Interactive effects of corticotropin releasing hormone receptor 1, serotonin transporter linked polymorphic region, and child maltreatment on diurnal cortisol regulation and internalizing symptomatology

Within an allostatic load framework, the effect of Gene × Environment (G × E) interactions on diurnal cortisol regulation and internalizing symptomatology were investigated. Variation in the corticotropin releasing hormone receptor 1 (CRHR1) TAT haplotype and serotonin transporter linked polymorphic region (5-HTTLPR) was determined in a sample of maltreated (n = 238, 21.4% with early physical and sexual abuse) and nonmaltreated (n = 255) children (M age = 10.08) participating in a summer research camp. Internalizing and depressive symptoms were assessed by other and self-report. G × E effects for CRHR1 and maltreatment and early abuse on diurnal cortisol regulation were observed; CRHR1 variation was related to cortisol dysregulation only among maltreated children. Early abuse and high internalizing symptoms also interacted to predict atypical diurnal cortisol regulation. The interaction of CRHR1, 5-HTTLPR, and child maltreatment (G × G × E) identified a subgroup of maltreated children with high internalizing symptoms who shared the same combination of the two genes. The findings support an allostatic load perspective on the effects of the chronic stress associated with child maltreatment on cortisol regulation and internalizing symptomatology as moderated by genetic variation.     

Gene × Environment interaction and resilience: effects of child maltreatment and serotonin, corticotropin releasing hormone, dopamine, and oxytocin genes

In this investigation, gene-environment interaction effects in predicting resilience in adaptive functioning among maltreated and nonmaltreated low-income children (N = 595) were examined. A multicomponent index of resilient functioning was derived and levels of resilient functioning were identified. Variants in four genes (serotonin transporter linked polymorphic region, corticotropin releasing hormone receptor 1, dopamine receptor D4-521C/T, and oxytocin receptor) were investigated. In a series of analyses of covariance, child maltreatment demonstrated a strong negative main effect on children's resilient functioning, whereas no main effects for any of the genotypes of the respective genes were found. However, gene-environment interactions involving genotypes of each of the respective genes and maltreatment status were obtained. For each respective gene, among children with a specific genotype, the relative advantage in resilient functioning of nonmaltreated compared to maltreated children was stronger than was the case for nonmaltreated and maltreated children with other genotypes of the respective gene. Across the four genes, a composite of the genotypes that more strongly differentiated resilient functioning between nonmaltreated and maltreated children provided further evidence of genetic variations influencing resilient functioning in nonmaltreated children, whereas genetic variation had a negligible effect on promoting resilience among maltreated children. Additional effects were observed for children based on the number of subtypes of maltreatment children experienced, as well as for abuse and neglect subgroups. Finally, maltreated and nonmaltreated children with high levels of resilience differed in their average number of differentiating genotypes. These results suggest that differential resilient outcomes are based on the interaction between genes and developmental experiences.     

Diverse patterns of neuroendocrine activity in maltreated children

Cortisol regulation was investigated in a sample of school-aged maltreated (n = 175) and demographically comparable low-income nonmaltreated (n = 209) children in the context of a day camp research program. Overall group differences between maltreated and nonmaltreated children were not found for average morning or average afternoon cortisol levels. However, significant variations were found that were based on the subtypes of maltreatment that the children had experienced. Maltreated children who had been both physically and sexually abused (as well as neglected or emotionally maltreated) exhibited substantial elevations in morning cortisol levels; children who had high (>1 SD) cortisol levels in both the morning and afternoon were also overrepresented in the multiple abuse group. Developmental timing of maltreatment did not account for these group differences, whereas the severity of sexual abuse was implicated. In contrast to the multiple abuse group, a subgroup of physically abused children showed evidence of a trend toward lower morning cortisol relative to nonmaltreated children with a significantly smaller decrease in cortisol levels from morning to afternoon. The findings are discussed in terms of the diversity of atypical cortisol regulation patterns that are exhibited among maltreated children.     

