.     

Association between maltreatment and polydrug use among adolescents

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.     

Infant Attachment Security and Early Childhood Behavioral Inhibition Interact to Predict Adolescent Social Anxiety Symptoms

Insecure attachment and behavioral inhibition (BI) increase risk for internalizing problems, but few longitudinal studies have examined their interaction in predicting adolescent anxiety. This study included 165 adolescents (ages 14–17 years) selected based on their reactivity to novelty at 4 months. Infant attachment was assessed with the Strange Situation. Multimethod BI assessments were conducted across childhood. Adolescents and their parents independently reported on anxiety. The interaction of attachment and BI significantly predicted adolescent anxiety symptoms, such that BI and anxiety were only associated among adolescents with histories of insecure attachment. Exploratory analyses revealed that this effect was driven by insecure‐resistant attachment and that the association between BI and social anxiety was significant only for insecure males. Clinical implications are discussed.