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Both childhood adversity (CA) and first-episode psychosis (FEP) have been linked to alterations in cortical thickness (CT). The interactive effects between different types of CAs and FEP on CT remain understudied.
Methods
One-hundred sixteen individuals with FEP (mean age = 23.8 ± 6.9 years, 34% females, 80.2% non-affective FEP) and 98 healthy controls (HCs) (mean age = 24.4 ± 6.2 years, 43% females) reported the presence/absence of CA <17 years using an adapted version of the Childhood Experience of Care and Abuse (CECA.Q) and the Retrospective Bullying Questionnaire (RBQ) and underwent magnetic resonance imaging (MRI) scans. Correlation analyses were used to assess associations between brain maps of CA and FEP effects. General linear models (GLMs) were performed to assess the interaction effects of CA and FEP on CT.
Results
Eighty-three individuals with FEP and 83 HCs reported exposure to at least one CA. CT alterations in FEP were similar to those found in participants exposed to separation from parents, bullying, parental discord, household poverty, and sexual abuse (r = 0.50 to 0.25). Exposure to neglect (β = −0.24, 95% CI [−0.37 to −0.12], p = 0.016) and overall maltreatment (β = −0.13, 95% CI [−0.20 to −0.06], p = 0.043) were associated with cortical thinning in the right medial orbitofrontal region.
Conclusions
Cortical alterations in individuals with FEP are similar to those observed in the context of socio-environmental adversity. Neglect and maltreatment may contribute to CT reductions in FEP. Our findings provide new insights into the specific neurobiological effects of CA in early psychosis.
Neglect remains understudied compared to other forms of maltreatment. While studies have shown that neglect has negative effects on mental health in adolescence, yet unresolved is whether these impacts result from critical period or cumulative effects. In the present article, we use a novel approach to compare these two hypotheses from the impact of two types of neglect, failure to provide (FTP) and lack of supervision (LOS), on adolescent depression and internalizing symptoms. Data derive from the LONGSCAN consortium, a diverse, multi-site, prospective study of children from approximately age 2–16. Despite our hypothesis that the critical period of early childhood would have the greatest impact on adolescent internalizing mental health, exposure to neglect during the critical period of adolescence (ages 12–16) was the best-fitting model for the effects of FTP neglect on depression, and the effects of LOS neglect on both depression and internalizing symptoms. The cumulative model (exposure across all time periods) best explained the effects of FTP neglect on internalizing symptoms. Results were robust to the addition of control variables, including other forms of maltreatment. These findings demonstrate that responding to neglect into adolescence must be considered as urgent for child welfare systems.
Medical practitioners have a statutory duty to notify the coroner, where the doctor suspects a ‘notifiable cause’ of death and where one considers a death ‘suspicious’, the police must also be informed immediately. This chapter explores the duties of the medical examiner and the duty of the coroner to investigate.
Most information about the association between childhood maltreatment (CM) and subsequent psychiatric morbidity is based on retrospective self-reports. Findings from longitudinal studies using prospective reports to statutory agencies may be subject to attrition. We therefore compared the prevalence to age 30 of inpatient psychiatric diagnoses in those who experienced agency-reported CM with those of the rest of the cohort using administrative data to minimise loss to follow-up.
Methods
We used linked administrative data for two birth cohorts of all individuals born in Queensland, Australia in 1983 and 1984 (N = 83,050) and followed to age 30 years. This was the entire cohort aside from 312 people who died. Information on CM came from statewide child protection data and psychiatric diagnoses from all public and private hospital admissions in Queensland.
Results
On adjusted analyses, the 4,703 participants (5.7%) who had been notified to the statewide child protection authority had three to eight times the odds of being admitted for any of the following psychiatric diagnoses by age 30 years old: schizophrenia-spectrum disorders, bipolar affective disorders, depression, anxiety and post-traumatic stress disorders (PTSD). There were similar findings for all the CM subtypes. Associations were especially strong for PTSD with between a seven – and nine-fold increase in the odds of admission.
