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.     

The ecology of adolescent maltreatment: a multilevel examination of adolescent physical abuse, sexual abuse, and neglect

This study examined the individual characteristics, family relations, and stress/social support of 50 maltreated adolescents and their mothers. Dyads were divided into 4 demographically similar groups: neglect, physical abuse, sexual abuse, and nonmaltreatment control. Results show that adolescent neglect was primarily associated with extrafamilial difficulties and social isolation. Adolescent physical abuse was linked more with rigidity in family relations, poorer maternal understanding of child developmental skills, and adolescent externalizing behaviors. In contrast, adolescent sexual abuse was related to maternal emotional problems and adolescent internalizing behaviors. In general, each group of maltreated adolescents experienced lower levels of family cohesion, more attention problems, and more daily stress than did their nonmaltreated counterparts. Findings are consistent with an ecological model of adolescent maltreatment.     

Transactional Associations Among Maternal Depression,Parent–Child Coercion,and Child Conduct Problems During Early Childhood

Maternal depression is among the most consistent and well-replicated risk factors for negative child outcomes, particularly in early childhood. Although children of depressed mothers are at an increased risk of adjustment problems, conversely, children with emotional or behavioral problems also have been found to adversely compromise maternal functioning, including increasing maternal depression. The purpose of this investigation was to examine transactional associations among maternal depression, parent–child coercive interaction, and children’s conduct and emotional problems in early childhood using a cross-lagged panel model. Participants were 731 toddlers and families that were part of the Early Steps Multisite Study, a sample of diverse ethnic backgrounds and communities (i.e., rural, urban, suburban) recruited from Women, Infants, and Children Nutritional Supplement Centers. Analyses provided support for the existence of some modest transactional relations between parent–child coercion and maternal depression and between maternal depression and child conduct problems. Cross-lagged effects were somewhat stronger between children age 2–3 than age 3–4. Similar patterns were observed in the model with child emotional problems replacing conduct problems, but relations between coercion and maternal depression were attenuated in this model. In addition, the transactional hypothesis was more strongly supported when maternal versus secondary caregiver reports were used for child problem behavior. The findings have implications for the need to support caregivers and reinforce positive parenting practices within family-centered interventions in early childhood.     

Socialization of children's emotion regulation in mother-child dyads: a developmental psychopathology perspective

This study investigated the socialization of children's emotion regulation in 25 physically maltreating and 25 nonmaltreating mother-child dyads. Maltreating mothers and their 6- to 12-year-old children were recruited from two parenting programs affiliated with Children's Protective Services with a control group matched on race, SES, child gender, and child age. Children and their mothers were interviewed individually about their (a) management of emotional expression. (b) strategies for coping with emotional arousal, and (c) anticipated consequences following emotional displays. Compared to controls, maltreated children expected less maternal support in response to their emotional displays, reported being less likely to display emotions to their mothers, and generated fewer effective coping strategies for anger. Maltreating mothers indicated less understanding of children's emotional displays and fewer effective strategies for helping children to cope with emotionally arousing situations than nonmaltreating mothers. Further, findings indicated that maternal socialization practices (e.g., providing support in response to children's emotional display, generating effective coping strategies for their child) mediate the relation between child maltreatment and children's regulation of emotional expression and emotional arousal. These findings suggest that children's emotion regulation strategies are influenced by their relationship with their social environment (e.g.. physically maltreating, nonmaltreating) and that the experience of a physically maltreating relationship may interfere with children's emotional development.     

Four-factor model of recidivism in male juvenile offenders

Assessing the protective elements of social relationships for sixty 7- to 12-year-old children and their mothers residing in homeless shelters and 61 children and their mothers in low-income housing allowed us to test an ecological model of the impact of social relationships, income, stress, and maternal mental health on child adjustment for children in these two types of distressed families. Social relationships included the quality of the child's relationships with parents, teachers, other relatives, and friends. The model showed that for the homeless group, a lack of social support and maternal depression were significantly associated with adjustment difficulties in the child, whereas for the housed low-income group, environmental stress was associated with behavioral adjustment problems in the child. Perceptions of self-worth were associated with the presense of supportive relationships for children in both groups.     

