A Test of Adolescent Internalizing and Externalizing Symptoms as Prospective Predictors of Type of Trauma Exposure and Posttraumatic Stress Disorder

The present study utilized longitudinal data from a high‐risk community sample (N = 377; 166 trauma‐exposed; 202 males; 175 females; 73% non‐Hispanic Caucasian) to test pretrauma measures of adolescent internalizing and externalizing symptoms as unique prospective predictors of type of trauma exposure and PTSD over and above the influence of correlated family adversity (a composite of family conflict, stress, and parental psychopathology). Data were analyzed with logistic and multinomial logistic regressions. Results indicated that females, but not males, with higher levels of internalizing (OR = 2.91) and externalizing (OR = 2.37) symptoms during adolescence were significantly more likely to be exposed to assaultive violence (over and above family adversity). In fact, males with higher levels of internalizing symptoms were significantly less likely to be exposed to assaultive violence (OR = 0.54). Neither internalizing nor externalizing symptoms uniquely predicted exposure to traumatic events that did not involve assaultive violence. Among trauma‐exposed participants, the unique association between internalizing symptoms and later PTSD yielded an odds ratio of 1.79 (p = .07) over and above the influences of family adversity, type of trauma exposure, and gender. Assaultive violence exposure fully mediated the association between females’ externalizing symptoms and future PTSD. Findings may help inform the prevention of both assaultive violence exposure and PTSD.     

Symptoms of Dissociation in a High‐Risk Sample of Young Children Exposed to Interpersonal Trauma: Prevalence,Correlates, and Contributors

Children who have experienced interpersonal trauma are at an increased risk of developing dissociation; however, little is known about the prevalence or correlates of dissociation in young children. The current study examined symptoms of dissociation in 140 children (mean age = 51.17 months, range = 36–72 months, SD = 10.31 months; 50.0% male; 45.7% Hispanic) who experienced trauma (e.g., witnessing domestic violence, experiencing abuse). Child dissociation and exposure to traumatic events were assessed using a clinician‐administered interview with the biological mother (mean age = 32.02 years, SD = 6.13; 49.3% Hispanic; 25.5% married or cohabitating). Mothers completed measures of maternal dissociation, depression/anxiety, and child behavior problems. At least subclinical dissociation was present for 24.3% of children. Robust regression with least trimmed squares estimation showed that greater maternal dissociation was related to greater child dissociation, adjusting for child internalizing symptoms, number of traumas, and maternal depression/anxiety, B = 0.09, χ² = 10.47, p < .001, R²Δ = .04. Children who experienced direct victimization did not exhibit a significantly higher level of dissociation compared to children who experienced other traumas, F(1, 138) = 3.76, p = .054, η² = .03. These findings highlight the need to assess dissociation in traumatized young children.     

Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth

Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2–17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10–17 years completed a self‐report survey on a wide range of gun violence exposures, and parents of younger children (aged 2–9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs = .10–.38, p < .001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10–17 years) polyvictimization was most strongly associated with posttraumatic symptoms, β = .35, p < .001, although witnessing gun violence still uniquely predicted a higher level of symptoms, β = .18, p < .01. For younger children (ages 2–9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, β = .15, p < .01 for both, even after controlling for polyvictimization. Mental health professionals and trauma‐informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.     

The Cycle of Violence: Associations Between Exposure to Violence,Trauma‐Related Symptoms and Aggression—Findings from Congolese Refugees in Uganda

War‐related trauma exposure has been linked to aggression and enhanced levels of community and family violence, suggesting a cycle of violence. Reactive aggression—an aggressive reaction to a perceived threat—has been associated with posttraumatic stress disorder (PTSD). In contrast, appetitive aggression—a hedonic, intrinsically motivated form of aggression—seems to be negatively related to PTSD in offender and military populations. This study examined the associations between exposure to violence, trauma‐related symptoms and aggression in a civilian population. In semistructured interviews, 290 Congolese refugees were questioned about trauma exposure, PTSD symptoms, and aggression. War‐related trauma exposure correlated positively with exposure to family and community violence in the past month (r = .31, p < .001), and appetitive (r = .18, p = .002) and reactive aggression (r = .29, p < .001). The relationship between war‐related trauma exposure and reactive aggressive behavior was mediated by PTSD symptoms and appetitive aggression. In a multiple sequential regression analysis, trauma exposure (β = .43, p < .001) and reactive aggression (β = .36, p < .001) were positively associated with PTSD symptoms, whereas appetitive aggression was negatively associated (β = ?.13, p = .007) with PTSD symptoms. Our findings were congruent with the cycle of violence hypothesis and indicate a differential relation between distinct subtypes of aggression and PTSD.     

