Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems.

PURPOSE: Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS: Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS: Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION: These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.

Knowledge of Evidence-Based Services Questionnaire: Development and Validation of a Short Form.

The Knowledge of Evidence-Based Services Questionnaire (KEBSQ) is an objective measure of therapist knowledge of practices derived from the evidence base for the treatment of youth psychopathology. However, the length of this measure (i.e., 40 items) and respondent demands associated with each item makes it burdensome for researchers and clinicians. This study developed and validated a Short Form of the KEBSQ using Item Response Theory measurement models. The Short Form consists of 17 items and generates two separate scores: Correct Endorsements and Correct Rejections. The Short Form was found to correlate highly with and perform similarly to the Full Form, providing preliminary validity evidence.

The Core Components of Evidence-Based Social Emotional Learning Programs.

Implementing social emotional learning (SEL) programs in school settings is a promising approach to promote critical social and emotional competencies for all students. However, there are several challenges to implementing manualized SEL programs in schools, including program cost, competing demands, and content that is predetermined and cannot be tailored to individual classroom needs. Identifying core components of evidence-based SEL programs may make it possible to develop more feasible approaches to implementing SEL in schools. The purpose of this study was to systematically identify the core components in evidence-based elementary school SEL programs, using the five interrelated sets of competencies identified by the Collaborative for Academic, Social, and Emotional Learning (CASEL) as an organizing framework. We present the components that were identified, and the rates at which each component was included in the sample of evidence-based SEL programs. The core components that occurred most frequently across programs were Social Skills (100% of programs), Identifying Others' Feelings (100% of programs), Identifying One's Own Feelings (92.3% of programs), and Behavioral Coping Skills/Relaxation (91.7% of programs). These findings illustrate the feasibility of systematically identifying core components from evidence-based SEL programs and suggest potential utility of developing and evaluating modularized SEL programs.

A meta-analysis of the relationship between socioeconomic status and executive function performance among children.

The relationship between childhood socioeconomic status (SES) and executive function (EF) has recently attracted attention within psychology, following reports of substantial SES disparities in children's EF. Adding to the importance of this relationship, EF has been proposed as a mediator of socioeconomic disparities in lifelong achievement and health. However, evidence about the relationship between childhood SES and EF is mixed, and there has been no systematic attempt to evaluate this relationship across studies. This meta-analysis systematically reviewed the literature for studies in which samples of children varying in SES were evaluated on EF, including studies with and without primary hypotheses about SES. The analysis included 8760 children between the ages of 2 and 18 gathered from 25 independent samples. Analyses showed a small but statistically significant correlation between SES and EF across all studies (rrandom  = .16, 95% CI [.12, .21]) without correcting for attenuation owing to range restriction or measurement unreliability. Substantial heterogeneity was observed among studies, and a number of factors, including the amount of SES variability in the sample and the number of EF measures used, emerged as moderators. Using only the 15 studies with meaningful SES variability in the sample, the average correlation between SES and EF was small-to-medium in size (rrandom  = .22, 95% CI [.17, .27]). Using only the six studies with multiple measures of EF, the relationship was medium in size (rrandom  = .28, 95% CI [.18, .37]). In sum, this meta-analysis supports the presence of SES disparities in EF and suggests that they are between small and medium in size, depending on the methods used to measure them.

Helping Practitioners Stop, Drop, and Roll: Suggestions to Help Improve Responses to Intense Clinical Events.

Community practitioners inconsistently implement evidence-based interventions. Implementation science emphasizes the importance of some practitioner characteristics, such as motivation, but factors such as practitioners' emotion regulation and cognitive processing receive less attention. Practitioners often operate in stressful environments that differ from those in which they received training. They may underestimate the impact of their emotional state on their ability to deliver evidence-based interventions. This "hot-cold state empathy gap" is not well studied in mental health care. In this Open Forum, the authors describe scenarios where this gap is affecting practitioners' ability to implement evidence-based practices. The authors provide suggestions to help practitioners plan for stressful situations.

Exploring Teachers' Intentions to Use Behavioral Classroom Interventions.

Multi-tiered systems of behavioral supports offer teachers tools to implement positive, antecedent- or consequence-based interventions for all students (i.e., Tier 1), and for those who need additional support (i.e., Tier 2), such as students with ADHD. Because these interventions may be challenging to use, targeted, theory-driven implementation strategies may assist teachers in implementing them with fidelity. This exploratory study examined teachers' intended and self-reported use of specific Tier 1 and Tier 2 behavioral classroom interventions. Sixty-five K-8 teachers from five urban public schools completed an online survey about their intentions to use and self-reported use of four Tier 1 and Tier 2 behavioral classroom interventions. Teachers' intentions varied by intervention, with the weakest intentions for using a daily behavior report (Tier 2), and weaker intentions for using high rates of specific praise than for other Tier 1 interventions. Teacher's self-reported use was significantly lower than intended use for Tier 1 interventions, but not Tier 2 interventions. Results were generally similar whether the referent group was students with ADHD symptoms or the entire class. These results suggest specific factors to target to support teachers' use of behavioral classroom interventions.

The relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders.

This study aimed to examine the relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders. The sample included 2617 adolescents who were enrolled in eighth grade in a large urban school district in the United States, were enrolled in Medicaid during eighth grade, and had a mental health diagnosis. Psychiatric hospitalization, school enrollment, school absences, out-of-school suspensions, school dropouts, and school exits for negative reasons were examined as mental health and educational outcomes. Compared with adolescents who used school mental health services for 2 years following eighth grade, adolescents who did not use school mental health service during the high school years had a significantly lower annual number of days enrolled in school and higher rates of exiting school for negative reasons such as school dropout and long-term hospitalization. Our findings support the positive role of school mental health care delivery in high schools in preventing negative educational outcomes for adolescents with psychiatric disorder.

A mixed-methods evaluation of organization and individual factors influencing provider intentions to use caregiver coaching in community-based early intervention.

BACKGROUND: Most psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers' intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers' intentions to implement the components of caregiver coaching. METHODS: We surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors. RESULTS: The associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers' attitudes toward coaching caregivers and their perceptions of caregivers' expectations for service were particularly salient themes related to their use of caregiver coaching. CONCLUSION: Results highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.

Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial.

BACKGROUND: Little is known about the effectiveness and cost-effectiveness of train-the-trainer implementation strategies in supporting mental health evidence-based practices in schools, and about the optimal level of support needed for TT strategies. METHODS: The current study is part of a larger type 2 hybrid cluster randomized controlled trial. It compares two train-the-trainer strategies, Train-the-Trainer (TT) and Train-the-Trainer plus ongoing consultation for trainers (TT +) on the delivery of a group cognitive behavioral treatment protocol for anxiety disorders. Participants were 33 therapists, 29 supervisors, and 125 students who were at risk for anxiety disorders from 22 urban schools. Implementation outcomes were implementation fidelity and treatment dosage. Student outcomes were child- and parent-reported symptoms of anxiety, child-reported symptoms of depression, and teacher-reported academic engagement. We estimated the cost of implementing the intervention in each condition and examined the probability that a support strategy for supervisors (TT vs TT +) is a good value for varying values of willingness to pay. RESULTS: Therapists in the TT and TT + conditions obtained similarly high implementation fidelity and students in the conditions received similar treatment dosages. A mixed effects modeling approach for student outcomes revealed time effects for symptoms of anxiety and depression reported by students, and emotional disaffection reported by teachers. There were no condition or condition × times effects. For both conditions, the time effects indicated an improvement from pre-treatment to post-treatment in symptoms of anxiety and depression and academic emotional engagement. The average cost of therapist, supervisor, and consultant time required to implement the intervention in each condition was $1002 for TT and $1431 for TT + (p = 0.01). There was a greater than 80% chance that TT was a good value compared to TT + for all values of willingness to pay per one-point improvement in anxiety scores. CONCLUSIONS: A TT implementation approach consisting of a thorough initial training workshop for therapists and supervisors as well as ongoing supervision for therapists resulted in adequate levels of fidelity and student outcomes but at a lower cost, compared to the TT + condition that also included ongoing external expert consultation for supervisors. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02651402.

Associations between children's socioeconomic status and prefrontal cortical thickness.

Childhood socioeconomic status (SES) predicts executive function performance and measures of prefrontal cortical function, but little is known about its anatomical correlates. Structural MRI and demographic data from a sample of 283 healthy children from the NIH MRI Study of Normal Brain Development were used to investigate the relationship between SES and prefrontal cortical thickness. Specifically, we assessed the association between two principal measures of childhood SES, family income and parental education, and gray matter thickness in specific subregions of prefrontal cortex and on the asymmetry of these areas. After correcting for multiple comparisons and controlling for potentially confounding variables, parental education significantly predicted cortical thickness in the right anterior cingulate gyrus and left superior frontal gyrus. These results suggest that brain structure in frontal regions may provide a meaningful link between SES and cognitive function among healthy, typically developing children.

Implementation resources to support teachers' use of behavioral classroom interventions: protocol of a randomized pilot trial.

BACKGROUND: Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. METHODS: We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student-teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. DISCUSSION: If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.

Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study.

