Post-traumatic Stress Disorder among child perpetrators and victims of violence from the Northern Uganda civil war: Findings from the WAYS study

War experiences are known risk factors for post-traumatic stress disorder (PTSD) and other poor psychosocial outcomes. This study aimed to assess the extent to which perpetrating violence (operationalised as intentional and unintentional killing or mutilation) and being a victim of violence (operationalised as being a victim of violence, e. g., witnessing violence, injuries, torture) predict PTSD and other psychosocial outcomes independently in war-affected youth of Northern Uganda. Data on war experiences, PTSD, psychosocial problems, and socio-demographic characteristics were collected from the youth formerly abducted by the Ugandan Lord’s Resistance Army (LRA) at baseline (mean age = 22.39 years; SD = 10.47) and at follow-up (mean age = 23.52 years; SD = 9.28) using self-report questionnaires. On average, the participants spent 3.13 years in captivity (SD = 2.99) and were abducted at 14.14 years of age (SD = 4.21). Regression models were fitted to predict PTSD and psychosocial outcomes from perpetrating violence controlling for being a victim of violence and demographic characteristics. Thirty-seven percent (n = 168) reported killing or being responsible for killing while in rebel captivity. After adjusting for being a victim of violence, perpetrating violence remained a statistically significant predictor of PTSD and poor psychosocial outcomes such as depression, anxiety, somatic complaints, psychotic symptoms, and conduct problems. Among war-affected youth returning from LRA captivity, perpetrating violence may just be as toxic a risk factor for PTSD and other psychosocial outcomes as being a victim of violence. Mental health workers should consider both the effects of being a victim of violence and perpetrating violence in treatment planning.     

Mental Health Problems of Displaced War-Affected Adolescents in Northern Uganda: Patterns of Agreement Between Self and Caregiver Assessment

We evaluate caregiver and adolescent concordance on adolescent mental health severity in war-affected Northern Uganda. Data were collected from 628 caregiver-adolescent dyads in two internally displaced persons’ camps. Internalizing and externalizing-type mental health problems were assessed using locally-developed scales. To evaluate concordance, mean caregiver and adolescent scores on each scale were compared using Pearson’s correlation coefficients and within-pair-differences were compared by subtracting caregiver from adolescent responses and using t tests to assess whether these differed from 0. Mental heath problem type and youth/caregiver gender and age were investigated as potential indicators of group differences. Adolescents consistently rated their problems as more severe for internalizing problems and less severe for externalizing problems compared with caregivers. Mothers’ reports exhibited better concordance for internalizing problems while fathers’ and other caregivers’ exhibited better concordance of externalizing problems. Results suggest researchers and program implementers need to be aware of respondent differences when planning studies and services.     

Predictors of Externalizing Behavior Problems in Early Elementary-Aged Children: The Role of Family and Home Environments

As children enter elementary school they display behavioral orientations that reveal potential developmental trajectories. Developmental transitions offer unique opportunities for examining developmental pathways and the factors that influence emerging pathways. The primary goal of this investigation was to examine characteristics of family and home contexts in predicting externalizing behavior problems among children transitioning into elementary school. Dimensions of the family and home environments of maltreated and nonmaltreated children (N = 177) were examined and used to predict externalizing behavior problems. Maltreatment was assessed using case file information, characteristics of the family and home environment were rated by interviewers, and externalizing behavior was assessed by mother's ratings on the Child Behavior Checklist. Relative to nonmaltreated children, the family environments of physically abused children were characterized by higher levels of negative social interactions. Also, in comparison to nonmaltreated children, the home environments of children who experienced neglect were characterized as less organized and clean. Hierarchical regression analyses revealed that physical abuse was the strongest predictor of externalizing behavior. After controlling for the contribution of physical abuse, mother's negative behavior toward the focal child, aggression between siblings, and the lack of an organized and clean home were each predictive of externalizing behavior.     

