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Journal ArticleDOI

Child Trauma Exposure and Psychopathology: Mechanisms of Risk and Resilience.

01 Apr 2017-Current opinion in psychology (Curr Opin Psychol)-Vol. 14, pp 29-34
TL;DR: A biopsychosocial model is presented outlining the mechanisms that link child trauma with psychopathology and protective factors that can mitigate these risk pathways, highlighting novel directions for interventions aimed at preventing the onset of psychopathology following child trauma.
Abstract: Exposure to trauma in childhood is associated with elevated risk for multiple forms of psychopathology Here we present a biopsychosocial model outlining the mechanisms that link child trauma with psychopathology and protective factors that can mitigate these risk pathways We focus on four mechanisms of enhanced threat processing: information processing biases that facilitate rapid identification of environmental threats, disruptions in learning mechanisms underlying the acquisition of fear, heightened emotional responses to potential threats, and difficulty disengaging from negative emotional content Supportive relationships with caregivers, heightened sensitivity to rewarding and positive stimuli, and mature amygdala-prefrontal circuitry each serve as potential buffers of these risk pathways, highlighting novel directions for interventions aimed at preventing the onset of psychopathology following child trauma
Citations
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Journal ArticleDOI
TL;DR: Evidence for accelerated development in amygdala-mPFC circuits was limited but emerged in other metrics of neurodevelopment, and progress in charting neurodevelopmental consequences of adversity requires larger samples, longitudinal designs, and more precise assessments of adversity.
Abstract: An extensive literature on childhood adversity and neurodevelopment has emerged over the past decade. We evaluate two conceptual models of adversity and neurodevelopment-the dimensional model of adversity and stress acceleration model-in a systematic review of 109 studies using MRI-based measures of neural structure and function in children and adolescents. Consistent with the dimensional model, children exposed to threat had reduced amygdala, medial prefrontal cortex (mPFC), and hippocampal volume and heightened amygdala activation to threat in a majority of studies; these patterns were not observed consistently in children exposed to deprivation. In contrast, reduced volume and altered function in frontoparietal regions were observed consistently in children exposed to deprivation but not children exposed to threat. Evidence for accelerated development in amygdala-mPFC circuits was limited but emerged in other metrics of neurodevelopment. Progress in charting neurodevelopmental consequences of adversity requires larger samples, longitudinal designs, and more precise assessments of adversity.

298 citations


Cites background from "Child Trauma Exposure and Psychopat..."

  • ...…stimuli, aversive learning, emotional reactivity, and emotion regulation in children exposed to violence (Heleniak et al. 2016,McLaughlin et al. 2016, Pollak & Sinha 2002, Pollak & Tolley-Schell 2003), particularly for negative stimuli that signal the presence of threat (McLaughlin & Lambert 2017)....

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Journal ArticleDOI
TL;DR: A transdiagnostic model of the developmental mechanisms that explain the strong links between childhood trauma and psychopathology as well as protective factors that promote resilience against multiple forms of psychopathology are articulated.
Abstract: Transdiagnostic processes confer risk for multiple types of psychopathology and explain the co-occurrence of different disorders. For this reason, transdiagnostic processes provide ideal targets for early intervention and treatment. Childhood trauma exposure is associated with elevated risk for virtually all commonly occurring forms of psychopathology. We articulate a transdiagnostic model of the developmental mechanisms that explain the strong links between childhood trauma and psychopathology as well as protective factors that promote resilience against multiple forms of psychopathology. We present a model of transdiagnostic mechanisms spanning three broad domains: social information processing, emotional processing, and accelerated biological aging. Changes in social information processing that prioritize threat-related information—such as heightened perceptual sensitivity to threat, misclassification of negative and neutral emotions as anger, and attention biases towards threat-related cues—have been consistently observed in children who have experienced trauma. Patterns of emotional processing common in children exposed to trauma include elevated emotional reactivity to threat-related stimuli, low emotional awareness, and difficulties with emotional learning and emotion regulation. More recently, a pattern of accelerated aging across multiple biological metrics, including pubertal development and cellular aging, has been found in trauma-exposed children. Although these changes in social information processing, emotional responding, and the pace of biological aging reflect developmental adaptations that may promote safety and provide other benefits for children raised in dangerous environments, they have been consistently associated with the emergence of multiple forms of internalizing and externalizing psychopathology and explain the link between childhood trauma exposure and transdiagnostic psychopathology. Children with higher levels of social support, particularly from caregivers, are less likely to develop psychopathology following trauma exposure. Caregiver buffering of threat-related processing may be one mechanism explaining this protective effect. Childhood trauma exposure is a powerful transdiagnostic risk factor associated with elevated risk for multiple forms of psychopathology across development. Changes in threat-related social and emotional processing and accelerated biological aging serve as transdiagnostic mechanisms linking childhood trauma with psychopathology. These transdiagnostic mechanisms represent critical targets for early interventions aimed at preventing the emergence of psychopathology in children who have experienced trauma.

