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Summary Background The effects of the COVID-19 pandemic on mental health have been understudied among vulnerable populations, particularly in fragile and conflict-affected settings. We aimed to analyse how the pandemic is related to early changes in mental health and parenting stress among caregivers, many of whom are internally displaced persons (IDP), in a conflict-affected setting in Colombia. Methods For this cohort study, we used longitudinal data from a psychosocial support programme in which 1376 caregivers were randomly assigned across four sequential cohorts. Recruitment of participants took place in March, 2018, for cohort 1; July, 2018, for cohort 2; March, 2019, for cohort 3; and July, 2019, for cohort 4. Participants completed assessments at baseline, 1-month, and 8-month follow-ups. The 8-month assessment occurred before the COVID-19 pandemic for participants in cohorts 1 and 2 (n=573), whereas those in cohorts 3 and 4 (n=803) were assessed during the early stages of the pandemic, 2–5 weeks after the national lockdown began on March 25, 2020. Primary caregiver anxiety and depression were measured with a scale adapted from the Symptoms Checklist-90-Revised and parenting stress was measured with the short form of the Parenting Stress Index. We estimated how mental health changed by comparing prepandemic and postpandemic 8-month outcomes using lagged-dependent variable models. Findings Results showed that the likelihood of reporting symptoms above the risk threshold increased by 14 percentage points for anxiety (95% CI 10–17), 5 percentage points for depression (0·5–9), and 10 percentage points for parental stress (5–15). The deterioration in mental health was stronger for IDP, participants with lower education or pre-existing mental health conditions, and for those reporting a higher number of stressors, including food insecurity and job loss. Interpretation Maternal mental health significantly worsened during the early stages of the pandemic. Considering the vulnerability and pre-existing mental health conditions of this population, the estimated effects are substantial. Policies in fragile and conflict-affected settings targeting IDP and other vulnerable people will be important to mitigate further mental health and socioeconomic problems. Funding Saving Brains–Grand Challenges Canada, Fundacion Exito, Fundacion FEMSA, United Way Colombia, Universidad de los Andes. Translation For the Spanish translation of the abstract see Supplementary Materials section.

This study examined maternal pregnancy wantedness and perceptions of paternal wantedness, and their associations with maternal perinatal mental health symptoms and relationship dynamics. Low-income, ethnically-diverse pregnant women (N = 101, Mage = 29.10 years, SDage = 6.56, rangeage = 18–44; 37% Latina, 22% African-American, 20% White, 21% biracial/multiracial/other) completed semi-structured interviews of pregnancy wantedness coded by trained raters, and standardized instruments of depression and PTSD symptoms during pregnancy and at 3–4-months postpartum. While maternal pregnancy wantedness (rated from 0-Predominately Ambivalent, 1-Mixed, and 2-Predominately Positive) showed no significant associations, a couple-level scale that combined maternal wantedness and her perceptions of paternal wantedness (Equally Positive Wantedness, Mom Wants More, Dad Wants More and Equally Ambivalent) showed several significant associations. Compared to women in the Equally Positive group, women in the Mom Wants More group had significantly higher prenatal and postnatal depression symptoms, prenatal PTSD symptoms, and prenatal and postnatal relationship conflict; and lower prenatal and postnatal relationship support. Women in the Mom Wants More group also had significantly higher prenatal and postnatal depression symptoms and prenatal conflict; and lower prenatal support than women in the Dad Wants More group. Women who perceive themselves as wanting the pregnancy more than their baby’s father are at higher risk for mental health and relationship problems than women who perceive themselves and their partners as equally ambivalent. Providers should ask women about their perceptions of partners’ pregnancy wantedness to inform delivery of targeted mental health and relationship-based intervention during pregnancy.

PReCIS:: Micropulse cyclophotocoagulation (MPCP) lowered intraocular pressure (IOP) in the short-term but nearly half required additional intervention. Mydriasis was the most common complication (11%); 15% lost ≥3 Snellen lines of acuity; 11% had persistent complications at last follow-up. PURPOSE The purpose of this study was to evaluate the efficacy and complications of MPCP in a large series of patients with all stages of glaucoma. DESIGN Multicenter, retrospective chart review of patients from 3 clinical sites. PARTICIPANTS One hundred sixty-seven eyes of 143 patients. METHODS MPCP was performed with 2000 mW energy, 31.3% duty cycle and 2 to 4 180-degree applications of 80 seconds duration each per treatment. The procedure was considered a failure if any of the following occurred: additional IOP lowering intervention

The psychological consequences of traumatic events for caregivers and their children have been extensively studied, with the majority of literature considering maternal influences. We aimed to compare these associations across caregiver sex in order to provide deeper insight into paternal influences. The indirect association between caregiver exposure to traumatic events (# of types) and child symptomatology (posttraumatic stress symptoms [PTSS] and socioemotional problems) was considered via three pathways: (a) child exposure to traumatic events (# of types), (b) caregiver symptomatology (depressive symptoms and PTSS) and (c) caregiving stress. Participants were caregiver-child dyads referred to an outpatient hospital clinic for treatment of PTSS amongst children aged zero to five (N = 222, 28% male caregivers). Male caregivers reported lower scores on all variables (d= 0.32–0.67) despite there being no caregiver sex differences in number of events experienced by children. Multi-group path analysis revealed that relationships amongst study variables were similar for male and female caregivers, with the exception of caregiver stress and symptoms. There was no relationship between number of events experienced by caregivers and caregiver stress for males, β = −0.07 (SE = 0.08), p = 0.356, though there was for females, β = 0.15 (SE = 0.07), p= 0.021. Additionally, the relationship between number of events and symptomatology was weaker (though still significant) for male caregivers, β = 0.27 (SE = 0.09), p = 0.005, compared to females, β = 0.38 (SE = 0.06), p

