Developmental Epidemiology

With research suggesting increasing incidence of pediatric neurodevelopmental disorders, questions regarding etiology continue to be raised. Neurodevelopmental function tests have been used in epidemiology studies to evaluate relationships between environmental chemical exposures and neurodevelopmental deficits. Limitations of currently used tests and difficulties with their interpretation have been described, but a comprehensive critical examination of tests commonly used in studies of environmental chemicals and pediatric neurodevelopmental disorders has not been conducted. We provide here a listing and critical evaluation of commonly used neurodevelopmental tests in studies exploring effects from chemical exposures and recommend measures that are not often used, but should be considered. We also discuss important considerations in selecting appropriate tests and provide a case study by reviewing the literature on polychlorinated biphenyls.

Developmental trauma disorder (DTD) and posttraumatic stress disorder (PTSD) have been found to have both shared and unique traumatic antecedents. The present study was an independent replication, with the DTD Structured Interview and the Traumatic Events Screening Instrument administered to 271 children in mental health treatment in six U.S. sites. On an unadjusted basis, DTD (27.3% prevalence, N = 74) and PTSD (40.2% prevalence, N = 109) both were associated with traumatic physical assault or abuse, family violence, emotional abuse, caregiver separation or impairment, and polyvictimization. After controlling for PTSD, DTD was associated emotional abuse, OR = 2.9, 95% CI [1.19, 6.95], and traumatic separation from a primary caregiver, OR = 2.2, 95% CI [1.04. 4.60], both of which also were associated with caregiver impairment, physical assault/abuse, and witnessing family/community violence. Three traumatic antecedents associated with PTSD were not associated with DTD: noninterperso...

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Following on a similar effort last year, five senior researchers have each selected two articles that they believe represent the best violence research published in 2012 and, like members of the panel that selected 2011 articles, once again provide comments about how they each approached this large task. In tandem with the results of last year's panel, the result provides some insight into how senior scholars stay abreast of key findings in the field of violence. The 10 selected articles, published in eight different outlets, include several national surveillance efforts, including one economic analysis; several that focus on ethnically and culturally diverse communities; and two on prevention and two on the challenges of clinical interviewing. They provide a snapshot of the issues, challenges, and achievements of the field today.

Youth raised by a caregiver experiencing harmful effects associated with alcohol use may experience multiple types of adversity. While the association between caregiver problem drinking and child maltreatment are well established, there is little knowledge on how caregiver problem drinking relates to trajectories of post-traumatic stress over time in youth who are at-risk or are involved in the child welfare system. Using data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), this study examined scores from the Trauma Symptom Checklist for youth at ages 8, 12 and 16. Controlling for caregiver depression, child behavioral health, and sociodemographics, results show that post-traumatic stress symptoms significantly decline over time for both groups, but youth of caregivers with problem drinking are more likely to report post-traumatic stress at age 16 in comparison to youth of caregivers with no problem drinking. These results can assist practitioners in identifying specific time points where tailored, trauma-informed, collaborative systems interventions can be developed to reduce the problems associated with youth post-traumatic stress. 1.1. Post-traumatic stress and trajectories over time While many youth at-risk for entry, or who are currently involved in the child welfare system have experienced multiple forms of adverse maltreatment, such as witnessing domestic violence, neglect, physical and sexual abuse. However, few are screened for trauma exposure and trauma symptoms (Greeson et al., 2011). Existing research has identified the association between childhood trauma and chronic adversity across the lifespan (D'Andrea, Ford, Stolbach, Spinazzola, & van der Kolk, 2012; Fratto, 2016). Evidence shows that youth at-risk for entry, or who are currently involved in the child welfare system often

The obligation to protect children is defined by law. However, there is fragility in identifying actual or potential situations that jeopardize their development. This review aims to identify the family risk factors that jeopardize child development. A scoping review was conducted following the Joanna Briggs Institute for Evidence-Based Practice framework and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, CINAHL, Nursing & Allied Health Collection: Comprehensive, MEDLINE Complete, and MedicLatina, with a time limit of 2010 to 2021. The search was restricted to documents written in Portuguese, English, and French. A total of 3998 articles were initially identified. After selecting and analysing, 28 risk factors were extracted from 29 articles. Four categories of risk factors were identified—namely, patterns of social and economic interaction, family characteristics, careg...

Research links high youth exposure to community violence (ECV) with negative health consequences, and the World Health Organization recommends ECV as a new adverse childhood experience (ACE) category. The current study is among the first to include ECV within the ACE categories, examining ACEs and behavioral health (BH) service usage, using a population-based adult sample. Results reveal ECV and ACE associations in the expected direction. Respondents reporting ECV before age 18 had higher ACE scores than those without ECV. Results demonstrate ECV's predictive power for later BH needs and confirm its utility as a new ACE category. Practice implications include attention to ECV among adult populations and mitigating long-term costs through early intervention and prevention.

