Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments.

Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

Sleep as a Moderator of Young Children's Traumatic Stress and Behavior Problems: a Treatment-Referred Sample.

Empirical evidence suggests young children who have experienced trauma are at risk of developing sleep problems and behavior difficulties, but it is unclear of the specific relation between these behavioral health concerns. The primary purpose of the study is to determine whether sleep problems moderate the relation between traumatic stress and behavior problems in a sample of young children referred for treatment. A secondary purpose is to explore if sleep problems also moderate the relation between specific domains of traumatic stress (i.e., intrusion, avoidance, arousal) and behavior problems. Data from 170 preschoolers ages 3 through 5 referred for treatment were gathered at intake and utilized in this study. Results indicate sleep problems moderate the effect of overall traumatic stress on behavior problems. This statistical finding also was found with intrusive symptoms, and the moderation analyses approached significance with avoidance and arousal. Our findings highlight the importance for clinicians to assess for sleep problems when young children who have experienced trauma are referred to them for treatment, particularly if a low level of overall traumatic stress is present.

Problematic Sexual Behavior in Children.

It is important for health care professionals to have a strong knowledge base of childhood sexual development, to know how to differentiate between problematic and normative sexual behaviors, and counsel parents accordingly given their assessment of the behaviors. A review of the literature suggests that sexual behaviors are a common occurrence in childhood, though some behaviors are rare regardless of age. Frequency of the behavior, developmental considerations, and the level of harm may help health care professionals assess whether the sexual behavior is typical or problematic. Research suggests that the development of problematic sexual behavior is related to a variety of child, family, developmental, and social factors. Recommendations for clinical care for this population are offered, and a case study highlights a health care professional's appropriate assessment and decision making.

Empirically-guided assessment of complex trauma for children in foster care: A focus on appropriate diagnosis of attachment concerns.

Complex trauma is defined as repeated or prolonged exposure to traumatic events perpetrated within the caregiving relationship during early childhood. Diagnostic decision making is challenging for this vulnerable population, given the widespread impact of these experiences across domains of developmental, social, emotional, and behavioral functioning. One domain, attachment, receives considerable attention for youth within the child welfare system, leading to frequent diagnosis of attachment disorders (i.e., reactive attachment disorder and disinhibited social engagement disorder). This is concerning, given the rarity, level of misunderstanding, associated stigma, and lack of psychometrically sound measures to assess attachment disorders. This article provides an overview of complex trauma and its effects, with a focus on attachment concerns. It subsequently describes one statewide assessment program for youth in the child welfare system with a history of experiencing complex trauma, elaborating on strengths and areas of future growth. A case study demonstrates the program's adherence to established guidelines and the resulting diagnoses and recommendations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Adverse experiences in infancy and toddlerhood: Relations to adaptive behavior and academic status in middle childhood.

Findings from the Adverse Childhood Experiences (ACE) study articulated the negative effects of childhood trauma on long-term well-being. The purpose of the current study is to examine the associations between ACEs experienced in infancy and toddlerhood and adaptive behavior and academic status in middle childhood. We used data collected from a sample of low-income families during the impacts study of Early Head Start (EHS). Data were collected by trained interviewers demonstrating at least 85% reliability with protocols. Data come from 1469 socio-demographically diverse mothers and children collected at or near ages 1, 2, 3, and 11. At ages 1, 2, and 3, an EHS-ACEs index was created based on interview and observation items. The EHS-ACEs indices were averaged to represent exposure across infancy and toddlerhood. At age 11, parents were asked about school outcomes and completed the Child Behavior Checklist. Across development, children were exposed to zero (19%), one (31%), two (27%), and three or more ACEs (23%). Logistic regression analyses, controlling for EHS program assignment, and parent, school, and child characteristics, showed ACEs were significantly associated with parental report of the child: having an individualized educational program since starting school and in the current school year, having been retained a grade in school, and problems with externalizing and internalizing behavior, as well as attention. Findings suggest that ACEs influence children's behavioral and academic outcomes early in development.

Buffering the negative effects of maternal alcohol problems on child behavior.

Our objective was to examine how mothers' warmth can protect children from the negative effects of maternal alcohol problems on children's externalizing behavior and, alternately, how harsh parenting can exacerbate the problem. We used data from 1,563 families eligible for Early Head Start and assessed when children were age 5 and again at age 11. We examined whether mothers' warmth or harsh parenting at age 5 moderated the effect of maternal alcohol problems on children's behavior problems at age 11. Results indicated that mothers' symptoms of alcohol problems when children were age 5 predicted greater externalizing behavior problems (aggression and rule breaking) when children were age 11. Aggression and rule-breaking behaviors, externalizing behaviors commonly associated with maternal alcohol problems, were lessened when mothers were warm and did not engage in harsh parenting techniques. Our findings highlight the importance of positive parenting techniques in high-risk families.

