Childhood maltreatment, PTSD, and Teen Dating Violence

1
Childhood maltreatment, PTSD, and Teen Dating
Violence

• Christine Wekerle,Ph.D.
• Associate Professor, Education, Psychology,
  Psychiatry
• The University of Western Ontario
• cwekerle_at_uwo.ca

2
Violence in intimate relationships can be
onein which great intensity of positive longing,
anger, and fear may be combined with a lack of
felt security, lapses in attention, dysfluent
communication, and unregulated arousal.
(Lyons-Ruth Jacobvitz, 1999)

3
Developmental Traumatology Tenets (DeBellis, 2001)

• The biological stress system response varies with
  individuals genetics, nature of the stressor,
  and whether the system can maintain homeostasis
  or whether it permanently changes due to stressor
• PTSD symptoms are normal responses, but when
  chronic can lead to adverse brain development
• PTSD symptoms represents pathway to more
  impairment intergenerational maltreatment
  follows PTSD mediation
• Chronic mobilization of the fight/flight
  response, is the key cause of persistent negative
  neurological effects and neurobiological changes
• PTSD key causal factor underlying broad range of
  academic and mental health impairments

4
Mediators Causal Factors Preceding Target Change

• The identification of mediator provides target
  for cost-effective intervention and ground for
  evidence-based policy decision.

5
Predictive Distal Factor Childhood Maltreatment

• Child maltreatment may be the single most
  preventable and intervenable contributor to child
  and adult mental illness
• (DeBellis, 2003)
• Effective parenting is the most powerful way to
  reduce youth problem behaviours
• (Kumpfer Alvarado, 2003)
• Adverse life events are not random
• Child maltreatment associated with more
  problematic family environments, other high
  impact negative life events (including
  overlapping types of maltreatment), poverty etc.
• (Costello et al., 2002)

6
(No Transcript)
7
CIS Study Caregiver Substance Abuse and
Environmental Risk Factors

• Poverty (income lt 15,000, OR1.6)
• Multiple moves in the past 6 months (3, OR5.2)
• Unsafe housing (OR1.9)
• Minority racial status (Aboriginal OR3.4 Other
  Minority OR1.4)
• Low caregiver education (OR1.9)
• Criminal activity (OR4.8)
• Involvement in a violent relationship (OR3.8)
• History of childhood maltreatment (OR3.2)
• Mental (OR2.8) and physical (OR2.6) health
  issues
• Lack of social supports (OR2.6)

8
DSM-IV PTSD Criteria

• Specifier (1) Acute (lt 3 months) (2) Chronic (gt
  3 months) (3) Delayed Onset (6 months past
  traumatic stressor)
• Issues Intensity, proximity, chronicity of
  stressor, age of child, relationship to
  perpetrator, presence of supportive and
  protective caretaker
• Criterion A Both must be present
• traumatic event w/ actual/threatened death or
  serious injury to threat to physical integrity to
  self/others
• response involved intense fear, helplessness,
  horror, disorganized or agitated behaviour

9
DSM-IV PTSD Symptomatology

• DSM- IV Symptom Classes
• Re-experiencing recurrent, intrusive thoughts
  bad dreams sense of re-living physiological
  reactivity and psychological distress at cue
  exposure
• (2) Avoidance/Numbing avoid thoughts, feelings,
  places, people, activities related to trauma
  gaps in recall feeling detached feeling
  problems pessimism about future
• (3) Arousal sleeping, anger, irritability,
  startle, hypervigilance, concentration
  difficulty
• Higher among chronic, abused youth (Fletcher,
  2003)

10
Mediators Causal Factors Preceding Target Change

• PTSD symptomatology as mediator
• Teens gt frequently endorse intrusive memories,
  numbness, reminders are distressing, dissociative
  response, efforts to forget about event,
  hypervigilance, reliving the event (Fletcher,
  2003)
• a significant proportion of adults diagnosed with
  alcohol dependence experience clinically
  significant levels of PTSD symptomatology
• individuals who suffer resultant PTSD as a result
  of childhood maltreatment may use alcohol as a
  means of coping (Stewart Israeli, 2002)
• PTSD interfere with relationship functioning

11
Cross-lagged Structural Model Of Trauma Symptoms
As A Predictor Of Child Maltreatment And Dating
Violence For Boys, Adjusted To Include
Independent Mediator Paths For Emotional Abuse
12
Cross-lagged Structural Model Of Trauma Symptoms
As A Predictor Of Child Maltreatment And Dating
Violence For Girls, Adjusted To Include
Independent Mediator Paths For Anger
13
Dating Violence PreventionThe Youth
Relationships Project

• Rationale Youth with a child maltreatment
  history at greater risk for relationship violence
  
• Target Age Mid-adolescence (age 14-17) By age
  14, 55 had romantic relationship by 17, 80 had
  romantic relationship, Carver et al., 2003
• Targets (1) concept of relationships
• (2) relationships skills
• (3) social action (mastery via advocacy)
• Program 18 sessions (2-hr) coeducational group
  format, coeducational facilitation
  semi-structured manual
• Results Reduced dating violence involvement,
  Reduced PTSD symptomatology within a RCT design
  with child welfare youth
• (Wolfe, Wekerle et al., 2003)