Conclusions
This is one of the largest studies of the long-term effects of CM, covering an entire jurisdiction. All types of maltreatment are significantly related to a range of psychiatric disorders requiring hospitalisation. Early identification, intervention and providing appropriate support to individuals who have experienced CM may help mitigate the long-term consequences and reduce the risk of subsequent mental health problems.
Child maltreatment impacts approximately one in seven children in the United States, leading to adverse outcomes throughout life. Adolescence is a time period critical for the development of executive function, but there is little research examining how abuse and neglect may differently affect the developmental trajectories of executive function throughout adolescence and into young adulthood. In the current study, 167 adolescents participated at six time points from ages 14 to 20. At each time point, adolescents completed behavioral tasks measuring the three dimensions of executive function (working memory, inhibitory control, and cognitive flexibility). Neglect and abuse in early life (ages 1–13) were reported at ages 18–19. Unconditional growth curve models revealed age-related improvement in all three executive function dimensions. Conditional growth curve models tested the prospective effects of recalled neglect and abuse on the developmental trajectories of executive function. The results revealed that neglect was associated with developmental changes in working memory abilities, such that greater levels of neglect during ages 1–13 were associated with slower increases in working memory abilities across ages 14–20. These findings highlight the adverse consequences of early neglect experiences shown by delayed working memory development during adolescence into young adulthood.
Adverse childhood experiences (ACEs) are a measure of childhood adversity and are associated with life-long morbidity. The impacts of ACEs on peripartum health including preeclampsia, a common and dangerous hypertensive disorder of pregnancy, remain unclear, however. Therefore, we aimed to determine ACE association with peripartum psychiatric health and prevalence of preeclampsia using a case–control design.
Methods:
Clinical data were aggregated and validated using a large, intergenerational knowledgebase developed at our institution. Depression symptoms were measured by standard clinical screeners: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). ACEs were assessed via survey. Scores were compared between participants with (N = 32) and without (N = 46) prior preeclampsia.
Results:
Participants with ACE scores ≥4 had significantly greater odds of preeclampsia than those with scores ≤ 3 (adjusted odds ratio = 6.71, 95% confidence interval:1.13–40.00; p = 0.037). Subsequent speculative analyses revealed that increased odds of preeclampsia may be driven by increased childhood abuse and neglect dimensions of the ACE score. PHQ-9 scores (3.73 vs. 1.86, p = 0.03), EPDS scores (6.38 vs. 3.71, p = 0.01), and the incidence of depression (37.5% vs. 23.9%, p = 0.05) were significantly higher in participants with a history of preeclampsia versus controls.
Conclusions:
Childhood sets the stage for life-long health. Our findings suggest that ACEs may be a risk factor for preeclampsia and depression, uniting the developmental origins of psychiatric and obstetric risk.
Stroke results in various cognitive and motor impairments. The most frequent cognitive problem is spatial and non-spatial attention, typically caused by unilateral brain lesion. Attention is typically assessed with several different paper-and-pencil tests, which have long been criticized for their lack of theoretical basis, their limited ecological validity to deficits experienced in daily life, and their lack of measurement sensitivity (Appelros et al., 2004; Azouvi, 2017). Here, our global aim was to develop an innovative integrative serious game in an immersive environment. The REASmash, combines the evaluation of spatial attention, non-spatial attention, and motor performance. We present the spatial and non-spatial cognitive attention evaluation results.
Participants and Methods:
Eighteen first stroke individuals and 40 age-match healthy controls were assessed on the REASmash. They were instructed to find a target mole presented amongst distractor moles. The stimulus array consisted of a grid of 6 columns and 4 rows of molehills, from which the target and 11, 17 and 23 distractors moles could randomly appear, in two search conditions (single feature condition and saliency condition). Responses were made with the ipsilesional hand for individuals with stroke and with the dominant hand for the healthy controls. Participants were evaluated also with two standardized clinical tests of attention; the hearts cancellation task of the Oxford Cognitive Screen, and the visual scanning subtest of the Test for Attentional Performance.
