Traumatic and stressful events in early childhood: can treatment help those at highest risk?

Objective

This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs).

Methods

Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs).

Results

For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group.

Conclusions

The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well.

Practice implications

Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks.     

The dollars and senselessness in failing to prioritize childhood maltreatment prevention

Childhood maltreatment captured medical attention almost 50 years ago. Reviews considering the evidence for published maltreatment prevention programming emerged about 20 years ago. In the second decade of the 21st century, evidence-based maltreatment prevention is a reality for at-risk groups; however, the research-to-practice and policy gap remains in most countries. This article considers the importance of personal financial health and how that is necessarily the building blocks of national health. It argues for the primacy of the goal of problem prevention—the prevention of childhood maltreatment. A twofold approach is suggested: (1) broad-scale adoption of evidence-based prevention and (2) and on-going commitment to refining the evidence base for effective, promising, and novel intervention.     

Effects of nonmaternal care in the first 3 years on children's academic skills and behavioral functioning in childhood and early adolescence: a sibling comparison study

Nonmaternal care of infant children is increasingly common, but there is disagreement as to whether it is harmful for children. Using data from 9,185 children (5 years and older) who participated in the Children of the National Longitudinal Survey of Youth, the current study compared 2 groups: those for whom nonmaternal care was initiated in the first 3 years and those for whom it was not. Between-family comparisons showed that early nonmaternal care was associated with higher achievement and lower behavior problem scores in childhood and adolescence. However, within-family comparisons failed to detect differences between siblings who had different early nonmaternal care experiences. The study concludes that the timing of entry to nonmaternal care in the first 3 years has neither positive nor negative effects on children's outcomes.     

A large-scale evaluation of the KiVa antibullying program: grades 4-6

This study demonstrates the effectiveness of the KiVa antibullying program using a large sample of 8,237 youth from Grades 4-6 (10-12 years). Altogether, 78 schools were randomly assigned to intervention (39 schools, 4,207 students) and control conditions (39 schools, 4,030 students). Multilevel regression analyses revealed that after 9 months of implementation, the intervention had consistent beneficial effects on 7 of the 11 dependent variables, including self- and peer-reported victimization and self-reported bullying. The results indicate that the KiVa program is effective in reducing school bullying and victimization in Grades 4-6. Despite some evidence against school-based interventions, the results suggest that well-conceived school-based programs can reduce victimization.     

Parental sensitivity and attachment in children with autism spectrum disorder: comparison with children with mental retardation, with language delays, and with typical development

This study on sensitivity and attachment included 55 toddlers and their parents. Samples included children with autism spectrum disorder (ASD), mental retardation, language delay, and typical development. Children were diagnosed at 4 years of age. Two years before diagnosis, attachment was assessed with the Strange Situation procedure, and parental sensitivity and child involvement during free play were assessed with the Emotional Availability Scale. Parents of children with ASD were equally sensitive as parents of children without ASD, but their children showed more attachment disorganization and less child involvement. More sensitive parents had more secure children, but only in the group without ASD. Less severe autistic symptoms in the social domain predicted more attachment security. Autism challenges the validity of attachment theory.     

Neighborhood and family influences on educational attainment: results from the Ontario child health study follow-up 2001

This study uses multilevel models to examine longitudinal associations between contextual influences (neighborhood and family) assessed in 1983 in a cohort of 2,355 children, 4-16 years of age, and educational attainment in 2001. Variation in educational attainment in 2001 attributable to between-neighborhood and between-family differences was 8.17% and 36.88%, respectively. The final model explained 33.64% of the variance in educational attainment, with unique variances of 14.53% for neighborhood and family-level variables combined versus 10.94% for child-level variables. Among the neighborhood and family-level variables, indicators of status (5.29%) versus parental capacity/family process (4.03%) made comparable predictions to attainment while children from economically disadvantaged families did not benefit educationally from living in more affluent areas.     