Maternal smoking during pregnancy increases the risk of obesity in the offspring. Not much is known about the associations with other measures of body composition. We assessed the associations of maternal smoking during pregnancy with the development of subcutaneous fat mass measured as peripheral and central skinfold thickness measurements in early childhood, in a population-based prospective cohort study from early fetal life onward in the city of Rotterdam, The Netherlands. The study was performed in 907 mothers and their children at the ages of 1.5, 6 and 24 months. As compared to nonsmoking mothers, mothers who continued smoking during pregnancy were more likely to have a younger age and a lower educational level. Their children had a lower birth weight, higher risk of small size for gestational age and were breastfed for a shorter duration (P-values \\0.01). We did not observe differences in peripheral, central and total subcutaneous fat mass between the offspring of nonsmoking mothers, mothers who smoked in first trimester only and mothers who continued smoking during pregnancy (P [ 0.05). Also, the reported number of cigarettes smoked by mothers in both first and third trimester of pregnancy were not associated with peripheral, central and total subcutaneous fat mass in the offspring at the ages of 1.5, 6 and 24 months. Our findings suggest that fetal exposure to cigarette smoke during pregnancy does not influence subcutaneous fat mass in early childhood. Follow-up studies are needed in children at older ages and to identify associations of maternal smoking during pregnancy with other measures of body composition.

Trauma exposure is common during childhood and adolescence and is associated with youth emotional and behavioral problems. The present study adds to the current literature on trauma exposure among adolescent clinical populations by examining the association between trauma exposure and adolescent self-report of emotional and behavioral problems broadly, including internalizing and externalizing symptoms, in addition to the trauma-specific symptoms of posttraumatic stress disorder (PTSD). This study included 94 female (64%) and male (36%) adolescents, ages 13-19, representing 4 clinical populations: those seeking inpatient psychiatry, outpatient psychiatry, residential substance abuse, and outpatient medical services. Adolescents self-reported trauma history and internalizing, externalizing, and PTSD symptoms. Most adolescents reported experiencing at least 1 traumatic event (83%; M = 2.28, SD = 1.83). Multiple regression analyses controlling for age, race/ethnicity, gender, and treat...

Child sexual exploitation (CSE) has a long and ignominious history and continues to emotionally and physically injure and adversely alter the development, sense of self, relationships, and life course of millions of children and adolescents worldwide. 1 The systematic review and meta-analysis by Laird et al 2 provides a thorough and rigorous evaluation of international research on risk and protective factors for sexually exploited children and adolescents. Consistent with findings from recent systematic reviews, 3,4 this review suggests that CSE is associated with sexual exposure, including sexual risk taking, multiple sexual partners, exposure to child or rape pornography, child sexual abuse, and sexting. However, these experiences may be aspects or consequences of CSE, as well as risk factors possibly associated with CSE, and they may have complex associations with one another and with other factors (eg, serving as mediators or moderators) that require careful longitudinal study and the ascertainment of varied individual trajectories and subgroups (eg, latent class or profile analysis). Many other factors associated with CSE are not specific to sexual exposure but instead reflect potentially traumatic adversities that have in common the disruption of primary relational bonds (ie, single-parent family, intimate partner violence, running away, homelessness, poverty, social isolation, household antisocial behaviors, physical and emotional abuse, revictimization, family involvement in sex work, and child protective services [CPS] involvement). Interestingly, most of these factors showed low to moderate heterogeneity (ie, 0%-74%) across studies: only single-parent family, running away, and CPS involvement showed highly variable risk levels, which could be associated with those factors not being singular vulnerabilities to CSE but instead having a mixture of both risk and protective features. For example, although single-parent families might confer vulnerability

The obligation to protect children is defined by law. However, there is fragility in identifying actual or potential situations that jeopardize their development. This review aims to identify the family risk factors that jeopardize child development. A scoping review was conducted following the Joanna Briggs Institute for Evidence-Based Practice framework and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, CINAHL, Nursing & Allied Health Collection: Comprehensive, MEDLINE Complete, and MedicLatina, with a time limit of 2010 to 2021. The search was restricted to documents written in Portuguese, English, and French. A total of 3998 articles were initially identified. After selecting and analysing, 28 risk factors were extracted from 29 articles. Four categories of risk factors were identified—namely, patterns of social and economic interaction, family characteristics, careg...

