The impact of early neglect on defensive and appetitive physiology during the pubertal transition: a study of startle and postauricular reflexes.

This study tested the effect of early neglect on defensive and appetitive physiology during puberty. Emotion-modulated reflexes, eye-blink startle (defensive) and postauricular (appetitive), were measured in 12-to-13-year-old internationally adopted youth (from foster care or from institutional settings) and compared to non-adopted US born controls. Startle Reflex: adopted youth displayed lower overall startle amplitude across all valences and startle potentiation to negative images was negatively related to severity of pre-adoption neglect. Postauricular reflex (PAR): adopted youth showed larger PAR magnitude across all valences. Puberty: adopted youth showed diminished PAR potentiation to positive images and startle potentiation during mid/late puberty versus the opposite pattern in not-adopted. Early neglect was associated with blunted fast defensive reflexes and heightened fast appetitive reflexes. After puberty, early neglected youth showed physiological hyporeactivity to threatening and appetitive stimuli versus heightened reactivity in not adopted youth. Behavioral correlates in this sample and possible neurodevelopmental mechanisms of psychophysiological differences are discussed.

Risk-taking and sensation-seeking propensity in postinstitutionalized early adolescents.

BACKGROUND: Youth with histories of institutional/orphanage care are at increased risk for externalizing and internalizing problems during childhood and adolescence. Although these problems have been well described, the related adolescent behaviors of risk-taking and sensation-seeking have not yet been explored in this population. This study examined risk-taking and sensation-seeking propensity, and associations with conduct problems and depressive symptoms, in early adolescents who were adopted as young children from institutional care. METHODS: Risk-taking and sensation-seeking propensities of 12- and 13-year-old postinstitutionalized (PI; n = 54) adolescents were compared with two groups: youth who were internationally adopted early from foster care (PFC; n = 44) and nonadopted youth (NA; n = 58). Participants were recruited to equally represent pre/early- and mid/late-pubertal stages within each group. Participants completed the youth version of the Balloon Analogue Risk Task (Lejuez et al., ) and the Sensation-Seeking Scale for Children (Russo et al., ). Parents completed clinical ratings of participants' conduct problems and depressive symptoms. RESULTS: PI adolescents demonstrated lower risk-taking than PFC and NA peers. Pre/early-pubertal PI youth showed lower sensation-seeking, while mid/late-pubertal PI youth did not differ from other groups. PI adolescents had higher levels of conduct problems but did not differ from the other youth in depressive symptoms. In PI youth only, conduct problems were negatively correlated with risk-taking and positively correlated with sensation-seeking, while depressive symptoms were negatively correlated with both risk-taking and sensation-seeking. CONCLUSIONS: Early institutional care is associated with less risk-taking and sensation-seeking during adolescence. The deprived environment of an institution likely contributes to PI youth having a preference for safe choices, which may only be partially reversed with puberty. Whether this reflects hyporesponsiveness to rewards and how it relates to psychopathology are discussed.

[Formula: see text] Relationship of parent-rated and objectively evaluated executive function to symptoms of posttraumatic stress and attention-deficit/hyperactivity disorder in homeless youth.

Compared to their stably housed peers, homeless, and highly mobile (HHM) youth experience disproportionately greater adversity and risk leading to a wide variety of poor developmental outcomes, and targeted interventions have the potential to mitigate such outcomes. A growing literature highlights the need for accurate diagnosis in high-risk populations given the considerable overlap between posttraumatic symptomology and behaviorally based disorders such as ADHD. Objective testing inferring neurobiological and circuit-based abnormalities in posttraumatic stress disorder (PTSD) and ADHD may provide a useful clinical tool to aid accurate diagnosis and treatment recommendations. This novel, exploratory study examined the relation between executive function (EF) as measured by objective testing and parent ratings with symptoms of posttraumatic stress and ADHD in 86 children (age 9 to 11) living in emergency homeless shelters. Parent-rated EF problems suggested broad impairment associated with ADHD symptoms but specific impairment in emotional/behavioral function associated with posttraumatic stress symptoms. While measures of inhibition and shifting EF were strongly associated with symptomology in bivariate correlations, they explained minimal variance in regression models. Internalizing behavior problems were associated with posttraumatic stress symptoms, while externalizing behavior problems were associated with ADHD symptoms. Implications for clinical practice and future research are discussed.

