2/21/2024 Neurobiological: Stress Response Systems How Can We Define Stress? Positive ● Brief increases in heart rate, mild elevations in stress hormone levels. Tolerable ● Serious, temporary stress responses, buffered by supportive relationships. Toxic ● Prolonged activation of stress response systems in the absence of protective relationships. Defining Stress Stress is a biological and psychological response to an experience encountering a threat that we feel we do not have the resources to deal with. Stressor = the stimulus/threat that causes stress. What Are the Body’s Stress Response Systems? Autonomic Nervous System (ANS) Conserves and mobilizes energy Stress Response Systems Sympathetic Adrenal Medullary (SAM) Pathway ● Released adrenaline and noradrenaline ● Prepares for sudden action, “fight or flight” Hypothalamic Pituitary Adrenocortical (HPA) Axis ● Releases cortisol ● Helps cope with stress When Stress Responses Become A Problem Problem/challenge is when we have to indicate these systems chronically or repeatedly Allostatic Load: Costs endured on the body following repeated or chronic bouts of stress ● Severe with repeated stress ● Physiological “wear and tear” HPA Axis: Typical Development Early life stress undermines the development of hypothalamic-pituitary-adrenocortical (HPA) axis regulation HPA axis serves two orthogonal functions: 1. Stress response 2. Diurnal rhythm Typical Diurnal Rhythm of Cortisol Adult-like diurnal rhythm emerges early during infancy ● High cortisol in the morning ● Low cortisol at night Serves basal, non-stressed functions ● Supports temperature regulation, learning, daily metabolism, immune system functioning, normal brain growth Neglect and LOW Morning Cortisol Opposite of what was predicted Children who experience neglect or abuse (including post-institutionalized children and infant/toddlers in foster care) were more likely to have low or blunted morning cortisol levels Some of my Work! Compared three groups of children with varying histories of early life risk: ● Foster care (n = 184): Children living in foster care involving involvement with CPS ● High-risk birth (n = 155): Children living with high-risk birth parents following involvement with CPS ● Low-risk comparison (n = 96): Children from the community with no history of involvement with Child Protective Services Summary of Study ● Findings suggest that children continuing to live in stressful environments show more atypical cortisol regulation than children placed in foster care ● Blunted pattern has been linked to risk for later psychiatric disorders ● Blunted pattern (hypoactivation) may reflect down-regulation of the system following heightened cortisol production (hyperactivation) Summary Responding to stress is evolutionary adaptive Several stress response systems work together to react to and cope with stress The HPA axis is one system that is affected by maltreatment ● Leading to blunted cortisol rhythms (low waking cortisol) It is critical to understand mechanisms of stress because they affect our well-being across areas of functioning 2/26/2024 Neurobiological: Brain Structure & Function How Can We Examine Brain Changes? Changes at the Neural Level ● Structural changes are changes in how the brain is structured, such as the volume/size of different brain regions or number of connections between regions. ● Functional changes are changes in how the brain functions to complete tasks; we can look at patterns of activation and measure of efficiency. Our Approach Selective review: Organized around specific brain regions (and associated functions) ● Keep in mind that brain regions are structurally and functionally interconnected ● Not a neuroscience class, more big picture ● Overly simplistic approach Brain Regions of Interest ● Amygdala: Emotion processing and anxiety. ● Hippocampus: Learning and memory ● Prefrontal Cortex: Executive function and ADHD Amygdala ● Located deep in temporal lobe ● Part of the limbic system ● Rapid development within the first few years of life Critical role in processing emotional information: ● Perceiving emotion in faces ● Evaluating threatening information ● Fear conditioning Maltreated children show: ● Deficits in emotion processing ● Higher internalizing problems (anxiety, depression) ● Perceptual biases for threatening information Amygdala Structure and Maltreatment Structure: ● In general, not much evidence for abuse and neglect with biological parents causing changes to amygdala volume. BUT, there is evidence that institutional care causes significant changes to the amygdala. ● Remember that institutional care reflects severe deprivation, extreme neglect. ● Larger amygdala volume in children adopted from orphanages after 15 months old. (Tottenham et al., 2010) ● Effects were evident in middle childhood, suggesting that there may be failure to recover from early adversity. Dose-dependent (Dose of exposure, not medicine) relationship: ● More time in institution, larger amygdala ● “Dose” of orphanage exposure on size Amygdala Function fMRI studies also show a link between institutional care and a sensitized amygdala