1
Psychological and Neurological
Consequences of Child Abuse
Summary of the Literature
Child Maltreatment and Risk for Psychopathology in Childhood
and Adulthood
- S.R. Jaffee, 2017
Epidemiology of Abuse and Neglect
- in 2014, approximately 3.9 million children were investigated for allegations of abuse or neglect
- 20% of these investigations were substantiated = 702 000 children nationally/9.4 per 1000 children
in population
- Review focuses on relationship between childhood maltreatment and mental health in childhood
and adulthood
- Maltreatment:
- Neglect = failure to meet children’ basic physical needs with respect to clothing, hygiene, food and
safety
- Emotional, sexual and physical abuse
- physical abuse = harm by caregiver or someone responsible for child resulting in non-accidental
physical injury
- 17% of victims are victims of physical abuse
- 8% victim of sexual abuse and 6% victims of psychological maltreatment , 6.8% victims of other
forms
- Children younger than 3 more likely to be victimised
- Boys and girls equally likely, African American children most likely
- Predictors: family poverty, young motherhood, parental history of antisocial behavior and
perpetrator’s history of maltreatment
Measuring Maltreatment
- childhood maltreatment is typically measured by retrospective self-report
- Biased by current mental state
- Subject to omission
- experiences in adulthood also biased retrospective reports
- Childhood history of maltreatment is actually poor predictor of who will abuse drugs as adult
- This review: focus on prospective, longitudinal studies in which maltreatment was measured in
childhood, informant reports
Maltreatment and Risk for Psychopathology
- whether maltreated children and adults are at elevated risk for psychopathology
- Studies that:
- Have prospective research design
- Demographically matched control sample or statistical adjustments
- Psychometrically valid measures
Maltreatment and Risk for Internalising and Externalising Psychopathology
- victims of maltreatment are at elevated risk for many externalising problems: ADHD, conduct
disorder, oppositional de iant disorder, delinquency, antisocial behavior and some studies but some
not indicate higher symptoms of substance abuse
- In adolescence, childhood and extent into adulthood
- adulthood:
- higher rates of antisocial personality disorder
- Self reported crime and criminal arrest
- Mixed results on drug and alcohol use
- also at risk for many internalising problems in childhood:
f
, 2
- Major Depressive disorder
- Anxiety disorders
- PTSD
- Symptoms of trauma
- Internalising symptoms
- Adulthood:
- MDD
- Anxiety disorders
- 59% of depression and anxiety cases worldwide are attributable to childhood maltreatment
- PTSD and its symptoms
- Via two pathways: maltreatment increases mental disorders and maltreatment sensitises the
neurobiological response to subsequent trauma
Maltreatment and Risk for Personality Disorders, Psychotic Symptoms and Suicide
- as adults, at risk for borderline personality disorder
- Also risk for Cluster B (dramatic) and Cluster c (anxious) personality disorders
- Elevated risk for suicide in childhood and adulthood
- Also self-injury elevated
- Elevated rates of psychotic symptoms in adolescence
- Elevated risks for psychotic disorder, schizoaffective disorder or schizophrenia
Causal Status Of Effects
- being neglected or abused as a child could cause victims to develop mental disorders that emerge in
childhood or adulthood
- Alternatively, history of maltreatment could be accounted for by genetic or non-genetic factors
associated with maltreatment
- Research designs that are best suited to choose between genetic and non-genetic explanations are
particularly ill-suited to the study of maltreatment
- Adoption design: social workers screen out adoptive parents likely to perpetrate and thus rates
are low
- Twin design: exposed to same risks factor etc. but rare that one twin is mistreated and the other
is not
- research designs that match maltreated children with sociodemographically similar youth may
therefore be the most feasible way of estimating unique effects of maltreatment on psychopathology
- One study showed: maltreated youth had signi icantly more depressive symptoms and suicidal
thoughts, substance use problems and criminal behaviors
- Socioeconomic disadvantage itself is associated with high rates of emotional and behavioral health
problems, poor life course outcomes and risk for maltreatment perpetration
Intergenerational Transmission of Maltreatment