Intergenerational Effects of Early Parental Adversity on Child Developmental Outcomes among Families Living in Emergency Homeless Shelters.

Adverse childhood experiences (ACEs) are associated with persistent physical and psychological impairments over time and intergenerational transmission of trauma. Few studies have examined contexts of acute adversity with an eye toward understanding intergenerational transmission of ACEs. Homelessness and residential mobility are strongly associated with increased deficits across key developmental domains throughout the lifespan. This study (N = 86 parent-child dyads living in emergency housing) examined the effect of parent ACEs under the age of 18 years on parent and child lifetime adverse experiences. Results demonstrated significant relationships between parent ACEs and parent adversity over 18 years of age, child lifetime adversity, and current child trauma symptomatology. These findings highlight the impact of parent early experiences on off spring and underscore the importance of understanding the impact of and intervening to end the intergenerational transmission of trauma in acute adversity. Implications of these findings, including intervention, policy, and practice, are discussed.

Health and Self-Regulation among School-Age Children Experiencing Family Homelessness.

Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) living in shelters were assessed for health, family stress/adversity, emotional-behavioral regulation, nonverbal intellectual abilities, and executive function. Vision problems were the most prevalent health condition, followed by chronic respiratory conditions. Cumulative risk, child executive function, and self-regulation problems in children were uniquely related to child physical health. Homeless children experience problems with cognitive, emotional, and behavioral regulation as well as physical health, occurring in a context of high psychosocial risk. Several aspects of children's self-regulation predict physical health in 9- to 11-year-old homeless children. Health promotion efforts in homeless families should address individual differences in children's self-regulation as a resilience factor.

Adversity and children experiencing family homelessness: Implications for health.

This study tests links between adversity and health problems among children in family emergency housing. Children who experience family homelessness are at risk to also experience high levels of stress, health problems, and need for pediatric care. Understanding the connection between stress and health holds the potential to reduce persistent health disparities. Analyses tested whether experiencing a greater number of stressful life events during the early years of life was related to worse health conditions, emergency health care utilization, and hospitalizations. Parents noted children's experience of negative stressful life events, health problems, emergency room (ER) use, and hospitalization. Two cohorts of kindergarten-aged children staying in emergency family housing participated in the study in 2006-07 (n = 104) and in 2008-09 (n = 138), with the results examined separately. In both cohorts, more health problems were acknowledged for children exposed to more negative stressful life events. Stressful life events were not related to ER use but did relate to hospitalization for the 2006-07 cohort. Results affirm links between stress in early childhood and health problems among children living in emergency housing. Findings are consistent with the hypothesis that adversity in early childhood contributes to income and racial disparities in health.

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing.

BACKGROUND: Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. METHODS: Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. RESULTS: Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. CONCLUSIONS: High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

The Confluence of Adverse Early Experience and Puberty on the Cortisol Awakening Response.

Associations between early deprivation/neglect in the form of institutional care with the cortisol awakening response (CAR) were examined as a function of pubertal status among 12- and 13-year-old post-institutionalized youth. CARs indexed hypothalamic-pituitary-adrenocortical reactivity. Post-institutionalized youth were compared to youth adopted internationally from foster care (adoption control) and to nonadopted youth reared in families comparable in parental education and income to the adoptive families. Post-institutionalized youth exhibited a blunted CAR if they were at earlier but not if they were at later stages of puberty. Similarly, for both groups of internationally adopted youth combined, earlier but not later stages of puberty were associated with more blunted CARs at higher but not lower levels of parent-reported pre-adoption physical and social neglect.