1. SLIDE #1) Before getting started, I’d just like to thank
my collaborators on this project, Ann Spilker and Joe
Allen, for all of their help in preparation of the talk this
morning, and to direct you to our lab’s website if you are
interested in additional information about our research.
2. SLIDE #2) So as mentioned, today I’m focusing broadly
on the relationships between emotionally stressful family
environments and internalizing symptoms in a sample of
late adolescents, followed longitudinally for 3 years
3. SLIDE #3) If you are sitting in this room, then you are
probably well aware of both the various types and
definitions of abuse. Among them are physical abuse,
physical neglect, emotional abuse, and emotional neglect.
a. Childhood abuse has far reaching implications on
development and adjustment in childhood,
adolescence and beyond, ranging from depression
(Toth et al. 1992), physical and relational aggression
(Teisl and Cicchetti 2008), delinquency (Salzinger et
al. 2007), and general internalizing and externalizing
problems in general (Manly et al. 2001).
b. One theory suggests that children who are
maltreated are unable to develop the ability to
negotiate important developmental challenges, and
that maltreatment interferes with their capacities to
establish and resolve developmental milestones
throughout childhood and adolescence (Cicchetti &
Lynch, 1995)
4. SLIDE #4) We are going to be focusing specifically on the
emotional and psychological forms of abuse, as research
has encouraged the investigation of the unique effects of
these different forms of abuse,
a. and partly because some research has found that the
emotional types can actually be more potent
predictors of internalizing symptoms than physical
types.
b. Also Kaplan and colleagues, in their recent review of
abuse and neglect research, commented that
emotional maltreatment is oftentimes underreported
because of the subtlety in which it can occur and
because of the emphasis of social agencies on the
physical safety of children. Therefore, the impact of
emotional abuse on later internalizing symptoms
may not be as well understood.
5. SLIDE #5) Previous literature suggests that children
with a history of emotional maltreatment are at an
increased risk for range of internalizing symptoms
including depression, low self-esteem, and anxiety.
a. One potential problem with some previous research,
however, is that they oftentimes ask participants to
retrospectively report on childhood abuse or
maltreatment, which can be problematic
presumably with more time passing and memories
becoming biased.
b. Additionally, many maltreatment studies investigate
abuse and neglect experienced during childhood, but
fail to concentrate on other important time periods
in the lifespan such as late adolescence.
6. SLIDE #6) Therefore, using a two year longitudinal
design, is to flesh out a bit more about relationships
between emotional stress and internalizing symptoms in a
period in mid to late adolescence from age 16 to age 18
that has not been adequately studied but can be
particularly important for understanding adolescents’
adjustment trajectories. For instance, at least one study
has shown that the average age of onset of a first
depressive episode is somewhere around age 15, so better
understanding what might contribute to that is vital. We
will focus on emotional abuse, and neglect, as well as
psychological control in predicting changes in depressive
symptoms, anxious symptoms, and self-worth.
7. SLIDE #7) We’ll be examining these questions in a
sample of 173 adolescents, drawn from the public school
system of Charlottesville, Virginia, who were interviewed
and observed in interactions with their parents and best
friends. This larger longitudinal study began assessing
teens when they were 13 years old
a. But we’ll be reporting results of annual assessments
beginning at age 16 up through age 18
b. The sample was evenly divided between males and
females
c. And is a normative community sample, so it was
representative of the population of the surrounding
area in terms of socioeconomics and race.
d. The study overall has maintained very low attrition
over the course of the now 12 years that it has been
running, and generally has over 90% participation
at any given time point.
8. SLIDE #8) We begin by examining the predictive
contribution of emotional neglect on internalizing
symptoms at 18.
a. To do this, we measured emotional neglect using
teens’ reports at age 16 on the emotional neglect
scale from the Childhood Trauma Questionnaire,
which asks adolescents to answer questions about
what it was like growing up in their family in the
past year.
b. Sample items are given on the slide here and include
statements like “People in my family felt close to one
another, I felt loved.” Note that positively worded
items were reverse coded so that higher scores equal
higher levels of reported emotional neglect.
9. SLIDE #9) The first internalizing symptom we focused on
was general anxiety, measured using self reports on the
State-Trait Anxiety Inventory. Sample items on this scale
include “I worry too much over something that doesn’t
really matter” and “I feel difficulties are piling up so that
I cannot overcome them.” We assessed general anxiety at
both 16 and 18.
10.
SLIDE #10) So what did we find? Note that in all
analyses, gender and income were controlled for, and
were not significant unless otherwise noted. Also, Full
Information Maximum Likelihood analyses were used for
each model presented today. So you can see here from
regression analyses that emotional neglect moderately
predicts relative increases in general anxiety from age 16
to age 18.
