Body mass index trajectory throughout adolescence: a comparison of maltreated adolescents by maltreatment type to a community sample.

BACKGROUND: Childhood maltreatment is associated with adult obesity, but there is conflicting evidence regarding the relationship between childhood maltreatment and obesity during adolescence. OBJECTIVES: To compare the body mass index (BMI) trajectory of adolescents with a specific type of maltreatment (sexual abuse, physical abuse, emotional abuse or neglect) to adolescents with another type of maltreatment (maltreated sample n = 303) and to a comparison group (n = 151). METHODS: Individual growth models were used to estimate average growth trajectories of BMI percentile separately by sex (ages 9 to 22 years). Unconditional and conditional linear and quadratic growth models were estimated and maltreatment types were added before including covariates (ethnicity, anxiety, depression and pubertal stage). RESULTS: BMI growth trajectories of sexually abused girls and neglected girls were significantly different from comparison girls. Comparison girls had a growth trajectory that reached its apex at 15 years and then began to decline, whereas sexually abused girls and neglected girls had lower BMI than comparison girls until age 16-17 years when their BMI was higher than comparison girls. CONCLUSIONS: Late adolescence appears to be the developmental period during which differences in BMI percentiles become pronounced between girls with sexual abuse or with neglect vs. comparison girls.

Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls.

Childhood sexual abuse is associated with an increased incidence of age-concurrent and adult psychopathology. Little is known, however, about the biological manifestations and sequelae of childhood sexual abuse. In this study, we characterized the hypothalamic-pituitary-adrenal axis of a self-selected sample of sexually abused and control girls recruited from a prospective longitudinal study. Plasma ACTH and total and free cortisol responses to ovine CRH (oCRH) stimulation were measured in 13 sexually abused and 13 control girls, aged 7-15 yr. Psychiatric profiles and 24-h urinary free cortisol (UFC) measures were also obtained. Sexually abused girls had a greater incidence of suicidal ideation (chi 2 = 4.51; df = 1; P < 0.05), suicide attempts (chi 2 = 4.51; df = 1; P < 0.05), and dysthymia (chi 2 = 8.85; df = 1; P < 0.01) than control girls. Sexually abused girls showed significantly lower basal (t = 2.1; df = 24; P < 0.05), and net oCRH stimulated (t = 2.2; df = 24; P < 0.05) ACTH levels and significantly reduced total ACTH responses (t = 2.5; df = 24; P < 0.05) compared with control subjects. Their total and free basal and oCRH-stimulated plasma cortisol levels and 24-h UFC measures, however, were similar to those in controls. The attenuated plasma ACTH with corresponding robust plasma cortisol responses to oCRH stimulation and normal 24-h UFC measures in sexually abused girls suggest a dysregulatory disorder of the HPA axis in these individuals. This may reflect pituitary hyporesponsiveness to oCRH. The ability of sexually abused subjects to correct for the proposed pituitary hyporesponsiveness to CRH may be related to their young age and the presence of intact glucocorticoid feedback regulatory mechanisms.

Urinary catecholamine excretion in sexually abused girls.

OBJECTIVE: The objective of this study was to examine urinary catecholamine excretion in a self-selected sample of sexually abused and demographically matched control girls recruited from a prospective, longitudinal study. METHOD: Twenty-four--hour urinary catecholamine and metabolite concentrations of epinephrine, norepinephrine, dopamine, 3-methoxy-4-hydroxyphenylglycol, metanephrine, normetanephrine, vanillylmandelic acid, 3,4-dihydroxyphenylacetic acid, and homovanillic acid were measured in 12 sexually abused and 9 control girls, aged 8 to 15 years. Psychiatric profiles also were obtained. RESULTS: The abused subjects excreted significantly greater amounts of metanephrine, vanillylmandelic acid, homovanillic acid, and total catecholamine synthesis as measured by the sum of epinephrine, norepinephrine, dopamine, and their metabolites compared to values from control subjects. When the means of all significant biochemical measures were adjusted by the covariate effect of height, only homovanillic acid and group interaction remained significant. There were positive trends toward significantly higher urinary excretion of metanephrine, vanillylmandelic acid, and total catecholamine synthesis. Sexually abused girls also had a greater incidence of suicidal ideation, suicide attempts, and dysthymia than control girls. CONCLUSIONS: These findings support the idea that sexually abused girls show evidence of higher catecholamine functional activity compared with controls. The clinical significance of these findings in their similarity to the psychobiology of both post-traumatic stress disorder and major depressive disorder. Results from this pilot study may be of value in understanding the mechanisms of depressive and anxiety disorders and in the clinical treatment of maltreated children.

