Considering the associations of adverse and positive childhood experiences with health behaviors and outcomes among emerging adults.

Childhood is a sensitive period of development during which early life experiences can facilitate either positive or negative health trajectories across subsequent developmental periods. Previous research has established strong links between adverse childhood experiences (ACEs) and adverse health outcomes (e.g., sleep-related problems, pain, substance use). Despite this, less is known about positive childhood experiences (PCEs) and how they may buffer the effects of ACEs on health outcomes. The current study investigated whether PCEs moderate the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference) in a sample of at-risk emerging adults. Participants (N = 165) were undergraduate college students (18-25 years of age) who reported frequent alcohol and/or cannabis use (≥3 times in the past week). A significant positive association was found between ACEs and cannabis use. There were also significant negative associations found between PCEs and pain interference and intensity. PCEs did not moderate any of the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference). Findings suggest that PCEs may be unlikely to serve as a strong enough protective factor during early life to decrease risk for suboptimal health and health behaviors during emerging adulthood among individuals who report a greater accumulation of ACEs. Longitudinal research is needed to identify additional related risk and protective factors during early life to further support health and health behavior during this transitional period of development and beyond.

ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization.

The present cross-sectional study evaluated whether traditional and/or cyber peer victimization served as mechanisms linking ADHD symptoms to sleep disturbance and sleep impairment in a sample of 284 third- through fifth-grade students (51.9% boys; 50.4% Hispanic/Latine) from two elementary schools in the United States. ADHD symptoms were assessed using teacher ratings. Children provided reports of their traditional and cyber victimization as well as their sleep disturbance and impairment. Results from path analysis models revealed significant indirect effects of traditional victimization on the links from ADHD symptoms to sleep disturbance and impairment. There was also a significant indirect effect of cyber victimization on the link from ADHD symptoms to sleep impairment. These findings suggest that experiences of traditional and cyber peer victimization may need to be addressed among children exhibiting ADHD symptoms in order to mitigate their risk for sleep problems and downstream effects on other domains of psychosocial functioning.

Associations between forms of aggression and peer victimization: Does prosocial behavior matter?

Relatively little is known regarding factors that may mitigate the strength of the associations between forms of aggressive behavior and peer victimization. The goal of the current study was to investigate prosocial behavior as a moderator of these links over a 2-year period during middle childhood. Participants included 410 third-grade students (53% boys) and their homeroom teachers. Results indicated that prosocial behavior was associated with lower initial levels of victimization, whereas relational aggression was associated with higher initial levels of victimization. Physical aggression predicted more stable patterns of victimization over time, and prosocial behavior moderated the prospective link from relational aggression to peer victimization; specifically, relational aggression predicted decreases in victimization at higher levels of prosocial behavior and more stable patterns over time when levels of prosocial behavior were low. Further, gender differences were observed in the moderating effect of prosocial behavior on the prospective link from physical aggression to peer victimization, such that it served as a risk factor for boys and a protective factor for girls.

Latent Profiles of Sleep Disturbance and Impairment in Elementary School-Age Youth: Concurrent and Longitudinal Associations with Emotional, Behavioral, and Academic Functioning.