The present study examined developmental antecedents of angels and ghosts in the nursery during the pregnancy and postnatal periods. Higher levels of benevolent childhood experiences (BCEs) were hypothesized to predict higher levels of angels in the nursery at both periods, whereas higher levels of adverse childhood experiences (ACEs) were expected to predict higher levels of ghost in the nursery at both periods. Participants were 101 low-income, ethnically diverse pregnant women (M = 29.10 years, SD = 6.56, range = 18–44; 37% Latina, 22% African American, 20% White, 13% biracial/multiracial, 8% other) planning to deliver at an urban general hospital. During their second or third trimester, they reported on ACEs, BCEs, and demographic information. During pregnancy and 3–4 months of postnatal, they completed the Angels in the Nursery Interview (Van Horn, Lieberman, & Harris, 2008), coded by trained raters for quality of loving memories with childhood caregivers (angel memories) and traumatic intrusions of childhood adversity (ghost memories). Results revealed moderate stability of angel and ghost memories across the perinatal period. Higher levels of BCEs directly predicted higher levels of angel memories during pregnancy, and indirectly predicted higher levels of angel memories during the postnatal period through angel memories during pregnancy. Higher levels of ACEs directly predicted higher levels of ghost memories during both periods. BCEs did not predict ghost memories and ACEs did not predict angel memories. Findings support independent pathways of risk and resilience through the pregnancy period with distinct origins in women’s childhood adversity versus positive childhood experiences. Implications for promoting intergenerational resilience by linking and leveraging BCEs and angel memories and recovering from ACEs and ghost memories are discussed.

The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe types of dissociation (depersonalization, derealization, gaps in awareness and memory, and dissociative reexperiencing) that would be relevant to a range of clinical populations, including those experiencing trauma-related dissociation. The current study used data from 10 ethnically and racially diverse clinical and community samples ( N = 3,879) to develop a brief version of the DSS (DSS-B). Item information curves were examined to identify items with the most precision in measuring above average levels of the latent trait within each subscale. Analyses revealed that the DSS-B preserved the factor structure and content domains of the full scale, and its scores had strong reliability and validity that were comparable to those of scores on the full measure. DSS-B scores showed high levels of measurement invariance across ethnoracial groups. Results indicate that DSS-B scores are reliable and valid in the populations studied.

Stereoselective photobromination of 1,6-anhydro-β-D-glucopyranose derivatives occurs at exo-H6. However, photobromination of 4-benzoyl-2,3-isopropylidene-1,6-anhydro-β-D-mannopyranose 6 produced un...

Romantic partner support from the father-to-be is associated with women’s mental health during pregnancy. However, most studies of partner support rely upon women’s responses to self-report questionnaires, which may be biased and should be corroborated by efficient, coder-rated measures of partner support. This study tested whether the Five-Minute Speech Sample (FMSS), adapted to assess expressed emotion about romantic partners, can provide information about partner support during pregnancy that is less prone to bias than self-report. Participants were 101 low-income, ethnically diverse pregnant women who completed self-report questions on partner support quality and the FMSS. Self-reported and coder-rated (FMSS) partner support were highly correlated and were each significantly associated with self-reported depressive and post-traumatic stress disorder (PTSD) symptoms, perceived stress, and partner victimization during pregnancy. Self-reported and coder-rated support corresponded in approximately 75% of cases; however, nearly 25% of women self-reported high support but received low FMSS support ratings. These women reported elevated PTSD symptoms, perceived stress, and victimization during pregnancy. While self-reported partner support may be valid for many respondents, the FMSS is less susceptible to reporting biases and may better identify women facing heightened psychopathology and stress during pregnancy, who would benefit from supportive intervention.

Caregivers’ ability to identify infant cues plays a crucial role in child development, enabling attuned and responsive caregiving that serves as the basis for secure attachment. At the same time, exposure to interpersonal violence (IPV) could alter mothers’ interpretations of social stimuli and interfere with normative parent-child interactional processes. The current study examined four interrelated hypotheses. The first two hypotheses test whether IPV-exposed mothers show bias toward fear or anger in interpreting infants’ facial expressions, and whether this bias is related to child symptoms. Our second set of hypotheses examines whether bias can be changed by Child-Parent Psychotherapy (CPP) and whether this change mediates treatment gains. 113 IPV-exposed mothers of 2 to 6 year old children completed the I FEEL picture task at baseline and again twelve months later. In the interim, 33 mothers were randomized into a treatment comparison group and the remainder received CPP. Analyses revealed that IPV-exposed mothers exhibit a perceptual bias toward fear, but not anger. Bias toward fear was linked to greater child internalizing symptoms while bias toward anger was linked to greater child externalizing symptoms. Participation in CPP resulted in decreased bias toward fearful faces. The treatment-related changes in mothers’ perceptions of children’s facial expression did not emerge as the mechanism by which CPP reduces children’s symptoms. These results suggest that exposure to IPV alters mothers’ ability to interpret infant facial expressions and that CPP is effective in reducing such biases.