186 citations


Cites background from "Child Trauma Exposure and Psychopat..."

  • ..., angry or fearful faces; social situations depicting people experiencing negative emotions) elicit greater emotional responses in children with trauma histories as compared to children who have never encountered trauma [31, 65]....

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  • ...Specifically, environments characterized by violence and high potential for harm can influence patterns of social, emotional, and neurobiological development in ways that facilitate the rapid detection of potential threats [31]....

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Journal ArticleDOI
TL;DR: Two studies measuring EF at multiple levels provide strong preliminary evidence for a novel model of the neurodevelopmental consequences of childhood adversity, which argues that deprivation is associated with poor executive function (EF), whereas threat is not.
Abstract: Childhood adversity is associated with increased risk for psychopathology. Neurodevelopmental pathways underlying this risk remain poorly understood. A recent conceptual model posits that childhood adversity can be deconstructed into at least two underlying dimensions, deprivation and threat, that are associated with distinct neurocognitive consequences. This model argues that deprivation (i.e., a lack of cognitive stimulation and learning opportunities) is associated with poor executive function (EF), whereas threat is not. We examine this hypothesis in two studies measuring EF at multiple levels: performance on EF tasks, neural recruitment during EF, and problems with EF in daily life. In Study 1, deprivation (low parental education and child neglect) was associated with greater parent-reported problems with EF in adolescents (N = 169; 13-17 years) after adjustment for levels of threat (community violence and abuse), which were unrelated to EF. In Study 2, low parental education was associated with poor working memory (WM) performance and inefficient neural recruitment in the parietal and prefrontal cortex during high WM load among adolescents (N = 51, 13-20 years) after adjusting for abuse, which was unrelated to WM task performance and neural recruitment during WM. These findings constitute strong preliminary evidence for a novel model of the neurodevelopmental consequences of childhood adversity.

156 citations

Journal ArticleDOI
TL;DR: Central problems in understanding the link between early-life adversity and children’s brain development are discussed and alternative formulations that hold promise for advancing knowledge about the neurobiological mechanisms through which adversity affects human development are suggested.
Abstract: Discovering the processes through which early adverse experiences affect children's nervous-system development, health, and behavior is critically important for developing effective interventions. However, advances in our understanding of these processes have been constrained by conceptualizations that rely on categories of adversity that are overlapping, have vague boundaries, and lack consistent biological evidence. Here, we discuss central problems in understanding the link between early-life adversity and children's brain development. We conclude by suggesting alternative formulations that hold promise for advancing knowledge about the neurobiological mechanisms through which adversity affects human development.

144 citations


Cites background from "Child Trauma Exposure and Psychopat..."

  • ...…participants who have had heterogeneous experiences will obscure potential links to discrete biological mechanisms—and the assumption that specific kinds of experiences affect specific aspects of brain function (Kuhlman et al., 2017; McLaughlin & Lambert, 2017; Palacios-Barrios & Hanson, 2019)....