The development of dissociation in maltreated preschool-aged children

Dissociation reflects disruptions in the integration of memories, perception, and identity into a coherent sense of self, and may develop following childhood maltreatment. The preschool years were identified as an important period for the development of dissociation. However, prior research has not examined the development of dissociation during this time. In order to address this gap, evidence of dissociation in 45 maltreated children, assessed for sexual abuse, physical abuse, and neglect, was compared with dissociation in 33 nonmaltreated children. Rather than depend on adult observer reports of behavior, the study sought to gain an understanding of dissociation from the child's own point of view. Because self-reports have limitations with such young children, a measure of dissociation evidenced in children's narrative story-stem completions was utilized. Maltreated children, especially physically abused children and sexually abused children, demonstrated more dissociation than did nonmaltreated children. Moreover, during the preschool period maltreated and nonmaltreated children followed different trajectories such that dissociation increased for maltreated children but did not do so for nonmaltreated children. Findings suggest that although the self is normatively integrated during the preschool period, it becomes increasingly fragmented for some maltreated children. Results are discussed in terms of cascading effects of maltreatment throughout development, and the importance of developmentally sensitive interventions.     

Dimensions of child maltreatment and children's adjustment: contributions of developmental timing and subtype.

This investigation examined the dimensions of developmental timing, subtype, and severity of maltreatment and their relations with child adaptation. The 814 children who participated in a summer day camp, 492 of whom were maltreated and 322 of whom were nonmaltreated comparison children, were assessed by camp counselors on their internalizing and externalizing symptomatology, aggressive, withdrawn, and cooperative behavior, and on personality dimensions of ego resiliency and ego control, and were rated by peers on disruptive, aggressive, and cooperative behavior. The severity within each subtype of maltreatment and the developmental period in which each subtype occurred were examined through hierarchical regression analyses. Additionally, children with similar timing or subtype patterns were grouped to explore diversity in outcomes. Results highlighted the role of severity of emotional maltreatment in the infancy-toddlerhood period and physical abuse during the preschool period in predicting externalizing behavior and aggression. Severity of physical neglect, particularly when it occurred during the preschool period, was associated with internalizing symptomatology and withdrawn behavior. Additionally, maltreatment during the school-age period contributed significant variance after earlier maltreatment was controlled. Chronic maltreatment, especially with onset during infancy-toddlerhood or preschool periods, was linked with more maladaptive outcomes. The implications of measuring multiple dimensions for improving research in child maltreatment are discussed.     

Child maltreatment and allostatic load: consequences for physical and mental health in children from low-income families

Child maltreatment and biomarkers of allostatic load were investigated in relation to child health problems and psychological symptomatology. Participants attended a summer research day camp and included 137 maltreated and 110 nonmaltreated low-income children, who were aged 8 to 10 years (M = 9.42) and racially and ethnically diverse; 52% were male. Measurements obtained included salivary cortisol and dehydroepiandosterone, body mass index, waist-hip ratio, and blood pressure; these indicators provided a composite index of allostatic load. Child self-report and camp adult-rater reports of child symptomatology were obtained; mothers provided information on health problems. The results indicated that higher allostatic load and child maltreatment status independently predicted poorer health outcomes and greater behavior problems. Moderation effects indicated that allostatic load was related to somatic complaints, attention problems, and thought problems only among maltreated children. Risks associated with high waist-hip ratio, low morning cortisol, and high morning dehydroepiandosterone also were related to depressive symptoms only for maltreated children. The results support an allostatic load conceptualization of the impact of high environmental stress and child abuse and neglect on child health and behavioral outcomes and have important implications for long-term physical and mental health.     

Cognitive and emotional differences in young maltreated children: a translational application of dynamic skill theory

Through a translational approach, dynamic skill theory enhances the understanding of the variation in the behavioral and cognitive presentations of a high-risk population-maltreated children. Two studies illustrate the application of normative developmental constructs from a dynamic skills perspective to samples of young maltreated and nonmaltreated children. Each study examines the emotional and cognitive development of maltreated children with attention to their developing world view or negativity bias and cognitive skills. Across both studies, maltreated children demonstrate negativity bias when compared to their nonmaltreated counterparts. Cognitive complexity demonstrated by the maltreated children is dependent upon a positive or negative context. Positive problem solving is more difficult for maltreated children when compared to their nonmaltreated counterparts. Differences by maltreatment type, severity, timing of the abuse, and identity of the perpetrator are also delineated, and variation in the resulting developmental trajectories in each case is explored. This translation of dynamic skill theory, as applied to maltreated children, enhances our basic understanding of their functioning, clarifies the nature of their developmental differences, and underscores the need for early intervention.     

