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Complex contexts of adversity such as family poverty and homelessness have been linked to multiple adverse, yet heterogenous risk profiles. Traditionally, high-risk environments have been examined through the framework of cumulative risk, which has been useful in exploring associations between risk factors and child and family outcomes. Methodologically, however, this approach lacks sensitivity to disentangle nuanced relationships between proximal experiences of various aspects of adversity and distal developmental and functional outcomes. These limitations underscore insufficiencies in currently existing typologies and risk assessment tools, translating to practical barriers to serving these underprivileged communities. The current dissertation seeks to explore alternative theoretical frameworks concerned with dimensional conceptualization of adversity. More specifically, Studies I and II draw on the Fragile Families and Child Wellbeing Study (FFCW) longitudinal data to test empirically a) the feasibility of dimensional decomposition of high-risk contexts of adversity; b) the effects of early life dimensional adversity on subsequent child development; and c) comparison of the ecological fit and predictive performance of cumulative risk and dimensional adversity models. Study I presents a case for integration of the two well-established dimensional frameworks into a three-dimensional parsimonious model of threat, deprivation, and unpredictability, modeled on the total sample of FFCW (N = 3253). Study I findings were consistent with theory, as children exposed to threat at three years of age showed more aggressive behaviors at age five; whereas exposure to deprivation at age three related to physical health problems and cognitive deficits at age five, and exposure to unpredictability at age three predicted risky behaviors and sexual risk-taking at age 15. Study II expands on Study I by applying the three-dimensional framework to a subset of FFCW multigenerati

Recent dimensional models of adversity informed by a neurobiological deficit framework highlights threat and deprivation as core dimensions, whereas models informed by an evolutionary, adaptational and functional framework calls attention to harshness and unpredictability. This report seeks to evaluate an integrative model of threat, deprivation, and unpredictability, drawing on the Fragile Families Study. Confirmatory factor analysis of presumed multiple indicators of each construct reveals an adequate three-factor structure of adversity. Theory-based targeted predictions of the developmental sequelae of each dimension also received empirical support, with deprivation linked to health problems and cognitive ability; threat linked to aggression; and unpredictability to substance use and sexual risk-taking. These findings lend credibility to utility of the three-dimensional integrative framework of adversity. It could thus inform development of dimensional measures of risk assessment and exploration of multidimensional adversity profiles, sensitive to individual differences in lived experiences, supporting patient-centered, strength-based approaches to services.

Complex contexts of adversity such as family poverty and homelessness have been linked to multiple adverse, yet heterogenous risk profiles. Traditionally, high-risk environments have been examined through the framework of cumulative risk, which has been useful in exploring associations between risk factors and child and family outcomes. Methodologically, however, this approach lacks sensitivity to disentangle nuanced relationships between proximal experiences of various aspects of adversity and distal developmental and functional outcomes. These limitations underscore insufficiencies in currently existing typologies and risk assessment tools, translating to practical barriers to serving these underprivileged communities. The current dissertation seeks to explore alternative theoretical frameworks concerned with dimensional conceptualization of adversity. More specifically, Studies I and II draw on the Fragile Families and Child Wellbeing Study (FFCW) longitudinal data to test empirically a) the feasibility of dimensional decomposition of high-risk contexts of adversity; b) the effects of early life dimensional adversity on subsequent child development; and c) comparison of the ecological fit and predictive performance of cumulative risk and dimensional adversity models. Study I presents a case for integration of the two well-established dimensional frameworks into a three-dimensional parsimonious model of threat, deprivation, and unpredictability, modeled on the total sample of FFCW (N = 3253). Study I findings were consistent with theory, as children exposed to threat at three years of age showed more aggressive behaviors at age five; whereas exposure to deprivation at age three related to physical health problems and cognitive deficits at age five, and exposure to unpredictability at age three predicted risky behaviors and sexual risk-taking at age 15. Study II expands on Study I by applying the three-dimensional framework to a subset of FFCW multigenerati

