Understanding the Impact of Childhood Maltreatment on Episstemic Trust, Learning and Psychopathology Throughout the Lifespan

Part 1presents a systematic literature review of 20 quantitative papers comparing maltreated and non-maltreated children’s performance on memory tasks involving varying degrees of interpersonal information. Findings suggest that children’s basic memory processes may be impaired when the to be remembered information contains more interpersonal content, however heterogeneity in terminology and methodology between studies impede the ability to draw firm conclusions. Part 2, which was part of a joint thesis project with MacGregor (2021), uses a novel retrospective measure of childhood maltreatment to explore the relationship between temporal characteristics of maltreatment subtypes and adult psychopathology symptomatology. The role of impaired social learning, as measured by a social learning task completed under one of four ostensive cue conditions, is also explored. Chronicity of maltreatment, and peer emotional bullying were identified as particular risk factors for adult psychopathology symptoms. Social learning was not found to mediate such associations. Part 3 provides a critical appraisal of the research process, considering the impact of completing this piece of work in the Covid-19 context, before moving on to consider the influence of previous personal clinical and research experience on the process. Implications of the research findings for future research, clinical practice, and my own career are considered

Understanding the cognitive and behavioural sequalae of child maltreatment

Background: Disinhibited Social Engagement Disorder (DSED) is a psychosocial disorder associated with child social neglect characterised by indiscriminate friendliness towards strangers. Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterised by impaired communication, fixed interests and repetitive behaviour. Problems with social relationships presenting in children with these diagnoses may appear superficially similar, yet there are differences in the quality of social interactions between groups which may be best identified via behavioural observation. Objective: This study examined the ability of an existing tool (The Waiting Room Observation Scale, WRO), designed to aid diagnosis of DSED, to differentiate between children with DSED symptoms and with ASD. Methods: Secondary analysis involving multinomial regression was conducted on existing data from typically developing children (n = 158), children with DSED symptoms (n = 59) and children with ASD (n = 16). Suggested improvements to the WRO were identified via qualitative behavioural observations of typically developing children (n =7), children with symptoms of DSED (n = 5), and children with diagnoses of ASD (n = 6) in an unfamiliar setting. Results: Behavioural observations demonstrated that while children with symptoms of DSED showed interest in strangers, children with ASD only interacted with strangers for specific reasons, e.g. to talk about their special interest or to reach for a toy. This difference was reflected in the analysis of the WRO: a lack of shyness with strangers was one of only two items that predicted DSED symptoms but not ASD group membership. Conclusions: Adding descriptive details outlining key differences between children presenting with ASD and with symptoms of DSED to specific WRO items could help clinicians to reflect upon these differences when formulating a child’s difficulties with social relationships or considering differential diagnosis

An Examination of Variations of Verbal Memory Performance in a Population of Children who have been Maltreated

This research examined the consequences of maltreatment on children's verbal memory, as measured by the California Verbal Learning Test (CVLT-C). The data were collected through an NIMH funded study at Duke University titled Life Events & Childhood Brain Development (funded under the title PTSD & Childhood Sexual Abuse: Psychobiology, Principal Investigator: Michael De Bellis). The analytic sample for this study consisted of 96 children who served as controls, and 91 children who had been maltreated. This study addressed the following research questions: 1) Do children who have been maltreated differ significantly from a control group on an overall measure of verbal memory performance? 2) Do children who have been maltreated differ significantly from a control group across five verbal memory factors? 3) Within the group of children who have been maltreated, are the total numbers of PTSD symptoms manifested predictive of variation in performance across the five verbal memory factors? 4) Within the group of children who have been maltreated, is the diagnostic status of PTSD predictive of variation in performance across the five verbal memory factors? Structural equation modeling was used to analyze these questions. Covariates such as attention, intelligence, race, gender, age, socioeconomic status, and type of maltreatment were included as predictors in the models.Doctor of Philosoph

Association of Early Life Stressors with Deficits in Child and Adolescent Cognitive Functioning

