Childhood adversity and co-occurring post-traumatic stress and externalizing symptoms among a predominantly low-income, African American sample of early adolescents.

Although there is strong evidence supporting the association between childhood adversity and symptomatology during adolescence, the extent to which adolescents present with distinct patterns of co-occurring post-traumatic stress (PTS) and externalizing symptoms remains unclear. Additionally, prior research suggests that experiencing nonviolent, negative life events may be more salient risk factors for developing some forms of psychopathology than exposure to violence. The current study used latent profile analysis to identify subgroups of early adolescents with distinct patterns of PTS, physical aggression, delinquency, and substance use, and examined subgroup differences in exposure to three forms of violent and nonviolent childhood adversity. Participants were a predominantly low-income, African American sample of 2,722 urban middle school students (M age = 12.9, 51% female). We identified four symptom profiles: low symptoms (83%), some externalizing (8%), high PTS (6%), and co-occurring PTS and externalizing symptoms (3%). A higher frequency of witnessing violence was associated with increased odds of membership in subgroups with externalizing symptoms, whereas a higher frequency of nonviolent, negative life events was associated with increased odds of membership in subgroups with PTS symptoms. Interventions aimed to address childhood adversity may be most effective when modules addressing both PTS and externalizing symptoms are incorporated.

Ecological promotive and protective factors deterring gun carriage for young adults living in communities with high rates of community violence.

This study identified promotive and protective factors that lessened the likelihood of handgun carriage in a sample of 141 predominantly Black (97%) young adults (ages 18-22) living in high burden communities experiencing elevated rates of violence. Participants completed surveys assessing overall risk and protective factors for violence across ecological contexts (e.g., individual/peer, family, school, and community). A series of regression and moderation analyses were conducted to ascertain direct (promotive) and indirect (protective) relations between factors across the ecological model and likelihood of gun carriage. Results indicated that (1) consistent with previous studies, both witnessing violence and violence victimization were significant risk factors for handgun carriage, (2) ethnic identity was a significant promotive factor related to a lower likelihood of handgun carriage, and (3) lack of family conflict, student status, and community assets were significant protective factors where higher levels of these factors attenuated the relation between exposure to community violence and likelihood of gun carriage. This is one of the first strengths-based studies examining factors that may mitigate the likelihood of gun carriage for young adults in high risk contexts. Our findings suggest that gun violence prevention efforts for high burden communities should support young adults by strengthening factors across the ecological model (e.g., individual, family, school, and community).

"Hurt people hurt people": Relations between adverse experiences and patterns of cyber and in-person aggression and victimization among urban adolescents.

This study identified subgroups of adolescents with distinct patterns of involvement with overt and relational in-person and cyber aggression and victimization. We also assessed subgroup similarities and differences in exposure to adverse childhood experiences (ACEs), exposure to community violence, and trauma symptoms. Using latent class analysis, we identified three subgroups among 265 adolescents (Mage = 14.3 years; 57% female; 96% African American) residing in three urban high-burden communities that included youth who reported: (a) combined (cyber and in-person) aggression and victimization (17%), (b) in-person aggression and victimization (51%), and (c) adolescents with limited involvement (32%). Youth in the combined aggressive-victims subgroup had the highest probability of endorsing exposure to community violence, trauma symptoms, and a higher number of ACEs overall as well as higher rates of both verbal and physical abuse compared to the other subgroups. Our results indicated that the adolescents who reported the highest frequencies of aggressive behavior were also the most victimized and traumatized. These findings provide context to aggressive behavior among adolescents living in high-burden, urban communities and underscore the need for trauma-informed prevention interventions.

Patterns of Parental Messages Supporting Fighting and Nonviolence Among Urban Middle School Students.

The purpose of this study was to identify subgroups of adolescents with distinct perceptions of parental messages supporting fighting and nonviolence. Latent class analysis identified four subgroups among 2,619 urban middle school students (90% African American; 52% female): messages supporting fighting (32%), messages supporting nonviolence (29%), mixed messages (23%), and no messages (16%). We found significant differences across subgroups in their frequency of physical aggression and peer victimization and beliefs about the use of aggressive and nonviolent responses to peer provocation. Beliefs significantly mediated the relation between parental messages subgroups and both aggression and victimization. Findings illustrate the heterogeneity in the messages urban adolescents perceive from their parents, as well as relations with adolescents' beliefs and behavior.

Social and Emotional Adjustment Across Aggressor/Victim Subgroups: Are Aggressive-Victims Distinct?