This replication study examined protective effects of positive childhood memories with caregivers (“angels in the nursery”) against lifespan and intergenerational transmission of trauma. More positive, elaborated angel memories were hypothesized to buffer associations between mothers’ childhood maltreatment and their adulthood posttraumatic stress disorder (PTSD) and depression symptoms, comorbid psychopathology, and children's trauma exposure. Participants were 185 mothers (M age = 30.67 years, SD = 6.44, range = 17–46 years, 54.6% Latina, 17.8% White, 10.3% African American, 17.3% other; 24% Spanish speaking) and children (M age = 42.51 months; SD = 15.95, range = 3–72 months; 51.4% male). Mothers completed the Angels in the Nursery Interview (Van Horn, Lieberman, & Harris, 2008), and assessments of childhood maltreatment, adulthood psychopathology, children's trauma exposure, and demographics. Angel memories significantly moderated associations between maltreatment and PTSD (but not depression) symptoms, comorbid psychopathology, and children's trauma exposure. For mothers with less positive, elaborated angel memories, higher levels of maltreatment predicted higher levels of psychopathology and children's trauma exposure. For mothers with more positive, elaborated memories, however, predictive associations were not significant, reflecting protective effects. Furthermore, protective effects against children's trauma exposure were significant only for female children, suggesting that angel memories may specifically buffer against intergenerational trauma from mothers to daughters.

Early childhood is a developmental period characterized by significant plasticity, heterogeneity in behaviors and biological functioning. Yet, cumulative cortisol secretion, as measured by hair cortisol, has not been examined longitudinally in relation to change in behavioral problems in young children. The current study examined cross-sectional and longitudinal associations between hair cortisol and changes in behavior problems in a combined sample (N = 88) of two groups of young children from low-income families: 1) A trauma-exposed sample that participated in Child-Parent Psychotherapy (CPP) (n = 43; Mean Age = 4.31, SD = 1.16; 53% Female; 77% Hispanic), and 2) A community sample of children from families experiencing high stress (n = 45; Mean Age = 3.20, SD = 0.29; 67% Female; 58% Hispanic). Cortisol was assayed from hair collected from children at baseline and, on average, one year later. Mothers completed the Child Behavior Checklist at the same time hair samples were collected. Baseline hair cortisol in children was not associated with maternally-reported child behavioral problems at baseline and did not predict change in behavior problems over time. In contrast, increases in cortisol were associated with greater improvement in child behavior problems (b = -2.98, p 0.05), controlling for group status and relevant covariates. Subgroup analyses showed that cortisol change across one year significantly differed between the two groups (p = 0.043): on average, community children exhibited a decrease, whereas CPP children demonstrated no change. Hair cortisol concentration was similarly related to improvements in mother-reported behavior problems across both CPP and community groups over time. In summary, there were no cross-sectional associations with hair cortisol, whereas increases were associated with improved child well-being. Findings demonstrate an important link between this increasingly common biomarker and child health, but suggest that changes over time may be more informative than cross-sectional associations.

Inflammatory pathways predict antidepressant treatment non-response among individuals with major depression; yet, this phenomenon may have broader transdiagnostic and transtherapeutic relevance. Among trauma-exposed mothers (Mage = 32 years) and their young children (Mage = 4 years), we tested whether genomic and proteomic biomarkers of pro-inflammatory imbalance prospectively predicted treatment response (PTSD and depression) to an empirically-supported behavioral treatment. Forty-three mother-child dyads without chronic disease completed Child Parent Psychotherapy (CPP) for roughly 9 months. Maternal blood was drawn pre-treatment, CD14 + monocytes isolated, gene expression derived from RNA sequencing (n = 34; Illumina HiSeq 4000;TruSeqcDNA library), and serum assayed (n = 43) for C-Reactive Protein (CRP) and interleukin-1s (IL-1s). Symptoms of PTSD and depression decreased significantly from pre- to post-treatment for both mothers and children (all p's

Early childhood and pregnancy are two sensitive periods of heightened immune plasticity, when exposure to adversity may disproportionately increase health risks. However, we need deeper phenotyping to disentangle the impact of adversity during sensitive periods from that across the total lifespan. This study examined whether retrospective reports of adversity during childhood or pregnancy were associated with inflammatory imbalance, in an ethnically diverse cohort of 53 low-income women seeking family-based trauma treatment following exposure to interpersonal violence. Structured interviews assessed early life adversity (trauma exposure ≤ age 5), pregnancy adversity, and total lifetime adversity. Blood serum was assayed for pro-inflammatory (TNF-a, IL-1ß, IL-6, and CRP) and anti-inflammatory (IL-1RA, IL-4, and IL-10) cytokines. CD14+ monocytes were isolated in a subsample (n = 42) and gene expression assayed by RNA sequencing (Illumina HiSeq 4000; TruSeq cDNA library). The primary outcome was a macrophage-associated M1/M2 gene expression phenotype. To evaluate sensitivity and specificity, we contrasted M1/M2 gene expression with a second, clinically-validated macrophage-associated immunosuppressive phenotype (endotoxin tolerance) and with pro-inflammatory and anti-inflammatory cytokine levels. Adjusting for demographics, socioeconomic status, and psychopathology, higher adversity in early life (ß = .337, p = 0.029) and pregnancy (ß = .332, p = 0.032) were each associated with higher M1/M2 gene expression, whereas higher lifetime adversity (ß = −.341, p = 0.031) was associated with lower immunosuppressive gene expression. Adversity during sensitive periods was uniquely associated with M1/M2 imbalance, among low-income women with interpersonal violence exposure. Given that M1/M2 imbalance is found in sepsis, severe COVID-19 and myriad chronic diseases, these findings implicate novel immune mechanisms underlying the impact of adversity on health.