11.
SLIDE #11) Next we examined the relationship
between emotional neglect and social anxiety. Social
anxiety was assessed using teens’ reports on the Social
Anxiety Scale for Adolescents.
a. We measured social anxiety at age 18 but did not
have a measure for social anxiety at age 16, so we
used general anxiety levels as a baseline for how
these teens were functioning at age 16. Sample items
include “I get nervous when I meet new people” and
“I only talk to people I know really well.”
12.
SLIDE #12) Regression analyses revealed that
emotional neglect also moderately predicts higher levels
of social anxiety. Note that because we did not have a
social anxiety assessment at age 16, this is not a perfect
change model, but we still see increases in social anxiety
from emotional neglect at 16, even after controlling for
general levels of baseline anxiety.
13.
SLIDE #13) We then turned to self worth, which
was measured using self reports on the Harter Self
Perception Profile for Adolescents. This was assessed at
both 16 and 18. The format for this measure asks the
teen’s closest friend to choose between two contrasting
descriptors and then rate the extent to which their choice
is sort of true or really true about the target teen. Item
responses are scored on a 4-point scale and then summed,
with higher scores indicating higher levels of self worth.
14.
SLIDE #14) We see the same pattern yet again, such
that emotional neglect predicts relative changes in self
worth at age 18, such that higher levels of reported
neglect at 16 predicts relative decreases in self worth at
age 18 and explains about a third of the variance in self
worth.
15.
SLIDE #15) Also, just to point out, the three
outcomes are only moderately correlated, so what we’re
seeing is three relatively different internalizing outcomes
of emotional neglect.
16.
SLIDE #16) Last but not least we tested the
association between neglect and depression. Depressive
symptoms at age 16 was measured using the well-known
Childhood Depression Inventory and then we switched to
using the Beck Depression Inventory at 18, which is a
more appropriate measure this age group.
a. Both of these measures use a continuum vs. a
threshold approach, recognizing that higher levels of
depressive symptoms that do not necessarily meet
diagnostic threshold may still be important in
predicting future dysfunction (Lewinsohn, Solomon,
Seeley, & Zeiss, 2000).
17.
SLIDE #17) Surprisingly, we did not see the same
pattern here and found that emotional neglect did not
predict depressive symptoms at age 18.
18.
SLIDE #18) In summary then we find that:
a. Emotional neglect longitudinally predicts increases
in general anxiety and social anxiety, and decreases
in self worth, but does not predict changes in
depressive symptoms
19.
SLIDE #19) Turning now to what does predict
depressive symptoms in late adolescence, we drew upon
diathesis stress models of depression to inform our next
set of analyses and considered whether perhaps there
were individual differences in what predicts depressive
symptoms. We focused on investigating more direct forms
of maltreatment as the stressors and also looked in
rejection sensitivity as an individual diathesis that could
help explain why some individuals who experience direct
emotional stress within the family go on to develop
depressive symptoms and some do not.
a. Rejection sensitivity has been defined as the
disposition to anxiously expect, readily perceive, and
intensely react to rejection by significant others, and
has been linked to depression in the literature,
though not always consistently
b. We, therefore, anticipated that direct forms of
mistreatment combined with an individual diathesis
to be particularly sensitive to interpersonal rejection
would predict increases in depressive symptoms.
20.
SLIDE #20) One emotionally harsh family
environment that is quite direct is emotional abuse, which
was assessed again with teens’ reports on the Childhood
Trauma Questionnaire at age 16. You’ll notice from the
sample item the difference in the sort of bluntness of this
type of mistreatment in the family, and likely would not
be interpreted by these teens as anything but unloving,
harsh, and cruel.
21.
SLIDE #21) We also assessed rejection sensitivity
through teens self reports at age 16 using a revised
version of the Rejection Sensitivity Questionnaire, which
was originally designed for college students so some of the
wording was changed to be used with the adolescents in
our study. This measure consists of 18 hypothetical
scenarios, and asks teens to determine how anxious they
would be about how the other person in the scenario
would respond and how likely they think the other person
is going to respond in a specific way. (higher scores=
higher sensitivity)
22.
SLIDE #22) What did we find? Well first, let me
orient you to the graph that you see here. So we have
depression level at age 18 on the Y-axis, with points below
0 indicating lower levels of depressive symptoms and
points above zero indicating higher levels. And then we
have high and low levels of reported emotional abuse on
the X axis.
e. So you can see visually that for teens who are not
very sensitive to rejection, their levels of experienced
emotional abuse in the family doesn’t much matter
in terms of their level of depression 2 years later.
f. Note that the significant interaction was found after
controlling for gender, income, and baseline levels of
depressive symptoms at age 16.