Background: Train-the-trainer (TT) implementation strategies (in which designated clinicians are trained to then train others in an intervention) are promising approaches to support mental health clinician use of evidence-based interventions in school contexts. However, there is little evidence to date examining clinicians' perceptions of the acceptability and feasibility of TT strategies, or comparing clinicians' perceptions of different types of TT strategies. Methods: The current study was conducted as part of a larger hybrid effectiveness-implementation trial, in which school-based therapists and supervisors received one of two different types of implementation support to implement cognitive behavioral therapy (CBT) groups for anxiety: TT (i.e., initial training for therapists and supervisors) or enhanced TT (TT+; i.e., initial training for therapists and supervisors, and ongoing external consultation for supervisors). We used applied thematic analysis to compare qualitative interview transcripts from 28 therapist interviews and 33 supervisor interviews from therapists and supervisors who received TT or TT+ support and report themes that were similar and different across the two groups. Results: Most themes were similar across the TT and TT+ conditions: therapists and supervisors in both conditions perceived the group anxiety intervention as acceptable and viewed supervision as acceptable, helpful, and feasible. Therapists and supervisors in both conditions had mixed impressions of the contextual appropriateness of the group anxiety intervention, and some reported logistical challenges with weekly supervision. Some unique themes were identified among the TT+ condition, including supervisors experiencing professional growth, and therapists and supervisors perceiving supervision as critically important and enjoyable. Conclusions: These results suggest that TT implementation support, using a model in which an internal supervisor receives initial training and then provides ongoing supervision, is acceptable and feasible to support a group CBT intervention in schools. The results also highlight additional benefits that therapists and supervisors perceived when supervisors received ongoing consultation. Clinical Trial Registration Information: The clinical trial from which these data were derived was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) prior to the time of first patient enrollment. The registration number is: NCT02651402.

It is important to understand how to best support mental health clinicians in using evidence-based interventions in school contexts. Train-the-trainer (TT) strategies, in which designated clinicians receive training to then support others in using the intervention, may be promising, and it is important to determine the optimal TT model. However, little is known about how clinicians perceive the acceptability and feasibility of implementing evidence-based mental health interventions with different types of TT support, which can include training and/or ongoing consultation for internal trainers. To address this gap, we used a qualitative approach to examine and compare themes from semistructured interviews with therapists and supervisors participating in two different types of TT implementation support to deliver an evidence-based group CBT intervention for anxiety within schools. Therapists and supervisors receiving both kinds of support had mostly positive perceptions of the intervention and implementation support. They viewed the group anxiety intervention as acceptable and impactful, although they had mixed perceptions about its contextual appropriateness. They viewed supervision as acceptable, helpful, and generally feasible, although challenging at times. However, unique themes among the group who received the more intensive type of TT support, such as supervisors experiencing professional growth over time, suggest that there may be additional benefits to the more intensive support. Overall, these results suggest that TT strategies are an acceptable and feasible approach to support clinicians in delivering group CBT in schools. This study highlights the benefit of embedding qualitative interviews within randomized controlled trials to better understand clinician experiences and perspectives.

A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness.

Background: Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Objectives: Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. Materials and methods: First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. Results: The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Conclusion: Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.

Parental education is associated with differential engagement of neural pathways during inhibitory control.

Response inhibition and socioeconomic status (SES) are critical predictors of many important outcomes, including educational attainment and health. The current study extends our understanding of SES and cognition by examining brain activity associated with response inhibition, during the key developmental period of adolescence. Adolescent males (N = 81), aged 16-17, completed a response inhibition task while undergoing fMRI brain imaging and reported on their parents' education, one component of socioeconomic status. A region of interest analysis showed that parental education was associated with brain activation differences in the classic response inhibition network (right inferior frontal gyrus + subthalamic nucleus + globus pallidus) despite the absence of consistent parental education-performance effects. Further, although activity in our main regions of interest was not associated with performance differences, several regions that were associated with better inhibitory performance (ventromedial prefrontal cortex, middle frontal gyrus, middle temporal gyrus, amygdala/hippocampus) also differed in their levels of activation according to parental education. Taken together, these results suggest that individuals from households with higher versus lower parental education engage key brain regions involved in response inhibition to differing degrees, though these differences may not translate into performance differences.

Barriers and Facilitators to Teachers' Use of Behavioral Classroom Interventions.

Multi-tiered behavioral classroom interventions are particularly important for students with or at risk for ADHD or other externalizing behaviors. Teachers often use these interventions infrequently or not as designed, and little is known about the barriers and facilitators to their use, especially from the teachers' perspective. Using an exploratory sequential approach, we first used semi-structured qualitative interviews to identify teacher-reported barriers and facilitators to using three Tier 1 and one Tier 2 behavioral classroom interventions with students with ADHD symptoms (Study 1). Then, we identified which barriers and facilitators were most frequently endorsed on a survey (Study 2). The types of barriers and facilitators that emerged from semi-structured interviews included teachers' beliefs about behavioral classroom interventions (i.e., about their effectiveness or the consequences of using them) that motivated teachers or reduced their motivation to use them, as well as factors that interfered or assisted with execution in the moment. The most frequently endorsed barriers were being distracted or forgetting due to competing demands, and feeling "stressed, frustrated, or burned out;" frequently endorsed facilitators included having a strong student-teacher relationship and having built the habit of using the intervention. Together, these results identify specific, malleable factors that can be targeted when supporting teachers in using Tier 1 and Tier 2 behavioral classroom interventions for students with ADHD symptoms. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09524-3.

