Lindsay Huffhines

The link between adverse childhood experiences and diabetes

Exposure to adversity in childhood (adverse childhood experiences [ACEs]) is linked to a number of chronic diseases in adulthood, yet there is limited research examining the impact of ACEs on diabetes. The current review sought to examine the association between ACEs, other trauma exposure or posttraumatic stress disorder (PTSD) diagnosis, and risk for diabetes. Thirty-eight studies are reviewed. Unlike in other diseases, several studies in diabetes show a threshold-response versus a dose-response relation, while other studies show a relation between greater abuse severity and diabetes risk. There were mixed results for studies examining abuse type and frequency. Chronic or comorbid PTSD was also related to increased diabetes risk among veterans, but in community samples, only trauma exposure predicted diabetes risk. While the research is still limited, diabetes researchers and clinicians should consider screening for ACEs and examine severity and frequency across abuse type as a predictor of both diabetes and poor diabetes outcomes.

Adaptive Intervention Designs in Pediatric Psychology: The Promise of Sequential Multiple Assignment Randomized Trials of Pediatric Interventions

This article summarizes the utility of multiphase optimization strategy (MOST) and sequential multiple assignment randomized trial (SMART) processes in the development of empirically derived adaptive interventions (AIs). Recent empirical evidence suggests that SMART designs conducted within the context of a MOST framework can be used for building and optimizing AIs and may lead to better clinical care. SMART designs help optimize AIs by determining the best sequencing of decision rules. However, despite their growing relevance, MOSTs and SMARTs are relatively underutilized in the development of pediatric interventions. MOST and SMART designs can be used for developing efficient and cost-effective AIs. Intervention research within the field of pediatric psychology may benefit from incorporating these designs.

Child Maltreatment, Trauma, and Physical Health Outcomes: The Role of Abuse Type and Placement Moves on Health Conditions and Service Use for Youth in Foster Care

OBJECTIVE The purpose of the study was to investigate the relations between abuse types, non-maltreatment-related trauma, and health service utilization in a sample of youth in foster care with and without chronic medical conditions. METHOD A total of 213 youth, aged 8-21 years, provided self-report of general trauma and abuse exposure. Medicaid claims for each child were collected from official state databases. RESULTS Exposure to sexual abuse, neglect, or general trauma but not exposure to physical abuse or psychological abuse increased the rates of medical visits, while only general trauma increased medical hospitalizations.  CONCLUSIONS Trauma types are not equally predictive of health care utilization for youth with chronic health conditions.

Diabetes conflict outstrips the positive impact of self‐efficacy on youth adherence and glycemic control in type 1 diabetes

To examine whether self‐efficacy buffers the deleterious consequences of diabetes‐specific family conflict on self‐monitoring blood glucose (SMBG) and glycated hemoglobin (HbA1c) in youth with type 1 diabetes mellitus (T1DM).

Coping styles in youth exposed to maltreatment: Longitudinal patterns reported by youth in foster care

Coping styles in youth living in foster care with a history of maltreatment were examined to determine the nature and stability of self-reported coping behavior over time. Participants included 542 (time 1), 377 (time 2), and 299 (time 3) youth ages 8-22 years (M=13.28years, SD=3.04). Using the Behavioral Inventory of Strategic Control, a dimensional, continuous measure of coping, across four possible coping styles endorsed in reference to specific potentially stressful situations, the results indicated that direct action coping was the most frequently endorsed or preferred style for more than 50% of the sample at each time point. A number of youth endorsed using more than one coping style, indicating some flexibility in the approach to coping when problems occur. Although most youth endorsed a preferred style, coping style endorsed did vary somewhat over time. The coping style endorsed also varied depending on the type of problem referenced, but no statistically significant differences were noted across situations, including social, academic, general, and foster-specific situations. Effects for age were also examined and the results indicated no significant differences across the age range for type of coping most commonly endorsed. The present study is the first large-scale, longitudinal assessment of coping styles in youth in foster care and the results suggest that coping is not a simple, categorical-only construct and the implications for the endorsement of the direct approach for youth in foster care along with the other findings are discussed.

Case file coding of child maltreatment: Methods, challenges, and innovations in a longitudinal project of youth in foster care

State social service agency case files are a common mechanism for obtaining information about a childs maltreatment history, yet these documents are often challenging for researchers to access, and then to process in a manner consistent with the requirements of social science research designs. Specifically, accessing and navigating case files is an extensive undertaking, and a task that many researchers have had to maneuver with little guidance. Even after the files are in hand and the research questions and relevant variables have been clarified, case file information about a childs maltreatment exposure can be idiosyncratic, vague, inconsistent, and incomplete, making coding such information into useful variables for statistical analyses difficult. The Modified Maltreatment Classification System (MMCS) is a popular tool used to guide the process, and though comprehensive, this coding system cannot cover all idiosyncrasies found in case files. It is not clear from the literature how researchers implement this system while accounting for issues outside of the purview of the MMCS or that arise during MMCS use. Finally, a large yet reliable file coding team is essential to the process, however, the literature lacks training guidelines and methods for establishing reliability between coders. In an effort to move the field toward a common approach, the purpose of the present discussion is to detail the process used by one large-scale study of child maltreatment, the Studying Pathways to Adjustment and Resilience in Kids (SPARK) project, a longitudinal study of resilience in youth in foster care. The article addresses each phase of case file coding, from accessing case files, to identifying how to measure constructs of interest, to dealing with exceptions to the coding system, to coding variables reliably, to training large teams of coders and monitoring for fidelity. Implications for a comprehensive and efficient approach to case file coding are discussed.