In recent years, research and practice on adverse childhood experiences (ACEs) have shifted from delineating effects of ACEs on adulthood health problems to preventing ACEs in children. Nonetheless, little attention has focused on how parents' own childhood experiences, adverse or positive, may influence the transmission of ACEs across generations. Children's risk for ACEs and potential for resilience may be linked to the early child-rearing experiences of their parents carried forward into parenting practices. Additionally, parents with multiple ACEs may have PTSD symptoms, an under-recognized mediator of risk in the intergenerational transmission of ACEs. Guided by developmental psychopathology and attachment theory with an emphasis on risk and resilience, we argue that a more comprehensive understanding of parents' childhood experiences is needed to inform prevention of ACEs in their children. Part I of this review applies risk and resilience concepts to pathways of intergenerational ACEs, highlighting parental PTSD symptoms as a key mediator, and promotive or protective processes that buffer children against intergenerational risk. Part II examines empirical findings indicating that parents' positive childhood experiences counteract intergenerational ACEs. Part III recommends clinically-sensitive screening of ACEs and positive childhood experiences in parents and children. Part IV addresses tertiary prevention strategies that mitigate intergenerational ACEs and promote positive parent-child relationships.

Prevention and amelioration of the myriad effects of toxic stress on child development is a significant public health concern. Scalable programmes to address this concern are lacking. Attachment Vi...

Background A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms. Methods A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex. Results Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly. Limitations Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter. Conclusions Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.

Five randomized controlled trials have shown that child-parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = -.13, p = .018, and hyperarousal, β = -.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, βrange = .15 to .33, and for those who participated in fewer treatment sessions, βrange = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = -.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics.

This pilot study provides the first empirical test of the concept of "Angels in the Nursery" by examining whether childhood memories of benevolent caregiving experiences protect against heightened levels of psychopathology in high-risk mothers. The study hypothesized that (a) elaborated childhood memories of feeling loved by a caregiver ("angel memories") would moderate adulthood posttraumatic stress disorder (PTSD) symptoms in mothers with childhood maltreatment histories, and (b) spontaneous traumatic intrusions ("ghost memories") would mediate childhood maltreatment and adulthood PTSD symptoms. Participants were 54 mothers (M = 32.79 years, SD = 8.91; 59.2% African American, 13.0% Caucasian, 5.6% Latina, 22.2% biracial/multiracial) who completed standardized assessments of childhood maltreatment and adulthood PTSD symptoms, and a novel instrument, the Angels in the Nursery Interview ("Angels Interview," Van Horn, Lieberman, & Harris, 2008). Results showed that angel memories significantly moderated childhood maltreatment and adulthood PTSD symptoms, consistent with a protective effect. Higher levels of ghost memories during the Angels Interview were significantly associated with more extensive childhood maltreatment, but did not mediate maltreatment and PTSD symptoms. Findings indicate that the Angels Interview can identify pathogenic intrusions rooted in childhood maltreatment and protective factors to promote maternal mental health and buffer the intergenerational transmission of trauma.

Exposure to domestic violence in the preschool years is consistently associated with children’s heightened risk for developing behavior problems. Maternal meta-emotion philosophy (awareness, acceptance, and coaching of children’s emotions) has been identified as an important protective factor in children’s development of internalizing and externalizing behaviors following exposure to domestic violence. However, mothers who are victims of domestic violence often experience symptoms of depression, anxiety, and post-traumatic stress, which may undermine their capacity to respond to their children’s negative emotions. The present study examines the protective role of maternal meta-emotion philosophy among mothers and preschool-aged children exposed to domestic violence. Participants were 95 mothers (mean age = 31.78) and their preschool-aged children (mean age = 4.11) who had witnessed domestic violence involving their mothers. Multiple regression analyses, controlling for family socioeconomic status and child exposure to interpersonal violence in the family, indicated that maternal symptomatology was positively associated with children’s internalizing problems. In addition, maternal awareness and coaching of children’s negative emotions was found to moderate relations between maternal symptomatology and children’s internalizing behaviors, and maternal awareness of children’s negative emotions was found to moderate relations between maternal symptomatology and children’s externalizing behaviors. These findings expand our understanding of maternal meta-emotion philosophy as a protective factor for preschoolers who have witnessed domestic violence.

The present study used a bioecological framework to examine associations between trauma exposure, trauma-related symptomatology, and executive function (EF) in an urban sample of 88 predominantly ethnic-minority, low-income preschoolers (age 2-5) exposed to interpersonal trauma. Contrary to hypotheses based on past literature documenting associations between trauma exposure and EF deficits in childhood, in regressions adjusting for child gender, family income, and caregiver education, neither trauma exposure or trauma-related symptoms (post-traumatic stress symptoms, internalizing behaviors, or externalizing behaviors) were significantly associated with children's EF performance. Associations between child trauma exposure, symptomatology, and executive function were not moderated by parental PTSD symptomatology; and EF was not differentially predicted by type of trauma. Results suggest that, within an ethnically-diverse sample of preschool-aged children exposed to multiple traumas, associations between trauma exposure, symptomatology, and EF may be particularly nuanced. Keywords: child trauma, posttraumatic stress, executive function, preschool-age children, child mental health.

