An Examination of Post-Traumatic Stress Symptoms and Aggression Among Children with a History of Adverse Childhood Experiences

Childhood aggression is associated with many deleterious outcomes and is a common reason for psychiatric referral (Card and Little 2006; Gurnani, Ivanov, and Newcorn 2016). One factor associated with childhood aggression is Adverse Childhood Experiences (ACEs; Felitti et al. 1998). However, existing research remains equivocal on which characteristics of ACEs (e.g., cumulative impact, typology, etc.) are significantly elated to aggression, especially when considering differential effects of ACEs on proactive aggression (PA) and reactive aggression (RA; Dodge and Coie, 1987). Post-traumatic stress symptoms (PTSS) are a common negative sequalae of ACEs and are characterized by disruptions in several cognitive, emotional, and behavioral processes similar to those associated with both RA and PA (e.g., Marsee 2008). As such, the examination of PTSS as an underlying mechanism of influence on the relation between ACEs, PA, and RA is warranted. The present study fills several gaps in the literature by examining ACE characteristics that might be related to PTSS, PA, and RA while also examining direct and indirect effects on the relation between ACEs, PTSS and PA and RA. Results indicated the type of ACE, specifically child maltreatment ACEs (CM-ACEs), was most strongly related to all outcome variables. Therefore, CM-ACEs were included in a path analysis with PTSS, PA, and RA. Results indicated a significant indirect effect for PTSS on the relation between CM-ACEs and RA (β = .18, p \u3c .01) but not PA. Findings have several implications for future research and clinical practice, especially for children with an extensive history of CM-ACEs

Pathways from Child Maltreatment to Proactive and Reactive Aggression: The Role of Post-Traumatic Stress Symptom Clusters

Objective: Childhood aggression is related to a myriad of negative concurrent and long-term outcomes. To mitigate the risks associated with childhood aggression, it is important to understand risk factors that might predispose one to aggressive behaviors. One risk factor commonly associated with aggression is the experience of child maltreatment. A common outcome associated with child maltreatment is the development of post-traumatic stress symptoms (PTSS). Several prevailing theoretical models of both post-traumatic stress and aggression indicate that these constructs have similar underlying cognitive, behavioral, and emotional mechanisms. Therefore, the present study examined the relations between and among child maltreatment, PTSS clusters, and proactive and reactive aggression in children. Method: Children between the ages of 6 and 14 who were enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. These variables were included as multiple outcomes in a path analysis model in which individual PTSS clusters were examined as potential multiple mediators of the relations between child maltreatment and proactive and reactive aggression. Results: Direct effects of child maltreatment and PTSS clusters on aggression were observed. Significant indirect effects of the intrusion PTSS cluster on the relation between child maltreatment and reactive aggression was found. Conclusions: Findings suggest that symptoms associated with these specific PTSS clusters might help explain the relation between child maltreatment and reactive aggression and therefore present important implications for clinical practice and future research

The moderating effect of avoidant coping on restrained eaters’ risk for disinhibited eating: Implications for dietary relapse prevention

Avoidant coping style was tested as a moderating variable for the effect of ego threat on chronic dieters’ (restrained eaters) risk for disinhibited eating. Young women ( n=146) were randomly assigned to a speech threat or to a no threat condition and then participated in a bogus ice cream taste test. Analyses of covariance revealed that restrained eaters who scored higher on a standardized measure of avoidant coping consumed significantly more ice cream than restrained eaters who scored lower on avoidant coping regardless of the threat condition to which they were assigned. The findings suggest that dieters prone to using avoidant coping strategies may be particularly vulnerable to overeating and, therefore, could be at risk for lapses in dietary restraint. Hence, dietary relapse prevention programs might target dieters who tend to use avoidant coping strategies for cognitive-behavioral therapy to teach them adaptive coping skills

Correlates of Psychomotor Symptoms In Autism

Stereotypical behaviors are defined as repetitive motor or vocal responses that serve no obvious adaptive function. The current diagnostic classification system, the DSM-IV-TR, includes the presence of stereotypical behaviors of interest in its criteria for autism. Rescarch suggests that as many as 85% of children with autism exhibit relative behaviors or mannerisms. However, stereotypical behaviors are not specific to autism and are associated with other disorders such as Tourette\u27s syndrome, schlzophrenia, and mental retardation. Although the DSM-IV-TR criteria for stereotypical behaviors, as outlined in the diagnostic criteria for autistic disorder, focuses on motor symptoms that tend to occur in excess (e.g., twirling, spinning, head-banging), a broader conceptualization of the types of motor abnormalities observed in individuals with autism has been proposed more recently. Stereotyped patterns of behavior include not only excessive atypical movement but also the loss of typical movement (e.g., catatonia) in this broader definition. support for this definition is evidenced by both clinical observations and empirical research. Research examining the overlap between catatonia and other stereotypic behaviors among individuals with autism suggest that the greatest risk for catatonic behaviors occurs in adolescence and may be precipitated by stressful events. Assessment tools for autism often include some measure of stereotyped behaviors and interest, but the presence of stereotypy is not in and of itself a pathiognomonic sign of autism. Focusing primarily on the presence of classic stereotypical behaviors in diagnoses may subsequently lead to overidentifying autism in very young or mentally retarded individuals. A number of theories have been proposed over the years to explain the function and etiology of stereotypical behaviors. Lovaas and his colleagues, for example, proposed that the sensory and perceptual stimuli created through repetitive behaviors may be self stimulating. Others suggest that stereotypical behaviors are maintained by socially mediated positive and negative reinforcers; whereas biological theories focus on dysfunctions in the serotonin, opioid, and dopaminergic systems in the brain