Violence exposure in adolescence can disrupt ongoing adjustment, yet few studies have examined potential mechanisms that can explain these effects. Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined associations among adolescent violence exposure and indicators of adjustment in young adulthood, and tested whether maladaptive trajectories of binge drinking could mediate these associations. Adolescents (N ϭ 3,342; Mage ϭ 16.09) reported on their violence exposure and binge drinking in an initial assessment (Wave 1). Adolescents were subsequently reassessed for binge drinking at 1 (Wave 2) and 6 years (Wave 3) post, and completed measures of adjustment (education, physical health, life satisfaction, depression, and delinquency) at 6 years post (Wave 3). Latent growth mixture modeling revealed 4 binge drinking trajectories: High Increasers (low baseline, large positive slope), Adolescence Elevated (high baseline, negative slope), Mid-Tier Stable (midlevel baseline, flat slope), and Slight Increasers (low baseline, small positive slope). Violence exposure was indirectly associated with (a) lower educational attainment and greater delinquency through an increased likelihood of being in the Adolescence Elevated binge drinking class, (b) lower life satisfaction through an increased likelihood of being in the High Increasers binge drinking class, and (c) worse physical heath through an increased likelihood of being in the Mid-Tier Stable binge drinking class. Violence-exposed adolescents may exhibit varying trajectories of binge drinking that carry differential risks for adverse outcomes, and disrupt adjustment during the transition to young adulthood. Implications for intervention and theory are discussed.

This article looks at a psychotherapist's lessons learned at the intersection of trauma and antisocial behavior in 20 years of working in American prisons, forensic hospitals, and trauma centers. Typically, posttraumatic stress disorder (PTSD) presents as an anxiety disorder with the symptom triad of avoidance, reexperiencing, and hyperarousal. Therapy can proceed once some level of safety has been achieved. But many potential patients do not have a safe space for the work to proceed. Instead, they are living in conditions of ongoing exposure to trauma that has been variously described as complex PTSD and continuous traumatic stress. Anxiety would hardly be adaptive for survival in this environment and, in fact, the symptom picture is often dominated by anger, aggression, and callousness. When these potential patients are found in jails, prisons, and hospital emergency rooms, their outward presentation, instead of centering on anxiety, can appear more like conduct disorder or even criminal psychopathy. They may have been victims, but they frequently have also been perpetrators of violence. These patients need and deserve a trauma-centered treatment, but exposure therapy is hardly appropriate for someone who is experiencing ongoing traumatic conditions. Therapy can proceed, however, and be successful, but the techniques that the therapist uses may be quite different from those found in other settings. A theory of how trauma connects to antisocial presentations will be described, and some of the lessons learned in working with this population will be shared.

Though childhood sexualized assault (CSA) increases risk for varied psychological difficulties, no single condition, syndrome, or set of difficulties is reliably associated with such experiences. CSA likely disrupts or impairs normal development in complex ways that depend on the risk and resilience factors present before, during, and after CSA. CSA characteristics that increase risk for later difficulties include young age, trauma inflicted by another person, number of occurrences, violence or intrusiveness, betrayal of trust, adverse peri-traumatic reactions, negative reactions from others following disclosure, and a context of previous sexualized assault or maltreatment. Resilience increases with positive self-esteem, better intellectual functioning, good self-control, positive social support, and early therapeutic intervention. CSA is associated with impaired psychological development, mental health disorders, behavioural and relationship difficulties, physical health problems, reduced intellectual function, lower educational achievement, lower occupational attainment, and reduced lifetime income. Any particular difficulty may be problematic in its own right and may also contribute to other difficulties in the interlocking domains of individual abilities and attributes, relationships, and significant life activities. In individual forensic assessment cases, general evidence on CSA risk/resilience and impacts can be used in combination with the lifespan developmental analysis (Barnes & Josefowitz, Psychological Injury and Law, 2014), to determine whether and how CSA contributed to psychological injuries.

Background: Mental health diseases are responsible for 16% of the global burden of disease in adolescents. Identifying the main determinants of these disorders in this age group can direct public and political efforts aimed at their prevention. Two previous meta-analyses showed a moderate and positive effect between exposure to community violence and mental health symptoms; however, there are still significant gaps to be addressed. Objectives: To evaluate whether adolescents’ exposure to a higher degree of community violence is associated with a higher risk of internalizing mental health symptoms and to investigate whether degrees of community violence events (victimization, witnesses and heard about) is associated with a higher risk of internalizing mental health outcomes (depression, anxiety and postraumatic stress disorder). Methods: A systematic review, research question and inclusion and exclusion criteria were developed according to the PEO format. The population consists of a...

