Parallel Process of Posttraumatic Stress and Externalizing Problems Among Youth at High Risk for Victimization.

Research shows comorbidity between posttraumatic stress symptoms (PTSS) and externalizing problems among polyvictimized youth. However, the impact of polyvictimization on the longitudinal co-development of PTSS and distinct forms of externalizing problems remains unclear. Growth trajectory modeling was used to address this gap. At ages 8, 12, and 16, polyvictimization was measured using youth, caregiver, and official records; whereas youth self-reported PTSS and caregivers reported aggression and delinquency. Results demonstrate that changes in PTSS and each externalizing domain were independent. Further, polyvictimization and PTSS/aggression were only associated at concurrent time points. In contrast, polyvictimization and delinquency were generally associated at concurrent and distal time points, suggesting that polyvictimization may have a more enduring impact on youths' delinquent behaviors than other symptoms.

Development and validation of a postnatal risk score that identifies children with prenatal alcohol exposure.

BACKGROUND: This study aimed to develop an efficient and easily calculable risk score that can be used to identify an individual's risk of having been exposed to alcohol prenatally. METHODS: Data for this study were collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, Phases 2 and 3. Two cohorts (ages 5 to 17 years) completed a comprehensive neurobehavioral battery and a standard dysmorphology exam: a development cohort (DC; n = 325) and a comparative cohort (CC; n = 523). Both cohorts included two groups: those with histories of heavy prenatal alcohol exposure (AE-DC, n = 121; AE-CC, n = 177) and a control group that included subjects with minimal or no prenatal alcohol exposure (CON-DC, n = 204; CON-CC, n = 346). Behavioral assessments and physical exam data were combined using regression techniques to derive a risk score indicating the likelihood of prenatal alcohol exposure. Subjects were then divided into two subgroups: (1) low risk and (2) high risk. Chi-square (χ2 ) determined classification accuracy and ROC curves were produced to assess the predictive accuracy. Correlations between risk scores and intelligence quotient and executive function scores were calculated. RESULTS: Subjects were accurately classified in the DC (χ2  = 78.61, p < 0.001) and CC (χ2  = 86.63, p < 0.001). The classification model also performed well in the DC (ROC = 0.835 [SE = 0.024, p < 0.001]) and CC (ROC = 0.786 [SE = 0.021, p < 0.001]). In the AE-CC and CON-CC, there were modest but significant associations between the risk score and executive function (AE-CC: r = -0.20, p = 0.034; CON-CC: r = -0.28, p < 0.001) and intelligence quotient (AE-CC: r = -0.20, p = 0.034; CON-CC: r = -0.28, p < 0.001). CONCLUSION(S): The risk score significantly distinguished alcohol-exposed from control subjects and correlated with important cognitive outcomes. It has significant clinical potential and could be easily deployed in clinical settings.

Mixed-Method Examination of Latinx Teachers' Perceptions of Daily Behavioral Report Card Interventions to Support Students with ADHD.

Daily behavioral report cards (DRC) are an efficacious intervention for children with ADHD, yet there is little information on Latinx teachers' perceptions about ADHD and preferences related to behavioral treatment. The purpose of the current study was to examine the feasibility and acceptability of behavioral consultation with Latinx teachers and students, with a particular focus on the DRC. Participants (n = 23) included elementary school teachers (100% Hispanic/Latinx, 96% female) working with predominantly Hispanic/Latinx students. We leveraged a convergent, mixed-method design to evaluate feasibility, acceptability, as well as several potentially associated factors (i.e., perceptual, practical/logistical, individual, and cultural factors). Quantitative and qualitative measures and analyses were guided by the Consolidated Framework for Intervention Research. We found that Latinx teachers' Daily Report Card (DRC) completion rates (80%) were comparable to previous studies with predominantly non-Latinx white teachers and students. Quantitative indicators of acceptability were also similar to the prior literature. Few variables were associated with DRC completion rates, with the exception of teacher self-report of stress and satisfaction, which were both positively associated with completion rates. Qualitative findings expanded quantitative trends; thematic analyses revealed two overarching themes, that (1) teachers' attitudes toward behavioral interventions matter a great deal, and that (2) teachers' perceived behavioral control over DRC implementation depends a lot on the environment. Findings highlight the importance of stakeholders' perspectives, including teachers, in translating research to practice in real world settings.