- cycle of violence hypothesis
- Proposes that adults who experienced abuse/neglect in childhood are at risk of maltreating their
own children
- Dif icult to study
- best-designed studies of the cycle: of icial records of maltreatment are available in both generations
and also self-reports
- Odds of an individual being reported to child protective services because their child was maltreated
were twice as great for parents who had documented childhood histories of victimisation
- On basis of self-report, rates were equal
- Overrepresentation of parents with histories of abuse -> detection bias
- Cycle of violence is not inevitable -> buffered by safe and nurturing relationships
- Child protective services has bias to investigate and substantiative cases of abuse or neglect when
they know the parent has a history of maltreatment
Mediators of Maltreatment Effects
- multiple potential mechanisms by which maltreatment increases risk
- 3 phenomena have been robustly associated with maltreatment:
- Hyper-vigilance to threat
- De icits in emotion recognition
- Insensitivity to rewards
Hyper-vigilance to Threat
f f f
, 3
- attention bias = tendency to devote more attention to mild threats, robust correlate of anxiety
- Children could become sensitised to threatening stimuli because of their exposure to anger etc.
- Increases risk for anxiety
- Selectively attentive to anger cues, dif iculty disengaging from anger cues and more likely to identify
ambitious facial expressions of anger
- Excessive attention to anger -> more symptoms of anxiety
- Method for assessing attention bias:
- Pairs of faces appear on either side of monitor
- One face any, one neutral
- Then press button where dot appears
- Attention bias higher: when children take longer to identify dot’s location when it appeared on
same side of the screen as the neutral face
- biased attention to angry faces, but not so sad or happy faces
- Greater bias to anger relative to youth who experience moderate or low levels of harsh parenting
- Attention bias has also been shown in children exposed to more normative forms of harsh parenting
- Youth with more authoritarian parenting -> more critical, higher negative affect and attention
bias, social anxiety
- government run foster care in Romania -> greater attention bias than youth who were randomised
at birth to receive Forster care interventions
- Positivity bias: lower levels of externalising problems, better social adjustment and engagement and
fewer emotionally withdrawn attachment disorder symptoms
- Not all studies ind this bias
- Or depending on short or long serotonin transporter
- biased attention to threat involves limbic and prefrontal cortical circuitry -> heightened amygdala
activity
- Heightened right amygdala reactivity to angry and fearful versus neutral faces in psychiatrically
healthy adults and bilateral amygdala reactivity to emotional faces versus neutral ones
- Activation limbic system mediate the effect of child emotional abuse on symptoms of anxiety in
adults
- Reduced activation of right dorsolateral PFC in response to fear and anger -> mediated associated
between abuse and anxiety
- hypervigilance could also explain increased rates of aggressive behavior in maltreated youth
- Social information processing styles characterised by a tendency to attribute hostile intent to
others whose behavior is ambiguous
- Physically abused children are not only more likely to make hostile attributions for a character’s
behaviour in vignettes involving possible social provocation, but also generate more aggressive
responses than comparison youth
- Neglected children generate more aggressive responses than comparison youth to vignettes in
which a child tries to gain entry to a peer group and the group’s response is positive, ambiguous
or negative
- low threshold for perceiving anger and a tendency to allocate attention to anger may increase the
likelihood that maltreated youth will attribute hostile intent to others’ behavior and react
accordingly
- Generate more aggressive response to potential social provocation and fewer prosocial responses
- More negative affect and punish their partner more
- Maltreated children and adults exhibit a biased attention to threatening stimuli, which partially
explains their risk for anxiety and aggression
- Dif iculty disengaging attention from anger cues
- Differences in indings could re lect the fact that samples vary in terms of their maltreatment
exposure snd differ in terms of PTSD symptomatology
De icits in Emotion Recognition