Personality, adrenal steroid hormones, and resilience in maltreated children: a multilevel perspective

In this multilevel investigation, resilience in adaptive functioning among maltreated and nonmaltreated low-income children (N = 677) was examined in relation to the regulation of two stress-responsive adrenal steroid hormones, cortisol and dehydroepiandrosterone (DHEA), as well as the personality constructs of ego resiliency and ego control. Maltreatment status was not related to differences in average levels of morning or afternoon cortisol or DHEA. However, lower morning cortisol was related to higher resilient functioning, but only in nonmaltreated children. In contrast, among physically abused children, high morning cortisol was related to higher resilient functioning. Morning and afternoon DHEA was negatively related to resilient functioning. Although diurnal change in cortisol was not related to resilience, for DHEA, maltreated children with high resilience showed an atypical rise in DHEA from morning to afternoon. Morning and afternoon cortisol/DHEA ratios were positively related to resilient functioning, but did not interact with maltreatment status. Ego resiliency and ego control strongly differentiated maltreated and nonmaltreated children, and the personality variables were substantially predictive of resilience. When considered together, demonstrated effects of personality, cortisol, and DHEA maintained independent contributions in predicting resilience among high-risk youth.     

Narrative representations of caregivers and self in maltreated pre-schoolers

This study examined narrative representations of parents and of self, as well as child behavior during the assessment, in maltreated (N = 56) and demographically comparable non-maltreated (N = 37) pre-school-aged children in a one-year longitudinal study. Maltreated children evidenced more negative representations of parents and of self at Time 2, including the juxtaposition of both a negative and a grandiose self. Over time there was a marginal interaction such that maltreated children portrayed fewer disciplining parent representations and nonmaltreated children portrayed more. Also over time, maltreated children portrayed marginally more grandiose self-representations and nonmaltreated children fewer. Furthermore, maltreated children demonstrated less responsivity to the examiner over time and nonmaltreated children demonstrated more. The deleterious effects of maltreatment on representations of self and of others, especially as development proceeds, are discussed, and the importance of providing attachment-informed intervention prior to the consolidation of these negative representations is highlighted.     

Narrative Representations of Moral-Affiliative and Conflictual Themes and Behavioral Problems in Maltreated Preschoolers

Examined whether maltreated preschoolers are more likely than nonmaltreated preschoolers to have fewer moral-affiliative and more conflictual narrative representations and whether these representations mediate child behavior problems. A structured narrative story-telling task was administered to assess representations, and independent ratings of behavior problems were obtained from teachers. The narratives of maltreated children contained more conflictual and fewer moral-affiliative themes. Maltreated children also exhibited more internalizing and externalizing behavior problems. A partial mediation effect of conflictual representations on the relation between child maltreatment and externalizing behavior problems was found. The results demonstrate the relation between child maltreatment and children's organization of their life experiences and their behavioral symptomatology.     

Interactions of child maltreatment and serotonin transporter and monoamine oxidase A polymorphisms: depressive symptomatology among adolescents from low socioeconomic status backgrounds

Child maltreatment and polymorphisms of the serotonin transporter (5-HTT) and monoamine oxidase A (MAOA) genes were examined in relation to depressive symptomatology. Adolescents (M age = 16.7 years) from low socioeconomic backgrounds with a history of child maltreatment (n = 207) or no such history (n = 132) were interviewed and provided buccal cells for genetic analysis. Gene x environment interactions were observed. Heightened depressive symptoms were found only among extensively maltreated youth with low MAOA activity. Among comparably maltreated youth with high MAOA activity, self-coping strategies related to lower symptoms. Sexual abuse and the 5-HTT short/short genotype predicted higher depression, anxiety, and somatic symptoms. This Gene x Environment interaction was further moderated by MAOA activity level. The results highlight the protective functions of genetic polymorphisms and coping strategies in high risk youth and offer direction for understanding resilience and its promotion from a multiple levels of analysis perspective.     