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Journal ArticleDOI
TL;DR: Emotion dysregulation following childhood maltreatment occurs at multiple stages of the emotion generation process, in some cases varies across development, and serves as a transdiagnostic mechanism linking child maltreatment with general psychopathology.
Abstract: Childhood maltreatment is associated with increased risk for most forms of psychopathology. We examine emotion dysregulation as a transdiagnostic mechanism linking maltreatment with general psychopathology. A sample of 262 children and adolescents participated; 162 (61.8%) experienced abuse or exposure to domestic violence. We assessed four emotion regulation processes (cognitive reappraisal, attention bias to threat, expressive suppression, and rumination) and emotional reactivity. Psychopathology symptoms were assessed concurrently and at a 2-year longitudinal follow-up. A general psychopathology factor (p factor), representing co-occurrence of psychopathology symptoms across multiple internalizing and externalizing domains, was estimated using confirmatory factor analysis. Maltreatment was associated with heightened emotional reactivity and greater use of expressive suppression and rumination. The association of maltreatment with attention bias varied across development, with maltreated children exhibiting a bias toward threat and adolescents a bias away from threat. Greater emotional reactivity and engagement in rumination mediated the longitudinal association between maltreatment and increased general psychopathology over time. Emotion dysregulation following childhood maltreatment occurs at multiple stages of the emotion generation process, in some cases varies across development, and serves as a transdiagnostic mechanism linking child maltreatment with general psychopathology.

140 citations


Cites background from "Child Trauma Exposure and Psychopat..."

  • ...Moreover, child maltreatment has been linked to differences in many specific forms of emotion regulation (Heleniak et al., 2016; McLaughlin & Lambert, 2017)....

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  • ...…increasing age comes an increasing capacity to regulate attention away from distressing emotional stimuli, overriding prepotent tendencies to orient toward potential threats (Morales et al., 2016) that may arise as a result of being raised in a dangerous environment (McLaughlin & Lambert, 2017)....

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  • ...Emotion dysregulation has been conceptualized as a key mechanism linking child maltreatment with multiple forms of psychopathology (Beauchaine, 2015; Heleniak, Jenness, Vander Stoep, McCauley, & McLaughlin, 2016; Kim & Cicchetti, 2010; Maughan & Cicchetti, 2002; McLaughlin & Lambert, 2017)....

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References
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Journal ArticleDOI
TL;DR: The findings emphasize the important role of emotion regulation as a risk or a protective mechanism in the link between earlier child maltreatment and later psychopathology through its influences on peer relations.
Abstract: Background: The aim of this study was to investigate longitudinal relations among child maltreatment, emotion regulation, peer acceptance and rejection, and psychopathology. Methods: Data were collected on 215 maltreated and 206 nonmaltreated children (ages 6–12 years) from low‐income families. Children were evaluated by camp counselors on emotion regulation and internalizing and externalizing symptomatology and were nominated by peers for peer acceptance and rejection. Results: Structural equation modeling analyses revealed that experiencing neglect, physical and/or sexual abuse, multiple maltreatment subtypes, and earlier onset of maltreatment were related to emotion dysregulation. Lower emotion regulation (Time 1) was associated with higher externalizing symptomatology (Time 1) that contributed to later peer rejection (Time 2), which in turn was related to higher externalizing symptomatology (Time 2). Conversely, higher emotion regulation was predictive of higher peer acceptance over time, which was related to lower internalizing symptomatology controlling for initial levels of symptomatology. Conclusions: The findings emphasize the important role of emotion regulation as a risk or a protective mechanism in the link between earlier child maltreatment and later psychopathology through its influences on peer relations.

934 citations


"Child Trauma Exposure and Psychopat..." refers background in this paper

  • ...Longitudinal studies confirm that emotion regulation difficulties are a mechanism linking child trauma to the onset of internalizing and externalizing symptoms [18,38]....