Developmental trauma disorder (DTD) and posttraumatic stress disorder (PTSD) have been found to have both shared and unique traumatic antecedents. The present study was an independent replication, with the DTD Structured Interview and the Traumatic Events Screening Instrument administered to 271 children in mental health treatment in six U.S. sites. On an unadjusted basis, DTD (27.3% prevalence, N = 74) and PTSD (40.2% prevalence, N = 109) both were associated with traumatic physical assault or abuse, family violence, emotional abuse, caregiver separation or impairment, and polyvictimization. After controlling for PTSD, DTD was associated emotional abuse, OR = 2.9, 95% CI [1.19, 6.95], and traumatic separation from a primary caregiver, OR = 2.2, 95% CI [1.04. 4.60], both of which also were associated with caregiver impairment, physical assault/abuse, and witnessing family/community violence. Three traumatic antecedents associated with PTSD were not associated with DTD: noninterpersonal trauma, sexual trauma, and traumatic loss. Children exposed to both traumatic victimization and attachment trauma (36.2%) or attachment trauma alone (32.5%) were more likely than children exposed only to victimization (17.5%) or those with no history of victimization or attachment trauma (8.1%) to meet the symptom criteria for DTD, χ 2 (3, N = 271) = 17.68, p < .001. Study findings replicate and extend prior DTD field trial study results, showing that, although PTSD and DTD share traumatic antecedents, DTD is uniquely associated with traumatic emotional abuse and caregiver separation. Further research is needed to examine how specific trauma types contribute to the risk, course, and severity of DTD. Developmental trauma disorder (DTD) is a childhood syndrome that was formulated to complement and extend

and I were so struck and pleased by one aspect of the second issue that we felt it was worth explicitly noting. What caught our attention was the diversity of material in this issue. Without plan or design, we found that the range and variety of topics and populations addressed was impressively broad. The questions raised by the pieces in this issue include ones as fundamental as what constitutes a psychological trauma (Hussain & Bhushan; Taylor & Weems), the consequences of exposure to traumatic events (Callahan & Borja; Ogata, Nishi, & Maeda; Walker, Reed, O'Neill, & Brown), and assessing the effectiveness of trauma-related treatment (Brand). The populations and types of trauma sampled span Japanese survivors of the loss of a family member to an accident or criminal assault (Ogata, Nishi, & Maeda), children and adolescents residing in New Orleans (Taylor & Weems), and Tibetan refugees residing in India (Hussain & Bhushan). Although most of the articles included here are relatively "mainstream" empirical studies, there is one review article (Walker, Reed, O'Neill, & Brown) and a naturalistic study (Brand). There are certainly other dimensions along which the articles contained herein could be divided, but rather than belabor the point, I wish to highlight why Drs. Courtois, Kendall-Tackett, and I feel that the variety represented by these pieces is of importance. On a practical level, we have already been asked by numerous potential authors whether particular types of articles are appropriate for submission to PT: TRPP. Although it happens, it is relatively rare that our answer to these inquiries is "no." While the Journal is certainly committed to maintaining a high level of scholarship, we recognize that quality contributions to the literature can take many forms. Achieving this objective unquestionably entails the publication of empirical studies, but it by no means is restricted to dissemination of quantitative research. Qualitative studies, literature reviews, theoretical works, clinical formulations, case studies, and policy papers are all welcome. Transcending the variations among the articles in this issue is a crucial similarity: each moves the field of trauma studies forward by addressing a novel question, employing innovative methodology, or both. Beyond the concrete matter of author inquiries about the scope of material relevant for publication in PT: TRPP lies a much broader philosophical stance to which our entire editorial staff strongly subscribes. We recognize and value that the field of psychological trauma encompasses a wide-ranging and multifaceted territory. Keeping in focus the vast permutations of types of events that can constitute trauma, both debilitating and growth-facilitating consequences of exposure to trauma, ways in which trauma and its impact can be conceptualized and addressed, variations in the experience of trauma in different populations, and the variety of intervention approaches that can be effectively applied to trauma-related difficulties is a daunting challenge. We believe it is extremely important that as many facets of this terrain be examined and represented in the pages of PT: TRPP as possible. Only by

There has been approximately 1.5 million service members who have spent service time in Iraq, of which about 500,000 have served two tours of combat (Whitlock, 2008 as cited by Huebner, Mancini, Bowen, & Orthner, 2009). Given that deployment tours can last up to 15 months, many military personnel have been spending more time overseas than at home. As the Global War on Terrorism (GWOT) continues the death rate continues to rise, there are many families and children that will have to cope with the death of a love one and the grief that comes with it. This article will bring awareness to helping professionals and agencies that work with military families and their relatives after the death of a service member. It will show the length and use of such modalities as the social learning theory and the grief cycle model in offering the best interventions and techniques when providing psychological services to families of services members who died while in combat. It will also provide a starting point and mid-point for love ones that may be seeking additional resources after the death of a family member.

