Early Health Risk Factors for Violence: Conceptualization, Review of the Evidence, and Implications

Violence and aggression are public health problems that can benefit from ongoing research into risk reduction and prevention. Current developmental theories of violence and aggression emphasize biological and psychosocial factors, particularly during adolescence. However, there has been less focus on understanding the interactive, multiplicative effects of these processes. Furthermore, little attention has been given to the pre-, peri-, and postnatal periods, where prevention and intervention may yield effective results. Early health risk factors that influence negative behavioral outcomes include prenatal and postnatal nutrition, tobacco use during pregnancy, maternal depression, birth complications, traumatic brain injury, lead exposure, and child abuse. There is an ample literature to suggest that these early health risk factors may increase the likelihood of childhood externalizing behaviors, aggression, juvenile delinquency, adult criminal behavior, and/or violence. This paper proposes an early health risk factors framework for violence prediction, built on existing developmental theories of criminal behavior and supported by empirical findings. This framework addresses gaps in the adolescent psychopathology literature and presents a novel conceptualization of behavioral disturbance that emphasizes the pre-, peri-, and post-natal periods, when a child's development is critical and the opportunity for behavioral and environmental modification is high. Implications for such a framework on violence prevention programs are discussed.     

Empathic deficits in sexual offenders: An integration of affective,social, and cognitive constructs

A number of researchers have suggested that lack of empathy is a critical feature in the assessment and treatment of sex offenders. However, difficulties with definitions of empathy and corresponding measures of that construct have led to limited and disparate empirical findings supporting this claim. Such findings may be due to a definition of empathy that fails to incorporate other key factors related to sexual offending. Factors such as inaccurate social perceptions, cognitive distortions, deficits in interpersonal intimacy, maladaptive emotional regulation abilities, and other socio-cognitive deficiencies thought to contribute to sexually assaultive behavior also share a number of core developmental features with affect and emotional responding. As socio-cognitive abilities tend to develop simultaneously at times as humans mature, it is suspected that social, cognitive, and affective skills impact one another's development and ultimately dictate the expression of empathy in adulthood. Accordingly, deficits in social skills, interpersonal intimacy, and cognitive processes necessary to emotional stability and appropriate social interaction may be critical to the development and expression of empathic deficits and subsequent efforts to treat or reduce such deficits in sexual offenders. This paper will review and integrate literature examining the relationship of various socio-cognitive factors to empathic deficits in sexual offenders.     

The critical role of nurturing environments for promoting human well-being

The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility-the ability to be mindful of one's thoughts and feelings and to act in the service of one's values even when one's thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Mu?oz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.     

A Unified,Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population.     

Childhood-Onset Multiple Sclerosis and Mood Disorders: A Case Study

Multiple Sclerosis (MS) is rare in children. Little research exists regarding emotional and behavioral disorders in childhood-onset MS, despite the occurrence of such problems in adults with MS. This paper describes the cognitive and behavioral characteristics of a boy diagnosed with MS at age 9 and mood disorder at age 10. He displayed no cognitive or behavioral problems prior to the onset of physical symptoms of MS. Three years after diagnosis, this child showed persistent problems with speed of processing, visual-motor skills, and parent and teacher-reported executive functioning. In addition, he had difficulties with emotional lability, behavioral disinhibition, depression, and social interaction. As with adults, children with MS may be at increased risk for mood disorder compared to their peers. Mood disorders in children with MS are likely to be multiply determined, although the specific causal mechanisms are unknown.     

Childhood-onset multiple sclerosis and mood disorders: a case study.

Multiple Sclerosis (MS) is rare in children. Little research exists regarding emotional and behavioral disorders in childhood-onset MS, despite the occurrence of such problems in adults with MS. This paper describes the cognitive and behavioral characteristics of a boy diagnosed with MS at age 9 and mood disorder at age 10. He displayed no cognitive or behavioral problems prior to the onset of physical symptoms of MS. Three years after diagnosis, this child showed persistent problems with speed of processing, visual-motor skills, and parent and teacher-reported executive functioning. In addition, he had difficulties with emotional lability, behavioral disinhibition, depression, and social interaction. As with adults, children with MS may be at increased risk for mood disorder compared to their peers. Mood disorders in children with MS are likely to be multiply determined, although the specific causal mechanisms are unknown.     

Emotional understanding: a comparison of physically maltreating and nonmaltreating mother-child dyads.

Investigated emotional understanding in 22 physically maltreating mothers and their children and a matched control group to determine the ways in which a maltreating relationship may interfere with children's emotional development. Findings indicated that, when compared to controls, maltreating mothers were less likely to engage in discussion reflective of emotional understanding (e.g., causes and consequences of emotion) and maltreated children demonstrated lower levels of emotional understanding. Further, significant relations emerged between maternal behavior (e.g., discussion of emotion) and children's emotional understanding skills. Findings are discussed from the functionalist approach to emotional development, emphasizing the importance of social context in the development of children's emotional understanding skills. Potential clinical applications are also considered.     

