IN THE FACE OF ADVERSE CHILDHOOD EXPERIENCES (ACES) [Meeting Abstract]
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
22.2 MATERNAL ADVERSE CHILDHOOD EXPERIENCES, PTSD, AND MATERNAL ATTRIBUTION OF CHILD EMOTIONAL COMPREHENSION [Meeting Abstract]
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
Parental Reflective Functioning correlates to brain activation in response to video-stimuli of mother-child dyads: Links to maternal trauma history and PTSD
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 (nÂ =Â 26) and without (nÂ =Â 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.
EEG recording during an emotional face-matching task in children of mothers with interpersonal violence-related posttraumatic stress disorder
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.
And Then There Was Intersubjectivity: Addressing Child Self and Mutual Dysregulation During Traumatic PlayIn Memory of Louis Sander
This article asserts that a traumatized mother, to maintain her psychobiological homeostasis, must avoid intersubjective connection with a child who is seeking it to regulate his own distress. In this case, what Lou Sander described as a "moment of meeting" cannot take place (Sander, 1995, p. 590). Case examples are used to illustrate how, when all are together in the consulting room, the reflective, mutually regulating therapist can facilitate moments of meeting between therapist, a mother who has been subjected to interpersonal violence, and her child, who has similarly been traumatized. Furthermore, I show how the therapist, in the face of the child's traumatic reenactment in play that can further trigger and dysregulate the traumatized parent, can intervene to coconstruct meaning, for both the traumatized child and mother, obviating mother's need to avoid the child's distress and post-traumatic re-experiencing. This allows meeting to occur, reordering the implicit relational knowing of both mother and child.
Maternal reflective functioning, interpersonal violence-related posttraumatic stress disorder, and risk for psychopathology in early childhood
The aim of this study was to examine associations between maternal mentalization, interactive behavior, and child symptoms in families in which mothers suffer from interpersonal violence-related posttraumatic stress disorder (IPV-PTSD). Fifty-six mothers and children (aged 12-42Â months) including mothers with a diagnosis of IPV-PTSD were studied. Mentalization was measured by the Parental Reflective Functioning (PRF) Scale. Interactive behavior during free-play was measured via the CARE-Index. Child symptoms were measured by the Infant-Toddler Social and Emotional Assessment (ITSEA). Data analyses included non-parametric correlations and multiple linear regression. Results showed that lower IPV-PTSD and higher Maternal Reflective Functioning (MRF) were related to greater maternal sensitivity. Lower MRF and greater controlling behavior were related to child dysregulation. MRF was found to be lower in the subgroup of IPV-PTSD when the child's father was the perpetrator of IPV. Both MRF and interactive behavior are thus likely to be important targets for intervention during sensitive periods of early social-emotional development.
Intergenerational Transmission of DNA Methylation Signatures Associated with Early Life Stress
Early life stress in humans (i.e. maltreatment, violence exposure, loss of a loved one) and in rodents (i.e. disrupted attachment or nesting, electric shock, restraint, predator odor) occurs during critical steps of neural circuit formation. ELS in humans is associated with increased risk for developmental psychopathology, including anxious and depressive phenotypes. The biological mechanisms underlying these potentially persistent maladaptive changes involve long-term epigenetic modifications, which have been suggested to be potentially transmissible to subsequent generations. DNA methylation is an epigenetic mechanism that modifies gene expression patterns in response to environmental challenges and influences mutation rates. It remains to be seen whether a functionally relevant fraction of DNA methylation marks can escape genome-wide erasures that occur in primordial germ cells and after fertilization within the zygote. Early life-stress-triggered changes in epigenetic mediated transmission of acquired behavioral traits among humans have been assessed mainly by targeting genes involved in the hypothalamic-pituitary-adrenal (HPA) axis, such as NR3C1 and FKBP5. Recently, researchers examining epigenetic transmission have begun to apply genome-wide approaches. In humans, reduced representation bisulfite sequencing (RRBS) was performed on peripheral samples that were obtained from individuals who were prenatally exposed to the "Dutch Hunger Winter", resulting in two Differentially Methylated Regions (DMRs) in INSR and CPTIA genes that were functionally, biologically and technically validated, and significantly associated with birth weights and LDL cholesterol levels in offspring. In rodents, non-genomic intergenerational transmission of anxiety which was associated with differentially methylated enhancers that were putatively involved in lipid signaling and synaptic/neurotransmission in hippocampal granule cells, was discovered also using RRBS. Finally, transgenerational transmission of altered behaviors was associated with sperm-derived microRNAs produced by ELS male mice. The field of epigenetic transmission is just beginning to enter the epigenomic era by using genome-wide analyses. Such approaches remain of strong interest to human studies, first in order to help to assess the relevance of the previous targeted studies, and second to discover new important epigenetic modifications of potential clinical importance. New discoveries may help to assess how transmittable the negative impact of stress may be to offspring. The latter may open doors for future treatments and resilience-promoting interventions, as well as new approaches to treat the effects of childhood trauma before the onset of psychiatric disorder.
