The Moderating and Mediating Role of Responsive Parenting Behavior in Explaining the Link between Intimate Partner Violence and Posttraumatic Stress Symptoms in Young Children.

Responsive parenting serves an influential role in explaining the link between children's exposure to intimate partner violence (IPV) and children's mental health impairment, but how this occurs is not well elucidated. In some cases, researchers examine parenting as a mediator to explain how IPV leads to maladaptive outcomes (i.e., IPV negatively impacts one's capacity for responsive parenting, which in turn impacts children), whereas others examine moderation in which either the absence of responsive parenting exacerbates adverse outcomes or increased responsive parenting buffers risk. Mediation addresses theoretical questions about how or why IPV leads to maladaptive outcomes, whereas moderation addresses who might be most impacted. However, responsive parenting has rarely, if ever, been tested as both a mediator and moderator of the link between IPV and posttraumatic stress symptoms (PTSS) within the same sample. The current study examined the mediating and moderating role of responsive parenting on physical IPV exposure and child PTSS in a longitudinal sample of 391 children ages 3 to 5 years (M = 4.74, SD = 0.89). Self-report measures of physical IPV exposure, parenting practices, and PTSS were completed by mothers. We found that responsive parenting significantly moderated and mediated the association between physical IPV exposure and child PTSS over time. Studies that include tests of both moderation and mediation are critical for advancing mechanistic insight into the role of parenting in the etiology of mental health impairment in children exposed to IPV.

Calibrating temper loss severity in the transition to toddlerhood: Implications for developmental science.

The integration of neurodevelopmental perspectives into clinical science has identified irritability as an early dimensional marker of lifespan mental health risk. Elucidating the developmental patterning of irritable behavior is key to differentiating normative variation from risk markers. Accounting for dysregulation and contextual features of irritability is useful for differentiation at preschool age, laying the groundwork for even earlier characterization. We provide initial evidence for the validity of the Multidimensional Assessment Profile of Disruptive Behavior Temper Loss Scale, Infant-Toddler version in two independent samples of 12-18-month-olds from the US. We calibrated the measure using item response theory in a large representative sample, then validated within an independent sample. We characterized the developmental patterning of irritable behaviors and their dimensional spectrum, and demonstrated test-retest reliability, and convergent validity. The MAP-DB-IT is a standardized, dimensional survey assessing irritability that serves as a tool for characterizing the developmental expression of early mental health risk.

Joint Consideration of Inhibitory Control and Irritability in Young Children: Contributions to Emergent Psychopathology.

Deficits in self-regulation capacity have been linked to subsequent impairment and clinical symptomology across the lifespan. Prior work has identified difficulty regulating angry emotions (i.e., irritability) as a powerful transdiagnostic indicator of current and future clinical concerns. Less is known regarding how irritability intersects with cognitive features of self-regulation, in particular inhibitory control, despite its mental health relevance. A promising avenue for improving specificity of clinical predictions in early childhood is multi-method, joint consideration of irritability and inhibitory control capacities. To advance early identification of impairment and psychopathology risk, we contrast group- and variable-based models of neurodevelopmental vulnerability at the interface of irritability and inhibitory control in contexts of varied motivational and emotional salience. This work was conducted in a longitudinal study of children recruited at well-child visits in Midwestern pediatric clinics at preschool age (N = 223, age range = 3-7 years). Group-based models (clustering and regression of clusters on clinical outcomes) indicated significant heterogeneity of self-regulation capacity in this sample. Meanwhile, variable-based models (continuous multiple regression) evidenced associations with concurrent clinical presentation, future symptoms, and impairment across the broad spectrum of psychopathology. Irritability transdiagnostically indicated internalizing and externalizing problems, concurrently and longitudinally. In contrast, inhibitory control was uniquely associated with attention-deficit/hyperactivity symptoms. We present these findings to advance a joint consideration approach to two promising indicators of neurodevelopmental vulnerability and mental health risk. Models suggest that both emotional and cognitive self-regulation capacities can address challenges in characterizing the developmental unfolding of psychopathology from preschool to early childhood age.

