Part II: Vulnerabilities and Risk Factors for Psychopathology

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Part II Vulnerabilities and Risk Factors for
Psychopathology
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Child Maltreatment and Risk for Psychopathology

• Chapter 5
• Sara R. Jaffee and Andrea Kohn Maikovich-Fong

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Terminological and Conceptual Issues

• Prevalence Rates of Maltreatment Among Subgroups
• Children under the age of 4 years represent
  approximately one third of victims (U.S.
  Department of Health and Human Services, 2011).
• Maltreatment rates are highest among African
  American, Native American/Alaska Native, and
  multiethnic youth, and lowest among Asian youth.
• Minority children are disproportionately
  represented in the child welfare system because
  minority families experience high rates of
  poverty and other social stressors rather than
  pervasive bias in the child welfare system (Drake
  et al., 2011).

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Maltreatment and Childrens Risk for
Psychopathology

• Maltreatment and Risk for Externalizing
  Psychopathology
• Maltreated children and adolescents are at higher
  risk of attention deficit/hyperactivity disorder,
  conduct disorder, oppositional defiant disorder,
  delinquency and antisocial behavior.
• Risk for externalizing problems extends into
  adulthood and may include elevated rates of
  antisocial personality disorder, self-reported
  crime, and criminal arrests.
• Findings with respect to drug and alcohol use
  have been mixed.
• The relationship between externalizing problems
  and child maltreatment varies as a function of
  age and sex.

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Maltreatment and Childrens Risk for
Psychopathology

• Maltreatment and Risk for Internalizing
  Psychopathology
• Maltreated children and adolescents are at higher
  risk of major depressive disorder, anxiety
  disorders, posttraumatic stress disorder (PTSD),
  and trauma symptoms.
• Risk for internalizing problems extends into
  adulthood and may include elevated rates of major
  depressive disorder, depressive symptoms, anxiety
  disorders, borderline personality disorder.
• Victims of child maltreatment are at elevated
  risk for suicide in adolescence and adulthood and
  engage in elevated rates of self-injury.

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Maltreatment and Childrens Risk for
Psychopathology

• Does the Association Between Maltreatment and
  Psychopathology Reflect Reverse Causation?
• Evidence consistent with the hypothesis that
  maltreatment was a cause of childrens antisocial
  behavior (Jaffee et al., 2004).
• Abuse was associated with changes over time in
  childrens antisocial behavior.
• A dose-response relationship between the severity
  of the abuse and the severity of childrens
  antisocial behavior.
• Genetic factors accounted for a small and
  statistically nonsignificant portion of the
  variation.
• Abuse remained a significant predictor of
  childrens antisocial behavior controlling for
  parental antisocial behavior.

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Etiological Formulations

• Biological Mechanisms
• Epigenetic effects of maltreatment
• Maltreatment may lead to psychopathology by
  triggering epigenetic mechanisms that regulate
  gene expression in the central nervous system.
• Maltreatment and limbic-hypothalamic pituitary
  adrenal (LHPA) axis function
• Maltreatment may dysregulate the LHPA axis due to
  chronic activation from stressors.
• LHPA axis dysregulation has been implicated in a
  range of mental disorders including depression,
  anxiety disorders, and conduct disorder
  (Arborelius, Owens, Plotsky, Nemeroff, 1999).

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Etiological Formulations

• Structural and functional changes in the brain
• Maltreatment increases risk for depression by
  altering dopaminergic circuitry projecting to the
  basal ganglia.
• Maltreated versus nonmaltreated children are
  selectively attentive to cues for anger, as
  evidenced, for example, by greater activation of
  the right amygdala and anterior insular
  bilaterally to angry faces.
• Hyperattention to threat mediates the association
  between a history of maltreatment and current
  symptoms of anxiety (Shackman et al., 2007).

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Etiological Formulations

• Cognitive, Behavioral, and Socioemotional
  Processes
• Externalizing problems
• Attribute hostile intent to others behavior and
  respond in an aggressive manner.
• Maltreated youth have difficulty regulating their
  own emotions leading to peer rejection.
• Maltreated preschoolers also have difficulty with
  emotion understanding.
• More positive beliefs about violence, which leads
  to antisocial peer groups and increases their
  risk for violent behavior.

10
Etiological Formulations

• Internalizing problems
• Sexual abuse in particular has been linked with a
  range of problems in self-functioning, defined in
  terms of self-coherence, self-continuity,
  self-affectivity, and self-agency (Stern, 1985).
• Some studies show that abused and neglected youth
  report elevated symptoms of dissociation compared
  with nonmaltreated youth (Macfie, Cicchetti,
  Toth, 2001).
• Others have found that sexually abused and
  neglected children are more likely to develop an
  external locus of control, with perceived
  external control accounting substantially for
  their elevated symptoms of internalizing problems
  (Bolger et al., 2001).

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Moderators of Maltreatment on Risk for
Psychopathology

• Characteristics of the Maltreatment
• Maltreatment subtype
• Maltreatment chronicity
• Developmental timing
• Characteristics of the Individual
• Sex
• Race
• Personality characteristics
• Genotype
• Characteristics of the Environment
• Neighborhood
• Social support
• Family environment

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Clinical Treatment of Maltreated Children

• The strongest empirical support is for
  trauma-focused cognitive behavioral therapy
• Dynamic play therapy for children with sexual
  behavior problems and their caregivers (group
  therapies)
• Cognitive processing therapy
• Eye movement desensitization and reprocessing
  therapy
• Multisystemic therapy
• Parent-child interaction therapy

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Conclusion

• Basic research Would benefit from more
  longitudinal research is needed to better
  understand the course of resilience and
  dysfunction over time.
• Biology research Would benefit from larger and
  more representative samples.
• Research on psychological sequelae of
  maltreatment Would benefit from research designs
  that allow for stronger causal inferences about
  potential mediators of maltreatment.
• Multilevel perspective research Is needed to
  trace the effects of maltreatment on pathways
  from genes to brain to behavior.
• Clinical research More research is needed to
  better evaluate treatment efficacy for maltreated
  children, to improve access to services and the
  quality of services for maltreated children, and
  to understand why some maltreated children
  respond better to treatment than others.