Impact of Adverse Childhood Experiences on Psychotic-Like Symptoms and Stress Reactivity in Daily Life in Nonclinical Young Adults.

BACKGROUND: There is increasing interest in elucidating the association of different childhood adversities with psychosis-spectrum symptoms as well as the mechanistic processes involved. This study used experience sampling methodology to examine (i) associations of a range of childhood adversities with psychosis symptom domains in daily life; (ii) whether associations of abuse and neglect with symptoms are consistent across self-report and interview methods of trauma assessment; and (iii) the role of different adversities in moderating affective, psychotic-like, and paranoid reactivity to situational and social stressors. METHOD: A total of 206 nonclinical young adults were administered self-report and interview measures to assess childhood abuse, neglect, bullying, losses, and general traumatic events. Participants received personal digital assistants that signaled them randomly eight times daily for one week to complete questionnaires about current experiences, including symptoms, affect, and stress. RESULTS: Self-reported and interview-based abuse and neglect were associated with psychotic-like and paranoid symptoms, whereas only self-reported neglect was associated with negative-like symptoms. Bullying was associated with psychotic-like symptoms. Losses and general traumatic events were not directly associated with any of the symptom domains. All the childhood adversities were associated with stress reactivity in daily life. Interpersonal adversities (abuse, neglect, bullying, and losses) moderated psychotic-like and/or paranoid reactivity to situational and social stressors, whereas general traumatic events moderated psychotic-like reactivity to situational stress. Also, different interpersonal adversities exacerbated psychotic-like and/or paranoid symptoms in response to distinct social stressors. DISCUSSION: The present study provides a unique examination of how childhood adversities impact the expression of spectrum symptoms in the real world and lends support to the notion that stress reactivity is a mechanism implicated in the experience of reality distortion in individuals exposed to childhood trauma. Investigating the interplay between childhood experience and current context is relevant for uncovering potential pathways to the extended psychosis phenotype.

Impact of Adverse Childhood Experiences on Psychotic-Like Symptoms and Stress Reactivity in Daily Life in Nonclinical Young Adults.

(Reprinted with permission from PLoS ONE 11(4): e0153557).

Interview Investigation of Insecure Attachment Styles as Mediators between Poor Childhood Care and Schizophrenia-Spectrum Phenomenology.

BACKGROUND: Insecure attachment styles have received theoretical attention and some initial empirical support as mediators between childhood adverse experiences and psychotic phenomena; however, further specificity needs investigating. The present interview study aimed to examine (i) whether two forms of poor childhood care, namely parental antipathy and role reversal, were associated with subclinical positive and negative symptoms and schizophrenia-spectrum personality disorder (PD) traits, and (ii) whether such associations were mediated by specific insecure attachment styles. METHOD: A total of 214 nonclinical young adults were interviewed for subclinical symptoms (Comprehensive Assessment of At-Risk Mental States), schizophrenia-spectrum PDs (Structured Clinical Interview for DSM-IV Axis II Disorders), poor childhood care (Childhood Experience of Care and Abuse Interview), and attachment style (Attachment Style Interview). Participants also completed the Beck Depression Inventory-II and all the analyses were conducted partialling out the effects of depressive symptoms. RESULTS: Both parental antipathy and role reversal were associated with subclinical positive symptoms and with paranoid and schizotypal PD traits. Role reversal was also associated with subclinical negative symptoms. Angry-dismissive attachment mediated associations between antipathy and subclinical positive symptoms and both angry-dismissive and enmeshed attachment mediated associations of antipathy with paranoid and schizotypal PD traits. Enmeshed attachment mediated associations of role reversal with paranoid and schizotypal PD traits. CONCLUSIONS: Attachment theory can inform lifespan models of how adverse developmental environments may increase the risk for psychosis. Insecure attachment provides a promising mechanism for understanding the development of schizophrenia-spectrum phenomenology and may offer a useful target for prophylactic intervention.

The relationship between attachment styles and internalizing or externalizing symptoms in clinical and nonclinical adolescents / Relación entre los estilos de apego y los síntomas externalizantes e internalizantes en adolescentes clínicos y no clínicos

Studies regarding the relationship between attachment and psychopathology during adolescence have been performed separately for clinical and nonclinical adolescents and have used different assessment measures, which together might produce a methodological bias that increases the association between attachment and psychopathology. With the aim of avoiding this bias, the present study used identical measures to explore the relationship between attachment styles and internalizing or externalizing symptoms in clinical and nonclinical samples of adolescents. The sample consisted of 258 adolescents, 129 clinical and 129 nonclinical, aged between 14 and 18 years. The adolescents in each sample were matched for age, gender, and socioeconomic status. Attachment was assessed using the CaMir Q-sort, and psychopathological symptoms were assessed by means of the Youth Self Report (YSR). The relationships between attachment and psychopathology were similar for clinical and nonclinical adolescents. A preoccupied attachment style predicted internalizing and externalizing symptoms, somatic complaints, anxious-fearful behavior, verbal aggression, attention-seeking behavior, and thinking problems. Compared to previous studies, this research has made it possible to identify broader, stronger, and more specific associations between preoccupied attachment style and psychopathological symptoms in adolescents