False belief understanding in maltreated children

False belief understanding was investigated in maltreated (N = 203), low socioeconomic status (SES) nonmaltreated (N = 143), and middle SES nonmaltreated (N = 172) 3- to 8-year-old children. Contrasts among the three groups provided an opportunity to examine the impact of family contextual influences on theory of mind development. Specifically, child maltreatment served as an "experiment of nature" in order to elucidate theory of mind abilities. Two false belief tasks and language assessments were administered. Among children with a verbal mental age of 49 months or greater, maltreatment was related to delays in the development of theory of mind, beyond the influence of chronological age and SES. The occurrence of maltreatment during the toddler period, onset during the toddler years, and physical abuse were features of maltreatment associated with delay in the development of theory of mind. Findings are discussed in terms of the influence of harsh caregiving on the development of theory of mind. Implications for the understanding of normal developmental processes are highlighted.     

Nature X nurture: genetic vulnerabilities interact with physical maltreatment to promote conduct problems

Maltreatment places children at risk for psychiatric morbidity, especially conduct problems. However, not all maltreated children develop conduct problems. We tested whether the effect of physical maltreatment on risk for conduct problems was strongest among those who were at high genetic risk for these problems using data from the E-risk Study, a representative cohort of 1,116 5-year-old British twin pairs and their families. Children's conduct problems were ascertained via parent and teacher interviews. Physical maltreatment was ascertained via parent report. Children's genetic risk for conduct problems was estimated as a function of their co-twin's conduct disorder status and the pair's zygosity. The effect of maltreatment on risk for conduct problems was strongest among those at high genetic risk. The experience of maltreatment was associated with an increase of 2% in the probability of a conduct disorder diagnosis among children at low genetic risk for conduct disorder but an increase of 24% among children at high genetic risk. Prediction of behavioral pathology can attain greater accuracy if both pathogenic environments and genetic risk are ascertained. Certain genotypes may promote resistance to trauma. Physically maltreated children whose first-degree relatives engage in antisocial behavior warrant priority for therapeutic intervention.     

Child maltreatment and the early onset of problem behaviors: can a program of nurse home visitation break the link?

This study investigated the relationship between child maltreatment and the early onset of problem behaviors in the Elmira Nurse Home Visitation Program. Participants were predominantly low-income and unmarried mothers and their first-born children who were randomized either to receive over 2 years of home-visitation services by nurses or to be placed in a comparison group. Data were drawn from a follow-up study that took place when the children were 15 years of age. Results demonstrated that, in the comparison group. child maltreatment was associated with significant increases in the number of early onset problem behaviors reported by the youth. For the youth in the nurse-visited group there was no relationship between maltreatment and early onset problem behaviors. We suggest that this finding was due to the effects of the intervention in reducing the number as well as the developmental timing of the maltreatment incidents. Results suggest that prenatal and infancy home visiting by nurses can moderate the risk of child maltreatment as a predictor of conduct problems and antisocial behavior among children and youth born into at-risk families.     

Emotion management skills in sexually maltreated and nonmaltreated girls: a developmental psychopathology perspective

Research has demonstrated that children who experience familial sexual maltreatment are at risk for developing psychological difficulties characterized by emotional and behavioral dysregulation. Surprisingly, however, little attention has been directed toward identifying processes in emotional development that differ in maltreated and nonmaltreated children. From a developmental psychopathology perspective, the present study examined emotion management skills (i.e., emotional understanding, emotion regulation) in 21 sexually maltreated girls and their nonmaltreated peers to determine how the experience of sexual maltreatment may interfere with normative emotional development. Findings indicated that sexually maltreated girls, in comparison to their nonmaltreated peers, demonstrate lower emotional understanding and decreased ability to regulate their emotions in accordance with cultural expectations. Further, maltreated girls expected less emotional support and more relational conflict from parents in response to sadness displays and from parents and peers in response to anger displays. These findings will be discussed from the functionalist approach to emotional development, emphasizing the importance of social context (e.g., maltreating, nonmaltreating) in the development of children's emotion management skills.     

True and false recall and dissociation among maltreated children: the role of self-schema

The current investigation addresses the manner through which trauma affects basic memory and self-system processes. True and false recall for self-referent stimuli were assessed in conjunction with dissociative symptomatology among abused (N=76), neglected (N=92), and nonmaltreated (N=116) school-aged children. Abused, neglected, and nonmaltreated children did not differ in the level of processing self-schema effect or in the occurrence and frequency of false recall. Rather, differences in the affective valence of false recall emerged as a function of maltreatment subtype and age. Regarding dissociation, the abused children displayed higher levels of dissociative symptomatology than did the nonmaltreated children. Although abused, neglected, and nonmaltreated children did not exhibit differences in the valence of their self-schemas, positive and negative self-schemas were related to self-integration differently among the subgroups of maltreatment. Negative self-schemas were associated with increased dissociation among the abused children, whereas positive self-schemas were related to increased dissociation for the neglected children. Thus, positive self-schemas displayed by the younger neglected children were related to higher dissociation, suggestive of defensive self-processing. Implications for clinical intervention are underscored.     