Individual and organizational factors that affect implementation of evidence-based practices for children with autism in public schools: a cross-sectional observational study.

BACKGROUND: Children with autism receive most of their intervention services in public schools, but implementation of evidence-based practices (EBPs) for autism varies. Studies suggest that individual (attitudes) and organizational characteristics (implementation leadership and climate) may influence providers' use of EBPs, but research is relatively limited in this area. This study examined individual and organizational factors associated with implementation of three EBPs-discrete trial training, pivotal response training, and visual schedules-for children with autism in special education classrooms in public elementary schools. METHODS: Participants included 67 autism support teachers and 85 other classroom staff from 52 public elementary schools in the northeastern United States. Participants reported their attitudes toward EBPs (e.g., intuitive appeal, willingness if required, openness, and divergence), implementation leadership and climate of their school, and the frequency with which they deliver each of three EBPs. Linear regression was used to estimate the association of attitudes about EBPs with organizational characteristics and intensity of EBP use. Demographic covariates with a bivariate association with EBP use significant at p < .20 were entered into the adjusted models. RESULTS: There were significant findings for only one EBP, discrete trial training. Teachers who reported higher perceived divergence (perceived difference of usual practice with academically developed or research-based practices) between EBPs and current practices used less discrete trial training (f2 = .18), and teachers who reported higher appeal (willingness to adopt EBPs given their intuitive appeal) of EBPs used more discrete trial training (f2 = .22). No organizational factors were significantly associated with implementation with any of the three EBPs. CONCLUSIONS: Attitudes toward EBPs may affect teachers' decisions to use EBPs; however, implementation leadership and climate did not predict EBP use. Future implementation efforts ought to consider the type of EBP and its fit within the context in terms of the EBP's similarities to and differences from existing practices and programs in the setting. Implementation strategies that target individual attitudes about EBPs may be warranted in public schools.

Do Student Characteristics Affect Teachers' Decisions to Use 1:1 Instruction?

One-to-one instruction is a critical component of evidence-based instruction for students with autism spectrum disorder, but is not used as often as recommended. Student characteristics may affect teachers' decisions to select a treatment and/or implement it. This study examined the associations between students' clinical and demographic characteristics and teachers' reported use of discrete trial training (DTT) and pivotal response training (PRT). Children's higher sensory symptoms, lower social approach, lower verbal skills and higher self-regulation difficulties were associated with more frequent 1:1 DTT and PRT. Results suggest that teachers give more frequent 1:1 instruction to children with more observable impairments, do not match children to type of 1:1 intervention, and may inadvertently neglect other students for whom individualized intervention may still be beneficial.

Executive Function as a Mediator Between SES and Academic Achievement Throughout Childhood.

Childhood socioeconomic status (SES), as measured by parental education and family income, is highly predictive of academic achievement, but little is known about how specific cognitive systems shape SES disparities in achievement outcomes. This study investigated the extent to which executive function (EF) mediated associations between parental education and family income and changes in reading and math achievement in a sample of 336 children between the ages of 6 and 15 years from the NIH MRI Study of Normal Brain Development. Verbal memory was simultaneously modeled as a comparison candidate mediator. SES predicted significant changes in reading and math achievement over a two-year time period. Furthermore, executive function, but not verbal memory, was found to partially mediate the relationship between SES variables and change in math achievement. Collectively, these results suggest that executive function may be an important link between childhood SES and academic achievement.

Childhood socioeconomic status and childhood maltreatment: Distinct associations with brain structure.

The present study examined the relationship between childhood socioeconomic status (SES), childhood maltreatment, and the volumes of the hippocampus and amygdala between the ages of 25 and 36 years. Previous work has linked both low SES and maltreatment with reduced hippocampal volume in childhood, an effect attributed to childhood stress. In 46 adult subjects, only childhood maltreatment, and not childhood SES, predicted hippocampal volume in regression analyses, with greater maltreatment associated with lower volume. Neither factor was related to amygdala volume. When current SES and recent interpersonal stressful events were also considered, recent interpersonal stressful events predicted smaller hippocampal volumes over and above childhood maltreatment. Finally, exploratory analyses revealed a significant sex by childhood SES interaction, with women's childhood SES showing a significantly more positive relation (less negative) with hippocampus volume than men's. The overall effect of childhood maltreatment but not SES, and the sex-specific effect of childhood SES, indicate that different forms of stressful childhood adversity affect brain development differently.