Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network

Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.     

Gender differences in mental health consequences of exposure to political violence among Israeli adolescents

This study examined the role played by gender differences in the relation between political violence exposure and mental health during adolescence. Understanding these differences is particularly pertinent during the period of adolescence characterized as it is by processes of identity formation and gender role consolidation. Participants were 154 high school students recruited from two high schools in central Israel (78 males, 76 females; average age 16.54), who completed the Political Life Events Scale for measurement of political violence exposure, the Brief Symptom Inventory-18 for assessment of psychological symptoms and disorders, a risk-taking behavior scale, and the Posttraumatic Stress Symptom Scale — Interview (PSS-I) for assessment of posttraumatic stress symptoms. Results reflected high levels on many psychological indicators. The dose–response hypothesis was partially confirmed with adolescents' higher reported political violence exposure related only to higher levels of somatization and greater severity of posttraumatic stress symptoms. Contrary to the literature, only a few gender differences emerged and these showed mixed patterns. Females showed higher levels of anxiety than males, and males showed higher levels of risk-taking behavior. Females exposed to low political violence exposure showed significantly less substance abuse than males but those with high exposure reported significantly higher levels of substance abuse, equivalent to those of males. Findings show a complex constellation of gender effects on relations between political violence exposure and different psychopathological outcomes. Findings of this study indicate the necessity for more refined examination of gender differences in psychological processes in reaction to living in conditions of protracted conflict and war.     

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social–emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood‐related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social–emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.     

Perceived Need for Psychosocial Services in the Context of Political Violence: Psychological Distress Among Israeli Mothers with Young Children

The current study investigated the association between mothers’ perceived need for psychosocial services due to exposure to political violence, and theirs and their children’s psychological distress. A representative sample of 904 Israeli mothers of young children aged 2–6 were asked to fill out a questionnaire about exposure to war and other types of trauma, psychological distress, social support, and perceived need for help. The results showed that mothers who reported a need for psychosocial services due to exposure to political violence had higher levels of exposure to political violence, depressive symptoms and more emotional problems in their young children than mothers who reported no need for help. Those who reported a need for psychosocial services also had less social support even when all other variables are controlled. Furthermore, Arab mothers and mothers with low family income perceived a greater need for psychosocial services. The implications of this study are relevant for policies of outreach to vulnerable groups in situations of ongoing political violence.     

The role of parental emotional validation and invalidation on children’s clinical symptoms: A study with children exposed to intimate partner violence

Abstract

Parental emotional validation has been proposed of as a major explanatory mechanism of the association between intimate partner violence (IPV) and children’s psychological problems. The present study examined the effect of parental emotional validation and invalidation on the relationship between exposure to IPV, and both post-traumatic stress disorder (PTSD) and depression symptoms. Sample was composed of Portuguese children exposed to IPV and an age- and gender-matched control group. Structural equation modeling was conducted. Children who were exposed to IPV presented higher scores on PTSD (p?<?.001, d?=?.99) and depression symptoms (p?<?.01, d?=?.63), and paternal (p?<?.05, d?=?.67) and maternal (p?<?.01, d?=?.81) emotional invalidation. Children who were exposed to IPV presented lower scores on paternal emotional validation (p?<?.001, d?=?1.23). Exposure to IPV directly predicts both PTSD and depression symptoms but the indirect effect was stronger. Paternal emotional validation moderated the impact of exposure to IPV on clinical symptoms; the relationship between exposure to IPV and both PTSD and depression symptoms was mediated by maternal emotional invalidation. Findings suggest the potential usefulness of parental emotional validation and invalidation as treatment goals in clinical intervention with this population. Interventions to improve the therapist-patient alliance recommend that therapists use emotional validation. Training of emotional validation skills in parenting training may prevent the deleterious effects of exposure to IPV.     

Marital Conflict and Children’s Adjustment: Evaluation of the Parenting Process Model

This investigation tested whether parenting mediates longitudinal associations between marital conflict and children’s adjustment. Data were drawn from a three‐wave study of 283 families with children aged 8 – 16 years at Wave 1. Relations among marital conflict, parenting (behavioral control, psychological autonomy, and warmth), and children’s adjustment (externalizing and internalizing) were examined. Structural equation models indicated multiple dimensions of parenting mediated relations between marital conflict and children’s adjustment. When including controls for earlier adjustment, behavioral control continued to mediate relations between marital conflict and change in children’s internalizing symptoms over time. These results advance parenting process models for relations between marital conflict and child adjustment and provide impetus for study of other pathways, including direct and child effects.     