14
MAP Feasibility Study Research Process

• Mean Age of tested youth 15.5 years
• Ineligibility Rate Overall 31 (Case closed,
  AWOL, Discharged, mental health issues,
  developmental delay, In custody, Not identified
  client)
• Refusal Rate Overall 30 (Community 55,
  In-care 17 Males 39 Females 19)
• Reasons given for Refusal Just not interested/
  no reason 65
• (Parental Refusal 14 Too busy 8Not
  comfortable sharing 5Other 8)
• Recruitment Rate Overall 70 (Community 45
  In-care 83Males 61 Females 81)
• Reasons given for participation Money 59No
  reason given 32 Other 9
• Average testing time 2.8 hrs (Range 2.0 to 4.5
  hrs)
• Avg. Cost/Ss/Testing 133.11 Youth paid ON
  minimum wage/4hrs
• Home (70.21) 28.00 98.21 (gt80 youth
  selected testing at residence)
• CAMH (1.90) 28.00 29.90
• (5.00 food/refreshment cost)

15
Descriptives of the MAP Preliminary Analysis
Sample

• Gender 47 (56) female, 37 male
• CAS status
• Crown Ward 32 (42.1)
• Society Ward 24 (31.6)
• Community Family/Temporary Care 7(9.2)
• Voluntary Care 1 (1.3)

16
Bullying

• Childhood Experiences of Victimization
  Questionnaire (CEVQ)
• Was Verbally bullied
• 60 endorsed, 50 before grade 6
• Was Physically bullied
• 40 endorsed, 34 between 6-8th grade
• Ontario Student Drug Use Survey (OSDUS)
• Frequency of being bullied at school (grades
  7-12) since September (past 6 months)
• 31 endorsed
• Frequency of bullying at school (grades 7-12)
  since September (past 6 months)
• 34 endorsed

17
Emotional Maltreatment

• CEVQ
• Witness verbal abuse to another adult
• 70 endorsed, 63 occurred before grade 6
• Witness physical abuse to another adult
• 43 endorsed, 55 occurred before grade 6
• Victim of verbal abuse by parents
• 74 endorsed, 59 occurred before grade 6
• CTQ (growing up as a child )
• Family said hurtful or insulting things
• 72 endorsed
• Being called stupid, lazy, or ugly by
  family
• 72 endorsed

18
Physical Maltreatment

• CEVQ
• Being pushed, grabbed, or shoved as a way to hurt
• 65 endorsed, 61 before grade 6, 81 parental
  perpetration
• Being kicked, bit or punched as a way to hurt
• 43 endorsed, 56 before grade 6, 78 parental
  perpetration
• Childhood Trauma Questionnaire
• (CTQ While growing up as a child )
• Being hit so hard it left marks
• 62 endorsed
• Being punished with belt, cord, hard objects
• 57 endorsed

19
Sexual Maltreatment

• CEVQ
• Being touched or forced to touch others private
  part
• 32 endorsed, 54 before grade 6
• Being coerced into having sex
• 26 endorsed, 43 before grade 6 30 high
  school
• CTQ (growing up as a child )
• Being forced to do or watch sexual things
• 20 endorsed
• Being molested
• 20 endorsed

20
Neglect

• CTQ (growing up as a child )
• Not having enough to eat
• 40 endorsed
• Parent too drunk or high to take care of the
  family
• 22 endorsed
• Had to wear dirty cloth
• 25 endorsed

21
Posttraumatic Stress Disorder Symptomatology

• Trauma Symptom Checklist for Children (TSCC)
• Feeling afraid something bad might happen
• 75 endorsed
• Remembering things that happened that I didnt
  like
• 74 endorsed
• Bad dreams or nightmare
• 63

22
Maltreatment and Trauma
23
MAP Feasibility Study Preliminary Result
Childhood Maltreatment
PTSD Symptomatology
Poor Mental Health Dating violence Risky sexual
behavior Substance abuse

• 90 of female adolescents had experienced either
  one or more forms of sexual abuse, and almost 80
  of male had experience either one or more forms
  of physical abuse.
• The severity and duration of maltreatment
  experience is associated with the number and
  acuteness of PTSD symptomatology
• While in general PTSD symptomatology is
  associated with the four indicators of poor
  developmental health in maltreated adolescents,
  there are stark gender differences
• PTSD symptomatology in maltreated female
  adolescents is associated with 1) internalizing
  symptoms, 2) victimization in dating violence, 3)
  risky sexual behavior illicit drug-use as part
  of their sexual activity, 4) experienced
  difficulty in stopping drug and alcohol even if
  they wanted to
• PTSD symptomatology in maltreated male
  adolescents is associated with 1) externalizing
  behaviors, 2) perpetration and victimization in
  dating violence, 3) risky sexual behavior
  un-protected sexual activities, 4) more illicit
  drug use

24
MAP Feasibility Study Preliminary Result

• Testing the full mediation model
• Feasibility has small sample size, not enough
  statistical power awaits MAP Longitudinal Study
• Only partial mediation of PTSD symptomatology in
  the relationship between childhood maltreatment
  and internalizing symptom in female, and between
  maltreatment and victimization in dating violence
  in the combined sample.
• Encourages continued research on PTSD
  symptomatology as a key mediator of diverse teen
  outcomes
• No current maltreatment-specific PTSD
  intervention for teens exists may need
  gender-specific intervention