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Mentalizing defines the set of social cognitive imaginative activities that enable interpretation of behaviors as arising from intentional mental states. Mentalization impairments have been related to childhood trauma (CT) and are widely present in people suffering from mental disorders. Nevertheless, the link between CT exposure, mentalization abilities, and related psychopathology remains unclear. This study aims to systematically review the evidence in this domain.
Methods
A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic review of literature published until December 2022 was conducted through an Ovid search (Medline, Embase, and PsycINFO). The review was registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42023455602).
Results
Twenty-nine studies were included in the qualitative synthesis. Twenty studies (69%) showed a significant negative correlation between CT and mentalization. There was solid evidence for this association in patients with psychotic disorders, as almost half the studies focused on this population. The few studies focusing on unipolar depression, personality disorders, and opioid addiction also reported a negative impact of CT on mentalization. In contrast, evidence for post-traumatic stress disorder was inconsistent, and no evidence was found for bipolar disorder. When stratifying for subtypes of CT, there was solid evidence that neglect (physical and emotional) decreased mentalization capacity, while abuse (physical, emotional, or sexual) was not associated with mentalization impairments.
Conclusions
Although causality cannot be established, there was substantial evidence that CT negatively affects mentalization across various psychiatric disorders, particularly psychotic disorders. These findings highlight the potential of targeting mentalization impairments in prevention and treatment strategies aiming to reduce the incidence and the social functioning burden of mental illness.
We conducted a systematic review and meta-analysis to quantify associations between overall and subtypes of CM, global/trait resilience, and five resilience domains (coping, self-esteem, emotion regulation, self-efficacy, and well-being) in adults, and to examine moderators and mediators of these associations. A systematic search was undertaken on 12 June 2024 to identify published peer-reviewed articles in five databases (PROSPERO-CRD42023394120). Of 15,262 records, 203 studies were included, comprising 145,317 adults (Mage = 29.62 years; 34.96% males); 183 studies and 557 effect sizes were pooled in random-effect meta-analyses. Overall CM and its subtypes were negatively associated with global/trait resilience and its domains (r = −0.081 to −0.330). Emotional abuse/neglect showed the largest magnitude of effect (r = −0.213 to −0.321). There was no meta-analytic evidence for an association between sexual abuse and coping, and physical abuse/neglect and self-esteem. Meta-regressions identified age, sample size, and study quality as moderators. Subgroup analyses found that associations between emotional abuse and emotion regulation were stronger, while associations between emotional abuse and self-esteem were weaker, in western versus non-western countries. No differences were found in associations between CM and resilience in clinical versus non-clinical samples. Narrative synthesis identified several mediators. Associations were of small magnitude and there were a limited number of studies, especially studies assessing CM subtypes, such as physical neglect, bullying, or domestic violence, and resilience domains, such as coping or self-efficacy, in males, and clinical samples. CM exposure negatively impacts resilience in adults, an effect observed across multiple maltreatment types and resilience domains. Interventions focused on resilience in adults with CM histories are needed to improve health and psychosocial outcomes.
This chapter presents the varied types of attention deficits that are observed in different special populations. These provide evidence for the importance of attention in many aspects of our lives, and this chapter explains how studies of these patients continues to motivate and shape much of the neuroscience research that will be covered in subsequent chapters. Patients suffering from unilateral neglect syndrome, subsequent to brain lesions, have revealed a network of temporo-parietal and ventral frontal regions, lateralized largely to the right hemisphere, that is critical for disengaging and reorienting attention. These patients also provide evidence for the distinction between space-based versus object-based attention. Damage to subcortical structures in the thalamus and superior colliculus are linked to deficits in engaging and moving attention, respectively. The history and current diagnostic criteria for attention deficit hyperactivity disorder (ADHD) are described, along with how this disorder affects multiple processes of attention. Symptoms of ADHD and the neglect syndrome are used to introduce the concepts of executive control, the filtering of irrelevant distractors, and the balance of top-down and bottom-up influences on attention. The possibility that dysfunctional attention mechanisms may also play a role in autism, schizophrenia, and anxiety disorders is discussed.
Adverse childhood experiences (ACEs) are associated with poor mental health outcomes, which are increasingly conceptualized from a transdiagnostic perspective. We examined the impact of ACEs on transdiagnostic mental health outcomes in young adulthood and explored potential effect modification. We included participants from the Avon Longitudinal Study of Parents and Children with prospectively measured data on ACEs from infancy till age 16 as well as mental health outcomes at ages 18 and 24. Exposures included emotional neglect, bullying, and physical, sexual or emotional abuse. The outcome was a pooled transdiagnostic Stage of 1b (subthreshold but clinically significant symptoms) or greater level (Stage 1b+) of depression, anxiety, or psychosis – a clinical stage typically associated with first need for mental health care. We conducted multivariable logistic regressions, with multiple imputation for missing data. We explored effect modification by sex at birth, first-degree family history of mental disorder, childhood neurocognition, and adolescent personality traits. Stage 1b + outcome was associated with any ACE (OR = 2.66, 95% CI = 1.68–4.22), any abuse (OR = 2.08, 95% CI = 1.38–3.14), bullying (OR = 2.15, 95% CI = 1.43–3.24), and emotional neglect (OR = 1.68, 95% CI = 1.06–2.67). Emotional neglect had a weaker association with the outcome among females (OR = 1.14, 95% CI = 0.61–2.14) than males (OR = 3.49, 95% CI = 1.64–7.42) and among those with higher extraversion (OR = 0.91, 95% CI = 0.85–0.97), in unweighted (n = 2,126) and weighted analyses (n = 7,815), with an openness–neglect interaction observed in the unweighted sample. Sex at birth, openness, and extraversion could modify the effects of adverse experiences, particularly emotional neglect, on the development of poorer transdiagnostic mental health outcomes.
