Ashley A. Knapp

Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda.

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.

An experimental test of the effects of parental modeling on panic-relevant escape and avoidance among early adolescents.

Escape and avoidance behaviors play a prominent role in the maintenance and possibly development of panic disorder, yet the literature regarding the etiology of these emotion-regulation strategies is relatively underdeveloped. The current study experimentally tests hypotheses that parental modeling of escape during a well-established panic-relevant biological challenge increases panic-relevant escape and avoidance among offspring. Fifty physically and psychologically healthy early adolescents (28 females; Mage=11.58; 86% Caucasian), stratified by gender, were randomly assigned to observe one of their parents (39 females; Mage=40.04): either (a) model completing a 3-min voluntary hyperventilation exercise (no escape modeling group) or (b) model premature termination of a similar procedure (escape modeling group). Offspring in the escape modeling group demonstrated a stronger escape response by discontinuing their own challenge sooner than those in the no-escape modeling group (r=.70). No group differences emerged in terms of avoidance responding, as indexed by nearly identical responding in terms of delay time before initiating the challenge, respiration rate, and self-reported willingness to engage in a second proposed challenge. Results suggest that parental behaviors may play an important role in the development of some forms of panic-relevant responding. These preliminary findings may have important implications for future prevention programs targeting parents and at-risk youth.

Traumatic Event Exposure and Alcohol Use Expectancies among Adolescents

Extant work suggests that trauma-exposed adolescents are at risk for problematic drinking. Although work conducted with adults suggests that trauma-exposed individuals drink to reduce negative affectivity, no work has yet examined alcohol use outcome expectancies (AOEs) among trauma-exposed adolescents. The current study examined positive AOEs as a function of trauma history among 63 community-recruited youths (Mage = 15.92; 46% girls). Findings indicated that trauma exposure predicted elevated tension-reduction AOEs. Furthermore, the indirect effect of tension-reduction expectancies accounted for a significant proportion of the relation between trauma exposure and alcohol use frequency. These preliminary data are discussed in terms of future research efforts.

Indirect effects of smoking motives on adolescent anger dysregulation and smoking.

Cigarette smoking is one of the leading causes of disease and death in the United States, and smoking typically begins in adolescence. It is therefore important to understand factors that relate to increased risk for cigarette smoking during this stage of development. Adolescence is a period when emotion regulatory capacities are still emerging and a common affective state to be regulated is anger, which adult research has linked to nicotine use. Drawing from work suggesting that negative affect reduction motives are one of the most common reasons for cigarette smoking, the current study was designed to evaluate the indirect effects of negative affect reduction motives on the relation between anger dysregulation and nicotine use within a sample of 119 treatment-seeking adolescents enrolled in group-based residential therapy. Results were generally consistent with hypotheses, suggesting significant indirect effects of negative affect reduction smoking motives on the relation between anger dysregulation and smoking outcomes. Findings are discussed in terms of negative affect reduction motives for cigarette use in the context of anger regulation among youths.

The roles of sex, anxious reactivity to bodily arousal, and anxiety sensitivity in coping motives for cigarette smoking among adolescents.

Evidence suggests that smoking to cope among adolescents is associated with a number of problematic outcomes (e.g., greater smoking frequency, higher rates of dependence). It is thus imperative to better understand factors that may increase the likelihood of smoking to cope among adolescents. Research suggests anxiety sensitivity (AS) is associated with smoking to cope among adults, although the link between AS and coping motives for cigarette use among youth is less clear. Gender differences have also been noted in AS. The current study investigates this association using a biological challenge paradigm. Specifically, the indirect effects of anxious reactivity to bodily arousal on the relation between the physical and mental AS factors and coping motives for cigarette smoking were examined within a sample of 108 adolescent cigarette smokers. Gender was examined as a moderator. Results suggested significant indirect effects of self-reported anxiety in response to bodily arousal on the relation between physical AS and coping motives for cigarette smoking. This indirect effect was moderated by gender, such that it was significant for females but not males. Models examining AS mental concerns and psychophysiological responding to the challenge were not significant. These results suggest that, relative to their low AS counterparts, female adolescents high in physical concerns respond with elevated anxiety in response to interoceptive arousal and, in turn, endorse elevated coping-related smoking motives. Findings are discussed in terms of implications for understanding the nature and origins of coping-related smoking motives and how such information can be used to inform intervention efforts. (PsycINFO Database Record