Given the importance of early prevention and intervention strategies for children exposed to trauma, detection of early risk factors for exposure to traumatic events in childhood is critical. The present study examined associations between three known prenatal risk factors that characterize environmental instability in utero-prenatal substance exposure, prenatal violence victimization, and unintended pregnancy-and child exposure to interparental violence and other adverse experiences in a sample of 198 mother-child dyads (M child age = 44.48 months) referred to a hospital clinic for treatment following exposure to trauma. Prenatal substance and violence exposure were associated with child trauma exposure, and prenatal violence victimization was also associated with maternal severity ratings of traumatic exposures. Unintended pregnancy was not associated with child trauma exposure or severity. These findings expand our understanding of prenatal risk factors for trauma exposure in childhood and, specifically, highlight prenatal substance exposure and violence victimization as risk factors for subsequent exposure to trauma in early childhood. Results suggest that prenatal prevention and intervention programs should target reducing maternal substance use and in-utero exposure to violence.Dada la importancia de las estrategias de prevención e intervención tempranas para niños expuestos al trauma, el detectar los tempranos factores de riesgo en el caso de estar expuesto a eventos traumáticos en la niñez es crítico. El presente estudio examinó las asociaciones entre tres conocidos factores de riesgo prenatales que caracterizan la inestabilidad ambiental en el útero -el haber estado expuesto a sustancias prenatalmente, la victimización de la violencia prenatal, y el embarazo no intencional -y el que el niño esté expuesto a la violencia entre progenitores (IPV) y otras experiencias adversas en un grupo muestra de 198 díadas madre-niño (edad promedio del niño = 44.48 meses) que habían sido referidas a una clínica hospital para el tratamiento que seguía al haber estado expuestos al trauma. El haber estado expuesto a sustancia y violencia prenatal se asoció con el hecho de que el niño había estado expuesto a trauma, y la victimización de la violencia prenatal también se asoció con la severidad maternal de clasificación de la exposición traumática. El embarazo no intencional no se asoció con la exposición del niño al trauma o la severidad. Estos resultados amplían nuestra comprensión de los factores de riesgo prenatales en cuanto al haber estado expuesto al trauma en la niñez y, específicamente, subrayan el haber estado expuesto a sustancias prenatalmente y la victimización de la violencia como subsecuentes factores de riesgo para estar expuesto al trauma en la temprana niñez. Los resultados sugieren que los programas de prevención e intervención prenatales deber enfocarse en reducir el uso de sustancias por parte de la madre y el estar expuesto dentro del útero a la violencia.Vu l'importance des stratégies de prévention précoce et d'intervention pour les enfants exposés au trauma, la détection de facteurs de risque précoce pour l'exposition à des événements traumatiques s'avère critique. Cette étude a examiné les liens entre trois facteurs de risque prénatals connus qui caractérisent l'instabilité environnementale in utero - l'exposition prénatale à des substances toxiques, la victimisation liée à la violence prénatale, et la grossesse involontaire - ainsi que l'exposition à la violence conjugale et d'autres expériences adverses chez un échantillon de 198 dyades mère-enfant (moyenne d’âge de l'enfant = 44,48 mois) envoyées consulter en clinique hospitalière pour un traitement suivant une exposition à un trauma. L'exposition à la toxicomanie et l'exposition à la violence étaient liées à l'exposition de l'enfant au trauma et la victimisation liée à la violence prénatale était également liée à la sévérité des scores maternels d'expositions traumatiques. La grossesse involontaire n’était pas liée à l'exposition au trauma de l'enfant ou à la sévérité. Ces résultats élargissent notre compréhension des facteurs prénatals d'exposition au trauma dans l'enfance et mettent en lumière plus spécifiquement l'exposition à la toxicomanie prénatale et la victimisation liée à la violence en tant que facteurs de risque d'exposition ultérieure au trauma durant la petite enfance. Les résultats suggèrent que la prévention prénatale et les programmes d'intervention devraient cibler la réduction d'utilisation toxicomane maternelle et l'exposition à la violence in-utero.Zusammenhänge zwischen pränataler Drogen- bzw. Gewaltexposition, ungewollter Schwangerschaft und Traumatisierung in der Kindheit in einem klinischen Setting Angesichts der Bedeutung früher Präventions- und Interventionsstrategien bei traumatisierten Kindern, ist die Aufdeckung potenzieller Risikofaktoren für Traumatisierung entscheidend. Die vorliegende Studie überprüft Zusammenhänge zwischen drei bekannten, eine Umgebungsinstabilität in utero charakterisierenden, pränatalen Risikofaktoren (pränatale Drogen- bzw. Gewaltexposition und ungewollte Schwangerschaft) und kindlicher Belastung durch zwischenelterliche Gewalt (interparental violence; IPV) sowie anderen widrigen Erfahrungen. Die Stichprobe bestand aus 198 Mutter-Kind Dyaden (mittleres Alter der Kinder = 44.48 Monate), die sich aufgrund traumatischer Erfahrungen in Behandlung begeben haben. Pränatale Drogen- bzw. Gewaltexposition wiesen Zusammenhänge zu kindlicher Traumatisierung auf. Des Weiteren wies pränatale Gewaltexposition auch einen Zusammenhang zu den mütterlichen Ratings der Traumaschwere auf. Ungewollte Schwangerschaft war nicht mit kindlicher Traumatisierung oder Traumaschwere assoziiert. Diese Ergebnisse ermöglichen es uns, pränatale Risikofaktoren für kindliche Traumatisierung besser zu verstehen. Insbesondere werden pränatale Drogen- und Gewaltexposition als Risikofaktoren für eine darauffolgende Traumatisierung in der frühen Kindheit hervorgehoben. Die Ergebnisse legen nahe, dass pränatale Präventions- und Interventionsprogramme darauf abzielen sollten, mütterlichen Drogenkonsum und Gewalterfahrungen in utero zu minimieren.胎児期の薬物暴露・胎児期の暴力虐待・予期せぬ妊娠と、臨床現場における小児期のトラウマ暴露の関連 トラウマに曝された子どもへの早期予防と介入の方法の重要性を考えると、小児期にトラウマとなる出来事に暴露される初期の危険因子を検出することは必須である。本研究は、トラウマに曝され治療のために病院の外来に紹介された198 組の母子 (子どもの平均年齢 44.48 ヶ月) において、胎内の環境不安定性を特徴づける３つの既知の出生前リスク因子−胎児期の薬物暴露、胎児期の暴力虐待、予期せぬ妊娠―と、パートナー間の暴力 (IPV) やその他の逆境体験に子どもが曝されること、との関連性を検討した。胎児期の薬物と暴力への暴露は、子どものトラウマ暴露と関連し、胎児期の暴力虐待は母親のトラウマ暴露の深刻さの評価とも関連した。予期せぬ妊娠は子どものトラウマ暴露や深刻さに関連していなかった。これらの結果から小児期のトラウマ暴露に関連する胎児期のリスク因子への我々の理解が広まり、特に胎児期の薬物暴露と暴力虐待は早期小児期のトラウマ暴露に引き続くリスク因子であると強調する。出生前の予防と介入プログラムは、母親の薬物使用と胎児期に暴力に晒されることを減らすことをターゲットにすべきであると、この結果から提案する。.產前物質使用丶產前暴力受害丶意外懷孕和兒童創傷在臨床環境中的關係 鑑於經歷過創傷的兒童早期預防和干預策略的重要性, 檢測兒童受創事件的早期風險因素至關重要。本研究在受創傷後轉診到醫院診所接受治療的 198 個母親-兒童二元組樣本中 (平均兒童年齡 = 44.48 個月), 探討三種已知的產前風險因素 - 產前使用物質丶產前暴力受害丶及意外懷孕 - 做成的不穩定環境與兒童經歷過父母間暴力 (IPV) 和其他不良經歷的關聯。母親產前物質使用和暴力經歷與兒童創傷有關, 產前暴力受害也與母親創傷的評分相關。意外懷孕與兒童創傷或嚴重程度無關。這些研究結果擴展了我們對兒童創傷的產前風險因素的理解, 特別強調產前物質使用和暴力受害, 是隨後兒童早期創傷的風險因素。結果表明, 產前預防和干預計劃的目標, 應該是減少母體物質使用和產前暴力經歷。.العلاقة بين التعرض للمواد المخدرة قبل الولادة، وإيذاء العنف قبل الولادة، والحمل غير المقصود، والتعرض للصدمات النفسية في مرحلة الطفولة في سياق إكلينيكي بالنظر إلى أهمية استراتيجيات الوقاية والتدخل المبكرة للأطفال المعرضين للصدمات النفسية، فإن الكشف عن عوامل الخطر المبكرة للتعرض للأحداث الصادمة في مرحلة الطفولة أمر بالغ الأهمية. تناولت هذه الدراسة الارتباطات بين ثلاثة عوامل خطر معروفة قبل الولادة تميز عدم الاستقرار البيئي في التعرض للمواد داخل الرحم قبل الولادة، والإيذاء أثناء الولادة، والحمل غير المقصود - وتعرض الأطفال للعنف بين الوالدين وغيره من التجارب السلبية في عينة من 198 من ثنائيات الأم والطفل (متوسط عمر الطفل = 44.48 شهراً) الذين تم إحالتهم إلى عيادة لتلقي العلاج بعد التعرض للصدمات. وترتبط المواد السابقة للولادة والتعرض للعنف بالتعرض لصدمات الأطفال، كما يرتبط الإيذاء الناجم عن العنف قبل الولادة بتقديرات الأم بشدة الصدمات. ولا يرتبط الحمل غير المقصود بالتعرض لصدمات الأطفال أو شدتها. وتوسع هذه النتائج فهمنا لعوامل الخطر قبل الولادة للتعرض للصدمات في مرحلة الطفولة، وعلى وجه التحديد، تسليط الضوء على التعرض لمواد ما قبل الولادة والإيذاء الناجم عن العنف كعوامل خطر للتعرض اللاحق للصدمات في مرحلة الطفولة المبكرة. وتشير النتائج إلى أن برامج الوقاية والتدخل قبل الولادة ينبغي أن تستهدف الحد من تعاطي المواد أثناء الحمل والتعرض للعنف داخل الرحم.

