Journal of Child & Adolescent Trauma最新文献

Despite well-documented associations between adverse childhood experiences (ACEs) and lifelong impairments in health and well-being, few studies have examined how to facilitate implementation of ACEs screening and referral programs in pediatric settings. We sought to identify facilitators and barriers related to screening for and addressing ACEs in a large integrated healthcare delivery system in Southern California. Using a developmental evaluation approach, we conducted twenty semi-structured interviews with pediatricians, nurses, social workers, and community referral organization staff. Interviews took place across six pediatric clinic pilot sites in Kaiser Permanente Southern California, where more than 7,000 pediatric patients were screened for ACEs between July 2018 and December 2019. Thematic analysis was conducted to identify themes. Key facilitators for screening and referrals for pediatric ACEs screening included providing clinician education to normalize conversations about ACEs, using screening data to provide more holistic and compassionate care, and collaborating across different types of clinicians. Key barriers included screening tool challenges related to patient confusion and cultural differences, capacity limitations, training issues, and care team silos. When used in the context of a trauma- and resilience-informed workforce, ACEs screening may be a powerful tool to support more collaborative and impactful care decisions that move away from symptom management to address root causes and promote prevention.

Childhood trauma is associated with poor health outcomes in adulthood, largely due to the impact of chronic stress on the body. Fortunately, there are certain protective characteristics, such as constraint (i.e., impulse control, inhibition, and avoidance of unconventional behavior and risk) and cognitive reappraisal (i.e., reframing circumstances in a more positive light). In the present study, we investigated the interaction between childhood trauma, resilience, and neural correlates of emotion processing. Participants responded to survey questions regarding childhood trauma and resilient characteristics. They were later invited to passively view neutral, unpleasant, and pleasant images while their brain activity was recorded via electroencephalography (EEG). We analyzed two event-related potential (ERP) components of interest: the Early Posterior Negativity (EPN) and Late Positive Potential (LPP). We found that childhood trauma was associated with decreased constraint and reduced sensitivity to unpleasant images (i.e., decreased LPP amplitude differences between neutral and unpleasant images as compared to controls). Further, constraint predicted increased sensitivity to pleasant images. In a hierarchical linear regression analysis, we found that constraint moderated the relation between childhood trauma and emotion processing, such that it predicted increased sensitivity to unpleasant images for adults with childhood trauma in particular. Childhood trauma and cognitive reappraisal independently predicted decreased sensitivity to unpleasant images, (i.e., decreased LPP amplitude differences between neutral and unpleasant images). Our findings suggest that childhood trauma and resilient characteristics independently and interactively influence emotion processing.

Abstract

Discrimination experienced by Black emerging adults with autism is rarely studied nor have their experiences been juxtaposed to Black emerging adults without autism. A mixed methods descriptive approach was used to describe responses to open-ended questions collected as part of a larger study of discrimination experienced by Black emerging adults with autism (n = 14) and Black emerging adults without autism (n = 20). Questions focused around racial discrimination, disability discrimination, and perception of the future. Qualitative and quantitative content analysis were applied. Qualitatively- a manifest approach was used, and quantitatively- frequency counts and ratios were identified within themes and subthemes. Four main themes and twelve subthemes were identified. Racial discrimination had two themes: 1) Impact on mental health, and 2) Societal threats, with five subthemes, each reported at higher rates by people without autism (Theme 1 = 5:7, Theme 2 = 3:11). Disability discrimination was only reported on by those with autism, and had one main theme of neurodiverse/autism bias, and three subthemes. Perception of the future contained the theme of emerging life hopes, with four subthemes. Subthemes relating to work/career/family and future unknown were reported more highly by those without autism than with autism (1:8 and 4:7 respectively), while subthemes describing diverse or unique priorities for fulfillment and mental wellness were reported only by those with autism (6:0 and 4:0 respectively). Study findings suggest unique experiences and needs among Black emerging adults with autism, as well as the consequences of anti-blackness and anti-ableism/neurobigotry which can have double impact in their lives, spanning different ages and stages. Results have implications for building resiliency among Black persons with autism and without autism as they transition to adulthood.

