Ordinary Magic: Resilience Processes in Development

Handbook of attachment: Theory, research, and clinical applications

The authors conducted a meta-analysis of studies on the correlation between parents’ PTSD symptom severity and children's psychological status. An extensive search of the literature yielded 550 studies that were screened for inclusion criteria (i.e., parent assessed for PTSD, child assessed for distress or behavioral problems, associations between parent PTSD and child status examined). Sixty-two studies were further reviewed, resulting in a final sample of 42 studies. Results yielded a moderate overall effect size r = .35. The authors compared effect sizes for studies where only the parent was exposed to a potentially traumatic event to studies where both parents and children were exposed. A series of moderators related to sample characteristics (sex of parent, type of traumatic event) and study methods (self-report vs. diagnostic interview, type of child assessment administered) were also evaluated. The only significant moderator was type of trauma; the effect size was larger for studies with parent–child dyads who were both exposed to interpersonal trauma (r = .46) than for combat veterans and their children (r = .27) and civilian parent–child dyads who were both exposed to war (r = .25). Results support the importance of considering the family context of trauma survivors and highlight areas for future research.

Traditional and Simplified Chinese Abstracts by AsianSTSS

標題：元分析有關父母的PTSD嚴重程度與子女心理困擾的關係



撮要：我們對父母PTSD症狀嚴重程度和子女心理狀況之間的關係這一類研究進行元分析。廣泛文獻研究後將550篇研究篩選納入標準(即：父母被評估PTSD，子女被評估困擾或行為問題，父母PTSD和子女狀況之間關係被評估)。審閱後有62篇，再閱後只有42篇餘下。結果有中度綜合有效值r=.35。將只有父母經歷創傷事件的研究和父母及子女共同經歷創傷的研究，作有效值比較。亦評估一系列與樣本特性(父母性別，創傷事件類型)及研究方法(自我報告對比診斷面談，兒童評估方法的類別)相關的調節因素。結果是：只有創傷類別是有效調節因素，父母—子女同時經歷人際創傷(r=.46)的研究對比退役軍人及子女(r=.27)和平民父母—子女同時經歷戰事(r=.25)的研究，有着較高有效值。研究支持創傷倖存者的家庭境況是必須考慮的，亦指示未來研究方向。



标题：元分析有关父母的PTSD严重程度与子女心理困扰的关系



撮要：我们对父母PTSD症状严重程度和子女心理状况之间的关系这一类研究进行元分析。广泛文献研究后将550篇研究筛选纳入标准(即：父母被评估PTSD，子女被评估困扰或行为问题，父母PTSD和子女状况之间关系被评估)。审阅后有62篇，再阅后只有42篇余下。结果有中度综合有效值r=.35。将只有父母经历创伤事件的研究和父母及子女共同经历创伤的研究，作有效值比较。亦评估一系列与样本特性(父母性别，创伤事件类型)及研究方法(自我报告对比诊断面谈，儿童评估方法的类别)相关的调节因素。结果是：只有创伤类别是有效调节因素，父母—子女同时经历人际创伤(r=.46)的研究对比退役军人及子女(r=.27)和平民父母—子女同时经历战事(r=.25)的研究，有着较高有效值。研究支持创伤幸存者的家庭境况是必须考虑的，亦指示未来研究方向。

Association between parents' PTSD severity and children's psychological distress: a meta-analysis.

SYNOPSIS A behavior-based neurobiological approach to the study of normative and high-risk parenting is presented and suggests that human affiliations are formed on the basis of bio-behavioral synchrony between the online physiological and behavioral processes of attachment partners. Theoretical foundations for the model ranging from neuroscience to phenomenology are discussed, and the unique expressions of micro-level synchrony are detailed across development. Specific disruptions to parameters of synchrony in various high-risk conditions and examples for time-locked processes of biology and behavior are described. Finally, implications of the findings to the implementation of specific interventions to mothers, fathers, and families are highlighted.

