Towards a Role for Clinical Pathology Diagnostics for Childhood Maltreatment.

Recent reports from the Center for Disease Control and Kaiser Permanente demonstrate that early life adverse experience leads to morbidity and mortality in adulthood. To date there are no objective tests that help care-givers or local child protective services make informed decisions for children with a history of abuse, neglect or trauma. This is the first report from a new group of trans-disciplinary investigators describing a new approach to identify the biological impact of childhood maltreatment using clinical pathology testing. Such new quantitative measurements will be useful to identify children at risk for poor mental and physical health outcomes and to follow response to interventions.

Body mass index trajectory throughout adolescence: a comparison of maltreated adolescents by maltreatment type to a community sample.

BACKGROUND: Childhood maltreatment is associated with adult obesity, but there is conflicting evidence regarding the relationship between childhood maltreatment and obesity during adolescence. OBJECTIVES: To compare the body mass index (BMI) trajectory of adolescents with a specific type of maltreatment (sexual abuse, physical abuse, emotional abuse or neglect) to adolescents with another type of maltreatment (maltreated sample n = 303) and to a comparison group (n = 151). METHODS: Individual growth models were used to estimate average growth trajectories of BMI percentile separately by sex (ages 9 to 22 years). Unconditional and conditional linear and quadratic growth models were estimated and maltreatment types were added before including covariates (ethnicity, anxiety, depression and pubertal stage). RESULTS: BMI growth trajectories of sexually abused girls and neglected girls were significantly different from comparison girls. Comparison girls had a growth trajectory that reached its apex at 15 years and then began to decline, whereas sexually abused girls and neglected girls had lower BMI than comparison girls until age 16-17 years when their BMI was higher than comparison girls. CONCLUSIONS: Late adolescence appears to be the developmental period during which differences in BMI percentiles become pronounced between girls with sexual abuse or with neglect vs. comparison girls.

A radiation hybrid map of mouse genes.

A comprehensive gene-based map of a genome is a powerful tool for genetic studies and is especially useful for the positional cloning and positional candidate approaches. The availability of gene maps for multiple organisms provides the foundation for detailed conserved-orthology maps showing the correspondence between conserved genomic segments. These maps make it possible to use cross-species information in gene hunts and shed light on the evolutionary forces that shape the genome. Here we report a radiation hybrid map of mouse genes, a combined project of the Whitehead Institute/Massachusetts Institute of Technology Center for Genome Research, the Medical Research Council UK Mouse Genome Centre, and the National Center for Biotechnology Information. The map contains 11,109 genes, screened against the T31 RH panel and positioned relative to a reference map containing 2,280 mouse genetic markers. It includes 3,658 genes homologous to the human genome sequence and provides a framework for overlaying the human genome sequence to the mouse and for sequencing the mouse genome.

Variants of intrafamilial sexual abuse experience: implications for short- and long-term development.

This study examines short- and long-term maladaptive outcomes in a sample of sexually abused females and a comparison group. The sample consists of intrafamilial sexual abuse victims ages 6-16 years at entry into the study and a demographically similar comparison group. The outcomes examined included measures of behavior and psychological problems such as aggressive behavior, depression, dissociation, and low self-esteem; and measures at two time points, first at entry into the study (median age 11 years) and approximately 7 years later (median age 18 years). The specific questions being addressed were (a) whether subgroups or profiles. based on the specific characteristics of the sexual abuse experienced, can be identified in this sample of abused females; and (b) whether these profile groups predict different patterns of adverse short- or long-term outcomes.

Social network constellation and sexuality of sexually abused and comparison girls in childhood and adolescence.

This longitudinal study examines how childhood and early adolescent (age 6 to 15) peer and nonpeer social networks relate to sexual attitudes and behaviors in adolescence and young adulthood (age 12 to 25) for sexually abused and comparison girls. A large number of male peers in childhood is related to heightened sexual activity, sexual preoccupation, increased sexual pressure, and risky sexual behavior in adolescence. High-quality, female, nonpeer relationships have a positive effect on attitudes toward casual sex. Multiple group models illuminate several cross-lag group moderators: (a) Abused girls who are happier with male nonpeers are less preoccupied with sex; (b) abused girls who are happier with male peers are more likely to use birth control; and (c) abused girls who have early physical relationships are more likely to engage in risky sexual behavior. Treatment implications include monitoring the effects of low-status peer groups, encouraging contact with female role models, and encouraging the formation of high-quality relationships with male peers and nonpeers.

A YAC-based physical map of the mouse genome.