Los estudios sobre la relación entre apego y psicopatología durante la adolescencia, se han realizado separadamente en muestras clínicas y no clínicas de adolescentes y han utilizado instrumentos de evaluación diferentes, lo que en conjunto ha podido dar lugar a un sesgo metodológico que ha incrementado la asociación entre apego y psicopatología. Con objeto de evitar este sesgo, en el presente estudio se utilizaron las mismas medidas para explorar la relación entre estilos de apego y síntomas internalizantes y externalizantes en grupos clínicos y no clínicos de adolescentes. La muestra estuvo formada por 248 adolescentes, entre 14 y 18 años de edad. Los adolescentes de cada grupo se emparejaron en edad, sexo y nivel socioeconó- mico. El apego se valoró con el cuestionario CaMir y los síntomas psicopatológicos con el Youth Self Report. Las relaciones entre apego y psicopatología fueron similares en adolescentes clínicos y no clínicos. El estilo de apego preocupado predijo síntomas internalizantes y externalizantes, quejas somáticas, conducta fóbico-ansiosa, agresividad verbal, conducta de búsqueda de atención y problemas de pensamiento. En comparación con estudios previos, esta investigación ha permitido identificar asociaciones más amplias, más fuertes y más específicas entre el estilo de apego preocupado y los síntomas psicopatológicos en adolescentes

Attachment style predicts affect, cognitive appraisals, and social functioning in daily life.

The way in which attachment styles are expressed in the moment as individuals navigate their real-life settings has remained an area largely untapped by attachment research. The present study examined how adult attachment styles are expressed in daily life using experience sampling methodology (ESM) in a sample of 206 Spanish young adults. Participants were administered the Attachment Style Interview (ASI) and received personal digital assistants that signaled them randomly eight times per day for 1 week to complete questionnaires about their current experiences and social context. As hypothesized, participants' momentary affective states, cognitive appraisals, and social functioning varied in meaningful ways as a function of their attachment style. Individuals with an anxious attachment, as compared with securely attached individuals, endorsed experiences that were congruent with hyperactivating tendencies, such as higher negative affect, stress, and perceived social rejection. By contrast, individuals with an avoidant attachment, relative to individuals with a secure attachment, endorsed experiences that were consistent with deactivating tendencies, such as decreased positive states and a decreased desire to be with others when alone. Furthermore, the expression of attachment styles in social contexts was shown to be dependent upon the subjective appraisal of the closeness of social contacts, and not merely upon the presence of social interactions. The findings support the ecological validity of the ASI and the person-by-situation character of attachment theory. Moreover, they highlight the utility of ESM for investigating how the predictions derived from attachment theory play out in the natural flow of real life.

Positive and negative schizotypy are associated with prodromal and schizophrenia-spectrum symptoms.

The present study examined the validity of psychometrically assessed positive and negative schizotypy in a study of 214 Spanish young adults using interview and questionnaire measures of impairment and psychopathology. Schizotypy provides a useful construct for understanding the etiology and development of schizophrenia and related disorders. Recent interview, laboratory, and experience sampling studies have supported the validity of psychometrically assessed positive and negative symptom dimensions. The present study expands on previous findings by examining the validity of these dimensions in a Spanish sample and employing a widely used interview measure of the schizophrenia prodrome. As hypothesized, the positive schizotypy dimension predicted CAARMS ultra high-risk or psychosis threshold status, and both dimensions uniquely predicted the presence of schizophrenia-spectrum personality disorders. Furthermore, positive schizotypy was associated with psychotic-like, paranoid, schizotypal, and mood symptoms, whereas negative schizotypy was associated with interview ratings of negative and schizoid symptoms. The schizotypy dimensions were also distinguished by their associations with self and other schemas. Positive schizotypy was associated with increased negative self and other schemas, whereas negative schizotypy was associated with decreased positive self and other schemas. The findings provide further construct validation of positive and negative schizotypy and support these dimensions as universal constructs.

Prevalence of major depression in preschool children.

The prevalence of preschool major depressive disorder (MDD) was studied in the community. The whole population of children between 3 and 6 years attending preschool nurseries in three areas (one urban, one rural and one suburban) in Spain (n = 1,427) were contacted. Selection was by a two-stage procedure. At stage I, the ESDM 3-6, a screening measure for preschool depression, was used to identify a sample for more intensive interviewing. Sensitivity and specificity of the cut-off point of the ESDM 3-6 had been previously tested in a pilot study (n = 229). During the first stage, 222 preschool children (15.6%) were found to be probable depressives, because they scored 27 or more, the cut-off used. At stage II, the children were interviewed and diagnosed by the consensus of two clinicians, blind to the ESDM 3-6 results. DSM-IV diagnostic criteria were used to define caseness. A total of 16 children (1.12%) met the MDD criteria. The prevalence by areas was urban 0.87%, rural 0.88%, suburban 1.43%. Sex distribution prevalence was 1:1. This study is a contribution to the scarce epidemiology of preschool depression in the community.