Family Conflict Moderates the Relation Between Negative Mood and Youth Internalizing and Externalizing Symptoms

Higher negative (or lower positive) mood is associated with internalizing and externalizing problems among some, but not all youth, suggesting that contextual factors may influence these temperament-symptom relations. Family conflict also is associated with internalizing and externalizing problems, although it is unclear whether family conflict influences the relation between negative mood and symptoms. To address this gap, we examined whether family conflict moderates the relations between temperamental negative mood and internalizing and externalizing symptoms. Participants were 775 youth (69?% male, 76?% Caucasian). Mothers and youth completed questionnaires when youth were ages 10–12 (time 1) and 12–14 (time 2). When exposed to higher family conflict at time 1, children higher in negative mood experienced higher time 2 internalizing and externalizing problems than children lower in negative mood. When exposed to lower family conflict, children’s internalizing and externalizing symptom levels were similar regardless of their levels of negative mood. Findings suggest that interventions aimed at reducing youth’s risk for internalizing and externalizing symptoms should address conflictual interactions within the larger family system, particularly among youth with higher negative mood.     

The Role of Family Income Dynamics in Predicting Trajectories of Internalizing and Externalizing Problems

Economic disparities in children’s behavioral functioning have been observed in prior research. Yet, studies have ignored important perspectives from developmental psychopathology and have not delineated how aspects of income dynamics (i.e., cumulative family income versus income volatility) differentially relate to behavior problems. To address these limitations, the current study examined how both cumulative income and income volatility predict trajectories of children’s internalizing and externalizing problems from kindergarten through fifth grade in a nationally representative sample of 10,900 children (51.4 % male). Results showed four distinct trajectories of internalizing problems and five distinct externalizing trajectories. Family income dynamics were related to trajectory group membership. Specifically, increased cumulative income decreased risk of membership in mid-increasing and mid-stable internalizing groups, and children whose families experienced multiple waves of income loss were 2.4 times as likely to be in the mid-increasing group instead of the low-stable group. With respect to externalizing, higher cumulative income increased the likelihood of belonging in the group exhibiting stably low externalizing problems. Experiencing income loss increased the risk of belonging in the trajectory group exhibiting chronically high externalizing behaviors. These results enhance our knowledge of the role of family income in the development of behavior problems.     

Imbalances and Impairments in Mental State Talk of Children with Internalizing and Externalizing Problems

ABSTRACT

The aims of this study were to investigate the associations between impairments and imbalances in children’s mental state talk, attachment security and abuse/neglect experiences, and to study how much of the variance in internalizing and externalizing problems was explained by mentalization problems. The sample included 100 Turkish children (M Age = 7.00 (SD = 2.01), 38% girls) referred to a outpatient psychotherapy clinic. Children were administered an attachment-based story stem task in order to code attachment security and different categories of mental state talk, including the extent of their direction (self vs other), balance, and appropriateness. Parents and teachers filled out socio-behavioral function scales. Findings indicated a significant positive association between externalizing problems and impaired mentalization. Internalizing problems were associated with mentalizing the other at the expense of one’s own mental states and underusing emotions. Attachment insecurity and adverse experiences were associated with mentalization impairments and imbalances. Finally, underuse of emotions and self-focused mental state talk predicted internalizing problems and impaired mental state talk predicted externalizing problems at trend level of significance. Qualitative analyses supported the results, which suggest that whereas children with externalizing problems suffer from severe mentalization deficits, children with internalizing problems undermentalize about themselves and emotions.     

Urban youth disruptive behavioral difficulties: exploring association with parenting and gender

The current study will examine behavioral difficulties among a sample of African American urban youth who were exposed to violence. Possible gender differences in disruptive behavioral difficulties, as well as possible associations between parental practices, family relationships, and youth disruptive behavioral difficulties are examined. A secondary data analysis from baseline data for 125 African American urban mothers and their children collected as part of a large-scale, urban, family-based, HIV prevention research study was analyzed. Findings reveal that externalizing behavioral problems in youth are associated with exposure to violence. Girls displayed significantly higher levels of externalizing behavioral difficulties than boys. Mothers' parenting practices and family relationships were associated with youths' externalizing behavior problems. Implications for interventions to reduce youths' exposure to violence and to develop gender sensitive interventions for youth and supportive interventions for their parents are discussed.     