Background: Evidence suggests that childhood is an important critical period for adult mental health outcomes. Most studies evaluating childhood factors use cross-sectional data, limiting our understanding of life course factors contributing to mental health. The purpose of this study was to evaluate the contribution of life course factors on adult mental health treatment from a longitudinal cohort of U.S. respondents. Methods: We used data from the National Longitudinal Survey of Youth-1997 (N=8,984) through the 2011 data collection year, in which n=7,009 adult respondents reported on the number of mental health visits between 2009-2011. We used zero-inflated negative binomial regression to evaluate the impact of childhood, adolescent, and adult factors on mental health visits. Results: Respondents with more than three adverse childhood experiences (ACE) reported in adolescence were significantly more likely to utilize mental health treatment as an adult (Incidence Rate Ratio[IRR]=1.30). No other childhood or adolescent factors contributed to adult mental health utilization. Adult factors associated with greater mental health visits included: having any health insurance (IRR=1.40), being unemployed (IRR=1.56) or employed part-time (IRR=1.31). African-American respondents had significantly fewer mental health visits than white respondents (IRR=0.79). Non-significant factors included: gender, ethnicity, parentreported childhood emotional problem, family receipt of governmental assistance as an adolescent, living in a high-poverty household as an adult, and living in a state with high unemployment. Conclusions: Critical periods of development, combined with cumulative risk and protective factors, contribute to adult mental health seeking. Adolescence is a critical period for trauma and later need for mental health treatment. Other factors, such as full-time employment, appear to be associated with reduced likelihood of the need for mental health treatment. Future evaluation of community and population-based approaches, including policy interventions, is needed to understand risk and protective factors contributing to mental health across the life course.

Developmental trauma disorder (DTD) is not a formally recognised as a diagnosis in the current diagnostic systems. There has been a push for its inclusion by child psychiatrists and psychologists within the past decade. There are a multitude of symptoms associated with DTD, which can manifest differently depending on the individual and the type of trauma they have experienced. The array of symptoms participants have reported in studies shows the difficulty in pinpointing exactly what individuals who have developmental trauma will experience throughout their lives. Based on previous works, a traumatic home environment is the most likely cause of DTD. Factors that may moderate developmental trauma disorder are discussed. Those at risk for DTD include: (i) children who have been separated from a parent; (ii) children who have experienced any form of maltreatment; and, (iii) people who, as infants, felt vulnerable and perceived their caregiver(s) as unpredictable. Exposure to trauma aff...

This dissertation consists of two studies designed to broaden our understanding of the impact of complex trauma on symptom profiles and outcomes of children in the child welfare system through the lenses of gender, development, and placement permanency. Data for both were obtained using the Child and Adolescent Strengths and Needs Comprehensive Assessment tool (CANS; Lyons, Gawron, & Kisiel, 2005) for youth ages 6-17 years involved in the child welfare system. In Study 1, I examined symptom profiles of 3,446 youth to determine the ability of gender, age, ethnicity, trauma type, and other adversity variables to predict the following CANS domains: posttraumatic stress symptoms (PTSS), emotional/ behavioral needs, risk behaviors, life domain functioning, and child strengths. Findings supported the hypothesis that males and females would exhibit a similar number and severity of PTSS subsequent to exposure to maltreatment, including complex trauma. Unique gender-specific developmental profiles of trauma exposure and symptomatology emerged. I concluded that the complex and dynamic interactions among gender, age, trauma experience, and psychosocial functioning are more complicated than can be elucidated in main effect or two-way interactions. It is therefore recommended that trauma researchers disaggregate analyses by gender in trauma research because the dynamics of trauma are different for males and females. In Study 2, I employed survival analyses to examine the ability of child characteristics, complex trauma exposure, and placement-related variables to predict placement disruption in a sample of 4,822 youth at highrisk for placement disruption. Older age, female gender, higher levels of externalizing behavior, and more prior placements increased risk for placement disruption, whereas longer time in care and type of out-of-home placement decreased risk for placement disruption in the sample. It is recommended that placement stability be directly targeted for those at higher risk through iii provision of intensive support to youth and their foster caregivers. Caseworkers should receive training about those subgroups most at-risk for placement disruption. Externalizing behavior and attachment, but not PTSS, mediated the relation between complex trauma and placement disruption. Intervention for youth with a history of complex trauma should focus on both attachment and externalizing behaviors. iv Statement of Co-Authorship This thesis contains two manuscript-style articles. The first was submitted to Child Abuse & Neglect but rejected, and has since been substantially revised. I plan to submit both manuscripts to appropriate journals following my post-defense revisions, as first author. Both manuscripts were prepared in collaboration with my thesis supervisor, Dr. John S. Lyons, who also facilitated access to the secondary data used in both studies through his academic and professional affiliations in Illinois. He is the second author on both manuscripts. The first manuscript was also prepared in consultation with my student colleague, Wendy den Dunnen,

Case studies are an important venue for reporting clinical processes relevant to clinical care, research agendas, and interprofessional collaboration. Clinical Practice in Pediatric Psychology (CPPP) is actively soliciting case studies to further the mission of promoting evidence-based practice, highlighting important areas for further empirical study related to biopsychosocial phenomena and advocating for the value and relevance of pediatric psychology in the current health care climate. This article highlights desired topic areas for case studies for CPPP, reviews methodological considerations, and provides recommendations for case study reporting. In addition, ethical considerations related to case study report methodology are reviewed. Our hope is that this article will promote submission and acceptance of case studies to Clinical Practice in Pediatric Psychology.