Childhood adversity can have long-term deleterious effects on adulthood mental health outcomes, but more research is needed examining how type and timing of childhood adversity affect mental health specifically during pregnancy. The current study examined the effects of total adverse childhood experiences (ACEs) on depression and posttraumatic stress disorder (PTSD) symptoms during pregnancy, unpacked effects of total adversity into childhood maltreatment versus family dysfunction experiences, and assessed age of onset effects of child maltreatment-specific experiences. Participants were 101 low-income pregnant women (M = 29.10 years, SD = 6.56, range = 18-44; 37% Latina, 22% African American, 20% White, 13% biracial/multiracial, 8% other; 26% Spanish-speaking) who completed instruments on childhood adversity, PTSD and depression symptoms during pregnancy, and demographics. Results indicated that total ACEs predicted elevated PTSD and depression symptoms during pregnancy, as did maltreatment ACEs, but not family dysfunction ACEs. Early childhood onset of maltreatment significantly predicted elevated PTSD symptoms during pregnancy, whereas middle childhood and adolescent onset did not. No age of onset of maltreatment variable significantly predicted depression symptoms during pregnancy. Findings underscore the importance of differentiating between childhood maltreatment versus family dysfunction ACEs and examining the timing and accumulation of maltreatment experiences during childhood, because these factors affect mental health during pregnancy. Findings also support universal prenatal screening for PTSD symptoms to identify at-risk pregnant women who could benefit from interventions to disrupt the intergenerational transmission of risk and give families the healthiest possible beginning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Infant mental health is explicitly relational in its focus, and therefore a diagnostic classification system for early childhood disorders should include attention not only to within-the-child psychopathology but also between child and caregiver psychopathology. In this article, we begin by providing a review of previous efforts to introduce this approach that date back more than 30 years. Next, we introduce changes proposed in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-5 (ZERO TO THREE, in press). In a major change from previous attempts, the DC:0-5 includes an Axis I "Relationship Specific Disorder of Early Childhood." This disorder intends to capture disordered behavior that is limited to one caregiver relationship rather than cross contextually. An axial characterization is continued from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-3R (ZERO TO THREE, 2005), but two major changes are introduced. First, the DC:0-5 proposes to simplify ratings of relationship adaptation/maladaptation, and to expand what is rated so that in addition to characterizing the child's relationship with his or her primary caregiver, there also is a characterization of the network of family relationships in which the child develops. This includes coparenting relationships and the entire network of close relationships that impinge on the young child's development and adaptation.

