Melissa A. Bright

Focus on Methodology: Salivary bioscience and research on adolescence: An integrated perspective

The characterization of the salivary proteome and advances in biotechnology create an opportunity for developmental scientists to measure multi-level components of biological systems in oral fluids and identify relationships with developmental processes and behavioral and social forces. The implications for developmental science are profound because from a single oral fluid specimen, information can be obtained about a broad array of biological systems and the genetic polymorphisms related to their function. The purpose of this review is to provide a conceptual and tactical roadmap for investigators interested in integrating these measurement tools into research on adolescent health and development.

Do Infants Show a Cortisol Awakening Response

Upon awakening from sleep, combined processes of deactivation of the hippocampus and activation of suprachiasmatic nucleus result in a marked increase in cortisol release from structures within the hypothalamic-pituitary-adrenal axis. This phenomenon, termed the cortisol awakening response (CAR), has been studied extensively in adults. In the current study, we examine this phenomenon for the first time in infancy. Saliva samples were collected by 32 mothers from themselves and their infants (13 males; 7.8-17.4 months of age) at the infants AM waking (and 30 min later), and upon waking from the infants first nap (and 30 min later). In contrast to what has been observed with the CAR in adults, cortisol levels declined from AM waking to 30 min post-waking. Moreover, cortisol levels did not significantly rise or fall following naps. Consistent with prior research, both group-level and dyadic-level analyses showed that cortisol levels for mother-infant dyads were associated.

Adverse childhood experiences and dental health in children and adolescents.

OBJECTIVE This study seeks to explore the how specific toxic stressors, specifically adverse childhood experiences (ACEs), and their frequencies may be associated with tooth condition and the presence of caries. METHODS Data from the 2011-12 National Survey for Child Health (NSCH), a nationally representative survey of child health, were used in this study. Pediatric dental health was measured using parent report of two characteristics: condition of teeth and having a toothache, decayed teeth, and/or unfilled cavities in the past 12 months. ACEs were measured by asking about a childs exposure to the divorce of a parent, parental incarceration, domestic violence, neighborhood violence, drug and alcohol abuse, mental illness, and financial hardship. Analyses were adjusted by sociodemographic characteristics, healthcare access and utilization, and comorbid chronic conditions. RESULTS The presence of even one ACE in a childs life increased the likelihood of having poor dental health. Additionally, having multiple ACEs had a cumulative negative effect on the condition of their teeth and the presence of dental caries (Odds Ratios 1.61-2.55). Adjusted models show that racial and socioeconomic factors still play a significant role in dental health. CONCLUSIONS In addition to the known disparities in dental caries, this study demonstrates that there is significant association between childhood psychosocial issues and dental health. Preventive dental care should be considered incorporating the screening of multiple biological stressors, including ACEs, in routine dental visits as a means of identifying and reducing dental health inequities.

Individual differences in the cortisol and salivary α‐amylase awakening responses in early childhood: Relations to age, sex, and sleep

Recent studies have examined post-waking changes in cortisol as a marker of HPA functioning, but questions remain about the stability of this response, as well as its relation to sleep and other ANS markers. The purposes of this study were to a) examine the presence and developmental changes in the cortisol awakening response (CAR) and salivary α-amylase awakening (sAA-AR) in a toddler sample and b) determine whether and how sleep relates to these responses in this age group. We measured cortisol and sAA upon awakening (and 30 min post-waking) and sleep characteristics using actigraphy (e.g., total sleep time, sleep efficiency, number of awakenings) in toddlers (N = 47; 36% female, ages 12-24 months). Forty-six percent of toddlers demonstrated a CAR and 52% demonstrated a sAA-AR. Strength of either response did not change linearly with age. Additionally, likelihood of demonstrating the CAR and sAA-AR was unrelated to age, sex, awakening time, time between samples, and time since feeding. Higher waking cortisol levels were associated with a shorter total sleep time and an earlier awakening. No associations were observed between sleep characteristics and the sAA-AR, ps > .05. Our findings suggest that these awakening responses function independently of sleep in toddlers. Additionally, the lack of change in percentage of children showing a CAR or sAA-AR across these ages suggests that these responses are stable and not emerging reliably across the second year of life.

Primary Care Pediatricians' Perceived Prevalence and Surveillance of Adverse Childhood Experiences in Low- Income Children

Objective. A recent policy statement from the American Academy of Pediatrics outlines the central role of pediatricians in screening for and addressing precipitants of toxic stress (e.g., adverse experiences). Despite these recommendations, it is unknown whether pediatricians are in fact screening for these precipitants. Methods. A sample of 210 pediatricians serving low-income children completed a survey regarding their responses to adverse childhood experiences (ACEs). Participants were asked to estimate the prevalence of ACEs in their practice, their current practices, and recommendations for screening. Results. For nearly all ACEs, pediatricians’ estimates of the prevalence in their practice were lower than state-reported prevalence. For many ACEs, the number of pediatricians who support the need for recommended screening was far higher than the number who reported actually screening. Conclusions. Our findings suggest clinicians serving primarily low-income families recommend screening but may underestimate the prevalence of ACEs in their practice and may not be equipped to screen or address these matters consistently.