Adverse Life Events, Coping and Internalizing and Externalizing Behaviors in Urban African American Youth

African American youth residing in low income urban neighborhoods are at increased risk of experiencing negative life events in multiple domains, increasing their risk for internalizing and externalizing behaviors. However, little is known about youth’s differential responses to life event stress, or protective processes and coping strategies for urban African American youth exposed to adverse life events. Thus, the present study examined whether variability in predominantly low income, urban African American youth’s responses to life event stress are accounted for by the type of life event experienced or the type of coping strategies used. Participants were a community sample of 353 urban African American youth (52.8 % girls; age range 8–12 years) who participated in the Multiple Opportunities to Reach Excellence (MORE) Project. Youth reported about their experiences with adverse life events, coping strategies, and internalizing and externalizing symptoms. Results indicated that violent life events were uniquely associated with externalizing behavior, while discrimination and economic stress were uniquely associated with internalizing behavior. The utility of coping strategies varied by gender, such that avoiding problems was protective for girls who experienced violent life events, but not for boys. For boys, exposure to violence was significantly positively associated with externalizing symptoms regardless of the amount of avoiding problems coping used. Findings suggest that interventions to develop coping strategies may need to be gender-specific as well as tailored for the types of stressors common for low income urban youth.     

Stepfamily Relationship Quality and Children's Internalizing and Externalizing Problems

The stepfamily literature is replete with between‐group analyses by which youth residing in stepfamilies are compared to youth in other family structures across indicators of adjustment and well‐being. Few longitudinal studies examine variation in stepfamily functioning to identify factors that promote the positive adjustment of stepchildren over time. Using a longitudinal sample of 191 stepchildren (56% female, mean age = 11.3 years), the current study examines the association between the relationship quality of three central stepfamily dyads (stepparent–child, parent–child, and stepcouple) and children's internalizing and externalizing problems concurrently and over time. Results from path analyses indicate that higher levels of parent–child affective quality are associated with lower levels of children's concurrent internalizing and externalizing problems at Wave 1. Higher levels of stepparent–child affective quality are associated with decreases in children's internalizing and externalizing problems at Wave 2 (6 months beyond baseline), even after controlling for children's internalizing and externalizing problems at Wave 1 and other covariates. The stepcouple relationship was not directly linked to youth outcomes. Our findings provide implications for future research and practice.     

Examining Externalizing Behavior Trajectories of Youth in Group Homes: Is there Evidence for Peer Contagion?

Although concerns about peer contagion are often cited in critiques of group treatments for troubled youths, few studies have examined the effects of exposure to deviant peers in residential group care settings. This study used administrative data of youth served at Boys Town, a nationally-known group care provider. Using latent class growth analysis, this study identified the externalizing behavior trajectories of youth in group care as well as the behavior trajectory of the peers with whom they lived, assessed the relationship between youth trajectory classes and individual and peer group characteristics as well as the relationship between an individual youth’s behavior pattern and the behavior pattern of proximal peers. Several results suggested the presence of peer contagion in group care: a trajectory class of gradually increasing externalizing behavior problems, the strength of deviant peer density in predicting an individual youth’s externalizing behavior trajectories and significant associations between behavior patterns of youth and proximal peers. While there is some evidence that suggests an increase in problem behavior during care, results from this study indicated that over 90% of the youth did not have an increase in problem behaviors and that positive peer influences may also be protective and inhibit problem behaviors.     