Child sexual abuse: a model of chronic trauma.

Although there is a general consensus among concerned professionals that exposure to community violence is likely to be stressful and may contribute significantly to immediate and long-term mental health problems, there is virtually no empirical research on either its acute or enduring effects. In the absence of data, investigators planning research in this area must look to other studies of the impact of chronic environmental trauma on children, including the effects of war and child maltreatment. Research on child abuse provides an important source of information on the effects of trauma on children because it draws on both prospective and retrospective studies crossing a variety of theoretical perspectives and disciplines. The existence of data on both the acute impact of abuse on children and its chronic effects and outcomes in adults informs the generation of developmentally based psychological and biological hypotheses. This paper utilizes data from research on the acute and chronic effects of sexual abuse to discuss three broad hypotheses that may be relevant to the study of the effects of community violence on children.

Development, reliability, and validity of a child dissociation scale.

Dissociation is a complex psychophysiological process that ranges along a continuum from minor, normal dissociation to Axis I psychopathology. High levels of dissociation are associated with increased self-destructive behaviors and other symptoms. Although several validated measures of dissociation exist for adults, no measures are available for children. The Child Dissociative Checklist (CDC) was developed to meet this need and is a reliable and valid observer report measure of dissociation in children. The CDC had a 1-year test-retest reliability coefficient of rho = .69 (N = 73, p = .0001) in a sample of normal and sexually abused girls. The CDC had high discriminant validity among four test samples including: normal control girls, sexually abused girls, boys and girls with dissociative disorder NOS and boys and girls with multiple personality disorder. The CDC is intended as a clinical screening instrument and as a research measure. The CDC is not designed to be used as a diagnostic instrument.

Hypnotizability and dissociativity in sexually abused girls.

Research on the relation between hypnotizability and clinical dissociation has led to contradictory findings. Measures of hypnotizability and dissociation are only weakly correlated in general population samples, but studies of posttraumatic stress and dissociative disorders patients have found elevated levels of clinical dissociation and hypnotizability respectively. This study assesses the relationships among hypnotizability, clinical dissociation and traumatic antecedents in 54 sexually abused girls, ages 6-15 years, and 51 matched controls. Hypnotizability was assessed on initial evaluation and again in matched subsamples at one year using the Stanford Hypnotic Clinical Scale for Children. Clinical dissociation was assessed using the Child Dissociative Checklist. Abuse variables were extracted from Child Protective Services reports. There were no significant differences in hypnotizability between abuse and control subjects. There were significant differences in clinical dissociation initially and on 1-year retest. Hypnotizability and clinical dissociation were only weakly correlated (r(105) = .118, p = NS). However, in the abuse group, highly hypnotizable subjects were significantly more dissociative. Higher levels of clinical dissociation were associated with abuse by multiple perpetrators and co-presence of physical abuse independent of the sexual abuse. A small subgroup of "double dissociative" subjects, high in both hypnotizability and dissociativity, was identified. Double dissociation was associated with multiple perpetrators and earlier onset of sexual abuse.

Disclosure patterns of sexual abuse and psychological functioning at a 1-year follow-up.

This study describes the disclosure processes of a sample of 68 sexually abused girls, with a focus on the manner in which abuse was revealed--on purpose, accidentally, or resulting from a precipitating event. This categorization is a more descriptive conceptualization of the disclosure process than has been proposed or assessed in previous studies. The circumstances surrounding disclosure are found to be related to long term psychological functioning. Children who disclosed accidentally were younger, experienced abuse for shorter durations, and received the most therapy. At follow-up, children who purposely disclosed had greater anxiety and greater difficulties coping. Discussion focuses on ways in which identifying and encouraging the least traumatic methods of disclosure would contribute to better outcomes for victims of sexual abuse.

Factors affecting utilization of treatment services by sexually abused girls.