In middle childhood and adolescence, the most rapidly developing brain areas are those responsible for three core features of &quot;executive functioning&quot; necessary for autonomous functioning and engagement in relationships. These features, involving primarily the prefrontal cortex, are conscious ...

BACKGROUND: Research indicates that childhood trauma is a pervasive, global, healthcare crisis with a majority (68%) of children having experienced exposure to traumatic events. 1 Youth who have multiple exposures to violence or victimization are at higher risk for mental health problems, behavioral problems, substance abuse, and delinquent behaviors, often resulting in their involvement with the court system. 2,3,4,5 The majority of children who experience traumatic events are seen first by their pediatricians, schools, or courts and law enforcement before being referred for trauma assessment/treatment. By training professionals in these groups, the University of Massachusetts Medical School Child Trauma Training Center (UMMS-CTTC) aims to identify and improve access for children who would benefit from evidence-based trauma-focused treatment, specifically, Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). 6 MISSION: The UMMS Child Trauma Training Center mission is to improve the identification of trauma and increase trauma-sensitive care and access to evidence-based trauma-focused treatment for at-risk and underserved populations in Central and Western Massachusetts, including court-involved youth and military families, ages 6 to 18 years.

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Patterns of trauma exposure and symptoms were examined in a sample of 16,212 children in Illinois child welfare. Data were collected on trauma histories, child and caregiver needs and strengths, and analyzed in light of the proposed Developmental Trauma Disorder diagnostic criteria. Youth exposed to both interpersonal violence and attachment-based ("non-violent") traumas within the caregiving system had significantly higher levels of affective/physiological, attentional/ behavioral, and self/relational dysregulation in addition to posttraumatic stress symptoms compared to youth with either type of trauma alone or in relation to other trauma experiences. These complexly traumatized children exhibited higher levels of functional impairment and were more likely to have placement disruptions and psychiatric hospitalizations. Findings suggest a developmental trauma framework can more adequately capture the spectrum of needs of these multiply traumatized youth than existing diagnostic formulations. Utilizing this framework for assessment, treatment planning, and intervention can lead to more targeted and effective services for these children.

Research links high youth exposure to community violence (ECV) with negative health consequences, and the World Health Organization recommends ECV as a new adverse childhood experience (ACE) category. The current study is among the first to include ECV within the ACE categories, examining ACEs and behavioral health (BH) service usage, using a population-based adult sample. Results reveal ECV and ACE associations in the expected direction. Respondents reporting ECV before age 18 had higher ACE scores than those without ECV. Results demonstrate ECV's predictive power for later BH needs and confirm its utility as a new ACE category. Practice implications include attention to ECV among adult populations and mitigating long-term costs through early intervention and prevention. IMPLICATIONS FOR PRACTICE • There are potential long-term adverse effects of trauma on adult health, so routinely assessing for ECV as well as ACEs among adult populations is recommended. • Early intervention in a school setting for youth who have experienced ECV can be an effective approach to prevent its adverse effect in later life.

As the university environment can present unique challenges, it is important to look at the ways in which childhood trauma can impact student resilience, especially in non-Western contexts. The present study examines the relationship between adverse childhood experiences (ACEs) and measures of resilience among college students in Turkey. Students reported low levels of childhood trauma, both overall as well as within the various ACE sub-categories. Correlational analysis revealed statistically significant associations between some ACEs and measures of resilience. In terms of gender differences, females reported greater emotional abuse at a statistically significant level compared to males. Trends in the data also showed gender differences in general resilience as well as in experiences of physical abuse, physical fights, and indirect community violence. Gender moderated the relationship between ACEs and two resilience measures, with female students experiencing greater ACEs in terms of self-efficacy and self-regulation. Findings shed light on some of the ways that childhood trauma may be manifested across gender groups in Turkey. Implications for Turkey’s higher education systems are discussed.

