Child maltreatment & trauma

Question 1

Physical abuse def

Answer 1

• Punching, beating, kicking, burning, shaking, or otherwise physically harming a child
• Often unintentional and resulting from severe physical punishment

Question 2

Neglect def

Answer 2

• Child’s basic needs are not being met
• Different types of neglect: physical, educational, emotional

Question 3

Sexual abuse

Answer 3

Touching genitals, intercourse, exhibitionism, production of pornographic photos

Question 4

Emotional abuse

Answer 4

Repeated acts by parents or caregivers that could or have caused serious behavioral, cognitive, emotional or mental disorders

Question 5

Challenges of studying incidence and prevalence of child abuse ()

Answer 5

(1) People may not be willing to report this (esp parents bc of DPJ)
(2) Metrics often based on children who are involved directly in Child Protection Services
(3) Retrospective report

Question 6

What’s a protective factor against child maltreatment

Answer 6

Upward Social Mobility
=> Counties where kids have a bigger chance of moving UP the economic income ladder (more potential for social mobility) → lower rates of childhood maltreatment
-> CONTROLLING FOR income inequality/poverty rates
-> Implications: Macroeconomic factors/policies that reduce income inequality + enhance economic mobility = likely to prevent childhood maltreatment

Question 7

… is most common experience of maltreatment

Answer 7

Neglect
- Followed by: physical abuse, sexual abuse, other, emotional abuse
=> Studies and treatment have focused primarily on physical and sexual abuse (understandable given severity)

Question 8

Study: Retrospective report (adults) of maltreatment reported before age 15. Results (6)

Answer 8

(1) No childhood maltreatment (~40%)
(2) Non-physical only (30%)
-> 99% reported Emotional abuse + Decent amount of partner violence
(3) Both non-physical and physical (20%)
(4) Physical only (5%)
(5) Females more likely than males to report experiencing non-physical maltreatment AND non-physical and physical
(6) Males are more likely to experience ONLY physical maltreatment (vs females)

Question 9

How did COVID-19 impact childhood maltreatment?

Answer 9

Evidence for notable increases in childhood maltreatment during lockdowns
=> Effect occurs across the globe
=> Effect was stronger in low and middle income countries (LMIC)

Question 10

Maltreatment shapes: (3)

Answer 10

(1) Brain development
(2) Physiological reactivity to stress
E.g. Production of cortisol/stress hormones could be blunted → you become less reactive to stress (not piked hormone responses)
(3) Understanding of emotion

Question 11

Study 1
Participants:
- 17 physically abused children
- 16 physically neglected children
- 15 children with no abuse history
- Between 3 and 5yo
Emotion recognition task:
- Children presented with 25 vignettes (i.e.g story) describing a protagonist experiencing one of 5 emotions: happiness, sadness, disgust, fear, anger
- After each story, child was shows 3 photos of facial expressions (one that’s correct and 2 wrong).
Results? (3)

Answer 11

Score = correct minus incorrect
(1) Neglected children were LESS sensitive to DIFFERENCES between facial expressions
(2) Physically abused children show a bias for ANGRY faces: More likely to pick “angry” regardless of the vignette
(3) Neglected children show a bias for SAD faces: Don’t know actually why. Maybe exposure to e.g. maternal depression

Question 12

Study 1
Participants:
- 17 physically abused children
- 16 physically neglected children
- 15 children with no abuse history
- Between 3 and 5yo
Emotion recognition task:
- Children are presented with 25 vignettes (story) describing a protagonist experiencing one of 5 emotions: happiness, sadness, disgust, fear, anger
- After each story, child was shows 3 photos of facial expressions (one that’s correct and 2 wrong).
POSSIBLE REASONS FOR FINDINGS (2)

Answer 12

• (1) Visually, children cannot DISCRIMINATE between the faces (not supported by follow up)
• (2) They have different UNDERSTANDING of the emotional displays (supported by follow-up)