Bio-behavioral Synchrony: A Model for Integrating Biological and Microsocial Behavioral Processes in the Study of Parenting

Sensitive periods (SP) in behavioral development appeared in the biological sciences during the first decade of the 20th century, and research in animal models beginning in the 1950s provide terminology and evidence for SP effects. This paper proposes a rigorous program for human SP research and argues that the complexity of the human brain and variability of the human ecology necessitate that SP effects must be studied in humans, employ longitudinal designs starting at birth, test mechanism-based hypotheses based on animal studies that manipulate early environments, and utilize high-risk conditions as "natural experiments." In light of research on the molecular basis of critical periods and their sequential cascades, it is proposed that the oxytocin (OT) system, an ancient and integrative system that cross-talks with the stress, reward, immune, and brain stem mediated homeostatic systems and supports mammalian sociality, plays a unique role in experience-dependent plasticity that buttresses SP effects due to its (a) dendritic mode of release leading to autoregulated functioning primed by early experience, (b) pulsatile pattern of activity, and (c) special role in neural plasticity at the molecular and network assembly levels. Synchrony, the coordination of biology and behavior during social contact, is suggested as a mechanism by which SP exert their effect on OT functionality, the social brain, and adult sociality. Findings from four high-risk birth cohorts, each followed repeatedly from birth to 10 years, provide unique "natural experiments" for human SP research based on specific programs in animal models. These include prematurity (maternal proximity), multiple birth (peer rearing), postpartum depression (low licking and grooming), and chronic unpredictable trauma (maternal rotation, variable foraging demands). In each cohort, hypotheses are based on the missing environmental component during SP, and findings on social synchrony, OT functionality, stress response, emotion regulation, and mental health accord with the multilevel and dynamic principles of developmental psychopathology. The results on the potential for reparation versus chronicity following early deprivation highlight a flexible conceptualization of resilience based on human SP research. Consideration of SP effects at the molecular, endocrine, brain, and behavioral levels and in relation to the neural plasticity and multifinality of human social functions may assist in fine-tuning early detection and the construction of targeted individualized interventions.

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Sensitive periods in human social development: New insights from research on oxytocin, synchrony, and high-risk parenting.

Objective Although millions of the world's children are growing up amidst armed conflict, little research has described the specific symptom manifestations and relational behavior in young children exposed to wartime trauma or assessed factors that chart pathways of risk and resilience. Method Participants included 232 Israeli children 1.5 to 5 years of age, 148 living near the Gaza Strip and exposed to daily war-related trauma and 84 controls. Children's symptoms were diagnosed, maternal and child attachment-related behaviors observed during the evocation of traumatic memories, and maternal psychological symptoms and social support were self-reported. Results PTSD was diagnosed in 37.8% of war-exposed children (n = 56). Children with PTSD exhibited multiple posttraumatic symptoms and substantial developmental regression. Symptoms observed in more than 60% of diagnosed children included nonverbal representation of trauma in play; frequent crying, night waking, and mood shifts; and social withdrawal and object focus. Mothers of children with PTSD reported the highest depression, anxiety, and posttraumatic symptoms and the lowest social support, and displayed the least sensitivity during trauma evocation. Attachment behavior of children in the Exposed-No-PTSD group was characterized by use of secure-base behavior, whereas children with PTSD showed increased behavioral avoidance. Mother's, but not child's, degree of trauma exposure and maternal PTSD correlated with child avoidance. Conclusions Large proportions of young children exposed to repeated wartime trauma exhibit a severe posttraumatic profile that places their future adaptation at significant risk. Although more resilient children actively seek maternal support, avoidance signals high risk. Maternal well-being, sensitive behavior, and support networks serve as resilience factors and should be the focus of interventions for families of war-exposed infants and children.

Posttraumatic Stress Disorder in Infants and Young Children Exposed to War-Related Trauma

Background
Although the effects of early-onset trauma on susceptibility to psychopathology are well-acknowledged, no study to date has followed risk and resilience trajectories in war-exposed young children over lengthy periods and charted predictors of individual pathways.

Method
In this prospective longitudinal study, we followed 232 children, including 148 exposed to repeated wartime trauma and 84 controls, at three time points: early childhood (1.5–5 years), middle childhood (5–8 years), and late childhood (9–11 years). Children were diagnosed at each time point and four trajectories defined: children exhibiting no pathology at any time point, those displaying early pathology that later remitted, those showing initial resilience followed by late pathology, and children presenting chronic pathology across the entire first decade. Maternal behavioral containment during trauma evocation and child social engagement during free play were observed in early childhood and maternal emotional distress self-reported across time.

Results
War-exposed children showed significantly higher rates of psychopathology, with 81% exhibiting pathology at some point during childhood. In middle childhood, exposed children displayed more posttraumatic stress disorders (PTSD), anxiety disorders, and attention-deficit/hyperactivity disorders (ADHD), and in late childhood more PTSD, conduct/oppositional defiant disorders, and ADHD. War-exposed children had more comorbid psychopathologies and number of comorbidities increased with age. Notably, war-exposure increased prevalence of chronic pathology by 24-fold. Maternal factors, including mother's uncontained style and emotional distress, increased risk for early and chronic psychopathology, whereas reduced child social engagement augmented risk for late pathology.

