Patricia Van Horn

Traumatic and Stressful Events in Early Childhood: Can Treatment Help Those at Highest Risk?

OBJECTIVE This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs). METHODS Participants comprised 75 preschool-aged children and their mothers referred to treatment following the childs exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs). RESULTS For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group. CONCLUSIONS The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well. PRACTICE IMPLICATIONS Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the childs treatment may be particularly effective in the treatment of young children exposed to multiple risks.

Trauma in early childhood: Empirical evidence and clinical implications

Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young childrens response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.

The Effects of Father Visitation on Preschool-Aged Witnesses of Domestic Violence

Fifty preschool children with varying amounts of visitation with their previously violent fathers were studied to determine if the amount of father visitation was related to their behavioral functioning. The possible association of the severity of violence witnessed and the quality of the mother-child relationship on child behaviors was also assessed. There was a significant negative relationship between internalizing and externalizing behaviors, as measured by the Child Behavior Checklist, and frequency of father visitation. Children who saw their fathers less frequently evidenced higher internalizing and externalizing scores. More severe levels of violence perpetrated by the father significantly predicted increased externalizing behavior scores but not internalizing scores. Severity of violence was more predictive of externalizing behaviors than frequency of father visitation.

Giving Voice to the Unsayable: Repairing the Effects of Trauma in Infancy and Early Childhood

The research on early trauma establishes conclusively that, although there are marked individual differences in how children in the first five years of life respond to and recover from trauma, they consistently show negative biological, emotional, social, and cognitive sequelae after enduring traumatic events. This evidence lends particular urgency to the development, evaluation and implementation of approaches to prevention and treatment that are both empirically supported and can be effectively adapted to mental health community programs and other service systems that serve traumatized children and their families. This article describes the clinical applications and community dissemination of child-parent psychotherapy (CPP), a relationship-based trauma treatment for young children and their families that has substantial empirical evidence of efficacy in decreasing symptoms of traumatic stress and restoring young childrens normative developmental trajectories. Clinical illustrations are provided to demonstrate how this intervention is conducted and to consider how it might effect therapeutic change.

Infants and Young Children in Military Families: A Conceptual Model for Intervention

Infants and young children of parents in the military deserve special attention because the first years of life are pivotal in establishing trusting attachment relationships, which are based on the developmental expectation that parents will be reliably available and protective both physically and emotionally. For young children in military families, the stresses of extended absences of mothers and/or fathers as the result of deployment abroad, recurrent separations and reunions resulting from repeated deployments, or parents struggling with the emotional sequelae of their war experiences, and the traumatic impact of parental injury and death can strain and derail the normative expectation of parental availability and protectiveness. This article describes the key features of mental health in infancy and early childhood, the developmentally expectable early anxieties that all children experience in the first years of life across cultures and circumstances, and the ways in which these normative anxieties are exacerbated by the specific circumstances of military families. The article also describes interventions that may be helpful in supporting military families and their children with the specific challenges they face.

Parental Representations in the Play of Preschool Aged Witnesses of Marital Violence

The play of young children has long been used clinically to understand children’s experiences and inner feelings. More recently, children’s play has been examined quantitatively to understand differences due to varying backgrounds, family relationships, etc. Forty preschool children (21 girls and 19 boys) aged 27 to 71 months from families with histories of domestic violence were observed using a play interview, The MacArthur Story Stem Battery, to determine if severity of violence, frequency of visitation with their previously violent fathers, and mother-child relationship functioning impacted how parents were represented in play. Overall, girls represented their parents more positively regardless of other family circumstances. Boys, especially those who did not visit regularly with their fathers, had negative representations of their mothers. Severity of violence did not predict negative parental representations in the sample.