Trauma-informed care (TIC) is a relatively new topic in the Estonian child protection system, but it has become the particular focus of substitute care. The Estonian child protection system focuses on protecting children from maltreatment, and neglects the adult carers’ right to adequate information about the child’s trauma experience. This makes trauma-informed care vague. This article is based on focus groups conducted for a wider study that aims to develop the basis for a TIC training course for foster parents and staff members working as direct caregivers in residential substitute care. The foster parents and staff members participated in four focus groups, with special attention on their experiences with TIC. The participants eagerly shared their experiences, and thematic narrative analysis was used during the data analysis. The central theme of the participants’ stories was the need for information about the child’s traumatic past. The findings indicate that a complex interplay exists between the needs of children entering substitute care and the capacity of the foster parents and residential care staff to meet those needs. It is complicated for a child to heal from trauma if the child’s past is hidden from their carers. This could result in re-traumatisation and hinder the child from making sense of past trauma. Estonia’s child protection system needs greater awareness of the impact of trauma on the child’s behaviour and how to help the child heal. This is directly connected to the need for clear and precise information, which is one of the basic rights of the child.

Contextual risk factors, such as adverse childhood experiences (ACEs), have a significant impact on the mental health of Black youth. Surprisingly, few studies focus efforts specifically on Black youth. The present study investigates the influence of ACEs on psychological distress among Black youth. Additionally, guided by social cognitive theory, this study highlights emotional self-control as a protective mechanism against the negative consequences of ACEs. Our findings show that ACEs (T1) predicted psychological distress among Black youth a year later (T2). Emotional self-control emerged as a significant buffer of ACEs on the association with psychological distress. Thus, to prevent negative mental health outcomes for Black youth, it is imperative to focus prevention efforts on the crucial risk factors that affect healthy development. By working to increase emotional self-control among Black youth who suffered adverse childhood experiences, negative mental health outcomes over time can be reduced.

Abstract

Despite ample evidence supporting the association between relational and overt aggression and social-psychological adjustment problems, little is known about how this association occurs among adolescents in non-Western cultures. The present study examined whether potentially traumatic peer experience, such as forms of peer victimization (relational and overt), influences the longitudinal association between forms of aggression (relational and overt) and social-psychological adjustment problems (internalizing and externalizing) among Japanese adolescents. Gender differences in the mediation of peer victimization were also examined. Two hundred and eighty-one Japanese students from nine classrooms and two public middle schools participated in this study (Time 1 M age = 12.72, SD = .45, 50% female). Data included three time points one year apart (Grades 7, 8, and 9). Results of structural equation modeling indicated that higher relational aggression in Grade 7 was associated with more internalizing and externalizing problems in Grade 9. Notably, relational aggression was associated with internalizing problems, but not with externalizing problems, through relational victimization for both boys and girls. Overt aggression in Grade 7 was significantly associated with externalizing problems in Grade 9, but overt victimization did not mediate this association. On the other hand, overt aggression did not predict internalizing problems in Grade 9, but the indirect effect of overt victimization was found in this association. The findings inform us of the need to intervene with at-risk youth, regardless of gender, who use relational aggression, experience potentially traumatic relational victimization, and subsequently exhibit high levels of mental health and behavioral problems in Japan.

The COVID-19 crisis may have deleterious effects on children’s and adolescents’ mental health. However, there have been no published studies in which the COVID-related stress symptoms were investigated in a French ordinary pediatric population. The main objective of this study was to examine virus threats and social distancing measures to determine which were more disturbing for children and adolescents, and which were better predictors of post traumatic stress symptoms (PTSS). 1639 parents of children aged between 1 and 18 participated in an online survey. Parents completed questionnaires regarding their children’s and adolescents’ mental health while in the first French confinement. The data showed that most children and adolescents had PTSS, such as irritability and tantrums, intrusive thoughts or memories, difficulties in falling asleep, aggression, trouble concentrating, and negative emotions. Multiple linear models supported that both virus threats and social distancing– related disturbances were predictors of PTSS scores, with social distancing being a stronger predictor of PTSS scores than virus threats. Additional analyses across age groups revealed that social distancing measures predicted two times more PTSS than virus threat measures in toddlers, while virus threat measures were a stronger predictor of PTSS in adolescents. This is the first study that has investigated stress symptoms in a French pediatric population during the first French confinement episode because of the COVID-19 crisis.