Conclusions
Early-onset chronic stress does not heal naturally, and its effects appear to exacerbate over time, with trauma-exposed children presenting a more comorbid, chronic, and externalizing profile as they grow older. Our findings demonstrate that responses to trauma are dynamic and variable and pinpoint age-specific effects of maternal and child factors on risk and resilience trajectories. Results highlight the importance of conducting long-term follow-up studies and constructing individually tailored early interventions following trauma exposure.

Risk and resilience trajectories in war-exposed children across the first decade of life

The current study examined biomarkers of stress in war-exposed young children and addressed maternal and child factors that may correlate with children’s stress response. Participants were 232 Israeli children aged 1.5–5 years, including 148 children exposed to continuous war. Similarly, 56 were diagnosed with posttraumatic stress disorder (PTSD) and 92 were defined as exposed-no-PTSD. Child cortisol (CT) and salivary alpha amylase (sAA), biomarkers of the hypothalamic–pituitary–adrenal and sympathetic–adrenal–medullary arms of the stress response, were measured at baseline, following challenge, and at recovery. Maternal CT and sAA, PTSD symptoms, and reciprocal parenting, and child negative emotionality and regulatory strategies were assessed. Differences between war-exposed children and controls emerged, but these were related to child PTSD status. Children with PTSD exhibited consistently low CT and sAA, exposed-no-PTSD displayed consistently high CT and sAA, and controls showed increase in CT following challenge and decrease at recovery and low sAA. Exposed children showed higher negative emotionality; however, whereas exposed-no-PTSD children employed comfort-seeking strategies, children with PTSD used withdrawal. Predictors of child CT included maternal CT, PTSD symptoms, low reciprocity, and negative emotionality. Findings suggest that high physiological arousal combined with approach strategies may be associated with greater resilience in the context of early trauma. It is estimated that millions of the world’s children are growing up amid political violence, continuous war, tribal and racial terrorism, genocide, militaryattacks on civilian locations, orguerrillawarfare (Belsky,2008;Masten & Narayan,2012). Others, such as children of combat soldiers in the United States, experience the aftermath of war-related trauma through a parent (McFarlane, 2009), while still others are exposed to a single act of terrorism, for instance, the September 11 attack (Chemtob, Nomura, & Abramovitz, 2008 )o r the Oklahoma City bombing (Pfefferbaum et al., 1999). Although systematic research is often difficult in zones of war, several studies have described children’s response to war and terrorism across the globe, including Lebanon (Bryce, Walker, Ghorayeb, & Kanj, 1989), Gaza (Qouta, Punamaki, & El Sarraj, 2003), Israel (Laor, Wolmer, & Cohen, 2001), Kosovo (Lopes Cardozo, Kaiser, Gotway, & Agani, 2003), Bosnia–Hercegovina (Smith, Perrin, Yule, & RabeHesketh, 2001), and Rwanda (Schaal, Jacob, Dusingizemungu, & Elbert, 2010). Studies indicate that political violence compromises children’s mental health, leading to anxiety, depression, posttraumatic symptoms, and conduct problems; that such problems tend to persist after the war has subsided; and that maternal factors, particularly the mother’s well-being and support networks, function as resilience factors (Allwood, Bell-Dolan, & Husain, 2002; Feldman & Vengrober, 2011). However, very little research has focused on infants and young children exposed to political violence, and we are aware of no study that tested hormones, observed parenting, and temperamental dispositions in warexposed young children. In this study, we recruited a large cohort of infants and young children aged 1.5 to 5 years living in a zone of continuous war. Our goal was to examine children’s physiological stress response and assess maternal and child factors that may correlate with variability in young children’s stress response in the context of war exposure. Two neuroendocrine markers of stress were tested, cortisol (CT) and salivary alpha amylase (sAA), which are considered as biomarkers of the two arms of the stress response: the hypothalamic–pituitary–adrenal (HPA) and the sympathetic–adrenal–medullary

Stress reactivity in war-exposed young children with and without posttraumatic stress disorder: relations to maternal stress hormones, parenting, and child emotionality and regulation.

Adva Vengrober

Papers

Posttraumatic Stress Disorder in Infants and Young Children Exposed to War-Related Trauma

Risk and resilience trajectories in war-exposed children across the first decade of life

Stress reactivity in war-exposed young children with and without posttraumatic stress disorder: relations to maternal stress hormones, parenting, and child emotionality and regulation.