The purpose of the current study is to investigate the relationship between expusre to childhood maltreatment and the development of the cerebellar vermis and cerebrocerebellum. Reduced volumes in certain brian structures have been discovered in childhood maltreatment survivors, including the amygdala, hippocampus, and corpus callosum (Bremmer, et al., 1997; De Bellis, et al., 1999; Jackowski, et al., 2007; Teicher, et al., 2003; Teicher, et al., 2012). Furthermore, a number of studies have examined the impact of childhood abuse on cerebellar volume, suggesting that the cerebellum is susceptible to the effects of early stress (Anderson, et al., 2002; Bauer, et al., 2009; Beers & De Bellis, 2002; Carrion, et al., 2009; De Bellis & Kuchibhatla, 2006). However, few studies have examined the relation between type, frequency, and timing of maltreatment and cerebellar volume. Previous studies have addressed some of these questions, but had small sample sizes and were focused on different structures of the brain (rBRemmer, et al., 1997; De Bellis, et al., 1999). The current study proposes to examine cerebllar volume in relation to type, frequency, and timing of maltreatment with a considerably large sample size. It is hypothesized that there will be a significant relation between type, frequency, and timing of maltreatment and cerebellar volume. As the impact of maltreatment and development of the brain is still not fully understood, the current study seeks to contribute to the neuropsychological understanding of maltreatment and possibly shed light on potential treatment implications. / text

Despite considerable declines in physical and sexual abuse over recent decades, child maltreatment remains a public health priority. In 2014, 702,000 children were determined to be victims of maltreatment, 75% of whom experienced neglect (DHHS, 2016). An area in need of further scrutiny is the complex relationship of multiple risk factors and the association of those risk factors with subsequent child welfare involvement. The purpose of this three-manuscript dissertation was to examine evidence-based child maltreatment prevention through an empiric examination of risk and novel prevention efforts. The first paper, Getting the Most Juice for the Squeeze: Where SafeCare® and Other Evidence-based Programs Need to Evolve to Better Protect Children, discusses the dissemination and implementation of evidence-based prevention programs using SafeCare as an applied example. The paper concludes with recommendations for evidence-based practices to improve the outcomes of children and families. Among several recommendations, this paper suggests considering innovative implementation settings, collaboration between systems, and response to the underlying risk factors for maltreatment. The second paper, Drug Court as a Potential Point of Intervention to Impact the Well-being of Children and Families of Substance-Using Parents, responds to the recommendation of collaboration and innovation from the first paper. This descriptive study sought to describe the needs of families of adult drug court populations related to parenting and mental health services. Baseline data indicated a low potential for abuse and the need for mental health services among drug court participants and their children under 18-years old. The findings from this paper indicate a potential intervention and collaboration opportunity between the child welfare and criminal justice systems. The third paper, An Examination of Risk Profiles among Mothers Involved with Child Protective Services, responds to the need to better understand underlying risk factors among child welfare involved families as discussed in the first paper. A latent class analysis was conducted to explore the heterogeneity among women reported to child protective services. In what is typically a homogenously treated and characterized sample, this analysis indicated three classes of risk and examined the classes’ association with subsequent referral to child protective services. The findings of this research support the recommendation of the importance of better understanding underlying risk factors to better align services with needs of children and families.