Developmental patterning of irritability enhances prediction of psychopathology in preadolescence: Improving RDoC with developmental science.

The transdiagnostic importance of irritability in psychopathology has been demonstrated. However, the contribution of developmentally unfolding irritability patterns to specific clinical and neural outcomes remains an important and unanswered question. To address this gap in the literature, irritability patterns of 110 youth from a large, diverse cohort were assessed at preschool age and again at early school age (∼2.5 years later) with a dimensional irritability scale designed to capture the normal:abnormal spectrum. At preadolescence (∼6 years later), clinical outcomes (internalizing/externalizing symptoms) derived from a semistructured clinical interview and neural outcomes (characterized as gray-matter-volume abnormalities) were assessed. For clinical outcomes, preschool-age irritability alone was a transdiagnostic predictor of internalizing and externalizing symptoms at preadolescence. However, in a model including both preschool and early school age, irritability provided greater specificity, suggesting that higher irritability at early school age related to elevated preadolescent externalizing but not internalizing symptoms. In terms of neural outcomes, elevated preschool irritability did not predict preadolescent gray-matter-volume abnormality; however, irritability at early school age demonstrated an interactive effect among regions, with reduced volume in preadolescence emotional regions (e.g., amygdala, medial orbitofrontal cortex) and increased volume in other regions (e.g., cerebellum). These complex patterns highlight the contribution of a developmentally informed approach, the National Institute of Mental Health's Research Domain Criteria (RDoC) approach, to yield transdiagnostic phenotypes and multiple units of analysis. Capturing these individual differences and developmental heterogeneity can provide critical insight into the unfolding of mechanisms underlying emerging psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Maternal posttraumatic stress predicts Mother-Child Symptom Flare-Ups over Time.

Although concurrent associations between parent and child posttraumatic stress symptoms (PTSS) have been well-documented, few longitudinal studies have examined bidirectional influences by modeling the effects of both parent and child PTSS simultaneously over time. The current study examines patterns of PTSS in children and their mothers beginning in preschool and continuing through elementary school age (ages 4-9 years) in a large, heterogeneous sample (N = 331 mother-child dyads). Mothers reported on their own and their child's posttraumatic stress symptoms. A random intercept cross-lagged panel model (RI-CLPM) was used to examine associations between symptoms across six time points. Results indicated that maternal and child symptoms were associated with each other at concurrent time points and tended to fluctuate in a synchronized manner relative to their overall mean symptom levels. Longitudinal cross-lagged paths were significant from mother to child, but non-significant from child to mother, suggesting that mothers' symptom fluctuation at one time point predicted significant fluctuation in children's symptoms at the subsequent time point. The concurrent co-variation of maternal and child symptoms and the predictive nature of maternal symptom flare-ups have important implications for both maternal and child mental health interventions and underscore the importance of attending to mothers' symptomatology early in treatment.

Development of an Abbreviated Adult Reading History Questionnaire (ARHQ-Brief) Using a Machine Learning Approach.

Several crucial reasons exist to determine whether an adult has had a reading disorder (RD) and to predict a child's likelihood of developing RD. The Adult Reading History Questionnaire (ARHQ) is among the most commonly used self-reported questionnaires. High ARHQ scores indicate an increased likelihood that an adult had RD as a child and that their children may develop RD. This study focused on whether a subset of ARHQ items (ARHQ-Brief) could be equally effective in assessing adults' reading history as the full ARHQ. We used a machine learning approach, lasso (known as L1 regularization), and identified 6 of 23 items that resulted in the ARHQ-Brief. Data from 97 adults and 47 children were included. With the ARHQ-Brief, we report a threshold of 0.323 as suitable to identify past likelihood of RD in adults with a sensitivity of 72.4% and a specificity of 81.5%. Comparison of predictive performances between ARHQ-Brief and the full ARHQ showed that ARHQ-Brief explained an additional 10%-35.2% of the variance in adult and child reading. Furthermore, we validated ARHQ-Brief's superior ability to predict reading ability using an independent sample of 28 children. We close by discussing limitations and future directions.