Mutual influences on maternal depression and child adjustment problems

Often undetected and poorly managed, maternal depression and child adjustment problems are common health problems and impose significant burden to society. Studies show evidence of mutual influences on maternal and child functioning, whereby depression in mothers increases risk of emotional and behavioral problems in children and vice versa. Biological mechanisms (genetics, in utero environment) mediate influences from mother to child, while psychosocial (attachment, child discipline, modeling, family functioning) and social capital (social resources, social support) mechanisms mediate transactional influences on maternal depression and child adjustment problems. Mutual family influences in the etiology and maintenance of psychological problems advance our understanding of pathways of risk and resilience and their implications for clinical interventions. This article explores the dynamic interplay of maternal and child distress and provides evidence for a biopsychosocial model of mediating factors with the aim of stimulating further research and contributing to more inclusive therapies for families.     

Factors influencing maltreated children's early adjustment in foster care

Internal representations of self and primary attachment figures may be one mechanism by which maltreatment affects children's interpersonal behavior and relationships with others. Research on the continuity and influence of maltreated children's attachment representations, however, has not included youngsters removed from abusive or neglectful home environments. This paper examines the influence of maltreated children's maternal and self-representations on subsequent relationships with foster mothers and behavioral adjustment in foster care. Participants included 32 children, ages 9-13 years, who entered foster placement for the first time after a sustained relationship with a maltreating biological mother. Upon initially entering foster care, children's maternal and self-representations were significantly related to each other and to severity of maltreatment history but not to other factors believed to influence the quality of parent-child relationship (e.g., maternal mental health, partner stability). In addition, these representations significantly predicted children's subsequent views of their relationships with foster mothers. Finally, children's behavior in their foster homes was associated with maltreatment severity, internal representations assessed at entry into foster care, and to concurrent perceptions of their new foster mothers. These findings advance our understanding of foster placement's role in maltreated children's development and provide preliminary insight into the processes associated with the formation of potentially compensatory relationships.     

Prefrontal activation in preschool children is associated with maternal adversity and child temperament: A preliminary fNIRS study of inhibitory control

Exposure to adversity is a well-documented risk factor for cognitive, behavioral, and mental health problems. In fact, the consequences of adversity may be intergenerational. A growing body of research suggests that maternal exposures to adversity, including those prior to childbirth, are associated with offspring biobehavioral development. In a sample of 36 mothers and their preschool-age children (mean child age = 4.21 ± 0.92 years), we used functional near-infrared spectroscopy to replicate and extend this work to include brain activation during inhibitory control in young children. We found that measures of maternal exposure to adversity, including cumulative, childhood, and preconception exposures, were significantly and positively associated with activation in the right frontopolar prefrontal cortex (PFC) and in the left temporal and parietal clusters during inhibitory control. In addition, and consistent with previous findings, children's increased negative affect and decreased effortful control were associated with increased right PFC activation during inhibitory control. These findings provide preliminary evidence that maternal and dispositional risk factors are linked to alterations in PFC functioning during the preschool years. Children of mothers with a history of exposure to adversity, as well as children who are less temperamentally regulated, may require increased neural resources to meet the cognitive demands of inhibitory control.     

Childhood chronic illness as a family stressor.

Investigated the impact of childhood chronic illness within a family context. We interviewed 30 mothers of 6- to 14-year-old children with asthma or diabetes and 30 mothers of healthy children of the same age and sex. Family functioning, extrafamilial social support available to mothers, and child life stress events were examined in relation to the children's psychological adjustment and illness events. The mothers of asthmatic children reported a greater number of internalizing behavior problems in their children, perceived their own social support as less adequate, and reported a greater number of stressful events. Regression analyses demonstrated that family functioning, maternal social support, and chronic illness were significantly related to the psychological adjustment of the child. The importance of family functioning and resources available to the family, such as social support, are discussed as protective influences in coping with childhood chronic illness.     

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.     