Teacher reports of peer aggression in preschool: its relationship to DSM-IV externalizing symptoms.

OBJECTIVE: to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses. METHOD: Subjects were 1104 children, 3-to-5-year-olds attending rural and urban pre-schools classes. Teachers completed the Peer Conflict Scale (PCS) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology ECI-4. RESULTS: 6.6% (n=73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n=29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder. CONCLUSIONS: The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression.

Teacher Reports of Peer Aggression in Preschool: its Relationship to DSM-IV Externalizing Symptoms

Objective: to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses. Method: Subjects were 1,104 children, 3-to-5-year-olds attending rural and urban pre-schools classes.Teachers completed the Peer Conflict Scale (PCS) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology ECI-4. Results: 6.6% (n = 73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n = 29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder. Conclusions: The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression (AU)

Objetivo: Determinar la prevalencia de agresión preescolar hacia iguales en la comunidad y su correlación con categorías externalizantes del DSM-IV. Método: La muestra fue de 1104 niños de 3 a 6 años, procedentes de aulas preescolares urbanas y rurales. Se aplicó a los maestros la Peer Conflict Scale(PCS), para recabar información de agresiones físicas directas, verbales, con objetos y simbólicas, y el cuestionario de psicopatología ECI-IV. Resultados: Un 6.6% (n = 73) puntuó positivamente por lo menos en un item de la PCS. Este porcentaje decreció hasta un 2.6 % (n = 29) con una definición de caso más exigente (mínimo tres ítems positivos). La agresión física directa fue la forma más frecuente de agresión seguida de agresión verbal y agresión con objetos. Hubo diferencias significativas según edad y sexo. La agresión dirigida a iguales se asocia al sexo masculino desde los 3 años. La agresión física directa, con objetos y verbal correlaciona con trastornos externalizantes, principalmente con trastornos oposicionistas. Conclusiones: Esta investigación en población española confirma la existencia de agresividad hacia iguales en preescolares así como diferencias según sexo. Nuestra principal aportación es haber encontrado diferencias de sexo en el inicio y en los tipos de agresividad hacia iguales (AU)

Temperamental dimension and anxiety problems in a clinical sample of three- to six-year old children: a study of variables.

In the last few years, many researchers have studied the presence of common dimensions of temperament in subjects with symptoms of anxiety. The aim of this study is to examine the association between temperamental dimensions (high negative affect and activity level) and anxiety problems in clinical preschool children. A total of 38 children, ages 3 to 6 years, from the Infant and Adolescent Mental Health Center of Girona and the Center of Diagnosis and Early Attention of Sabadell and Olot were evaluated by parents and psychologists. Their parents completed several screening scales and, subsequently, clinical child psychopathology professionals carried out diagnostic interviews with children from the sample who presented signs of anxiety. Findings showed that children with high levels of negative affect and low activity level have pronounced symptoms of anxiety. However, children with anxiety disorders do not present different temperament styles from their peers without these pathologies.

Temperamental dimension and anxiety problems in a clinical sample of three- to six-year old children: a study of variables

In the last few years, many researchers have studied the presence of common dimensions of temperament in subjects with symptoms of anxiety. The aim of this study is to examine the association between temperamental dimensions (high negative affect and activity level) and anxiety problems in clinical preschool children. A total of 38 children, ages 3 to 6 years, from the Infant and Adolescent MentalHealth Center of Girona and the Center of Diagnosis and Early Attention of Sabadell and Olot were evaluated by parents and psychologists. Their parents completed several screening scales and, subsequently, clinical child psychopathology professionals carried out diagnostic interviews with children from the sample who presented signs of anxiety. Findings showed that children with high levels of negative affect and low activity level have pronounced symptoms of anxiety. However, children with anxiety disorders do not present different temperament styles from their peers without these pathologies (AU)

En los últimos años, diversos investigadores han estudiado la presencia de dimensiones temperamentales comunes en sujetos con sintomatología ansiosa. El objetivo del presente estudio es examinar la asociación entre dimensiones temperamentales (afecto negativo y nivel de actividad) y problemas de ansiedad en niños clínicos preescolares. Un total de 38 niños de 3 a 6 años de edad, pertenecientes al Centro deSalud Mental Infanto-Juvenil de Girona y al Centro de Diagnóstico y Atención Precoz de Sabadell y Olot, fueron evaluados por sus padres y por psicólogos. Los padres contestaron a diversas escalas de cribaje y, posteriormente, diversos profesionales en psicopatología clínica infantil realizaron entrevistas diagnósticas a los niños de la muestra que presentaban indicios de ansiedad. Los hallazgos obtenidos muestran que los niños con elevados niveles de afecto negativo y bajos niveles de actividad presentan elevada sintomatología ansiosa. Sin embargo, los niños con trastornos de ansiedad no presentan un estilo temperamental distinto al de los niños sin estas patologías (AU)