Amygdala Function and Maltreatment Sensitized amygdala (Tottenham et al., 2011) ● Previously institutionalized children show heightened amygdala activity to fearful compared to neutral faces ● Similar to adult-like pattern of responses ● May reflect precocial development Greater amygdala activation to fearful faces associated with: ● Poorer social competence ● Less eye contact Sensitized amygdala ● Not only institutionalized children ● Also see similar effects in children in US foster care (Mehta et al., 2010) ● History of neglect associated with greater activation in amygdala to fearful and angry faces, relative to neutral Emotion Processing Processing of emotional faces (Pollak et al.) ● Physically abused children: Enhanced attention to negative faces ● Example: Morphing faces study ● ● ● ● Event Related Potentials (ERPs) Extracted from ongoing electroencephalogram (EEG) Electrical changes in the brain in response to specific event Relatively easy to measure High temporal resolution P300 (positive deflection at 300ms) ● Associated with attention toward emotionally-evocative stimuli, such as emotional faces ● Most children show similar P300 across emotion expressions ○ Abused children show larger P300 to angry faces than other faces Amygdala Summary Changes in the amygdala: ● Larger amygdala volume (specific to extreme neglect) ● Heightened amygdala sensitivity ● Differential neurological processing of emotion Implications for behavioral/emotional well-being? ● Anxiety disorders (more attention toward threat) ● Hostile attributions (bias toward angry/hostility) Hippocampus Also part of the limbic system Sensitive to child stress due to: ● Prolonged development ● High density of glucocorticoid receptors Critical role in: ● Memory and learning ● Emotion Processing (along with amygdala) ● Modulating HPA axis response to stress Relative to non-maltreated children, maltreated children show: ● Deficits in short-term and long-term memory functioning Hippocampus Structure and Maltreatment When measured in childhood: In general, not much evidence for hippocampal volume differences in children who experience maltreatment or institutional care vs. typical children. ● Exception: Children with maltreatment-related PTSD show larger hippocampal volume, with positive associations to level of psychopathology (Tupler & DeBellis, 2006) When measured in adulthood: Studies consistently find decreased volume of the hippocampus in adults who experienced childhood maltreatment vs those who did not Hippocampus Function and Maltreatment Reduced activation in memory/learning tasks ● fMRI study about encoding and retrieval of visually-presented words (Carrion et al., 2010) ● Compared with typical children, maltreated children with PTSD symptoms showed reduced activation in hippocampus during retrieval ● PET study: Adult survivors of sexual abuse with PTSD showed reduced hippocampal activation during verbal memory task (Brenner et al., 2003) Hippocampus Summary Changes in the hippocampus: ● Decreased hippocampal volume (in adulthood) ● Decreased hippocampal activation during memory tests Possible mechanism: Increased exposure to stress hormones (cortisol) Implications for cognitive functioning? ● Poorer learning and memory Prefrontal Cortex ● Extended development, from birth through adulthood ● Very sensitive to early experience Critical role in executive functions ● Planning, memory, inhibitory control, controlling attention Relative to non-maltreated children, maltreated children show: ● Higher rates of ADHD ● Poorer executive function Prefrontal Cortex Structure and Maltreatment Some evidence of smaller volumes in sub-regions of the prefrontal cortex in childhood (e.g., Hanson et al., 2010) and adulthood (e.g., Anderson et al., 2008) ● This pattern (decreased prefrontal cortex volume) has also been found in children with ADHD Notably, evidence is mixed, with other studies showing no difference, or larger volume. Neglect and Prefrontal Cortex Children with history of institutional care showed smaller PFC than comparison children (Gunnar et al.) Prefrontal Cortex Function and Maltreatment Maltreated children show patterns of neural activation during executive function tasks that look similar to children with ADHD ● Example “Go/No-go Task” ● No-go trials require response inhibition (the ability to inhibit (control) a dominant response) During no-go trials, non-maltreated children show activation in a region in the prefrontal cortex associated with response inhibition… In contrast, maltreated children do not show activation in this area (show it in a different part of the brain) ● Pattern of neural activation for maltreated children looks like children with ADHD Prefrontal Cortex Summary Changes in the prefrontal cortex: ● Decreased volume (although mixed findings) ● Different pattern of activation (more similar to children with ADHD than typical children) Implications for executive functioning ● Ability to inhibit a dominant response ● Ability to sustain attention to a boring task ● Ability to direct/allocate attentional resources ● Cognitive flexibility, working memory, etc. How Are Brain