Despite prior studies supporting the existence of "aggressive-victims", it remains unclear if they possess unique risk factors from adolescents who are mostly aggressive or victimized. The present study sought to determine whether aggressive-victims differ from adolescents with distinct patterns of involvement in aggression and victimization in their social and emotional adjustment. Secondary analyses were conducted on baseline data from 984 seventh grade students (54% female) from three schools. Most participants identified their race as White (49%) or African American (19%), with 24% identifying as Latino/a. Latent class analysis identified four subgroups: predominant-aggressors (25%), predominant-victims (17%), aggressive-victims (12%), and limited-involvement (47%). The findings did not provide evidence of unique social-emotional characteristics of aggressive-victims that were not accounted for by their involvement in both aggression and victimization. Further evidence of unique differences in risk factors is needed to support targeted interventions for aggressive-victims.

Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury.

BACKGROUND: Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service. METHODS: This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up. RESULTS: Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals. CONCLUSION: Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Individual- and Peer-Level Risk and Protective Factors for Gun Carriage Among Adolescents Living in Low-Income Urban Communities.

Carrying a handgun is an established risk factor for firearm violence, with detrimental and too often irreversible consequences for adolescents including injury and mortality. Although researchers identified a number of risk factors for adolescent handgun carriage, little is known regarding the role of strengths or developmental assets in buffering against risk. The goal of this study was to identify both risk and protective factors for handgun carriage among a predominantly African American (88%) community-based sample of adolescents (Mage = 14.3) who resided in urban communities with high rates of poverty and exposure to violence. Consistent with prior work, we found that adolescents with access to a handgun or with friends who had carried a handgun had higher odds of carrying a handgun themselves in the past 3 months. Handgun access, friends' handgun carriage, and beliefs supporting reactive aggression were identified as risk factors for handgun carriage. Although personal and social assets and positive outlook moderated these relations, the direction was contrary to our hypotheses. We believe that these findings are in part due to structural inequities and social norms impacting adolescents in urban communities characterized by concentrated poverty and high rates of violence. Our findings highlight the value of moving beyond a deficit-oriented framework to gain a more nuanced understanding of the dynamics among both positive and negative factors that alter risk for handgun carriage among African American youth living in low-income urban areas.

Peer Factors as Mediators of Relations Between Exposure to Violence and Physical Aggression in Middle School Students in a Low-Income Urban Community.

Objective: Although prior research has demonstrated that peers influence both physical aggression and exposure to violence during adolescence, few studies have investigated the extent to which peers play a role in relations between physical aggression and violence exposure. This longitudinal study examined peer pressure for fighting, friends' delinquent behavior, and friends' support for fighting as mediators of relations between exposure to violence through witnessing and victimization, and adolescents' frequency of physical aggression. Method: Participants were 2,707 adolescents attending three urban middle schools (Mage = 12.4; 52% female; 79% African American, 17% Hispanic/Latino). Participants completed measures of their frequency of physical aggression, witnessing community violence, victimization by violence, and negative life events, and peer variables at four waves within the same school year. Results: Cross-lagged analyses indicated that the role of peer variables as mediators varied as a function of the type of exposure and the direction of effects. Whereas peer pressure for fighting mediated relations between witnessing violence and changes in physical aggression, friends' delinquent behavior mediated relations between physical aggression and changes in witnessing violence and victimization. In contrast, violent victimization was not associated with changes in any of the peer factors when included in the same model as witnessing violence. Conclusions: These findings highlight the role of peers as both a cause and a consequence of adolescents' aggressive behavior and exposure to violence. They suggest focusing on peer variables as targets for interventions to disrupt connections between exposure to violence and physical aggression during early adolescence.

Positive Engagement with Pets Buffers the Impact of Intimate Partner Violence on Callous-Unemotional Traits in Children.

Childhood exposure to intimate partner violence (IPV) is associated with serious psychological outcomes including increased odds of developing callous-unemotional (CU) traits and behaviors. Recent studies suggest that concomitant exposure to animal cruelty (AC) may increase this risk. However, even under these circumstances, bonds with companion animals may still be a protective factor that buffers the deleterious impact of IPV on child adjustment. This cross-sectional study evaluates whether, and to what extent, the association between exposure to IPV and children's CU and empathic-prosocial (EP) traits vary as a function of children's positive engagement with pets and exposure to AC. Participants included 204 children (aged 7-12 years; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western US state. We conducted multiple moderation analyses to evaluate each outcome individually (i.e., CU traits, EP traits), adjusting for the effects of child age, gender, and Hispanic ethnicity. Positive engagement with pets significantly moderated the relationship between IPV and CU traits, ∇R = 0.03, F (1, 195) = 7.43, ß = -0.17, t(195) = -2.73, p = .007. Specifically, when high levels of positive engagement with pets is present, IPV is negatively associated with CU traits, whereas the reverse was true at low levels of positive engagement with pets. Evidence of moderation by AC was not supported. Our findings suggest that children who form close relationships with their pets in the context of IPV appear to derive important support from these animals; safeguarding the well-being of these animals may be critical to their long-term emotional health.