OBJECTIVE: The links from youth sleep problems to emotional, behavioral, and academic functioning are well documented. Latent variable mixture modeling (LVMM) has been used to explore these relations; however, additional research is needed in diverse samples and with self-reports of sleep-related difficulties. The objectives of the current study were to identify profiles based on patterns of sleep disturbance and impairment and explore associations among profiles and functioning at baseline and over a subsequent 6-month period. METHODS: Participants were 278 third- through fifth-grade students (M age = 9.27; 51.8% male; 51.1% Hispanic/Latine) and homeroom teachers. Children completed measures of sleep disturbance and impairment, emotion (dys)regulation, and depressive, anxiety, and anger symptoms. Teachers completed measures of youth's emotional and conduct problems, emotion (dys)regulation, and academic performance. LVMM was conducted. RESULTS: Three profiles emerged: (1) "Average Sleep Disturbance and Impairment" (n = 148); (2) "Elevated Sleep Disturbance and Average Sleep Impairment" (n = 40); and (3) "Elevated Sleep Disturbance and Impairment" (n = 90). Overall, youth with above average sleep problems had worse functioning at baseline. Further, youth in Profile 3 exhibited increases in self-reported symptoms of depression, anxiety, and anger, as well as worsening teacher-reported academic performance and conduct problems. In contrast, youth in Profile 2 exhibited improvements in self-reported symptoms of depression, anxiety, and anger, as well as teacher-reported emotion regulation, conduct problems, and academic performance. CONCLUSIONS: Results highlight the importance of examining self-reports of sleep problems and the need for intervention among children exhibiting elevated sleep disturbance and impairment.

Impact of Sibling Victimization on Child Internalizing Symptoms.

The current study examined associations between sibling victimization and anxiety and depression symptoms while also considering peer victimization within time and six months later among elementary school-age youth. Both sibling and peer victimization were associated with depression symptoms within as well as across time when considered independently. However, when examined together, peer victimization was only uniquely associated with depression symptoms within time and sibling victimization was only uniquely associated with depression symptoms across time. Sibling and peer victimization were associated with anxiety symptoms within, but not across, time when examined independently, and no associations were evident when sibling and peer victimization were examined simultaneously. No interactive effects of sibling and peer victimization were evident for depression or anxiety symptoms, indicating unique rather than cumulative contributions. Findings suggest that the impact of sibling victimization on depression symptoms is more robust than effects of peer victimization over time.

Differences in mental health engagement and follow-up among Black and White patients after traumatic injury.

BACKGROUND: Severe injury necessitating hospitalization is experienced by nearly three million US adults annually. Posttraumatic stress disorder and depression are prevalent clinical outcomes. The mechanisms by which programs equitably promote mental health recovery among trauma-exposed patients are understudied. We evaluated clinical outcomes and engagement among a cohort of Black and White patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate mental health recovery after traumatic injury. METHODS: Trauma Resilience and Recovery Program is a four-step model that includes (1) bedside psychoeducation about mental health recovery following traumatic injury, (2) a text-messaging symptom tracking system, (3) a 30-day postinjury mental health screen, and (4) referrals to mental health services. Data describe 1,550 patients enrolled in TRRP within a Level I trauma center ( Mage = 40.86; SD, 17.32), 611 of whom identified as Black (74.5% male) and 939 of whom identified as White (67.7% male). RESULTS: Enrollment in TRRP was nearly universal (97.9%) regardless of race or injury mechanism. Enrollment and usage of the text-message system were statistically similar between Black (35.7%) and White patients (39.5%). Trauma Resilience and Recovery Program reengaged Black and White patients at a similar rate at the 30-day postinjury follow-up. However, Black patients were more likely to report peritraumatic distress at the bedside and clinical elevations in posttraumatic stress disorder and depression on the 30-day screen. Referrals were more likely to be accepted by Black patients relative to White patients with clinically elevated symptoms. CONCLUSION: Enrollment and engagement were comparable among Black and White patients served by TRRP. Data provide preliminary evidence to suggest that TRRP is feasible and acceptable and engages patients in mental health follow-up equitably. However, research that includes careful measurement of social determinants of health and long-term follow-up examining initiation, completion, and benefit from treatment is needed. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

Interactive Effects of Coping Strategies and Emotion Dysregulation on Risk for Peer Victimization.

