Faculty Bibliography

Background:Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. Methods:Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). Results:We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. Conclusion:These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.

Violence-related post-traumatic stress disorder (PTSD) in the context of war and terrorism has become an increasingly pressing public health issue relevant to refugee children and families. PTSD and related psychopathology in children can adversely affect all domains of development and, in particular, interfere with learning and socialization. When the experience of violent trauma and related loss is shared with the entire family, resulting impairment and distress may prevent caregivers from being psychologically available to process their traumatized children's emotional communication and otherwise meet their children's developmental needs. When children suffer from PTSD, it may be impossible to put their experience and related thoughts and feelings into words, let alone a coherent narrative. The latter difficulty can be even more pronounced when the child displays dissociative symptoms, possibly signaling a dissociative subtype of PTSD. Thus, the narrative within the child's play during psychotherapy becomes all the more important as an indicator of the child's internal world. This case report is an example both of evaluation and of psychotherapy that is both psychodynamic and trauma-informed with a 10-year-old Afghani boy who suffered the violent loss of his father at age of 3 years, leading to his immigration to Switzerland. This paper addresses the question of how the psychotherapist can accompany the child through the elaboration of his trauma and how the therapist can contribute to the co-construction of a coherent narrative of the child's experience and to the restoration of an intersubjective connection between the traumatized child and caregiver.

This article discusses empirical research findings that demonstrate psychobiological dysregulation among violently traumatized mothers of very young children and then describes what effects this dysregulation can have on the mother-infant relationship. Out of this research, the first author developed CAVES originally as an experimental evaluation technique and test-intervention. The theoretical premise, evidence-base, and signature features of the CAVES are described along with a case example showing how it quickly became the foundation for a new brief psychotherapeutic model for traumatized parents and their very young children ages 0 to 4, CAVEAT. The essentials of CAVEAT as a 16-session manualized treatment model are also presented with a case example as illustration. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Abstract (German) Dieser Artikel diskutiert empirische Forschungsergebnisse, die bei gewalt- sam traumatisierten Muttern von Kleinkindern eine psychobiologische Dysregulation nachweisen, und beschreibt deren Auswirkungen auf die Mutter-Kind-Beziehung. Aus dieser Forschung entwickelte der Erstautor die CAVES als experimentelle Evaluationstechnik und Test-Intervention. Die theoretischen Grundlagen, die Evidenzbasis und Hauptmerkmale der CAVES werden zusammen mit einem Fallbeispiel beschrieben, das zeigt, wie CAVES zu einem neuen Modell fur eine kurze Psychotherapie fur traumatisierte Eltern und ihre Kinder im Alter von 0 bis 4 wurde (CAVEAT). Das Behandlungsmodell der CAVEAT mit 16 Sitzungen, das auch als Manual besteht, wird anhand eines Fallbeispiels veranschaulicht (PsycInfo Database Record (c) 2022 APA, all rights reserved)

BACKGROUND:The pandemic caused by coronavirus disease 2019 (COVID-19) has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies, however, carry a significant risk for mental health, which can lead to increased short-term and long-term mortality and is currently not included in modeling the impact of the pandemic. METHODS:We used years of life lost (YLL) as the main outcome measure, applied to Switzerland as an example. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status, and social isolation, as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans. RESULTS:The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average of 9.79 YLL. CONCLUSIONS:The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.

Introduction/UNASSIGNED:The present study investigates the association of lifetime interpersonal violence (IPV) exposure, related posttraumatic stress disorder (IPV-PTSD), and appraisal of the degree of threat posed by facial avatars. Methods/UNASSIGNED:We recorded self-rated responses and high-density electroencephalography (HD-EEG) among women, 16 of whom with lifetime IPV-PTSD and 14 with no PTSD, during a face-evaluation task that displayed male face avatars varying in their degree of threat as rated along dimensions of dominance and trustworthiness. Results/UNASSIGNED:The study found a significant association between lifetime IPV exposure, under-estimation of dominance, and over-estimation of trustworthiness. Characterization of EEG microstates supported that lifetime IPV-PTSD modulates emotional appraisal, specifically in encoding and decoding processing associated with N170 and LPP evoked potentials. EEG source localization demonstrated an overactivation of the limbic system, in particular the parahippocampal gyrus, in response to non-threatening avatars. Additionally, dysfunctional involvement of attention-related processing anterior prefrontal cortex (aPFC) was found in response to relatively trustworthy avatars in IPV-PTSD individuals compared with non-PTSD controls. Discussion/UNASSIGNED:This study showed that IPV exposure and related PTSD modulate individuals' evaluation of facial characteristics suggesting threat. Atypical processing of these avatar characteristics was marked by group differences in brain regions linked to facial processing, emotion regulation, and memory.

