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Child maltreatment is a reliable predictor of posttraumatic stress disorder (PTSD) symptoms. However, not all maltreated children develop PTSD symptoms, suggesting that additional mediating variables explain how certain maltreated children develop PTSD symptoms and others do not. The current study tested three potential mediators of the relationship between child maltreatment and subsequent PTSD symptoms: (a) respiratory sinus arrhythmia reactivity, (b) cortisol reactivity, and (c) experiential avoidance, or the unwillingness to experience painful private events, such as thoughts and memories. Maltreated (n = 51) and nonmaltreated groups (n = 59) completed a stressor paradigm, a measure of experiential avoidance, and a semistructured interview of PTSD symptoms. One year later, participants were readministered the PTSD symptoms interview. Results of a multiple mediator model showed the set of potential mediators mediated the relationship between child maltreatment and subsequent PTSD symptoms. However, experiential avoidance was the only significant, specific indirect effect, demonstrating that maltreated children avoiding painful private events after the abuse were more likely to develop a range of PTSD symptoms 1 year later. These results highlight the importance of experiential avoidance in the development of PTSD symptoms for maltreated children, and implications for secondary prevention and clinical intervention models are discussed.
This is a report on the research design and findings of a 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development. The conceptual framework integrated concepts of psychological adjustment with theory regarding how psychobiological factors might impact development. Participants included 6- to 16-year-old females with substantiated sexual abuse and a demographically similar comparison group. A cross-sequential design was used and six assessments have taken place, with participants at median age 11 at the first assessment and median age 25 at the sixth assessment. Mothers of participants took part in the early assessments and offspring took part at the sixth assessment. Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic–pituitary–adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation, Diagnostic and Statistical Manual of Mental Disorders diagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. There was also a pattern of considerable within group variability. Based on this complex network of findings, implications for optimal treatments are elucidated. Translational aspects of extending observational research into clinical practice are discussed in terms that will likely have a sustained impact on several major public health initiatives.
Perhaps the starkest interpretation of Eileen Anderson-Fye's case study, “Maria: Cultural Change and Posttraumatic Stress in the Life of a Belizean Adolescent Girl,” is that simply to bestow a psychiatric diagnosis such as posttraumatic stress disorder (PTSD) upon an impressionable young adolescent girl like Maria is to condemn her to suffer from that disorder. There are some who would draw such a conclusion from this chapter. Indeed, there is a litany of professional and public statements to the effect that merely asking about possible child abuse or about certain symptoms associated with child abuse actually causes patients to falsely believe that they were abused – so called false memory syndrome – when, in fact, they were not. For some reason, those who believe in this syndrome regard young female patients as especially susceptible to being influenced into making false allegations of sexual abuse against their fathers.
A more nuanced interpretation would be that by providing a special language with which to talk about troubling experiences one can shape an individual's perception of the experience and, perhaps, even the way in which they symptomatically express the pain that those experiences have caused in them. Just as a doctor's diagnosis of cancer does not actually cause the cancer, it can, nonetheless, completely change how patients think about themselves and how they relate to others.
A diagnosis can also change the way in which doctors and psychotherapists perceive their patients.
Inconsistencies exist in literature examining hypothalamic–pituitary–adrenal (HPA) axis activity in children and adults who have experienced childhood abuse. Hence, the extent and manner to which childhood abuse may disrupt HPA axis development is largely unknown. To address these inconsistencies, the developmental course of nonstress cortisol in a long-term longitudinal study was assessed at six time points from childhood through adolescence and into young adulthood to determine whether childhood abuse results in disrupted cortisol activity. Nonstress, morning cortisol was measured in 84 females with confirmed familial sexual abuse and 89 nonabused, comparison females. Although dynamically controlling for co-occurring depression and anxiety, hierarchical linear modeling (HLM) showed that relative to comparison females, the linear trend for abused females was significantly less steep when cortisol was examined across development from age 6 to age 30, t (1, 180) = −2.55, p < .01, indicating attenuation in cortisol activity starting in adolescence with significantly lower levels of cortisol by early adulthood, F (1, 162) = 4.78, p < .01. As a more direct test of the attenuation hypothesis, supplemental HLM analyses of data arrayed by time since the disclosure of abuse indicated that cortisol activity was initially significantly higher, t (1, 425) = 2.18, p < .05, and slopes were significantly less steep t (1, 205) = −2.66, p < .01, for abused females. These findings demonstrate how the experience of childhood abuse might disrupt the neurobiology of stress, providing some support for the attenuation hypothesis that victims of abuse may experience cortisol hyposecretion subsequent to a period of heightened secretion.
This study examines the relationship of child sexual abuse to classroom academic performance and behavior in a sample of 6–16-year-old girls. Half of the sample was sexually abused by a family member. The other half is a demographically similar nonabused comparison group. Measures of academic performance include school records, teacher's ratings of classroom behavior and performance, and parental reports of school performance. Possible mediators of the impact of sexual abuse on classroom performance and behavior – cognitive capability, perceived competence, and behavior problems–are also measured. Results can be summarized as follows, (a) A history of sexual abuse does predict academic performance: Abuse is directly negatively related to ratings of classroom social competence, competent learner, and overall academic performance and positively related to school avoidant behavior, but is not related to grades, (b) Sexual abuse is negatively related to cognitive ability and positively related to measures of behavior problems indicating depression, destructiveness, and dissociation, (c) Cognitive ability and perceived competence predict the more “academic” aspects of academic performance—grades, ratings as a competent learner, and overall academic performance. Behavior problems predict ratings as a competent learner, classroom social competence, school avoidant behavior, and overall academmic performance.
Inflicted traumatic brain injury (ITBI) or shaken baby syndrome is recognized as a major cause of disability and death in the pediatric population. Although advances have been made in the recognition of the clinical, radiographic, and pathological findings of ITBI, less is known about the long-term outcomes of survivors. Health care providers recognize that these infants and children frequently have poor outcomes. Although an infant or child who sustains an ITBI may look well immediately after the trauma, that child may be left with serious and permanent disabilities.
This study examines short- and long-term maladaptive outcomes in a sample of sexually
abused females and a comparison group. The sample consists of intrafamilial sexual abuse victims
ages 6–16 years at entry into the study and a demographically similar comparison group.
The outcomes examined included measures of behavior and psychological problems such as
aggressive behavior, depression, dissociation, and low self-esteem; and measures at two time
points, first at entry into the study (median age 11 years) and approximately 7 years later (median
age 18 years). The specific questions being addressed were (a) whether subgroups or profiles,
based on the specific characteristics of the sexual abuse experienced, can be identified in this
sample of abused females; and (b) whether these profile groups predict different patterns of
adverse short- or long-term outcomes.