Assessing stress-related treatment needs among girls at risk for poor functional outcomes: The impact of cumulative adversity, criterion traumas, and non-criterion events

Abstract

Despite growing recognition that cumulative adversity (total stressor exposure), including complex trauma, increases the risk for psychopathology and impacts development, assessment strategies lag behind: Trauma-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (parental separations) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: 1) an average of 14 adverse Criterion-A and non-Criterion event exposures; 2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; 3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and 4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities.

Association of adverse prenatal exposure burden with child psychopathology in the Adolescent Brain Cognitive Development (ABCD) Study

“…Primary prenatal exposures of interest were obtained based on caregiver recall and recorded in the ABCD Developmental History Questionnaire . The following 15 exposures were extracted for each individual and coded as present or absent, consistent with dichotomous analyses used in previous studies (e.g., [ 9 , 18 , 25 , 26 ]):…”

“…Primary prenatal exposures of interest were obtained based on caregiver recall and recorded in the ABCD Developmental History Questionnaire. The following 15 exposures were extracted for each individual and coded as present or absent, consistent with dichotomous analyses used in previous studies (e.g., [9,18,25,26]): [1] unplanned pregnancy; [2][3][4][5][6] maternal use of alcohol, tobacco, marijuana, cocaine, or opiates, before pregnancy was recognized ("early" exposure); [7][8][9][10][11] maternal use of alcohol, tobacco, marijuana, cocaine, or opiates, after pregnancy was recognized ("late" exposure);…”

“…While cumulative effects of adverse postnatal exposures have been observed in children [ 24 , 25 ] and adults [ 26 ], the loading burden of experiencing multiple types of adverse prenatal events has been studied only in a relatively small sample of preschool-aged children [ 27 ] and children with autism [ 28 ]. Further, adverse prenatal exposures frequently co-occur, reflecting both causal links (e.g., maternal substance use resulting in other pregnancy complications [ 29 ]), and shared background factors (e.g., poverty increasing risk for both maternal substance use and other pregnancy complications [ 30 ]).…”

Psychotic‐spectrum symptoms, cumulative adversity exposure and substance use among high‐risk girls

“…The impact of a range of stressors on neurodevelopment, cognition and thought disorders; however, suggests youth with disruptive behaviour, C‐TA‐ and psychotic‐spectrum symptoms may fall within the developmental disorders continuum, or extended phenotype (Howes & Kapur, ; Kaymaz & Van Os, ; Lansing, Virk, Notestine, Plante, & Fennema‐Notestine, ; Mayo et al, ). Our prior data suggest C‐TA has neurological implications in brain regions associated with executive function and language abilities in delinquent boys; and greater psychopathology and impairment in delinquent girls is associated with C‐TA relative to single‐event PTSD inquiries, indicating methods of diagnosing PTSD may underestimate mental health needs and perpetuate health disparities (Lansing et al, , ). Therefore, longitudinal C‐TA data may improve our understanding of psychosis proneness‐persistence‐impairment models (Van Os et al, ) and clinical high‐risk syndrome for psychosis development (Mayo et al, ).…”

“…Girls were detained for over a month and completed detoxification, if indicated, prior to GRF placement. Girls were screened and consented consistent with federal regulations, the University of California, San Diego Institutional Review Board and Department of Health and Human Services, as described in Appendix S1, Supplemental Methods and Results, and previously reported (Lansing et al, ; Lansing, Plante, & Beck, ).…”