An aim of this research was to gain prevalence rates of emotional abuse (EA) and emotional neglect (EN) in a community based adolescent sample. This exploratory research also attempted to determine the impact of EA, EN and a combination of the two (emotional maltreatment; EM) on adolescent’s emotion regulation (ER). The impact of temperament, gender and age was also considered, along with the adolescent’s subsequent quality of life ratings. Method: A total of 540 adolescents (mean age 14 years) were recruited through their secondary schools, and completed the following questionnaires: the EN and EA subtests of the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1994); the Early Adolescent Temperament Questionnaire – Short Form (EATQ – SF; Ellis & Rothbart, 1999); the Basic Emotions Scale (BES; Power, 2006); the Regulation of Emotions Questionnaire (REQ; Phillips & Power, 2007) and the Kid Screen -10 item Health Questionnaire for Children and Young People (Ravens-Sieberer et al., 2005). Results: Prevalence rates of EA and EN were reported. Differences were detected between EA and EN in terms of how they affect experiences of basic emotions and how they impact on ER, even after controlling for temperament. Only EA was associated with aggression, whereas both EA and EN were associated with depressive mood and reduced quality of life. Conclusions: EA and EN are different maltreatment experiences which have different detrimental effects on the individual, therefore requiring different interventions.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Research has shown an association between childhood maltreatment and risk factors for cardiovascular disease and depression. The purpose of this study is to examine the total and unique effects of various forms of childhood maltreatment on the development of risk factors for cardiovascular disease and depression in both women and men. Data for this study will be obtained from retrospective chart review and from an already established research database at a private healthcare facility specializing in the treatment of trauma and addiction. All information will pertain to participants’ admission to the healthcare facility and will include self‐report data on childhood maltreatment and symptoms of depression, as well as retrospective chart review data regarding physiological metrics of risk for cardiovascular disease (blood pressure, cholesterol, diabetes). Results from 290 patients indicated that emotional abuse and emotional neglect were the leading predictors of negative outcomes with emotional neglect being a significant predictor of adult depression even after controlling for age, gender, and marital status. Younger participants and women reported higher levels of depression. However, the gender‐specific regressions showed that younger age and emotional neglect remained significant predictors of depression, with the percent variance explained by the model being greater among men compared to women. This greater effect size among men was driven by a stronger association between younger age and depression in men than in women. Childhood emotional abuse was associated with greater risk for coronary heart disease, even after controlling for gender and marital status. Gender‐specific analyses showed that, for men, childhood physical neglect emerged as a significant predictor of coronary heart disease risk after controlling for marital status. Contrary to predictions, among women, none of the five types of childhood maltreatment emerged as a significant predictor of coronary heart disease risk. Moreover, depression was inversely associated with risk for coronary heart disease. In other words, higher levels of depression were consistently associated with lower levels of coronary heart disease risk. This was attributed to the fact that younger people reported higher levels of depression, but younger age was also associated with lower levels of coronary heart disease risk. Furthermore, the results of this study can be used to develop screening tools, based on childhood maltreatment severity and type, for depression and cardiovascular disease. To what degree are specific types of childhood abuse and neglect (i.e., emotional, physical, or sexual) risk factors for depression and cardiovascular disease and how are these risks moderated by gender? Hypotheses: 1) It is expected that higher levels of childhood neglect and abuse (all forms taken together) will be related to higher levels of depressive symptoms and greater risk for cardiovascular disease. 2) Comparing five basic forms of neglect and abuse, it is anticipated that emotional abuse will have the strongest association with elevations in depression and cardiovascular risk. 3) It is hypothesized that the relation between childhood maltreatment and cardiovascular risk will be stronger in women compared to men.

The current investigation examines the relationship between parenting, emotion regulation, and symptoms of psychopathology in maltreating and non-maltreating parent-child dyads. The participants in this study were 114 children (67 maltreated and 57 non-maltreated) from ages 1 to 4. Child affect and effortful control along with parent affect were observed during a parentchild interaction procedure. Symptoms of psychopathology were measured using the Child Behavior Checklist. The maltreated children in this study exhibited more irritability/anger, affect lability, and internalizing symptomatology, along with less positive affect than their non-maltreated peers. These data also suggest that parental affect is related to internalizing symptomatology; but this relationship is stronger for the maltreated group. Contrary to expectations emotion regulation did not fully mediate the relationship between parenting and psychopathology. Clusters of maladaptive affect, "angry" and "labile", emerged in the maltreated group along with a more "resilient" group characterized by positive affect, positive parental affect, and lower levels of psychopathology.