A physical map of the mouse genome is an essential tool for both positional cloning and genomic sequencing in this key model system for biomedical research. Indeed, the construction of a mouse physical map with markers spaced at an average interval of 300 kb is one of the stated goals of the Human Genome Project. Here we report the results of a project at the Whitehead Institute/MIT Center for Genome Research to construct such a physical map of the mouse. We built the map by screening sequenced-tagged sites (STSs) against a large-insert yeast artificial chromosome (YAC) library and then integrating the STS-content information with a dense genetic map. The integrated map shows the location of 9,787 loci, providing landmarks with an average spacing of approximately 300 kb and affording YAC coverage of approximately 92% of the mouse genome. We also report the results of a project at the MRC UK Mouse Genome Centre targeted at chromosome X. The project produced a YAC-based map containing 619 loci (with 121 loci in common with the Whitehead map and 498 additional loci), providing especially dense coverage of this sex chromosome. The YAC-based physical map directly facilitates positional cloning of mouse mutations by providing ready access to most of the genome. More generally, use of this map in addition to a newly constructed radiation hybrid (RH) map provides a comprehensive framework for mouse genomic studies.

The health of overseas-born Australians, 1994-1996.

Analysis of mortality, hospital separations and self-reported health indicators by country of birth group has confirmed that overseas-born populations are generally in better health than their Australian-born contemporaries. The better health of the overseas-born may be reflected in both the willingness and eligibility of individuals to emigrate. Overseas-born individuals were placed into one of four groups according to place of birth. These included the United Kingdom and Ireland, Other Europe, Asia and Other. All population groups reported lower mortality and hospitalisation rates for all causes of disease combined. The Asian-born population had the lowest mortality rates with 38% less mortality for males and 30% less for females. Hospitalisation rates were also lower for the Asian-born, with males and females having 46% and 37% fewer hospital separations compared to the Australian-born population. However, diabetes mortality was greater for males and females from Other Europe, Asia and Other regions. Both males and females from the United Kingdom and Ireland group showed increased mortality from lung cancer. Mortality and hospitalisation for cervical cancer was also significantly higher for Asian-born and Other females. The mortality and hospitalisation data corresponded well with self-reported prevalence of health-related risk factors. For example, self-reported diabetes prevalence was higher for the Other Europe, Asia and Other groups. Asian and Other females reported significantly less use of regular Pap smear tests, reflecting their increased mortality and hospitalisation for cervical cancer. These results support the finding of past studies that the health of migrants is generally better than that of the Australian-born population and reflects a 'healthy migrant' effect.

Disclosure patterns of sexual abuse and psychological functioning at a 1-year follow-up.

This study describes the disclosure processes of a sample of 68 sexually abused girls, with a focus on the manner in which abuse was revealed--on purpose, accidentally, or resulting from a precipitating event. This categorization is a more descriptive conceptualization of the disclosure process than has been proposed or assessed in previous studies. The circumstances surrounding disclosure are found to be related to long term psychological functioning. Children who disclosed accidentally were younger, experienced abuse for shorter durations, and received the most therapy. At follow-up, children who purposely disclosed had greater anxiety and greater difficulties coping. Discussion focuses on ways in which identifying and encouraging the least traumatic methods of disclosure would contribute to better outcomes for victims of sexual abuse.

Factors affecting utilization of treatment services by sexually abused girls.

This study describes the naturalistic therapy experiences of a sample of sexually abused girls and the relationship of these experiences to demographic factors, abuse experiences, psychopathology, and family functioning. The sample consisted of 81 sexually abused girls, aged 6 to 16, participating in a longitudinal study of the effects of sexual abuse. Results indicated strong effects for abuse experiences and child psychopathology on the total amount of therapy received. Patterns of treatment utilization were associated with ethnic minority status, but these differences are confounded by differing abuse experiences for racial groups in the sample. Other patterns of treatment utilization are discussed, as well as issues for further research and implications for treatment providers.

Antinuclear antibodies and thyroid function in sexually abused girls.

Sexually abused girls manifest dysregulation of physiological stress response systems. In this exploratory investigation, 14 sexually abused and 13 control girls, ages 8-15 years, recruited from a prospective, longitudinal study, underwent plasma antinuclear antibody and thyroid function tests. Thyroid function tests and plasma antinuclear antibody titers did not differ between sexually abused and control girls. However, a significantly higher incidence of plasma antinuclear antibody titers was seen in abused subjects when compared with the frequency of positive antinuclear antibody titers in a sample of 22 adult healthy female volunteers, ages 20-58 years. These findings suggest that sexually abused girls may show evidence of an alteration in normal immune homeostatic function.

Hypnotizability and dissociativity in sexually abused girls.