Negative Stereotypes of Ethnic Outgroups: A Longitudinal Examination Among Palestinian,Israeli Jewish,and Israeli Arab Youth

Ethno‐political conflict impacts thousands of youth globally and has been associated with a number of negative psychological outcomes. Extant literature has mostly addressed the adverse emotional and behavioral outcomes of exposure while failing to examine change over time in social cognitive factors in contexts of ethno‐political conflict. Using cohort sequential longitudinal data, this study examines ethnic variation in the development of negative stereotypes about ethnic outgroups among Palestinian (n = 600), Israeli Jewish (n = 451), and Israeli Arab (n = 450) youth over 3 years. Age and exposure to ethno‐political violence were included as covariates for these trajectories. Findings indicate important ethnic differences in trajectories of negative stereotypes about ethnic outgroups, as well as variation in how such trajectories are shaped by prolonged ethno‐political conflict.     

Secondary Traumatization Among Adult Children of PTSD Veterans: The Role of Mother–Child Relationships

The study examined the level of secondary traumatization among adult children of Israeli war veterans with post-traumatic stress disorder (PTSD) as manifested in emotional distress, stress resulting from terrorist attacks, and capacity for intimacy. In addition, the role of the mother–child relationship as a moderator of these manifestations of distress was examined. Forty-six adult children of fathers with chronic PTSD, and 46 adult children of fathers who had participated in a war but did not have PTSD participated. Findings revealed that adult children of PTSD veterans showed higher levels of psychological distress, greater terror-related stress, and a lower capacity for intimacy than children of non-PTSD veterans. Positive relationship with the mother was found to moderate the level of participants' capacity for intimacy and their levels of psychiatric symptoms.     

Family Conflict in Childhood and Adolescence and Depressive Symptoms in Emerging Adulthood: Mediation by Disengagement Coping

Exposure to family conflict in childhood increases risk for later life psychological maladjustment. The family environment shapes the development of coping strategies used to manage interpersonal stressors, representing a pathway through which adverse family experiences impact later emotional functioning. In 2 studies, we evaluated engagement and disengagement coping as mediators of the relation between family conflict in childhood and depressive symptoms in young adulthood. Study 1 included participants from continuously married families exposed to higher and lower quality childhood family environments and found that disengagement partially mediated the relation between family conflict and depressive symptoms. Study 2 examined these relations among emerging adults who experienced parental divorce. Results indicated that disengagement coping fully mediated the relation between family conflict and depression. Engagement did not emerge as a mediator in either study. Elevated family conflict across varying family structures might be associated with poor adjustment via disengaged responses to stress.     

Adolescents' Emotional Experiences of Mother–Adolescent Conflict Predict Internalizing and Externalizing Symptoms

Research on adolescent emotion has generally focused on expressions of emotion; however, there are reasons to believe that adolescents' experiences of emotion may be related to adolescent development in unique and important ways. This study examined the relation of adolescents' emotional experiences of conflict with their mothers to their internalizing and externalizing symptoms at three time points, each a year apart. After participating in videotaped conflict negotiation tasks with their mothers, adolescents (N=80) watched the videotape of their interactions and used a joystick to make continuous ratings of how negative, positive, or neutral they felt during the discussions. Hierarchical Linear Modeling was used to assess relations among their continuous emotion ratings and their internalizing and externalizing symptoms 1 year before the interaction task, at the time of the interaction task, and 1 year later. Adolescents' externalizing symptoms at the time of the conflict task were associated with negative emotion that decreased across the conflict discussion. Relations between emotional experience and internalizing symptoms a year later were moderated by adolescent gender, revealing that a tolerance for increasing negative emotion predicts fewer future internalizing symptoms for girls. The importance of adolescents' ability to tolerate negative emotion during normal developmental conflicts is discussed.     