Validity and Reliability of Executive Function Measures in Children With Heavy Prenatal Alcohol Exposure: Correspondence Between Multiple Raters and Laboratory Measures.

BACKGROUND: Rating scales are designed to complement traditional performance-based measures, and both can provide useful information about the functioning of youth with histories of prenatal alcohol exposure. Few studies, however, have compared ratings from multiple informants or the relationship between these subjective rating scale scores and the objective results from laboratory performance-based scales. METHODS: The current study addressed both of these questions in 3 study groups: children with histories of prenatal alcohol exposure (n = 47), attention-deficit/hyperactivity disorder (ADHD; n = 41), and typically developing controls (CON; n = 73). All subjects completed a standardized neuropsychological test battery, including laboratory measures of executive functioning and a self-report measure of executive function behaviors. Parents and teachers completed corresponding rating scales of executive function behaviors for each subject. This study assessed the relationship between these behavior rating scales and corresponding neuropsychological tests, and interrater agreement among the multiple informants. RESULTS: Weak correlations were found between the rating scales and laboratory measures, indicating poor convergent validity for the behavior rating scale. Interrater reliability was found but it differed by group. Agreement was found between parent and teacher ratings for children with prenatal alcohol exposure, whereas teacher-child agreement was found for those with ADHD. CONCLUSIONS: Findings from this study indicate that behavior ratings can be used to supplement laboratory measures but may not be measuring cognitive abilities regardless of whether a clinical diagnosis is present. A multimethod approach should be used when measuring skills in this domain. This was one of the first studies to examine cross-informant agreement in a sample of children with prenatal alcohol exposure. Further research is necessary to understand why interrater agreement differed for children with prenatal alcohol exposure and those with ADHD.

Overcoming racial battle fatigue: The associations between racial microaggressions, coping, and mental health among Chicana/o and Latina/o college students.

OBJECTIVES: The current study tested a conditional process model to determine if (a) different problem-focused coping styles mediated the association between racial microaggressions and mental health, and (b) ethnic identity exploration and commitment moderated these associations. METHOD: Participants were 681 Chicana/o and Latina/o undergraduates matriculating at a public research university in the southwestern United States; 71.7% (n = 488) identified as female and the average age of participants was 20.1 years. Data collected using an online survey were analyzed using structural equation modeling with bootstrapped confidence intervals. RESULTS: Experiencing more racial microaggressions was associated with students' use of more problem-focused coping styles, as well as poorer mental health. All coping styles partially mediated the association between microaggressions and mental health. However, only reflective coping was associated with more positive mental health; reactive and suppressive coping were associated with poorer mental health. These associations were not moderated by ethnic identity. CONCLUSIONS: Consistent with the racial battle fatigue framework, experiencing racial microaggressions in college may contribute to diminished mental well-being for Chicana/o and Latina/o students. Using reflective rather than suppressive or reactive coping styles could facilitate psychological well-being following racial microaggressions among Chicana/o and Latina/o college students. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Black and proud: The role of ethnic-racial identity in the development of future expectations among at-risk adolescents.

OBJECTIVES: Research examining factors that foster future expectations has been limited, especially among at-risk ethnic minority adolescents. The present study prospectively examined the protective role of ethnic-racial identity (ERI) in the association between adverse childhood experiences (ACEs) and future family, educational, and occupational expectations among at-risk Black and White adolescents. METHODS: Data were collected from 558 adolescents (73% Black, 27% White) who were at-risk for family violence and participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Information about ACEs was collected prospectively (CPS records and caregiver reports) between birth and age 12. Adolescents reported their ERI, feelings of affirmation and belonging, to their ethnic-racial groups at age 12 and their future expectations at age 14. RESULTS: Structural equation models revealed that in general, ACEs were associated with more negative educational expectations, b = -.04, p < .001, and stronger ERI was associated with decreased expectations for occupational difficulties, b = -.36, p < .001. Tests of moderation revealed that for Black, but not White adolescents, stronger ERI was significantly associated with more positive educational expectations, b = .36, p < .001, and that the negative association between ACEs and educational and occupational expectations was mitigated by stronger ERI, b = .15, p < .001. CONCLUSIONS: Findings underscore the importance of cultivating strong ERI among at-risk Black adolescents as a positive coping strategy to increase their educational and occupational expectations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Racial/ethnic differences in caregivers' perceptions of the need for and utilization of adolescent psychological counseling and support services.