Disgusted by Sexual Abuse: Exploring the Association Between Disgust Sensitivity and Posttraumatic Stress Symptoms Among Mothers of Sexually Abused Children

Nonoffending mothers of sexually abused children often exhibit high levels of posttraumatic stress (PTS) symptoms. Emerging evidence suggests that trait‐like individual differences in sensitivity to disgust play a role in the development of PTS symptoms. One such individual difference, disgust sensitivity, has not been examined as far as we are aware among victims of secondary traumatic stress. The current study examined associations between disgust sensitivity and PTS symptoms among mothers of sexually abused children (N = 72). Mothers completed the Impact of Event Scale‐Revised and the Three Domain Disgust Scale (Tybur, Lieberman, & Griskevicius, 2009). More than one third of mothers scored above a suggested cutoff (mean score = 1.5) for high levels of PTS symptoms. Hierarchical linear regression analysis results indicated that sexual disgust sensitivity (β = .39, p = .002) was associated with PTS symptoms (R² = .18). An interaction analysis showed that sexual disgust sensitivity was associated with maternal PTS symptoms only when the perpetrator was not biologically related to the child (β = ?.32, p = .047; R² = .28). Our findings suggested that sexual disgust sensitivity may be a risk factor for developing PTS symptoms among mothers of sexually abused children.     

Secondary Traumatization in Vietnam Veterans’ Families

This research focused on secondary traumatization of wives and offspring of 115 male Vietnam veterans, a subsample from the National Vietnam Veterans Readjustment Study who had one or more children aged 6 to 16 years and had had a clinical interview. Traumatization was defined as meeting criteria for lifetime war‐related posttraumatic stress disorder (PTSD). Secondary traumatization was operationalized by elevated scores on children's internalizing or externalizing behavior problems and on wives’ demoralization. There was evidence of secondary traumatization in the veterans’ sons (odds ratio [OR] = 20.31 for internalizing behavior problems). Current PTSD in the veterans was associated with demoralization in their wives or partners (β = 0.24), which in turn was associated with behavior problems in their daughters (ORs = 2.67 and 4.61 for internalizing and externalizing behavior problems, respectively; these were adjusted for veteran's PTSD). Demoralization of the wife or partner was also associated with current alcoholism in the veterans (β = 0.30, adjusting for veteran's PTSD). These associations were also adjusted for other veteran risk factors, including severity of combat exposure, involvement in harming civilians or prisoners, and prewar vulnerability. Even with the degree of secondary traumatization present, the veterans’ children appeared at least as healthy as counterparts in the general population.     

Parent Discrepancies in Ratings of Child Behaviors Following Wartime Deployment

Researchers have shown that parents often disagree in their ratings of their children's behavior, and that these discrepancies are typically related to child and family characteristics (e.g., child's age, parent psychopathology). Few studies, however, have examined discrepancies in how mothers and fathers rate child behavior during a stressful family context such as a parent's wartime deployment. The present study of 174 military families (children aged 6 to 11 years; 54.0% female) examined whether family factors (parental sense of control, marital satisfaction) and contextual risk factors related to a parent's wartime deployment (number and length of deployments, battle experiences, and posttraumatic stress disorder [PTSD] symptoms) were associated with discrepancies in how mothers and fathers rated internalizing and externalizing behaviors in their children. Using a latent congruency model, our results showed that when parents self‐reported higher levels of PTSD symptoms, both mothers, β = ?.33, p = .021, and fathers, β = .41, p = .026, tended to also report higher levels of internalizing symptoms in their child, relative to what their spouse reported. In comparison to mothers, fathers also tended to report higher levels of child externalizing symptoms, β = .44, p = .019. Our findings may help clinicians understand how parent mental health within a stressful family context relates and/or informs a parent's ratings on assessments of his or her child's internalizing and externalizing symptoms.     

