Trauma-Informed Care for Youth in Foster Care.

For decades, evidence has shown an undeniable connection between childhood trauma and chronic adverse reactions across the lifespan (Bilchik & Nash, 2008; Perry, 2001; Perry, 2006). Childhood traumatic experiences are associated with serious and persistent, long-term physical, psychological, and substance abuse issues. In addition to adverse effects on physical health, research indicates that early childhood trauma has particularly adverse effects on adolescent self-esteem, coping skills, school performance, self-regulation, critical thinking, self-motivation, and the ability to build healthy relationships (O'Connell, Boat, & Warner, 2009). A traumatic event is a dangerous or distressing experience, outside the range of usual human experience that overwhelms the capacity to cope and frequently results in intense emotional and physical reactions, feelings of helplessness and terror, and threatens serious injury or death (The National Child Traumatic Stress Network [NCTSNET], 2014). Approximately five million children each year in the United States experience some type of traumatic experience (Perry, 2006). Nationwide community studies estimate between 25% and 61% of children and adolescents have a history of at least one exposure to a potentially traumatic event and 38.5% of American adults claim to have experienced at least one traumatic event before the age of 13 (Briggs et al., 2012; Gerson & Rappaport, 2013). According to results of a 2002-2003 survey of 900 New York City adolescents, 24% reported a history of witnessing someone being shot, 12% reported exposure to someone being killed, and 51% reported witnessing someone being beaten or mugged (O'Connell et al., 2009). Each year, 2-3 million children are victims of maltreatment, a type of trauma, including physical and/or sexual abuse (U.S. Department of Health and Human Services, 2014; Perry, 2006). Compared to the general population, youth in foster care are significantly more likely to have experienced violence, specifically abuse and/or neglect (Burns et al., 2004). It is estimated that approximately 90-percent of children in foster care have experienced a traumatic event, with nearly half reporting exposure to four or more types of traumatic events (Stein et al., 2001). Given the widespread prevalence of traumatic exposures, it is important for the mental health professionals working with foster care youth, to be aware of the prevalence and various types of trauma that are most common. Focus in treatment is typically on behavioral and emotional reactions rather than addressing the context of these symptoms, including trauma exposure histories and trauma-specific reactions. Clinicians must maintain awareness of the frequency and impact of childhood traumatic experiences on subsequent behaviors and overall functioning. Clinicians should appreciate the link between how traumatized children understand the world and interact with others differently from other children and how to provide appropriate treatment for children with a history of traumatic exposures. Practitioners must remain alert to symptoms that may suggest a history of trauma and must have an understanding of the difficulties adolescents may face regulating their emotions and behavior, as a symptom of a past traumatic experience. The failure to address trauma through screening, assessment, and treatment has major implications for long-term public health costs and services.

Effects of a psychosocial family-based preventive intervention on cortisol response to a social challenge in preschoolers at high risk for antisocial behavior.

CONTEXT: Salivary cortisol levels during social challenge relate to adaptive functioning in children and adults. Low cortisol levels have been related to conduct problems and antisocial behavior. Although studies in rodents implicate early-life social experience in cortisol regulation, no studies with humans have examined the effects of an experimentally manipulated early-life social experience on cortisol regulation. OBJECTIVE: To examine the effects of experimental manipulations of social experience on cortisol response to a social challenge in preschoolers at risk for antisocial behavior. DESIGN: Randomized controlled trial. SETTING: Department of Child and Adolescent Psychiatry, New York University School of Medicine. PARTICIPANTS: Ninety-two preschool-age siblings of youths adjudicated for delinquent acts. Intervention Family-based intervention included 22 weekly group sessions for parents and preschoolers and 10 biweekly home visits conducted during a 6- to 8-month period. MAIN OUTCOME MEASURES: Salivary cortisol levels before and after a social challenge (entry into an unfamiliar peer group). RESULTS: Relative to controls, children in the intervention condition had increased cortisol levels in anticipation of the peer social challenge. Increases were relative to both preintervention cortisol levels during the challenge and cortisol levels in the home, which were not altered by the intervention. CONCLUSIONS: A family-based preventive intervention for children at high risk for antisocial behavior alters stress response in anticipation of a peer social challenge. The experimentally induced change in cortisol levels parallels patterns found in normally developing, low-risk children.

Escaping the nuclear confines: signal-dependent pre-mRNA splicing in anucleate platelets.

Platelets are specialized hemostatic cells that circulate in the blood as anucleate cytoplasts. We report that platelets unexpectedly possess a functional spliceosome, a complex that processes pre-mRNAs in the nuclei of other cell types. Spliceosome components are present in the cytoplasm of human megakaryocytes and in proplatelets that extend from megakaryocytes. Primary human platelets also contain essential spliceosome factors including small nuclear RNAs, splicing proteins, and endogenous pre-mRNAs. In response to integrin engagement and surface receptor activation, platelets precisely excise introns from interleukin-1beta pre-mRNA, yielding a mature message that is translated into protein. Signal-dependent splicing is a novel function of platelets that demonstrates remarkable specialization in the regulatory repertoire of this anucleate cell. While this mechanism may be unique to platelets, it also suggests previously unrecognized diversity regarding the functional roles of the spliceosome in eukaryotic cells.