Beyond recidivism: reconceptualizing success through relational health for trauma-exposed youth experiencing juvenile justice involvement.

Youth who have histories of trauma exposure face unique barriers and needs in navigating the juvenile justice system. Accordingly, reliance on recidivism as the primary "success" metric falls short for trauma-impacted youth and may actually prolong their justice involvement. Caregivers and juvenile justice professionals (i.e., judges, attorneys, detention and probation staff, case managers, and mental health clinicians) often struggle to identify and adequately address these challenges and pitfalls. This policy brief provides an overview of specialized considerations for traumatized youth with respect to common policies and practices, namely mandated placement, treatment, and timelines. Specific examples and actionable recommendations are provided to assist juvenile justice professionals and treatment providers with systemic efforts to more appropriately and effectively customize juvenile justice policies and programs for these extremely vulnerable youth.

Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries.

BACKGROUND: Childhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning in adulthood among Europeans, while taking into account the mediating role of adulthood socioeconomic disadvantage (SED) in these associations. METHODS: Using the European Social Survey (ESS) collected in 2014, nationally representative cross-sectional data from 35 475 participants aged 15 years and older in 19 European countries were analysed. Logistic regressions were conducted to assess associations of retrospectively reported family conflict and/or financial strain in childhood with physical and mental health as well as health behaviours and social functioning in adulthood. RESULTS: A quarter of the European population reported having experienced family conflict, financial strain or both in childhood. Financial strain was reported more among older age groups and conflict more among younger age groups. A dose-response pattern with increased risk was demonstrated for almost all physical, behavioral, mental and social outcomes for these aspects of CA compared with no CA, with the highest risk observed in those who experienced both financial strain and family conflict. Adulthood SED mediated a significant proportion of the associations with financial strain (ranging from 5.4% to 72.4%), but did not mediate the associations with conflict. CONCLUSION: Individuals reporting family conflict or financial strain during childhood are at increased risk of developing a wide range of health and social problems. Those who report financial strain in childhood are more likely to experience SED in adulthood, which in turn increases their risk of experiencing health and social problems. Reported family conflict during childhood conferred increased risk of health and social problems, but adulthood SED did not appear to operate as an indirect pathway.

Timing of Early-Life Stress and the Development of Brain-Related Capacities.

Early-life stress (ELS) poses risks for developmental and mental health problems throughout the lifespan. More research is needed regarding how specific ELS experiences influence specific aspects of neurodevelopment. We examined the association between ELS, defined as severe adversity (e.g., domestic violence, caregiver drug use) and severe relational poverty (e.g., caregiver neglect, lack of caregiver attunement), occurring during the first 2 months of life and a variety of brain-related, clinician-rated functions, including self-regulation and relational capacities. Interdisciplinary clinicians using the Neurosequential Model of Therapeutics (NMT), an approach to clinical problem solving, reported on the timing and type of treatment-seeking children's (N = 2,155; 8-10 years) stressful experiences during four developmental periods: Perinatal (0-2 months), Infancy (2-12 months), Early Childhood (13 months to 4 years), and Childhood (4-11 years). They also reported on children's current functioning in 32 brain-related domains (e.g., sleep, arousal, impulsivity, empathy, concrete cognition). Non-negative matrix factorization (NMF) was conducted on the 32 brain-related domains to identify latent factors, yielding four factors comprising Sensory Integration, Self-Regulation, Relational, and Cognitive functioning. Regularized hierarchical models were then used to identify associations between ELS and each latent factor while controlling for stress occurring during subsequent developmental periods, and children's current degree of relational health. ELS (stress occurring during the first 2 months of life), specifically a severe lack of positive relational experiences (e.g., caregiver neglect, lack of caregiver attunement), was associated with the Sensory Integration and Self-Regulation factors. The Relational factor was better explained by stress occurring during childhood, and the Cognitive factor by stress occurring during infancy and childhood. Implications for how the timing and type of stress experiences may influence brain-related outcomes that are observed in clinical settings are discussed. Future directions include longitudinal follow-ups and greater specification of environmental variables, such as types of interventions received and when they were received, that may interact with ELS experiences to influence brain-related outcomes.

Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children.

BACKGROUND: The association between developmental adversity and children's functioning is complex, particularly given the multifaceted nature of adverse experiences. The association between the timing of experience and outcomes is underresearched and clinically under-appreciated. We examine how the timing of both adverse (including potentially traumatic) events and relational poverty are associated with developmental outcomes. METHOD: Clinicians using the Neurosequential Model of Therapeutics (NMT), an approach to clinical problem solving, reported on the timing of children's developmental experiences, their degree of current relational health, and current functioning in key brain-mediated domains (N = 3523 6- to 13-year-old children). A regularized hierarchical model produced stable and generalizable estimates regarding associations between the timing of experiences across four developmental periods: Perinatal (0-2 mos), Infancy (2-12 mos), Early Childhood (13 mos to 4 years), and Childhood (4 to 11 years) and current functioning. RESULTS: Perinatal developmental experiences were more strongly associated with compromised current functioning than such experiences occurring during other periods. Perinatal relational poverty was a stronger predictor than perinatal adversity. During subsequent developmental periods, the influence of relational poverty diminished, while the influence of adversity remained strong throughout early childhood. Current relational health, however, was the strongest predictor of functioning. CONCLUSION: Findings expand the understanding of the association between the timing of adversity and relationally impoverished experiences and children's functioning. Although early life experiences are significantly impactful, relationally enriched environments may buffer these effects.

Clinical improvements in adopted children with fetal alcohol spectrum disorders through neurodevelopmentally informed clinical intervention: A pilot study.

Research on early intervention for young children (infants and toddlers) with fetal alcohol spectrum disorders (FASD), particularly children with comorbid maltreatment experiences, is limited. Existing research has primarily focused on structuring environments to be responsive to the needs experienced by children with FASD rather than improving their functioning. The purpose of this study is to present outcomes from an early psychosocial intervention with 10 adopted, maltreated young children diagnosed with FASD, aged 10-53 months (M = 35 months), and their adoptive parents. The potential for early, targeted interventions to improve developmental outcomes for children with prenatal alcohol exposure was examined, as well as improving the skills of and reducing stress experienced by their adoptive parents. Based on the outcomes of a neurodevelopmentally informed assessment protocol, the 10 children whose data are presented were recommended to receive a range of regulatory, somatosensory, relational, and cognitive enrichments. As part of their treatment, children and caregivers received Child-Parent Psychotherapy (CPP), and caregivers (here, adoptive parents) also received Mindful Parenting Education (MPE). Related-samples Wilcoxon signed-rank tests indicated that scores of several measures of child developmental functioning improved from pre- to post-intervention and that parents' caregiving skills improved while their caregiving stress decreased. Reliable change analyses indicated that change observed from pre- to post-intervention was reliable. The promise of using neurodevelopmentally informed assessment strategies to sequence interventions for young children with diverse neurodevelopmental insults is discussed.

The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology.

BACKGROUND: Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being. METHODS: After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological "case example" of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). RESULTS: Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggression-related domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. CONCLUSIONS: The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.