Recent dimensional models of adversity informed by a neurobiological deficit framework highlights threat and deprivation as core dimensions, whereas models informed by an evolutionary, adaptational and functional framework calls attention to harshness and unpredictability. This report seeks to evaluate an integrative model of threat, deprivation, and unpredictability, drawing on the Fragile Families Study. Confirmatory factor analysis of presumed multiple indicators of each construct reveals an adequate three-factor structure of adversity. Theory-based targeted predictions of the developmental sequelae of each dimension also received empirical support, with deprivation linked to health problems and cognitive ability; threat linked to aggression; and unpredictability to substance use and sexual risk-taking. These findings lend credibility to utility of the three-dimensional integrative framework of adversity. It could thus inform development of dimensional measures of risk assessment and exploration of multidimensional adversity profiles, sensitive to individual differences in lived experiences, supporting patient-centered, strength-based approaches to services.

BackgroundRecent advancements in pediatric mental health (MH) increased accessibility of evidence-based interventions. Yet, accessibility alone does not explain the rise in MH services use (MHSU). Maltreatment-related adversity, symptom severity, and access to early interventions have been linked to ongoing need for services, yet their joint contributions to continuities in MHSU remain unclear.ObjectiveThe study examines the role of maltreatment, externalizing symptom severity, and referral for early intervention in pediatric MHSU across five years. To evaluate engagement in treatment, we accounted for treatment progress and referral type, comparing MHSU in court-mandated and voluntary participants.Participants and settingParticipants were 321 children (M = 4.3 years; 58.9 % boys) referred to parent-child interaction therapy (PCIT), an evidence-based intervention for families struggling with child disruptive behaviors and maltreating families involved with child welfare. Services were provided at a university-affiliated clinic in a metropolitan county.MethodSymptom severity was assessed with standardized questionnaires; maltreatment history and referral type were obtained from casefile reviews. MHSU was tracked through county behavioral health diagnostic reports. The data were analyzed using structural equation modeling.ResultsResults indicated that for the 44.9 % of children with onward referrals, the frequency of service use, but not progress in treatment, predicted ongoing services. Maltreatment emerged as a universal predictor, while externalizing predicted MHSU only in court-mandated participants, suggesting referral type contributes to quantifiable differences in MH needs.ConclusionsFindings emphasize importance of ongoing funding for pediatric MH services, and the need to explore mechanisms underlying continuous MHSU in vulnerable children.

BackgroundRecent advancements in pediatric mental health (MH) increased accessibility of evidence-based interventions. Yet, accessibility alone does not explain the rise in MH services use (MHSU). Maltreatment-related adversity, symptom severity, and access to early interventions have been linked to ongoing need for services, yet their joint contributions to continuities in MHSU remain unclear.ObjectiveThe study examines the role of maltreatment, externalizing symptom severity, and referral for early intervention in pediatric MHSU across five years. To evaluate engagement in treatment, we accounted for treatment progress and referral type, comparing MHSU in court-mandated and voluntary participants.Participants and settingParticipants were 321 children (M = 4.3 years; 58.9 % boys) referred to parent-child interaction therapy (PCIT), an evidence-based intervention for families struggling with child disruptive behaviors and maltreating families involved with child welfare. Services were provided at a university-affiliated clinic in a metropolitan county.MethodSymptom severity was assessed with standardized questionnaires; maltreatment history and referral type were obtained from casefile reviews. MHSU was tracked through county behavioral health diagnostic reports. The data were analyzed using structural equation modeling.ResultsResults indicated that for the 44.9 % of children with onward referrals, the frequency of service use, but not progress in treatment, predicted ongoing services. Maltreatment emerged as a universal predictor, while externalizing predicted MHSU only in court-mandated participants, suggesting referral type contributes to quantifiable differences in MH needs.ConclusionsFindings emphasize importance of ongoing funding for pediatric MH services, and the need to explore mechanisms underlying continuous MHSU in vulnerable children.