Attention is critical to our daily lives, from simple acts of reading or listening to a conversation to the more demanding situations of trying to concentrate in a noisy environment or driving on a busy roadway. This book offers a concise introduction to the science of attention, featuring real-world examples and fascinating studies of clinical disorders and brain injuries. It introduces cognitive neuroscience methods and covers the different types and core processes of attention. The links between attention, perception, and action are explained, along with exciting new insights into the brain mechanisms of attention revealed by cutting-edge research. Learning tools – including an extensive glossary, chapter reviews, and suggestions for further reading – highlight key points and provide a scaffolding for use in courses. This book is ideally suited for graduate or advanced undergraduate students as well as for anyone interested in the role attention plays in our lives.
Edited by
James Ip, Great Ormond Street Hospital for Children, London,Grant Stuart, Great Ormond Street Hospital for Children, London,Isabeau Walker, Great Ormond Street Hospital for Children, London,Ian James, Great Ormond Street Hospital for Children, London
This chapter explains principles of safeguarding, the relevant law and statutory framework, the role of the anaesthetist in safeguarding, specific forms of abuse, the safeguarding process for children when concerns arise and the investigation process when a child dies.
This chapter explores what we know about violence against young people with cognitive disability. It looks at what can make it more likely that young people with cognitive disability are abused. It’s hard to really know how many young people with cognitive disability have experienced violence. Young people with cognitive disability can be harmed by workers, family, or friends who are meant to help them. Abuse can happen in many places. Services and society need to learn how to keep young people with cognitive disability safe. We need to make sure young people can make decisions for themselves.
Young people with cognitive disability, families, and practitioners reported many acts of violence against young people. The violence included physical abuse, sexual assault/abuse, neglect, exploitation, emotional and psychological abuse, and domestic and family violence. Young people were abused by other young people with disability, family members, partners, practitioners, and services. Young people in this book found the strength to speak up and tell their stories of violence.
Becoming an adult involved lots of changes and challenges for young people with cognitive disability. Many services, and sometimes families, judged young people badly because they had a cognitive disability. Young people needed help to be independent, but this wasn’t always given to them. Some young people were lonely and found so-called friends who abused them. Aboriginal and/or Torres Strait Islander young people and young people from culturally and linguistically diverse backgrounds needed others to understand and respect their culture. LQBTIQA+ young people wanted love and acceptance as they became adults.
Based on facial expression experiments, childhood adversity may be associated with threat-related information processing bias. Yet, it is unclear whether this generalizes to other threat-related stimuli, such as social and non-social visual scenes.
Methods
We combined fast periodic visual stimulation with frequency-tagging electroencephalography (EEG) and eye-tracking to assess automatic and implicit neural discrimination, neural salience and preferential looking towards negative versus neutral social and non-social visual scenes in young adults aged 16–24 years (51 with childhood adversity and psychiatric symptoms and 43 controls).
Results
Controls showed enhanced negative-neutral neural discrimination within a social versus non-social context. However, this facilitating effect of social content was absent in those with adversity, suggesting a selective alteration in social threat processing. Moreover, individual differences in adversity severity, and more specifically threat experiences (but not neglect experiences), were associated with decreased neural discrimination of negative versus neutral social scenes, corresponding to similar findings in facial expression processing, indicating the robustness of adversity-related deficits in threat-safety discrimination across social visual stimuli.
Conclusions
The adversity-related decreased threat-safety discrimination might impact individuals’ perception of social cues in daily life and relate to poor social functioning and future development of psychopathology.
This book presents the lived experiences of young people with cognitive disability and their struggles as they transition to adulthood. Whether you are a young person yourself looking to transition to adulthood, a parent, or a professional supporting a young person, this book will help you understand the systemic failures which have caused abuse, exploitation, neglect and violence. But it will also outline the inner and outer resources which have enabled young people to maintain their self-belief and overcome adversity. Despite the fact society is failing these young people, the young people in this book speak of belief and have hope for the future. Drawing upon the United Nations human rights framework, this book provides a narrative for empowerment and reform. It involves the input of co-researchers with disability and includes Easy English summaries in each chapter to ensure its accessibility to young people with cognitive disability.
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.