The purpose of this study was to determine whether the ACEs questionnaire could be a viable screener tool for identifying children in need of neuropsychological testing. This study consisted of a sample of child participants aged 8-17 years (N=53) who were divided into a no ACEs group or the ACEs group (1 or more ACEs) depending on parental responses to the ACEs questionnaire. Participants completed a series of virtual neuropsychological tests that assessed overall neurocognitive functioning, memory, and attention. No significant differences between the no ACEs group and the ACEs group in performance of the overall Neurocognitive Index, Composite Memory Index, or Complex Attention Index emerged. While no significant differences were found in this study, the demographic make-up of the sample could in part explain the absence of significant findings. The sample for this study included highly educated parents who resided in a higher SES bracket. These and other limitations are discussed. While this study did have limitations, several future directions were identified that would strengthen this area of research

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early.

open5noParental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents’ addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.openParolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P.Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P

A mechanistic investigation of neuro-cognitive and experiential factors associated with psychiatric vulnerability following childhood maltreatment

Childhood maltreatment is one of the most potent predictors of future psychopathology. While progress has been made in documenting a number of cognitive and neurobiological mechanisms that might underpin this association, investigations to date have focused on a limited number of domains. The primary aim of this thesis was, therefore, to advance and extend our understanding of the neurocognitive domains that may contribute to increased psychiatric vulnerability following childhood maltreatment. In the first empirical chapter (Chapter Two), using a model-based fMRI analytic approach and a probabilistic passive-avoidance task, we showed that childhood maltreatment is associated with recalibrations in the neurocomputational processes that underlie reinforcement-based decision-making. These are expected-value representation and prediction-error signalling to reward and punishment cues. In Chapter Three we showed that altered brain responses to threat (in the form of heighted amygdala reactivity) and an increased propensity to experience stressful life events predict future internalising symptoms among individuals with a history of maltreatment. In Chapter Four we found that experiencing maltreatment during childhood is associated with difficulties in imagining specific and detailed possible future scenarios (‘Overgeneral Episodic Future Thinking’). In Chapter Five, a history of maltreatment was linked to deficits in interpersonal problem solving skills – this, in turn, contributed to the association between maltreatment and poor mental health. The findings of this thesis increase our understanding of how childhood maltreatment impacts neurobiological, cognitive and social functioning in ways that may potentiate subsequent risk of psychopathology. In the longer term, it is hoped that these findings will contribute to the development of screening tools and novel preventative clinical approaches that could foster a resilient outcome for those maltreated individuals at greatest psychiatric vulnerability

Neuropsychiatric profile of a cohort of perinatally infected HIV positive children after one year of antiretroviral medication

Includes abstract.Includes bibliographical references.The Highly Active Antiretroviral Therapy (HAART) era in the mid-nineties signalled a dramatic change in the long-term outcome of Human Immunodeficiency Virus (HIV). Many children have shown significant neurologic benefit, and in particular, a decline in the incidence of HIV encephalopathy. As increasing numbers of children have survived into adolescence and early adulthood new challenges have arisen, such as the detection and characterization of milder forms of HIV-associated neurocognitive deficits in children previously thought to be asymptomatic..

Therapeutic interventions employed when working with maltreated children

A number of effective treatments are available for children and young people who have developed various forms of psychological difficulties as a consequence of traumatic experiences. The aim of this paper is to review the therapeutic approaches employed when working with children who have been exposed to various forms of abuse and neglect during their childhood. This paper provides relevant information to psychotherapists and counsellors on new trends in therapy, as well as techniques and possibilities in interventions in this field, not only with respect to traumatised children, but also family members and other caregivers involved in the child’s life. Furthermore, this paper reviews the therapeutic interventions used to treat emotionally, sexually, and physically abused children, neglected children, children who have witnessed domestic violence, and children who have been exposed to multiple forms of abuse

Reward Processing and High-Risk Behaviour in Adolescents with a History of Childhood Abuse