Neurophysiological patterns associated with blunted emotional face processing and withdrawal tendencies in young children exposed to intimate partner violence.

Studies linking child maltreatment to abnormal neurophysiological responses to emotional stimuli and mental health impairment have not specifically explored these patterns in young children exposed to intimate partner violence (IPV). The present study examined two neurophysiological indicators, resting-state electroencephalography and an emotion event-related potential (ERP) in 21 IPV exposed and 30 nonexposed children ages 4-6 years recruited from the community and domestic violence shelters. Frontal alpha asymmetry (FAA) was assessed while at rest. FAA is often associated with avoidant/withdrawn behavior and increased risk of IPV-related mental health conditions (e.g., depression). Additionally, the late positive potential (LPP) ERP component, reflecting motivated attention, was acquired in the context of an age-appropriate affective oddball paradigm with low probability animal pictures as targets and human facial expressions (angry, happy, neutral) as distracters. Results demonstrated that IPV-exposed children, compared with nonexposed children, exhibited lower left FAA during resting state and reduced LPPs to oddball targets and affective faces relative to neutral faces in the oddball task. Together, these results suggest neural patterns associated with a blunted response to emotional stimuli and withdrawal tendencies, respectively, in young children exposed to IPV. Implications for emotional socialization in this vulnerable population are discussed.

Maternal Socialization is Associated with Prosocial Behavior in At-Risk Young Children.

Prosocial behaviors are a key component of young children's developing social competence. The current study examines the impact of two types of maternal socialization on young children's prosocial behaviors: emotional expressiveness (defined as maternal displayed positive and negative affect) and direct coaching of prosocial responses and explores the relationship of these socialization behaviors with mothers' own histories of psychosocial risk. An ethnically and socioeconomically diverse sample from the United States of 80 mother-child dyads at high risk for violence exposure was assessed when the children were preschool age. All of the maternal emotion socialization behaviors were evaluated by direct observation. The sample included 40 mothers with a history of childhood trauma and 40 mothers without such a history, matched on demographic characteristics. Results indicated that mothers with a history of childhood trauma experiences expressed more positive affect than those without childhood trauma, but the groups did not differ in expressed negative affect or prosocial coaching behaviors. For the full sample, even after controlling for relevant demographic and psychosocial risk factors, socialization behaviors were associated with preschool children's prosocial behavior. Findings reinforce the critical role of parental socialization behaviors in the development of young children's peer-directed prosocial behaviors and highlight the importance of helping parents to develop effective socialization skills.

Profiling COVID-related experiences in the United States with the Epidemic-Pandemic Impacts Inventory: Linkages to psychosocial functioning.

The COVID-19 pandemic has had a profound impact on the lives of individuals, families, and communities around the world with constraints on multiple aspects of daily life. The purpose of the present study was to identify specific profiles of pandemic-related experiences and their relation to psychosocial functioning using the 92-item Epidemic-Pandemic Impacts Inventory (EPII). Data were collected as part of a cross-sectional, online survey of adults (18+) residing in the Northeast region of the United States (N = 652) and recruited via online advertisements. Person-centered latent class analysis (LCA) was applied to 38 pandemic-related experiences that showed a significant bivariate correlation with perceived stress. Measures of psychosocial risk were also obtained. Results revealed five unique profiles of respondents based on patterns of pandemic-related experiences. Three profiles representing about 64% of the sample were characterized by moderate to high exposure to adverse experiences during the pandemic and were more likely to screen positive for depression, anxiety, and posttraumatic stress. These profiles were differentiated by sociodemographic differences, including age, caregiving, and employment status. Two profiles differentiated by age and caregiver status represented about 36% of the sample and were characterized by relatively low exposure to adverse experiences and lower risk for psychosocial impairment. Findings support the EPII as an instrument for measuring tangible and meaningful experiences in the context of an unprecedented pandemic disaster. This research may serve to identify high-risk subpopulations toward developing public health strategies for supporting families and communities in the context of public health emergencies such as the COVID-19 pandemic.