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-5; ZERO TO THREE) is scheduled to be published in 2016. The articles in this section are selective reviews that have been undertaken as part of the process of refining and updating the nosology. They provide the rationales for new disorders, for disorders that had not been included previously in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R; ZERO TO THREE, 2005), and for changes in how certain types of disorders are conceptualized.

Intimate partner violence (IPV) victimization during pregnancy is a major public health concern, yet little is known about how risk factors for IPV during pregnancy may depend on whether women have histories of victimization dating back to early childhood (ages 0-5 years). This study examined whether risk factors for physical IPV victimization during pregnancy (a pregnancy that was not planned and prenatal substance use) differed for women with versus without early childhood victimization. Participants were 236 ethnically diverse, low-income biological mothers ( M = 30.94 years; 50.0% Latina, 16.9% Caucasian, 13.1% African American, and 16.9% multiracial) of children aged 0 to 6 years. Mothers were classified into four groups based on whether they had experienced early childhood victimization and physical IPV victimization during pregnancy with the target child. Multinomial logistic regressions, controlling for demographic characteristics, examined whether a pregnancy not planned and prenatal substance use predicted group membership. Compared to mothers with early victimization only, mothers with both early childhood victimization and physical IPV during pregnancy were more than 3 times as likely to report that their pregnancy with the target child was not planned. In follow-up analyses, mothers with early victimization and physical IPV during pregnancy also reported higher lifetime parity than mothers with physical IPV during pregnancy but no early victimization. Early childhood victimization may place women on a risk pathway to physical IPV during pregnancy, particularly if the pregnancy is not planned. Prevention and policy efforts should screen women for early childhood victimization to understand risks for physical IPV during pregnancy.

This study examined type and timing of childhood experiences – both adverse (ACEs; Felitti et al., 1998 ) and benevolent (BCEs, a novel index of childhood resources; Narayan, Rivera, Bernstein, Harris, & Lieberman, 2018 ) on several pregnancy-related outcomes. Participants were 101 low-income pregnant women (M = 29.10 years, SD = 6.56, range = 18–44; 37% Latina, 22% African-American, 20% White, 13% biracial/multiracial, 8% other) who completed the ACEs questionnaire for childhood maltreatment versus family dysfunction and the BCEs scale, including the ages when experiences occurred [i.e., 0–5 years (early childhood), 6–12 years (middle childhood), and 13–18 years (adolescence)]. They also reported on psychopathology symptoms, risky reproductive planning, stressful life events (SLEs), and demographics. Analyses supported type, rather than timing of experiences: specific experiences (i.e., maltreatment versus family dysfunction versus BCEs) predicted specific outcomes, regardless of the developmental period when they occurred. Specifically, maltreatment predicted PTSD symptoms, BCEs predicted risky reproductive planning, and family dysfunction and BCEs predicted SLEs. Experiences that began earlier were also more predictive than experiences that began later. Findings suggest that adverse versus benevolent childhood experiences are uniquely linked to adaptation during pregnancy and underscore the importance of also including BCEs in prenatal screening.

CPP is een op de relatie gebaseerde behandeling die focust op de ouder-kindinteractie en op de percepties die de betrokkenen van elkaar hebben, met bijzondere aandacht voor veiligheid en vertrouwen versus gevaar en angst als het belangrijkste intersubjectieve domein waarin ouder en kind gedurende de eerste jaren van het leven met elkaar omgaan. Het theoretische kader weerspiegelt een integratie van de perspectieven van de psychoanalyse, de gehechtheidstheorie en de ontwikkelingspsychopathologie.

Geen van deze zes modaliteiten is op zichzelf uniek voor CPP. De unieke waarde van CPP zit ’m in het geintegreerde gebruik van deze modaliteiten, die flexibel worden ingezet afhankelijk van de behoeften van het gezin. In die zin is CPP echt een multidisciplinaire aanpak, die elementen van maatschappelijk werk, geestelijke gezondheidszorg, onderwijs en pleitbezorging (advocacy) combineert.