MATERNAL EXPECTATIONS FOR MASTERY OF DEVELOPMENTAL TASKS IN JAPAN AND THE UNITED STATES*

Maternal expectations about development help organize parental behavior by providing internal referents against which a child's growth and behavior are evaluated, thus identifying occasions for intervention by the adult. Fifty-eight mothers from Japan and 67 mothers from the United States were interviewed about the ages at which they expected their four-year-old children to acquire a number of specific developmental skills. There were no differences between the two groups of mothers in mean age of mastery expectation across all 38 items but Japanese mothers expected early mastery on skills that indicated emotional maturity, self-control, and social courtesy. Mothers in the U.S. expected mastery at an earlier age on items indicating verbal assertiveness and social skills with peers. Maternal expectations were found to correlate with children's performance on tests of school aptitude when the children were six years of age.     

Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.     

Serial order processing in human infants and the role of multisensory redundancy

Perception, production, and understanding of sequences is fundamental to human behavior and depends, in large part, on the ability to detect serial order. Despite the importance of this issue across many domains of human functioning, the development of serial order skills has been neglected in developmental studies. The current article reviews evidence that the basic temporal and spatiotemporal skills that are necessary for the development of serial order skills emerge early in human development. The article then presents recent evidence from the authors laboratory showing that serial order perceptual skills emerge at the same time and improve rapidly. Consistent with a multisensory redundancy view of perception, when serial order perceptual abilities first emerge in infancy, they depend critically on the redundant specification of sequences in both the auditory and visual modalities. The findings suggest that infants ability to perceive the surface serial order characteristics of sequentially organized events provides the necessary antecedents to the development of more complex serial order skills that ultimately enable us to extract meanings from sequentially organized events and perform complex sequential actions.Edited by: Marie-Hélène Giard and Mark Wallace     

Unresolved Childhood Sexual Abuse and Older Adults: Late-Life Vulnerabilities

Several long-term correlates of childhood sexual abuse (CSA) have been identified, including depression, fear, anxiety, guilt, anger, and poor interpersonal functioning (e.g., Browne and Finkelhor, 1986). However, little is know about how CSA survivors fare in old age. This article addresses the impact of unresolved CSA on late-life (emotional, cognitive, and behavioral) functioning. Three case studies of older adults ages 60 and older who were struggling with unresolved CSA are presented. Two observed stressors (loss of social support and declining health) and one developmental task (reminiscence or life-review) appear to be linked to exacerbated vulnerabilities in older survivors. Specifically, because CSA may arrest specific childhood developmental tasks (e.g., ability to form secure attachments, autonomy) or facilitate development of coping strategies that are maladaptive when outside of an abusive environment (e.g., generalized interpersonal distrust, avoidance, dissociation), the survivor may be at risk for developmental vulnerabilities for dysfunction in adulthood. These vulnerabilities may exacerbate unresolved CSA, particularly when the adult encounters stressors or developmental tasks that exceed his or her capacity for adaptive coping. Recommendations for mental health professionals and future research are suggested.     

Creating Nurturing Environments: A Science-Based Framework for Promoting Child Health and Development Within High-Poverty Neighborhoods

Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities.     

Intervention to Strengthen Emotional Self-Regulation in Children with Emerging Mental Health Problems: Proximal Impact on School Behavior

A model for teaching children skills to strengthen emotional self-regulation is introduced, informed by the developmental concept of scaffolding. Adult modeling/instruction, role-play and in vivo coaching are tailored to children’s level of understanding and skill to promote use of skills in reallife contexts. Two-hundred twenty-six kindergarten—3rd grade children identified with elevated behavioral and social classroom problems from a population-based screening participated in a waitlisted randomized trial of the Rochester Resilience Project derived from this model. In 14 lessons with school-based mentors, children were taught a hierarchical set of skills: monitoring of emotions; selfcontrol/ reducing escalation of emotions; and maintaining control and regaining equilibrium. Mentors provided classroom reinforcement of skill use. Multi-level modeling accounting for the nesting of children in schools and classrooms showed the following effects at post-intervention: reduced problems rated by teachers in behavior control, peer social skills, shy-withdrawn and off-task behaviors (ES 0.31–0.47). Peer social skills improved for girls but not for boys. Children receiving the intervention had a 46% mean decrease in disciplinary referrals and a 43% decrease in suspensions during the 4-month intervention period. Limitations and future directions to promote skill transfer are discussed.     