Thesis advisor: Thomas M. Crea / Child sexual abuse is a major public health problem in the United States, but identifying risk, especially in young children with suspicion of abuse, poses many challenges. The aim of this study is to understand how clinicians judge the possible presence of sexual abuse in children where serious suspicion exists but without substantiated abuse. This study used data from randomly selected sexual abuse and trauma evaluations of preschool and school-aged children presenting to Boston Children’s Hospital (BCH) Outpatient Child Protection Program between 2000-2007 (N=100) to examine the association between child and family risk factors and level of clinician concern regarding likelihood of child sexual abuse. Multi-nomial logistic regression analysis was used to examine the relationship between child and family risk factors and level of clinician concern regarding suspicion of abuse, moderated by child’s gender and age. Results indicated that a child’s disclosure and trauma presentation were the key factors that clinicians considered within the higher level of clinician concern regarding likelihood of sexual abuse. Implications for future research and clinical practice include attention to methodology research to assist with the development and validation of assessments for evaluation of risk in complex cases of suspicion of sexual abuse that can be offered in clinical setting, without sole reliance on the child’s ability to disclose in order to access help. Additionally, it is essential that research focuses on the development of clinical models to help with clinical decision making protocols in ambiguous cases of sexual abuse with children who may not be in a position to disclose, but serious concerns have been raised, with focus on increasing their safety. The findings in this research strongly suggest that it is essential to continue to focus on assisting children who present with suspicion of sexual abuse in complex cases that do not fit neatly into our current forensic and child protective services systems. This is especially necessary with the most vulnerable children where disclosure is unlikely, but clinical evaluations can yield recommendations that maximize efforts at increasing safety, child mental health, and family cohesion, and build on strengths while simultaneously accounting for risks. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

This two-study dissertation aimed to develop a comprehensive understanding of mental health need identification, service referral process, availability of services, and type of mental health services in Ontario for children who have experienced maltreatment with a specific focus on childhood sexual abuse (CSA). The first study was descriptive and involved an email questionnaire completed by Directors of Service in each of the 53 Ontario Children’s Aid Societies (CAS). While the primary purpose of study 1 was to inform the sample for study 2, it also provided information about the identification of mental health needs and the referral process to mental health services for children who have experienced maltreatment. Based on the finding that the majority of mental health service referrals are made to community-based psychologists (80%), study 2 was designed to assess the availability, type, and empirical support of treatments provided by Ontario psychologists and psychological associates to children who have experienced CSA. Through the first provincial census of child and adolescent psychology clinicians registered with the College of Psychologists of Ontario, this study addressed the following questions: (1) What are the demographic, work setting, and treatment provision characteristics of these clinicians? (2) Within this population, what is the proportion and distribution of clinicians who provide treatment to children who have experienced CSA?; (3) To what extent do these treatment services map onto empirically-supported treatments (ESTs) for children who have experienced CSA?; and (4) How do clinicians’ demographic, work setting, treatment provision characteristics, and attitudes toward ESTs predict their approach to intervention? Results indicated that clinicians who worked with children who have experienced CSA differed significantly from other clinicians in terms of age, work setting, self-reported theoretical orientation, and clients’ primary presenting problems. Moreover, clinician age, self-reported theoretical orientation, time devoted to clinical training activities, and general attitudes toward ESTs predicted the use of ESTs among clinicians who work with children who have experienced CSA. Limitations and implications for future research are addressed within each study.

