Faculty Bibliography

This article focuses on the relational and developmental aspects of young children's post-traumatic stress reactions to specific events such a terrorists attacks, car accidents, or single traumatic medical interventions.

This article considers the phenomenon of intergenerational transmission of trauma during the first years of life with particular attention to interpersonal violent trauma. A review of the literature is followed by a detailed case report of a violence-exposed mother and her initially 14-month-old daughter. This case report takes the reader from baseline assessment through multimodal treatment of the family and provides follow-up into the child's sixth year of life. Maternal communication of trauma-associated affect and memory traces via action and language in day-to-day interactions is discussed, along with a hypothetical mechanism to account for distorted maternal perception and disorganizing interactive behavior in the wake of violent trauma. © 2004 The Analytic Press, Inc.

UNLABELLED: To understand the determinants of frightening/frightened and other atypical maternal behavior, the authors studied a sample of 41 inner-city mothers of very young children (ages 8-50 months), the mothers of whom had lifetime histories of interpersonal violent trauma (i.e., physical or sexual abuse, and domestic violence) and related posttraumatic stress. METHOD: The authors measured (1) maternal salivary cortisol levels before and 30 minutes after a videotaped play paradigm with their children, involving two separations and reunions; and (2) cortisol reactivity 30 minutes after separation stress. Data were analyzed using Pearson bivariate correlations, ANOVA, and multiple linear regressions. RESULTS: Salivary cortisol "baseline" values were significantly negatively correlated with childhood interpersonal violent trauma severity (i.e., trauma severity prior to age 16). However, cortisol reactivity was not significantly correlated with interpersonal violent trauma severity at this level of analysis. Although baseline salivary cortisol values were not significantly correlated with current overall psychiatric or depressive symptoms, they were negatively correlated with severity of current posttraumatic stress symptoms (PTSS) and with dissociative symptoms. Neither dimensions of negativity nor distortion of maternal attributions showed any significant association with prestress or poststress salivary cortisol levels. Salivary cortisol baseline was negatively correlated with atypical maternal behavior via measurement of the level of disrupted communication, at a trend-level of significance. CONCLUSIONS: Violent trauma-associated dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may be a marker for increased risk for intergenerational transmission via parenting behavior with young children. Low salivary cortisol prior to separation stress and blunted cortisol reactivity to separation may also be markers for posttraumatic stress.

This case-study presents in detail the clinical assessment of a 29-year-old mother and her daughter who first presented to infant mental health specialists at age 16-months, with a hospital record suggesting the presence of a dyadic disturbance since age 8-months. Data from psychiatric and neurological assessments, as well as observational measures of child and mother are reviewed with attention to issues of disturbed attachment, intergenerational trauma, and cultural factors for this inner-city Latino dyad. Severe maternal affect dysregulation in the wake of chronic, early-onset violent-trauma exposure manifested as psychogenic seizures, referred to in the mother's native Spanish as "ataques de nervios," the latter, an idiom of distress, commonly associated with childhood trauma and dissociation. We explore the mechanisms by which the mothers' reexperiencing of violent traumatic experience, together with physiologic hyperarousal and associated negative affects, are communicated to the very young child and the clinician-observer via action and language from moment to moment during the assessment process. The paper concludes with a discussion of diagnostic and treatment implications by Drs. Marshall, Gaensbauer, and Zeanah.

In a pilot study, the authors examine features of mothers' relationships to their mothers, spouses, and daughters associated with their daughters' male-perpetrated child sexual abuse. Fifteen inner-city Latino mothers and daughters (ages 1-9 years), referred by child protective agencies for highly suspect or confirmed child sexual abuse, were compared to 20 matched control dyads. Significantly more case mothers than controls reported relational disturbances intergenerationally, including hostility toward their daughters. Mother-daughter relationships should be thoroughly assessed when evaluating a child for child sexual abuse.

OBJECTIVE: Ataque de nervios is a common, self-labeled Hispanic folk diagnosis. It typically describes episodic, dramatic outbursts of negative emotion in response to a stressor, sometimes involving destructive behavior. Dissociation and affective dysregulation during such episodes suggested a link to childhood trauma. We therefore assessed psychiatric diagnoses, history of ataque, and childhood trauma in treatment-seeking Hispanic outpatients (N = 70). Significantly more subjects with an anxiety or affective disorder plus ataque reported a history of physical abuse, sexual abuse, and/or or a substance-abusing caretaker than those with psychiatric disorder but no ataque. In some Hispanic individuals, ataque may represent a culturally sanctioned expression of extreme affect dysregulation associated with childhood trauma. Patients with ataque de nervios should receive a thorough traumatic history assessment.