Incidence of Hearing Loss in Patients With Neurofibromatosis Type 1 at a Tertiary Care Pediatric Hospital.

BACKGROUND: Hearing loss has not been thoroughly investigated as a comorbidity in larger cohorts with neurofibromatosis type 1 (NF1). METHODS: Available audiometric data were reviewed from patients with NF1 seen at a tertiary pediatric hospital to assess prevalence and risk factors for hearing loss. RESULTS: Of 1172 patients with NF1 seen between 2010 and 2022, 90 had available audiometric data and 48 of 90 patients (53%) had one or more audiogram revealing hearing loss. Those not referred to audiology were presumed to have normal hearing, resulting in a conservative hearing loss estimate of 4% for children and young adults with NF1. Of 90 patients with audiograms, 29 (32%) had conductive loss (CHL), 15 (17%) had sensorineural loss (SNHL), and 3 (3%) had mixed hearing loss. Hearing loss type was undetermined for one patient. For children with CHL, six had permanent CHL secondary to plexiform neurofibroma, 19 CHL were transient due to active middle ear dysfunction, and four CHL cases were indeterminate in etiology. For three children with SNHL or mixed hearing loss, etiology included history of ototoxic chemotherapy and/or family history of SNHL. In the 16 patients with SNHL or mixed hearing loss with more than one audiogram over time, progressive hearing decline was noted in eight of 16, and 26 of 178 hearing thresholds (15%) progressed. CONCLUSIONS: Our findings suggest that audiometric evaluations should be considered for at least a subset of children with NF1, given the higher-than-expected rate of hearing loss in patients with NF1 compared with the general population.

Programming Levels and Speech Perception in Pediatric Cochlear Implant Recipients With Enlarged Vestibular Aqueduct or GJB2 Mutation.

OBJECTIVE: To determine the relationship between hearing loss etiology, cochlear implant (CI) programming levels, and speech perception performance in a large clinical cohort of pediatric CI recipients. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care hospitals. PATIENTS: A total of 136 pediatric CI recipients (218 ears) were included in this study. All patients had diagnoses of either enlarged vestibular aqueduct (EVA) or GJB2 (Connexin-26) mutation confirmed via radiographic data and/or genetic reports. All patients received audiologic care at either Boston Children's Hospital or Massachusetts Eye and Ear in Boston, MA, between the years 1999 and 2020. MAIN OUTCOME MEASURES: Electrode impedances and programming levels for each active electrode and speech perception scores were evaluated as a function of etiology (EVA or GJB2 mutation). RESULTS: Children with EVA had significantly higher impedances and programming levels (thresholds and upper stimulation levels) than the children with GJB2 mutation. Speech perception scores did not differ as a function of etiology in this sample; rather, they were positively correlated with duration of CI experience (time since implantation). CONCLUSIONS: Differences in electrode impedances and CI programming levels suggest that the electrode-neuron interface varies systematically as a function of hearing loss etiology in pediatric CI recipients with EVA and those with GJB2 mutation. Time with the CI was a better predictor of speech perception scores than etiology, suggesting that children can adapt to CI stimulation with experience.

Effect of Hearing Device Use on Speech-in-Noise Performance in Children with Severe-to-Profound Unilateral Hearing Loss.

