Traumatic subject sense of threat to life, bodily

Traumatic experiences and chronic stress or adversity in
childhood are known to impact functioning across domains throughout the
lifespan, including interpersonal, educational, vocational, and familial
functioning and physical and mental health across the lifespan. Such
experiences, when measured using the Adverse Childhood Experiences (ACEs) scale
or one of its offspring, have been shown to predict physical, psychological,
and social outcomes and to have a cumulative effect in that the more childhood
adversity a person reports experiencing, the greater likelihood and number of
later functional issues they experience (Feletti et al., 1998; Violence Prevention, 2016).
Given the intergenerational transmission of trauma effects through perpetuation
by adults who themselves experienced trauma and the impact of corollary
stressors (such as physical and emotional health problems) that adults who have
ACEs often develop, it is reasonable to expect that parents with higher ACEs
would be more likely to have children who themselves have high ACEs. However,
direct exposure to adverse experiences is not the only possible mechanism by
which trauma impacts of parental ACEs may be transmitted intergenerationally.

Firstly, there is very little work on the possible direct
impact of parental ACEs on child social-emotional learning (SEL) or behavioral
difficulties that controls for child experiences of adversity. In addition, parental
resilience, or the ability to “bounce back” in the face of stress or adversity (Smith
et al., 2008), could alter the impact of parental ACEs either by reducing the
impact of the parent’s ACEs, reducing the likelihood the child has experienced
ACEs, or both. This study aims to explore the possible relationship between
parental experiences of childhood adversity as measured by ACEs on child
social-emotional learning and internalizing and externalizing behavior
difficulties while controlling for ACEs in the life of the child. The possible
mediating effect of parental resilience will also be explored.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

Trauma

            Psychological
trauma is “the unique individual experience of an event or enduring conditions,
in which: the individual’s ability to integrate his/her emotional experience is
overwhelmed, or the individual experiences a subject sense of threat to life,
bodily integrity, or sanity (Pearlman & Saakvitne, 1995, p. 60).” Traumatic
experiences in childhood, also called early life stress in the literature, have
been studied from a variety of perspectives and linked with changes in
neurobiology, poorer interpersonal functioning, increased risk of physical and
mental health problems, reduced telomere length, and long-term negative
outcomes across functional domains (Kendall-Tackett, 2009; Mersky &
Topitzes, 2010; Nemeroff, 2016). Specifically, increases in somatic complaints
and major illnesses such as heart disease, asthma, inflammatory responses,
chronic pain issues, and diabetes as well as increased incidence of substance
use, anxiety and mood disorders, psychosis, self-injury, and suicide have been
found. Trauma also predicts lower socioeconomic status, less educational attainment
and IQ, and higher reported life stress (Elliot
& Vaitilinham, 2008; Perez
& Spatz Widom, 1994; Tarullo, 2012). Socially, increased
engagement in violence and delinquency (Gold, Wolan Sullivan, & Lewis,
2011; Mersky & Topitzes, 2010; Xiamong & Corso, 2007) and poor social
skills (Perry, 2012) have been found in samples with childhood trauma
experiences.

Neurological
changes associated with trauma and chronic stress, or the response to emotional
pressure suffered for a prolonged period of time in which an individual
perceives he or she has little or no control (McEwen, 2007), include changes in
functionality, volume, and connectivity in the amygdala, corpus collosum,
hippocampus, and hypothalamus-pituitary-adrenal axis, increased corticosteroid
levels, and altered frontal lobe volume and activity (Lupien, McEwen, Guunar,
& Heim, 2009; McCrory, Dr Brito, & Viding, 2010; Nemeroff, 2016). These
areas of the brain are specifically associated with mood regulation, threat
assessment and response, the stress response, behavioral inhibition, and
executive functioning. Appropriate assessment of and response to the
environment and self are necessary skills for self-regulation and appropriate
social behavior as well as responsible decision making. Such skills, in
addition to the ability to direct and maintain attention, plan appropriate
actions, and understand consequences are necessary for appropriate decision
making and successful social, academic, and vocational functioning.  There is some evidence that these changes
impact caregiving behaviors and potentially even alter hormone and neuropeptide
functioning at an epigenetic level, leading to intergenerational transmission
through genetic and behavioral pathways (Bos, 2017). Thus, traumatic events and
chronic life stressors during early life are not only associated with a variety
of negative outcomes in physical and mental health and social, academic, and
vocational functioning, but also result in neurobiological changes that may
underlie much of the difficulty. 

