Community-engaged research: Bringing the science of developmental psychopathology into the real world.

The science of developmental psychopathology has made outstanding progress over the past 40 years in understanding adaptive and maladaptive developmental processes across the life span. Yet most of this work has been researcher driven with little involvement of community partners in the research process, limiting the potential public health significance of our work. To continue to advance the field we must move beyond the physical and conceptual walls of our research laboratories and into the real world. In this article, we define and describe the importance of community-engaged research, and present our overarching principles for engaging the community including practicing respect, shared power and decision-making, prioritizing the needs of the community, and engaging in consistent and transparent communication. We present several associated recommendations for best practice and highlight examples from our own research that is grounded in a developmental psychopathology perspective to illustrate these practices. Recommendations for the future of the discipline of development and psychopathology, with emphasis on training and continuing education, are described.

Does sleep link child maltreatment to depressive symptoms among incoming first-year college students?

Study Objectives: We examined whether sleep (i.e. quality, regularity, and duration) mediated associations between child maltreatment (CM) and depressive symptoms among emerging adults undergoing the major life transition of starting college. Methods: Students (N = 1400; 44% male; 48% non-Hispanic white, 20% non-Hispanic Asian, 15% Hispanic all races, 7% non-Hispanic black, and 10% non-Hispanic other races) completed daily sleep diaries for 9 weeks, followed by the Childhood Trauma Questionnaire-Short Form, Pittsburgh Sleep Quality Index, and the Center for Epidemiologic Studies Depression Scale (CES-D). DSD data were used to compute participants' Sleep Regularity Index and average 24-hour total sleep time. We used a nonparametric structural equation modeling bootstrap approach and full information maximum likelihood to account for missing data. In model 1, we controlled for sex and race and ethnicity. In model 2, we further adjusted for baseline CES-D scores. Results: The prevalence of self-reported moderate-to-severe CM was 22%. Small but significant indirect effects of CM on greater depressive symptoms through worse sleep quality (ß = 0.06, 95% CI = 0.04, 0.09) and lower sleep regularity (ß = 0.02, 95% CI = 0.005, 0.03) were observed in model 1. In model 2, only the indirect effect of sleep quality remained significant (ß = 0.03, 95% CI = 0.01, 0.06). Conclusions: Poorer sleep quality may partially account for associations between CM and depressive symptoms during the first semester of college. Including sleep as a target in student health interventions on college campuses may not only help buffer against poor mental health outcomes for students with CM, but also poor academic and socioeconomic outcomes long-term.

Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program.

Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.

Examining the Biological Impacts of Parent-Child Relationship Dynamics on Preschool-Aged Children who have Experienced Adversity.

Parent-child relationship dynamics have been shown to predict socioemotional and behavioral outcomes for children, but little is known about how they may affect biological development. The aim of this study was to test if observational assessments of parent-child relationship dynamics (cohesion, enmeshment, and disengagement) were associated with three biological indices of early life adversity and downstream health risk: (1) methylation of the glucocorticoid receptor gene (NR3C1), (2) telomere attrition, and (3) mitochondrial biogenesis, indexed by mitochondrial DNA copy number (mtDNAcn), all of which were measured in children's saliva. We tested hypotheses using a sample of 254 preschool-aged children (M age = 51.04 months) with and without child welfare-substantiated maltreatment (52% with documented case of moderate-severe maltreatment) who were racially and ethnically diverse (17% Black, 40% White, 23% biracial, and 20% other races; 45% Hispanic) and from primarily low-income backgrounds (91% qualified for public assistance). Results of path analyses revealed that: (1) higher parent-child cohesion was associated with lower levels of methylation of NR3C1 exon 1D and longer telomeres, and (2) higher parent-child disengagement was associated with higher levels of methylation of NR3C1 exon 1D and shorter telomeres. Results suggest that parent-child relationship dynamics may have distinct biological effects on children.

Maternal Childhood Adversity and Infant Epigenetic Aging: Moderation by Restless Sleep During Pregnancy.