This study investigates the childhood traumas of individuals who experienced parental death in childhood or adolescence in Turkey. Participants (n = 382; 63.1% female and 36.9% male; M_AGE=29.41, SD = 9.6) are composed of individuals who lost either or both of their parents before the age of 18. The findings indicated that there is a significant difference between the subdimensions of Childhood Trauma Questionaire and the study variables including gender, marital status, educational status, number of siblings, gender of the deceased parent, the caregiver after the parental death, relationship with the surviving parent and the age at the time of parental death (p < .05). The results further show that individuals who lost their parents before the age of 10, who lost their mothers, and who received care from other relatives instead of parents are exposed to more neglect and abuse. By identifying childhood traumas in individuals and examining related variables, the findings contribute trauma-informed social work practices. Based on the results, it is recommended that school social work programs focus on monitoring the relationship between caregivers and children, as well as enhancing the psychosocial well-being of students. These programs can also serve as a means to raise awareness among professionals and students.

Developing sound evidence of program effectiveness can be difficult for many programs initiated by schools and communities, and impedes many beneficial programs from broader dissemination. This paper shares results of an evaluation approach used with a bullying and victimization prevention program with elementary school children called the radKIDS® Personal Empowerment and Safety Education Program. The purpose of this study was to examine indicators of initial effectiveness of the radKIDS® program for elementary school child safety skill development and instructor training to reduce child victimization and associated trauma and empower healthy psychosocial child development. The study involved 330 active radKIDS® instructors surveyed during two separate two-week periods, resulting in 148 completed questionnaires (45%). Instructors rated their perceptions of what children effectively learned in radKIDS®, the effectiveness of instructor training, and on Social Emotional Learning (SEL) competencies addressed in the program. Evaluation findings confirmed the theoretical model of the program, and that the developmental safety domains impacting children in radKIDS® differs from those in other bullying prevention interventions focused on SEL and other competencies. Recommended areas of improvement for the program included making training less time consuming and more flexible in delivery, provide more practice opportunities and time on skill acquisition during training, and increase supervision and guidance during program implementation.

Purpose

Long-term psychological effects may occur after childhood dog bite injuries. We performed a national survey to assess psychosocial interventions for children presenting with dog bite injuries to pediatric trauma centers.

Methods

A 26-question, online survey was administered to Pediatric Trauma Program Managers in the United States (n = 83). The survey queried whether institutions provide directed psychosocial interventions to pediatric dog bite injury patients in the Emergency Department, inpatient, or outpatient settings and the types of interventions being used. Descriptive statistics were performed to demonstrate survey results.

Results

In total, 28 American College of Surgeons or State-verified Pediatric Trauma Centers responded to the survey (n = 28/83, 34%). Of the respondents, 18 (64.3%) did not have any interventions in place to address the psychosocial effects of pediatric patients’ dog bite injuries. Of the 10 (35.7%) institutions with interventions in place, the types of psychosocial resources offered included: automated order sets within the electronic medical record, specialized teams that assess the patient while hospitalized or outpatient, child psychology referrals initiated at discharge, pet therapy, and trauma resiliency programs.

Conclusion

Most institutions surveyed did not have protocols or interventions in place to address psychosocial disturbances in children with dog bite injuries. We provide the example of our institution’s practice, in which automatic psychology consults are placed for every child who is admitted with a dog bite injury. Performing caregiver education in the emergency department, providing caregivers with regional psychosocial resources, and communicating with a child’s pediatrician may promote the necessary standardized psychological screening and/or follow up of these patients.