Adverse Childhood
Experiences (ACEs).

Traditionally,
various adversities, such as poverty, physical abuse, or parental divorce,
would be studied individually to assess their impact on short- and long- term
outcomes. Adverse Childhood Experiences (ACEs) were conceptualized by the
Centers for Disease Control as a way of looking at the prevalence, impact, and
interrelationships between each form of adversity (Violence Prevention, 2016). ACEs
were first introduced to the epidemiological literature by the Kaiser-Centers
for Disease Control Adverse Childhood Experiences Study that ran from 1995 to
1997 in which it was found that ACEs predicted a multitude of health related
behaviors and outcomes from smoking and substance use to obesity, autoimmune
disorder incidence, and early death (Feletti et al., 1998; Violence Prevention,
2016). Such findings have been replicated and expanded across multiple studies
with a variety of populations both in the United States and internationally.

Much
as childhood trauma more generally has been found to do, ACEs score predicts
increased substance issues including alcoholism and alcohol abuse, smoking,
earlier initiation of smoking/alcohol use, and illicit drug use (Felitti &
Anda, 2010; Merrick et al., 2017) as well as sexual and relational health
problems including intimate partner violence, increased number of sexual
partners, early and unintended pregnancy, early initiation of sexual
experience, sexually transmitted diseases, and risk of sexual violence (Felitti
& Anda, 2010). Increased rates of depression and anxiety, somatization,
dissociation, and suicide attempts that show a dose-response effect were also
found (Edwards, Holden, Felitti, & Anda, 2003; Felitti & Anda, 2010;
Merrick et al., 2017) Moreover, ACEs show strong, graded correlations with
likelihood of serious job-related problems, high absenteeism, and ongoing
financial instability (Anda & Felitti, 2004). In addition, and perhaps
because of, the increase in these outcomes in adulthood, maternal ACEs predict
developmental concerns among their children, including social-emotional,
behavioral, cognitive, and physical health (Folger et al., 2017; McDonnell and
Valentino, 2016; Sun et al., 2017).

While the exact categories included in ACEs questionnaires
vary somewhat based on likelihood of certain events (e.g. the International
Questionnaire the World Health Organization uses includes exposure to war,
forced migration, genital mutilation, and other community stressors rare in the
domestic US population), such questionnaires generally include assessment of
childhood experience of physical, sexual, or emotional abuse, physical or
emotional neglect, and household dysfunction in the form of substance use,
mental illness, or incarceration of a family member, parental separation, and
domestic violence in the home (Bethel et al., 2017). 

ACES
are common and interrelated. Indeed, Dong et al. (2004) found with the original
study population of 8,629 adults in the United States that two-thirds reported
at least one ACE with 81-89% of those reporting one ACE reporting at least one
additional ACE (Dong et al., 2004). ACEs score, both in cumulative format and
when broken down into sub-scales of abuse/neglect and household dysfunction,
have implications beyond predicting risky health behaviors and physical
illness. The original study was replicated and expanded by the Behavioral Risk
Factor Surveillance System (BRFSS) over several years with the most recent
available data being from 2010 as well as several additional independent
studies in the United States and internationally. Some studies have found that
ongoing relationship problems, substance use, somatic symptoms, and emotional
distress mediate relationships between ACEs and outcomes in a variety of
domains (Anda & Felitti, 2004; Folger et al., 2017). Indeed, ongoing
difficulties with emotional well-being, unstable or dysfunctional relationship
dynamics, increased risk behavior, and physical health problems appear to
function in complex interrelated ways to mediate many of the findings
associated with increased ACEs scores.

Resilience.

Resilience
is defined in this study as the ability to “bounce back” in the face of
adversity or trauma (Smith et al., 2008). Resilience is generally related to the ability to adapt to
changing circumstances and persist in the face of challenges, and is both a
characteristic and a process (Zellars, Justice, & Beck, 2011); content
analysis has identified the areas of positive coping, social support, and personal
competence as potentially underlying resilience. Resilient people are able to
form strong relationships and access them for support when needed, to form
shared goals and work with others to achieve them (Rutter, 1985). Moreover,
they can tolerate negative emotions while remaining humorous, optimistic, and
patient, with strong self-efficacy and self-esteem, and an action orientation
to problem solving (Rutter, 1985). 

