Exploring the Nexus of Adverse Childhood Experiences and Aggression in Children and Adolescents: A Scoping Review.

A strong relation between adverse childhood experiences (ACE) and aggression has been established in adult populations, with less research examining this relation earlier in development. The purpose of this study was to complete a scoping review of the current evidence available on the relation between ACE and aggression and subtypes of aggression within a child and adolescent population. Inclusion criteria for the review included publications in English between 1998 and 2023, use of a child/adolescent population, and peer-review and quantitative publications. Databases searched included PubMed, APA PsycINFO, Scopus, and EBSCO, and search terms included words related to ACE and aggression. Initial selection was based on title and abstract, with 32 papers meeting eligibility criteria for inclusion. Two authors extracted the relevant characteristics of the studies independently and conferred on any disagreements. The overall findings from the scoping review suggest that there is a strong link between aggression and ACE; however, this link may not be as strong for specific subtypes of aggression. Additionally, characteristics of ACE may play role in understanding this relation, but little research is available within a child and adolescent population. A few studies have attempted to examine potential mediators and moderators of this relation; however, none have been replicated within a child and adolescent population. The findings from this review support the need for additional research in this area and identify significant gaps in the literature that need to be addressed within a child and adolescent population.

Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms.

Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.

Psychometric properties of the children's emotion management scales within a psychiatric sample.

The Children's Emotion Management Scales (CEMS) are widely used measures of children's emotion regulation strategies in response to three specific emotions: sadness, anger, and worry. Original factor analyses suggested a three-factor subscale structure for each emotion: inhibition, dysregulation, and coping (Zeman et al., 2001, 2002, 2010). However, this factor structure had not been reexamined since it was originally developed, including within a racially diverse psychiatric sample. The present study attempted to address this gap for the Anger Management Scale and Sadness Management Scale separately, as well as testing the overarching structure of these two in combination. Participants included 302 children (ages 8-12; 70.4% boys; 55.72% African American; 39.3% White) from inpatient and outpatient centers and their primary caregivers. The three-factor structure replicated well with the Anger Management Scale and Sadness Management Scale separately in our sample. A bifactor model that included both higher order emotion factors (i.e., Anger and Sadness) and higher order strategy factors (i.e., Coping, Dysregulation, and Inhibition) best represented the overarching structure of the CEMS. Results from latent correlations and structural regressions showed that some of these factors were related to child-reported depressive symptoms and parent-reported disruptive behaviors, supporting the validity of the bifactor model conceptualization of scores on the CEMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pathways from child maltreatment to proactive and reactive aggression: The role of posttraumatic 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 1 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 posttraumatic stress symptoms (PTSS). Several prevailing theoretical models of both posttraumatic 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. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

It took a pandemic: Perspectives on impact, stress, and telehealth from caregivers of people with autism.

Shelter in place mandates due to the COVID-19 pandemic left caregivers to determine how to best meet the therapeutic requirements of their children with autism spectrum disorder (ASD). Understanding the challenges faced by families, and their experiences using telehealth for the first time, may help make services sustainable in future public health emergencies. A sample of 70 caregivers of people with ASD from across the US completed an anonymous online survey. Results indicate that impaired emotion regulation was a primary contributor of parent-reported stress for persons with ASD during the pandemic, while loss of established structure and routine contributed to parental stress. Nearly half the sample reported using telehealth for the first time. Many caregivers were appreciative that telehealth permitted continuation of services, but expressed concerns about limited effectiveness due in part to their children's social communication problems.

"This may be a really good opportunity to make the world a more autism friendly place": Professionals' perspectives on the effects of COVID-19 on autistic individuals.