- ability to accurately recognise and understand emotions is a key developmental task that facilitates
social interaction
- Children and adults who exhibit de icits in emotion understanding are more likely to suffer social
rejection
- Understanding of emotions partly derives from parents’ efforts to model and explain emotions
- Quality of emotion socialisation is likely to be different in abusive or neglectful families
- eg. Maltreating mothers have been shown to engage in less validation, coaching and more
invalidation of children’s emotions and themselves express less prototypical emotions
f ff f f f
, 4
- high-risk parents are less accurate in emotion recognition, thus can not respond appropriately to
their children’s emotions
- Maltreated youth are poorer at identifying facial expression of emotion
- Neglected children -> less likely to differentiate facial expressions of emotion
- Physically abused children -> show bias to recognising emotions as angry
- Also dif iculties with matching emotional outcomes with their common elicitors
- Effects bigger for emotion recognition than understanding
- Adversely affects their abilities to respond appropriately when others express emotions
- Affect their ability to predict reaction that their own negative behaviour will elicit from others .>
heightened likelihood to be rejected by peers
Reward Responsiveness
- reduced responsiveness to reward is hypothesised to be a neural mechanism by which
maltreatment increases risk for depression
- Less sensitive to cues for reward than non-maltreated controls
- Mesolimbic dopaminergic circuitry projects to basal ganglia -> involved in responsively to reward in
anticipation
- Rate reward cues less positively and are more aroused when loss is anticipated
- Less ventral striatum activation in anticipation of rewards
- Rates of depression tend to increase in adolescence and individual differences in the development of
reward related neural circuitry associated with early life stress may underlie this increase
- Youth who experience neglect showed less change in ventral striatal activity
- Mediates the association between neglect and adolescent symptoms of depression
- Makes it more plausible that reduced responsively to reward is a potential risk mechanism
- anterior cingulate cortex (ACC) is involved in reinforced learning
- Slow maturation of ACC leaves it vulnerable to impacts of chronic stressors
- Excessive release of glucocorticoids as part of the stress response
- sexually abused women less accurate in picking reward stimuli
- Due to affected development of ACC -> affecting the ability to learn from positive experiences and
perpetuating maladaptive decision making that increases risk for depression
- less responsive to reward
- Don’t discriminate cues
Moderators of Child Maltreatment
- factors that exacerbate effects of maltreatment on risk for psychopathology (diathesis stress
framework)
- Or as factors that promote competence in mental health, academic or interpersonal domains despite
exposure to maltreatment (resilience framework)
- 12-22% of those maltreated are de ined as resilient
- Effect of maltreatment on risk for psychopathology is largely similar across demographic groups
- Evidence that the association between maltreatment and risk for psychopathology varies as a
function of maltreatment subtype is weak and inconsistent
- Maltreatment that is chronic tends to be more strongly associated with risk for psychopathology
than maltreatment that occurs sporadically or that is con ined to a single developmental period
Genetic Moderators of Maltreatment Effects
- genotype by maltreatment (GxE) interaction
- Monoamine oxidase A (MAOA) genotype
- Serotonin Transporter-linked polymorphic region (5-HTTLPR; SLC6A4)
MAOA x maltreatment
- MAOA gene is involved in the metabolism of dopamine, serotonin and norepinephrine
- Found in study: MAOA gene associated with violent behaviour among males in a large dutch
family
- Low activity variant that leads to lower MAOA expression and a high activity variant that leads to
higher MAOA expression
- MAOA gene is located on X chromosome -> male are hemizygous and females can carry zero, one
or two copies
- Men who had experienced abuse in a longitudinal study had elevated levels of antisocial behavior
problems if they carried the low activity variant of the MAOA gene
- Not at risk when high activity variant
- Association between early life adversity and antisocial outcomes were signi icantly stronger for
males who carried the low versus high activity variant of the MAOA gene
f f f f