Psychosocial Adjustment Across Aggressor/Victim Subgroups: A Systematic Review and Critical Evaluation of Theory.

Theoretical conceptualizations of "aggressive-victims" portray them as more emotionally dysregulated and socially inept than adolescents who are either aggressive or victimized. The purpose of this systematic review is to synthesize the literature comparing the psychosocial adjustment of aggressor/victim subgroups (i.e., aggressive-victims, predominant-aggressors, predominant-victims, and youth with limited involvement) and determine whether empirical findings are consistent with theory, particularly regarding whether aggressive-victims possess unique and shared characteristics relative to those with other patterns of involvement in aggression. This review focuses on studies with early adolescent samples given the heightened vulnerability for aggression and victimization and the need for more effective interventions during this developmental period. A systematic search of three databases (PubMed, PsycINFO, Academic Search Complete) identified 25 studies, which varied in their sample characteristics, approach to defining subgroups, and findings regarding the unique and shared characteristics of aggressive-victims. I propose several guidelines for future research in this area and highlight several gaps in our existing knowledge. Implications for theory and prevention efforts are discussed.

Attachment to Pets Moderates Transitions in Latent Patterns of Mental Health Following the Onset of the COVID-19 Pandemic: Results of a Survey of U.S. Adults.

This cross-sectional study examined whether, and to what extent, attachment to pets was associated with changes in latent patterns of adults' perceived mental health symptoms during the COVID-19 pandemic (n = 1942). We used latent transition analysis to determine the stability of subgroup membership pre- and post-COVID and the effect of attachment to pets on transition probabilities. Mental health before COVID-19 was measured retrospectively. Five subgroups were identified: low symptoms, mild symptoms, moderate symptoms, high symptoms, and severe symptoms. Among individuals in the moderate and high symptoms subgroups, those who reported high attachment to pets generally had greater odds of transitioning to a less severe symptom profile (OR = 2.12) over time than those with low attachment to pets (OR = 1.39). However, those who had a severe symptom profile and high attachment to pets had lower odds of transitioning to a less severe symptom profile (OR = 0.30) and higher odds of maintaining a severe symptom profile (OR = 3.33) than those with low attachment to pets. These findings suggest that the protective and risk effects of attachment to pets differ based on individuals' psychological symptom patterns across multiple indicators. We discuss the implications of these findings for research, policy, and practice.

Psychometric Properties of the Infant Toddler Activity Card Sort.

The Infant Toddler Activity Card Sort (ITACS) is a new measure that engages caregivers in goal development by measuring participation in early childhood. Initial evaluation of the ITACS is required to assess its psychometric properties. To evaluate test-retest reliability, concurrent validity, and between-group differences of the ITACS. Caregivers (N = 208) of children 0-3 years, who were typically developing (TD) or had a developmental delay (DD), completed the ITACS and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) with repeat assessment after 2 weeks later (n = 117). The ITACS demonstrated moderate concurrent validity with the PEDI-CAT. Children with DD had significantly more activity concerns on the ITACS than TD. Adequate test-retest reliability was not achieved. The ITACS is a useful tool for identifying caregiver concerns in activity engagement; interventions can be tailored to address concerns and increase participation in childhood routines.

The Infant Toddler Activity Card Sort: A Caregiver Report Measure of Children's Occupational Engagement in Family Activities and Routines.

Early intervention (EI) therapy services aim to address family-centered goals to facilitate young children's development and participation in meaningful life activities. Current methods to evaluate children in EI assess discrete developmental skills but provide little information on the child's ability to successfully incorporate that skill in everyday life. Furthermore, traditional measures have limited opportunity for parent report, despite parent engagement being a critical component for successful implementation of EI services. A measure that involves parents in the therapeutic process to track family-driven EI goals related to a child's occupational engagement in meaningful family activities and routines is desperately needed. Using a qualitative design and conventional content analysis, we identified 41 distinct activities of infant-toddlers from a cohort of 23 caregivers. Activity items were matched with photographs and validated with experts in pediatric rehabilitation using the Delphi method. The resulting 40 activity/photograph pairs were used to develop a new measure of pediatric occupational engagement, the Infant Toddler Activity Card Sort (ITACS).