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Journal ArticleDOI
TL;DR: The results suggest that to the extent that children's experience with the world varies, so too will their interpretation and understanding of emotional signals, and physically abused children showed the most variance across emotions.
Abstract: The contributions to the recognition of emotional signals of (a) experience and learning versus (b) internal predispositions are difficult to investigate because children are virtually always exposed to complex emotional experiences from birth. The recognition of emotion among physically abused and physically neglected preschoolers was assessed in order to examine the effects of atypical experience on emotional development. In Experiment 1, children matched a facial expression to an emotional situation. Neglected children had more difficulty discriminating emotional expressions than did control or physically abused children. Physically abused children displayed a response bias for angry facial expressions. In Experiment 2, children rated the similarity of facial expressions. Control children viewed discrete emotions as dissimilar, neglected children saw fewer distinctions between emotions, and physically abused children showed the most variance across emotions. These results suggest that to the extent that children's experience with the world varies, so too will their interpretation and understanding of emotional signals.

765 citations

Journal ArticleDOI
TL;DR: Early abuse increased the risk of teacher-rated externalizing outcomes in Grades 3 and 4 by fourfold, and this effect could not be accounted for by confounded ecological or child factors.
Abstract: The authors tested the hypothesis that early physical abuse is associated with later externalizing behavior outcomes and that this relation is mediated by the intervening development of biased social information-processing patterns. They assessed 584 randomly selected boys and girls from European American and African American backgrounds for the lifetime experience of physical abuse through clinical interviews with mothers prior to the child's matriculation in kindergarten. Early abuse increased the risk of teacher-rated externalizing outcomes in Grades 3 and 4 by fourfold, and this effect could not be accounted for by confounded ecological or child factors. Abuse was associated with later processing patterns (encoding errors, hostile attributional biases, accessing of aggressive responses, and positive evaluations of aggression), which, in turn, predicted later externalizing outcomes.

748 citations


"Child Trauma Exposure and Psychopat..." refers background in this paper

  • ...situations, extensive evidence documents that children exposed to trauma are more likely to attend to threatening cues, ignore non-threatening cues, and generate hostile attributions than children without trauma histories [13]....

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  • ...These disruptions in social information processing are developmental mechanisms that underlie the association of child trauma with anxiety [12], PTSD [15], aggression and conduct problems [10,13]....

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Journal ArticleDOI
TL;DR: It is argued that these previously undifferentiated dimensions of experience exert strong and distinct influences on neural development that cannot be fully explained by prevailing models focusing only on stress pathways.

682 citations


"Child Trauma Exposure and Psychopat..." refers background in this paper

  • ...Trauma exposure and threat processing Traumatic events involve harm or threat of harm [5]....

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Journal ArticleDOI
TL;DR: It is demonstrated that, as in the rodent, children who experienced early maternal deprivation exhibit early emergence of mature amygdala–prefrontal connectivity, suggesting that accelerated amygdala–mPFC development is an ontogenetic adaptation in response to early adversity.
Abstract: Under typical conditions, medial prefrontal cortex (mPFC) connections with the amygdala are immature during childhood and become adult-like during adolescence. Rodent models show that maternal deprivation accelerates this development, prompting examination of human amygdala–mPFC phenotypes following maternal deprivation. Previously institutionalized youths, who experienced early maternal deprivation, exhibited atypical amygdala– mPFC connectivity. Specifically, unlike the immature connectivity (positive amygdala–mPFC coupling) of comparison children, children with a history of early adversity evidenced mature connectivity (negative amygdala–mPFC coupling) and thus, resembled the adolescent phenotype. This connectivity pattern was mediated by the hormone cortisol, suggesting that stress-induced modifications of the hypothalamic–pituitary–adrenal axis shape amygdala–mPFC circuitry. Despite being age-atypical, negative amygdala–mPFC coupling conferred some degree of reduced anxiety, although anxiety was still significantly higher in the previously institutionalized group. These findings suggest that accelerated amygdala–mPFC development is an ontogenetic adaptation in response to early adversity.

650 citations

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