Youth Arrested for Trading Sex Have the Highest Rates of Childhood Adversity A Statewide Study of Juvenile Offenders

A history of childhood adversity is associated with high-risk behaviors and criminal activity in both adolescents and adults. Furthermore, individuals with histories of child maltreatment are at higher risk for engaging in risky sexual behavior, experiencing re-victimization, and in some cases, becoming sexual offenders. The purpose of the current study was to examine the prevalence of individual and cumulative adverse childhood experiences (ACEs) reported by 102 offending youth who were arrested for trading sex and 64,227 offending youth who were arrested for various other crimes, using Florida’s Positive Achievement Change Tool. Youth with violations related to sex trafficking had higher rates for each ACE as well as number of ACEs, particularly sexual abuse and physical neglect. These findings have implications for identifying adverse experiences in both maltreated and offending youth as well as tailoring services to prevent re-victimization.

Animal cruelty as an indicator of family trauma: Using adverse childhood experiences to look beyond child abuse and domestic violence

Youth who engage in animal cruelty are known to be at increased risk of perpetrating violence on other people in their lives including peers, loved ones, and elder family members. These youths have often been exposed to family violence, including animal cruelty perpetrated on their beloved pets by violent adults. The current study utilizes a data set of 81,000 juvenile offenders whose adverse childhood experiences are known and includes 466 youth who self-report engaging in animal cruelty. Compared to the larger group of juvenile offenders, the children admitting to engaging in animal cruelty are younger at time of first arrest, more likely to be male, and more likely to be White. When looking at their reports of adverse childhood experiences (ACEs), they are more likely than other juvenile offenders to have an array of adverse experiences beyond family violence and to have four or more ACEs. Although the youth who are cruel to animals are already troubled, the fact that they present to law enforcement at early ages provides early opportunities for intervention. Service providers outside the law enforcement field, such as teachers, physicians, veterinarians and animal control officers may be able to identify these vulnerable youth, and refer them to needed services before violence is visited on other humans.

Intergenerational Continuity of Risky Parenting: A Person-Oriented Approach to Assessing Parenting Behaviors

Limited research has investigated the long-term effects of childhood emotional abuse on later forms of parenting. This study utilized a person-centered approach to explore the relation between retrospectively-reported maternal childhood emotional abuse and observed parenting behaviors during a conflict discussion. Data were collected from 53 caregiver-child dyads with children ages 8–11. Results of a model-based clustering procedure (Mclust; Fraley and Raftery 2006) identified three parenting styles (negative, at-risk, positive) that were based on five observed parenting behaviors (emotion regulation, anger, hostility, psychological control, and psychological unavailability). Results indicated that higher levels of childhood emotional abuse were reported by women in the at-risk and negative parenting subgroups. Mothers in the negative parenting and at-risk parenting clusters exhibited greater levels of emotional abuse when compared to the positive parenting cluster. Possible implications are discussed, and results underscore the importance of emotionally abusive developmental experiences in the understanding of risk for maladaptive parenting behaviors.

Visits to Primary Care and Emergency Department Reliance for Foster Youth: Impact of Medicaid Managed Care

OBJECTIVE To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access. METHODS Secondary administrative data were obtained from Medicaid programs in one state that transitioned foster youth from an FFS to an MC (Texas) and another state, comparable in population size and racial/ethnic diversity, which continuously enrolled foster youth in an FFS system (Florida). Eligible participants were foster youth (aged 0-18 years) enrolled in these states between 2006 and 2010 (n = 126,714). A Puhani approach to difference-in-difference was used to identify the effect of transition after adjusting for race/ethnicity, gender, and health status. Data were used to calculate access to primary and preventive care as well as ED reliance. ED reliance was operationalized as the number of ED visits relative to the number of total ambulatory visits; high ED reliance was defined as ≥33%. RESULTS The transition to MC was associated with a 6% to 13% increase in access to primary care. Preventive care visits were 10% to 13% higher among foster youth in MC compared to those in FFS. ED reliance declined for the intervention group but to a lesser extent than did the control group, yielding a positive mean percentage change. CONCLUSIONS Foster youth access to care may benefit from a Medicaid MC delivery system, particularly as the plans used are designed with the unique needs of this vulnerable population.

Association of Adverse Childhood Experiences with Co-occurring Health Conditions in Early Childhood

Objective: To understand how adverse childhood experiences (ACEs) are associated with co-occurring physical, mental and developmental problems during early childhood. Method: A subsample of 19,957 children aged 2–5 years were selected from the 2011–2012 National Survey for Child Health. Outcomes included 18 health conditions organized in singular condition domains (physical, mental, and developmental), and combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). Predictors included 8 ACEs (divorce of a parent, death of a parent, exposure to domestic violence, living with someone with a drug or alcohol abuse problem, household member with a mental illness, parent incarceration, neighborhood violence, discrimination). Multivariable logistic regression was performed controlling for demographic characteristics, having a personal doctor, health insurance coverage, and seeing a health care professional in the previous year. Results: Experiencing 3 or more ACEs before the age of 5 years was associated with increased likelihood of nearly every co-occurring condition combination across 3 domains of health. Most notably, experiencing 3 or more ACEs was also associated with a 2-fold increase in likelihood of having ≥1 physical condition and ≥1 developmental condition, a 9-fold increase in likelihood of having ≥1 mental and ≥1 developmental condition, and a 7-fold increase in likelihood of having ≥1 physical, ≥1 mental, and ≥1 developmental condition. Conclusion: This study demonstrates that we can identify the health effects of adversity quite early in development and that management should include communication between both health care and early childhood education providers.