BACKGROUND: Black caregivers may be more likely to have negative experiences with mental health services/providers and lack knowledge of psychopathology and mental health services relative to White caregivers. These perceptual and informational barriers could influence the likelihood that Black caregivers utilize psychological counseling and support services for their adolescents compared to White caregivers. The current study examined differences between Black and White caregivers in the associations between their adolescents' internalizing and externalizing problems and their perceptions of need for and utilization of psychological counseling and support services. METHOD: Data for the present study were collected from 741 diverse caregivers (63% Black, 37% non-Hispanic White) about their adolescents. Caregivers reported their adolescent's psychopathology and their perceptions of their adolescent's need for and utilization of psychological counseling, parenting classes, and youth mentoring programs. RESULTS: Caregivers who reported that their adolescents had clinically elevated psychopathology were more likely to report a need for psychological counseling or support services in general. However, they were only more likely to report that their adolescents received psychological counseling services. Black caregivers were significantly less likely than White caregivers to report that their adolescent needed psychological counseling and were more likely than White caregivers to report that their adolescents needed a youth mentoring program if they had clinically elevated externalizing problems. CONCLUSIONS: Black caregivers may perceive mentoring programs as a less stigmatizing and more culturally congruent support service for addressing externalizing problems. Integration and dissemination of evidence-based intervention strategies to underserved populations using culturally acceptable intervention modalities is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Step Beyond Maternal Depression and Child Behavior Problems: The Role of Mother-Child Aggression.

Previous researchers have identified problematic mother-child interaction patterns as a potential pathway through which maternal depressive symptoms impact child behavior problems, but could not establish the temporal precedence of these associations. This longitudinal study investigated mother-child aggression as a mechanism in the association between maternal depressive symptoms that occurred during infancy and subsequent child behavior problems among high-risk families. Two hundred thirty-four socioeconomically disadvantaged families were recruited from neighborhoods with high rates of family violence. During infancy (12-18 months), early childhood (4 years), and middle childhood (6 years), mothers reported their current depressive symptoms and use of psychological and physical aggression with their child. During early and middle childhood, mothers reported their children's behavior problems. Using path analyses, a temporal process was identified in which mother-child aggression during early childhood mediated the association between maternal depressive symptoms during infancy and higher levels of externalizing behavior problems during middle childhood. Mother--child aggression did not mediate the association between maternal depressive symptoms during infancy and higher levels of internalizing behavior problems during middle childhood. Early maternal depressive symptoms that occur during infancy are important risk factors for subsequent mother-child aggression, which, in turn, contributes to more child externalizing behavior problems. Therefore, screening mothers for depressive symptoms and providing intervention and prevention services to improve mother-child interactions may be crucial to preventing the exacerbation of externalizing behavior problems. Additional research is needed to identify pathways to child internalizing behavior problems.

Direct and Indirect Pathways From Adverse Childhood Experiences to High School Dropout Among High-Risk Adolescents.

Adverse childhood experiences (ACEs) are associated with an increased risk for school dropout. This study examined pathways from childhood adversity to school dropout through academic, behavioral, emotional, and social pathways. Data were collected prospectively from 728 adolescents and their caregivers who participated in the Longitudinal Studies of Child Abuse and Neglect and from child protective services records. Path analyses revealed a direct association between ACEs and dropout, as well as indirect effects through poor reading achievement and elevated externalizing problems. ACEs were associated with elevated internalizing problems, which were negatively associated with dropout. However, ACEs were not associated with peer influences. Implications of the identified mechanisms in the ACEs and school dropout association for future preventive interventions are discussed.

Cost-Effectiveness of a Behavioral Psychosocial Treatment Integrated Across Home and School for Pediatric ADHD-Inattentive Type.

We conducted a cost-effectiveness analysis (CEA) of two behavioral psychosocial interventions for children with ADHD-inattentive type: Child Life and Attention Skills (CLAS) program and parent-focused treatment (PFT) compared to community-based treatment as usual (TAU). The CEA evaluated cost per ADHD case resolved measured by parent and teacher reports of ADHD inattentive symptoms. Total cost per patient for CLAS, PFT, and TAU were $1559, $710, and $0. CLAS, the costliest treatment, was more effective than PFT and TAU. The incremental cost-effectiveness ratios (ICER) per disordered case resolved are: $3997 for CLAS versus TAU, $3227 for PFT versus TAU, and $4994 for CLAS versus PFT. PFT is the more cost-effective option based on initial CEA. However, CLAS may be comparably cost-effective by streamlining the model, which resulted in an ICER of $29 compared to PFT. Notably, cost for CLAS is substantially below the annual cost for unresolved ADHD.