The Moderating Effect of Risk Exposure on an Efficacious Intervention for Maltreated Children

The current study extends research on the impact of the Fostering Healthy Futures program (Taussig & Culhane, 2010), a 9-month mentoring and skills group preventive intervention for maltreated children, by examining whether the effect of Fostering Healthy Futures is moderated by children’s baseline risk exposure (i.e., number of adverse childhood experiences). Participants included 156 racially and ethnically diverse children (ages 9–11, 50.7% female) recently placed in foster care due to maltreatment who were randomized to intervention or control conditions. Baseline and 6-month postintervention measures included a multi-informant index of mental health functioning and youth-reported symptoms of posttraumatic stress, dissociation, coping skills, social-acceptance, global self-worth, social support, and quality of life. A previously published, empirically derived risk index was used to assess level of exposure to 6 adverse childhood experiences (i.e., physical abuse, sexual abuse, removal from a single parent household, high level of exposure to community violence, and high numbers of caregiver and school transitions). Significant Intervention × Risk interactions were observed in regression models predicting 6-month postintervention symptoms of posttraumatic stress (β = .38, p < .001) and dissociation (β = .30, p < .01). Among children with low to moderate levels of risk, intervention participants evidenced fewer symptoms, whereas intervention participants with high levels of risk did not differ from the control group. The results of this study suggest that maltreated children exposed to high numbers of adverse childhood experiences may not experience the same reduction in trauma symptoms postintervention relative to children exposed to fewer adversities.     

Children with physical handicaps and their mothers: the interrelation of social support, maternal adjustment, and child adjustment.

Examined the interrelation of maternal adjustment, mother-child interaction, and child adjustment in 29 families of children with spina bifida and without mental retardation and in 28 families of children without handicaps. A multivariate, ecological model proposed that adjustment of mother and child depends on the adaptiveness of maternal response to the stress of the physical handicap and on the ability of mothers to create an optimal caregiving environment through mother-child interaction. Analyses examining the relationships among maternal social support, maternal psychological adjustment, and child adjustment are reported. Social support was found to be related to higher maternal psychological adjustment and to higher child adjustment, and maternal psychological adjustment was related positively to child adjustment in both groups. No significant differences were found between groups in the examined relationships or in the levels of resources and adjustment. Results underscore strengths of families of children with spina bifida in their adaptation to the stress of the handicap.     

Child functional independence and maternal psychosocial stress as risk factors threatening adaptation in mothers of physically or sensorially handicapped children

This study investigated the contribution of child functional independence and maternal psychosocial stress to the adaptation of 119 mothers. Each mother had a child, aged 2-18 years, with a physical or sensory disability. Multiple dimensions of each construct were measured through self-report. Child functional independence did not uniquely explain variation in mothers' adaptation. However, maternal stress was uniquely associated with maternal mental health, but not physical health or social functioning, even when controlling for demographic status, disability type, and functional independence. Daily hassles and handicap-related psychosocial stress in particular put mothers at risk for reporting mental health problems.     

Depression, partnership, social support, and parenting: interaction of maternal factors with behavioral problems of the child

Background: Children of depressed mothers are at elevated risk to develop behavioral problems. Besides maternal depression, other risk factors like interpersonal functioning, are discussed. The object of this study was to investigate the predictive value of the maternal variables depression, partnership, social support, and parenting for internal and external behavioral problems of the children. Methods: A total of 100 mothers and their children who participated in a German mother–child rehabilitation program were interviewed by questionnaire. Structural equation modeling was conducted in order to determine the predictive value of the mentioned maternal variables on behavioral problems of the children. Results: Behavioral problems of the children can be predicted by the parenting and the partnership of the mothers. Mothers with more parenting difficulties and with less containment with partnership report more behavioral problems of their children. Depression and social support do indirectly predict the child’s problems. Limitations: The data is from a cross-sectional sample. Therefore, path models do not demonstrate causation. All information is based upon maternal report. Conclusions: These findings suggest the need for intervention programs which focus on the parenting and the partnership of the mothers. More research with independent assessment is needed.     

Middle Childhood Attachment Strategies: validation of an observational measure

The purpose of this study was to assess behavioral manifestations of attachment in middle childhood, and to evaluate their relations with key theoretical correlates. The sample consisted of 87 children (aged 10–12 years) and their mothers. Dyads participated in an 8-min videotaped discussion of a conflict in their relationships, later scored with the Middle Childhood Attachment Strategies Coding System (MCAS) for key features of all child attachment patterns described in previous literature (secure, ambivalent, avoidant, disorganized-disoriented, caregiving/role-confused, hostile/punitive). To assess validity, relations among MCAS dimensions and other measures of attachment, parenting, and psychological adjustment were evaluated. Results provide preliminary evidence for the psychometric properties of the MCAS in that its behaviorally assessed patterns were associated with theoretically relevant constructs, including maternal warmth/acceptance and psychological control, and children’s social competence, depression, and behavioral problems. The MCAS opens new grounds for expanding our understanding of attachment and its outcomes in middle childhood.     