This two-study dissertation aimed to develop a comprehensive understanding of mental health need identification, service referral process, availability of services, and type of mental health services in Ontario for children who have experienced maltreatment with a specific focus on childhood sexual abuse (CSA). The first study was descriptive and involved an email questionnaire completed by Directors of Service in each of the 53 Ontario Children’s Aid Societies (CAS). While the primary purpose of study 1 was to inform the sample for study 2, it also provided information about the identification of mental health needs and the referral process to mental health services for children who have experienced maltreatment. Based on the finding that the majority of mental health service referrals are made to community-based psychologists (80%), study 2 was designed to assess the availability, type, and empirical support of treatments provided by Ontario psychologists and psychological associates to children who have experienced CSA. Through the first provincial census of child and adolescent psychology clinicians registered with the College of Psychologists of Ontario, this study addressed the following questions: (1) What are the demographic, work setting, and treatment provision characteristics of these clinicians? (2) Within this population, what is the proportion and distribution of clinicians who provide treatment to children who have experienced CSA?; (3) To what extent do these treatment services map onto empirically-supported treatments (ESTs) for children who have experienced CSA?; and (4) How do clinicians’ demographic, work setting, treatment provision characteristics, and attitudes toward ESTs predict their approach to intervention? Results indicated that clinicians who worked with children who have experienced CSA differed significantly from other clinicians in terms of age, work setting, self-reported theoretical orientation, and clients’ primary presenting problems. Moreover, clinician age, self-reported theoretical orientation, time devoted to clinical training activities, and general attitudes toward ESTs predicted the use of ESTs among clinicians who work with children who have experienced CSA. Limitations and implications for future research are addressed within each study.

Major Depressive Disorder is a highly prevalent and recurrent psychological disorder, affecting approximately 12% of Canadians across their lifetime and 5% each year. Studies have shown that a history of childhood maltreatment increases risk for depression by conferring a vulnerability to the effects of stressful life events (i.e., stress sensitization). The goal of the current investigation was to examine whether the relation between childhood maltreatment and stress sensitization in depression is influenced by age group and depression history. This study also sought to investigate whether specific characteristics of the maltreatment experience differentially relate to stress sensitization. Two hundred and seven clinically depressed adolescents (i.e., 12 – 17 years; n = 59) and adults (i.e., 18 – 64 years; n = 148) participated in this study. Childhood accounts of maltreatment were assessed using the Childhood Experience of Care and Abuse Scale, and stressful life events experienced 3 months prior to depression onset were assessed using the Life Events and Difficulties Schedule. Results revealed that individuals with a history of severe maltreatment reported lower severity levels of stressful life events prior to depression onset than did those without such a history, but only among adolescents. Further, this relation was specific to independent stressors (i.e., those totally or nearly totally independent of the behaviour of the individual) and not dependent stressors (i.e., those at least partly due to the individual’s behaviour), and was specific to emotional abuse. Results also suggested that it is the experience of severe maltreatment, rather than particular aspects of it, that sensitizes individuals to the effects of stress. In summary, this study provides support for the relation of childhood maltreatment to stress sensitization in adolescents. Maltreated adolescents may be especially vulnerable to the depressogenic effects of stress, perhaps because their maltreatment experience is more proximal to depression onset. In contrast, other relevant processes (e.g., cognitive schema and neurobiological consolidation, chronic stress) may drive stress sensitization in adulthood; however, further research is required to investigate such mechanisms. Limitations and clinical implications are discussed. / Thesis (Master, Psychology) -- Queen's University, 2011-08-31 19:15:16.313

Using a qualitative approach this thesis aimed to investigate perception of self, others, and relationships in individuals with a history of chronic, childhood, parental, childhood, psychological maltreatment. Six participants (3 staff; 3 clients) from low-cost counselling agency completed a semi-structured interview designed to assess perceptions of self, others, and relationships. Interpretative Phenomenological Analysis yielded four superordinate themes: shame-based perception of self; self-protection from emotional pain; egocentric perception of others; and shame-based roles in relationships. The results of this study were compared with current literature on childhood maltreatment, including psychological maltreatment, and perception of self, others, and relationships, and significant similarities were found between research to date and the findings of this study. Theoretical links were then made to Bowlby’s (1969) attachment theory. The findings of this study suggest that psychological maltreatment has significant, pervasive, deleterious consequences for the individual’s perception of self-worth, awareness of others, and interpersonal functioning, and implies that childhood psychological maltreatment merits greater attention and investigation, especially the issue of perception of others.