The aim of the current longitudinal study was to examine the interactive effects of six common coping strategies (i.e., adult support seeking, friend support seeking, problem solving, humor, passive coping, and cognitive distancing) and emotion (i.e., anger and sadness) dysregulation on concurrent levels and subsequent trajectories of peer victimization over a 2-year period. Participants were 287 predominantly Caucasian students (53.7% boys; ages 6-9) from an elementary school located in the Midwestern United States. Self-reported coping strategies and emotion dysregulation were assessed at baseline; children also provided ratings of peer victimization annually over a 2-year period. Results indicated that the effectiveness of particular coping strategies may depend on children's overt, undercontrolled displays of anger and sadness. Consistent with recent recommendations, these findings suggest that some youth may require interventions that focus on both enhancing emotion regulation skills and teaching strategies for responding to peer victimization in a more adaptive manner.

Emotion Regulation Attenuates the Prospective Links from Peer Victimization to Internalizing Symptoms during Middle Childhood.

Objective: Peer victimization has been shown to be a robust predictor of depressive and anxiety symptoms over time. Relatively little is known, however, regarding what protective factors may attenuate these associations and render youth more resilient to this interpersonal stressor. Therefore, the current study examined sadness and worry regulation as moderators of the prospective links from peer victimization to internalizing symptoms over a 1-year period.Method: Participants included 464 predominantly Caucasian children (54.7% boys; ages 7-10), as well as their homeroom teachers, from an elementary school located in the Midwestern United States. Child and teacher reports of peer victimization and child reports of sadness and worry regulation were assessed at Time 1. Children also provided ratings of depressive and anxiety symptoms at Time 1, approximately 6 months later (Time 2), and again approximately 1 year later (Time 3). Moderating effects were evaluated using a series of multivariate latent growth curve models.Results: Consistent with expectations, sadness regulation attenuated the prospective links from both child- and teacher-reported peer victimization to internalizing symptoms. Worry regulation also attenuated the prospective links from teacher-reported peer victimization to internalizing symptoms. The moderating effects of emotion regulation did not differ according to gender.Conclusions: Findings suggest that the ability to effectively manage feelings of sadness and worry may serve as a buffer against the internalizing symptoms associated with peer victimization. Additional research is needed to determine whether interventions focused on enhancing victims' emotion regulation skills reduce their subsequent risk for depressive and anxiety symptoms.

Anger and Attention Problems as Mechanisms Linking Maltreatment Subtypes and Witnessed Violence to Social Functioning Among Children in Out-of-Home Care.

Research has consistently shown that child maltreatment and witnessed violence lead to disrupted patterns of social functioning, yet the mechanisms underlying these pathways remain unclear. This cross-sectional study evaluated whether anger and/or attention problems mediated the links from abuse, neglect, and witnessed violence to peer problems and aggressive behavior. Participants included a diverse sample of 470 children (ages 8-11; 52.1% boys) living in out-of-home care. Subtype and severity of maltreatment exposure were coded using Child Protection Services' intake reports and court records. Witnessed violence and anger were assessed using child-reports, and caregivers provided ratings of attention problems and social functioning. Indirect effects were tested using a series of structural equation path analysis models. Results indicated that anger fully mediated the links from witnessed violence to both peer problems and aggressive behavior. Further, attention problems fully mediated the links from physical abuse and physical neglect to both peer problems and aggressive behavior. These findings highlight the need for interventions to target anger regulation and attentional control among children in out-of-home care in order to mitigate their risk for social maladjustment.

Fostering Healthy Futures Preventive Intervention for Children in Foster Care: Long-term Delinquency Outcomes from a Randomized Controlled Trial.

Child maltreatment and foster care placement are strong risk factors for delinquency and juvenile justice involvement, and there is substantial crossover between youth in the child welfare and juvenile justice systems. This study examines the long-term impact of the Fostering Healthy Futures (FHF) program, a 30-week mentoring and skills group preventive intervention for preadolescent maltreated children in foster care. Participants included 426 children recently placed in out-of-home care who were randomized to intervention or control conditions. Outcomes included both self-reported delinquency, measured at multiple time points between 6 months and 12 years post-intervention, as well as court records of delinquency charges, which were measured for 7 consecutive years beginning 3 months after the intervention began. Results from multilevel models indicated that the intervention group self-reported 30-82% less total and non-violent delinquency than the control group between ages 14 and 18. Court charges for total and violent delinquency in mid-adolescence were also 15-30% lower for the intervention group. These findings indicate that a mentoring and skills training program in preadolescence can reduce delinquency and justice involvement for children who are at high risk for these outcomes.

