Maureen A. Allwood

Children's trauma and adjustment reactions to violent and nonviolent war experiences

OBJECTIVE According to most studies, more than half of children exposed to war meet criteria for posttraumatic stress disorder (PTSD). Although we know that children are adversely affected by atrocities of war, we do not know which specific war events are associated with childrens stress reactions. For example, it is unclear whether differences exist in response to violent versus nonviolent war-trauma experiences. This study examined the relationship of violent and nonviolent war experiences to childrens trauma reactions and adjustment in a group of children from Bosnia. METHOD During the 1994 siege in Sarajevo, 791 children aged 6 to 16 years participated in a study of trauma experience and response, in which assessment questionnaires (Impact of Event Scale, PTSD Reaction Index, Childrens Depression Inventory, Child Behavior Checklist, and War Experience Questionnaire) were completed by children and their teachers. RESULTS In this sample 41% had clinically significant PTSD symptoms. Children were adversely affected by exposure to both violent and nonviolent war-traumas. An additive effect of trauma exposure on trauma reactions was also found. However, many war experiences were not associated with childrens adjustment and trauma reactions. CONCLUSIONS Additive effects of violence and deprivations during war may overwhelm the coping skills of children and leave them vulnerable to externalizing and internalizing adjustment difficulties and symptoms of PTSD.

Direct and moderating links of salivary alpha-amylase and cortisol stress-reactivity to youth behavioral and emotional adjustment

Recent studies have revealed evidence for interactions between autonomic nervous system (ANS) activity, indexed by saliva alpha amylase (sAA), and hypothalamic-pituitary-adrenocortical activity, in predicting psychological functioning. The present study extends this work by examining individual differences in sAA and cortisol stress reactivity in relation to behavioral and emotional adjustment in youth. Participants were 56 healthy children (age 7-16). sAA, cortisol, and other physiological and affective responses were measured before, during, and after stressor tasks (either performance or peer rejection). Basal and stress responsive sAA and cortisol as well as their interactions were assessed in relation to externalizing and internalizing behaviors and trait anxiety. sAA was positively related to anxiety, while sAA reactivity moderated associations between cortisol reactivity and problem behavior. Results highlight the importance of measuring multiple physiological systems to elucidate mechanisms underlying behavioral and emotional dysregulation.

Posttrauma Numbing of Fear, Detachment, and Arousal Predict Delinquent Behaviors in Early Adolescence

This study elaborated on associations between youths trauma-related emotional numbing across multiple affective domains (e.g., fear, sadness, happiness, anger) and delinquent behaviors. The study also examined whether the effects of posttrauma emotional numbing varied by the occurrence of posttrauma arousal symptoms. Participants were 123 middle school boys and girls from working-class, urban communities. Emotional numbing, particularly diminished fear, was related to both home and community violence exposure. Numbing of fearful emotions was associated with all types of delinquent behaviors examined. In addition, numbing of sadness was associated with aggression. Interactions between numbing of fear and hyperarousal suggested a complex pattern of emotional processing following exposure to traumatic events in which numbing related to delinquent behavior only in the context of high posttrauma arousal. These patterns may coalesce to place youth at risk for early involvement in delinquent behaviors.

The Relationship between PTSD Symptoms and Attention Problems in Children Exposed to the Bosnian War.

The authors examined the mediating role of posttraumatic stress symptoms in the relationship between traumatic event exposure and attention problems in a sample of 791 Sarajevan children exposed to the Bosnian war. They hypothesized that because of similarities in the arousal symptoms of posttraumatic stress disorder (PTSD) and the hyperactive—inattentive symptoms of attention-deficit/hyperactivity disorder (ADHD), PTSD symptoms would mediate the relationship between trauma exposure and attention problems. The findings support the hypothesis. The findings also show evidence of a reporter effect, whereby the relationship between trauma symptoms and attention problems was strongest when both types of symptoms were reported by school officials. Given the potentially spurious relationship between trauma exposure and attention problems, careful consideration must be given to the diagnosis of traumatized youth who present with ADHD symptoms. In accordance with practice guidelines, a multi-informant, multi-measure approach in the assessment of attention problems is strongly recommended.

Social Information Processing in Children: Specific Relations to Anxiety, Depression, and Affect.

Two studies examined shared and unique relations of social information processing (SIP) to youths anxious and depressive symptoms. Whether SIP added unique variance over and above trait affect in predicting internalizing symptoms was also examined. In Study 1, 215 youth (ages 8–13) completed symptom measures of anxiety and depression and a vignette-based interview measure of SIP. Anxiety and depression were each related to a more negative information-processing style. Only depression was uniquely related to a less positive information processing style. In Study 2, 127 youth (ages 10–13) completed measures of anxiety, depression, SIP, and trait affect. SIPs relations to internalizing symptoms were replicated. Over and above negative affect, negative SIP predicted both anxiety and depression. Low positive SIP added variance over and above positive affect in predicting only depression. Finally, SIP functioning partially mediated the relations of affect to internalizing symptoms.