Two divergent areas of study have focused on the experiences of grief, i.e., bereavement, and on trauma and its aftermath. The grief literature has its foundations in psychodynamic and relational theories, and thus treatment modalities have focused on resolving relationship issues through reminiscence and developing a new sense of the relationship and of the self, independent of the lost loved one. The trauma literature, while having some psychodynamic roots, has been founded primarily on biological and cognitive formulations. Again, while many different treatments are discussed, cognitivebehavioral approaches based on cognitive restructuring and symptom management dominate the practice efficacy literature. But trauma and bereavement/loss are not mutually exclusive, and when a practitioner is faced with a client suffering from both, it is necessary to attempt to integrate these divergent theories and at times antithetical treatment approaches. This paper therefore seeks to address the issue of treatment efficacy in traumatic loss and develop guidelines for evidence-based approaches to practice. [Brief Treatment and Crisis Intervention 4:289-309 (2004)]

Adolescence is a unique developmental period in which youth are at heightened risk for violence perpetration and victimization, both of which can adversely affect the course of normal psychosocial development and health across the life course. The possible range of violent experiences during adolescence is broad, including physical and relational peer violence, bullying, sexual violence, cyber-aggression, child maltreatment, exposure to parental intimate partner violence, exposure to aggressive media, and more. The 8 articles in this special issue span this wide range of violence experiences. In helping to fill gaps in knowledge about the nature and processes by which violence develops, and how violence experiences affect adolescents, these articles as a group also offer direction for future research. They illustrate the need for research that cuts across the separate bodies of research on violence involving youth, that tackles thorny questions about the conceptualization of violence in its myriad forms, and that considers the ways in which the various forms and dimensions of violence operate together, across levels of the social ecology, to influence outcomes. The findings in this collection of studies also have implications for the development of prevention and intervention programs to address the problem of violence in adolescence.

Background and Objectives. Adverse childhood experiences include stressful and potentially traumatic events associated with a higher risk of long-term behavioral problems and chronic illnesses. In this study, we had estimated the prevalence of adverse childhood experiences (ACEs) and association with depression symptoms prevalence and severity as a function of ACE counts. Methods. A cross-sectional school-based study was employed. Five hundred forty-six secondary school students were selected using multistage sampling technique from 5 selected secondary schools. We obtained retrospective information on adverse childhood experiences of adolescents by ACEs, self-reported 10-item questionnaire, and current depression prevalence and severity by PHQ-9. Multivariate linear regression models were used to estimate child depression severity by retrospective ACE count. Results. Among the 546 adolescents who participated in this study, 285 (50.7%) of the participants answered yes to at least one or more questions among the total 10 questions of ACEs. Experiences of ACEs increased the risk for depressive symptoms, with unstandardized β = 1.123 (β = 1.123, 95% CI (0.872, 1.373). We found a strong, dose-response relationship between the ACE score and the probability of lifetime and recent depressive disorders (p < 0:0001). Conclusions. The number of ACEs has a graded relationship to both the prevalence and severity of depressive symptoms. These results suggest that exposure to ACEs is associated with an increased risk of depressive symptoms up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span.

Objective: This study determined whether county-level social determinants of health and adverse childhood experiences (ACE) were associated with emotional support and health-related quality of life (HRQOL) in adulthood. This study represents the largest population-based investigation on ACE to include county-level indicators of the social ecology. Method: We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey (29,212 adults from 5 states) and the American Community Survey (2010; 304 counties). Multilevel structural equation models were employed to test direct and indirect associations between county-level social determinants of health, ACEs and indicators of adult HRQOL. Results: At the individual level, ACEs were associated with lower emotional support, and lower emotional support was associated with worse physical and mental HRQOL. Parental divorce was associated with better mental HRQOL for individuals who reported Ն2 forms of childhood maltreatment and/or negative household environments during childhood. At the county-level, low median income and high county-level unemployment were associated with low emotional support, and high median income and high unemployment were directly associated with poor physical and mental HRQOL. Conclusion: Findings from this study suggest that intervention efforts designed to promote positive emotional supports for adults who have experienced ACEs, particularly for those living in disadvantaged counties, may ameliorate potential health consequences during adulthood.

Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention.

Background: The impact of adverse childhood experiences (ACEs) significantly determines whether an individual will be functional or dysfunctional in adulthood. 
Aims: The current study examines the prevalence and the socio-demographic correlates of ACEs.  It also estimates  the relative risk for ACEs and the risk for major depression in adulthood with respect to the significant socio-demographic factors.
Methods: Data collected using a Demographic proforma and Childhood Experiences of Care and Abuse Questionnaire-2 from 600 youth, selected through multi-stage stratified sampling from selected educational institutions in Kerala, South India, were analyzed using SPSS-20. Descriptive and inferential statistics (Chi square test, Mann-Whitney U test, and Odds Ratio from Risk analysis) were used.
Results: ACEs were highly prevalent (91%) among youth and more than half of them had experienced three or more ACEs. In the case of ACE severity, gender was significantly associated with psychological abuse, physical abuse and sexual abuse. Males had exposure to more severe ACEs than females. The odds of having physical and sexual abuses, and risk for major depression in adulthood were significantly greater (two times) among males than females. Further, the odds of experiencing antipathy, sexual and psychological abuses (two times), physical abuse (three times), and, risk for major depression in adulthood (four times)  were significantly greater among youth with family dysfunction than those without it.
Conclusions: Irrespective of gender, Kerala’s youth have exposure to multiple ACEs. However, males and those with family dysfunction are at greater risk (physical and sexual abuses, and major depression in adulthood). It highlights the need for specific efforts and policies for prevention of ACEs.