Maternal exposure to childhood adversity is associated with detrimental health outcomes throughout the lifespan and may have implications for offspring. Evidence links maternal adverse childhood experiences (ACEs) to detrimental birth outcomes, yet the impact on the infant's epigenome is unclear. Moreover, maternal sleep habits during pregnancy may influence this association. Here, we explore whether restless sleep during pregnancy moderates the association between exposure to maternal childhood adversity and infant epigenetic age acceleration in 332 mother-infant dyads (56% female; 39% Black; 25% Hispanic). During the 2nd trimester, mothers self-reported childhood adversity and past-week restless sleep; DNA methylation from umbilical vein endothelial cells was used to estimate five epigenetic clocks. Multivariable linear regression was used to test study hypotheses. Despite no evidence of main effects, there was evidence of an interaction between maternal ACEs and restless sleep in predicting infant epigenetic age acceleration using the EPIC Gestational Age clock. Only infants whose mothers reported exposure to both ACEs and restless sleep demonstrated accelerated epigenetic aging. Results provide preliminary evidence that maternal childhood adversity and sleep may influence the infant epigenome.

Circulating Cell-Free Mitochondrial DNA and Depressive Symptoms Among Low-Active Adults Who Smoke.

OBJECTIVES: Mitochondrial dysfunction is implicated in the pathophysiology of psychiatric disorders. Levels of circulating cell-free mitochondrial DNA (cf-mtDNA) are observed to be altered in depression. However, the few studies that have measured cf-mtDNA in depression have reported conflicting findings. This study examined cf-mtDNA and depressive symptoms in low-active adults who smoke. METHODS: Participants were adults 18 to 65 years old ( N = 109; 76% female) with low baseline physical activity and depressive symptoms recruited for a smoking cessation study. Self-report measures assessed depression severity, positive and negative affect, and behavioral activation. Blood was collected and analyzed for cf-mtDNA. Relationships between depressive symptoms and cf-mtDNA were examined with correlations and linear regression. RESULTS: Levels of cf-mtDNA were associated with categorically defined depression (Center for Epidemiologic Studies Depression Scale score >15), lower positive affect, and decreased behavioral activation ( p < .05). Relationships remained significant after adjustment for age, sex, and nicotine dependence. In a linear regression model including all depressive symptom measures as predictors, Center for Epidemiologic Studies Depression Scale group and lower positive affect remained significant. CONCLUSIONS: This work suggests that mitochondrial changes are associated with depressive symptoms in low-active adults who smoke. Higher levels of cf-mtDNA in association with depression and with lower positive affect and decreased behavioral activation are consistent with a possible role for mitochondrial function in depressive symptoms.

Reflective supervision and consultation and its impact within early childhood-serving programs: A systematic review.

Reflective supervision and consultation (RS/C) is regarded as best practice within the infant/early childhood mental health field. Benefits of RS/C on the early childhood workforce and children and families have been demonstrated through case studies, conceptual pieces, and individual research studies. However, findings across studies have not been summarized using gold-standard methodology, thus the state of existing empirical support for RS/C is unclear. This systematic review examined the collective evidence for RS/C across diverse early childhood-serving programs. Electronic databases were searched to identify studies investigating associations between RS/C and professionals' reflective capacity and well-being, child/family outcomes, and implementation factors. Twenty-eight papers were identified. Studies showed positive associations between RS/C and early childhood-serving professionals' reflective capacity and well-being, with qualitative studies reporting more consistent results than studies using quantitative methods. Many methodological limitations were identified, including incomplete reporting of study designs and participant characteristics, variability in outcome measures, and lack of randomization and comparison groups. Furthermore, few studies examined child and family outcomes. Therefore, while RS/C shows great promise, it was difficult to ascertain its overall effectiveness from an empirical standpoint. Establishing RS/C as an empirically supported approach will be possible with more rigorous research.