Results:
Validation results showed significant and strong correlations between the REASmash and the two reference tests, with the REASmash showing high sensitivity and specificity (i.e., the correct identification of the post-stroke vs. control individuals). The REASmash also showed significant and strong test/re-test reliability. We additionally evaluated user experience using the UEQ, and the results showed excellent attractiveness and novelty, and good stimulation and efficiency.
Conclusions:
In conclusion, the REASmash is a novel immersive virtual environment serious game that is valid, sensitive, and usable. It provides a new diagnosis measure spatial and non-spatial attention impairment.
The prism adaptation (PA) with rightward shifting lenses is a promising rehabilitation technique for left hemispatial neglect. The PA has also been applied in healthy individuals to investigate cognitive mechanism(s) underlining such adaptation. Importantly, studies have suggested that PA may primarily impact the functions of the dorsal or the ventral attentional stream, and we have previously reported that PA to the upward and downward shifting lenses leads to a significant aftereffect in vertical line bisection task. However, this post-adaptation effect, similarly to that seen in the horizontal plane, might have been modified by the presence of the vertical pseudoneglect healthy participants often experience prior to PA. Thus, the aim of this study was to test this hypothesis.
Participants and Methods:
30 right-handed healthy adults (age M=22,4) performed a computerized line bisection (LB) in vertical and horizontal condition. The bisections were performed twice: before and after PA procedure. Participants took experimental procedure three times, each in at least 24 h of break, each time in one of three conditions of shifting lenses; down, up, control. Both LB tasks (vertical and horizontal) consisted of 24 lines, each centered on 23" touch screen. The participants were asked to find the middle of the line. Throughout the experiment, participants were comfortably seated with their head positioned on a chinrest. Participants were fitted with prismatic goggles that deviated their visual field by 10 degrees. For the adaptation we used the Peg-the-mole procedure consisting of 120 pointing movements.
Results:
To assess the effect of the vertical PA on landmark judgments we performed a repeated measures ANOVA with direction of PA (upward/downward), the condition of LB (vertical/ horizontal) and pre- vs post adaptation as a between-subjects factor. This analysis revealed a main effect of the direction of PA (p< 0.001) and a main effect of condition (p< 0.001). Overall, however, only adaptation in up-shifting lenses led to significant aftereffects (p<0.05). Further, when we excluded participants who did not exhibited horizontal pseudoneglect in preadaptation LB, the effect of PA in downshifting PA emerged in vertical LB (p<0.05). Further, this group also exhibited the aftereffect of PA in up-shifting lenses for the horizontal (p<0.01) and the vertical LB (p<0.05). Additionally, these participants exhibited a congruent tendency after upward and downward PA, and tended to allocate their attention more upward and rightward.
Conclusions:
The results of this study confirm that the vertical PA evokes a visuo-spatial bias. Moreover, the PA aftereffect seems to be modified by the presence of the pre-adaptation pseudoneglect. Whereas the mechanism inducing this bias is not fully known, it might be explained in light of the interhemispheric activation-inhibition balance. Both the upward and downward PA may primarily lead to activation of the posterior regions of the right hemisphere, and this activation may result with the upward and rightward bias in the LB task. However, future research with neuroimaging techniques is needed to test this hypothesis.
This chapter examines the specific challenges faced by individuals with a history of childhood maltreatment (CM) as they transition into parenthood. The transition to parenthood involves many challenges that require adjustment, such as adapting to one’s own bodily changes (for the birthing parent), forging a parental identity, and attaching to the infant. Although these tasks may not be easy for any parent-to-be, those who have experienced maltreatment during their childhood may find them especially difficult. One crucial domain in which these early life experiences might influence their core parenting skills is the ability to emotionally regulate themselves as well as model positive emotional regulatory processes for their children. The author presents various perspectives to explain how these early life experiences of abuse and neglect affect parental emotion self-regulation and current parenting approaches. This chapter adds valuable tools to the parental toolbox of those with a history of CM and guides such parents on how their regulatory skills can be improved to better equip themselves to cope with potential parenting challenges and raise well-adjusted children.