Maternal posttraumatic stress and FKBP5 Genotype interact to predict trauma-related symptoms in preschool-age offspring.

BACKGROUND: Children of parents with posttraumatic stress (PTS) face heightened risk for developing emotional and behavioral problems, regardless of whether they experience a traumatic event themselves. The current study investigates whether child FKBP5, a stress relevant gene shown to interact with child trauma exposure to increase risk for PTS, also moderates the well-established link between maternal PTS and child symptoms. METHODS: Data are derived from a longitudinal lab-based study for which 205 dyads of trauma-exposed mothers and their preschool-age children from a sample enriched for violence exposure provided DNA samples and completed measures of maternal and child trauma-related symptoms. Hypotheses tested whether child FKBP5 rs1360780 SNP genotype interacts with child trauma exposure and maternal PTS to predict child trauma-related symptoms. RESULTS: Hypotheses were partially supported, with maternal PTS predicting increased child symptoms for children carrying the minor T-allele (CT/TT), but not those homozygous for the major C-allele. LIMITATIONS: Study results may not generalize to lower-risk or non-clinical populations, did not assess between-group differences in race/ethnicity, and do not consider other genes that may interact with FKBP5 or contribute to genetic risk for trauma-related impairment. CONCLUSIONS: These findings provide the first evidence that the robust gene x environment interaction involving FKBP5 and child trauma exposure extends to other environmental perturbations, including maternal PTS. Our results highlight the importance of efforts to address trauma-related psychopathology in caregivers, which may disrupt intergenerational risk processes and improve outcomes for children.

An Item Response Theory examination of the original and short forms of the Difficulties in Emotion Regulation Scale (DERS) in pregnant women.

OBJECTIVES: Emotion dysregulation during pregnancy may impede women's capacity to navigate increased stressors during this period and may elevate risk for psychosocial impairment, especially for socioeconomically disadvantaged or racially marginalized women. Valid and efficient assessment of emotion dysregulation is needed. METHODS: We used Item Response Theory (IRT) to examine the Difficulties in Emotion Regulation Scale (DERS) in 248 low income, primarily Latina/x pregnant women, to compare the short forms relative to the full DERS. RESULTS: IRT indicated that the short forms exhibited modest reliability, but also indicated a substantial decrease in information (i.e., reliability) for the short forms compared with the full DERS. IRT indicated that the DERS-16 appeared more reliable (conserve more information) relative to the other short forms, the DERS-SF and DERS-18. CONCLUSION: Findings suggest that clinicians and researchers use the full DERS when time permits and the DERS-16 when needing a briefer version.

Cultural socialization in childhood: Analysis of parent-child conversations with a direct observation measure.

Cultural factors influence the development of all children. Yet, current knowledge of explicit cultural socialization processes in childhood remains limited, mainly by failing to incorporate the experiences of young children. To address this critical gap, the authors introduce the OMERS-Peds task, an observational measurement designed to systematically identify and compare the content of cultural messages passed down from caregivers to offspring during early school age years. The OMERS-Peds was administered to mothers and children (n = 275) from three diverse racial/ethnic backgrounds (African American (n = 153), Hispanic (n = 61), and non-Hispanic White (n = 61)) within the longitudinal Multidimensional Assessment of Preschoolers (MAPS) Study. The OMERS-Peds coding system was used to rate how strongly families endorsed 5 key constructs: family culture, religion, identity, ethnicity, and race. A series of χ2 statistic tests were used to compare scores across racial/ethnic backgrounds, and within families (between children and their mothers). Analyses revealed that in the cultural socialization conversations occurring in early childhood, parents and children prioritize talking about their family's culture and religion. Independent of their racial/ethnic backgrounds, mothers and children seldom discussed race and ethnicity. Contrary to research with older children, differences were mainly identified within families, rather than across racial/ethnic groups. Findings support the need to include children's perspectives in the assessments of cultural socialization, as opposed to relying primarily on parent reports, and highlight the importance of having an observational methodology that allows researchers to examine parent-child bidirectional interactions during early school age years in a systematic manner. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations among childhood threat and deprivation experiences, emotion dysregulation, and mental health in pregnant women.