Bidirectional associations between affective empathy and proactive and reactive aggression.

Preliminary evidence indicates that affective empathy is differentially related to proactive and reactive functions of aggression. However, additional longitudinal research is needed to understand the potential reciprocal nature of these links. The current study examined the bidirectional associations between affective empathy and proactive and reactive aggression over a 6-month period during middle childhood, with attention to potential gender differences. Data were collected from 294 elementary school children (52% girls; M = 9.25 years; SD = 0.944 years) and their homeroom teachers. Affective empathy was assessed using self-reports, and teachers provided ratings of children's functions of aggression. Data were collected during the fall and spring of one academic year. Overall, results suggest some evidence that affective empathy and functions of aggression are reciprocally linked over time. As predicted, Time 1 empathy was inversely associated with Time 2 proactive aggression and Time 1 reactive aggression was inversely associated with Time 2 empathy. Contrary to expectations, Time 1 proactive aggression was marginally positively associated with Time 2 empathy, and Time 1 empathy was not significantly associated with Time 2 reactive aggression. These prospective links did not differ according to gender. Implications and directions for future research are discussed.

Incorporating evidence-based behavioral teacher training into Head Start mental health consultation: Description and initial outcomes of a large-scale program.

Development of a multicomponent mental health consultation program for a countywide Head Start program is described. The consultation program incorporates strategies from the evidence-based practice, Teacher-Child Interaction Training (TCIT). Through large group professional development trainings before the school year, comprehensive feedback reports based on observations, and in-class coaching via modeling and performance feedback on teachers' use of TCIT skills, the consultation program served 55 Head Start classrooms with 789 children. Outcome data are presented on teachers' improvement in TCIT skill use and the relative effectiveness of two coaching methods (i.e., modeling and performance feedback) used during consultation. Results from multilevel modeling analyses indicated that teachers improved in the use of multiple observed TCIT skills between the initial and midyear assessment (i.e., increased frequency of labeled praises, reflections, behavioral descriptions, and commands that were complied with; decreased frequency of commands that children did not have an opportunity to comply with). Additionally, teachers who received coaching in the form of performance feedback, in comparison to modeling, exhibited greater gains in the frequency of labeled praises and commands that resulted in compliance. Discussion focuses on implementation of evidence-based practice in large-scale preventative early interventions, study limitations, and directions for future research.

Examining ODD/ADHD Symptom Dimensions as Predictors of Social, Emotional, and Academic Trajectories in Middle Childhood.

The goal of this article is to investigate the symptom dimensions of oppositional defiant disorder (ODD; irritability, defiance) and attention deficit/hyperactivity disorder (ADHD; inattention, hyperactivity-impulsivity) as predictors of academic performance, depressive symptoms, and peer functioning in middle childhood. Children (N = 346; 51% female) were assessed via teacher-report on measures of ODD/ADHD symptoms at baseline (Grades K-2) and academic performance, depressive symptoms, peer rejection, and victimization on 7 occasions over 4 school years (K-2 through 3-5). Self-report and grade point average data collected in Grades 3-5 served as converging outcome measures. Latent growth curve and multiple regression models were estimated using a hierarchical/sensitivity approach to assess robustness and specificity of effects. Irritability predicted higher baseline depressive symptoms, peer rejection, and victimization, whereas defiance predicted higher baseline peer rejection; however, none of these ODD-related effects persisted 3 years later to Grades 3-5. In contrast, inattention predicted persistently poorer academic performance, persistently higher depressive symptoms, and higher baseline victimization; hyperactivity-impulsivity predicted subsequent peer rejection and victimization in Grades 3-5. In converging models, only inattention emerged as a robust predictor of 3-year outcomes (viz., grade point average, depressive symptoms, peer rejection, and relational victimization). Broadly, ODD dimensions-particularly irritability-may be linked to acute disturbances in social-emotional functioning in school-age children, whereas ADHD dimensions may predict more persistent patterns of peer, affective, and academic problems. By examining all 4 ODD/ADHD symptom dimensions simultaneously, the present analyses offer clarity and specificity regarding which dimensions affect what outcomes, and when. Findings underscore the importance of multidimensional approaches to research, assessment, and intervention.