Are abusive fractures in young children becoming less common? Changes over 24 years

OBJECTIVE: To determine whether the proportion of fractures rated as abusive in children <36 months of age evaluated at a regional pediatric hospital increased over a 24-year period from 1979 to 2002. Fractures were chosen as an example of serious injuries in young children. METHODS: Medical records were abstracted for all children <36 months of age who were seen at a single pediatric hospital with a fracture during three time periods: 1979-1983, 1991-1994, and 1999-2002. After reviewing the abstracted and radiographic information, two clinicians (one an expert on child abuse) and two pediatric radiologists each rated the likelihood of abuse using explicit criteria and a seven-point scale from definite abuse to definite unintentional injury. Ratings were done independently; when disagreements occurred, the case was discussed, and a joint rating was agreed upon, if possible. The proportions of cases rated as abuse were compared over the three time periods, and logistic regression was used to calculate adjusted odds ratios (OR). RESULTS: In the early, middle, and late samples, there were 200, 240, and 232 children, respectively, with fractures. The proportion of cases rated as abuse decreased from 22.5% in the early period to 10.0% in the middle period and was 10.8% in the late period (p<.001). When comparing the odds of abuse in the middle and late groups to the odds of abuse in the early group (controlling for age, gender, ethnicity, type of medical insurance, and site of pediatric care), the adjusted ORs were .31 (95% CI=.15, .62) for the middle group and .45 (95% CI=.23, .86) for the late group. Thus, the odds of a given case being rated as abuse decreased by over 50% from the early period to the middle and late time periods. No statistically significant difference was found when comparing the odds of abuse for the middle group to those of the late group, OR: 1.46 (95% CI=.69, 3.08). CONCLUSIONS: The proportion of abusive fractures in young children decreased substantially from 1979-1983 to 1991-1994 and 1999-2002 at a major pediatric hospital. We speculate that this decrease may reflect early recognition of less serious forms of maltreatment and the availability of services to high-risk families.     

韵律

我一直以为,夏季的韵律就藏在那浓密的树阴里。朱熹有诗句说:"高蝉多远韵,茂树有余音。"是的,你听见了吗?那一声声悠长的蝉鸣。还记得儿时的夏夜,我总是随父     

ICONic training: use of a course management system to provide continual reference student education

In an effort to provide continuing education to the students working at the Hardin Library reference desk, staff members have created an online training course using the University of Iowa's course management system called ICON(Iowa Courses Online). The course has four main components-a content page, an article discussion forum, quizzes, and a challenging questions module. ICON has quickly become an essential training resource and has also provided an electronic professional community for students who primarily work in isolation. Additionally, the experience with the software has positioned the library to provide training support for the health campus and to take advantage of new technology based collaborations.     

The Bioinformatics Program at Washington University's Bernard Becker Medical Library: making it happen

The need for a Bioinformatics Program became apparent after repeated requests from researchers for bioinformatics resources and the University's announcement of BioMed 21, a 300 million dollars biomedical science initiative to bring "new knowledge of the human genetic blueprint to the patient's bedside and change how illnesses are understood, diagnosed, and successfully treated." A Bioinformatics Specialist with a strong background in the fields of Molecular Biology and Biostatistics was hired. Program development started in 2003. Initially, three core courses were developed: Sequence Similarity Search, Genetic Variation, and Human Genome Resources. Each of these courses was offered twice per semester. Additionally, partnerships were established within the University Medical School Community (e.g., the Genome Sequencing Center) to license and teach Spotfire's DecisionSite for Functional Genomics, a software package used to analyze microarray data. From March to May 2005, seven Spotfire classes were taught. Each Spotfire class consisted of seven hours of classroom work. Also, in-depth consultations were scheduled with faculty and researchers to address their specific needs. These consultations led to requests for other software packages to purchase and manage, including Lasergene and CSD (Cambridge Crystal Structure Database). Efforts to reach outside of the University Community were made through the development of a Bioinformatics Web site.