Factor Analyses of the Pediatric Symptom Checklist-17 With African-American and Caucasian Pediatric Populations

Objectives To validate a three-factor model for the Pediatric Symptom Checklist-17 (PSC-17) and evaluate its diagnostic accuracy with African-American and Caucasian children with and without a chronic illness. Methods Mothers of 723 youth diagnosed with either type I diabetes (n = 210) or sickle cell disease (n = 191) and a nonill peer group (n = 322) completed a demographic questionnaire, the PSC-17, and the Child Behavior Checklist (CBCL). Results Confirmatory factor analyses and tests of measurement invariance validated a three-factor structure for the PSC-17 with African-American and Caucasian youth with and without a chronic illness. Receiver operating characteristic curves revealed optimal cut-off scores that are similar to published reports. Conclusions A three-factor solution was replicated for the PSC-17 with African-American and Caucasian children with and without a chronic illness. Cut-off scores for identifying children at risk for emotional/behavioral problems were evaluated using the CBCL as the gold standard and are discussed

Child Routines and Youths\u27 Adherence to Treatment for Type 1 Diabetes

Objective Type 1 diabetes (T1DM) is a chronic life-threatening disease that requires strict adherence to daily treatment tasks. Although necessary for survival, children who present with behavior problems tend to show problems complying with the treatment regimen, thereby increasing their risk for morbidity and premature mortality. The risk of poor treatment adherence is hypothesized to be lower for these children, however, if they engage in more routine behaviors. Given the potential clinical implications, this hypothesis and two theoretical models proposed to elucidate the underlying psychological process for the role of child routines in treatment adherence were evaluated empirically. The first model hypothesized that child routines protect (moderator variable) behaviorally problematic children from poor treatment adherence, whereas the alternative model hypothesized that child routines mediate the relation between childhood behavior problems and poor treatment adherence. Methods Parents of T1DM patients (N = 111) ranging from 6 to 16 years of age (M = 12 years) reported on their child\u27s behavior problems, routine behaviors, and adherence to treatment for T1DM using standardized measures. Baron and Kenny\u27s statistical procedures for testing moderation and mediation hypotheses were used to evaluate the proposed models. Results Regression analyses did not support the moderation hypothesis but did support the hypothesis that engaging in child routines mediates the relation between childhood behavior problems and poor treatment adherence. Conclusions Parents of behaviorally problematic children diagnosed with T1DM might be advised to instill routines in their child\u27s daily activities to increase the likelihood of treatment adherence, and thereby reduce the risk of morbidity and early mortality. Implications for clinical interventions are discussed

Pathways to Suicidal Behaviors in Childhood

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N = 87; M age = 9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the children\u27s suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed

Factor Analysis of the Pediatric Symptom Checklist With a Chronically Ill Pediatric Population

The psychometric properties and factor structure of a widely used screening measure for behavioral and emotional dysfunction, the Pediatric Symptom Checklist (PSC), was extended to a population of chronically ill children. Parents of 404 children ranging from 6 to 17 years of age and diagnosed with either insulin-dependent diabetes mellitus (IDDM) or sickle cell disease (SCD) completed the PSC while waiting for a routine medical appointment. The measure\u27s internal consistency was found to be high, Cronbach\u27s alpha = .89, and test-retest reliability across 4 months was observed to be acceptable, r = .77. A principal components analysis with an oblique (promax) rotation yielded a four-factor solution with factors that included items representative of internalizing, externalizing, attention, and chronic illness-related problems, respectively. Cronbach alpha estimates ranged from .78 to .83 for the first three factors but was lower for the chronic illness-related problems factor (Cronbach\u27s alpha = .60). A three-factor solution and reliability estimates were recomputed without the chronic illness items that yielded the same reliability estimates for each of the three factors and for the full scale. The three-factor solution was also found to be similar to a published factor structure obtained with a primary care sample, rc = .90-.91. The findings lend support to extending the PSC\u27s clinical utility to tertiary care pediatric settings. Further research is recommended with a broader range of chronic illness groups to increase generalizability

Nocturnal Enuresis and Psychosocial Problems In Pediatric Sickle Cell Disease and Sibling Controls

To evaluate current and lifetime prevalence rates of nocturnal enuresis and psychosocial problems among children with sickle cell disease (SCD) in comparison with sibling controls, a structured interview and the Pediatric Symptom Checklist were administered to primary caretakers regarding 126 of their children aged 5 to 17 with SCD and 47 sibling controls. Lifetime rates of enuresis among children with SCD were comparable to similar studies, and exceeded population prevalence and sibling control rates. In addition, enuretic children had higher levels of total psychosocial problems on the Pediatric Symptom Checklist regardless of group status, although patterns of subscale differences varied by group and enuresis history after controlling for child age. These findings replicate and extend previous findings and provide further evidence to support a need for monitoring of hydration levels and screening for psychosocial problems among children with SCD and enuresis, as well as evaluation of the psychometric properties of psychosocial screening measures and identification of efficacious treatments for enuresis in children with SCD