The Influence of Internalizing Symptoms and Emotion Dysregulation on the Association Between Witnessed Community Violence and Aggression Among Urban Adolescents.

The current cross-sectional study examined whether internalizing (i.e. anxiety and depressive) symptoms and/or emotion dysregulation moderated the association between witnessed community violence and aggressive behavior. Participants were 180 predominantly African American adolescents (62% girls; M age = 15.87 years, SD = 1.19 years) from a high school located in an urban community in the United States. Approximately 95% of adolescents reported having witnessed at least one violent act during their lifetimes, with many endorsing repeated exposure to severe acts of community violence. Results indicated that emotion dysregulation exacerbated the association between witnessed community violence and aggression. A quadratic effect of anxiety symptoms also moderated this association, such that witnessed community violence was linked to aggression at low and high, but not moderate, levels of anxiety symptoms. In contrast, a quadratic effect of depressive symptoms was uniquely related to aggression, regardless of witnessed community violence. Directions for future research and implications for practice are reviewed.

Pilot evaluation of a targeted intervention for peer-victimized youth.

OBJECTIVE: Due to the limited effectiveness of extant prevention and intervention strategies, the current study is an initial evaluation of a cognitive behavioral group intervention, originally designed to treat symptoms of depression and anxiety, for youth who experienced peer victimization. METHODS: Twelve third- through fifth-grade youth participated in the intervention, and their data were compared with 12 youth who were a part of a naturalistic control group. Additionally, school-wide data are reported to provide overall school trends. RESULTS: Whereas the intervention group participants exhibited decreases in relational victimization, depressive symptoms, and passive coping, the control group participants exhibited nonsignificant increases in relational victimization, depressive symptoms, and passive coping. School-wide data also indicated overall increases in relational victimization and depressive symptoms, but no changes in passive coping. CONCLUSION: Findings suggest that cognitive behavioral group interventions may provide a promising avenue for addressing the mental health needs of victimized elementary school-age youth.

Bidirectional Associations between Peer Victimization and Functions of Aggression in Middle Childhood: Further Evaluation across Informants and Academic Years.

The current 3-wave study examined bidirectional associations between peer victimization and functions of aggression across informants over a 1-year period in middle childhood, with attention to potential gender differences. Participants included 198 children (51% girls) in the third and fourth grades and their homeroom teachers. Peer victimization was assessed using both child- and teacher-reports, and teachers provided ratings of reactive and proactive aggression. Cross-classified multilevel cross-lagged models indicated that child-reports, but not teacher-reports, of peer victimization predicted higher levels of reactive aggression within and across academic years. Further, reactive aggression predicted subsequent increases in child- and teacher-reports of peer victimization across each wave of data. Several gender differences, particularly in the crossed paths between proactive aggression and peer victimization, also emerged. Whereas peer victimization was found to partially account for the stability of reactive aggression over time, reactive aggression did not account for the stability of peer victimization. Taken together with previous research, the current findings suggest that child-reports of peer victimization may help identify youth who are risk for exhibiting increased reactive aggression over time. Further, they highlight the need to target reactively aggressive behavior for the prevention of peer victimization in middle childhood.

Anxiety symptoms as a moderator of the reciprocal links between forms of aggression and peer victimization in middle childhood.