Background: The COVID-19 (C-19) pandemic affects everyone. Autistic individuals may be at increased risk of experiencing difficulties coping with the impact of C-19 (e.g. due to unexpected changes to usual activities and routines, and the general sense of uncertainty). This preliminary study gathered the perspectives of health and social care professionals, and researchers, about: (1) vulnerability factors for coping with the pandemic; (2) the impact of the pandemic; (3) service provision during the pandemic; and (4) interventions to support reintegration during and post the pandemic. Method: We conducted an online survey, comprising Likert-scale and free text responses. Quantitative data were analysed descriptively, and qualitative data thematically. Results: Thirty-seven participants, working in clinical, education and academic settings with autistic individuals, completed the survey. C-19 had substantially impacted service provision, causing major disruption or loss of services. Thematic analysis indicated six overarching themes: (1) vulnerability factors for coping with C-19 and lockdown; (2) positive and negative impact of lockdown (for autistic individuals, families and professionals); (3) public health response to C-19; (4) service provision during the pandemic; (5) inequalities; and (6) looking to the future. Conclusions: Professionals, across disciplines and settings, must now work together with autistic individuals and their families, to understand the impact of these extraordinary circumstances and develop ways everyone can be supported more effectively.

Comorbid Internalizing and Externalizing Symptoms Among Children with ADHD: The Influence of Parental Distress, Parenting Practices, and Child Routines.

Emotional/behavioral concerns are common among children with ADHD. Familial factors (e.g., parental adjustment, parenting behaviors) are linked to the presence of comorbid internalizing/externalizing symptoms among children with ADHD. The purpose of the present study was to evaluate a model that includes multiple familial variables and their direct and indirect effects on child emotional and behavioral problems among children with ADHD. Participants included parents of children (6-12 years of age; M = 8.87, SD = 1.92) with a diagnosis of ADHD (N = 300). Participants completed measures of child emotional/behavioral concerns, parental distress, routines, and parenting behaviors. Path analyses revealed direct effects for parental distress, parent behavior and routines on child adjustment, after controlling for the other variables. A significant indirect relation between parental distress, routines, and externalizing behavior was observed. These findings highlight one specific path through which parental distress appears to influence specific behavioral concerns that are commonly observed in children with ADHD.

Sluggish Cognitive Tempo and Behavioral Difficulties in Children with ADHD: Associations with Internalizing and Externalizing Symptoms.

Sluggish cognitive tempo (SCT) appears to be distinct from attention-deficit/hyperactivity disorder (ADHD) and unique patterns of association between SCT and comorbid symptoms have been reported in the literature. The current study examined the relation between environmental supports and comorbid concerns among children with high SCT. Parents of children (ages 6-12) with a diagnosis of ADHD and clinically elevated SCT (N = 126) completed measures of emotional/behavioral functioning, child routines, and parental adjustment. Regression analyses revealed that after controlling for child age and parental adjustment, Household and Daily Living routines were associated with lower levels of externalizing symptoms while Discipline routines were associated with higher levels of these symptoms, accounting for nearly 20% of the variance in the equation. The findings suggest that for children with ADHD and high SCT routines may play an important role as an environmental support for externalizing symptoms.

Predicting Internalizing and Externalizing Symptoms in Children with ASD: Evaluation of a Contextual Model of Parental Factors.

Parental adjustment, parenting behaviors, and child routines have been linked to internalizing and externalizing child behavior. The purpose of the present study was to evaluate a comprehensive model examining relations among these variables in children with ASD and their parents. Based on Sameroff's Transactional Model of Development (Sameroff in: The transactional model of development: How children and contexts shape each other, American Psychological Association, Washington, DC, 2009), researchers hypothesized that these factors would collectively predict child behavior. Parents (n = 67) completed measures of parental adjustment, parenting behaviors, child routines, and child behavior using the Hopkins Symptom Checklist, Alabama Parenting Questionnaire, Child Routines Inventory, and Child Behavior Checklist, respectively. Results indicated that parental adjustment predicted harsh/disengaged parenting (B = 0.17, p < .01) and internalizing behavior (B = 0.32, p < .01). Harsh/disengaged parenting and warm/supportive parenting predicted externalizing behavior (B = 0.59, p < .01) and internalizing behavior (B = - 0.49 p < .01), respectively.

A Longitudinal Study of Hardiness as a Buffer for Posttraumatic Stress Symptoms in Mothers of Children with Cancer.