OBJECTIVES: Limited evidence exists for the use of rerouting devices in children with severe-to-profound unilateral sensorineural hearing loss. Many laboratory studies to date have evaluated hearing-in-noise performance in specific target-masker spatial configurations within a small group of participants and with only a subset of available hearing devices. In the present study, the efficacy of all major types of nonsurgical devices was evaluated within a larger group of pediatric subjects on a challenging speech-in-noise recognition task. DESIGN: Children (7-18 years) with unaided severe-to-profound unilateral hearing loss (UHL' n = 36) or bilateral normal hearing (NH, n = 36) participated in the present study. The signal-to-noise ratio (SNR) required for 50% speech understanding (SNR-50) was measured using BKB sentences in the presence of proprietary restaurant noise (R-SPACE BSIN-R) in the R-SPACE Sound System. Subjects listened under 2 target/masker spatial configurations. The target signal was directed toward subjects' NH or hearing-impaired ear (45º azimuth), while the interfering restaurant noise masker was presented from the remaining 7 loudspeakers encircling the subject, spaced every 45º. Head position was fixed during testing. The presentation level of target sentences and masking noise varied over time to estimate the SNR-50 (dB). The following devices were tested in all participants with severe-to-profound UHL: air conduction (AC) contralateral routing of signal (CROS), bone conduction (BC) CROS fitted on a headband with and without the use of remote microphone (RM), and an ear-level RM hearing assistance technology (HAT) system. RESULTS: As a group, participants with severe-to-profound UHL performed best when the target signal was directed toward their NH ear. Across listening conditions, there was an average 8.5 dB improvement in SNR-50 by simply orienting the NH ear toward the target signal. When unaided, participants with severe-to-profound UHL performed as well as participants with NH when the target signal was directed toward the NH ear. Performance was negatively affected by AC CROS when the target signal was directed toward the NH ear, whereas no statistically significant change in performance was observed when using BC CROS. When the target signal was directed toward participants' hearing-impaired ear, all tested devices improved SNR-50 compared with the unaided condition, with small improvements (1-2 dB) observed with CROS devices and the largest improvement (9 dB) gained with the personal ear-level RM HAT system. No added benefit nor decrement was observed when RM was added to BC CROS using a 50/50 mixing ratio when the target was directed toward the impaired ear. CONCLUSIONS: In a challenging listening environment with diffuse restaurant noise, SNR-50 was most improved in the study sample when using a personal ear-level RM HAT system. Although tested rerouting devices offered measurable improvement in performance (1-2 dB in SNR-50) when the target was directed to the impaired ear, benefit may be offset by a detriment in performance in the opposing condition. Findings continue to support use of RM HAT for children with severe-to-profound UHL in adverse listening environments, when there is one primary talker of interest, to ensure advantageous SNRs.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness.

More children with single-sided deafness (SSD) are receiving cochlear implants (CIs) due to the expansion of CI indications. This unique group of pediatric patients has different needs than the typical recipient with bilateral deafness and requires special consideration and care. The goal of cochlear implantation in these children is to provide bilateral input to encourage the development of binaural hearing. Considerations for candidacy and follow-up care should reflect and measure these goals. The purpose of this document is to review the current evidence and provide guidance for CI candidacy, evaluation, and management in children with SSD.

The role of negative emotionality in the development of child executive function and language abilities from toddlerhood to first grade: An adoption study.

Understanding the role of negative emotionality in the development of executive functioning (EF) and language skills can help identify developmental windows that may provide promising opportunities for intervention. In addition, because EF and language skills are, in part, genetically influenced, intergenerational transmission patterns are important to consider. The prospective parent-offspring adoption design used in this study provides a unique opportunity to examine the intergenerational transmission of EF and language skills. Participants were 561 children adopted around the time of birth. Accounting for birth mother EF and language contributions, we examined the role of child negative emotionality in toddlerhood (age 9 to 27 months) and childhood (age 4.5 to 7 years) on child EF and language skills in first grade (age 7 years). There was continuity in EF from age 27 months to 7 years, and in language ability from age 27 months to 7 years, with no cross-lagged effects between child EF and language ability. Negative emotionality at age 9 months predicted lower EF and lower language abilities at age 7 years, and growth in negative emotionality from age 4.5 to 7 years predicted lower child EF at age 7 years. Overall, findings suggested that lower negative emotionality at age 9 months was associated with higher toddler and child EF and language skills and that preventing growth in negative emotionality from age 4.5 to 7 years may lead to improvements in child EF. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Incidence, Time Course, and Implications of Electrode Abnormalities in Pediatric Cochlear Implant Recipients.