Psychological Symptoms of Sexually Victimized Children and Adolescents Compared With Other Maltreatment Subtypes

The differential effects of sexual victimization and other forms of maltreatment on psychological functioning are not well understood. A sample of sexually victimized children and adolescents (N = 70; 6.3–17.9 years) and a group of youth with a history of nonsexual maltreatment (N = 108; 6.7–16.9 years) were compared using measures of mental health and psychosocial functioning. Assessments included standardized clinical interviews on individual maltreatment history and current psychopathology as well as questionnaires on behavioral and emotional symptoms, including posttraumatic stress symptoms. The results from this study suggest that the risk of experiencing any current mental disorders was independent of type of maltreatment. The risk of meeting the criteria for a current diagnosis of major depression, however, is greater among youth with a history of maltreatment that includes sexual victimization. The significant impact of sexual victimization on posttraumatic stress symptoms was found to be nonsignificant after controlling for age and gender effects. The results indicate that the outcomes of child maltreatment depend on type of maltreatment, but age and gender must be taken into account.     

Change in externalizing problems over time among ethnic minority youth exposed to violence

Youth exposed to violence, many of whom are from racial/ethnic minority backgrounds, are at high risk for externalizing problems such as aggressive and oppositional behavior, conduct problems, and delinquency. Most interventions target youth with already high levels of such problems, while selective prevention efforts have received less attention. It is important for researchers, policy makers and practitioners to understand how such problems develop and change over time, and how selective prevention may impact externalizing problems. In this study, we examined one-year trajectories of externalizing problems in 883 low-income, ethnic minority youth exposed to violence who participated in randomized controlled trials testing a prevention program for high-risk youth called the Strengthening Families Program. We found three trajectories of externalizing problems: Low Externalizing (43% of the sample had consistently low levels of externalizing symptoms), Persisters (39% of the sample had consistently high levels of externalizing symptoms), and Improvers (18% of the sample had initially high levels of externalizing symptoms that decreased over time). There were demographic differences between the three trajectories with individuals in the Low Externalizing trajectory more likely to be female and younger than those in the other two trajectories and Persisters and Improvers had significantly more problems with baseline internalizing symptoms, family conflict, and parenting behavior compared to the Low Externalizing trajectory. Logistic regressions then tested several predictors of membership in the Persisters trajectory compared to the Improvers trajectory, controlling for all covariates simultaneously. Only baseline parenting behavior and intervention group membership significantly predicted trajectory membership, and these were small and unreliable effects. Thus, children with varying levels of violence exposure, co-occurring emotional/behavioral problems and family issues, and varying demographics (e.g., age and gender) may do equally well over time, but engagement in this type of intervention may increase the likelihood that high levels of externalizing problems are ameliorated over time.     

Emotional Divorce: Child’s Well-Being

The effects of parental emotional divorce on the levels of depression, anxiety, stress, and aggression in children, as measured by the Depression, Anxiety, and Stress Scale (DASS) and Aggression Questionnaire were studied. The measures were administered to a sample of 81 Iranian children ranging in age from 10 to 12 years old; 50 were in the legal divorce group and 31 were in the emotional divorce group. Children of emotionally divorced parents showed significantly higher levels of emotional and behavioral problems than counterparts from legally divorced parents. They reported more depression, anxiety, stress, and aggression. Additionally, moderate, severe, and extremely severe levels of emotional and behavioral problems were more common among emotional divorce children than legal divorce ones. In conclusion, the findings clearly showed that emotional divorce is more harmful than legal divorce. The differences between emotionally divorced and legally divorced families and the diversity of emotional and behavioral reactions among their children are discussed.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.     

Observed Infant Reactions During Live Interparental Conflict

Associations between interparental conflict and infant reactions were examined. Infants' history of exposure to interparental conflict and infant reactive temperament were examined as moderators. A community sample of 74 infants, aged 6–14 months, participated with their parents. Behavioral observations were made of parents' marital conflict and their infants' reactions. Parents reported on their emotional states during conflict, infants' history of exposure to interparental conflict, and infant temperament. Multilevel modeling indicated that infants showed differential responses to marital conflict; destructive and depressive conflict were associated with increased infant discussion attending and negative reactions, whereas constructive conflict was associated with decreased discussion attending and negative reactions. Infants' history of exposure to marital conflict and infant reactive temperament emerged as moderators.     