Waves Affected by Maltreatment? Institutional Care Reduces Alpha Power Lower alpha power/higher theta power seen in institutionalized ● Similar findings have been seen in children living in poverty Predictive of ADHD (and signature of ADHD) Bucharest Early Intervention Project (BEIP) What happens when we randomly assign some children to receive high-quality family foster care? EEG Activity Summary Maltreatment is associated with a different pattern of EEG activity (similar to ADHD) Implications for cognitive functioning ● Attention/ADHD ● Academic performance and IQ Implications of Brain Changes for Well-Being Ability to do well in school/job ● Attention, memory, cognitive ability, executive functioning skills Ability to respond adaptively in social situations ● Accurately interpreting emotional cues, inhibiting automatic responses, integrating information to respond appropriately Implications of Brain Changes for Parenting When these children grow up, think about how these brain changes may affect their parenting ● Effects on executive functioning (info-processing model) ● Effects on social relationships ● Effects on well-being more generally ○ Ability to maintain a job, manage schedule ○ Psychopathology (e.g., anxiety, depression) ○ Ability to manage stress Are Changes Permanent? Emerging Evidence that interventions can prevent some of the effects of early adversity on biological regulation and the brain Summary ● Early adversity and maltreatment can affect the structure and function of the developing brain ● Changes in the brain may affect attention and memory, learning, and emotion regulation ● The brain is still developing for a prolonged period, so interventions can help prevent or even reverse some of these effects. 2/28/2024 Effects of Maltreatment on Physical Health Cardiovascular Disease Diseases including the heart and/or blood vessels Estimated association between maltreatment and cardiovascular disease ● Severe physical abuse: 45% higher risk ● Sexual abuse: 62% higher risk Findings hold even when controlling for: Other childhood stressors (e.g., poverty, divorce); Adults Health behavior (e.g., poor eating, smoking); Adult stressors; Adult depression Nutrition and Metabolic Disorders Diseases that disrupt normal metabolism ● Metabolic syndrome: increased blood pressure, high blood sugar, excess body fat, high cholesterol ● Obesity ● Type 2 Diabetes Meta-analysis of 41 studies supports link between childhood maltreatment and obesity (Dense & Tan, 2013) Cognitive Decline and Dementia Cognitive decline related to: ● Loss of myelin integrity ● Cortical thinning ● Drop in regional brain volume Together, changes can lead to forgetfulness, lower problem-solving ability, decreased attention Higher prevalence of these issues in adults who report childhood experiences of maltreatment Cellular Aging Telomeres are nucleotide repeats that cap the end of chromosomes, and function to protect DNA from damage during replication Considered a marker for biological age Maltreatment and Cellular Aging Retrospective reports of moderate/severe maltreatment (reported on Childhood Trauma Questionnaire) associated with shorter telomere length in adults (Tyrka et al., 2009) Number of childhood adversities (death of parent, severe marital discord, parental substance use, etc) associated with telomere length (Kananen et al., 2010; Keicolt-Glaser et al., 2011) Exposure to violence associated with telomere length attrition from age 5 to age 10 (Shalev et al., 2012) Length of time in institutional care associated with shorter telomere length in middle childhood (Bucharest Early Intervention Project: Drury et al., 2011) Example From My Research 4- to 5-year-old children with CPS involvement (high-risk) or without (low-risk) Parent sensitivity protected against cellular aging (If parents are more responsive/sensitive to high risk kids, they will have more protected telomeres) Pathways To Age-Related Disease These age-related diseases are also associated with each other Likely to co-occur Together, lead to earlier mortality Allostatic Load Allostasis ● “Stability through change” ● Adaption in the face of stressful situations ● Via changes in hormones ● Adaptive in the short-term Allostatic Load ● Wear and tear on the body due to chronic stress ● Constantly managing threats through activating body’s response system Summary Child maltreatment gets “under the skin” ● Leads to long term physical health problems ○ Age-related health conditions, earlier mortality ● Leads to health risk behaviors ○ Smoking, drinking Mechanisms: Changes to biological systems ● Endocrine, Nervous, Immune 3/4/2024 Effects of Maltreatment Socio-Emotional: Attachment Attachment Theory Attachment definition: An enduring tie to a special person, characterized by a tendency to seek and maintain closeness, especially during times of stress What happens when we lack an attachment figure (e.g., orphanage care) or when our attachment figure is a source of stress (e.g., neglect/abuse)? Development Of Attachment Theory John Bowlby: Father of attachment theory Multiple driving forces behind his formation of attachment