Mothers of children diagnosed with cancer have been found to be at a heightened risk for post-traumatic stress symptoms (PTSS). In an effort to identify a potential buffer, hardiness was examined as a protective factor for PTSS among mothers of children that were diagnosed with cancer in the past 2 weeks. Using a prospective design, mothers completed measures of PTSS and hardiness at the time of their child's cancer diagnosis and then again at 6- and 12-months post-diagnosis. Random effects regression analyses revealed that mothers who scored high on hardiness were less likely to experience PTSS after controlling for the effect of time. PTSS cluster-specific relations with hardiness were also examined, which revealed that mothers who scored high on hardiness experienced fewer avoidance/numbing symptoms at the time of their child's diagnosis of cancer and across 12 months; whereas mothers who scored low on hardiness tended to experience more avoidance/numbing symptoms at the time of their child's diagnosis. However, these symptoms declined gradually over the course of 12 months. The present findings support examining hardiness further as a buffer against specific PTSS clusters and exploring options for identifying and treating mothers of children with cancer that may be at risk for PTSS.

Racial/ethnic disparities in the risk of posttraumatic stress disorder symptoms among mothers of children diagnosed with cancer and Type-1 diabetes mellitus.

OBJECTIVE: Research findings have indicated that mothers of children diagnosed with life-threatening illnesses can be at risk for posttraumatic stress disorder (PTSD) symptoms (PTSS), with African American mothers being especially vulnerable because of evidence suggesting higher rates of PTSD among both African Americans and women. Race/ethnicity, past trauma exposure and the interaction of these variables were evaluated as risk factors for PTSS, depression, and state and trait anxiety among African American and Caucasian mothers of chronically ill children. METHOD: Mothers of children (N = 91) diagnosed with a life-threatening illness (i.e., cancer or Type-I diabetes mellitus [T1DM]) completed standardized measures and provided a salivary cortisol sample while attending medical appointments for their ill children. RESULTS: A MANCOVA revealed that mothers of children diagnosed with T1DM had higher cortisol levels than mothers of children with cancer. There was no racial or ethnic disparity in the risk of PTSS among the mothers. CONCLUSION: These findings suggest that mothers of children with T1DM may be vulnerable to stress reactions, as reflected by cortisol, a biological marker. Clinicians and researchers might consider illness-specific features when evaluating the risk of stress reactions among mothers of children with life-threatening illnesses. (PsycINFO Database Record

A Preliminary Investigation of the Relation Between Thyroid Functioning and Sluggish Cognitive Tempo in Children.

OBJECTIVE: To test the hypothesis that thyroid functioning would be uniquely associated with sluggish cognitive tempo (SCT) symptoms but not Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms of ADHD. METHOD: Serum thyroid stimulating hormone (TSH) was collected from a sample of psychiatrically hospitalized children ( N = 570; ages = 6-12), with rates of TSH similar to those found in the normative pediatric population. Caregivers completed narrowband measures of SCT and ADHD symptoms and broadband measures of internalizing/externalizing symptoms. RESULTS: A significant, positive relation was found between TSH concentration and SCT symptoms, but not between TSH and ADHD symptoms. Furthermore, regression analyses indicated that the association between TSH and SCT remained significant after controlling for child demographic characteristics, broadband measures of internalizing and externalizing symptoms, and ADHD symptoms. However, effects were small in magnitude. CONCLUSION: Although preliminary, results indicate that thyroid functioning may be related to SCT. Given the small effects, however, it is important for future research to examine other endocrine and biological correlates that may inform models of the developmental psychopathology of SCT.

Sluggish cognitive tempo is associated with suicide risk in psychiatrically hospitalized children.