A Meta‐Analysis of the Impact of Natural Disasters on Internalizing and Externalizing Problems in Youth

Although exposure to natural disasters can lead to diverse mental health (MH) outcomes in youth, most child disaster MH research has focused on posttraumatic stress symptoms (PTSS). To highlight the likelihood of other MH outcomes, we meta‐analyzed studies that have examined other (non‐PTSS) internalizing and externalizing behavior problems in youth exposed to natural disasters. We used PRISMA guidelines to systematically gather studies that have examined the association between natural disaster exposure and non‐PTSS internalizing and/or externalizing problems in samples of children and adolescents. Analyses of random effects models of 62 studies examining non‐PTSS internalizing problems and 26 studies examining externalizing problems showed exposure to natural disasters was significantly associated with non‐PTSS internalizing, r_mean = .18, k = 70, and externalizing problems, r_mean = .08; k = 31, in youth. Moderator analyses revealed a stronger association between disaster exposure and non‐PTSS internalizing problems in countries with a “medium” Human Development Index (HDI) ranking, r = .56, than in countries with “high,” r = .15, and “very high,” r = .16, HDI rankings. We also found a stronger association between disaster exposure and externalizing problems in countries with a medium HDI ranking, r = .54, versus high, r = .05, and very high, r = .04, HDI rankings, and based on parent, r = .16, compared to child, r = ?.01, report. Results support the need for assessment of multiple postdisaster MH outcomes to inform comprehensive interventions. We also include a discussion of the state of the disaster MH research.     

Coping Strategies and Psychological Symptoms Among Children on St. Thomas in the Aftermath of Hurricanes Irma and Maria

Research has shown that experiencing a hurricane can lead to internalizing, externalizing, and posttraumatic stress (PTS) symptoms in children. However, the effects of experiencing two hurricanes within a short time frame have not been examined. Moreover, there is limited research examining how children's coping is linked to their psychological functioning and no research using the empirically supported conceptualization of coping that includes primary control coping (i.e., attempts to control the stressor) and secondary control coping (i.e., attempts to adapt to the stressor). This study examined the psychological functioning of 108 children and adolescents (69.7% Black, Non-Hispanic; 56.5% female; M age = 11.59 years, SD = 2.43) in Grades 3–12 as measured 3 months after experiencing Hurricanes Irma and Maria on the island of St. Thomas. Participants completed electronic questionnaires about their demographic characteristics, hurricane exposure (i.e., perceived life-threat, life-threatening events, loss/disruption after hurricanes), coping strategies utilized, and their psychological functioning (i.e., PTS, internalizing, and externalizing symptoms). A principal component analysis of the coping items determined four coping factors: primary control, secondary control, disengagement, and negative coping. Linear regressions, including children's age and aspects of hurricane exposure, found primary control coping was positively associated with PTS symptoms, β = .18, whereas secondary control coping was negatively associated with PTS and externalizing symptoms, βs = −.17 and −.19, respectively. Negative coping, but not disengagement coping, was positively associated with all three outcomes, βs = .31–.42. These findings suggest positive ways children can cope after experiencing a hurricane, informing possible early intervention efforts.     

The Role of Depressive Symptoms in Substance Use Among African American Boys Exposed to Community Violence

Adolescents exposed to community violence (CV) are at increased risk for alcohol, marijuana, and tobacco use. The disproportionate exposure to CV among African American boys heightens their susceptibility to substance use and related problems. Depressive symptoms are linked to both CV exposure and adolescent substance use; however, their role in the link between CV exposure and substance use in African American male adolescents has received little attention. The current study examined whether depressive symptoms mediate or moderate the associations between CV exposure and substance use among African American male adolescents. Participants were 225 African American adolescent boys in Baltimore, Maryland who completed measures of CV exposure and depressive symptoms in 10th grade and measures of substance use in 10th and 11th grades. Hierarchal linear regression analyses indicated that depressive symptoms moderated associations between violent victimization and alcohol and tobacco use, R² = .21–.30, ps < .001. There was a positive association between CV victimization and alcohol and tobacco use among those who reported high levels of depressive symptoms but not low levels. Depressive symptoms also moderated the link between witnessing CV and alcohol use such that witnessing CV was negatively related to alcohol use among those who reported high levels of depressive symptoms only. The findings suggest that depressive symptoms may play an important role in differentiating alcohol and tobacco use outcomes in CV-exposed African American boys. Prevention efforts should assess for depressive symptoms to identify adolescent boys with the highest risk of substance use.     