A la consulta y supervisión con reflexión (RS/C) se le considera como práctica óptima dentro del campo de la salud mental infantil y la temprana niñez. Los beneficios de RS/C en la fuerza laboral de la temprana niñez, así como en niños y familias, han quedado demostrados a través de estudios de casos, componentes conceptuales y estudios individuales de investigación. Sin embargo, los resultados en la gama de estudios no han sido resumidos usando una metodología arquetípica; por tanto, el estado del apoyo empírico existente para RS/C no está claro. Esta sistemática revisión examinó la evidencia colectiva de RS/C a lo largo de los diversos programas que se dedican a la temprana niñez. Se investigaron bancos electrónicos de datos para identificar estudios que investigaron las asociaciones entre RS/C y la capacidad de reflexión y bienestar de profesionales, los resultados en niño y familia, así como los factores de implementación. Se identificaron veintiocho artículos. Los estudios mostraron asociaciones positivas entre RS/C y la capacidad de reflexión y bienestar de profesionales que prestan servicios en al campo de la temprana niñez, con estudios cualitativos que reportaron resultados más consistentes que los estudios que usaron métodos cuantitativos. Se identificaron muchas limitaciones metodológicas, incluyendo un incompleto reporte de los diseños del estudio y las características de los participantes, la variabilidad en las medidas para los resultados, así como una falta de aleatorización y grupos de comparación. Es más, pocos estudios examinaron los resultados en el niño y la familia. Por tanto, mientras que RS/C muestra gran promesa, fue difícil cerciorarse de su efectividad en términos generales desde un punto de vista empírico. Establecer RS/C como un acercamiento empíricamente apoyado será posible con una investigación más rigurosa.

La supervision et la conversation par réflexion (RS/C) est considérée comme étant la meilleure pratique dans le domaine de la santé mentale du nourrisson et de la petite enfance. Les bénéfices de la RS/C sur les effectifs de la petite enfance et les enfants et leurs familles ont été prouvés au travers d'études de cas, de travaux conceptuels et d'études individuelles de recherche. Cependant les résultats au travers des études n'ont pas été résumés au moyen d'une méthodologie de référence et par conséquent l'état du soutien empirique existent pour le RS/C n'est pas clair. Cette revue systématique a examiné les preuves collectives de la RS/C au travers de divers programmes servant la petite enfance. Les bases de données électroniques ont été utilisées afin d'identifier des études se penchant sur les liens entre la RS/C et la capacité de réflexion des professionnels ainsi que leur bien-être, les résultats pour l'enfant/la famille et les facteurs de mise en place. Vingt-huit études ont été identifiées. Les études ont démontré des liens positifs entre la RS/C et la capacité de réflexion et le bien-être de professionnels de la petite enfance, avec des études qualitatives faisant état de résultats plus constants que les études utilisant des méthodes quantitatives. Plusieurs limitations méthodologiques ont été identifiées, y compris le fait de rapporter de manière incomplète les méthodologies des études et les caractéristiques des participants, la variabilité des mesures des résultats, et le manque de de groupes de randomisation et de contrôle. De plus, peu d'études ont examiné les résultats de l'enfant et de la famille. En conclusion, bien que la RS/C soit promettante, il était difficile de vérifier son efficacité générale d'un point de vue empirique. L'établissement de la RS/C en tant qu'approche soutenue empiriquement sera possible avec des recherches plus rigoureuses.

Maternal perinatal hypertensive disorders and parenting in infancy.

