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Sensitive periods for the effect of childhood interpersonal violence on psychiatric disorder onset among adolescents

  • Erin C. Dunn (a1), Yan Wang (a2), Jenny Tse (a3), Katie A. McLaughlin (a4), Garrett Fitzmaurice (a5), Stephen E. Gilman (a6) and Ezra S. Susser (a7)...
Abstract
Background

Although childhood adversity is a strong determinant of psychopathology, it remains unclear whether there are ‘sensitive periods’ when a first episode of adversity is most harmful.

Aims

To examine whether variation in the developmental timing of a first episode of interpersonal violence (up to age 18) associates with risk for psychopathology.

Method

Using cross-sectional data, we examined the association between age at first exposure to four types of interpersonal violence (physical abuse by parents, physical abuse by others, rape, and sexual assault/molestation) and onset of four classes of DSM-IV disorders (distress, fear, behaviour, substance use) (n=9984). Age at exposure was defined as: early childhood (ages 0–5), middle childhood (ages 6–10) and adolescence (ages 11–18).

Results

Exposure to interpersonal violence at any age period about doubled the risk of a psychiatric disorder (odds ratios (ORs) = 1.51–2.52). However, few differences in risk were observed based on the timing of first exposure. After conducting 20 tests of association, only three significant differences in risk were observed based on the timing of exposure; these results suggested an elevated risk of behaviour disorder among youth first exposed to any type of interpersonal violence during adolescence (OR = 2.37, 95% CI 1.69–3.34), especially being beaten by another person (OR = 2.44; 95% CI 1.57–3.79), and an elevated risk of substance use disorder among youth beaten by someone during adolescence (OR=2.77, 95% CI 1.94–3.96).

Conclusions

Children exposed to interpersonal violence had an elevated risk of psychiatric disorder. However, age at first episode of exposure was largely unassociated with psychopathology risk.

Copyright
Corresponding author
Erin C. Dunn, ScD, MPH. Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building Sixth Floor, Boston, MA 02114, USA. Email: dunnreprints@gmail.com
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Declaration of interest

None.