Child maltreatment, attention networks, and potential precursors to borderline personality disorder

Potential precursors to borderline personality disorder (BPD) were investigated in a sample of 185 maltreated and 175 nonmaltreated school-aged children attending a summer camp research program. Self-report, peer-report, and counselor-report measures were utilized to assess developmental constructs conceptualized to constitute vulnerability for later emerging BPD. These areas, including personality features, representational models of self, parent, and peers, interpersonal relationship difficulties with peers and adults, and suicidal/self-harm behavior, were used to develop a BPD precursors composite. Additionally, the efficiency of three attention networks was assessed with a computerized task. Maltreated children had higher mean scores on the BPD precursors composite, and children classified as having high levels of these precursors were more prevalent in the maltreatment group. No maltreatment group differences were found for the efficiency of the three attention networks; however, children with high levels of BPD precursors evinced less efficient processing of the conflict attention network, comparable to findings observed among adult patients with BPD. Child maltreatment and efficiency of the conflict attention network independently predicted scores on the BPD precursors composite. Experiential and biological contributions to risk for BPD and recommendations for prevention and intervention are discussed.     

The impact of child maltreatment and psychopathology on neuroendocrine functioning.

Cortisol regulation was investigated in a sample of school-aged maltreated (n = 167) and demographically comparable low-income nonmaltreated (n = 204) boys and girls in the context of a day camp research program. The presence of clinical-level internalizing and clinical-level externalizing symptomatology was determined through adult report and child self report. Children who exhibited clinical-level internalizing problems only, clinical-level externalizing problems only, and comorbid clinical-level internalizing and extemalizing problems were identified. Clinical-level cases were more prevalent among the maltreated children. Maltreated children with clinical-level internalizing problems were distinguished by higher morning, afternoon, and average daily cortisol levels across the week of camp attendance. In contrast, nonmaltreated boys with clinical-level externalizing problems emerged as distinct in terms of low levels of morning and average daily levels of cortisol. Maltreated children with comorbid clinical-level internalizing and externalizing problems were more likely not to show the expected diumal decrease in cortisol. The findings are discussed in terms of the joint impact of maltreatment and different forms of psychopathology on neuroendocrine regulation.     

Children's basic memory processes, stress, and maltreatment

Building upon methods and research utilized with normative populations, we examine extant assumptions regarding the effects of child maltreatment on memory. The effects of stress on basic memory processes is examined, and potential neurobiological changes relevant to memory development are examined. The impact of maltreatment-related sequelae (including dissociation and depression) on basic memory processes as well as false memories and suggestibility are also outlined. Although there is a clear need for additional research, the investigations that do exist reveal that maltreated children's basic memory processes are not reliably different from that of other, nonmaltreated children.     

Emotion and resilience: a multilevel investigation of hemispheric electroencephalogram asymmetry and emotion regulation in maltreated and nonmaltreated children

The current study was a multilevel investigation of resilience, emotion regulation, and hemispheric electroencephalogram (EEG) asymmetry in a sample of maltreated and nonmaltreated school age children. It was predicted that the positive emotionality and increased emotion regulatory ability associated with resilient functioning would be associated with relatively greater left frontal EEG activity. The study also investigated differences in pathways to resilience between maltreated and nonmaltreated children. The findings indicated that EEG asymmetry across central cortical regions distinguished between resilient and nonresilient children, with greater left hemisphere activity characterizing those who were resilient. In addition, nonmaltreated children showed greater left hemisphere EEG activity across parietal cortical regions. There was also a significant interaction between resilience, maltreatment status, and gender for asymmetry at anterior frontal electrodes, where nonmaltreated resilient females had greater relative left frontal activity compared to more right frontal activity exhibited by resilient maltreated females. An observational measure of emotion regulation significantly contributed to the prediction of resilience in the maltreated and nonmaltreated children, but EEG asymmetry in central cortical regions independently predicted resilience only in the maltreated group. The findings are discussed in terms of their meaning for the development of resilient functioning.