Maternal mental health strongly influences parenting during infancy. However, it is unclear whether maternal physical health conditions in the perinatal period may also impact parenting. Examining the association of hypertensive disorders - a common physical health problem in pregnancy - with subsequent parenting behaviors is an important first step in understanding the connection between maternal physical health and parenting during this critical developmental period. This study evaluated whether hypertensive disorders of pregnancy (HDP) and hypertensive disorders (HD) diagnosed after the birth of the infant were associated with parenting self-efficacy, parenting stress, and observed parental responsiveness during mother-infant interactions at 6 and 12 months postpartum among a sample of racially and ethnically diverse mothers and their infants (N = 295). Results showed that mothers with an HDP or HD diagnosis had lower levels of parenting self-efficacy, higher levels of parenting stress, and lower levels of observed parental responsiveness compared to mothers without an HDP or HD diagnosis. Given that women with childhood adversity are at higher risk for experiencing HDP/HD and may have more difficulties with parenting compared to women without childhood adversity, we utilized a sample of mothers wherein most had experienced at least one form of adversity in their childhoods. Exploratory analyses revealed that HDP/HD moderated the relation between early life experiences and parenting outcomes in all but one model. Associations between HDP/HD and parenting are discussed, with implications for how we understand maternal physical health as a determinant of parenting in the perinatal period.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health.

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Los síntomas de estrés materno postraumático (PTSS) se asocian con consecuencias adversas para niños de mayor edad, pero pocos estudios han examinado las conexiones entre PTSS materno perinatal y los resultados en el infante. El estar expuesta al trauma y la sicopatología de este, incluyendo PTSS, a menudo se intensifican más en el caso de mujeres durante el embarazo y hasta un año después del parto. Por tanto, el período perinatal pudiera ser un omento crítico para comprender el riesgo que el PTSS materno y otros factores de salud mental presentan para la salud socioemocional y física de los infantes. Este estudio exploró la relación entre el PTSS materno y los problemas de salud socioemocional y física del infante en un grupo muestra de díadas madre-infante racial y étnicamente diversas (N = 295), evaluadas prenatalmente y a los 12 meses después del parto. Este estudio también examinó si hay: (1) efectos moderadores de los síntomas depresivos maternos y el estrés de crianza sobre estas asociaciones y (2) efectos indirectos de PTSS sobre los resultados en el infante a través de la observada sensibilidad materna. Los resultados indican que los síntomas depresivos y el estrés de crianza, en vez de PTSS, estaban asociados con mayores problemas de salud socioemocional del infante. Sin embargo, el PTSS se asoció con mayores problemas de salud física en el infante cuando las madres también reportaron niveles clínicamente significativos de síntomas depresivos. No se corroboró el que la sensibilidad materna fuera un mecanismo intermediario de conexión entre PTSS y otros factores de salud mental materna y resultados en el infante.

Les symptômes des stress posttraumatique (SPT) maternel sont liés à des conséquences adverses pour les enfants plus âgés mais peu d'études ont examiné les liens entre le SPT périnatal maternel et les résultats sur les nourrissons. L'exposition au trauma et la psychopathologie, y compris le SPT, est souvent accrues pour les femmes durant la grossesse jusqu'à un an après la naissance. Par conséquent la période périnatale peut être un moment critique pour la compréhension du risque que posent le SPT maternel et d'autres facteurs de santé mentale à la santé socio-émotionnelle et physique des nourrissons. Cette étude a exploré la relation entre le SPT maternel et les problèmes socio-émotionnels et physiques des nourrissons chez un échantillon de dyades mère-nourrisson racialement et ethniquement diverses (N = 295) évaluées au stade prénatal et à 12 mois après la naissance. Cette étude a aussi examiné s'il existait : (1) des effets modérateurs de symptômes dépressifs maternels et du stress de parentage sur ces associations et (2) des effets indirects de SPT sur les résultats du nourrisson à travers une sensibilité maternelle observée. Les résultats ont indiqué que les symptômes dépressifs postpartum et le stress de parentage, plus que le SPT, étaient liés à des problèmes plus élevés de santé socio-émotionnels du nourrisson. Cependant le SPT prénatal était lié à de plus grands problèmes de santé physique du nourrisson quand les mères faisaient aussi état de niveaux cliniquement élevés de symptômes dépressifs postpartum. La sensibilité maternelle n'était pas liée au SPT maternel, aux symptômes dépressifs ou au stress de parentage, et n'était pas non plus liée à la santé socio-émotionnelle et physique du nourrisson. Donc la sensibilité maternelle n'a pas testée comme mécanisme intermédiaire liant la santé mentale maternelle aux résultats du nourrisson. Les implications pour la promotion de la santé mentale maternelle dans la période périnatale afin de soutenir la santé socio-émotionnelle et physique des nourrissons sont discutées.