Do the Long-Term Consequences of Neglect Differ for Children of Different Races and Ethnic Backgrounds?

Scant research has examined how children of different races or ethnic backgrounds manifest consequences of neglect. We examined multiple domains of functioning (academic/intellectual, social/behavioral, and psychiatric), three theories (racial invariance, double jeopardy, and resilience), and potential confounding variables. Children with documented cases of neglect (ages 0–11) and matched controls without such histories were followed up and interviewed in adulthood (N = 1,039). The sample was 47.3% female, 62.4% White, 34.3% Black, and 3.4% Hispanic. Black and White neglected children showed negative consequences for IQ, reading ability, and occupational status compared to controls. Compared to same race and ethnic group controls, neglected White children showed extensive mental health consequences, Black children showed more anxiety and dysthymia, and Hispanic children showed increased risk for alcohol problems. Black and White neglected children differed in risk for violence compared to same race controls: Neglected Black children were arrested for violence two times more often than Black controls, whereas neglected White children were more likely than White controls to report engaging in violence. Findings provide some support for each theory (racial invariance, double jeopardy, and resilience). Understanding the factors that account for similarities and differences in consequences requires further investigation. Implications for research and policy are discussed.

Child Abuse and Neglect, Developmental Role Attainment, and Adult Arrests:

This study examines whether developmental role attainment in three areas (high school graduation, employment, and marriage) mediates the relationship between childhood abuse and neglect and adult arrest. Children with documented cases of physical and sexual abuse and neglect (before age 11) and a comparison group of nonabused or neglected children were matched on age, sex, race, and approximate socioeconomic status (N = 1,169) and followed-up and interviewed at approximate age 29. Arrest records were collected from law enforcement agencies. Childhood abuse and neglect predicted decreased likelihood of graduating from high school, current employment, and current marriage and greater likelihood of juvenile and adult arrest. Each of these developmental roles partially mediated the relationship between childhood abuse and neglect and adult arrest. The importance of these three developmental milestones and implications of the results for intervening with abused and neglected youth are discussed.

Comorbidity and Service Utilization Among Psychiatrically Hospitalized Adolescents with Posttraumatic Stress Disorder

ABSTRACT Trauma exposure and posttraumatic stress disorder (PTSD) symptoms in youth have been associated with both internalizing and externalizing disorders. This study examined the prevalence of PTSD and comorbid disorders in a sample of 377 psychiatrically hospitalized adolescents. Adolescents diagnosed with PTSD had higher rates of comorbid major depressive disorder and conduct disorder as compared to adolescents without PTSD. In addition, adolescents with PTSD reported more suicidal ideations and utilized more hospital services than their non-PTSD counterparts. Findings indicate that psychiatrically hospitalized adolescents with PTSD are in need of more intensive and extended treatment services than their peers without PTSD.

Depressive Symptoms, Including Lack of Future Orientation, as Mediators in the Relationship between Adverse Life Events and Delinquent Behaviors

The present study provided a cross-sectional examination of associations among adverse life events, depressive symptoms, and delinquency in a community sample of 123 early adolescent boys and girls. We also examined whether depressive cognitions, including hopelessness, differentially mediated the relations between exposure to adverse events and delinquent behaviors. Depressive cognitions, especially lack of future orientation, were associated with delinquent behaviors and partially mediated the relationship between adverse events and delinquent behaviors. Findings highlight the importance of future orientation among adversity-exposed youth, and suggest that interventions for trauma should focus on instilling optimism and hope as a means of reducing risk for negative outcomes, including delinquency.

Negative Cognitions as a Moderator in the Relationship Between PTSD and Substance Use in a Psychiatrically Hospitalized Adolescent Sample

Adolescents exposed to trauma are more likely to engage in alcohol and marijuana use compared to their nontrauma-exposed counterparts; however, little is known about factors that may moderate these associations. This study examined the potential moderating effect of cognitions relevant to exposure to trauma (i.e., negative view of self, world, and future) in the association between posttraumatic stress disorder (PTSD) diagnosis and substance use among a psychiatric inpatient sample of 188 adolescents. Findings were that PTSD diagnosis was not significantly associated with substance-use diagnoses, but was associated with substance-use symptoms, accounting for 2.9% and 9.6% of the variance in alcohol and marijuana symptoms, respectively. The association between PTSD diagnosis and substance use symptoms, however, was moderated by negative cognitions, with PTSD and high negative cognitions (but not low negative cognitions) being significantly positively associated with substance use symptoms. The relevant cognitions differed for alcohol symptoms and marijuana symptoms. Children and adolescents who experience trauma and PTSD may benefit from early interventions that focus on cognitive processes as one potential moderator in the development of posttrauma substance use.