Day 21-22 - Childhood Trauma

Question 1

What are the 1y incidence rates of child maltreatment in the US and in Canada?

Answer 1

• US: 12/1000
• CA: 9.7/1000

Question 2

When responding anonymously, __% of parents report using forms of physical punishment that constitute child abuse

Answer 2

10%

Question 3

What is the most common form of child maltreatment?

Answer 3

neglect

Question 4

(younger/older) children are more likely to be neglected
(younger/older) children are more likely to be sexually abused

Answer 4

YOUNGER
OLDER (>12y)

Question 5

(girls/boys) are more likely to be sexually abused

Answer 5

girls

Question 6

Label the following as protective factors or risk factors for child maltreatment:
- single-parent families
- poverty
- upward social mobility
- lockdowns during pandemic

Answer 6

• single-parent families: RISK
• poverty: RISK
• upward social mobility: PROTECTIVE
• lockdowns during pandemic: RISK

Question 7

What did Pollack’s original study on emotion recognition and child maltreatment find? What are the 2 possible reasons for these findings?

Study where kids presented w vignettes and asked to pick emotional face that went with emotion in vignette

Answer 7

• physically abused children show bias for angry faces
• neglected children show bias for sad faces
• maybe kids can’t visually discriminate btw faces
• maybe kids have diff understanding of emotional displays

Question 8

What did Pollack’s follow-up study on ER and child maltreatment find? Which hypothesis was supported?

Answer 8

• no diffs between groups in emotion discrimination task! (means they CAN see differences between emotions)
• task where they had to rate similarity of two emotional faces using shelves on wall
• neglected kids perceive less diff btw angry, sad, fearful
• physically abused kids and controls perceive more diff btw anger and other emotions
• supports hypothesis that experience of maltreatment changes understanding of emotion!!!

Question 9

What did the study on ER and child maltreatment that used pixilated pictures of emotional faces find?

Answer 9

• physically abused kids identify anger faster!
• physically abused kids identify sad faces SLOWER
• no diffs for fearful and happy faces

Question 10

What are 2 examples supporting the diathesis-stress model of maltreatment leading to later psychopathology?

Answer 10

• low MAOA activity + maltreatment predicts antisocial behavior in adulthood
• short allele in serotonin transporter gene 5-HTTLPR ass w increased depression only for those who experience significant life stress OR maltreatment!!

Question 11

What other factor moderates the relationship between maltreated children w short 5-HTTLPR allele and depression rates

Answer 11

social support! (acts as protective factor, moderates the moderator)

Question 12

maltreatment as a risk factor for later psychopathology supports (multifinality/equifinality)

Answer 12

multifinality

Question 13

What is a Criterion A stressor?

Answer 13

• actual/threatened death, serious injury, sexual violation
• can be direct experience, witnessed, experience of close other, or repeated exposure to details of event
• recent scholarship includes racism/discrimination as trauma

Question 14

What are the 4 core features of PTSD? How many of each and how long do they have to last for diagnosis?

Answer 14

• INTRUSION (need 1 of memories, flashbacks, nightmares, etc)
• AVOIDANCE (need 1 of avoiding thoughts/feelings/stimuli)
• EXTREME AROUSAL (need 2 of diff w sleep, irritable/aggressive, hypervigilence, etc)
• NEGATIVE COGNITIONS/MOOD (need 2 of distorted blame, persistent trauma-related negative emotions, diminished interest in activities, alienation from others, etc)

Question 15

What symptoms are required for a PTSD diagnosis in kids 6 or younger?

Answer 15

• 1+ sx of intrusion
• 1+ sx of avoidance and/or negative cognitions
• 2+ sx of extreme arousal

Question 16

How can PTSD manifest differently in young children (under 6)?

Answer 16

• symptoms can be expressed through play
• reenactment
• more behaviorally anchored (eg will withdraw instead of “feeling” detached)
• irritability expanded to include tantrums

Question 17

What is the lifetime prevalence of PTSD in teens?

Answer 17

5%

Question 18

__% of youth who experienced a significant trauma reported at least 1 symptom of PTSD

Answer 18

85%

Question 19

What are the 5 disorders in the new DSM5 category of trauma and stressor related disorders?

Answer 19

• acute stress disorder
• adjustment disorder
• PTSD
• reactive attachment disorder
• disinhibited social engagement disorder

Question 20

What is Acute Stress Disorder?

Answer 20

• development during/within 1 month after exposure to trauma of at least 9 sx ass w intrusion, negative mood, dissociation, avoidance, arousal
• basically PTSD but w shorter time frame
• will get PTSD diagnosis is sx persist after 1m

Question 21

What is adjustment disorder?

Answer 21

• unusual/disproportionate reaction to more common and less severe forms of stress

Question 22

What are the diagnostic criteria for reactive attachment disorder (A-G)?

Answer 22

A. Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers manifested by BOTH rare/minimal comfort seeking when distressed and rare/minimal response to comfort when distressed

B. Persistent social/emotional disturbance including at least 2 of: minimal social/emotional responsiveness, limited positive affect, episodes of unexplained irritability, sadness, or fearfulness

C. Child has experienced pattern of neglect in at least 1 of: social/emotional neglect, repeated changes in primary caregivers, or rearing in unusual settings w limited opportunities to form selective attachments

D. care in Criterion C presumed responsible for Criterion A

E. does not meet criteria for ASD

F. evident BEFORE 5yrs

G. child has developmental age of at least 9mo

Question 23

What are the 2 specifiers for reactive attachment disorder?

Answer 23

• persistent (>12mo)
• severe (all symptoms met at relatively high levels)

Question 24

What are the diagnostic criteria for disinhibited social engagement disorder (A-E)?

Answer 24

A. Pattern of behavior in which child actively approaches and interacts w unfamiliar adults and exhibits at lease 2 of: reduced reticence in approaching/interacting w unfamiliar adults, overly familiar verbal/physical behavior, diminished checking back w caregiver in unfamiliar settings, or willingness to go off w unfamiliar adult w minimal hesitation

B. Behaviors in A not limited to impulsivity (as in ADHD)

C. Child has experienced pattern of neglect in at least 1 of: social/emotional neglect, repeated changes in primary caregivers, or rearing in unusual settings w limited opportunities to form selective attachments

D. care in Criterion C presumed responsible for Criterion A

E. child has developmental age of at least 9mo

Question 25

What are the 2 specifiers of disinhibited social engagement disorder?

Answer 25

• persistent (>12mo)
• severe (all symptoms met at relatively high levels)

Question 26

What are the 3 components of trauma-focused CBT?

Answer 26

• psychoeducation for parent + child
• skills building to deal w extreme anxiety (parent + child)
• trauma narrative (shared w caregiver so child isn’t alone)

Question 27

What did the study comparing TF-CBT and child centered therapy find?

Answer 27

• random assignment to tx for 12 weeks
• both groups, parent + child improved on most outcomes
• kids in TF-CBT group demonstrated greater diagnostic recovery (20% still met PTSD criteria vs 46% in CCT)