OBJECTIVE: Women who have experienced childhood maltreatment are at increased risk for experiencing mental health problems. When these occur during pregnancy, they are associated with birth complications and worse developmental outcomes for children. Emotion dysregulation (ED) may be an important, and potentially modifiable, mechanism that links women's maltreatment experiences with their mental health. However, there is limited information about the emotion regulation skills of pregnant women to guide treatment. The current study examines the unique effects of childhood threat (physical, sexual, and emotional abuse and exposure to violence) and deprivation (physical and emotional neglect and separation from primary caregivers) experiences on pregnant women's ED, posttraumatic stress and negative emotional symptoms, and social support. METHOD: Two hundred forty-three women were recruited from an urban prenatal care clinic, the majority of whom identified as Latinx (80%) and low-income (90%). The mean age of the women was 27 years (SD = 5.5). RESULTS: Structural equation modeling revealed significant indirect pathways from childhood threat experiences to posttraumatic stress and negative emotional symptoms via women's ED. In contrast, childhood deprivation experiences were associated with inattention to one's emotions and low perceived social support. CONCLUSIONS: These results underscore the importance of identifying women during pregnancy who may be at risk for ED or emotional inattentiveness due to childhood maltreatment experiences and providing prevention and intervention efforts aimed at enhancing their emotional awareness and regulation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intimate Partner Violence Exposure and Childhood Psychopathology: Associations with Discriminating Fearful and Angry Faces in Young Children.

Purpose: Childhood exposure to traumatic violence may shape how children respond to threatening faces and increase risk for psychopathology. Maltreated children may exhibit altered processing of threatening faces; however, the effects of witnessing intimate partner violence (IPV) on children's discrimination of facial expressions is under-studied. Emotional face processing differentially relates to psychopathology, with some evidence suggesting improved detection of angry faces in children with fear-related anxiety symptoms, whereas externalizing symptoms are associated with poorer detection of fearful faces and perhaps emotional faces broadly. Method: In this cross-sectional study, we examined discrimination of threatening emotional faces (angry, fearful) in relation to experiences of probable abuse and witnessing of physical IPV, as well as psychopathology. Children (N = 137, mean age = 5.01 years, SD = 0.81) completed a "face in the crowd task" designed to examine discrimination of angry and fearful faces. Children either searched for an angry face among fearful distractor faces or a fearful face among angry distractors. Probable child abuse, witnessed IPV, and symptoms were assessed in semi-structured maternal interviews. Results: Children who witnessed violence showed poorer accuracy when fearful faces were the target; however, effects for probable abuse were non-significant. Greater fear-related anxiety symptoms were associated with poorer accuracy for fearful faces. Externalizing symptoms were associated with poorer overall accuracy. Conclusions: Findings suggest that IPV and fear-related anxiety symptoms were associated with difficulty detecting fearful faces when angry distractors were present, consistent with prior research. Implications of violence- and symptom-associated deficits in emotional face processing are discussed.

Toward a Developmental Nosology for Disruptive Mood Dysregulation Disorder in Early Childhood.