Footnotes
References
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1 McLaughlin, KA, Green, JG, Gruber, MJ, Gruber, MJ, Sampson, NA, et al. Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication II: associations with persistence of DSM-IV disorders. Arch Gen Psychiatry 2010; 67: 124–32.
2 McLaughlin, KA, Green, JG, Gruber, MJ, Sampson, NA, Zaslavsky, AM, Kessler, RC. Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. JAMA Psychiatry 2012; 69: 1151–60.
3 Norman, RE, Byambaa, M, De, R, Butchart, A, Scott, J, Vos, T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med 2012; 9: e1001349.
4 Knudsen, E. Sensitive periods in the development of the brain and behavior. J Cogn Neurosci 2004; 16: 1412–25.
5 Bornstein, MH. Sensitive periods in development: structural characteristics and causal interpretations. Psychol Bull 1989; 105: 179–97.
6 Barnett, D, Manly, JT, Cicchetti, D. Defining child maltreatment: the interface between policy and research. In Child Abuse, Child Development, and Social Policy (eds Cicchetti, D, Toth, SL): 7–73. Ablex, 1993.
7 English, DJ, Graham, JC, Litrownik, AJ, Everson, M, Bangdiwala, SI. Defining maltreatment chronicity: are there differences in child outcomes. Child Abuse Negl 2005; 29: 575–95.
8 McLaughlin, KA, Sheridan, MA, Nelson, CA. Neglect as a violation of species-expectant experience: neurodevelopmental consequences. Biol Psychiatry 2017; 82: 462–71.
9 McLaughlin, KA, Sheridan, MA, Lambert, HK. Childhood adversity and neural development: deprivation and threat as distinct dimensions of early experience. Neurosci Biobehav Rev 2014; 47: 578–91.
10 Cicchetti, D, Toth, SL. A developmental psychopathology perspective on child abuse and neglect. J Am Acad Child Adolesc Psychiatry 1995; 34: 541–65.
11 Cicchetti, D. Socioemotional, personality, and biological development: illustrations from a multilevel developmental psychopathology perspective on child maltreatment. Annu Rev Psychol 2016; 67: 187211.
12 Quas, JA, Goodman, GS, Jones, DP. Predictors of attributions of self-blame and internalizing behavior problems in sexually abused children. J Child Psychol Psychiatry 2003; 44: 723–36.
13 Compas, BE, Connor-Smith, JK, Saltzman, H, Thomsen, AH, Wadsworth, ME. Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull 2001; 127: 87127.
14 Maccoby, EE. Social-emotional development and response to stressors, In Stress, Coping, and Development in Children (eds Rutter, M, Garmezy, N): 217–34. McGraw-Hill, 1983.
15 Garbarino, J. Troubled youth, troubled families: the dynamics of adolescent maltreatment, In Child Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect (eds Cicchetti, D, Carlson, V): 685706. Cambridge University Press, 1989.
16 Stroud, LR, Foster, EM, Papandonatos, GD, Handwerger, K, Granger, DA, Kivlighan, KT, et al. Stress response and the adolescent transition: performance versus peer rejection stressors. Dev Psychopathol 2009; 21: 4768.
17 Thornberry, TP, Henry, KL, Ireland, TO, Smith, CA. The causal impact of childhood-limited maltreatment and adolescent maltreatment on early adult adjustment. J Adolesc Health 2010; 46: 359–65.
18 Keiley, MK, Howe, TR, Dodge, KA, Bates, JE, Petti, GS. The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems. Dev Psychopathol 2001; 13: 891912.
19 Kaplow, JB, widom, CS. Age of onset of child maltreatment predicts long-term mental health outcomes. J Abnorm Psychol 2007; 116: 176–87.
20 Dunn, EC, McLaughlin, KA, Slopen, N, Rosand, J, Smoller, JW. Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adulthood: results from the National Longitudinal Study of Adolescent Health. Depress Anxiety 2013; 30: 955–64.
21 Dunn, EC, Nishimi, K, Lott, AP, Bradley, B. Is developmental timing of trauma exposure associated with depressive and post-traumatic stress disorder symptoms in adulthood? J Psych Res 2017; 84: 119127.
22 Maercker, A, Michael, T, Fehm, L, Becker, ES, Margraf, J. Age of traumatisation as a predictor of post-traumatic stress disorder or major depression in young women. Br J Psychiatry 2004; 184: 482–7.
23 McCutcheon, W, Heath, AC, Nelson, EC, Bucholz, KK, Madden, PA, Martin, NG, et al. Accumulation of trauma over time and risk for depression in a twin sample. Psychol Med 2009; 39: 431–41.
24 Schoedl, AF, Costa, MC, Mari, JJ, Mello, MF, Tyrka, AR, Carpenter, LL, et al. The clinical correlates of reported childhood sexual abuse: an association between age at trauma onset and severity of depression and PTSD in adults. J Child Sex Abus 2010; 19: 156–70.
25 Khan, A, McCormack, HC, Bolger, EA, McGreenery, CE, Vitaliano, G, Polcari, A, et al. Childhood maltreatment, depression, and suicidal ideation: critical importance of parental and peer emotional abuse during developmental sensitive periods in males and females. Front Psychiatry 2015; 6: 42.
26 Harpur, U, Polek, E, van Harmelen, AL. The role of timing of maltreatment and child intelligence in pathways to low symptoms of depression and anxiety in adolescence. Child Abuse Negl 2015; 47: 2437.
27 Thornberry, TP, Ireland, TO, Smith, CA. The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Dev Psychopathol 2001; 13: 957–79.
28 Jaffee, SR, Maikovich-Fong, AK. Effects of chronic maltreatment and maltreatment timing on children's behavior and cognitive abilities. J Child Psychol Psychiatry 2011; 52: 184–94.
29 Oldehinkel, AJ, Ormel, J, Verhulst, FC, Nederhof, E. Childhood adversities and adolescent depression: a matter of both risk and resilience. Dev Psychopathol 2014; 26: 1067–75.