BACKGROUND: Although identified as a significant public health concern, few studies have examined correlates of suicide risk in school-aged children. Recent studies show a relation between sluggish cognitive tempo (SCT) symptoms and a range of adverse outcomes linked to suicidal ideation, including depression, emotion dysregulation, lowered self-esteem, and peer problems/social withdrawal, yet no study to date has examined SCT in relation to suicide risk. METHODS: We tested the hypothesis that SCT would be associated with suicide risk in a sample of 95 psychiatrically hospitalized children (74% male; 62% black) between the ages of 8 and 12 (M = 10.01, SD = 1.50). Parents completed measures of their child's psychiatric symptoms, including SCT and depression, as well as a measure of their own psychopathology. Children completed measures assessing loneliness and depression. Both parents and children completed measures of suicide risk. RESULTS: White children reported greater suicide risk than nonwhite children. After controlling for demographic characteristics, loneliness, parental psychopathology, and correlated psychiatric symptoms, including both parent- and child self-reported depressive symptoms, SCT remained uniquely associated with children's suicide risk. Results were consistent across both parent and child measures of suicide risk. CONCLUSIONS: This multi-informant study provides strong preliminary support for an association between SCT symptoms and suicide risk in psychiatrically hospitalized children, above and beyond loneliness, depression, and demographic characteristics. Findings are discussed in the context of the interpersonal theory of suicide. Additional studies are needed to replicate and extend these findings, with a particular need for studies that examine the cognitive processes and daydreaming content of individuals displaying elevated SCT symptomatology.

The Role of Parenting Styles in the Relation Between Functions of Aggression and Internalizing Symptoms in a Child Psychiatric Inpatient Population.

Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.

A longitudinal study of the role of cortisol in posttraumatic stress disorder symptom clusters.

BACKGROUND AND OBJECTIVES: Research examining the role of cortisol in posttraumatic stress disorder (PTSD) has largely been cross-sectional studies and few studies have examined cortisol in relation to specific symptom clusters. Examining cortisol in relation to specific PTSD symptom clusters could aid in identifying candidates for symptom-specific treatments. Hence, cortisol was examined in relation to specific PTSD symptom clusters including reexperiencing, avoidance, numbing, and hyperarousal symptoms. DESIGN: A repeated-measures longitudinal design was utilized to predict PTSD symptom clusters. METHODS: Mothers of children (N = 27) diagnosed with cancer completed a measure of PTSD, and they provided salivary cortisol samples at the time of their child's diagnosis as well as monthly for the following 12 months. RESULTS: Multi-level modeling analyses revealed that higher cortisol levels were significantly related to higher levels of numbing symptoms. Although numbing symptoms declined as cortisol levels declined across 12 months postcancer diagnosis, mothers with higher cortisol levels still reported more numbing symptoms. Reexperiencing, avoidance, and hyperarousal symptoms were not found to be related to cortisol level across time. CONCLUSIONS: The findings offer support for the role of cortisol in the manifestation of numbing symptoms. Further research is recommended with other trauma groups to maximize generalizations.

Sluggish cognitive tempo in psychiatrically hospitalized children: factor structure and relations to internalizing symptoms, social problems, and observed behavioral dysregulation.

As research examining sluggish cognitive tempo (SCT) advances, it is important to examine the structure and validity of SCT in a variety of samples, including samples of children who are clinically-distressed but not referred specifically for attention-deficit/hyperactivity disorder (ADHD). The present study used a large sample of psychiatrically hospitalized children (N = 680; 73 % male; 66 % African American) between the ages of 6 and 12 to examine the latent structure of SCT, ADHD, oppositional defiant disorder (ODD), depression, and anxiety using confirmatory factor analysis (CFA). Results of the CFA analyses demonstrated that SCT is distinct from these other dimensions of child psychopathology, including ADHD inattention, depression, and anxiety. Regression analyses indicated that SCT symptoms were positively associated with depression and, to a lesser degree, anxiety. SCT symptoms were also positively associated with children's general social problems, whereas SCT symptoms were negatively associated with an observational measure of behavioral dysregulation (i.e., frequency of time-outs received as a part of a manualized behavior modification program). These associations were significant above and beyond relevant child demographic variables (i.e., age, sex, race), children's other mental health symptoms (i.e., ADHD, ODD, depression, anxiety symptoms), and, for all relations except child anxiety, parents' own anxiety and depression symptoms.

Child routines and parental adjustment as correlates of internalizing and externalizing symptoms in children diagnosed with ADHD.

Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood, and the presence of comorbid externalizing and internalizing symptoms often result in severe negative long-term consequences. Multiple etiological factors contribute to the development of co-occurring symptoms. Family stability and consistency appear to be particularly important in effectively managing behavioral concerns. One important factor in producing consistency and stability is the use of routines. The current study examined how routines may be related to internalizing/externalizing symptoms in a clinical sample (N = 371) of children with ADHD (M age = 9.13, SD = 1.96; 77% male). After controlling for child age, gender, and parental adjustment, routines predicted both internalizing and externalizing symptoms. Specific subtypes of routines including Household, Discipline, and Homework Routines were found to significantly predict symptomatology. A positive relation was found between parental and child adjustment problems; however, support for routines moderating the relation between parent and child adjustment was not supported.

The role of cortisol and psychopathic traits in aggression among at-risk girls: tests of mediating hypotheses.

Multiple etiological factors (e.g., biological and personality predispositions) have been linked to the development of aggression. The purpose of the present study was to examine the relation between proactive/reactive aggression and biological (HPA-axis functioning) and personality characteristics (subdimensions of psychopathy) among girls at risk for aggressive behavior. Participants included girls (N = 158) admitted for acute psychiatric inpatient treatment (M age = 9.72; SD = 1.99). Parents completed a measure of proactive/reactive aggression and psychopathy upon admission. Fasting plasma cortisol levels were obtained the morning following the child's admission. Correlational analyses revealed a significant negative correlation between cortisol and the narcissism and impulsivity subdimensions of psychopathy as well as proactive/reactive aggression. A significant positive relation between proactive and reactive aggression and the three subdimensions of psychopathy was also observed. Path analyses revealed that only narcissism was uniquely and positively related to proactive and reactive aggression. Tests of indirect effects from cortisol to aggression through subdimensions of psychopathy indicated significant pathways via narcissism to proactive and reactive aggression. The findings support previous research linking narcissism uniquely to aggression for girls and suggest that the relation between cortisol and proactive/reactive aggression is mediated by narcissism.

Parental coping and posttraumatic stress symptoms among pediatric cancer populations: tests of competing models.

OBJECTIVE: The objective of this study is to examine the relation between parental coping style and the risk of parental and child posttraumatic stress symptoms (PTSS) among pediatric cancer survivors. METHODS: Child survivors of cancer ranging from 6 to 16 years of age (N = 111) completed standardized measures of depression and PTSS, while their parents completed standardized measures of PTSS and coping styles. RESULTS: Correlational analyses revealed that active and passive coping strategies were positively related to parental PTSS. Although child and parental PTSS were significantly related to each other, only one parental coping strategy-using substances-was significantly related to child PTSS. Regression analyses revealed support for a mediation and not for a moderation model for this relation, thereby suggesting that the relation between parental and child PTSS is mediated by parental substance use. CONCLUSIONS: Clinical implications including identifying risk factors for PTSS among pediatric cancer survivors are discussed.

Oppositional defiant disorder symptoms in relation to psychopathic traits and aggression among psychiatrically hospitalized children: ADHD symptoms as a potential moderator.

Oppositional defiant disorder (ODD) is associated with elevated rates of psychopathic traits and aggression. However, it remains unclear if attention-deficit/hyperactivity disorder (ADHD) symptoms exacerbate these relations, particularly in samples of children who are severely clinically distressed. The purpose of the present study was to test ADHD symptoms as a potential moderator of the relations of ODD symptoms to psychopathic traits (i.e., callous-unemotional [CU] traits, narcissism) and to aggressive subtypes (i.e., proactive, reactive aggression) in a large sample of children in an acute psychiatric inpatient facility (n = 699; ages 6-12). Multiple regression analyses indicated that, after controlling for child demographic variables, ADHD symptoms marginally exacerbated the relation between ODD symptoms and CU traits. Both ODD and ADHD symptoms had an additive, but not a multiplicative effect, in predicting narcissism. In addition, for a subset of the full sample for whom data were available (n =351), ADHD symptoms exacerbated the relation between ODD symptoms and both reactive and proactive aggression. These results suggest that ADHD symptoms tend to have a negative effect on the relation between ODD symptoms and markers of antisociality among children receiving acute psychiatric care.