Depression and God: The Effects of Major Depressive Disorder on Theology and Religious Identity

Major depressive disorder (MDD) has deep roots in brain function. Recent physiological research ties brain areas involved with depression to areas that process emotions. Among the research surveyed, a link was found between the activity levels of the prefrontal cortex (PFC), the orbitofrontal cortex (OFC), and parts of the anterior cingulate cortex (ACC). These links prove to be useful in understanding how an individual might have problems processing emotional experiences. This relates directly to how a person interacts in a religious environment. Religious leaders should share the physicians’ mantra of primum non nocere, which means “first, do no harm.” Skewed views of God can emerge from "gaps in understanding" related to topics such as sin, substance abuse, divine intimacy, and end-of-life questions.     

Aggression and school social dynamics: The good, the bad, and the ordinary

A social dynamics perspective of aggression in school is presented. This framework focuses on the role of natural social processes in the establishment and maintenance of aggressive behavior in the school context. The five articles in this special issue are briefly reviewed and a synthesis of their contributions for understanding the social dynamics of aggression in school is underscored. Future research and intervention implications are also discussed. The need for examining the role of school social dynamics in conducting social skills interventions, functional behavioral assessments, and the development of positive behavioral support plans is emphasized.     

Neonatal hippocampal lesion alters the functional maturation of the prefrontal cortex and the early cognitive development in pre-juvenile rats

Mnemonic and executive performance is encoded into activity patterns of complex neuronal networks. Lesion studies revealed that adult recognition memory critically depends on the activation of the prefrontal cortex (PFC) and hippocampus (HP). However, its developmental profile remains poorly elucidated. We previously showed the rat PFC and HP are functionally coupled in theta- and gamma-band oscillations during neonatal [postnatal day (P) 5-8] and pre-juvenile (P10-15) stages of development. Here, we assess the behavioral readout of this early prefrontal-hippocampal activation by investigating the ontogeny and the mechanisms of novelty detection and recognition memory in relationship to the functional integrity of the PFC and HP. Excitotoxic lesion of the HP at birth led to abnormal oscillatory entrainment of the PFC throughout neonatal and pre-juvenile development. Although the onset of novelty detection correlated rather with the maturation of sensory perception and motor skills than with hippocampal integrity, the pre-juvenile performance in item, spatial and temporal order recognition memory significantly decreased after HP lesion at birth. This poorer performance does result neither from abnormal developmental milestones and locomotion nor from increased anxiety. Thus, novelty recognition in rat emerges during the second postnatal week and requires functional integrity of communication within neuronal networks including the PFC and HP.     

Editorial: Applications of Cognitive and Behavioral Therapy in Response to COVID-19

The corona virus (COVID-19) continues to have a devastating health, economic, and social impact on our local and international communities. Cognitive and Behavioral Therapies (CBTs), as a family of therapies that posit cognitive, behavioral, emotional, and interpersonal change processes in the understanding and successful treatment of mental health disorders, have risen to the challenge. This special issue represents contributions from CBT experts on the impact on psychopathology, new assessment methods, adaptations of integrated behavioral health, telehealth, psychology training, and discusses a public health framework. The issue includes a series of articles offering guidance for the clinician on interventions for those impacted by trauma, CBT for youth and families, and telehealth for psychotic spectrum disorders and group therapy for social anxiety.     

Maternal Depression and Children’s Cognitive and Socio-Emotional Development at First Grade: The Moderating Role of Classroom Emotional Climate

This study examined whether a warm and positive classroom emotional climate would buffer the detrimental effects of maternal depression on children’s cognitive and socioemotional adjustment at first grade. Based on 1364 dyads, four waves of data spanning 6 months to first grade were used to examine paths between mothers’ early cumulative depressive symptoms and five first-grade outcomes (internalizing and externalizing behavior problems, social competence, academic functioning, and relationship with teachers). Classroom emotional climate was observed at first grade. Multiple group modeling revealed that children who were placed in a classroom that was characterized by a warm and positive emotional climate were shown to be less severely, or not, affected by mothers’ depressive symptoms in terms of the development of externalizing problems, social skills, cognitive performance, and relational functioning. Guided by the bioecological perspective, the current study showed synergic effects of intra-familial and extra-familial elements on an array of children’s developmental outcomes over time.     

Social Neuroscience: Progress and Implications for Mental Health

ABSTRACT— Social neuroscience is a new, interdisciplinary field devoted to understanding how biological systems implement social processes and behavior. Social neuroscience capitalizes on biological concepts and methods to inform and refine theories of social behavior, and it uses social and behavioral constructs and data to inform and refine theories of neural organization and function. We focus here on the progress and potential of social neuroscience in the area of mental health. Research in social neuroscience has grown dramatically in recent years. Among the most active areas of research we found are brain-imaging studies in normal children and adults; animal models of social behavior; studies of stroke patients; imaging studies of psychiatric patients; and research on social determinants of peripheral neural, neuroendocrine, and immunological processes. We also found that these areas of research are proceeding along largely independent trajectories. Our goals in this article are to review the development of this field, examine some currently promising approaches, identify obstacles and opportunities for future advances and integration, and consider how this research can inform work on the diagnosis and treatment of mental disorders.