The current short-term longitudinal study evaluated whether anxiety symptoms moderated the bidirectional associations between forms (i.e., physical and relational) of aggression and peer victimization over a 1-year period during middle childhood. Participants were 228 predominantly Caucasian children (50.4% boys; M = 8.32 years, SD = .95 years) in the second through fourth grades and their homeroom teachers. Children completed a self-report measure of anxiety symptoms at Time 1. Peer victimization was assessed using self-reports at Time 1 and approximately 1 year later (Time 2), and teachers provided ratings of children's aggressive behavior at both time points. A series of cross-lagged path analysis models indicated that high (+1 SD) initial levels of anxiety symptoms exacerbated the prospective link from Time 1 relational aggression to Time 2 peer victimization; conversely, when initial levels of anxiety symptoms were low (-1 SD), relational aggression predicted lower levels of subsequent peer victimization. Time 1 peer victimization was also found to predict lower levels of Time 2 physical aggression when initial levels of anxiety symptoms were low, and Time 1 anxiety symptoms were uniquely related to higher levels of relational aggression over a 1-year period. Regions of significance were calculated to further decompose significant interactions, which did not differ according to gender. Study findings are discussed within a social information processing theoretical framework, and directions for future research and implications for practice are reviewed. Specifically, co-occurring anxiety symptoms may need to be addressed in interventions for both aggression and peer victimization during middle childhood.

Associations Between Physical and Relational Forms of Peer Aggression and Victimization and Risk for Substance Use Among Elementary School-Age Youth.

This study examined associations between physical and relational forms of aggression and victimization and risk for willingness to engage in substance use and actual use in a sample of 231 (50% Male) 2nd thru 4th grade students (Mean age = 8.3 years). Physical aggression was more strongly associated with risk for substance use outcomes than physical victimization. Neither relational aggression nor victimization were linked to risk for substance use. Specifically targeting physical aggression for the prevention of early substance use among elementary school-age youth appears to be warranted.

Peer Victimization and Forms of Aggression During Middle Childhood: The Role of Emotion Regulation.

The current short-term longitudinal study evaluated whether anger and sadness regulation moderated the associations between peer victimization and physical and relational forms of aggression over a 6-month period. Participants included 278 predominantly Caucasian children (51.8% female) between 8 and 12 years of age (M = 9.33, SD = 0.99). Peer victimization was assessed at Time 1 using child- and teacher-reports, and teachers provided ratings of children's aggressive behavior at Time 1 and Time 2. Children also completed self-report measures of anger and sadness regulation at Time 1. Results from multilevel models provided support for the notion that children's ability to effectively regulate their feelings of anger and sadness influences the relations among peer victimization and forms of aggression over time. As anticipated, high levels of anger regulation attenuated the link between child-reported peer victimization and physical aggression. Further, when levels of anger regulation were high, teacher-reported peer victimization predicted subsequent decreases in physical aggression. Contrary to expectations, however, high levels of anger and sadness regulation exacerbated the association between child-reported peer victimization and relational aggression, and teacher-reported peer victimization predicted decreases in relational aggression over time when levels of anger regulation were low. Directions for future research and implications for practice are discussed.

The Moderating Effect of Physical Activity on the Association Between ADHD Symptoms and Peer Victimization in Middle Childhood.

Previous research has demonstrated that symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with higher levels of victimization, but little is known about protective factors. The purpose of the study was to examine whether physical activity attenuated the associations among ADHD symptoms and physical and relational victimization 1.5 years later. Participants included 168 s through fourth grade students (M age = 8.43; 52.4 % boys) who completed self-reports of physical activity and victimization; teachers provided ratings of ADHD symptoms. ADHD symptoms predicted subsequent increases in physical, but not relational, victimization among children who reported engaging in moderate/high levels of physical activity, especially out of the school context (moderate: ß = .26, p = .03; high: ß = .55, p < .001). Findings suggest that children with ADHD symptoms may benefit from being taught the skills necessary to appropriately engage in physical activity and from being monitored while engaging in activity in order to limit physical victimization that they might experience.