The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care.

Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.

A Review of Associations between Externalizing Behaviors and Prenatal Cannabis Exposure: Limitations & Future Directions.

In utero cannabis exposure can disrupt fetal development and increase risk for various behavioral disruptions, including hyperactivity, inattention, delinquent behaviors, and later substance abuse, among others. This review summarizes the findings from contemporary investigations linking prenatal cannabis exposure to the development of psychopathology and identifies the limitations within the literature, which constrain our interpretations and generalizability. These limitations include a lack of genetic/familial control for confounding and limited data examining real world products, the full range of cannabinoids, and motives for use specifically in pregnant women. Taken together, our review reveals the need to continue to improve upon study designs in order to allow researchers to accurately draw conclusions about the development of behavioral consequences of prenatal cannabis exposure. Findings from such studies would inform policy and practices regarding cannabis use during pregnancy and move the field toward developing a comprehensive teratogenic profile of cannabis similar to what is characterized in the prenatal alcohol and tobacco literature.

Cascades of Risk Linking Intimate Partner Violence and Adverse Childhood Experiences to Less Sensitive Caregiving During Infancy.

This study evaluated if maternal intimate partner violence (IPV) had indirect effects on sensitive parenting in infancy through prenatal depressive symptoms and postpartum parenting stress and if maternal adverse childhood experiences (ACEs) moderated these indirect effects. We hypothesized that: (a) IPV would be associated with greater prenatal depressive symptoms, which would predict greater postpartum parenting stress, and ultimately less sensitive parenting and (b) the link between IPV and depressive symptoms would be strongest for mothers with high ACEs. Participants included 295 mothers and their infants who were assessed prenatally and at 12 months postpartum. Path analyses indicated that mothers with higher IPV endorsed greater prenatal depressive symptoms, which was in turn associated with postpartum parenting stress, and ultimately less sensitive parenting behavior. Moderation analyses revealed that these indirect effects varied as a function of maternal ACEs, with the link between IPV and depressive symptoms only present for mothers who reported high ACEs. Because less sensitive caregiving is often an early indicator of child maltreatment risk, understanding precursors to sensitivity is critical to increase precision in parenting interventions designed to reduce risk for maltreatment. Results may inform evidence-based preventive interventions for mothers and infants at high-risk for child abuse and neglect.

A systematic review of childhood maltreatment and DNA methylation: candidate gene and epigenome-wide approaches.

Childhood maltreatment is a major risk factor for chronic and severe mental and physical health problems across the lifespan. Increasing evidence supports the hypothesis that maltreatment is associated with epigenetic changes that may subsequently serve as mechanisms of disease. The current review uses a systematic approach to identify and summarize the literature related to childhood maltreatment and alterations in DNA methylation in humans. A total of 100 empirical articles were identified in our systematic review of research published prior to or during March 2020, including studies that focused on candidate genes and studies that leveraged epigenome-wide data in both children and adults. Themes arising from the literature, including consistent and inconsistent patterns of results, are presented. Several directions for future research, including important methodological considerations for future study design, are discussed. Taken together, the literature on childhood maltreatment and DNA methylation underscores the complexity of transactions between the environment and biology across development.

Intergenerational Effects of Maternal Childhood Experiences on Maternal Parenting and Infant Developmental Progress.