Do Parents’ Adverse Childhood Experiences Influence Treatment Responses to Parent-Child Interaction Therapy? An exploratory Study with a Child Welfare Sample

This exploratory study of 23 parent–child dyads receiving child welfare services examined the association between the number of adverse childhood experiences (ACEs) parents reported and their children’s externalizing behaviors. We also assessed whether the effects of Parent-Child Interaction Therapy (PCIT) on externalizing behaviors varied by parents’ ACE histories. Results indicated that parents’ ACE scores were associated with child externalizing symptoms at baseline, but not at a second postbaseline assessment. Although all parents reported reductions in child externalizing behavior from baseline to postbaseline, only reductions reported by parents with four or more ACEs were statistically significant. Implications for implementing PCIT with trauma-exposed families are discussed.     

Relation Between Parent Psychiatric Symptoms and Youth Problems: Moderation through Family Structure and Youth Gender

Links between parents’ psychiatric symptoms and their children’s behavioral and emotional problems have been widely documented in previous research, and the search for moderators of this association has begun. However, family structure (single versus dual-parent households) has received little attention as a potential moderator, despite indirect evidence that risk may be elevated in single-parent homes. Two other candidate moderators—youth gender and age—have been tested directly, but with inconsistent findings across studies, perhaps in part because studies have differed in whether they used youth clinical samples and in which informants (parents vs. youths) reported on youth problems. In the present study, we examined these three candidate moderators using a sample of exclusively clinic-referred youths (N?=?333, 34 % girls, aged 7–14,) and assessing youth problems through both parent- and youth-reports. Both family structure and youth gender emerged as robust moderators across parent and youth informants. Parent symptoms were associated with youth internalizing and externalizing problems in single-parent but not dual-parent homes; and parent symptoms were associated with youth internalizing problems among boys, but not girls. The moderator findings suggest that the risks associated with parent psychopathology may not be uniform but may depend, in part, on family structure and youth gender.     

Maternal experience of their infants’ crying in the context of war trauma: Determinants and consequences

We examined, first, how prenatal maternal mental health and war trauma predicted mothers’ experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother–infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother–infant interaction and infant sensorimotor and language development at 12 months of infants’ age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers’ sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers’ active and positive responses predicted high emotional availability in mother–infant interaction. Crying is the first communication tool for infants, and mothers’ sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.     

The Third Rail of Family Systems: Sibling Relationships, Mental and Behavioral Health, and Preventive Intervention in Childhood and Adolescence

Sibling relationships are an important context for development, but are often ignored in research and preventive interventions with youth and families. In childhood and adolescence, siblings spend considerable time together, and siblings’ characteristics and sibling dynamics substantially influence developmental trajectories and outcomes. This paper reviews research on sibling relationships in childhood and adolescence, focusing on sibling dynamics as part of the family system and sibling influences on adjustment problems, including internalizing and externalizing behaviors and substance use. We present a theoretical model that describes three key pathways of sibling influence: one that extends through siblings’ experiences with peers and school, and two that operate largely through family relationships. We then describe the few existing preventive interventions that target sibling relationships and discuss the potential utility of integrating siblings into child and family programs.     

Externalizing Disorders in Adolescence Mediate the Effects of Maternal Depression on Substance Use Disorders

Maternal depression has been linked to increased risk of substance use disorders (SUDs) in offspring. Cross-sectional studies have identified relationships among maternal depression, externalizing disorders and SUDs, but no longitudinal examination of causality has been undertaken. In order to address this gap in the literature, depression and externalizing disorders at or prior to age 15 were tested as mediators of the relationship between maternal depression and SUDs diagnosed between ages 16 and 20 in a sample of 702 Australian youth (363 women) using path models. Mothers’ and fathers’ substance diagnoses and earlier onset of substance abuse in youth were controlled for in all analyses. Consistent with previous work, maternal depression predicted SUDs between ages 16 and 20. An indirect effect of maternal depression through youth externalizing disorders diagnosed by age 16 was detected for alcohol and cannabis use disorders, but not drug disorders. Early adolescent depression was not a mediator of the relationship between maternal depression and any of the substance outcomes measured. To our knowledge, this study is the first to examine depression and externalizing disorders in early adolescence as mediators of the effect of maternal depression on psychopathology in later adolescence. Further work is needed to understand how family environment and genetic factors may explain the mediation by externalizing disorders.     