Alle behandelingen op het gebied van de geestelijke gezondheidszorg hebben een aantal basisprincipes gemeen die van wezenlijk belang zijn voor hun effectiviteit. Een van die principes is een voorspelbaar en betrouwbaar schema van bijeenkomsten die gefocust zijn op de ervaring van de client. Een ander principe is gebruik van emotionele steun, warmte en empathie als wezenlijke extra aspecten van de therapeutische interventie.

Geweld binnen het huwelijk gaat vaak samen met een hoge frequentie van kindermishandeling, die kan worden gepleegd door beide ouders, of die nu samenwonen of niet. Het kan zijn dat de therapeut in het verloop van een sessie getuige is van kindermishandeling of dat het kind of de ouder tijdens een sessie een incident uit het verleden beschrijft dat gekwalificeerd zou kunnen worden als kindermishandeling.

De veiligheid van de therapeut is een belangrijke overweging bij het bepalen van de geschikte locatie voor de interventie. Wanneer er onzekerheid bestaat over de veiligheid van de buurt of de huiselijke omstandigheden, is het belangrijk om dit eerst met de ouder te bespreken voordat wordt vastgesteld of de sessies thuis kunnen plaatsvinden. Veel ouders zijn zich maar al te zeer bewust van het gevaar in hun directe omgeving en waarderen de eerlijkheid van de therapeut en zijn expliciete vertrouwen in de input van de ouder.

Op de beeindiging van een huwelijk of een samenwoonrelatie die te wijten is aan huiselijk geweld, volgen vaak een echtscheiding met veel conflicten en een bittere voogdijstrijd. Een veelvoorkomend scenario is dat de mishandelde vrouw bang is dat bezoek zonder toezicht of met overnachting bij de gewelddadige vader de veiligheid van het kind in gevaar brengt. De vader ontkent vaak dat er geweld heeft plaatsgevonden of dat dit zo ernstig was als de moeder dat afschildert, en vindt dat zijn ouderlijke rechten niet geschonden mogen worden. Aanklachten en tegenaanklachten van het in gevaar brengen van het kind en van loyaliteitsmisbruik kunnen leiden tot langdurige juridische geschillen, waarbij beide partijen proberen bewijs te verzamelen voor hun respectievelijke standpunt.

CPP is opgenomen als een evidencebased behandeling in de Substance Abuse and Mental Health Services Administration National Registry of Evidence-Based Programs and Practices (zie http://nrepp.samhsa.gov) op basis van vijf gerandomiseerde studies die elk voor CPP betere uitkomsten hebben gevonden in vergelijking met controlegroepen. Het wetenschappelijk bewijs wordt in dit hoofdstuk beschreven.

CPP kan in diverse settings worden uitgevoerd. De twee meest voorkomende settings zijn de therapeutische speelruimte en thuis, en beide hebben hun voordelen en beperkingen. Wanneer de behandeling wordt uitgevoerd in een therapeutische speelruimte fungeert de setting door haar voorspelbaarheid als een veilige afgesloten ruimte. Daarin kunnen de ouder en het kind zonder afleiding van buiten hun moeilijkheden zichtbaar laten worden en oefenen met adaptievere conflictoplossingsstrategieen. Aan de andere kant loop je het risico dat veel van de acute spanningen die van invloed zijn op de alledaagse ouder-kindrelatie in de therapeutische speelruimte onopgemerkt en onbehandeld blijven.

In de derde en laatste fase gaat het om het geleidelijk verminderen van de focus op de problemen en een toenemende focus op de positieve veranderingen die gerealiseerd zijn. Daarbij worden herinneringen opgehaald aan specifieke gezamenlijke belevenissen, wordt vergeleken hoe de dingen waren aan het begin van de behandeling en hoe het nu is, en wordt erkend dat de behandeling haar eind nadert. Gevoelens die samenhangen met verlies als gevolg van de beeindiging (boosheid, verdriet, spijt over onafgedane kwesties, dankbaarheid voor verbeteringen) worden aan de orde gesteld, en er wordt op gereflecteerd.

Alle psychotherapieen zouden ontwikkeling moeten beschouwen als een proces dat de hele levensduur omvat en waarbij het gaat om een beweging richting gezonde groei en om niet-gehaalde mijlpalen, verstoringen, belemmeringen en pathologische patronen. CPP incorporeert de conceptuele principes van de ontwikkelingspsychopathologie, een multidisciplinair veld dat een levensduurperspectief hanteert op het begrijpen van de vele processen die werkzaam zijn bij de oorsprong, de ontwikkeling en de consolidatie van psychopathologie. Ontwikkelingspsychopathologie integreert een verscheidenheid aan disciplines, waaronder ontwikkelings-, klinische, sociale en experimentele psychologie; psychiatrie; psychoanalyse; sociologie; culturele antropologie; embryologie; genetica; neurowetenschap; en epidemiologie.

Jonge kinderen zijn eindeloos spontaan. Ze zijn nooit authentieker en meer op hun gemak dan wanneer zij bepalen wat ze willen doen. Het opvolgen van instructies is een vaardigheid die ze met veel moeite verwerven. Deze ontwikkelingskenmerken zijn ingebouwd in de structuur van CPP. De behandeling berust niet op een programma van sessie tot sessie, maar maakt gebruik van de gelegenheden die het kind en de ouders bieden via hun spontane activiteiten en interacties van moment tot moment.