OBJECTIVE: This study evaluated the intergenerational indirect effects of maternal childhood experiences on infant progress in reaching developmental milestones through maternal scaffolding behaviors. We hypothesized that mothers who perceived their own mothers as highly supportive in childhood, even in the context of adverse childhood experiences (ACEs), would be more likely to engage in scaffolding with their infants, which in turn would predict greater infant developmental progress (e.g., less risk for developmental delay). METHODS: Participants included 295 low-income mothers and their infants who were assessed prenatally and at 6 and 12 months postpartum. Mothers retrospectively reported on their childhood experiences, maternal parenting behaviors were observationally rated at 6 months postpartum, and infant developmental progress (communication, problem-solving, gross motor, fine motor, and personal-social) was assessed at 6 and 12 months postpartum using the Ages and Stages Questionnaire. RESULTS: The results of autoregressive structural equation models indicated that mothers who perceived their own mothers as highly supportive in childhood were more likely to engage in scaffolding behaviors with their infants, who in turn made greater progress (e.g., showed less risk for developmental delay) in reaching developmental milestones from 6 to 12 months postpartum. Follow-up analyses revealed that indirect effects were specific to infant problem-solving and communication skills. Maternal ACEs were not associated with parenting or infant developmental progress. CONCLUSION: Parenting behaviors in 1 generation influence parenting behaviors in the next, which has implications for infant developmental progress. The results may inform evidence-based preventive interventions for mothers and infants living in contexts of risk.

Household Chaos Moderates Indirect Pathways Involving Domestic Violence, Parenting Practices, and Behavior Problems among Preschool Children.

PURPOSE: This study examined the moderating role of household chaos in indirect pathways involving domestic violence (DV), parenting practices (punitive discipline and responsive), and preschool children's internalizing and externalizing symptoms. We hypothesized that high levels of household chaos would amplify links between domestic violence and parenting difficulties, and that parenting difficulties would in turn predict child behavior problems. METHOD: Participants in this multimethod (survey, semi-structured interview, child protection records) study included 274 preschool children (M age = 50.86 months) and their primary caregivers who were assessed in the home at two time-points spaced 6 months apart. Child welfare documentation of moderate-severe maltreatment within the last 6 months was present for 52% of children, 44% were in households characterized by DV, and most families qualified for public assistance. Hypotheses were tested using path analysis with manifest variables within a structural equation modeling framework. RESULTS: All models provided excellent fit to the data. DV was associated with punitive discipline practices only when household chaos was high. Punitive discipline practices in turn predicted greater child externalizing symptoms 6 months later. Follow-up analyses revealed that the moderating role of chaos was specific to DV, rather than general to other forms of adversity (child maltreatment, lifetime contextual stressors, traumatic events). This interaction between DV and chaos was salient even when controlling for exposure to other adversities and demographic covariates. CONCLUSIONS: Results point to multiple potential targets of intervention that may ultimately buffer children from the risk posed by experiencing DV in the home.

Molecular markers of neuroendocrine function and mitochondrial biogenesis associated with early life stress.

OBJECTIVE: Glucocorticoid receptor gene (NR3C1) promoter methylation influences cellular expression of the glucocorticoid receptor and is a proposed mechanism by which early life stress impacts neuroendocrine function. Mitochondria are sensitive and responsive to neuroendocrine stress signaling through the glucocorticoid receptor, and recent evidence with this sample and others shows that mitochondrial DNA copy number (mtDNAcn) is increased in adults with a history of early stress. No prior work has examined the role of NR3C1 methylation in the association between early life stress and mtDNAcn alterations. METHODS: Adult participants (n = 290) completed diagnostic interviews and questionnaires characterizing early stress and lifetime psychiatric symptoms. Medical conditions, active substance abuse, and prescription medications other than oral contraceptives were exclusionary. Subjects with a history of lifetime bipolar, obsessive-compulsive, or psychotic disorders were excluded; individuals with other forms of major psychopathology were included. Whole blood mtDNAcn was measured using qPCR; NR3C1 methylation was measured via pyrosequencing. Multiple regression and bootstrapping procedures tested NR3C1 methylation as a mediator of effects of early stress on mtDNAcn. RESULTS: The positive association between early adversity and mtDNAcn (p = .02) was mediated by negative associations of early adversity with NR3C1 methylation (p = .02) and NR3C1 methylation with mtDNAcn (p < .001). The indirect effect involving early adversity, NR3C1 methylation, and mtDNAcn was significant (95 % CI [.002, .030]). CONCLUSIONS: NR3C1 methylation significantly mediates the association between early stress and mtDNAcn, suggesting that glucocorticoid receptor signaling may be a mechanistic pathway underlying mtDNAcn alterations of interest for future longitudinal work.