OBJECTIVES: To identify the incidence of specific abnormal impedance patterns or electrode faults, and determine their implication and significance, in a pediatric population of cochlear implant recipients. DESIGN: Nine hundred fifty-six cochlear implant devices (621 recipients) were included in this retrospective study. Devices were included if the implantation surgery was performed at our tertiary care hospital, and the recipient was 21 years of age or younger at the time the device was implanted. Device models incapable of producing impedance measures by telemetry were excluded from the study. Individual devices with abnormal impedance measures indicating an open circuit (OC), short circuit (SC), or partial short circuit (partial SC) were included in the study, unless these abnormalities occurred only in the OR and not postoperatively. Device and patient characteristics were examined to determine their relationship to increased incidence of electrode faults or atypical patterns. RESULTS: The incidence of software-identified electrode faults in our exclusively pediatric population was similar to that reported in the literature containing mixed-age cohorts. Nine percent of devices experienced at least one OC or one pair of SCs. Although higher incidence of these faults was seen in some specific device models, the long-term average of these faults was equivalent across manufacturers. No factors examined in this study increased the likelihood of experiencing a software-identified electrode fault. Within the study period under examination (October 1997 to March 2018), partial SCs (presenting as zig-zag or low-flat impedance patterns) were only observed in Cochlear devices. While the incidence of these partial SC abnormalities (non-software-identified faults) was 6% across all models of Cochlear devices, the CI24RCS experienced the highest incidence of partial SCs. The incidence of this pattern was lower in models manufactured after CI24RCS. CONCLUSIONS: This study provides incidence of various cochlear implant electrode impedance abnormalities across a large cohort of pediatric recipients. The incidence of all electrode abnormalities was relatively low, particularly partial SCs, which are less well recognized and not currently identified by clinician-accessible software. Incidence of software-identified electrode faults (i.e., SCs and OCs) in our pediatric-only study is similar to the incidence reported in other mixed-population and adult-only studies. These common electrode faults generally are not associated with device failure, and clinicians should feel comfortable reassuring families that an individual electrode fault does not imply an impending device failure. Conversely, those atypical impedance patterns not currently flagged by the programming software as abnormal, but visible to the clinician's eye (i.e., partial SCs in zig-zag or low-flat patterns), have a higher likelihood of device damage and failure. Performance in patients with electrode arrays exhibiting these atypical patterns should be closely monitored for any functional decrement, and proactively managed to maintain performance whenever possible.

The Affective Lives of Doubled-Up Latinx Youth: Influences of School Experiences, Familism, and Ethnic Identity Exploration.

Doubled-up Latinx youth experience many daily challenges associated with ethnic minority status and residential instability. Doubled-up youth share housing with non-custodial caregivers such as friends and/or extended family members primarily because of economic hardship and a breakdown in available parental support. Using data from baseline and 10 days of twice-a-day surveys, this study examined how in-school positive experiences, familism (i.e., a perspective that gives precedence to the family), and ethnic identity (i.e. affirmation, exploration, and resolution) influence after school positive (e.g. feeling joyful/happy) and negative (e.g., feeling stressed/anxious) affect among doubled up Latinx youth (70% female; M age = 16.5). Results indicate that in-school positive experiences were associated with more after school positive affect and less after school negative affect. Additionally, youth with higher levels of familism reported experiencing less after school negative affect. However, gender moderated the relation of ethnic identity exploration and experiences of after school positive affect. Specifically, females with higher levels of ethnic identity exploration reported relatively lower levels of after school positive affect compared to males. Overall, study findings highlight the importance of both person-level and varying contextual influences on the affective lives of doubled-up Latinx youth.

Auditory Comprehension in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss.

Purpose The purpose of this study was to measure auditory comprehension performance in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH) in quiet and in the presence of child-produced two-talker babble (TTB). Method Listeners were school-aged children (7-12 years) with permanent UHL (n = 25) or NH (n = 14). Comprehension of three short stories taken from the Test of Narrative Language (Gillam & Pearson, 2004) was measured in quiet and in the presence of TTB at two signal-to-noise ratios (SNRs): (a) +6 dB and (b) the individualized SNR required to achieve 50% sentence understanding in the presence of the same TTB masker in a prior study (Griffin, Poissant, & Freyman, 2019). Target/masker spatial configuration was 0°/±60° azimuth. Results As a group, subjects with UHL demonstrated auditory comprehension abilities in favorable listening environments (i.e., quiet, +6 dB SNR) that were statistically equivalent to the NH group. However, in the most challenging listening condition (individualized SNR), many subjects with UHL demonstrated poorer comprehension performance than their age-matched peers with NH. Comprehension abilities were not associated with degree of UHL, unaided speech intelligibility index at 65 dB SPL in the impaired ear, side of UHL, or sex. Conclusions As a group, children with UHL demonstrated deficits in auditory comprehension compared to age-matched peers with NH in challenging listening environments. Findings highlight the importance of ensuring good SNRs for children with UHL.

Daily social and affective lives of homeless youth: What is the role of teacher and peer social support?