Psychometric Properties of the Child PTSD Symptom Scale in Latino Children

The Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001 ) is a self‐report measure of posttraumatic stress disorder symptoms (PTSD) in children and adolescents. Despite widespread use of this measure, no study to our knowledge has examined its psychometric properties in Latino children. This study examined the factor structure, internal consistency, and convergent validity of the measure utilizing a sample of 161 Latino students (M = 11.42 years, SD = 0.70) at high risk of exposure to community violence. Confirmatory factor analyses suggested that a 3‐factor model consistent with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000 ) provided the best fit to the data. Internal consistency of the total scale and subscales was high when completed in English or Spanish. All Child PTSD Symptom Scale scores were positively correlated with violence exposure. As additional evidence of convergent validity, scores evidenced stronger correlations with internalizing symptoms than with externalizing symptoms. Results supported the use of the Child PTSD Symptom Scale as a measure of PTSD severity in Latino children, but additional research is needed to determine appropriate clinical cutoffs for Latino youths exposed to chronic levels of violence. Implications for clinical practice and future research are discussed.     

The Effects of Multiple Interpersonal Traumas on Psychological Maladjustment of Sexually Abused Children in Korea

The purpose of the present study was to explore the effects of multiple interpersonal traumas on psychiatric diagnosis and behavior problems of sexually abused children in Korea. With 495 children (ages 4–13 years) referred to a public counseling center for sexual abuse in Korea, we found significant differences in the rate of psychiatric diagnoses (r = .23) and severity of behavioral problems (internalizing d = 0.49, externalizing d = 0.40, total d = 0.52) between children who were victims of sexual abuse only (n = 362) and youth who were victims of interpersonal trauma experiences in addition to sexual abuse (n = 133). The effects of multiple interpersonal trauma experiences on single versus multiple diagnoses remained significant in the logistic regression analysis where demographic variables, family environmental factors, sexual abuse characteristics, and postincident factors were considered together, odds ratio (OR) = 0.44, 95% confidence interval (CI) = [0.25, 0.77], p < .01. Similarly, multiple regression analyses revealed a significant effect of multiple interpersonal trauma experiences on severity of behavioral problems above and beyond all aforementioned variables (internalizing β =.12, p = .019, externalizing β = .11, p = .036, total β = .14, p =.008). The results suggested that children with multiple interpersonal traumas are clearly at a greater risk for negative consequences following sexual abuse.     

The impact of intimate partner violence and additional traumatic events on trauma symptoms and PTSD in preschool-aged children

Children exposed to intimate partner violence (IPV) are at increased risk for developing traumatic stress symptoms and posttraumatic stress disorder (PTSD). Unfortunately, children who witness IPV are often exposed to additional traumatic events. Previous research has indicated that approximately one third of children experience 2 or more direct victimizations each year, and that exposure to one type of victimization places children at risk for exposure to additional types of victimization. Yet little is known about the impact of these additional traumas on children's functioning. For a sample of 120 preschool children (age 4-6 years) exposed to IPV in the past 2 years, 38% were exposed to additional traumatic events, including sexual assaults by family members, physical assaults, serious accidents, and/or life-threatening illnesses. Those exposed to both IPV and additional traumatic events had higher rates of PTSD diagnoses, traumatic stress symptoms (d = 0.96), and internalizing (d = 0.86) and externalizing behavior (d = 0.47) problems, than those exposed to IPV alone. We also compared DSM-IV diagnostic criteria to proposed criteria for evaluating traumatic stress in preschool-aged children. Results revealed the importance of conducting a complete assessment of traumatic events prior to treating children exposed to IPV.     