OBJECTIVE: Disruptive mood dysregulation disorder (DMDD) in DSM, characterized by severe, chronic irritability, currently excludes children <6 years of age. However, capitalizing on a burgeoning developmental science base to differentiate clinically salient irritability in young children may enable earlier identification. The objective of this study was to advance an empirically derived framework for early childhood DMDD (EC-DMDD) by modeling and validating DMDD patterns in early childhood and generating clinically informative, optimized behaviors with thresholds. METHOD: Data (N = 425) were from 3 longitudinal assessments of the MAPS Study, spanning preschool (means = 4.7 and 5.5 years) to early school age (mean = 6.8 years). The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) Temper Loss scale captured irritability, the Family Life Impairment Scale (FLIS) assessed cross-domain impairment at the preschool time points and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was used to assess clinical status at early school age. Latent transition analyses differentiated children with EC-DMDD from children with low, transient, or nonimpairing irritability. RESULTS: Developmental patterning of irritability proved important for normal:abnormal differentiation. Of children, 27% had initially high irritability, but only two-thirds of these were persistently highly irritable. Thus, "false positives" based on a single screen would be substantial. Yet, "false negatives" are low, as <1% of children with baseline low irritability demonstrated later high irritability. Based on the sequential preschool-age time points, 6.7% of children were identified with EC-DMDD, characterized by persistent irritability with pervasive impairment, similar to prevalence at older ages. Specific behaviors included low frustration tolerance; dysregulated, developmentally unexpectable tantrums; and sustained irritable mood, all of which sensitively (0.85-0.96) and specifically (0.80-0.91) identified EC-DMDD. EC-DMDD predicted irritability-related syndromes (DMDD, oppositional defiant disorder) at early school age better than downward extension of DSM DMDD criteria to preschool age. CONCLUSION: These findings provide empirical thresholds for preschool-age clinical identification of DMDD patterns. The results lay the foundation for validation of DMDD in early childhood and inform revision of DSM criteria.

The Early Childhood Irritability-Related Impairment Interview (E-CRI): A Novel Method for Assessing Young Children's Developmentally Impairing Irritability.

Irritability is a substrate of more than one dozen clinical syndromes. Thus, identifying when it is atypical and interfering with functioning is crucial to the prevention of mental disorder in the earliest phase of the clinical sequence. Advances in developmentally based measurement of irritability have enabled differentiation of normative irritable mood and tantrums from indicators of concern, beginning in infancy. However, developmentally sensitive assessments of irritability-related impairment are lacking. We introduce the Early Childhood Irritability-Related Impairment Interview (E-CRI), which assesses impairment associated with irritable mood and tantrums across contexts. Reliability and validity are established across two independent samples varied by developmental period: the Emotional Growth preschool sample (EmoGrow; N = 151, M = 4.82 years) and the When to Worry infant/toddler sample (W2W; N = 330, M = 14 months). We generated a well-fitting two-factor E-CRI model, with tantrum- and irritable mood-related impairment factors. The E-CRI exhibited good interrater, test-retest, and longitudinal reliability. Construct and clinical validity were also demonstrated. In both samples, E-CRI factors showed association to internalizing and externalizing problems, and to caregiver-reported concern in W2W. Tantrum-related impairment demonstrated stronger and more consistent explanatory value across outcomes, while mood-related impairment added explanatory utility for internalizing problems. The E-CRI also showed incremental utility beyond variance explained by the Family Life Impairment Scale (FLIS) survey indicator of developmental impairment. The E-CRI holds promise as an indicator of impairment to inform identification of typical versus atypical patterns reflecting early emerging irritability-related syndromes in the initial phase of the clinical sequence.

Multi-method assessment of irritability and differential linkages to neurophysiological indicators of attention allocation to emotional faces in young children.

Facilitated attention toward angry stimuli (attention bias) may contribute to anger proneness and temper outbursts exhibited by children with high irritability. However, most studies linking attention bias and irritability rely on behavioral measures with limited precision and no studies have explored these associations in young children. The present study explores irritability-related attention biases toward anger in young children (N = 128; ages 4-7 years) engaged in a dot-probe task with emotional faces, as assessed with event-related brain potential (ERP) indices of early selective attention and multi-method assessment of irritability. Irritability assessed via semi-structured clinical interview predicted larger anterior N1 amplitudes to all faces. In contrast, irritability assessed via a laboratory observation paradigm predicted reduced P1 amplitudes to angry relative to neutral faces. These findings suggest that altered early attentional processing occurs in young children with high irritability; however, the nature of these patterns may vary with methodological features of the irritability assessments. Future investigations using different assessment tools may provide greater clarity regarding the underlying neurocognitive correlates of irritability. Such studies may also contribute to the ongoing debates about how to best define and measure irritability across the developmental spectrum in a manner that is most informative for linkage to neural processes.