Maternal mentalization affects mothers’ – but not children’s – weight via emotional eating

Previous research on childhood obesity has shown that maternal obesity is an important risk factor for this malady. Because biological and environmental factors are able to explain the transgenerational transmission of obesity only in part, psychological risk factors (e.g., emotional eating) have become more important in recent research. As maternal mentalization – which lays the foundation for the child’s ability to regulate his/her emotions – has not yet been investigated, we examined the effects of mentalization on maternal and childhood obesity. By investigating groups of obese (n = 30) and normal-weight (n = 30) mothers and their children aged 18 to 55 months, we found, contrary to our expectations, that obese mothers’ mentalization (Reflective Functioning Scale) was similar to that of mothers with normal weight and that mentalization showed no direct effect on the child’s weight. However, we found hints of an indirect influence of mentalization via emotional eating on mothers’ but not on children’s weight and via mother–child attachment (Attachment Q-Set) on children’s weight. Possible reasons for these inconclusive effects are discussed.     

The quality of the mother-child relationship in high-risk dyads: application of the Emotional Availability Scales in an intergenerational, longitudinal study

The present research examined how family psychosocial risk may be associated with emotional availability (EA) across age and time in two longitudinal, intergenerational studies with high-risk, disadvantaged mother-child dyads. Study 1 examined dyads during preschool and middle childhood. Study 2 examined a different sample of dyads, tested intensively at five time points (6, 12, and 18 months; preschool; and school age). Across studies, maternal childhood histories of aggression and social withdrawal predicted negative EA (higher levels of maternal hostility) during mother-child interactions at preschool age. In Study 1, mothers with higher levels of social withdrawal during childhood had preschoolers who were less appropriately responsive to and involving of their mothers during interactions. In Study 2, higher levels of observed appropriate maternal structuring predicted child responsiveness while observed maternal sensitivity (and structuring) predicted observed child involvement. More maternal social support and better home environment combined with lower stress predicted better mother-child relationship quality. Findings contribute to the burgeoning literature on EA by focusing on a high-risk community sample across time and generations. Results are interpreted in light of the developmental psychopathology framework, and have implications for a broader understanding of how EA is related to parental history and personal characteristics, as well as ongoing family and environmental context.     

Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.

     

Depressed mothers coming to primary care: maternal reports of problems with their children

BACKGROUND: Studies of depressed mothers have generally been conducted in psychiatric settings with non-minority, middle-class women. Primary care has an increasing role in early detection and treatment, especially for the poor who have less access to specialized mental health services. Data on the relationship between maternal depression and problems in the offspring in a primary care context could help physicians to more effectively identify children in need of psychiatric help. METHODS: All mothers aged 25 to 55 from a systematic sample of consecutive adults (response rate, 80%) in an urban general medicine practice were screened using the PRIME-MD Patient Health Questionnaire (PHQ). Mothers who screened positive for major depression (n=85); other psychiatric disorders, but not major depression (n=67); or no psychiatric disorders (n=191) were compared on their children's history of emotional problems, unmet need for mental health treatment, parent-child discord, maternal functional status and mental health treatment. RESULTS: Compared to non-psychiatric controls, depressed mothers reported a three-times greater risk of serious emotional problems in their children (95% confidence interval [CI], 1.7-6.1); a four-times greater risk of having their children's problems left untreated (95% CI, 2.3-8.2), and a 10-times greater risk of having poor mother-child relations within the past month (95% CI, 3.9-29.4). Depressed mothers reported more functional disability, more psychiatric treatment and more problems in their offspring than mothers with non-depressive psychiatric disorders. Although a majority of mothers (regardless of psychiatric status) believed that counseling (96%) or medication (84%) should be offered to those with serious emotional problems, only about half (49%) of the depressed mothers had received mental health treatment in the past month. LIMITATIONS: Children were not assessed directly. CONCLUSIONS: The children of low-income depressed women at a general medicine practice were reported to have a greatly increased risk for emotional problems. Many mothers had not received treatment for their own emotional problems. By enquiring about the emotional health of children of adult primary care patients, primary care providers have an opportunity to promote early detection and to facilitate appropriate treatment for both the mothers and their children.     

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.