Key words: Adverse Childhood Experiences, Child maltreatment, Child abuse, Mental health, Youth.

Compared to many parts of the world, there has been little research in Pacific Island nations into the effects of Adverse Childhood Experiences (ACEs) on adult health. This is a significant gap for local evidence-based child protection. We describe findings from a survey of 400 men aged 18-70 years recruited from randomly sampled households in Honiara city, Solomon Islands. Most men reported multiple adversities during childhood (80.7% three or more; 46% five or more), such as exposure to community and domestic violence, bullying, physical maltreatment and sexual abuse. Men with multiple ACEs had significantly lower well-being and more psychological distress, recent stressful life events and health risk behaviours. This study reports the first observation that betel quid chewing increased as a function of multiple ACEs. In comparison to recent East Asian studies, the S.I. data suggest that the collective geographic category of " Asia-Pacific " masks significant intra-regional differences in childhood adversities.

This study was designed to test the feasibility and child clinical outcomes for group-based trauma-focused cognitive behavior therapy (TF-CBT) for orphaned children in Tanzania. There were 64 children with at least mild symptoms of grief and/or traumatic stress and their guardians who participated in this open trial. The TF-CBT for Child Traumatic Grief protocol was adapted for use with a group, resulting in 12 weekly sessions for children and guardians separately with conjoint activities and 3 individual visits with child and guardian. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary child outcomes assessed were symptoms of grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pretreatment, posttreatment, and 3 and 12 months after the end of treatment. Results showed improved scores on all outcomes posttreatment, sustained at 3 and 12 months. Effect sizes (Cohen's d) for baseline to posttreatment were 1.36 for child reported grief symptoms, 1.87 for child-reported PTS, and 1.15 for guardian report of child PTS.

Objective: Mass casualty events pose dilemmas for community clinicians, often challenging their existing clinical toolkits. However, few clinicians were trained to be experts in explaining the unfolding events to the community, creating resources, and interacting with journalists. The objective of this article is to explain knowledge, skills, and attitudes that mental health professionals need to consider when working with journalists, especially those covering children affected by disaster. Methods: In service of these objectives, this article reviews controversies, evidence, and best practices to facilitate effective collaborations and consultations with journalists. Advice includes information on how to be a good source to journalists. Results and conclusions: Clinicians can ethically and effectively help journalists tell accurate and compelling stories about the psychological effects of disasters when they understand and respect the aims, culture, and ethics of journalism.

The purpose of the present study was to examine the evidence for the complex trauma definition in children, utilizing children's self-reported trauma-related symptoms. Two hundred and twelve children (ages 8–16) exposed to a traumatic event were included in the study. The symptom reports of children who experienced complex trauma were contrasted with children who experienced a trauma that did not meet the full complex trauma definition: 1) acute noninterpersonal trauma, 2) acute interpersonal trauma, 3) trauma that began early in life (i.e., prior to age 10), and 4) chronic interpersonal trauma that began later in childhood.. Significant differences in children's self-reported symptoms were observed when children who experienced complex trauma were compared to those who experienced a traumatic event that met none of the characteristics of complex trauma exposure. Explanations for the findings are discussed.

Objective: To better understand the role earlier stressful environments have in predicting functional somatic symptoms (FSS) in late adolescence, this study explores the effect the occurrence of earlier changes in family dynamics and friendship conflict have on FSS. Method: We used data from the Consortium for Longitudinal Studies on Child Abuse and Neglect (N ϭ 1,314), a large, prospective study of children at risk for maltreatment and their parent/caregiver from approximately 4 to 18 years of age. Results: We found a significant, small (Effect Size ϭ .10), positive association between the frequency of family dynamic change during middle childhood (ages 6 -12 years) and FSS at age 18 but not during middle adolescence (ages 14 and 16). Conflict with a same-sex best friend at age 16 moderated the association between the frequency of change and FSS. The frequency of family dynamic change in middle childhood and middle adolescence was associated with greater FSS among those who reported greater conflict but not for those who reported experiencing lower conflict. Overall, these effects were specific to friendship conflict and remained when other friendship processes (intimacy and companionship) were included, did not generalize to anxiety/depressive symptoms, and predicted FSS without comorbid anxiety/depressive symptoms. No gender differences were found. The change-conflict interaction differed according to type of family dynamic change (parental vs. residential). Conclusion: Findings emphasize how earlier exposure to frequent changes in family dynamics in middle childhood is particularly associated with late-adolescent health, especially in the context of greater friendship conflict.