The Potential Protective Role of Peer Relationships on School Engagement in At-Risk Adolescents.

Negative outcomes associated with adverse childhood experiences are well established, but little is known about protective factors that could promote positive adjustment among high-risk youth. This study examined the potential protective role of positive peer relationships in the association between adverse childhood experiences and school engagement among at-risk adolescents. Data were collected prospectively from birth until age 16 from 831 diverse adolescents (52.6% female; 54% African American, 24% Caucasian) who were at-risk for family violence and their caregivers. The significant and negative associations between adversities and school engagement outcomes at age 16 were mitigated by peer intimacy and companionship and exacerbated by peer conflict. The findings underscore the importance of fostering positive peer relationships for improving school engagement among at-risk adolescents.

Long-Term Placement Trajectories of Children Who Were Maltreated and Entered the Child Welfare System at an Early Age: Consequences for Physical and Behavioral Well-Being.

OBJECTIVE: This study aimed to identify children's long-term placement trajectories following early child welfare involvement and the association of these trajectories with subsequent physical and behavioral well-being. METHOD: Participants were 330 children who entered out-of-home care following a substantiated report of child abuse or neglect during infancy/early childhood and their caregivers. Participants were interviewed at child ages 4 and 12 years to assess children's physical and behavioral well-being and every 2 years in between to determine child placements. RESULTS: Latent Class Analyses identified four stable placement trajectories (i.e., adopted [32%], kinship care [15%], stable reunified [27%], and stable foster care [9%]), and two unstable trajectories (i.e., disrupted reunified [12%] and unstable foster care [5%]). Logistic regressions revealed that children in the unstable trajectories had significantly poorer physical and behavioral well-being than children in stable trajectories. CONCLUSIONS AND RELEVANCE: Maltreated children placed in out-of-home care are at risk for long-term placement instability and poorer physical and behavioral well-being.

Parenting Mediates Symptoms and Impairment in Children With ADHD-Inattentive Type.

The current study investigates potential pathways between inattentive symptom severity, positive and negative parenting practices, and functional impairment (i.e., academic, social, and home impairment) in a sample of children diagnosed with attention-deficit/hyperactivity disorder, Predominantly Inattentive Type (ADHD-I). Participants included 199 children and their parents and teachers enrolled in a randomized clinical trial investigating the efficacy of an integrated psychosocial intervention for children with ADHD-I. Boys constituted slightly more than half the sample; children averaged 8.6 years of age (range = 7-11) and were from varied ethnic/racial backgrounds. As part of the initial screening and assessment procedures, parents and teachers completed questionnaires assessing child behavior and parent/family functioning. Results supported both main effects of symptoms and parenting on impairment, as well as a mediational path between symptoms and impairment via parenting, as observed by parents in the home setting. Specifically, higher severity of inattention was associated with higher rates of homework, social, and home impairment. Negative parenting contributed to homework and home impairment, and positive and negative parenting contributed to social impairment, incrementally above and beyond the impact of inattention symptom severity alone. Negative parenting partially mediated the relationship between inattentive symptom severity and impairment, such that higher rates of inattention were associated with higher rates of negative parenting, which in turn was associated with higher rates of homework, social, and home impairment. Results provide support for underlying mechanisms for associations between symptoms and impairment in children with ADHD-I and identify potential intervention targets to improve impairment experienced by these children.

Developmental transitions in presentations of externalizing problems among boys and girls at risk for child maltreatment.

