LONG-TERM CONSEQUENCES OF EARLY NEGLECT AND ABUSE

Introduction: Early neglect and abuse are a major societal problem, with negative consequences for the victim. There is clear evidence that early neglect and abuse are related to an increased prevalence of mental health problems. On the other hand there are children that show resilience towards negative influences in early childhood. In this paper I will describe results of empirical studies that reveal the negative consequences of adverse childhood experiences (ACE) as well as studies on resilience. Methods: Studies relevant for the topic are reviewed. Results: In many individuals adverse childhood experiences lead to impaired functioning of neural structures that increase the risk for later psychopathology and maldaptive functioning. However, according to one of the major principles of developmental psychopathology we see multifinality of outcome as some individuals show signs of resilience. Conclusion: Efforts to prevent adverse influences on children early in life are urgently needed to prevent long-lasting negative consequences that go along with subjective suffering and enormous societal costs. More research is needed to understand the mechanisms of vulnerability and resilience

LONG-TERM CONSEQUENCES OF EARLY NEGLECT AND ABUSE

Introduction: Early neglect and abuse are a major societal problem, with negative consequences for the victim. There is clear evidence that early neglect and abuse are related to an increased prevalence of mental health problems. On the other hand there are children that show resilience towards negative influences in early childhood. In this paper I will describe results of empirical studies that reveal the negative consequences of adverse childhood experiences (ACE) as well as studies on resilience. Methods: Studies relevant for the topic are reviewed. Results: In many individuals adverse childhood experiences lead to impaired functioning of neural structures that increase the risk for later psychopathology and maldaptive functioning. However, according to one of the major principles of developmental psychopathology we see multifinality of outcome as some individuals show signs of resilience. Conclusion: Efforts to prevent adverse influences on children early in life are urgently needed to prevent long-lasting negative consequences that go along with subjective suffering and enormous societal costs. More research is needed to understand the mechanisms of vulnerability and resilience

Identity development in adolescents with mental problems

Background: In the revision of the Diagnostic and Statistical Manual (DSM-5), "Identity" is an essential diagnostic criterion for personality disorders (self-related personality functioning) in the alternative approach to the diagnosis of personality disorders in Section III of DSM-5. Integrating a broad range of established identity concepts, AIDA (Assessment of Identity Development in Adolescence) is a new questionnaire to assess pathology-related identity development in healthy and disturbed adolescents aged 12 to 18 years. Aim of the present study is to investigate differences in identity development between adolescents with different psychiatric diagnoses. Methods: Participants were 86 adolescent psychiatric in- and outpatients aged 12 to 18 years. The test set includes the questionnaire AIDA and two semi-structured psychiatric interviews (SCID-II, K-DIPS). The patients were assigned to three diagnostic groups (personality disorders, internalizing disorders, externalizing disorders). Differences were analyzed by multivariate analysis of variance MANOVA. Results: In line with our hypotheses, patients with personality disorders showed the highest scores in all AIDA scales with T>70. Patients with externalizing disorders showed scores in an average range compared to population norms, while patients with internalizing disorders lay in between with scores around T=60. The AIDA total score was highly significant between the groups with a remarkable effect size of f= 0.44. Conclusion: Impairment of identity development differs between adolescent patients with different forms of mental disorders. The AIDA questionnaire is able to discriminate between these groups. This may help to improve assessment and treatment of adolescents with severe psychiatric problems

Assessment and Treatment of Identity Pathology During Adolescence

Personality disorders can be seen as patterns of maladaptive personality traits that have their onset during childhood or adolescence and that have an impact on the individual throughout the life span. Identity disturbance is seen as the central construct for detecting severe personality pathology—and, most notably, borderline personality disorder—in adults and adolescents. Therefore, in the revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the construct of “identity” has been integrated as a core diagnostic criterion for personality disorders. One of the most central tasks of normal adolescent development is the consolidation of identity. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning. By contrast, identity diffusion is viewed as a lack of integration of the concept of the self and significant others; it is also seen as the basis for subsequent personality pathology, including that of borderline personality disorder, which leads to a broad spectrum of maladaptive and dysfunctional behaviors. To measure identity pathology and its improvement with treatment, we developed a self-report questionnaire entitled Assessment of Identity Development in Adolescence to establish a reliable, valid, and time-efficient inventory to represent a dimensional concept of healthy and impaired personality development. The reliability of this self-report questionnaire is excellent, and the total score differentiated significantly between controls and patients with personality disorders. Adolescent Identity Treatment is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, behavior-oriented home plans, and family work support the therapeutic process of the adolescent

Early detection and intervention for borderline personality disorder in adolescence

Poremećaji ličnosti su obrasci maladaptivnih crta ličnosti koji svoj početak imaju u djetinjstvu ili adolescenciji i utječu na pojedinca tijekom cijelog života. Granični poremećaj ličnosti (GPL) je vrlo težak, ali izlječiv mentalni poremećaj. Iako GPL ima početak u adolescenciji i ranoj odrasloj dobi, dijagnoza se često postavlja kasno. U većini slučajeva specifični tretman se nudi kasno u tijeku poremećaja, a i to relativno malom broju pojedinaca. Unatoč znanstvenim dokazima za validnost dijagnoze poremećaja ličnosti u djetinjstvu i adolescenciji, dijagnosticiranje često ostaje tabu u ovim dobnim skupinama.Personality disorders are patterns of maladaptive personality traits that have their onset in childhood or adolescence and have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe but treatable mental disorder. Although BPD has its onset in adolescence and early adulthood, the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Despite the scientific evidence for the validity of personality disorders in childhood and adolescence, many clinicians remain reluctant to use the diagnosis in young people

Early detection and intervention for borderline personality disorder in adolescence