30 Manly, JT, Kim, JE, Rogosch, FA, Cicchetti, D. Dimensions of child maltreatment and children's adjustment: contributions of developmental timing and subtype. Dev Psychopathol 2001; 13: 759–82.
31 Pietrek, C, Elbert, T, Weierstall, R, Müller, O, Rockstroh, B. Childhood adversities in relation to psychiatric disorders. Psychiatry Res 2013; 206: 103–10.
32 Glod, CA, Teicher, MH. Relationship between early abuse, posttraumatic stress disorder, and activity levels in prepubertal children. J Am Acad Child Adolesc Psychiatry 1996; 35: 1384–93.
33 McCutcheon, W, Sartor, CE, Pommer, NE, Bucholz, KK, Nelson, EC, Madden, PA, et al. Age at trauma exposure and PTSD risk in young adult women. J Trauma Stress 2010; 23: 811–4.
34 Estaugh, V, Power, C. Family disruption in early life and drinking in young adulthood. Alcohol Alcohol 1991; 26: 639–44.
35 Freeman, RC, Collier, K, Parillo, KM. Early life sexual abuse as a risk factor for crack cocaine use in a sample of community-recruited women at high risk for illicit drug use. Am J Drug Alcohol Abuse 2002; 28: 109–31.
36 Spak, L, Spak, F, Allebeck, P. Sexual abuse and alcoholism in a female population. Addiction 1998; 93: 1365–73.
37 Kessler, RC, Merikangas, KR. The national comorbidity survey replication (NCS-R): background and aims. Int J Methods Psychiatr Res 2004; 13: 60–8.
38 Kessler, RC, Avenevoli, S, Costello, EJ, Green, JG, Gruber, MJ, Heeringa, S, et al. National comorbidity survey replication adolescent supplement (NCS-A): II. Overview and design. J Am Acad Child Adolesc Psychiatry 2009; 48: 380–5.
39 Wittchen, HU. Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 1994; 28: 5784.
40 Merikangas, KR, Avenevoli, S, Costello, EI, Koretz, D, Kessler, RC. National comorbidity survey replication adolescent supplement (NCS-A): 1. Background and measures. J Am Acad Child Adolesc Psychiatry 2009; 48: 367–79.
41 Kessler, RC, Avenevoli, S, McLaughlin, KA, Green, JG, Lakoma, MD, Petukhova, M. Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med 2012; 42: 19972010.
42 De Los Reyes, A, Kazdin, AE. Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychol Bull 2005; 131: 483509.
43 Knauper, B, Cannell, CF, Schwarz, N, Bruce, ML, Kessler, RC. Improving the accuracy of major depression age of onset reports in the US National Comorbidity Survey. Int J Methods Psychiatr Res 1999; 8: 3948.
44 Koenen, KC, Roberts, AL, Stone, DM, Dunn, EC. The epidemiology of early childhood trauma. In The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic (eds Lanius, R, Vermetten, E): 1324. Cambridge University Press, 2010.
45 Dunn, EC, Gilman, SE, Willett, JB, Slopen, NB, Molnar, BE. The impact of exposure to interpersonal violence on gender differences in adolescent-onset major depression: results from the National Comorbidity Survey Replication (NCS-R). Depress Anxiety 2012; 29: 392–9.
46 Gaub, M, Carlson, CL. Gender differences in ADHD: a meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry 1997; 36: 1036–45.
47 Green, JG, McLaughlin, KA, Berglund, PA, Gruber, MJ, Sampson, NA, Zaslavsky, AM, et al. Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 2010; 67: 113–23.
48 Singer, JD, Willett, JB. Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. Oxford University Press, 2003.
49 Andersen, SL, Tomada, A, Vincow, ES, Valente, E, Polcari, A, Teicher, MH. Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci 2008; 20: 292301.
50 Kessler, RC, Avenevoli, S, Costello, EJ, Georgiades, K, Green, JG, Gruber, MJ, et al. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 2012; 69: 372–80.
51 Dunn, EC, Busso, DS, Raffeld, M, Smoller, JW, Nelson, CA, Doyle, AE, et al. Does developmental timing of exposure to child maltreatment predict memory performance in adulthood? Results from a large, population-based sample. Child Abuse Neglect 2016; 51: 181–91.
52 Maughan, B, Rowe, R, Messer, J, Goodman, R, Meltzer, H. Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J Child Psychol Psychiatry 2004; 45: 609–21.
53 Bryant-Waugh, RJ, Lask, BD, Shafran, RL, Fosson, AR. Do doctors recognise eating disorders in children? Arch Dis Child 1992; 67: 103.
54 Blakemore, SJ. Development of the social brain in adolescence. JR Soc Med 2012; 105: 111–6.
55 Blakemore, SJ, Choudhury, S. Development of the adolescent brain: implications for executive function and social cognition. J Child Psychology Psychiatry 2006; 47: 296312.
56 Casey, BJ, Jones, RM. Neurobiology of the adolescent brain and behavior: implications for substance use disorders. J Am Acad Child Adolesc Psychiatry 2010; 49: 1189–201.
57 Somerville, LH, Casey, BJ. Developmental neurobiology of cognitive control and motivational systems. Curr Opin Neurobiol 2010; 20: 236–41.
58 Marshall, AD. Developmental timing of trauma exposure relative to puberty and the nature of psychopathology among adolescent girls. J Am Acad Child Adolesc Psychiatry 2016; 55: 2532.
59 Hardt, J, Rutter, M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry 2004; 45: 260–73.
60 Scott, KM, McLaughlin, KA, Smith, DAR, Ellis, PM. Childhood maltreatment and DSM-IV adult mental disorders: comparison of prospective and retrospective findings. Br J Psychiatry 2012; 200: 469–75.
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Sensitive periods for the effect of childhood interpersonal violence on psychiatric disorder onset among adolescents