The present study examined the impact of children's maltreatment experiences on the emergence of externalizing problem presentations among children during different developmental periods. The sample included 788 youth and their caregivers who participated in a multisite, prospective study of youth at-risk for maltreatment. Externalizing problems were assessed at ages 4, 8, and 12, and symptoms and diagnoses of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder were assessed at age 14, during interviews with youth and caregivers. Information about maltreatment allegations was coded from official records. Latent transition analysis identified three groups of youth with similar presentations of externalizing problems ("well adjusted," "hyperactive/oppositional," and "aggressive/rule-breaking") and transitions between groups from ages 4, 8, and 12. A "defiant/deceitful" group also emerged at age 12. Girls were generally more likely to present as well adjusted than boys. Children with recent physical abuse allegations had an increased risk for aggressive/rule-breaking presentations during the preschool and preadolescent years, while children with sexual abuse or neglect allegations had lower probabilities of having well-adjusted presentations during middle childhood. These findings indicate that persistently severe aggressive conduct problems, which are related to the most concerning outcomes, can be identified early, particularly among neglected and physically and sexually abused children.

Additive effects of parent adherence on social and behavioral outcomes of a collaborative school-home behavioral intervention for ADHD.

The present study evaluated the impact of the Collaborative Life Skills Program (CLS), a novel school-home psychosocial intervention, on social and behavioral impairments among children with attention and behavior problems. Fifty-seven ethnically/racially diverse children (70 % boys) with attention and/or behavior problems in the second through fifth grades participated in a pilot study. Ten school-based mental health professionals were trained and then implemented the intervention at their respective schools. Children significantly improved from pre- to post-treatment on parent, teacher, and report card ratings of children's social and behavioral functioning. Treatment improvements were consistent for children with and without co-occurring disruptive behavior problems. The impact of the intervention was enhanced when parents used the intervention strategies more regularly, according to both clinicians' and parents' reports. Findings support the emphasis of CLS on coordinating intervention strategies across contexts to facilitate the generalization of treatment-related improvements in social and behavioral functioning.

Racial/ethnic differences in anorexia and bulimia diagnoses among U.S. college students.

This study examined the prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) diagnoses among college students from different racial/ethnic backgrounds. Utilizing archival data from the American College Health Association - National College Health Assessment II-C (ACHA-NCHA II-C), information from 426,425 college students collected between 2015 and 2019 was examined. Binary logistic regression analyses were conducted to determine the prevalence of AN and BN diagnoses among various racial and ethnic groups. The highest odds of AN diagnosis were observed among American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) students, with odds ranging from 2.143 (compared to White students) to 3.744 (compared to Black students). White students had higher odds of AN than Black (OR = 1.748), Hispanic/Latino (OR = 1.706), and Asian (OR = 1.531) students. Biracial/Multiracial students had significantly higher odds of AN than Black (OR = 1.653), Hispanic/Latino (OR = 1.616), and Asian (OR = 1.449) students. In terms of BN diagnoses, AI/AN/NH students had the highest odds compared to all other groups, ranging from 2.149 (compared to White students) to 2.899 (compared to Hispanic/Latino students). White students had higher odds of BN than Black (OR = 1.271) and Hispanic/Latino (OR = 1.350) students. Biracial/Multiracial students also had significantly higher odds of BN than Black (OR = 1.388) and Hispanic/Latino (OR = 1.474) students. Asian students had higher odds of BN than Black (OR = 1.252) and Hispanic/Latino (OR = 1.329) students. These findings demonstrate complex patterns of AN and BN diagnoses among different racial/ethnic groups. These results highlight the need for culturally sensitive prevention and treatment plans on college campuses.

Racial and Ethnic Disparities in Weight Loss Behaviors Among US College Students.

Purpose: Weight loss behaviors are prevalent among college students and are associated with adverse physical and psychological outcomes, such as an elevated risk of developing an eating disorder. While cross-ethnic differences have been reported, no consistent pattern has emerged. The purpose of this study was to examine racial and ethnic differences in weight loss behaviors among female and male college students. Patients and Methods: The American College Health Association-National College Health Assessment (ACHA-NCHA) II-C survey data from the collection periods from 2015 to 2019 was used. A total of 426,425 students participated in the survey. Most participants were White (60%) and female (68.5%). Information on students' age, body mass index (BMI), and self-rated health was also collected. Logistic regression analyses were performed to determine cross-ethnic differences in weight loss methods among female and male students. Results: Students' weight loss behaviors were assessed and included dieting, exercising, vomiting or taking laxatives, and the use of diet pills in the past 30 days. More than half of the participants attempted to lose weight through exercise (53.5%), and 40.3% of students dieted to lose weight in the past month. Purging and the use of diet pills were endorsed by 2.9% and 2.8% of the participants, respectively. With few exceptions, male students from racial and ethnic minority backgrounds were more likely to engage in extreme weight control practices (ie, vomiting or taking laxatives, taking diet pills) than White male students, while female students from racial and ethnic minority backgrounds were less likely to use diet and exercise as weight loss methods than White female students. For all outcomes, Biracial/Multiracial and Hispanic/Latino male students were more likely to attempt weight loss than White male students. Biracial/Multiracial female students more frequently endorsed extreme weight control behaviors than White female students. Conclusion: The results of the present study add to the growing body of literature on the relationship between race and ethnicity and weight loss behaviors. The findings indicate the need for tailored educational and intervention programs on college campuses.