Question 13

Study 2:
Participants:
- 13 physically abused children
- 15 physically neglected children
- 11 children with no abuse history
- Between 3 and 5 years of age
Emotion discrimination task: Shown two photographs of models showing emotions and asked “same or different”
Emotion differentiation task: Children shown photographs of two models and asked to rate the similarity of the facial expressions
Results? (2)

Answer 13

(1) Emotion discrimination task: NO differences between three groups on this task
=> It is not they cannot SEE the differences
(2) Emotion differentiation task
-> Neglected children perceived LESS DISTINCTION between ANGRY, SAD, FEARFUL facial expressions
-> Physically abused children and control children perceived MORE distinction between ANGER and other negative emotions

Question 14

Conclusion of study 1 and study 2

Answer 14

Experience of maltreatment changes understanding of emotion
=> Role of experience in learning emotions

Question 15

Study 3:
Participants:
- 8 to 10 years of age
- 24 physically abused children
- 23 non-maltreated children
- Presented children with photos displaying angry, sad, fearful, and happy facial images
Images are slowly filled in randomly, so that the expression gradually appears
DV is how early the child can identify the photo
-> At 3.3 second intervals, more of photo filled in, At each interval, children were prompted to identify the emotion
-> Had to rate their confidence in their choice from (1) Guess to (5) Certainty
-> Only correct responses with a rating of 4 or 5 were used
Results? (3)

Answer 15

(1) No diff in the recognition of HAPPY/FEARFUL faces; neither fearful faces
(2) Kids who experience PHYSICAL ABUSE are quicker to identify anger
(3) Kids who experience PHYSICAL ABUSE are SLOWER to identify sadness

Question 16

Study 3: Conclusions (2)

Answer 16

(1) Early experience of maltreatment fundamentally changes how children perceive emotions
(2) Children who have been physically abused show a bias for identifying angry faces, and they need less information to identify angry faces
-> Implications for their behavior and emotional response

Question 17

Recent review – Emotion recognition among adults with history of childhood maltreatment (Bérubé et al., 2023) Results? (4)

Answer 17

(1) General: Childhood maltreatment impacts adult’s ability to recognize facial expressions (on kid + adult faces)
(2) Anger AND Fear are recognized more rapidly and at a lower intensity
(3) Happiness is less well recognized
(4) Emotion recognition also related to greater brain activation for the maltreated group

Question 18

Recent review – Emotion recognition among adults with history of childhood maltreatment (Bérubé et al., 2023) – Implications (2)

Answer 18

(1) Interventions could help focus on helping maltreated adults/kids to recognize and respond to emotional signals (recalibrate emotion recognition → response more typical).
(2) Giving more attention to adults with a history of maltreatment who may become parents (responsiveness with child’s emotional signals)

Question 19

Child Maltreatment and Psychopathology: Diathesis-Stress Models (3)

Answer 19

(1) Genetic predispositions interacting with maltreatment to lead to later psychopathology: Gene polymorphisms
(2) => E.g. MAOA for antisocial behaviour
(3) => Serotonin transporter gene 5-HTTLPR for depression

Question 20

Serotonin transporter gene 5-HTTLPR: Allele explanation

Answer 20

Diathesis = short allele
=> Associated with increased depression, but only for those who experience significant life stress
-> Interaction between genotype and risk

Question 21

Study: Association between severity of maltreatment and allele on probability of MDD (3) see graph

Answer 21

(1) NO MAIN EFFECT of genotype
(2) NO MAIN EFFECT of maltreatment
(3) Interaction between genotype and risk
(Long allele almost like a protection)

Question 22

Study: Association between severity of maltreatment and allele on probability of MDD => protective factors (2)

Answer 22

Social support
(1) The moderator was itself moderated by something else
(2) Maltreated children with a short allele and poor social support had rates of depression 2x higher than maltreated children with a short allele and social support
=> 3 way interaction! If strong social support, flattens interaction between maltreatment & genotype