Developmental delay in communication among toddlers and its relationship to caregiving behavior among violence-exposed, posttraumatically stressed mothers
OBJECTIVES/OBJECTIVE:This study aimed to understand if maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) is associated with delayed language development among very young children ("toddlers"). METHODS:Data were collected from 61 mothers and toddlers (ages 12-42 months, mean ageâ€¯=â€¯25.6â€¯months SDâ€¯=â€¯8.70). Child expressive and receptive language development was assessed by the Ages and Stages Questionnaire (ASQ) communication subscale (ASQCS) that measures language acquisition. Observed maternal caregiving behavior was coded from videos of 10-min free-play interactions via the CARE-Index. Correlations, Mann-Whitney tests, and multiple linear regression were performed. RESULTS:There was no significant association between maternal IPV-PTSD severity and the ASQCS. Maternal IPV-PTSD severity was associated with continuous maternal behavior variables (i.e. sensitive and controlling behavior on the CARE-Index) across the entire sample and regardless of child gender. Maternal sensitivity was positively and significantly associated with the ASQCS. Controlling behavior was negatively and significantly associated with the ASQCS. CONCLUSIONS:Results are consistent with the literature that while maternal IPV-PTSD severity is not associated with child language delays, the quality of maternal interactive behavior is associated both with child language development and with maternal IPV-PTSD severity. Further study is needed to understand if the level of child language development contributes to intergenerational risk or resilience for relational violence and/or victimization.
The Association of Maternal Exposure to Domestic Violence During Childhood With Prenatal Attachment, Maternal-Fetal Heart Rate, and Infant Behavioral Regulation
Human and animal models suggest that maternal hormonal and physiological adaptations during pregnancy shape maternal brain functioning and behavior crucial for offspring care and survival. Less sensitive maternal behavior, often associated with psychobiological dysregulation and the offspring's behavioral and emotional disorders, has been observed in mothers who have experienced adverse childhood experiences. Strong evidence shows that children who are exposed to domestic violence (DV) are at risk of being abused or becoming abusive in adulthood. Yet little is known about the effect of childhood exposure to DV on the expecting mother, her subsequent caregiving behavior and related effects on her infant. Thus, the present study examined the association of maternal exposure to DV during childhood on prenatal maternal attachment, maternal heart rate reactivity to an infant-crying stimulus and post-natal infant emotional regulation. Thirty-three women with and without exposure to DV during childhood were recruited during the first trimester of pregnancy and followed until 6-month after birth. The Maternal Antenatal Attachment Scale (MAAS) was used to measure prenatal attachment of the mother to her fetus during the second trimester of pregnancy, maternal and fetal heart rate reactivity to an infant-crying stimulus was assessed at the third trimester of pregnancy, and the Infant Behavior Questionnaire-Revised (IBQ-R) was used to assess infant emotional regulation at 6-months. Results showed that pregnant women that were exposed to DV during childhood had a poorer quality of prenatal attachment of mother to fetus, regardless of whether they also experienced DV during adulthood. In addition, maternal exposure to DV during childhood was associated with increased maternal heart rate to infant-crying stimulus and worse infant emotional regulation. These findings highlight the importance of prenatal screening for maternal exposure to DV during childhood as a risk factor for disturbances in the development of maternal attachment, dysfunctional maternal behavior and emotion dysregulation.
The association of serotonin receptor 3A methylation with maternal violence exposure, neural activity, and child aggression
BACKGROUND: Methylation of the serotonin 3A receptor gene (HTR3A) has been linked to child maltreatment and adult psychopathology. The present study examined whether HTR3A methylation might be associated with mothers' lifetime exposure to interpersonal violence (IPV), IPV-related psychopathology, child disturbance of attachment, and maternal neural activity. METHODS: Number of maternal lifetime IPV exposures and measures of maternal psychopathology including posttraumatic stress disorder (PTSD), major depression and aggressive behavior (AgB), and a measure of child attachment disturbance known as "secure base distortion" (SBD) were assessed in a sample of 35 mothers and children aged 12-42 months. Brain fMRI activation was assessed in mothers using 30-s silent film excerpts depicting menacing adult male-female interactions versus prosocial and neutral interactions. Group and continuous analyses were performed to test for associations between clinical and fMRI variables with DNA methylation. RESULTS: Maternal IPV exposure-frequency was associated with maternal PTSD; and maternal IPV-PTSD was in turn associated with child SBD. Methylation status of several CpG sites in the HTR3A gene was associated with maternal IPV and IPV-PTSD severity, AgB and child SBD, in particular, self-endangering behavior. Methylation status at a specific CpG site (CpG2_III) was associated with decreased medial prefrontal cortical (mPFC) activity in response to film-stimuli of adult male-female interactions evocative of violence as compared to prosocial and neutral interactions. CONCLUSIONS: Methylation status of the HTR3A gene in mothers is linked to maternal IPV-related psychopathology, trauma-induced brain activation patterns, and child attachment disturbance in the form of SBD during a sensitive period in the development of self-regulation.