Linking Maternal Socialization of Positive Emotions to Children’s Behavioral Problems: The Moderating Role of Self-Control

Little is known about how parents socialize children’s positive affect regulation during late childhood. Consequently, we examined how mothers’ reported responses to their children’s (aged 7–12 years) positive emotions were linked to children’s behavioral problems and how children’s self-control moderated these associations. Our results indicated that maternal encouragement of positive emotions predicted fewer externalizing behaviors, but only for youth with lower self-control. Maternal explanation about their children’s positive emotions was unrelated to youth’s behavioral problems. Lastly, maternal dismissing responses to their children’s positive emotions (i.e., reprimanding responses and discomfort) were related to more externalizing and internalizing in youth, and these effects were not dependent on the children’s self-control. The current study adds to the limited research on positive affect socialization and offers some evidence that youth’s self-control may serve as a vantage-sensitivity factor in the association between maternal positive affect socialization and youth adjustment.     

The developmental trajectories of attention focusing, attentional and behavioral persistence, and externalizing problems during school-age years

The developmental trajectories of attention focusing (by parents' and teachers' reports) and attentional and behavioral persistence (observed during a laboratory task)--2 indexes of effortful control--and externalizing problems from ages 5 to 10 years were examined for 356 children combined from a pair of 3-wave (2 years apart) longitudinal studies. The authors identified clusters of children with distinct trajectories for these variables and examined the links between the effortful control trajectories and the externalizing problem trajectories. Although attention focusing remained relatively stable, attentional and behavioral persistence continued to show mean-level changes (especially among the children with lower levels of persistence). Children with high and stable trajectories of effortful control tended to exhibit low and stable trajectories of externalizing problems, whereas those with lower and/or less stable trajectories of effortful control showed more elevated and/or fluctuating trajectories of externalizing problems.     

Low-income mothers' patterns of partnership instability and adolescents' socioemotional well-being

The present study investigated the association of family structure and maternal partnership instability patterns with adolescents' behavioral and emotional well-being among urban low-income families. Analyses employed data from the Three-City Study to track maternal partnerships over the youth's life span, linking longitudinal family structure and transition patterns to adolescent well-being (N = 2305). Families were classified into nine mutually exclusive longitudinal partnership groups based on current status at wave 3 (single, married, or cohabiting) and the longevity of that status: always (since adolescent's birth with no transitions), stable (lasting two years or more, preceded by transitions), or new (transpiring in the past 2 years). Adolescents in the always married group displayed less delinquency and externalizing problems, according to both youth and mother reports, than peers in always single-parent or newly married households. In contrast, youth in always cohabiting households had higher maternal ratings of internalizing problems and youth with newly cohabiting mothers reported higher psychological distress than peers in similar stability groups with single or married mothers. Overall, several potential explanatory processes for the family structure and stability patterns surfaced: married parent families reported less economic hardship, more family routines and father involvement, and less maternal psychological distress and parenting stress than their single and cohabiting counterparts. Policy implications of these findings are discussed.     

Child Psychosocial Adjustment and Parenting in Families Affected by Maternal HIV/AIDS

Child adjustment and parenting were examined in twenty-three 9–16-year-old youth from families affected by maternal HIV infection and 20 same-age peers whose mothers were not infected. Children whose mothers were seropositive reported significantly more externalizing problems. Infected mothers reported less age-appropriate supervision/monitoring relative to non-infected mothers. Better mother-child relationship quality and less impairment in parental supervision/monitoring of age-appropriate youth behaviors were associated with fewer externalizing difficulties among the HIV-positive group only. Similarly, only among HIV-infected mothers was refraining from engaging in inconsistent disciplinary tactics associated with lower reports of internalizing and externalizing problems. These data highlight the promise of programs targeting parenting skills to prevent or ameliorate child difficulties.