Differentiation of the Self and Posttraumatic Symptomatology Among ex-POWs and Their Wives

War captivity is a highly traumatic experience which sometimes has deleterious effects on both ex-POWs and their wives. This study examined the relationships between posttraumatic stress disorder (PTSD) symptoms and differentiation among male ex-prisoners of war (ex-POWs; n  = 103), their wives ( n  = 82), and comparable controls. Results show that ex-POWs and their wives endorsed more PTSD symptoms than controls. Ex-POWs endorsed more cut-off and fusion than controls, while their wives endorsed only more fusion than control wives. Finally, the relationship between differentiation and PTSD was found to be stronger among ex-POW couples than among control couples. The unique characteristics of war captivity and the relationships between avoidance symptoms and cut-off were suggested as possible explanations .     

Incongruent Teen Pregnancy Attitudes,Coparenting Conflict,and Support Among Mexican‐Origin Adolescent Mothers

The current longitudinal study examined whether differences between Mexican‐origin adolescent mothers and their mother figures (N = 204 dyads) in attitudes on the status attained through teen pregnancy were associated with conflict in their coparenting relationship and whether coparenting conflict was associated with adolescent mothers' perceptions of social support. Findings revealed that when adolescents held more positive attitudes than their mother figures about the status gained through teen pregnancy, they tended to report greater coparenting conflict with their mother figures. Furthermore, greater coparenting conflict was significantly associated with decreases in adolescents' perceptions of social support (i.e., emotional, instrumental, companion support) 1 year later. Findings underscore the importance of incongruent attitudes and the quality of coparenting relationships between adolescent mothers and their mother figures in relation to support processes. Findings are discussed with respect to understanding Mexican‐origin adolescent mothers' social support in the context of family subsystem attitudes and interactions.     

Why should child welfare pay more attention to emotional maltreatment?

A significant body of research indicates that emotional maltreatment (EMT) is harmful to children, resulting in long-term negative impacts on emotional and behavioral development. The child welfare system's focus on physical abuse, physical neglect, and sexual abuse has led a relative lack of attention to EMT. Reported rates of EMT vary widely across states – ranging from 0.2% to 44.9% in a recent national report on child maltreatment – indicating that it is not being measured consistently. This paper uses data collected by the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to (1) describe the nature and characteristics of emotional maltreatment experienced by 846 LONGSCAN youth across time, and (2) describe the relation between four subtypes of emotional maltreatment (psychological safety and security, acceptance and self-esteem, autonomy, and restriction) and child trauma symptoms and risk behaviors at age 18. Exposure to EMT was related to increased trauma symptoms and risky behaviors. EMT is common, identifiable, harmful, and potentially preventable; and a better understanding of it will help to inform the provision of effective child welfare and mental health services to children and their families. Findings suggest a need for greater understanding of parental behaviors, and the motivations behind them, that result in emotionally harmful outcomes for children, as well as a better understanding of appropriate interventions for children who experience various types of EMT.     

Career Adaptability of Trauma Survivors: The Moderating Role of Posttraumatic Growth

Impaired functioning in occupational domains is a diagnostic characteristic of posttraumatic stress disorder, and yet the interactions between trauma and career remain understudied. This study examined the relationships between trauma symptoms, posttraumatic growth, and career adaptability in college students who identified as trauma survivors (N = 215). Results indicated that (a) trauma symptoms and posttraumatic growth were both significantly predictive of career adaptability and (b) posttraumatic growth moderated the relationship between trauma and career adaptability. The impact of demographic factors and implications for career counselors and counselor educators are also discussed.     

Marital Conflict and Children's Emotional Security in the Context of Parental Depression

Evidence has emerged for emotional security as an explanatory variable linking marital conflict to children's adjustment. Further evidence suggests parental psychopathology is a key factor in child development. To advance understanding of the pathways by which these family risk factors impact children's development, the mediational role of emotional security for children with parents who have potentially clinical levels of depression compared to children whose parents have lower levels of symptomatology was examined (i.e., moderated mediation). Participants included 297 families assessed annually for 3 years. Paternal depression moderated pathways, such that marital conflict was associated with greater child emotional insecurity 2 years later in the context of paternal depression. Testing alternative pathways, emotional insecurity mediated relations between maternal depression and externalizing problems.