Longitudinal Associations Between Dysfunctional Maltreatment-Related Cognitions and Psychopathology in Children and Adolescents.

Dysfunctional posttraumatic cognitions seem to play an important role in adjustment after traumatic experiences. However, little research has been done on maltreated children and adolescents. Furthermore, possible causal associations between cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems have rarely been investigated. In the current study, 263 maltreated children and adolescents (8-17 years of age) were assessed at baseline and again at time points 6 and either 12 or 18 months later. Cross-lagged panel analyses were used to gain a better understanding of the course of and associations among dysfunctional maltreatment-related cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems. Ratings of all variables significantly decreased over time. Moderate to strong autoregressive paths emerged for all variables, denoting stability. Furthermore, the variables showed moderate to high correlations at every assessment. Posttraumatic stress symptoms moderately predicted dysfunctional maltreatment-related cognitions as well as internalizing and externalizing problems 6 months after baseline. Cross-lagged paths from the cognitions as well as from internalizing and externalizing problems to all other variables were not significant. Age, gender, and maltreatment characteristics did not play a relevant role in these cross-lagged associations when they were included as covariates. Our results underline the cognitive scar model, in which preceding posttraumatic stress symptoms adversely impact cognitions. Posttraumatic stress symptoms appear to be an important target for treatment as their reduction may help decrease internalizing and externalizing problems as well.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Asociaciones Longitudinales Entre Cogniciones Disfuncionales Relacionadas Con Maltrato Y Psicopatología En Niños Y Adolescentes COGNICIONES DISFUNCIONALES RELACIONADAS CON MALTRATATO Las cogniciones postraumáticas disfuncionales parecen jugar un papel importante en la adaptación después de experiencias traumáticas. Sin embargo, se ha realizado poca investigación en niños y adolescentes maltratados. Además, se ha investigado muy poco las posibles asociaciones causales entre cogniciones, síntomas de estrés postraumático y los problemas de internalización y externalización. En este estudio, 263 niños y adolescentes maltratados (de 8 a 17 años de edad) fueron evaluados al inicio y nuevamente en los períodos de 6 y 12 o 18 meses posteriores. Se utilizaron análisis de casos de cruce desfasado para obtener una mejor comprensión del curso y las asociaciones entre las cogniciones relacionadas con el maltrato disfuncional, los síntomas de estrés postraumático y problemas de internalización y externalización. Las calificaciones de todas las variables disminuyeron significativamente en el tiempo. Trayectorias autorregresivos moderadas a fuertes surgieron para todas las variables, denotando estabilidad. Además, las variables mostraron correlaciones moderadas a altas en cada evaluación. Los síntomas de estrés postraumático predijeron moderadamente cogniciones disfuncionales relacionados con maltrato como también los problemas de internalización y externalización 6 meses después de la evaluación inicial. Trayectorias de cruce desfasado de las cogniciones, como de los problemas de internalización y externalización a todas las demás variables no fueron significativas. Las características de edad, género y maltrato no jugaron un papel relevante en estas asociaciones de cruce desfasado cuando se incluyeron como covariables. Nuestros resultados destacan el modelo de cicatriz cognitiva, en el que los síntomas de estrés postraumático precedente afectan negativamente las cogniciones. Los síntomas de estrés postraumático parecen ser una un objetivo importante para el tratamiento, ya que su reducción puede también ayudar a disminuir los problemas de internalización y de externalización.

The impact of maltreatment characteristics and revicitimization on functioning trajectories in children and adolescents: A growth mixture model analysis.

Person-centered approaches are considered promising methods for a deeper understanding of the causes and consequences of maltreatment. So far, only few studies have employed such approaches in the study of maltreatment. The aim of the present study was to examine the impact of maltreatment-related variables on trajectories after maltreatment. Growth mixture modelling (GMM) was used to examine different trajectories of functioning in 206 children and adolescents (M = 9.8 years) with a history of child maltreatment. Trajectories were analyzed in regards to maltreatment characteristics and revictimization using multinomial logistic regression. The participants were followed up over a 12 months period including three assessments. Four trajectories were identified: resilient (22.9%), worsening (15.1%), recovering (32.2%), chronic (29.8%). Revictimization (OR: 2.6-5.5), a longer period between first and last reported incident of maltreatment (OR: 0.033 - 0.038) and consequently the age at first (OR: 0.039 - 0.054) and age at last reported incident (OR: 20.3-26.9) were significant predictors of a worsening functioning trajectory. Having experienced neglect predicted a worsening trajectory in contrast to a chronic and resilient trajectory (OR = 4.8-5.2). Findings suggest that a clinical follow-up of children with a history of maltreatment is crucial as this population represents a high risk sample. A worsening trajectory was closely associated with revictimization. Functioning trajectories seem to be directly linked to chronicity and timing of maltreatment. Implications are discussed.

[Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect]. / Erfahrungen mit einem kultur- und migrationsspezifischen Workshop für Fachkräfte der Kinder- und Jugend- hilfe in der Arbeit mit misshandelten Kindern und Jugendlichen.

Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.

Usual Care for Maltreatment-Related Pediatric Posttraumatic Stress Disorder in Germany.

Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.

Dysfunctional maltreatment-related cognitions in children and adolescents.

BACKGROUND: Dysfunctional trauma-related cognitions correlate highly with chronic stress. Studies on maltreatment-related cognitions and their predictors in children and adolescents are rare. METHODS: The study sample consisted of 231 children aged 8-17 years who had experienced maltreatment including domestic violence, emotional abuse, neglect, physical, and sexual abuse. Using multiple linear regression analysis, gender, age, index-event, multi-type maltreatment, out-of-home-care, and migration background were investigated as possible predictors of dysfunctional maltreatment-related cognitions. Additionally, the associations between dysfunctional cognitions and posttraumatic stress symptoms (PTSS) as well as further internalizing and externalizing symptoms were calculated. RESULTS: Gender emerged as a significant predictor of dysfunctional maltreatment-related cognitions. Moreover, there was an interaction effect of gender and age, with female adolescents showing most dysfunctional cognitions. Furthermore, experiencing five different maltreatment types had an impact, leading to more dysfunctional cognitions compared to single-type maltreatment. Dysfunctional maltreatment-related cognitions correlated highly with PTSS and internalizing symptoms, and moderately with externalizing symptoms. CONCLUSIONS: Dysfunctional maltreatment-related cognitions are associated with psychological symptoms after maltreatment and, therefore, need to be addressed in assessment and treatment. Trial registration DRKS00003979. Registered 03 July 2012.

Effectiveness of manualized case management on utilization of evidence-based treatments for children and adolescents after maltreatment: A randomized controlled trial.

The objective of this study was to compare structured case management (CM) to usual care (UC) for helping victims of child abuse and neglect (CAN) with mental disorders access evidence-based treatment (EBT). N=121 children and adolescents aged 4-17 with a history of CAN and a current mental disorder were recruited in three German states in a multi-center parallel group trial. They were randomly assigned, stratified by study site and level of psychosocial functioning, to receive CM additionally to UC or only UC. CM was delivered by trained professionals and volunteers, most of them affiliated to local child welfare agencies or NGOs. UC comprised child welfare services typically delivered in Germany. The primary outcome was EBT utilization after 6 months. Secondary outcome was the time until commencement of EBT. Outcomes were determined by semi-structured clinical interviews with assessors blinded to group allocation. Predictors of access to EBT and barriers to utilization of treatment were analyzed. The intent to treat analysis showed that after 6 months 23 of 60 participants recruited to CM (38%) and 19 of 61 participants recruited to UC (31%) were using EBT, χ2 (1, N=121)=0.689, p=.261. Female gender, out-of-home placement, and home state were significant predictors of access to EBT. Less than 40% of participants across both groups were successfully referred to EBT. Access to EBT seems to be in part due to system-level barriers, namely lack of implementation of EBT in community settings. TRIAL REGISTRATION: DRKS00003979 German Clinical Trials Register.

Data on maltreatment profiles and psychopathology in children and adolescents.

We present data on maltreatment profiles and psychopathology of 358 children and adolescents (4-17 years). Data on maltreatment profiles has been categorized into six major maltreatment types: physical abuse, emotional abuse, sexual abuse, sexual abuse with penetration, exposure to intimate partner violence and neglect. The data on history of maltreatment is based on the interview version of the Juvenile Victimization Questionnaire (JVQ). Additionally data on psychopathology in general as well as specific disorders according to DSM-IV based on K-SADS-PL is presented. The data was used to examine patterns of co-occurrences of maltreatment and associated clinical outcome variables using latent class analysis (LCA), "Experience by children and adolescents of more than one type of maltreatment: association of different classes of maltreatment profiles with clinical outcome variables" (Witt et al.,) [1].

Experience by children and adolescents of more than one type of maltreatment: Association of different classes of maltreatment profiles with clinical outcome variables.

Most victims of child abuse have experienced more than one type of maltreatment, yet there is a lack of understanding of the impact of specific combinations of types of maltreatment. This study aimed to identify meaningful classes of maltreatment profiles and to associate them with short-term clinical outcomes. A total of 358 German children and adolescents aged 4-17 with a known history of child maltreatment were included in the study. Through interviews and questionnaires, information was obtained from participants and their primary caregivers on history of maltreatment, sociodemographics, psychopathology, level of psychosocial functioning, and health-related quality of life. Types of abuse were categorized into six major groups: sexual abuse in general, sexual abuse with penetration, physical abuse, emotional abuse, neglect, and exposure to domestic violence. A latent class analysis (LCA) was performed to determine distinct multi-type maltreatment profiles, which were then assessed for their associations with the sociodemographic and clinical outcome variables. The LCA revealed that participants could be categorized into three meaningful classes according to history of maltreatment: (1) experience of multiple types of maltreatment excluding sexual abuse (63.1%), (2) experience of multiple types of maltreatment including sexual abuse (26.5%), and (3) experience of predominantly sexual abuse (10.3%). Members of Class 2 showed significantly worse short-term outcomes on psychopathology, level of functioning, and quality of life compared to the other classes. Three distinct profiles of multiple types of maltreatment were empirically identified in this sample. Exposure to multiple types of abuse was associated with poorer outcomes.