theory: 1. Reaction against psychoanalytic thinking 2. Observations of deprivation 3. Ethology and evolutionary theory 1. Reaction against psychoanalytic thinking ● Prevailing theories about “fantasies” vs real interactions 2. Observation of the effects of deprivation ● 44 adolescent thieves study (1994): “affectionless” ● Hospitalization without parental visualization 3. Ethology and evolutionary theory ● Lorenz (1957) and gosling imprinting ○ Maintaining proximity in order to enhance survival ● Harry Harlow monkey studies ○ Tried to separate the source of comfort from the source of food Key Principles Of Attachment Theory Unless there are incredibly unusual conditions, all children will develop an attachment ● There is a variability in the quality of these attachments The quality of an attachment relationship depends on the quality of caregiving a child receives ● Relationship-specific (can be different with different parents) The quality of an attachment relationship will predict the quality of future relationships and socioemotional functioning ● The strength of these predictive associations depends on other factors in the environment ● They are no deterministic associations Measurement Of Infant Attachment Quality Strange Situation (Mary Ainsworth) ● Parent and baby in room together ● New person (stranger) comes in and out ● Two brief separations and reunions Code the quality of attachment based on the child’s behavior during reunion Attachment Quality Categories Organized ● Secure ● Insecure-Avoidant ● Resistant All coherent, adaptive strategies for dealing with distress; child’s strategy makes sense Disorganized ● Researchers noticed that some children’s behaviors did not fit into organized categories ● No coherent pattern for handling distress ● Behaviors, reflecting a breakdown in strategy: 1. Odd or anomalous response (e.g., freezing) 2. Contradictory responses (e.g., crying while backing up) 3. Apprehension or fear of the parent Disorganized Attachment Why does a disorganized attachment develop in the context of maltreatment ● Parent is a source of fear rather than a source of comfort ● Creates an “unsolvable dilemma” (fright without solution); Mary Main & Judith Solomon Precursors of disorganized attachment ● Maltreatment ● Frightening/Frightened parental behavior ● 5 or more sociodemographic risk factors; poverty, parental mental illness, pooreducation, etc. Socioemotional Functioning Quality of attachment influences social and emotional outcomes ● Emotion regulation, peer relationships, competence at school, mental health/well-being Disorganized attachment is associated with: ● Higher rates of externalizing behaviors (e.g., aggression oppositional behavior) ● Dissociation Attachment and Physical Health Insecure attachment is associated with increased risk of physical health problems ● Obesity ● Self-reported illness Institutional Care and Attachment Institutional/orphanage care is an unusual context: ● Babies are biologically built expecting a parent; what happens when they don’t have one? “Disinhibited” Attachment Multiple terms: ● Disinhibited attachment ● Indiscriminate friendliness ● Indiscriminate sociability ● Disinhibited social engagement disorder (DSM) Children behave as if strangers are attachment figures Most common among children in institutional care Summary Children’s attachment quality depends on the type of parenting they receive When children experience maltreatment, they are at increased risk for disorganized attachment ● Disorganized attachment is associated with mental health problems Institutional care may lead to disinhibited attachment 3/6/2024 Effects of Maltreatment Socio-Emotional: Emotion Regulation and Peers Basic Emotions Paul Eckman (1972) suggested that there are six basic emotions that are universal throughout human cultures: 1. Fear 2. Disgust 3. Anger 4. Surprise 5. Happiness 6. Sadness Importance Of Emotions Emotions are evolutionary ● Fear can keep us safe! (Fight or flight response) ● Emotions may promote prosocial behaviors and can motivate us to help others, function as a cooperative society, etc. Normative Emotion Development Three major components involved: 1. Emotion Recognition 2. Emotion Expression 3. Emotion Regulation Emotion Recognition Emotion Recognition: ● The ability to accurately recognize and identify emotional expression in others Complex process Influenced by child experiences, expectations, & learning Females are generally more accurate at labeling facial expressions of emotion than males in childhood and adulthood Typically, children are first able to accurately identify happy faces, followed by sad and angry, then fear and surprise; neutral faces are challenging for young children to identify Typical children and adults attend to happy, fearful, and angry faces similarly (some biases to angry/fearful faces in adults, as an evolutionary process to alert us to possible danger in the environment) Emotion Expression Emotion Expression: ● The ability to accurately recognize and identify emotional expressions in others ● Ideally the expression on one’s face matches the emotion being experienced (opposed to smiling to cover anger; these mis-matched emotional expressions are common to pathology) Young children will often behave according to their current emotional status (as would be expected, sad children may cry, angry children may pout or tantrum, etc.) Kids aren’t always great at knowing how they feel or how to appropriately express themselves, they learn this process from caregivers who help regulate emotion expression Emotion Regulation The process of controlling (regulating) the expression, magnitude, or duration of an emotion response in order to accomplish specific goals or meet situation demands 1. 