Contributors to traumatic exposure and posttraumatic stress disorder in juvenile justice youths

This study considers demographic, offense, and disorder contributors to exposure and posttraumatic stress disorder (PTSD) in a large (N = 9,611) dataset of standardized psychiatric assessments resulting from nationwide collaborations with justice agencies. Youths' antisocial history may elevate risk for traumatic exposure and PTSD; additionally, traumatic victimization increases risk for externalizing behavior. Rates of all types of traumatic exposure and PTSD were clearly elevated and expectably related to disorder and antisocial behavior. Males were significantly more likely than females to report assaultive violence, whereas females were significantly more likely than males to report forced sexual activity. Gender interactions with disorder and antisocial behavior were contributory only in predicting forced sexual activity: females' exposure was not conditional on features characterizing males' exposure. Findings highlight the high levels of trauma exposure at all levels of juvenile justice processing, and the particular vulnerability of males with internalizing psychopathology. Consistent with increased recent interest in the diagnosis of developmental trauma disorder, and given the likely interconnectedness between traumatic exposure and externalizing symptoms, treatment approaches for justice youths should address their co-occurrence.     

Coping Self‐Efficacy Moderates the Association Between Severity of Partner Violence and PTSD Symptoms Among Incarcerated Women

Previous research indicates self‐efficacy may function as a protective factor for survivors of partner violence (PV), including coping self‐efficacy specific to domestic violence. We hypothesized that domestic violence coping self‐efficacy would moderate the association between recent PV and posttraumatic stress disorder (PTSD) symptoms in a sample of incarcerated women, such that the association between PV and PTSD would be strongest at low levels of domestic violence coping self‐efficacy. Participants (N = 102) were incarcerated women who reported PV in the year prior to incarceration. They were aged 19–55 years (M = 33.57, SD = 9.32), identified predominantly as European American (84.3%), American Indian (15.7%), and Hispanic (14.7%), with 80.4% completing high school or more in terms of education. Participants responded to self‐report measures of PV, trauma history, domestic violence coping self‐efficacy, and current PTSD symptoms. In a series of sequential regression analyses, PV (β = .65, sr² = .06, p = .017) was significantly associated with current PTSD symptoms above and beyond past trauma history (β = .37, sr² = .14, p < .001), and this association was moderated by domestic violence coping self‐efficacy (Domestic Violence Coping Self‐Efficacy × Partner Violence; β = ?.54, sr² = .03, p = .044). The relationship between PV and PTSD symptoms was greatest at low and average levels of domestic violence coping self‐efficacy and nonsignificant at high levels of domestic violence coping self‐efficacy. These findings highlight the importance of assessing domestic violence coping self‐efficacy in incarcerated women with recent PV, given that domestic violence coping self‐efficacy appeared to be protective against symptoms of PTSD.     

The Role of Parenting Stress in Young Children's Mental Health Functioning After Exposure to Family Violence

This study evaluates the associations of young children's exposure to family violence events, parenting stress, and children's mental health functioning. Caregivers provided data for 188 children ages 3 to 5 years attending Head Start programming. Caregivers reported 75% of children had experienced at least 1 type of trauma event, and 27% of children had experienced a family violence event. Child mental health functioning was significantly associated with family violence exposure after controlling for children's age, gender, household income, and other trauma exposure (β = .14, p = .033). Stress in the parenting role partially mediated the relationship between family violence exposure and young children's mental health functioning (β = .12, p = .015, 95% confidence interval [0.02, 0.21]). Interventions for young children exposed to family violence should address the needs of the child, as well as the caregiver while also building healthy parent–child relationships to facilitate positive outcomes in children faced with trauma.     