Youth spend a significant amount of time in school surrounded by and interacting with teachers and peers. For doubled-up homeless youth (i.e., youth who share housing with a series of friends and/or extended family members), in-school relationships may be important for their emotional functioning. The current study captured dynamic processes by which in-school teacher and peer social support (i.e., baseline assessments of prior support and daily early-day reports of school day support) influence homeless youth's daily emotional well-being, as assessed by positive and negative affect later in the day. Specifically, a baseline survey was used in combination with a 10-day twice-a-day diary design to examine the competing influences of prior (i.e., between-person) and daily (i.e., within-person) social support from teachers and peers during the school day. Baseline teacher support and early-day peer support were associated with higher later-day positive affect. In contrast, baseline peer support was associated with lower later-day negative affect. Baseline peer support moderated the association between early-day peer support and later-day positive affect, in that there was a significant effect of early-day peer support and later-day positive affect for youth who reported medium and high levels of baseline peer support. However, the later-day positive affect of youth who reported low baseline levels of social support did not appear to benefit from early-day peer support. Results suggest that the source of support (i.e., teacher and peer) differently influences daily affect and that receiving daily in-school support can promote daily positive affect while mitigating negative affect for doubled-up homeless youth. Overall, study findings suggest that providing peer and teacher social support is a promising prevention and intervention approach for fostering resilience among doubled-up homeless youth.

Longitudinal examination of pathways to peer problems in middle childhood: A siblings-reared-apart design.

To advance research from Dishion and others on associations between parenting and peer problems across childhood, we used a sample of 177 sibling pairs reared apart since birth (because of adoption of one of the siblings) to examine associations between parental hostility and children's peer problems when children were ages 7 and 9.5 years (n = 329 children). We extended conventional cross-lagged parent-peer models by incorporating child inhibitory control as an additional predictor and examining genetic contributions via birth mother psychopathology. Path models indicated a cross-lagged association from parental hostility to later peer problems. When child inhibitory control was included, birth mother internalizing symptoms were associated with poorer child inhibitory control, which was associated with more parental hostility and peer problems. The cross-lagged paths from parental hostility to peer problems were no longer significant in the full model. Multigroup analyses revealed that the path from birth mother internalizing symptoms to child inhibitory control was significantly higher for birth parent-reared children, indicating the possible contribution of passive gene-environment correlation to this association. Exploratory analyses suggested that each child's unique rearing context contributed to his or her inhibitory control and peer behavior. Implications for the development of evidence-based interventions are discussed.

Did I Inherit My Moral Compass? Examining Socialization and Evocative Mechanisms for Virtuous Character Development.

Virtuous character development in children is correlated with parenting behavior, but the role of genetic influences in this association has not been examined. Using a longitudinal twin/sibling study (N = 720; Time 1 (T1) Mage = 12-14 years, Time 3 (T3) Mage = 25-27 years), the current report examines associations among parental negativity/positivity and offspring responsibility during adolescence, and subsequent young adult conscientiousness. Findings indicate that associations among parental negativity and offspring virtuous character during adolescence and young adulthood are due primarily to heritable influences. In contrast, the association between concurrent parental positivity and adolescent responsibility was due primarily to heritable and shared environmental influences. These findings underscore the contributions of heritable influences to the associations between parenting and virtuous character that have previously been assumed to be only environmentally influenced, emphasizing the complexity of mechanisms involved in the development of virtuous character.

Parent-adolescent conflict and young adult romantic relationship negativity: Genetic and environmental influences.

Prior work indicates that aspects of interpersonal relationships are heritable, including negativity within parent-adolescent relationships as well as romantic relationships during adulthood. There have not, however, been systematic studies to disentangle genetic and environmental influences on relationship dynamics with parents as they relate to romantic partner relationship dynamics. Thus, the present study examined genetic and environmental influences on associations between parent-adolescent conflict and young adult reports of negativity with a romantic partner using a longitudinal twin/sibling design. We found that genetic, shared, and nonshared environmental factors contributed to conflict in parent-adolescent relationships and that genetic and nonshared environmental factors uniquely contributed to negativity in the romantic partnership during young adulthood. The longitudinal association between parent-adolescent conflict and romantic relationship conflict was explained entirely by genetic influences shared by the 2 constructs. These findings have implications for understanding interpersonal functioning across different relationship types, spanning multiple developmental periods. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Speech-in-Noise and Quality-of-Life Measures in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss.