2. 3. 4. 5. Emotion Regulation Strategies Avoidance or Distraction: Avoiding situations that may make you feel uncomfortable/unhappy/scared, a form of attentional deployment Suppression: Suppressing or burying thoughts that are scary or remind you of painful things Worry & Rumination: Examples of attentional deployment where one focuses on the negative without productively solving problems Reappraisal/Reframing: Thinking of a situation in a new way (“Jane didn’t wave back at me the other day on campus. I guess she could be mad at me, but it’s also possible she just didn’t see me because she’s so busy these days”) Humor: An effective strategy that can upregulate positive emotions & downregulate negative ones; may also be used as a form of avoidance Effective emotion regulation: Children can flexibly use a range of socially appropriate response to deal with demands of a situation that elicit negative emotions Even in infancy, emotion regulation can be seen ● Attempts to self soothe Older children may use distraction or more advanced self-soothing behaviors such as singing to self when upset What Influences Development Of Emotion? Intrinsic sources of influence 1. Temperament 2. Biological factors (Stress reactivity) 3. Distress Intolerance Extrinsic sources of influence 1. Parent plays critical role as “co-regulator” in early childhood ● Example: Child falls and scrapes knee, parent rushes over to calm and soothe child Why Is Emotion Important? Emotion recognition, expression, and regulation support important developmental processes: ● Ability to identify/understand one’s own feelings ● Accurately read/interpret emotional states in others ● Manage own strong emotions and their expression in a constructive manner ● Regulate one's own behavior ● Develop empathy for others ● Establish and maintain relationships Maladaptive Emotion Development A disruption in normal functioning in these emotional processes can lead to a cascade of negative effects Often leads to long term deficits in emotion regulation & functioning Problems with emotions regulation characterize approx 75% of psychological disorders in the DSM ● Mood and anxiety disorders are diagnosed primarily on the basis of emotion dysregulation Adaptive emotion regulation may protect you from risk of developing coronary heart disease (mitigates toxic effects of stressful life experiences, such as maltreatment) Maltreatment and Emotion Recognition Physically abused children show sensitivity to anger cues: quicker to identify angry faces (selective attention to threat) Enhanced capacity to identify threatening cues in the environment may be adaptive depending on context Neglected children show difficulty recognizing emotions across the board; more difficulty discriminating emotional expressions than control or physically abused children Maltreatment and Emotion Expression Evidence of over-expression of negative emotions and under-expression of positive emotions Maltreatment and Emotion Regulation More difficulty calming after negative emotions are elicited: ● Faster to react ● More likely to get stuck ● Longer to calm down ● Physically abused children: Increase in brain electrical activity when looking for angry faces; rapid orienting to & delayed disengagement from anger cues Maladaptive Emotion Development These deficits in emotion recognition, expression, and regulation predict: 1. Difficulty with social interactions 2. Psychopathology ● Internalizing ● Externalizing Interim Summary Emotional development plays an important role in adaptive functioning across contexts Emotional development can be thought about in terms of: ● Emotion recognition ● Emotion expression ● Emotion regulation Maltreatment can lead to deficits in all of these emotion processes Peer Relations Overview Quality of social relationships are linked to functioning in other areas Mental & physical health is negatively impacted by not having close others Social support for parents: critical (must be able to connect with others, trust, seek help, etc, and is shaped by early experiences) Two Models 1. Attachment theory 2. Social network theory Attachment Theory Quality of parent-child relationships is directly predictive of peer relationships ● Secure attachments lead to more positive peer interactions ● Insecure attachment leads to: 1. Hostile, negative interactions - and greater likelihood of being rejected by peers 2. Passive, unskilled interactions - and greater likelihood of being ignored by peers Secure attachments ● Developed