Having addressed exploitation and violence towards elders, the book moves to consider how some enslavers chose the less physical – but no less cruel – route of abandoning, selling, or simply neglecting enslaved people once they had become “old and broken.” Chapter 2 covers manumission laws and the efforts of enslavers to work around these; the significance of age to the dynamics of, and experiences in, the internal slave trade; and the tragic consequences of neglect for elders deemed unproductive by those whom enslaved them. Proslavery claims of “retirement” or of care from cradle-to-grave were no match for the economic self-interest of enslavers, small and large, and the driving force of slavery revolved around taking the “best years and the best strength” from enslaved people. This chapter shows how enslaved people understood this exploitative dynamic, and the horrifying consequences of it for Black elders, all too well
iLookOut, a web-based child abuse training for early childcare professionals (ECPs), has been shown to improve knowledge and attitudes related to correctly identifying and reporting suspected cases of child abuse. The overarching goal of the present study is to examine “what works for whom” for iLookOut in order to identify strategies for optimizing learner outcomes.
Methods:
This prospective study enrolled 12,705 ECPs who completed iLookOut (November 2014–December 2018). We used structural equation models to test whether learner demographic and professional characteristics were differentially associated with implementation outcomes (i.e., acceptability and appropriateness) and whether these mediated subsequent indicators of training effectiveness (i.e., gains in knowledge).
Results:
Consistent with previous research, individuals with lower baseline knowledge scores showed greater knowledge gains (β = −.57; p < .001). Greater knowledge gains were seen for learners who reported higher acceptability (β = .08; p < .001) or appropriateness (β = .14; p < .001). Implementation outcomes strongly associated with knowledge gains included acceptability for female learners and appropriateness for learners who had not completed high school or had >15 years of experience in childcare settings. Where mediation was found, for the majority of groups, appropriateness emerged as the driving mediator.
Conclusion:
Implementation outcomes emerged as important drivers of knowledge change for most groups. The iLookOut Core Training’s use of a multimedia learning environment, video-based storylines, and game-based techniques were endorsed by learners and correlated with increases in knowledge. Future work should explore why aspects of the iLookOut training are rated as less acceptable or appropriate by some groups and what changes would improve efficacy for low performing learners.
Chapter 7 summarises the book’s findings and explains their implications for advocacy and law reform. It argues that recognition of the indivisibility of human rights is important to ensure that targeted services are provided for people with disability to address their disproportionate levels of socio-economic disadvantage. It decries the privileging of civil and political rights especially the right to legal capacity over all other rights, for encouraging the ‘lazy state’ that erroneously justifies its neglect of marginalised people in the name of upholding their human rights. It provides the example of personalised or individualised services premised on simplistic notions of choice and control, which often fail to uphold the rights of people with cognitive disabilities. It stresses the importance for the state and community of acknowledging difference to promote services that ensure civil, economic, political, social and cultural inclusion in all cases.
Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies (N = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies (N = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.
Attachment theory has played an important role in attempts to understand the “cycle of violence,” where maltreated children are at increased risk for perpetrating violence later in life. However, little is known empirically about whether adult attachment insecurity in close relationships may partly explain the link between childhood maltreatment and violent behavior. This study aimed to address this gap using data from a prospective longitudinal study of documented childhood abuse and neglect cases and demographically matched controls (ages 0–11 years), who were followed into adulthood and interviewed (N = 892). Participants completed the Relationship Scales Questionnaire assessing adult attachment styles at mean age 39.54. Criminal arrest data were used to determine arrests for violence after the assessment of attachment through mean age 50.54. There were significant direct paths from childhood maltreatment and adult attachment insecurity to violent arrests after attachment measurement. Attachment insecurity partly explained the higher levels of violence in individuals with maltreatment histories. Analyses of maltreatment subtypes and attachment styles revealed that attachment anxiety appeared to mediate paths between neglect and physical abuse and later violence. There were no significant indirect paths from neglect or physical abuse to violence via attachment avoidance. Implications and future directions are discussed.
Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22–25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence.
Elder mistreatment is common and often overlooked by health-care providers. It may include physical abuse, psychological and emotional abuse, sexual abuse, financial exploitation, and neglect. While any older adult may be susceptible, particular mitigating factors discussed in this chapter include cognitive impairment and dementia, multimorbidity, substance use, socioeconomics and culture, and social isolation. Strategies for approaching clinical cases, identifying signs and symptoms, and developing interventions are explored using illustrative cases and selected findings from the growing literature on elder mistreatment across care settings.
Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA).
Methods/design:
The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains.
Results:
Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual’s orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search.
Conclusions:
The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.
This chapter explores the late 20th/early 21st century historical roots and reasoning of the animal protection movement’s efforts to strengthen animal anti-cruelty laws. With that backdrop, the chapter then discusses the essential need for data narrowly focused on anti-cruelty investigation and prosecution outcomes as advocates today consider criminal justice reform policy developments, and how recent legal and social advances can help support animal victims in the future.
Child maltreatment gives rise to atypical patterns of social functioning with peers which might be particularly pronounced in early adolescence when peer influence typically peaks. Yet, few neuroimaging studies in adolescents use peer interaction paradigms to parse neural correlates of distinct maltreatment exposures. This fMRI study examines effects of abuse, neglect, and emotional maltreatment (EM) among 98 youth (n = 58 maltreated; n = 40 matched controls) using an event-related Cyberball paradigm affording assessment of both social exclusion and inclusion across early and mid-adolescence (≤13.5 years, n = 50; >13.5 years, n = 48). Younger adolescents showed increased activation to social exclusion versus inclusion in regions implicated in mentalizing (e.g., superior temporal gyrus). Individual exposure-specific analyses suggested that neglect and EM coincided with less reduction of activation to social exclusion relative to inclusion in the dorsal anterior cingulate cortex/pre-supplementary motor area (dACC/pre-SMA) among younger versus older adolescents. Integrative follow-up analyses showed that EM accounted for this dACC/pre-SMA activation pattern over and above other exposures. Moreover, age-independent results within respective exposure groups revealed that greater magnitude of neglect predicted blunted exclusion-related activity in the parahippocampal gyrus, while EM predicted increased activation to social exclusion in the precuneus/posterior cingulate cortex.
Adverse childhood experiences (ACE) are associated with an increased risk for dementia, but this relationship and modifying factors are poorly understood. This study is the first to our knowledge to comprehensively examine the effect of ACE on specific cognitive functions and measures associated with greater risk and resiliency to cognitive decline in independent community-dwelling older adults.
Methods:
Verbal/nonverbal intelligence, verbal memory, visual memory, and executive attention were assessed. Self-report measures examined depression, self-efficacy, and subjective cognitive concerns (SCC). The ACE questionnaire measured childhood experiences of abuse, neglect, and household dysfunction.
Results:
Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and SCC. ACE scores were a significant predictor of intellectual function and executive attention; however, these relationships were no longer significant after adjusting for education. Follow-up analyses using the PROCESS macro revealed that relationships among higher ACE scores with intellectual function and executive attention were mediated by education.
Conclusions:
Greater childhood adversity may increase vulnerability for cognitive impairment by impacting early education, socioeconomic status, and mental health. These findings have clinical implications for enhancing levels of cognitive reserve and addressing modifiable risk factors to prevent or attenuate cognitive decline in older adults.