  • Erin C. Dunn (a1), Yan Wang (a2), Jenny Tse (a3), Katie A. McLaughlin (a4), Garrett Fitzmaurice (a5), Stephen E. Gilman (a6) and Ezra S. Susser (a7)...
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Author's Reply

Erin Dunn, Massachusetts General Hospital
08 March 2018

We are grateful to Zhong and colleagues for their thoughtful feedback on our article (1). In response to these concerns, we wish to make five points regarding our study.

1. We undertook this analysis expecting to find sensitive periods. We used one of the best datasets available to test this sensitive period hypothesis, and yet did not find identifiable sensitive periods linking exposure to interpersonal violence to risk of psychiatric disorders. While the National Comorbidity Survey Replication Adolescent Supplement dataset had many strengths, it also – like any other dataset – had limitations, as noted by us and Zhong and colleagues.

2. Our results suggest that the association between the developmental timing of exposure to interpersonal violence and risk for psychiatric disorders is inconclusive. However, absence of evidence is not evidence of absence, particularly when few studies in this area have been conducted. Only through efforts to replicate these findings will we be able to evaluate the strength of support for the existence (or lack of existence) of sensitive periods linking exposure to adversity to psychiatric disorder risk.

3. We agree that a more fine-grained approach to classifying age at first exposure is the best strategy to study sensitive periods. In fact, we have done this in the past, showing that collapsing into crude age categories can obscure important developmental timing differences in the effect of adversity on psychiatric symptoms (2). However, in this analysis we did not have sufficiently large cell counts to make such analyses feasible.

4. As noted, we also agree that future studies should incorporate multiple dimensions of maltreatment – including its severity, frequency and duration – along with age at first exposure. The challenge, of course, is that few studies have been designed to characterize these domains in ways that enable researchers to carefully disentangle and parse out such effects.

5. Family history is certainly an important variable to include and we have done so in our recent work (3), though interestingly we do not find sizable differences across results before and after adjustment for maternal psychopathology, for example. As insights regarding the genetic contributions of psychiatric disorders continue to emerge through genome-wide association studies (GWAS), it may become possible to include personal and family-based polygenic risk factors as covariates. As noted, efforts to study neglect are also needed, as neglect is the most commonly experienced type of child maltreatment (4).

Our research group (www.thedunnlab.com) is continuing to search for sensitive periods through several studies and we hope that others will do the same. Such research efforts will be strengthened by incorporating the helpful feedback by Zhong and colleagues. Ultimately, this work will illuminate the degree to which risk for psychiatric disorders can be significantly reduced by preventing exposure to adversity during especially vulnerable life stages. 

References

1. Dunn EC, Wang Y, Tse J, McLaughlin KA, Fitzmaurice G, Gilman SE, et al. Sensitive periods for the effect of childhood interpersonal violence on psychiatric disorder onset among adolescents. The British Journal of Psychiatry: The Journal of Mental Science. 2017; 211(6): 365.

2. Dunn EC, McLaughlin KA, Slopen N, Rosand J, Smoller JW. Developmental timing of child maltreatment and symptoms of depression and suicidality in young adulthood: Results from the National Longitudinal Study of Adolescent Health. Depression and Anxiety. 2013; 30: 955-64.