Poremećaji ličnosti su obrasci maladaptivnih crta ličnosti koji svoj početak imaju u djetinjstvu ili adolescenciji i utječu na pojedinca tijekom cijelog života. Granični poremećaj ličnosti (GPL) je vrlo težak, ali izlječiv mentalni poremećaj. Iako GPL ima početak u adolescenciji i ranoj odrasloj dobi, dijagnoza se često postavlja kasno. U većini slučajeva specifični tretman se nudi kasno u tijeku poremećaja, a i to relativno malom broju pojedinaca. Unatoč znanstvenim dokazima za validnost dijagnoze poremećaja ličnosti u djetinjstvu i adolescenciji, dijagnosticiranje često ostaje tabu u ovim dobnim skupinama.Personality disorders are patterns of maladaptive personality traits that have their onset in childhood or adolescence and have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe but treatable mental disorder. Although BPD has its onset in adolescence and early adulthood, the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Despite the scientific evidence for the validity of personality disorders in childhood and adolescence, many clinicians remain reluctant to use the diagnosis in young people

Impaired Personality Functioning in Children and Adolescents Assessed with the LoPF-Q 6-18 PR in Parent-Report and Convergence with Maladaptive Personality Traits and Personality Structure in School and Clinic Samples

To investigate if the Personality Disorder (PD) severity concept (Criterion A) of the ICD-11 and DSM-5 AMPD is applicable to children and adolescents, following the ICD-11 lifespan perspective of mental disorders, age-specific and informant-adapted assessment tools are needed. The LoPF-Q 6-18 PR (Levels of Personality Functioning Questionnaire Parent Rating) was developed to assess Impaired Personality Functioning (IPF) in children aged 6–18 in parent-reported form. It is based on the established self-report questionnaire LoPF-Q 12-18. Psychometric properties were investigated in a German-speaking clinical and school sample containing 599 subjects. The final 36-item version of LoPF-Q 6-18 PR showed good scale reliabilities with 0.96 for the total scale IPF and 0.90-0.87 for the domain scales Identity, Self-direction, Empathy, and Intimacy/Attachment and an acceptable model fit in a hierarchical CFA with CFI = 0.936, RMSEA = 0.078, and SRMR = 0.068. The total score discriminated significantly and with large effect sizes between the school population and (a) adolescent PD patients (d = 2.7 standard deviations) and (b) the younger patients (6–11-year-olds) with internalizing and externalizing disorders (d = 2.2 standard deviations). Informant agreement between parent and self-report was good at 0.47. Good construct validity can be assumed given sound covariation with related measures of psychopathology (CBCL 4-18, STiP-5.1, OPD-CA2-SQ PR) and maladaptive traits (PID5BF+ M CA IRF) in line with theory and matching the result patterns obtained in older samples in self-report. The results suggest that parent-reported assessments of IPF and maladaptive traits are equivalent to self-reported measures for Criterion A and B. Assessing IPF as early as age six might be a valuable step to foster early detection of PD, or maladaptive personality development, respectively individuals at risk

Supervised Speaker Diarization Using Random Forests: A Tool for Psychotherapy Process Research

Speaker diarization is the practice of determining who speaks when in audio recordings. Psychotherapy research often relies on labor intensive manual diarization. Unsupervised methods are available but yield higher error rates. We present a method for supervised speaker diarization based on random forests. It can be considered a compromise between commonly used labor-intensive manual coding and fully automated procedures. The method is validated using the EMRAI synthetic speech corpus and is made publicly available. It yields low diarization error rates (M: 5.61%, STD: 2.19). Supervised speaker diarization is a promising method for psychotherapy research and similar fields

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth

Despite high rates of adverse childhood experiences (ACEs) and personality-related distur bances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowl edge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or ju venile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime

Impaired Personality Functioning in Children and Adolescents Assessed with the LoPF-Q 6-18 PR in Parent-Report and Convergence with Maladaptive Personality Traits and Personality Structure in School and Clinic Samples

To investigate if the Personality Disorder (PD) severity concept (Criterion A) of the ICD-11 and DSM-5 AMPD is applicable to children and adolescents, following the ICD-11 lifespan perspective of mental disorders, age-specific and informant-adapted assessment tools are needed. The LoPF-Q 6-18 PR (Levels of Personality Functioning Questionnaire Parent Rating) was developed to assess Impaired Personality Functioning (IPF) in children aged 6–18 in parent-reported form. It is based on the established self-report questionnaire LoPF-Q 12-18. Psychometric properties were investigated in a German-speaking clinical and school sample containing 599 subjects. The final 36-item version of LoPF-Q 6-18 PR showed good scale reliabilities with 0.96 for the total scale IPF and 0.90-0.87 for the domain scales Identity, Self-direction, Empathy, and Intimacy/Attachment and an acceptable model fit in a hierarchical CFA with CFI = 0.936, RMSEA = 0.078, and SRMR = 0.068. The total score discriminated significantly and with large effect sizes between the school population and (a) adolescent PD patients (d = 2.7 standard deviations) and (b) the younger patients (6–11-year-olds) with internalizing and externalizing disorders (d = 2.2 standard deviations). Informant agreement between parent and self-report was good at 0.47. Good construct validity can be assumed given sound covariation with related measures of psychopathology (CBCL 4-18, STiP-5.1, OPD-CA2-SQ PR) and maladaptive traits (PID5BF+ M CA IRF) in line with theory and matching the result patterns obtained in older samples in self-report. The results suggest that parent-reported assessments of IPF and maladaptive traits are equivalent to self-reported measures for Criterion A and B. Assessing IPF as early as age six might be a valuable step to foster early detection of PD, or maladaptive personality development, respectively individuals at risk