Question 23

Serotonin Transporter Gene (5-HTTLPR) x Maltreatment: If we take a meta analysis

Answer 23

Evidence for SMALL but SIGNIFICANT interaction between 5 HTTPLR serotonin transporter gene MODERATING relation between life stress and depression
-> Well-replicated effect

Question 24

PTSD: Some debates about Criterion A as a diagnostic criteria (exposure to trauma). Why? (2)

Answer 24

• Recent scholarship acknowledging consistent experienced and vicarious exposure to racism as experiences of trauma
• Recent review of meta-analyses shows discrimination has = to stronger impact on youth mental health outcomes than traumatic experiences/maltreatment such as neglect

Question 25

PTSD in Children 6 Years of Age & Younger: Symptom presentation (3)

Answer 25

Lower level of cognitive ability so… - Symptoms may be expressed through play (e.g. violent play with toys) - Reenactment - More behaviorally anchored: social withdrawal, Persistent reduction in expression of positive emotions, Irritability expanded to include tantrums

Question 26

...% of youth who experienced a significant trauma reported at least one symptom of PTSD

Answer 26

85% -> Doesn’t mean they all continue on towards PTSD but at least 1 symptom

Question 27

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (7)

Answer 27

(1) Psychoeducation: What are normal trauma responses? Potential impacts of trauma on functioning (2) Skill building & Mastery: How to manage the child when they get irritable? or they can’t sleep? (3) Trauma narrative (through a medium of choice: drawing, cartoons, writing, etc.): telling the story and the thoughts (taking them out of the box, cognitions and how it affects us → not bc we’re a bad person, not bc of us…) (4) Cognitive Techniques: Classic part of CBT to deal with negative cognitions around trauma (5) Relaxation skills (6) Safety skills: How can I feel safe in the environments I’m moving through? Don’t need to always feel hypervigilant (7) Graded exposure: Linked to trauma narrative. Repeated exposure → will lower sensitivity to the trauma

Question 28

Study: TF-CBT for Child Sexual Abuse Participants: - 2 sites - 229 youths enrolled - Age 8 to 14 - 79% female - PTSD symptoms (89% diagnosed) - 90% experienced many traumas (polyvictimization) Design: - Random assignment - TF-CBT vs. “child centered therapy” (CCT) - Groups were comparable on PTSD diagnoses Results? (2)

Answer 28

(1) In both treatment groups, children and parents improved on most outcomes (2) Compared to CCT, children receiving TF-CBT demonstrated Greater diagnostic recovery: - Fewer PTSD sx - Less shame around the traumas they experienced - Less depression (multifinality, reducing comorbid conditions) - Fewer total problems - Greater trust Parents: - Less parent depression - Less self-blame - More support of child - Better parenting in general

Question 29

Child-centered therapy (CTT) def (4)

Answer 29

(1) Focuses on establishing a trusting relationship with the therapist (2) Encourages parents and children to structure treatment (3) Decide when and how to address the trauma (4) Therapist provides active listening and empathy, and encourages parents and children to develop strategies for coping with what happened => Both have strong theoretical basis and are widely used

Question 30

Newer systematic review of TF-CBT among preschool-aged children – McGuire et al., 2021

Answer 30

- 11 studies - Mix of RCTs, case studies, single group designs - TF-CBT with pre-school aged children => Trending in positive direction (even for very young kids). No enough studies with very young population to gave enough consistency to say it’s highly effective.

Question 31

Summary: therapies for trauma (4)

Answer 31

(1) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (2) Child-centered therapy (CCT) (3) Cognitive Processing Therapy (CPT): Involves creating + repeatedly reviewing narrative, Doesn’t involve family as much, Adapting unhelpful beliefs about the trauma (4) Prolonged Exposure Therapy (PE): Rly focused on exposure, not rly cognitive behavioural side of things