Educational handouts for Latino youth who are obese.

Although obesity is a significant problem for many children in the United States, youth who are ethnic minorities, especially Latinos, are at an even great risk than their White counterparts. This ethnic disparity suggests that it is important to target Latino youth with prevention and intervention efforts if there is to be a meaningful decline in pediatric obesity rates. Unfortunately, children, including Latino youth, often do not receive specific recommendations at their primary care visits regarding proper nutrition and exercise. With this in mind, we summarized literature related to pediatric obesity in Latino youth and translated four educational handouts that were previously published in English. The handouts are designed to be used by a variety of different professionals who work in pediatric obesity clinics and are an efficient way to share detailed information with patients.

Promoting adolescent behavioral adjustment in violent neighborhoods: supportive families can make a difference!

This study examined the moderating effects of family cohesion on the relationship between community violence and child internalizing and externalizing problems at age 18. The study sample consisted of 728 children and families who were part of the Infant Health and Development Program, an intervention study for low-birthweight, preterm infants. Six of eight sites in the Infant Health and Development Program were in large metropolitan areas; two served rural and urban areas. About half of the sample was African American. Research teams collected data from caregivers multiple times in the first 3 years of the target child's life, and at 4, 5, 6½, 8, and 18 years. Caregivers reported on community violence, neighborhood problems with (a) drug users/sellers; (b) delinquent gangs; and (c) crime, assaults, and burglaries reports when children were 4, 5, and 8 years of age. Family cohesion was assessed twice, at ages 6½ and 8 years, using caregiver reports on the Family Environment Scale. Adolescent self-report of Internalizing and Externalizing Behavior Problems at age 18 were assessed using the Behavior Problems Index. In this study, the association between adolescent psychosocial outcomes and community violence were moderated by family cohesion and gender such that being in a highly cohesive family as a child protected male children from the negative effects of community violence. Findings demonstrate the long-term protective effects of family cohesion on child behavioral development for male children but suggest a need to examine additional supports for females exposed to community violence during childhood.

The Relation Between ADHD Symptoms and Alcohol Use in College Students.

OBJECTIVE: Although there is evidence to suggest an association between ADHD and alcohol use in college students, results are inconclusive primarily because studies have failed to control for related variables. Thus, this study was designed to systematically compare the relative contributions of inattention and hyperactivity/impulsivity to alcohol use and alcohol-related problems in a sample of college students while controlling for effects of antisocial behaviors. METHOD: A total of 192 undergraduate college students from a rural Midwestern university received class credit for participating in the study. They completed measures of alcohol use, ADHD symptoms, and antisocial behavior. RESULTS: Hierarchical regressions revealed inattention, but not hyperactivity/impulsivity, was related to alcohol-related problems even when controlling for antisocial behavior. However, neither inattention nor hyperactivity/impulsivity was related to alcohol use regardless of whether current antisocial behavior was controlled. CONCLUSION: Inattention may be an important factor related to alcohol-related problems in college students.

Maladaptive eating patterns in children.

Given the increasing frequency of obesity and related maladaptive eating patterns in pediatric populations, health care professionals in a variety of settings must find ways to treat persons who are obese and have maladaptive eating patterns. The authors summarized literature related to binge eating disorder, boredom eating, emotional eating, and night eating syndrome and developed educational handouts designed for children/adolescents and their families who present with these eating problems. These educational handouts may be used by primary care physicians, psychologists, psychiatrists, nurses, and other specialists in medical settings. They are free for use in educational purposes, with permission from the authors, but are not intended to replace appropriate health care and follow-up.

The impact of technology dependence on children and their families.

Advances in medical care and technologies have prolonged life for many children with medical complexity. These advances and their effects reinforce the need for further research to determine how children and their families are being affected by technology dependence and their quality of life. A review of the literature suggests that children, as well as their family members, are negatively affected by technology dependence in a variety of psychosocial domains. Implications for clinical care and future research of this population are discussed.

An examination of multiple predictors of orthographic functioning.

The purpose of this study was to compare three variables in terms of how well they predict orthographic functioning. To this end, the authors examined the relative contributions of rapid automatic naming, exposure to print, and visual processing to a composite measure of orthographic functioning in a heterogeneous group of 8- to 12-year-old children. Hierarchical regression analyses revealed that rapid naming, exposure to print, and visual processing were each predictive of orthographic functioning when controlling for the other variables as well as vocabulary knowledge and phonological awareness. Thus, it appears that both linguistic and visual abilities are related to orthographic functioning.