positive “internal working model” (how you think about yourself, others and your relationships) ● Likely think of self as worthy of attention and care ● Think of others as available to provide support when needed ● Think of relationships as positive and important Insecurely attached individuals: Less likely to develop these positive representations, may have trouble trusting others, or don’t see self as worthy of positive relationships Social Network Model Other factors beyond early attachment predict quality of peer relationships: 1. Availability of peer contact ● ● Does parent facilitate interactions with peers joining a playgroup? Daycare? If no, child’s peer problems may reflect skills deficits in lack of experience/opportunities to develop peer skills 2. General social fearfulness ● If child is generally fearful of interacting with others, may not approach peers as often, will lack experience ● Social isolation is a key factor for maltreating parents, so important to consider this theory! Maltreatment and Peer Relations What does the research tell us? Compared with non-maltreated children, maltreated children are more likely to have a number of problems related to peer functioning ● More aggressive ● More withdrawn ● Peer rejection/victimization ● Deficits in positive social interactions Mechanisms What goes wrong that leads to problematic peer relationships? Social cognitive skills deficits and emotion regulation difficulties ● Problems with perspective taking ● Problems with identifying alternative solutions to peer problems ● Difficulty understanding appropriate affective responses Hostile attribution biases ● Perceive ambiguous cues and interactions as hostile 3/18/2024 Effect Of Maltreatment: Psychopathology Psychopathology Definition Psychological disorders characterized by: ● Deviance ● Dysfunction ● Distress Often discussed in categorical terms ● Important to consider as dimensional Psychopathology As A Predictor Psychopathology as a predictor in maltreatment etiology ● Patient with psychopathology (e.g., Depression) ● Child with psychopathology (e.g., ADHD) Maternal Depression Child Maltreatment Child ODD We’ve discussed possible mechanisms Our Focus We will discuss primarily as an outcome But it’s important that you keep in mind that these are complex pathways linking causes, mediators, and outcomes associated with maltreatment ● And psychopathology plays a role at each point Maltreatment and Psychopathology Maltreated individuals are more likely to have a number of types of psychopathology:: ● Post-Traumatic Stress Disorder (PTSD) ● Internalizing: Depression and anxiety ● Externalizing: Antisocial Personality Disorder ● Substance Abuse PTSD Diagnostic Criteria Criterion A: Exposure to a trauma/stressor The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): ● Direct exposure ● Witnessing the trauma ● Learning that a relative/friend was exposed to a trauma ● Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics) Criterion B: Intrusion symptoms ● Unwanted upsetting memories ● Nightmares ● Flashbacks ● Emotional distress after exposure to traumatic reminders ● Physical reactivity after exposure to traumatic reminders Criterion C: Avoidance Avoidance of trauma-related stimuli after the trauma, in the following way(s): ● Trauma related thoughts or feelings ● Trauma related external reminders Criterion D: Negative alterations in cognitions and mood Negative thoughts or feelings that began or worsened after the trauma, in the following way(s): ● Inability to recall key features of the trauma ● Overly negative thoughts and associations about oneself or the world ● Exaggerated blame of self or others for causing the trauma ● Negative affect Criterion E: Alterations in arousal and reactivity ● Irritability or aggression ● Risky or destructive behavior ● Hypervigilance ● Heightened startle reaction ● Difficulty concentrating ● Difficulty sleeping Significant impairment to functioning Causes significant distress Causes impairment to social occupational functioning ● Missing school or work ● Can’t concentrate ● Poor performance ● Dysfunction in interpersonal relationships PTSD Risk What increases risk of PTSD following trauma? Characteristics of the trauma 1. Interpersonal (Always the case with maltreatment) 2. Unpredictable, Uncontrollable 3. Greater perceived life threat Lack of social support High degree of other life stresses ● ● ● Considerations Trauma does not always lead to PTSD Not everything bad is considered a trauma PTSD is not permanent, and is treatable Depression: Diagnosis Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks ● Mood represents a change from the person’s baseline ● Impaired function: social, occupational, educational Specific symptoms, at least 5 of these 9, present nearly every day: 1. Depressed most of the day, nearly every day 2. Decreased interest or pleasure in most activities 3. Significant weight change (5%) or change in appetite 4. Change in sleep: Insomnia or hypersomnia 5. Change in activity: Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Feelings of worthlessness or excessive or inappropriate guilt 8. Concentration: Diminished ability to think or concentrate 9. Suicidiality: Thoughts of death or suicide, or has suicidal behaviors Depression: Changes Across Development Early childhood: Irritability, Anger, Acting out or Somatic complaint ● May be hard to separate from externalizing behavior Increase in prevalence during adolescence ● Starts to see gender differences (higher in females) Comorbidity ● Often co-occurs with anxiety disorders Maltreatment and Depression Maltreatment increases risk for depression ● Brown et al. (1999) found almost a threefold increase for depression in adolescence ● In a prospective longitudinal design, Widom et al, (2007) found increased risk for adult depression for all types of maltreatment Maltreatment increases risk for suicide attempts ● Widom (1998) found that 19% of 20-year-olds who experienced maltreatment had at least 1 suicide attempt, compared with 8% of matched controls ● For sexual abuse, also increased risk of self-harm behavior Why Are They Linked? Alterations in brain structure and function ● Prefrontal cortex and amygdala HPA axis dysregulation ● In adults with depression, often show dysregulated HPA axis activity, poor emotion regulation Attachment insecurity Lack of social relationships Conduct Problems Early childhood: Oppositional Defiant Disorder ● Argumentative with adults ● Acting out, not following rules Middle childhood and adolescence: Conduct Disorder ● Breaking rules, e.g., skipping school ● Getting in fights ● Engaging in dangerous or destructive activity (e.g., setting fires) ● Engaging in illegal activity (e.g., drug use, stealing) Adulthood: Antisocial Personality Disorders ● Persistent pattern of aggressive and antisocial behavior after age 18 (with markers occurring before that) ● ● ● ● ● Possible Mechanisms Linking Maltreatment To Externalizing Problems Alterations in brain structure and function Poor emotion regulation Attachment insecurity Lack of social relationships “Callous-unemotional” traits Summary Maltreatment and other forms of early adversity can increase risk for many types of psychological disorders ● PTSD ● Internalizing (e.g., depression) ● Externalizing (e.g., ODD) There are many possible mechanisms that account for increased risk Not all children develop psychopathology (resilience!) 3/20/2024 Effects Of Maltreatment: Consequences For Society Overview 1. Income disparity as another societal issue 2. Consequences of maltreatment on society 3. Using monetary outcomes to guide change Income Inequality Many of the outcomes affected by maltreatment are also affected by other societal problems Income inequality affects: 1. Educational and job opportunities 2. Mental well-being 3. Physical health Consequences For Society Why should we examine how child maltreatment affects society at large? How can we quantify the effects of child maltreatment on society? Quantifying The Effects Prevalence: In 2012: ● 3.4 million referrals (for 6.3 children) ● 62% of these investigated ● Of those investigated, about 20% substantiated ● 686,000 substantiated cases (just in 2012) Considerations about these estimates Effects on individuals ● Behavior and mental health outcomes ● Delinquency, school drop-out, criminality ● Chronic diseases and physical health ● Academic, occupational, economic success All of these have costs! Economic Impact: Crime Children who are maltreated are more than twice as likely to engage in a number of crimes ● The estimate is higher for more severe abuse Economic Impact: School Child maltreatment strongly affects school performance ● Lower GPA ● Lower rates of homework completion ● Higher dropout rates ● Neurocognitive Deficits Economic Impact: Health Maltreated children have significantly more short-term and long-term health problems Short-term ● Physical injury from physical abuse ● Slow rate of growth resulting from neglect Long-term ● Chronic health conditions (obesity, diabetes, hypertension, cardiovascular disease, asthma) ● Substance abuse and psychiatric problems Economic Burden Study (Fang et al., 2012) How would you know how much $$ being maltreated adds to average expenses? ● Compare average costs between groups ● Maltreated versus non-maltreated ● Estimated cost for an outcome times incremental effect of maltreatment on outcome Direct costs: 1. Short-term health care costs 2. Child welfare costs 3. Criminal justice costs Indirect costs: 1. Long-term medical costs 2. Productivity losses 3. Special education costs 4. Criminal justice (later outcomes) Based on 2008 estimate of 579,000 new cases, aggregate lifetime costs would be $121.6 BILLION!!! ● ($124 billion if include fatal cases) If you use rates of all cases that are investigated (rather than just substantiated), estimate increases to $585 billion Summary Maltreatment poses a high financial burden on a societal level ● Due to child welfare, education, and criminal justice costs ● Mental and physical health care costs ● Loss of productivity These data can be used to inform approaches for prevention and intervention 3/25/2024 Effects Of Maltreatment: Resilience Developmental Psychopathology Study of both maladaptive and