OBJECTIVES: (1) Measure sentence recognition in co-located and spatially separated target and masker configurations in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH). (2) Compare self-reported hearing-related quality-of-life (QoL) scores in school-aged children with UHL and NH. DESIGN: Listeners were school-aged children (6 to 12 yrs) with permanent UHL (n = 41) or NH (n = 35) and adults with NH (n = 23). Sentence reception thresholds (SRTs) were measured using Hearing In Noise Test-Children sentences in quiet and in the presence of 2-talker child babble or a speech-shaped noise masker in target/masker spatial configurations: 0/0, 0/-60, 0/+60, or 0/±60 degrees azimuth. Maskers were presented at a fixed level of 55 dBA, while the level of the target sentences varied adaptively to estimate the SRT. Hearing-related QoL was measured using the Hearing Environments and Reflection on Quality of Life (HEAR-QL-26) questionnaire for child subjects. RESULTS: As a group, subjects with unaided UHL had higher (poorer) SRTs than age-matched peers with NH in all listening conditions. Effects of age, masker type, and spatial configuration of target and masker signals were found. Spatial release from masking was significantly reduced in conditions where the masker was directed toward UHL subjects' normal-hearing ear. Hearing-related QoL scores were significantly poorer in subjects with UHL compared to those with NH. Degree of UHL, as measured by four-frequency pure-tone average, was significantly correlated with SRTs only in the two conditions where the masker was directed towards subjects' normal-hearing ear, although the unaided Speech Intelligibility Index at 65 dB SPL was significantly correlated with SRTs in four conditions, some of which directed the masker to the impaired ear or both ears. Neither pure-tone average nor unaided Speech Intelligibility Index was correlated with QoL scores. CONCLUSIONS: As a group, school-aged children with UHL showed substantial reductions in masked speech perception and hearing-related QoL, irrespective of sex, laterality of hearing loss, and degree of hearing loss. While some children demonstrated normal or near-normal performance in certain listening conditions, a disproportionate number of thresholds fell in the poorest decile of the NH data. These findings add to the growing literature challenging the past assumption that one ear is "good enough."

A Longitudinal Examination of Service Utilization and Trauma Symptoms among Young Women with Prior Foster Care and Juvenile Justice System Involvement.

We investigated the prediction of young adult service utilization and trauma symptoms from adverse childhood experiences (ACEs) and adolescent mental health symptoms in young women with dual child welfare and juvenile justice system involvement. A sample of 166 females (ages 13 to 17) was followed to examine the transition to young adulthood. Path models indicated that more ACEs were associated with poorer adolescent mental health. Adolescent mental health symptoms were associated with more young adult trauma symptoms and service utilization. Implications for service providers and policy-makers are discussed.

Can monaural temporal masking explain the ongoing precedence effect?

The precedence effect for transient sounds has been proposed to be based primarily on monaural processes, manifested by asymmetric temporal masking. This study explored the potential for monaural explanations with longer ("ongoing") sounds exhibiting the precedence effect. Transient stimuli were single lead-lag noise burst pairs; ongoing stimuli were trains of 63 burst pairs. Unlike with transients, monaural masking data for ongoing sounds showed no advantage for the lead, and are inconsistent with asymmetric audibility as an explanation for ongoing precedence. This result, along with supplementary measurements of interaural time discrimination, suggests different explanations for transient and ongoing precedence.

Transactions Between Substance Use Intervention, the Oxytocin Receptor (OXTR) Gene, and Peer Substance Use Predicting Youth Alcohol Use.

This study investigated the oxytocin receptor (OXTR) gene's moderation of associations between exposure to a substance misuse intervention, average peer substance use, and adolescents' own alcohol use during the 9th-grade. OXTR genetic risk was measured using five single nucleotide polymorphisms (SNPs), and peer substance use was based on youths' nominated closest friends' own reports of alcohol, cigarette, and marijuana use, based on data from the PROSPER project. Regression models revealed several findings. First, low OXTR risk was linked to affiliating with friends who reported less substance use in the intervention condition but not the control condition. Second, affiliating with high substance-using friends predicted youth alcohol risk regardless of OXTR risk or intervention condition. Third, although high OXTR risk youth in the intervention condition who associated with low substance-using friends reported somewhat higher alcohol use than comparable youth in the control group, the absolute level of alcohol use among these youth was still among the lowest in the sample.

Twelve Steps, Two Factors: Coping Strategies Moderate the Association Between Craving and Daily 12-Step Use in a College Recovery Community.

