Measuring early life adversity: A dimensional approach.

Exposure to adversity in childhood is associated with elevations in numerous physical and mental health outcomes across the life course. The biological embedding of early experience during periods of developmental plasticity is one pathway that contributes to these associations. Dimensional models specify mechanistic pathways linking different dimensions of adversity to health and well-being outcomes later in life. While findings from existing studies testing these dimensions have provided promising preliminary support for these models, less agreement exists about how to measure the experiences that comprise each dimension. Here, we review existing approaches to measuring two dimensions of adversity: threat and deprivation. We recommend specific measures for measuring these constructs and, when possible, document when the same measure can be used by different reporters and across the lifespan to maximize the utility with which these recommendations can be applied. Through this approach, we hope to stimulate progress in understanding how particular dimensions of early environmental experience contribute to lifelong health.

Beyond child maltreatment: The incremental value of household dysfunction in the prediction of negative beliefs and internalizing symptoms in women.

Child maltreatment is associated with negative mental health outcomes including depression, posttraumatic stress disorder (PTSD), and anxiety. Maltreatment experiences can result in negative beliefs about safety and wellbeing, which may maintain negative mental health symptoms. Household dysfunction (eg, impaired caregiver) is considered less severe than maltreatment but more problematic than well-functioning family environments. Objective: This study investigates the incremental value household dysfunction contributes, above effects of maltreatment, to the prediction of internalizing symptoms (PTSD, depression, anxiety), and the extent to which negative beliefs might maintain these symptoms. Participants/methods: Female college students (N = 252; Mage = 19.2) electronically reported childhood exposure to maltreatment and household dysfunction, current maladaptive beliefs and internalizing symptoms. Results: Structural equation modeling showed household dysfunction significantly predicted internalizing symptoms after controlling for maltreatment experiences; this association was mediated through negative beliefs. Conclusions: Results suggest the additional importance of considering elements of household dysfunction when exploring traumatic histories.

In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT).

OBJECTIVE: Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth cognitive processes and symptoms. METHOD: Participants were a racially diverse sample of Medicaid-eligible youth (ages 7-17) and their nonoffending caregivers (N = 71 pairs) who received TF-CBT through an effectiveness study in a community setting. Caregiver and youth processes were coded from audio-recorded sessions, and outcomes were measured using the Child Behavior Checklist (CBCL) and UCLA PTSD Reaction Index for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV; UPID) at 3, 6, 9, and 12 months postintake. RESULTS: Piecewise linear growth curve modeling revealed that during the trauma narrative phase of TF-CBT, caregivers' cognitive-emotional processing of their own and their child's trauma-related reactions predicted decreases in youth internalizing and externalizing symptoms over treatment. Caregiver support predicted lower internalizing symptoms over follow-up. In contrast, caregiver avoidance and blame of the child predicted worsening of youth internalizing and externalizing symptoms over follow-up. Caregiver avoidance early in treatment also predicted worsening of externalizing symptoms over follow-up. During the narrative phase, caregiver blame and avoidance were correlated with more child overgeneralization of trauma beliefs, and blame was also associated with less child accommodation of balanced beliefs. CONCLUSIONS: The association between in-session caregiver behaviors and youth symptomatology during and after TF-CBT highlights the importance of assessing and targeting these behaviors to improve clinical outcomes. (PsycINFO Database Record