A preliminary study of subclinical panic symptom elevations among adolescent offspring of parents with PTSD who smoke

Objectives: Research has linked parental post-traumatic stress disorder (PTSD) and parental smoking to a wide array of psychological and physical health concerns among offspring. Furthermore, the combination of parental anxiety psychopathology generally, along with smoking, has been linked to elevated adolescent panic symptomatology. However, no research has examined the unique and interactive associations between parental PTSD and smoking in terms of offspring panic. Method: The current study sought to begin to address this gap in the literature by examining adolescent-reported panic symptom levels as a function of parent-reported PTSD and current smoking. Results: Among 25 dyads (Mparent age = 42.92 years [SD = 6.71]; Moffspring age = 15.80 years [SD = 1.04]), adolescent offspring of smokers with PTSD reported significantly higher panic symptoms compared with all other combinations of these factors after controlling for multiple theoretically relevant and empirically associated covariates. Supporting model specificity, parental PTSD and smoking were not related to adolescent depression or other types of anxiety. Conclusions: These results are consistent with research linking the combination of parental anxiety psychopathology and smoking to offspring panic generally, and parental PTSD and smoking to panic symptoms specifically. Research on possible mechanisms of intergenerational transmission as well as replication and extension of these findings is now needed.

Adolescent Worry Induction: An Experimental Laboratory Evaluation

Available research indicates that worry is an important process in need of further investigation, particularly among adolescents. While a sizable body of literature has examined the nature, prevalence, and correlates of worry in both adults and youth, laboratory investigations of this variable using a real-time worry induction paradigm have been completed almost exclusively with adults. The current study aimed to extend the literature by experimentally examining the validity of a worry induction in a sample of adolescents. Fifty adolescents between the ages of 12 and 17 years were randomly assigned to either a worry or a neutral thought condition. Results provided initial support for the validity of using an ideographic worry induction procedure with adolescents, suggesting the induction produces elevated generalized negative affectivity and future-oriented mentation relative to a control group. Unexpectedly, predictions regarding the effects of the induction on verbal-linguistic thoughts were not supported. Results are discussed in terms of their convergence and divergence with the adult literature as well as relevant developmental factors to consider in future utilization of worry induction procedures in order to better understand the phenomenology and consequences of worry among youth.

A laboratory-based test of the relation between adolescent alcohol use and panic-relevant responding.

A burgeoning literature supports a link between alcohol use and panic-spectrum problems (e.g., panic attacks, disorder) among adolescents, but the direction of influence has yet to be properly examined. From a theoretical perspective, panic-spectrum problems may increase risk for problematic drinking via affect regulation efforts (e.g., self-medication), and problematic consumption also may increase or initiate panic-relevant responding (e.g., learning or kindling models). The objective of the current investigation was to examine the role of prior alcohol use in predicting panic-relevant responding, as well as panic symptom history in predicting the desire to consume alcohol, in the context of either a voluntary hyperventilation or a low-arousal task. Participants were community-recruited adolescents aged 12-17 years (n = 92, Mage = 15.42, SD = 1.51; 39.1% girls). Results indicated that prior alcohol use predicted panic-relevant responding among those undergoing the hyperventilation task (but not the low-arousal task), and that this finding was robust to the inclusion of theoretically relevant covariates (i.e., age, sex, negative affectivity). However, panic symptom history did not predict the desire to consume alcohol as a function of either the hyperventilation or low-arousal condition. This work sheds further light on the nature of the relation between panic-spectrum problems and problematic alcohol use in adolescence. Specifically, the current findings suggest that frequent alcohol use may increase panic vulnerability among adolescents, whereas acute panic symptoms may not elicit the immediate (self-reported) desire to drink.