BACKGROUND: Affiliating with 12-step groups appears to reduce relapse risk. By relying on between-person designs, extant research has been unable to examine daily mechanisms through which 12-step group affiliation contributes to recovery. OBJECTIVES: To examine the daily use and factor structure of the 12 steps and intrapersonal predictors and moderators of 12-step use. To determine whether the 12 steps were used in response to daily craving and, if so, which steps and in what contexts. METHODS: Data comprised 1304 end-of-day diary data entries from 55 young adults collected in 2008 from members of a college recovery community, combined with person-level baseline measures. Exploratory factor analysis examined the factor structure, and multi-level models examined both day-level and person-level predictors and moderators of step use, including meeting attendance, drug and alcohol dependence, social support, and coping strategies. RESULTS: Analyses produced two factors: Everyday steps, comprising surrender and maintenance steps, and action steps. Moderation analyses revealed that only action steps were significantly associated with craving, suggesting that craving can spur their use, but only among individuals pursuing certain general strategies for coping with stress: Separate median-split models produced significant associations between craving and action steps only among individuals high in avoidance, high in support-seeking, and/or low in problem-solving. Conclusions/Importance: This is the first study to empirically discern a 2-factor structure underlying the 12 steps, and to show that the two sets of steps are used in different contexts. The study also illustrates the value of person-centered approaches to recovery research and practice.

Psychometric Evaluation of the Comprehensive Trauma Interview PTSD Symptoms Scale Following Exposure to Child Maltreatment.

The current study evaluated the psychometric properties of the Comprehensive Trauma Interview Post-Traumatic Stress Disorder (PTSD) Symptoms Scale (CTI-PSS), a novel method of assessing PTSD symptoms following exposure to a range of child adversities in the child maltreatment population. A sample of female adolescents ( n = 343) exposed to substantiated child sexual abuse and a nonmaltreated comparison condition completed the CTI-PSS and other established measures to assess internal consistency, factor structure, test discriminability as well as convergent, discriminant, and incremental validities. Results demonstrated that the CTI-PSS is a reliable and valid measure of PTSD symptoms with good discriminability and a factor structure that fits existing conceptualizations of the PTSD construct. It also demonstrated strong convergence with an established measure of PTSD symptoms and explained unique variance in the prediction of child sexual abuse status. Overall, the CTI-PSS appears to be a useful instrument for assessing PTSD symptoms in the child maltreatment population.

Contamination in the Prospective Study of Child Maltreatment and Female Adolescent Health.

OBJECTIVE: To evaluate the impact of contamination, or the presence of child maltreatment in a comparison condition, when estimating the broad, longitudinal effects of child maltreatment on female health at the transition to adulthood. METHODS: The Female Adolescent Development Study (N = 514; age range: 14-19 years) used a prospective cohort design to examine the effects of substantiated child maltreatment on teenage births, obesity, major depression, and past-month cigarette use. Contamination was controlled via a multimethod strategy that used both adolescent self-report and Child Protective Services records to remove cases of child maltreatment from the comparison condition. RESULTS: Substantiated child maltreatment significantly predicted each outcome, relative risks = 1.47-2.95, 95% confidence intervals: 1.03-7.06, with increases in corresponding effect size magnitudes, only when contamination was controlled using the multimethod strategy. CONCLUSIONS: Contamination truncates risk estimates of child maltreatment and controlling it can strengthen overall conclusions about the effects of child maltreatment on female health.

Symptoms of major depressive disorder subsequent to child maltreatment: Examining change across multiple levels of analysis to identify transdiagnostic risk pathways.

Major depressive disorder (MDD) is a prevalent psychiatric condition in the child maltreatment population. However, not all children who have been maltreated will develop MDD or MDD symptoms, suggesting the presence of unique risk pathways that explain how certain children develop MDD symptoms when others do not. The current study tested several candidate risk pathways to MDD symptoms following child maltreatment: neuroendocrine, autonomic, affective, and emotion regulation. Female adolescents (N = 110; age range = 14-19) were recruited into a substantiated child maltreatment or comparison condition and completed a laboratory stressor, saliva samples, and measures of emotion regulation, negative affect, and MDD symptoms. MDD symptoms were reassessed 18 months later. Mediational modeling revealed that emotion regulation was the only significant indirect effect of the relationship between child maltreatment and subsequent MDD symptoms, demonstrating that children exposed to maltreatment had greater difficulties managing affective states that in turn led to more severe MDD symptoms. These results highlight the importance of emotion dysregulation as a central risk pathway to MDD following child maltreatment. Areas of future research and implications for optimizing prevention and clinical intervention through the direct targeting of transdiagnostic risk pathways are discussed.