Psychological Symptoms of Sexually Victimized Children and Adolescents Compared With Other Maltreatment Subtypes.

The differential effects of sexual victimization and other forms of maltreatment on psychological functioning are not well understood. A sample of sexually victimized children and adolescents (N = 70; 6.3-17.9 years) and a group of youth with a history of nonsexual maltreatment (N = 108; 6.7-16.9 years) were compared using measures of mental health and psychosocial functioning. Assessments included standardized clinical interviews on individual maltreatment history and current psychopathology as well as questionnaires on behavioral and emotional symptoms, including posttraumatic stress symptoms. The results from this study suggest that the risk of experiencing any current mental disorders was independent of type of maltreatment. The risk of meeting the criteria for a current diagnosis of major depression, however, is greater among youth with a history of maltreatment that includes sexual victimization. The significant impact of sexual victimization on posttraumatic stress symptoms was found to be nonsignificant after controlling for age and gender effects. The results indicate that the outcomes of child maltreatment depend on type of maltreatment, but age and gender must be taken into account.

[Children and adolescents after child abuse and neglect: Do they receive appropriate treatment?]. / Kinder und Jugendliche mit Misshandlungserfahrungen: bekommen sie die Versorgung, die sie brauchen?

BACKGROUND: Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood. OBJECTIVES: This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN. METHODS: From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews. RESULTS: Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment. CONCLUSIONS: The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.

Please Tell! Barriers to Disclosing Sexual Victimization and Subsequent Social Support Perceived by Children and Adolescents.

The present study examines barriers to disclosing sexual victimization and perceived social support after disclosure from the perspective of children and adolescents. Forty-two children and adolescents aged 6 to 17 years participated in semistructured interviews about their history of sexual victimization, the delay of disclosure, barriers to disclosure, informal and formal recipients of disclosure, as well as abuse-specific social support as perceived by the recipients. The participants disclosed their victimization with a delay of approximately 17 months, ranging from immediate reporting to 10 years of nondisclosure. The most frequent reasons to withhold the information were feelings of shame and threats by the perpetrator. A majority felt that people believed and supported them after disclosing, but a considerable proportion of study participants reported a lack of perceived protection against recurring victimization. The results underline the importance of educating children and adolescents about sexual victimization and of encouraging the immediate reporting of critical incidents. Possibilities to address the barriers identified in this study are discussed.

[Improving Access to Evidence Based Interventions for Children and Adolescents with Mental Disorders After Child Abuse and Neglect]. / Verbesserter Zugang zu evidenzbasierten Therapien für psychisch kranke Kinder und Jugendliche nach Kindesmisshandlung und -missbrauch.

Victims of child abuse and neglect are more likely to develop emotional and behavioral problems than their non-abused peers. In many cases they do not receive evidence based treatments. Based on pilot studies and clinical experience, a structured and manualized case-management protocol was developed to provide child welfare professionals guidance, direction and support in helping these families find and engage in appropriate treatment. The protocol is described. A survey among child welfare workers indicates a lack of knowledge about mental disorders in victims of child abuse as well as an insufficient cooperation between the child welfare and the mental healthcare system. Child welfare workers who have applied the manual evaluate it positively. This study shows that the structured case-management can be implemented in a child welfare setting.

Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature.

OBJECTIVE: This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization. METHODS: A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample. RESULTS: In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment. CONCLUSIONS: Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.

[Trauma history and posttraumatic stress symptoms among children and adolescents attending a mental health service]. / Traumaanamnese und posttraumatische Stresssymptomatik in einer kinder- und jugendpsychiatrischen Inanspruchnahmepopulation.

OBJECTIVE: Systematic exploration of potentially traumatic events and posttraumatic stress symptoms of patients attending a hospital for child and adolescent psychiatry and psychotherapy. METHODS: The UCLA PTSD Reaction Index for DSM-IV was filled in by 413 children and adolescents and 403 caregivers at their first attendance at the clinic. RESULTS: At least one traumatic event was reported by 46.9% of the children and adolescents and/or caregivers. Clinically relevant post-traumatic stress symptoms were reported in 22.9%. CONCLUSION: In the investigated sample routinely performed screening assessments can identify clinically relevant post-traumatic stress symptoms in almost one of four patients of child mental health services.