Objectives: Toxic stress in young children, also known as adverse childhood experiences (ACEs), may lead to changes in their nervous system, affect their development, and influence their mental and physical health. Pediatricians and child and adolescent psychiatrists are uniquely positioned to help families in difficult situations to reduce the risk of recurring trauma. They are also in the best position to make accurate diagnoses and to design appropriate, multimodal treatment plans. This often can involve treatment of several family members, particularly because trauma is often transmitted intergenerationally and needs to be addressed accordingly. This Symposium will bring the audience up to date on work being conducted on ACEs in a number of areas. It will introduce participants to the latest research findings in the ACE literature on young children. It will focus on recent neurophysiological findings related to the transgenerational carryover of maternal ACEs. New information about the role of fathers in ACE research will be provided, and targeted interventions that may be used in primary care settings will be described.
Method(s): This Symposium will consist of 5 parts: 1) a presentation on ACEs and opportunities for intervention in Early Head Start (EHS) programs; 2) a review of transgenerational effects of maternal ACEs and their implications for future studies; 3) a review of the literature on the roles of fathers in ACE studies and paternal risk factors for child maltreatment; 4) a discussion of maternal ACEs, PTSD, and maternal attribution of child emotional comprehension; and 5) a brief summary discussion of the program as a whole followed by a question-and-answer session.
Result(s): Participants will learn that ACEs are associated with numerous chronic health problems in young children. They will be able to recognize that there are various screening methods that effectively assess for ACEs. At the end of the Symposium, participants will identify the importance of individual and systems-level approaches that can help promote resilience and counteract ACEs.
Conclusion(s): Screening and intervention for ACEs are feasible and should be part of most child and adolescent psychiatry and pediatrics' programs. This Symposium offers up-to-date information on the latest ACE-related research. STRESS, CAN, EC
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Objectives: This study investigated the following: 1) how maternal interpersonal violence (IPV)-PTSD and/or maternal exposure to violent events during childhood might affect children's capacities of emotion comprehension; and 2) how traumatized mothers perceive their own child's capacities for emotion comprehension.
Method(s): This longitudinal follow-up study of mothers and toddlers included 37 mothers exposed to IPV with PTSD and 26 mothers without PTSD. The study also included their school-age children (mean age = 7.1 years, SD = 1.2). Measures included the Test of Emotional Comprehension (TEC). The TEC investigates children's understanding of emotions ranging from basic comprehension (ie, external causes on emotions) to a deeper, more complex type of understanding (ie, mixed emotions, possibility of regulating emotions). Both children and mothers responded, with mothers asked to respond as they imagined their child would. Data analyses included Mann-Whitney U nonparametric group comparisons and logistic regression modeling.
Result(s): Mothers with IPV-PTSD compared with control subjects underestimated their children's capacities for emotional comprehension (U = 327.5, p < 0.05). When looking at specific maternal adverse childhood experiences (ACEs), physical abuse and exposure to family violence were associated with higher levels of maternal misattribution of child responses on the TEC after covarying for socioeconomic status and maternal depression (p < 0.01).
Conclusion(s): Mothers who have childhood exposure to physical abuse and family violence are more likely to make errors in emotional comprehension when asked to take their school-age child's perspective. Mothers suffering from related PTSD tend to underestimate their children's capacity for emotional comprehension. These findings will be contextualized in light of published findings from the toddler phase of this study and discussed in terms of their implications for intervention. AGG, PAT, CAN
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Parental Reflective Functioning is a parent's capacity to infer mental states in herself and her child. Parental Reflective Functioning is linked to the quality of parent-child attachment and promotes parent-child mutual emotion regulation. We examined neural correlates of parental reflective functioning and their relationship to physical abuse. Participants were mothers with (n = 26) and without (n = 22) history of childhood physical abuse. Parental reflective functioning was assessed by coding transcripts of maternal narrative responses on interviews. All mothers also underwent magnetic resonance imaging while watching video clips of children during mother-child separation and play. Parental reflective functioning was significantly lower among mothers with histories of childhood physical abuse. When mothers without history of childhood physical abuse watched scenes of separation versus play, brain activation was positively correlated with parental reflective functioning in the ventromedial prefrontal cortex, and negatively associated with the dorsolateral prefrontal cortex and insula. These associations were not present when limiting analyses to mothers reporting abuse histories. Regions subserving emotion regulation and empathy were associated with parental reflective functioning; yet these regions were not featured in maltreated mothers. These data suggest that childhood physical abuse exposure may alter the psychobiology that is linked to emotional comprehension and regulation.

The aim of this study was to examine the effects of maternal interpersonal violence-related posttraumatic disorder (IPV-PTSD) on child appraisal of emotion, as measured by high-density electroencephalography (HD-EEG) during an Emotional Face-matching Task (EFMT). We recorded HD-EEG in 47 children of mothers with and without IPV-PTSD during an Emotional Face-matching Task (EFMT). Mothers and children each performed the EFMT. Behavioral results demonstrated that both mothers who were directly exposed to violent events, and their children, presented attentional bias toward negative emotions when processing facial stimuli. EEG findings confirmed differences in emotion appraisal between children of IPV-PTSD mothers and non-PTSD controls at scalp-level and in terms of source localization upon which children of IPV-PTSD mothers demonstrated decreased activation of the right dorsolateral prefrontal cortex (dlPFC) in response to angry and fearful faces as compared to non-PTSD children with respect to the N170 component. Our study, to our knowledge, is the first to show that maternal IPV-PTSD significantly affects a mother's own and her child's neural activity in response to facial expressions of negative emotion. These findings are potentially important to the development and study of effective interventions to interrupt intergenerational cycles of violence and trauma.