3. Dunn EC, Soare TW, Raffeld MR, Busso DS, Crawford KM, Davis KA, et al. What life course theoretical models best explain the relationship between exposure to childhood adversity and psychopathology symptoms: recency, accumulation, or sensitive periods? Psychological Medicine. in press.

4. U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2016. U.S. Government Printing Office, 2018.

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Conflict of interest: None declared

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None-association was found between age at first child maltreatment exposure and psychopathology risk? Too soon to conclude

Shaoling Zhong, the Mental Health Institute of the Second Xiangya Hospital, Central South University
Jiansong Zhou, the Mental Health Institute of the Second Xiangya Hospital, Central South University
Xiaoping Wang, the Mental Health Institute of the Second Xiangya Hospital, Central South University
24 January 2018

We thank Dunn(1) and colleagues for their study examining the association between age at first episode exposure to child maltreatment and psychiatry disorder among adolescents. The authors reported a negative association between the two variables following a representative nationwide study of English-speaking US adolescents.

However, we feel that the age classification was too crude to be set at three groups: Early childhood (0-5y), middle childhood (6-10y) and adolescents (11-18y). The authors(1) cited three articles as their references. But, one of them used a small sample(2), while the other two used more refined measures of age groups (3, 4). We feel that sensitive periods only appear within shorter periods, such as infancy (0-2 y), preschool (3-5y), early school age (6-8y), and school age (9-11), as Kaplow (3) and his colleagues did. With this age grouping, the authors found differences lay in the consequences as a function of the age of first child maltreatment. Since it remains unclear whether the age grouping will hide the effects under it, it might have been useful to stratify the age more refined.

Second, although that the severity level or duration of interpersonal violence was not captured in Dunn’s study, which was stated as one of the limitations, one thing need to emphasize is that, dimensions such as severity, frequency/chronicity are associated with the occurrence of developmental outcomes (5). In other studies, severity levels are highly associated with the behavior (aggression), even override the effects of the gene (5). Further studies aimed at exploring associations between age at first episode of exposure and psychopathology risk should include severity, frequency and duration, despite of age of the first episode of interpersonal violence.

Third, family history was not adjusted for psychiatric disorders in this study, which could be a valid potential confounder for the occurrence of psychiatric disorders. Mixing those with a positive family history would mean an exceptional confound for the psychiatric disorder, which might affect the results. Additionally, neglect, one of most serious ways of child maltreatment, is associated with increased psychological risks (6). Considering that the importance that neglect plays in the role of psychopathy risk, such as increased stress reactivity evident, research on this topic is needed.

Still, we thank the authors(1) for confirming the exposure to violence is highly associated with psychiatric disorders for adolescents. That is significant for clinicians and families to take early intervention opportunities for adolescents with child maltreatment.

1. Dunn EC, Wang Y, Tse J, Mclaughlin KA, Fitzmaurice G, Gilman SE, et al. Sensitive periods for the effect of childhood interpersonal violence on psychiatric disorder onset among adolescents. British Journal of Psychiatry the Journal of Mental Science. 2017: bjp.bp.117.208397.

2. Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH. Preliminary evidence for the sensitive periods in the effect of childhood sexual abuse on regional brain development. Journal of Neuropsychiatry & Clinical Neurosciences. 2008; 20(3): 292.

3. Kaplow JB, Widom CS. Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology. 2007; 116(1): 176.

4. M.P.H ECDSD, Katie AMPD, Natalie SSD, M.Sc. JRMD, Sc.D JWSMD. DEVELOPMENTAL TIMING OF CHILD MALTREATMENT AND SYMPTOMS OF DEPRESSION AND SUICIDAL IDEATION IN YOUNG ADULTHOOD: RESULTS FROM THE NATIONAL LONGITUDINAL STUDY OF ADOLESCENT HEALTH. Depression & Anxiety. 2013; 30(10): 955–64.

5. Cicchetti D. Socioemotional, Personality, and Biological Development: Illustrations from a Multilevel Developmental Psychopathology Perspective on Child Maltreatment. Annual Review of Psychology. 2016; 67(1): 187.

6. Duffy A, Jones S, Goodday S, Bentall R. Candidate Risks Indicators for Bipolar Disorder: Early Intervention Opportunities in High-Risk Youth. International Journal of Neuropsychopharmacology. 2016; 19(1).
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Conflict of interest: None declared

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