Research on the relation between hypnotizability and clinical dissociation has led to contradictory findings. Measures of hypnotizability and dissociation are only weakly correlated in general population samples, but studies of posttraumatic stress and dissociative disorders patients have found elevated levels of clinical dissociation and hypnotizability respectively. This study assesses the relationships among hypnotizability, clinical dissociation and traumatic antecedents in 54 sexually abused girls, ages 6-15 years, and 51 matched controls. Hypnotizability was assessed on initial evaluation and again in matched subsamples at one year using the Stanford Hypnotic Clinical Scale for Children. Clinical dissociation was assessed using the Child Dissociative Checklist. Abuse variables were extracted from Child Protective Services reports. There were no significant differences in hypnotizability between abuse and control subjects. There were significant differences in clinical dissociation initially and on 1-year retest. Hypnotizability and clinical dissociation were only weakly correlated (r(105) = .118, p = NS). However, in the abuse group, highly hypnotizable subjects were significantly more dissociative. Higher levels of clinical dissociation were associated with abuse by multiple perpetrators and co-presence of physical abuse independent of the sexual abuse. A small subgroup of "double dissociative" subjects, high in both hypnotizability and dissociativity, was identified. Double dissociation was associated with multiple perpetrators and earlier onset of sexual abuse.

Urinary catecholamine excretion in sexually abused girls.

OBJECTIVE: The objective of this study was to examine urinary catecholamine excretion in a self-selected sample of sexually abused and demographically matched control girls recruited from a prospective, longitudinal study. METHOD: Twenty-four--hour urinary catecholamine and metabolite concentrations of epinephrine, norepinephrine, dopamine, 3-methoxy-4-hydroxyphenylglycol, metanephrine, normetanephrine, vanillylmandelic acid, 3,4-dihydroxyphenylacetic acid, and homovanillic acid were measured in 12 sexually abused and 9 control girls, aged 8 to 15 years. Psychiatric profiles also were obtained. RESULTS: The abused subjects excreted significantly greater amounts of metanephrine, vanillylmandelic acid, homovanillic acid, and total catecholamine synthesis as measured by the sum of epinephrine, norepinephrine, dopamine, and their metabolites compared to values from control subjects. When the means of all significant biochemical measures were adjusted by the covariate effect of height, only homovanillic acid and group interaction remained significant. There were positive trends toward significantly higher urinary excretion of metanephrine, vanillylmandelic acid, and total catecholamine synthesis. Sexually abused girls also had a greater incidence of suicidal ideation, suicide attempts, and dysthymia than control girls. CONCLUSIONS: These findings support the idea that sexually abused girls show evidence of higher catecholamine functional activity compared with controls. The clinical significance of these findings in their similarity to the psychobiology of both post-traumatic stress disorder and major depressive disorder. Results from this pilot study may be of value in understanding the mechanisms of depressive and anxiety disorders and in the clinical treatment of maltreated children.

Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls.

Childhood sexual abuse is associated with an increased incidence of age-concurrent and adult psychopathology. Little is known, however, about the biological manifestations and sequelae of childhood sexual abuse. In this study, we characterized the hypothalamic-pituitary-adrenal axis of a self-selected sample of sexually abused and control girls recruited from a prospective longitudinal study. Plasma ACTH and total and free cortisol responses to ovine CRH (oCRH) stimulation were measured in 13 sexually abused and 13 control girls, aged 7-15 yr. Psychiatric profiles and 24-h urinary free cortisol (UFC) measures were also obtained. Sexually abused girls had a greater incidence of suicidal ideation (chi 2 = 4.51; df = 1; P < 0.05), suicide attempts (chi 2 = 4.51; df = 1; P < 0.05), and dysthymia (chi 2 = 8.85; df = 1; P < 0.01) than control girls. Sexually abused girls showed significantly lower basal (t = 2.1; df = 24; P < 0.05), and net oCRH stimulated (t = 2.2; df = 24; P < 0.05) ACTH levels and significantly reduced total ACTH responses (t = 2.5; df = 24; P < 0.05) compared with control subjects. Their total and free basal and oCRH-stimulated plasma cortisol levels and 24-h UFC measures, however, were similar to those in controls. The attenuated plasma ACTH with corresponding robust plasma cortisol responses to oCRH stimulation and normal 24-h UFC measures in sexually abused girls suggest a dysregulatory disorder of the HPA axis in these individuals. This may reflect pituitary hyporesponsiveness to oCRH. The ability of sexually abused subjects to correct for the proposed pituitary hyporesponsiveness to CRH may be related to their young age and the presence of intact glucocorticoid feedback regulatory mechanisms.

Development, reliability, and validity of a child dissociation scale.