Adverse impact of multiple separations or loss of primary caregivers on young children.

Background: Young children may be adversely impacted by separation from and loss of caregivers and other loved ones. Such experiences often co-occur with interpersonal violence, unpredictability and other traumas. Whether separation/loss has unique effects independent of those other adversities is not known. Objective: This study aimed to establish whether separation/loss is associated with trauma-related symptoms, psychiatric disorders, and functional impairment in 18- to 48-month-old children independent of other adversities. Methods: Data from a cross-sectional community and clinical cohort were analyzed. Recruitment occurred in pediatric primary care, mental health, and developmental services sites. Children (33% female) were heterogeneous in ethnic background (55% minority) and family socioeconomic status (40% living in poverty). Results: Separation/loss was common (30.9% single type, 15.0% multiple types) and frequent amongst violence-exposed children (84.4% of violence-exposed children had experienced separation/loss from a loved one). However, violence exposure was uncommon amongst children with separation/loss experiences (only 23.9% were violence-exposed). Separation/loss was significantly associated with symptoms of posttraumatic stress and reactive attachment, as well as impairment and psychiatric disorders in models that controlled for sociodemographic and contextual risks, including other traumas. Psychiatric disorders were approximately 2.5 times more likely in children who had experienced multiple separations/losses, after accounting for interpersonal violence which was also significant. Conclusion: Professionals working with young children, policy-makers and caregivers should be aware that an accumulation of caregiver separations/losses, irrespective of violence and other traumatic exposure, may have detrimental effects on young children especially in the context of prior separations/losses or disruptions in their lives.

Antecedentes: los niños pequeños pueden verse afectados negativamente por la separación y la pérdida de los cuidadores y otros seres queridos. Tales experiencias a menudo se producen conjuntamente con la violencia interpersonal, la imprevisibilidad y otros traumas. Se desconoce si la separación/pérdida tiene efectos únicos independientes de esas otras adversidades.Objetivo: Este estudio tuvo como objetivo establecer si la separación/pérdida está asociada con síntomas relacionados con el trauma, trastornos psiquiátricos y deterioro funcional en niños de 18 a 48 meses de edad, independientemente de otras adversidades.Métodos: Se analizaron datos de una comunidad de corte transversal y una cohorte clínica. El reclutamiento se realizó en los centros de atención primaria pediátrica, salud mental y servicios de desarrollo. Los niños (33% mujeres) eran heterogéneos en cuanto a antecedentes étnicos (55% de minorías) y estatus socioeconómico familiar (40% que viven en la pobreza). Resultados: la separación/pérdida fue común (30.9% tipo único, 15.0% tipos múltiples) y frecuente entre los niños expuestos a la violencia ((84.4% de los niños expuestos a la violencia habían experimentado la separación/pérdida de un ser querido). Sin embargo, la exposición a la violencia fue poco frecuente entre los niños con experiencias de separación/pérdida (solo el 23,9% estaba expuesto a la violencia). La separación/pérdida se asoció significativamente con los síntomas de estrés postraumático y el apego reactivo, así como con el deterioro y los trastornos psiquiátricos en modelos que controlaban riesgos sociodemográficos y contextuales, incluidos otros traumas. Los trastornos psiquiátricos fueron aproximadamente 2.5 veces más probables en los niños que habían sufrido múltiples separaciones/pérdidas, después de considerar la violencia interpersonal, que también fue importante.Conclusión: Los profesionales que trabajan con niños pequeños, políticos y cuidadores deben ser conscientes de que una acumulación de separaciones/pérdidas de cuidadores, independientemente de la violencia y otras exposiciones traumáticas, puede tener efectos perjudiciales en los niños pequeños, especialmente en el contexto de separaciones/pérdidas previas o interrupciones en sus vidas.