This study describes the naturalistic therapy experiences of a sample of sexually abused girls and the relationship of these experiences to demographic factors, abuse experiences, psychopathology, and family functioning. The sample consisted of 81 sexually abused girls, aged 6 to 16, participating in a longitudinal study of the effects of sexual abuse. Results indicated strong effects for abuse experiences and child psychopathology on the total amount of therapy received. Patterns of treatment utilization were associated with ethnic minority status, but these differences are confounded by differing abuse experiences for racial groups in the sample. Other patterns of treatment utilization are discussed, as well as issues for further research and implications for treatment providers.

Social network constellation and sexuality of sexually abused and comparison girls in childhood and adolescence.

This longitudinal study examines how childhood and early adolescent (age 6 to 15) peer and nonpeer social networks relate to sexual attitudes and behaviors in adolescence and young adulthood (age 12 to 25) for sexually abused and comparison girls. A large number of male peers in childhood is related to heightened sexual activity, sexual preoccupation, increased sexual pressure, and risky sexual behavior in adolescence. High-quality, female, nonpeer relationships have a positive effect on attitudes toward casual sex. Multiple group models illuminate several cross-lag group moderators: (a) Abused girls who are happier with male nonpeers are less preoccupied with sex; (b) abused girls who are happier with male peers are more likely to use birth control; and (c) abused girls who have early physical relationships are more likely to engage in risky sexual behavior. Treatment implications include monitoring the effects of low-status peer groups, encouraging contact with female role models, and encouraging the formation of high-quality relationships with male peers and nonpeers.

A multimethod approach to the assessment of physical abuse.

Numerous and heterogeneous symptoms of maladjustment have been documented among victims of physical abuse. Much of the well-controlled, theoretically guided research is rooted in methodology designed to search for group differences between abused children and a comparison group. Given the recognized methodological problems in constructing appropriate comparison groups for abused children, this study is designed to examine alternative methodological approaches. The purpose of the study is to utilize a case study to illustrate the utility of a multimethod approach to highlight intraindividual variation in the impact of abuse. This study of physically abused twin boys demonstrates that differential patterns of findings are revealed by standardized assessment in comparison to behavioral observation. The results underscore intraindividual variation in the impact of abuse. It is suggested that innate temperamental factors interact with parent-child interaction patterns to account for such intraindividual variation.

Variants of intrafamilial sexual abuse experience: implications for short- and long-term development.

This study examines short- and long-term maladaptive outcomes in a sample of sexually abused females and a comparison group. The sample consists of intrafamilial sexual abuse victims ages 6-16 years at entry into the study and a demographically similar comparison group. The outcomes examined included measures of behavior and psychological problems such as aggressive behavior, depression, dissociation, and low self-esteem; and measures at two time points, first at entry into the study (median age 11 years) and approximately 7 years later (median age 18 years). The specific questions being addressed were (a) whether subgroups or profiles. based on the specific characteristics of the sexual abuse experienced, can be identified in this sample of abused females; and (b) whether these profile groups predict different patterns of adverse short- or long-term outcomes.

Is an intervention program necessary in order to improve economically disadvantaged children's IQ scores?

The hypothesis was investigated that alleviation of negative motivational factors underlies much of the 10-point IQ increase commonly found in economically disadvantaged children's performance following a preschool intervention program. Head Start and non-Head Start groups were tested on IQ and motivational measures 3 times before and during the Head Start year (pretest, retest, posttest). Both groups showed comparable IQ gains on retesting, but only the Head Start group showed continued gain from retest to posttest. Parallel changes were found on a motivational measure of wariness of an unfamiliar examiner. The test-retest improvement of both groups was interpreted as resulting from increased familiarity with the testing situation. The continued improvement of the Head Start children was interpreted as reflecting changes in the children's motivational structures as a result of attending a preschool intervention program.

Antinuclear antibodies and thyroid function in sexually abused girls.

Sexually abused girls manifest dysregulation of physiological stress response systems. In this exploratory investigation, 14 sexually abused and 13 control girls, ages 8-15 years, recruited from a prospective, longitudinal study, underwent plasma antinuclear antibody and thyroid function tests. Thyroid function tests and plasma antinuclear antibody titers did not differ between sexually abused and control girls. However, a significantly higher incidence of plasma antinuclear antibody titers was seen in abused subjects when compared with the frequency of positive antinuclear antibody titers in a sample of 22 adult healthy female volunteers, ages 20-58 years. These findings suggest that sexually abused girls may show evidence of an alteration in normal immune homeostatic function.