Sex Differences in Associations between Early Adversity, Child Temperament, and Behavior Problems.

Early adversity is associated with both internalizing and externalizing problems among children, and effects of adversity on dimensions of child temperament may underlie these links. However, very little is known about the role of child sex in these processes. The current study examined if there are indirect effects of early adversity on behavior problems through dimensions of child temperament and if these indirect effects vary across child sex. Participants in this multimethod (parent-report survey, semi-structured interview, child protection records) study included 274 preschool-aged children (M age = 50.86 months; 52% with documented case of moderate-severe maltreatment) and their primary caregivers assessed at two time-points spaced 6 months apart. Results of multi-group path analyses revealed that while anger mediated associations between lifetime stress and behavior problems for the full sample, inhibitory control and appropriate attentional allocation were significant intermediary mechanisms of lifetime stress for boys, but not for girls. Inhibitory control mediated associations between maltreatment and behavior problems for the full sample, but appropriate attentional allocation mediated these associations for boys only. Results suggest that early adversity influences child behavior problems through child temperament, particularly for boys. This work supports the perspective that temperament is influenced by characteristics of the early rearing environment, and the indirect effects of adversity on behavior problems through temperament vary across sex.

Infant sleep moderates the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning.

Observed infant temperamental difficulty and infant sleep efficiency and sleep variability were examined as predictors of maternal depressive symptoms, maternal sensitivity, and family functioning. Eight observations at 8-months postpartum were used to assess infant temperament, and actigraphy was used to measure infant sleep for 1-week at the time of the 8-month assessment. Structured clinical interviews were used to assess maternal depressive symptoms between 5 and 12 months postpartum and at 15 months postpartum, and observational assessments were used to assess maternal sensitivity and family functioning at 15 months postpartum. Variability in infant sleep moderated the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning. Infant temperament was positively associated with maternal depressive symptoms when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Likewise, infant temperament was negatively associated with maternal sensitivity and family functioning when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Results underscore the importance of infant sleep for maternal and family health.

Childhood maltreatment, behavioral adjustment, and molecular markers of cellular aging in preschool-aged children: A cohort study.

OBJECTIVE: Childhood maltreatment is a major risk factor for the development of behavioral problems and poor physical and mental health. Accelerated cellular aging, through reduced telomere length and mitochondrial dysfunction, may be a mechanism underlying these associations. METHODS: Families with (n = 133) and without (n = 123) child welfare documentation of moderate-severe maltreatment in the past six months participated in this study. Children ranged in age from 3 to 5 years, were racially and ethnically diverse, and 91% qualified for public assistance. Structured record review and interviews were used to assess a history of maltreatment and other adversities. Telomere length and mitochondrial DNA copy number (mtDNAcn) were measured from saliva DNA using real-time PCR. Measures were repeated at a six-month follow-up assessment. Repeated measures general linear models were used to examine the effects of maltreatment and other adversities on telomere length and mtDNAcn over time. RESULTS: Maltreatment and other adverse experiences were significant positive predictors of both telomere length and mtDNAcn over time. Internalizing and externalizing behavior problems were also both significantly associated with telomere length, but only internalizing symptoms were associated with mtDNAcn. CONCLUSIONS: This is the first study to show that mtDNAcn is altered in children with stress and trauma, and the findings are consistent with recent studies of adults. Surprisingly, children who experienced moderate-severe levels of maltreatment in the prior six months had longer telomeres, possibly reflecting compensatory changes in response to recent trauma. Telomere length and mtDNAcn were also associated with behavioral problems, suggesting that these measures of cellular aging may be causally implicated in the pathophysiology of stress-related conditions.