Mental Health Among Adolescents Exposed to a Tornado: The Influence of Social Support and Its Interactions With Sociodemographic Characteristics and Disaster Exposure

Approximately 25% of youths experience a natural disaster and many experience disaster‐related distress, including symptoms of posttraumatic stress disorder (PTSD) and depression. This study contributes to the literature by examining PTSD and depressive symptoms among 2,000 adolescents (50.9% female, 70.5% White) assessed after exposure to tornadoes in 2011. The authors hypothesized that greater tornado exposure, female sex, and younger age would be associated with distress, and that social support would interact with these associations. Analyses showed that PTSD symptoms were associated with lower levels of social support (β = ?.28, p < .001), greater tornado exposure (β = .14, p < .001), lower household income (β = ?.06, p = .013, female sex (β = ?.10, p < .001), and older age (β = .07, p = .002), with a 3‐way interaction between tornado exposure, sex, and social support (β = ?.06, p = .017). For boys, the influence of tornado exposure on PTSD symptoms increased as social support decreased. Regardless of level of tornado exposure, low social support was related to PTSD symptoms for girls; depressive symptom results were similar. These findings were generally consistent with the literature and provide guidance for intervention development focused on strengthening social support at the individual, family, and community levels.     

Multiple Deployments and Combat Trauma: Do Homefront Stressors Increase the Risk for Posttraumatic Stress Symptoms?

Multiple deployments are common among military personnel who served in Operation Enduring Freedom and Operation Iraqi Freedom and are associated with greater posttraumatic stress symptoms (PTSS). Homefront stressors (i.e., family, occupational problems) resulting from deployments may increase the risk of PTSS. Moreover, with multiple deployments, a new deployment may occur while still experiencing homefront stressors from previous tours. This prospective study assessed whether homefront stressors from a previous tour increased the risk of PTSS after a new deployment. It also examined the effects of homefront stressors at postdeployment. Survey data were obtained from U.S. National Guard soldiers with previous deployments prior to (Wave 1) and after (Wave 2) a new deployment to Iraq (N = 196). Homefront stressors reported at Wave 1 (β = .154, p = .015) and Wave 2 (β = .214, p = .002) were both significantly predictive of PTSS at postdeployment, even after adjusting for warzone stressors, predeployment PTSS, and other variables. A pattern of chronic homefront stressors (i.e., homefront stressors at pre‐ and postdeployment) was associated with higher levels of PTSS at postdeployment (β = .220, p = .002). Service members with multiple deployments are at greater risk for PTSS if deployed with homefront stressors from previous tours and/or face these stressors at postdeployment.     

Effects of Narrative Exposure Therapy on Posttraumatic Stress Disorder,Depression, and Insomnia in Traumatized North Korean Refugee Youth

Refugees affected by multiple traumatic stressors are at high risk for developing trauma-related mental disorders, including posttraumatic stress disorder (PTSD), depression, and insomnia, which is sometimes overlooked. The present study examined the effectiveness of narrative exposure therapy (NET) on trauma-related symptoms in a sample of North Korean refugee youth. We focused on sleep patterns in addition to changes in symptom severity for PTSD, depression, and internalizing and externalizing symptoms. North Korean refugee youth (N = 20) with PTSD were assigned to either an NET-based treatment group or a control group, which consisted of treatment as usual (TAU). There were clinically significant reductions in PTSD, depression, and internalizing and externalizing symptoms for the NET group, Hedges’ g = 3.6, but not the TAU group. The change in diagnostic status for PTSD was more notable for participants in the NET group compared to the TAU group. Of note, NET also produced a significant improvement in insomnia symptoms and sleep quality, Hedges’ g = 2.1. The substantial recovery regarding overall posttraumatic symptoms in the NET group was observed 2 weeks after the end of treatment and remained stable at 6-month follow-up. The results of the present study suggest that NET may be a treatment option for traumatized North Korean refugee youth and may also be effective for the treatment of sleep problems that arise from traumatic experiences.     

Effects of violence exposure and daily stressors on psychological outcomes in urban adolescents

Relations between adolescent violence exposure, daily stress, and psychological outcome were examined. Parent/adolescent dyads (N = 80) completed questionnaires, which included parent ratings of adolescent externalizing and internalizing problems and adolescent self-ratings of emotional adjustment. Severity of daily stress moderated the relation between levels of violence exposure and extent of adolescent externalizing and internalizing problems. The relation was significant at higher levels of daily stress, but nonsignificant at lower levels of stress. In contrast, daily stress did not emerge as a moderator in the relation between violence exposure and adolescent emotional adjustment. Results suggest that adolescents experiencing high levels of violence exposure and daily stress should be considered at great risk for poor psychological outcome.