adaptive developmental trajectories Multifinality: Individuals with same experience may have different outcomes ● Influenced by biological and psychological processes, subsequent/past experiences, social context, timing of experiences, etc. What Is “Resilience”? “The capacity of a dynamic system to withstand or recover from significant challenges that threaten its stability, viability, or development” (Dr. Ann Masten) Positive adaptation despite experiencing adversity that typically disrupts development ● Positive outcomes from high-risks context ● Recovery from trauma ● Overcoming adversity to succeed in life ● Unexpected positive development Important Considerations Why study resilience? ● Better understand developmental theory ● Informing design and implementation of intervention programs Resilience is not fixed or stable ● Can move from not resilient, and from resilient to not resilient By definition, resilience requires some adverse experience Competence A d v e r s it L o H i g h Highly Vulnerable Competent, Doing Well Maladaptive Resilient Measurement How do we measure resilience? ● What is the criteria for “doing okay” in life? Competence with regard to developmentally salient tasks: a pattern of effective functioning as demonstrated by successfully engaging and achieving developmental tasks for people of a given age, culture, and time in history Measurement: In Childhood Examples of competence with regard to developmentally salient tasks: ● Infant: Formation of secure attachment ● Toddler: Development of effective problem-solving ● ● Preschool: Initiation of positive peer relationships School-age: Average academic performance Measurement: In Adulthood Composite index across multiple domains Example list for adulthood (McGloin & Wisdom, 2001): ● Employment ● No homelessness ● High school graduation ● Social activity ● No psychiatric disorder ● No substance abuse ● No arrest ● No self-reported violence Resilient functioning = 6 out of 8 Self-report of personal characteristics that increase resilience in the face of adversity Connor-Davidson Resilience Scale ● Low resilience scores associated with sleep quality and mental health (Notario Pacheco et al. 2011) 10-Item Connor-Davidson Scale Individual-Level Predictors ● ● ● ● ● ● Intelligence Self-control (executive functioning) Self-esteem, confidence, self-efficacy Hope, positive thinking Motivation Genetic protective factors Family-Level Predictors Parent-Child Relationships ● Responsive parenting Other close relationships ● Quality of peer relationships ○ At least one reciprocal peer relationship ● Romantic partner Community-Level Predictors ● Peer relationships ● Teacher relationships ● Effective schools ● Safe communities, resource availability Multiple Pathways To Resilience A: Post-Traumatic Growth B: Stress Resistance C: Recovery following maladaptive functioning Miller et al. (2011) Children raised in low-SES families go on to have high rates of chronic illness as adults But, a sizeable minority of low-SES children remain healthy across the life-span Research question: What factors account for such resilience? ● Upward socioeconomic mobility? ● Parental nurturance? Participants: 1205 middle-aged Americans Main predictor: Childhood SES (parental educational attainment) Main outcome measure: Metabolic syndrome ● Central adiposity ● And at least 2 out of the 4 additional health issues: 1. High blood pressure 2. Raised triglyceride levels 3. Raised fasting-glucose levels 4. Low high-density lipoprotein levels Moderators: Parental nurturance ● “How much did he/she understand your problems and worries?” ● “How much time and attention did he/she give you when you needed it?” Socioeconomic mobility ● Moving from low to high SES Question 1: Does childhood SES predict adult metabolic syndrome? YES. Question 2: Are there individuals from low-SES backgrounds that are resilient to metabolic syndrome? YES. Question 3: Do upward (a) social mobility and (b) parental nurturance moderate this pathway? ● That is, are there resilience factors that prevent individuals from low-SES backgrounds from developing metabolic syndrome? Question 3a: Does upward social mobility protect against metabolic syndrome for low childhood SES? NO. Question 3b: Does parental nurturance protect against metabolic syndrome for low childhood SES? YES. Parental nurturance serves as a buffer from health consequences for individuals from low-SES backgrounds This is a clear example of resilience… ● Low SES = Health issues ● Some low-SES individuals don’t have health issues ● Parental nurturance is a factor that predicts individuals’ resilience What are some implications of this? ● ● ● ● ● ● Building Resilience Facilitating supportive adult-child relationships Building a sense of self-efficacy and perceived control Providing opportunities to strengthen adaptive skills and self-regulatory capacities Summary Resilience refers to positive adaptation despite experiencing adversity that typically disrupts development There are multiple pathways towards resilience Factors that promote resilience can occur at the individual, family, and community level.