Funding for this study was provided by a Young Investigator Award from the Brain and Behaviour Research Foundation (NARSAD – Grant Number: 18774) awarded to Pia Pechtel. Pia Pechtel reports no biomedical financial interests or potential conflicts of interest.Systematic Literature Review: Abstract Objective: Childhood abuse (CA) is commonly associated with increased frequency of high-risk behaviours (HRB) in adolescence. Similarly, research has highlighted links between CA and blunted responses to reward. To date, little attention has been devoted to examine if altered reward processes may also be linked to increased engagement in HRB. To explore this hypothesis, this systematic review collated research that investigated the relationship among CA, reward processes and HRB. Specifically, the review addressed the question: Are HRB associated with altered reward processes in children and adults with a history of CA? Method: Behavioural and neurobiological studies on CA, reward processing and HRB in children and adults were selected from multidisciplinary and subject-specific databases published prior to the 1st of March 2016. The systematic literature search yielded 271 records with 198 non-duplicated results. Screening of 14 full-text publications led to five eligible studies synthesized in this review. Results: Results confirmed impaired reward learning and increased HRB in those with a history of CA. Associations of blunted anticipatory or consummatory reward processing and HRB in individuals with CA remained inconclusive. Conclusions: Reward learning appears to be associated with CA. Further research is required to explore the relationship between reward processes and HRB. Understanding CA from a neurodevelopment perspective is a critical step to developing effective intervention strategies to reduce HRB. Empirical Paper: Abstract Objective: Following childhood abuse (CA), adolescence often sees the onset of depression and high-risk behaviour (HRB). Despite the prevalence, little is known about underlying neurobiological factors linking CA and HRB. To address this gap, I examined if anticipatory and consummatory reward processing in adolescents with CA predict frequency of HRB, irrespective of depressive symptoms. Methods: Thirty-seven adolescents (M=17.08 years; SD = 1.86) participated in the study: 13 females with CA and current major depressive disorder (MDD), eight females with MDD and no CA, and 16 individuals with no CA and no MDD for comparison (control group). Adolescents completed the Card-Guessing paradigm to assess reward processing, while undergoing a magnetic resonance imaging scan. Neural region-of-interest responses in the striatum and pallidum were assessed during anticipatory and consummatory reward phases. Hierarchical regression models investigated if neural responses to reward were altered based on exposure to CA and if altered neural responses predicted higher use of HRB. Results: Data showed that (1) depressed adolescents engaged more frequently in HRB irrespective of history of CA, (2) anticipatory and consummatory reward processes were not altered based on a history of CA, and (3) blunted activation in right pallidum in anticipation of rewards predicted HRB irrespective of depressive symptoms. Conclusion: Although the current study did not confirm changes in reward processing following CA, blunted reward ‘wanting’ was linked to more frequent HRB. Findings are relevant to theories highlighting the critical role of the pallidum in perceiving cues as rewarding and in initiating goal-directed actions to obtain rewards.Young Investigator Award from the Brain and Behaviour Research Foundation (NARSAD

Developmental Aspects of Schizotypy and Suspiciousness: a Review.

PURPOSE OF THE REVIEW: This review identifies the early developmental processes that contribute to schizotypy and suspiciousness in adolescence and adulthood. It includes the most recent literature on these phenomena in childhood. RECENT FINDINGS: The early developmental processes that affect schizotypy and paranoia in later life are complex. In contrast to existing studies of psychiatric patients and clinical/nonclinical adult populations, the study of schizotypy and suspiciousness in young children and adolescents is possible due to new child-appropriate dimensional assessments. New assessments and the advancement of technology (e.g., virtual reality in mental health) as well as statistical modeling (e.g., mediation and latent-class analyses) in large data have helped identified the developmental aspects (e.g., psychosocial, neurocognitive and brain factors, nutrition, and childhood correlates) that predict schizotypy and suspiciousness in later life. SUMMARY: Prospective longitudinal designs in community youths can enhance our understanding of the etiology of schizophrenia-spectrum disorders and, in the future, the development of preventive interventions by extending adult theories and interventions to younger populations.Betty Behrens Research Fellowship, Clare Hall, University of Cambridg