A Short Form of the Trauma Symptom Checklist for Children

The purpose of the current study was to develop a short form (SF) of the Trauma Symptom Checklist for Children (TSCC). The TSCC-SF) maintained 29 items, from the original 54 items, in a sample (N = 215) of sexually abused children who were seeking treatment at a child advocacy center. Exploratory factor analysis refined the original measure, and confirmatory factor analysis provided evidence for best fit for a six-factor, 29-item model. The TSCC-SF evidenced good internal reliability and showed convergent validity with child ratings of post-traumatic stress disorder (PTSD) symptoms obtained from the University of California at Los Angeles PTSD Reaction Index. The TSCC-SF has promise as a shorter assessment measure with sexually abused children in numerous settings, including child advocacy centers and pediatric clinics, where efficient screening and assessment are essential for providing the best standard of care.

A Pilot Study of Universal Teacher–Child Interaction Training at a Therapeutic Preschool for Young Maltreated Children

Young children are disproportionately exposed to maltreatment but are underrepresented in research on effective treatments. Universal Teacher-Child Interaction Training (TCIT-U), developed from Parent-Child Interaction Therapy, may be especially appropriate for maltreated children as they often experience caregiver disruptions which pose challenges to traditional parent-child treatment. Furthermore, research suggests that teachers can play an important role for children who lack positive caregiving experiences. The current study examined the effectiveness of TCIT-U versus treatment-as-usual (TAU) at a therapeutic preschool for youth exposed to maltreatment. Thirty-eight children (2–5 years old) and eight teachers from four classrooms participated in the study. Teacher behaviors were observed and coded at baseline, mid-treatment, post-treatment, and 3-month follow-up. Teachers reported on children’s behavior and social-emotional skills at baseline, post-treatment, and 3-month follow-up. TCIT-U teachers demonstrated substantial increases in positive attending skills (PRIDE [Praise, Reflection, Imitation, Description, and Enjoyment] skills) and decreases in negative talk and questions during intervention phases, and these skills were maintained at follow-up. In addition, children in the TCIT-U classrooms demonstrated a significantly greater increase in overall social-emotional skills by post-treatment than children in the TAU classrooms, and effect sizes were moderate for all child outcomes. Findings provide preliminary support for TCIT-U’s effectiveness in a therapeutic setting for children exposed to maltreatment.

Maltreatment, Coping, and Substance Use in Youth in Foster Care: Examination of Moderation Models:

Child maltreatment is associated with negative outcomes such as substance use (SU). This study tested relations among maltreatment history, coping behavior, and SU behavior in youth residing in foster care. Participants were 210 youth (Mage = 12.71 years; SD = 2.95) in foster care who completed self-report measures through an audio computer-assisted self-interview program. Using a structural equation modeling framework and latent measurement constructs, positive associations were identified between maltreatment at baseline and coping behavior outcomes as well as SU behavior outcome approximately 4.5 months later. Specifically, greater severity and chronicity of maltreatment was associated with greater SU behavior as well as indirect action, prosocial, and asocial coping behavior. Maltreatment was not significantly related to direct action coping behavior. In moderation tests, only asocial coping provided a significant interaction effect for SU behavior outcomes; SU behavior did not moderate pathways between maltreatment and coping behavior. For youth in foster care, the coping approach may be varied and relate differentially to SU behavior outcomes, with asocial approaches to coping acting as a buffer for the maltreatment/SU relation. Additionally, SU remains an important target for intervention and prevention in youth residing in foster care.

The relation between dimensions of maltreatment, placement instability, and mental health among youth in foster care

Youth in foster care with maltreatment experiences often demonstrate higher rates of mental and behavioral health problems compared to youth in the general population as well as maltreated youth who remain at home. Previous research has demonstrated that dimensions of maltreatment (type, frequency, and severity) and placement instability are two prominent factors that account for high rates of psychopathology (e.g., depression, anxiety, and disruptive behavior disorders). The present study sought to clarify the relation between maltreatment and mental health among youth in foster care by studying both the isolated dimensions of maltreatment and cumulative maltreatment, and to determine whether the effects of maltreatment on mental health operated indirectly through placement instability. Information on youth in foster cares (N = 496, Mage = 13.14) mental and behavioral health, maltreatment history, and placement changes were obtained from state records and primary caregivers. Using a SEM framework, the results suggest that maltreatment and placement instability each independently relate to mental and behavioral health problems. Further, none of the maltreatment types predicted greater placement instability in the current models. These findings suggest that placement stability is critical for mental health for youth in foster care, regardless of the type, severity, or frequency of their maltreatment experiences. Results also indicated that, although cumulative maltreatment predicted both internalizing and externalizing symptoms, maltreatment frequency and severity had direct relations to externalizing symptoms only. These findings underscore the utility of comprehensive maltreatment assessment, encouraging researchers and clinicians to assess and carefully consider the relation between maltreatment dimensions and outcomes.