Dissociation is a complex psychophysiological process that ranges along a continuum from minor, normal dissociation to Axis I psychopathology. High levels of dissociation are associated with increased self-destructive behaviors and other symptoms. Although several validated measures of dissociation exist for adults, no measures are available for children. The Child Dissociative Checklist (CDC) was developed to meet this need and is a reliable and valid observer report measure of dissociation in children. The CDC had a 1-year test-retest reliability coefficient of rho = .69 (N = 73, p = .0001) in a sample of normal and sexually abused girls. The CDC had high discriminant validity among four test samples including: normal control girls, sexually abused girls, boys and girls with dissociative disorder NOS and boys and girls with multiple personality disorder. The CDC is intended as a clinical screening instrument and as a research measure. The CDC is not designed to be used as a diagnostic instrument.

Child sexual abuse: a model of chronic trauma.

Although there is a general consensus among concerned professionals that exposure to community violence is likely to be stressful and may contribute significantly to immediate and long-term mental health problems, there is virtually no empirical research on either its acute or enduring effects. In the absence of data, investigators planning research in this area must look to other studies of the impact of chronic environmental trauma on children, including the effects of war and child maltreatment. Research on child abuse provides an important source of information on the effects of trauma on children because it draws on both prospective and retrospective studies crossing a variety of theoretical perspectives and disciplines. The existence of data on both the acute impact of abuse on children and its chronic effects and outcomes in adults informs the generation of developmentally based psychological and biological hypotheses. This paper utilizes data from research on the acute and chronic effects of sexual abuse to discuss three broad hypotheses that may be relevant to the study of the effects of community violence on children.

A multimethod approach to the assessment of physical abuse.

Numerous and heterogeneous symptoms of maladjustment have been documented among victims of physical abuse. Much of the well-controlled, theoretically guided research is rooted in methodology designed to search for group differences between abused children and a comparison group. Given the recognized methodological problems in constructing appropriate comparison groups for abused children, this study is designed to examine alternative methodological approaches. The purpose of the study is to utilize a case study to illustrate the utility of a multimethod approach to highlight intraindividual variation in the impact of abuse. This study of physically abused twin boys demonstrates that differential patterns of findings are revealed by standardized assessment in comparison to behavioral observation. The results underscore intraindividual variation in the impact of abuse. It is suggested that innate temperamental factors interact with parent-child interaction patterns to account for such intraindividual variation.

Metabolic balance of manganese in young men consuming diets containing five levels of dietary manganese.

Five healthy men, ages 19-20, were fed a diet for 105 d to measure manganese balance during consumption of conventional foods. The study was divided into five periods of 21, 21, 38, 11 and 14 d, in which the daily dietary intakes of manganese (Mn) were 2.89, 2.06, 1.21, 3.79 and 2.65 mg, respectively. During the last 7 d of each dietary period, subjects resided in a metabolic unit and fasting blood samples were drawn on two mornings. Feces and urine were collected during the last 6 d and integumental losses were collected during the last 60 h of each period. The mean Mn balances for periods 1-5 were -0.083, -0.018, -0.088, +0.657 and +0.136 mg/d, respectively. Corresponding apparent retentions were -2.90, -0.88, -7.40, +17.33 and +5.12%. The mean sum of endogenous and exogenous losses when intake was theoretically zero was calculated to be 392 micrograms/d. When these total losses were combined with the mean positive retention, the theoretical mean dietary level of Mn required for positive balance for these male subjects was 3.5 mg/d or 50 micrograms/kg.

Manganese balance and clinical observations in young men fed a manganese-deficient diet.

A balance study was conducted to determine the minimum requirement for manganese (Mn) and to examine the effects of Mn depletion. Seven male subjects, age 19-22, were fed a Mn-adequate diet of conventional foods (2.59 mg Mn/d, 135 mg cholesterol, and P:S ratio of 0.86) for 3 wk to establish base-line data. Then a purified diet containing 0.11 mg Mn/d was fed for 39 d (depletion), followed by two 5-d periods of 1.53 and 2.55 mg Mn/d (repletion). Diets, feces, urine, and integument were analyzed for Mn, and blood was analyzed for Mn, cholesterol, and other constituents. Plasma levels of cholesterol decreased from 170 to 152 mg/dL during the base-line period, and then to 142 mg/dL at the end of depletion, but did not respond to 10 days of repletion. A fleeting dermatitis, Miliaria crystallina, developed in five of the seven subjects at the end of depletion, but disappeared as repletion began. The minimum requirement for Mn on this purified diet, calculated by the factorial method using Mn balance at three levels of intake was 0.74 mg/d. This requirement would be increased to 2.11 mg/d if the obligatory loss was combined with the lowest individual percentage of retention.