Psychometric Assessment of the Eyberg Child Behavior Inventory in Children with Autism in Community Settings.

The Eyberg Child Behavior Inventory (ECBI) is a frequently used measure to assess interfering behaviors in children and psychometric properties have recently been examined in children with autism spectrum disorder (ASD). There is a need to confirm the identified factors and examine the factor structure in a racially/ethnically diverse, community-based sample. The current study conducts a psychometric analysis of the ECBI in a sample of children with ASD receiving publicly-funded mental health services. Data were collected from 201 children with ASD ages 5-13 years (60% Hispanic/Latinx) participating in a community effectiveness trial. Confirmatory factor analysis indicated poor model fit using previously identified factors and a new four-factor solution was identified. Clinical and research implications of these findings are discussed.

Everyday Conflict in Families at Risk for Violence Exposure: Examining Unique, Bidirectional Associations with Children's Anxious- and Withdrawn-Depressed Symptoms.

Exposure to family conflict during childhood increases risk for the development of anxiety and mood problems, though the potential for bidirectionality in this association remains unknown. It is also unclear whether nonviolent family conflict is related to children's anxious- and withdrawn-depressive symptoms within high-risk family contexts, independent of more severe events such as children's exposure to violent victimization. Participants included 1,281 children and their caregivers identified as being at high risk for family violence, interviewed prospectively at ages 6, 8, and 10 about family conflict, children's anxious- and withdrawn-depressive behaviors, and children's victimization experiences. After controlling for cumulative victimization prior to and between each time point, significant cross-lagged, bidirectional associations were identified between family conflict and children's anxious- and withdrawn-depressive symptoms across ages 6 and 8, but not across ages 8 and 10. Invariance testing revealed no differences in model fit between boys and girls and minimal differences depending on whether families were reported for maltreatment prior to recruitment. Findings are partially supportive of a conceptualization of the family-child relationship that is reciprocal, while highlighting the role of daily negative familial interactions, over and above experiences of victimization, in predicting anxious- and withdrawn-depressed symptoms in early and middle childhood.

Conduct Problems As a Pathway From Childhood Adversity to Community Violence Exposure: The Protective Roles of Caregiver Knowledge and Involvement.

Exposure to community violence (ECV) poses a prevalent threat to the health and development of adolescents. Research indicates those who have more Adverse Childhood Experiences (ACEs) are at higher risk for ECV, which further exacerbates risk of negative mental and physical health impacts. Additionally, those with more ACEs are more likely to exhibit conduct problems, which has also been linked to risk for ECV. Despite the prevalence and impact of ECV, there is limited longitudinal research on the risk factors that precede this exposure as well as family-level factors that may prevent it. The current study examined conduct problems as a potential mediator between ACEs and future indirect (i.e. witnessing) ECV in adolescents. Additionally, this study included caregiver factors, such as caregiver knowledge about their adolescent, caregiver involvement, and caregiver-adolescent relationship quality as potential protective moderators. Participants included (N = 1137) caregiver-adolescent dyads identified as at-risk for child maltreatment prior to child's age four for inclusion in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Conduct problems at age 14 mediated the relationship between ACEs from ages 0-12 and indirect ECV at age 16 (standardized indirect effect = .03, p = .005). Caregiver knowledge moderated the indirect relationship (b = -.40, p = .030), and caregiver involvement moderated the direct relationship between ACEs and indirect ECV (b = -.03, p = .033). Findings expand our knowledge about the longitudinal pathways that increase risk of violence exposure over the course of adolescent development, as well as the protective benefits caregivers can offer to disrupt these pathways and reduce risk of future traumatization. Implications are discussed for interventions that aim to address and prevent trauma and adverse outcomes among youth exposed to child maltreatment, household dysfunction, and community violence.