SLIDE #23) However, highly rejection sensitive teens seem
particularly vulnerable to emotional abuse, such that abuse
predicts increases in depressive symptoms at age 18 ONLY for
teens who are highly rejection sensitive.
a. We further tested the slope of the red line using
Aikin & West’s simple slope analysis guidelines and
found that this increase in depressive symptoms is
significant. The slope of the blue line, however, was
not significant.
23.
SLIDE #24) We then looked at one last emotionally
stressful family environment combined with rejection
sensitivity, and that was paternal psychological control.
A subset of fathers’ reported on their own level of
psychological control vs. autonomy granting towards
their teens on the Childhood Report of Parenting
Behavior when teens were 16. Again, note the directness
of psychological control in items such as I am always
telling my son/daughter how he/she should behave.
24.
SLIDE #25) We find another significant interaction
between paternal psychological control and rejection
sensitivity in predicting increases in depressive symptoms
after accounting for gender, income, and depressive
symptoms at 16.
a. Again, we see that paternal psychological control
does not much matter in predicting depressive
symptoms for teens who are low in rejection
sensitivity.
25.
SLIDE #26) However, teens who are highly
rejection sensitive are much more vulnerable to the
fathers’ controlling nature, such that psychological
control predicts increases in depressive symptoms at age
18 only for teens who particularly sensitive to rejection.
a. Simple slope analysis also revealed that the slope of
the highly rejection sensitive group was significant,
while the slope of low rejection sensitive group was
not.
26.
SLIDE #27) Before getting to our overall
conclusions, I’d like to point out a few limitations of this
study
a. First, the majority of our measures presented today
were self report aside from the father reports of
control, so it could very well be that adolescents who
report high levels of mistreatment from their
families also tend to report high levels of
internalizing symptoms and vice versa
b. Additionally, these data are non-experimental and
we are not assuming any causal relationships
c. We are only examining three types of stress and
abuse, and as we acknowledged in the beginning of
this talk today, there are several other forms of
maltreatment that could be investigated, and would
likely have important implications for internalizing
symptoms
d. Finally, we are only looking at a very short time
frame in adolescence, and although this study sheds
light on how these things play out into late
adolescence, it will be important for future work to
consider what happens in terms of the development
of internalizing symptoms into young adulthood and
beyond
27.
SLIDE #28) One overarching theme of these
findings is that psychological forms of abuse seem to
interfere with a key developmental task in adolescence,
which is the establishment of individuals’ autonomy.
These teens likely internalize the messages they are
receiving from caretakers that they are unlovable,
worthless and inadequate, and potentially fail to develop
a sense of agency, leading them to shut down in social
situations, feel badly about themselves, and become sad
and down.
a. Additionally, consistent with cognitive diathesis
stress models of depression, the last set of findings
suggest that in mid to late adolescence, perhaps
emotional abuse and psychological control are not
enough on their own but that combined with a
heightened sensitivity to interpersonal rejection
contribute to increased depressive symptoms.
b. It may be that rejection sensitive adolescents
interpret their families’ criticism and over-bearing
behaviors even more personally, subsequently
assume they are flawed or unworthy, and/or
anticipate a catastrophic outcome of their this
negativity (e.g., Abramson, Metalsky, & Alloy, 1989;
Beck, 1987). In this case, depressive symptoms may
develop because these adolescents are left feeling
particularly overwhelmed, demoralized and/or
hopeless in this type of controlling and stressful
family environment.
c. Our findings also suggest that perhaps neglect and
abuse are related to internalizing symptoms in
slightly different ways.
i. An extension of the hopelessness theory by
Rose and Abramson theorizes that emotional
abuse is more likely to lead to a depressogenic,
negative cognitive styles than other forms of
abuse because the extremely negative
cognitions such as “you are unlovable and
inadequate” are directly supplied to the person
being abused or controlled, whereas in a less
direct form of maltreatment like neglect, the
adolescent has more opportunity to make
benevolent or maybe even neutral attributions
about themselves.
ii. Perhaps then neglect serves to reinforce a lack
of confidence or ability in oneself or with
others in social situations, whereas abuse
combined with an already existing
vulnerability to rejection contributes to more
severe depressogenic states.
iii. Of course, future research will be needed to
parse apart the differential predictions of
abuse and neglect in late adolescence. Future
research should also continue to look into
individual differences and mechanisms in the
experience of extreme stress in the family, as
some may not go on to experience
psychopathology, and understanding why that
is will be important to further uncover.
28.
SLIDE #29) Thank you, and thanks to all of my
collaborators as well as the National Institute of Child
Health and Human Development for funding awarded to
Joe Allen.