Resilience
predicts a variety of improved outcomes among individuals who experienced
trauma or early adversity. Negative impacts of trauma on physical health
outcomes, such as decreased longevity and increased heart disease, are found to
be mitigated by resilience (Connor, 2003, 2006; Lazarus, 1993; Tugade, Fredrickson, & Barrett,
2004). Improved
well-being, performance, and satisfaction in the vocational domain is also
predicted by greater presence of indicators of resilience (Avery, Luthans,
Smith, & Palmer, 2010, Luthans, Avolio, Avery, & Norman, 2007; Luthans,
Avolio, Walumbwa, & Li, 2005; Youseef & Luthans, 2007). Resilience has
also been found to mitigate the impact of adverse childhood experiences on
physical and mental health outcomes and to increase health related quality of
life (Banyard, Hamby, & Grych, 2017).

Just
as trauma and ACEs have neurobiological effects, there is evidence of
neurobiological and genetic correlates of resilience as well. The beneficial
traits and abilities reported by Rutter (1985) appear to be related to
underlying neurological systems relating to fear and threat
assessment/response, social behaviors such as bonding and teamwork, and reward
systems (Charney, 2004). Several neurobiological responses and mechanisms appear
associated with resilience and vulnerability, including: hormones such as
cortisol and dopamine that may make resilience more dfficult and several
neurochemicals that may function protectively and thus increase resilience
(serotonin, testosterone, estrogen, galanin, dehydroepiandrosterone,
neuropeptide Y, and benzodiazepine receptors) may ultimately promote
resilience, while the release of others (corticotropin-releasing hormone and
the locus ceruleus-norepinephrine system) (Charney, 2004).  The tendency to develop anxiety disorders and
trauma-related psychological disorders such as PTSD may also be partially
mediated by genetic factors (True, 1993).

Social-Emotional Learning

 

Social-emotional
learning is vital to successful functioning across settings in a child or
adult’s life. Social-emotional learning (SEL) is a construct including behavioral,
cognitive, and affective capacities that promote identification and regulation
of the self, recognize and empathize with the internal life of others, build
positive relationships, act responsibly in his or her own life, and use sound
judgement (CASEL, 2015). These skills underlie successful
functioning across the lifespan and across environments including home, school,
peer groups, and, eventually, romantic and career contexts. Social-emotional
learning is particularly important in academic settings where classroom
functioning, peer relationships, academic performance, attitudes towards
school, and responsible decision making can be predicted (Zins, Bloodworth, Weissberg, & Walberg, 2004). A meta-analysis by Zin and Elias (2007) found
that of the 11 categories with the greatest influence on overall learning, 8
were directly related to SEL and a failure to develop those skills were a risk
factor for difficulties in a variety of domains across the lifespan (Zins et al., 2004).     

Social-Emotional
Learning Competencies Identified by CASEL.

The Collaborative
for Social-emotional Learning (CASEL; CASEL, 2015) developed a framework of
five competency areas in the domain of social-emotional learning that underlie
successful functioning across environments: self-awareness (identifying one’s
own thoughts, emotions, and values), self-management (managing thoughts,
feelings, and behaviors, including inhibitory control and goal-directed
planning and behavior), social-awareness (empathy and perspective taking,
recognizing and following social rules, and cross-cultural awareness of
emotions and points of view), relationship skills (understanding and skills to
build and maintain healthy, positive interpersonal relationships such as active
listening, conflict resolution, sharing, and asking for help), and responsible
decision-making (understanding and using ethics, social expectations, and
consequences to make appropriate judgements and decisions) (Dymnicki, Sambolt, & Kidron, 2013).

The Correlates of
Social-Emotional Learning.

Social-emotional
learning is foundational for academic success (Payton et
al., 2008AG1 ) and teaching
social-emotional learning has a demonstrated positive effects on multiple
aspects of a child’s functioning including ethical understanding, teacher-child
relationships, conflict resolution skills, and self-esteem as well as decreased
engagement in risk-taking behaviors (Zins & Elias, 2006; Zins,
Elias, & Greenberg, 2003). Receiving social-emotional skill training
can improve school achievement and improve school related behaviors such as
participation and attendance as well as attitudes towards the school
environment (Durlak, Weissberg, Dymnicki, Taylor, &
Schellinger, 2011). School-wide SEL programs have been
associated with improved school outcomes across domains and cost-benefit
analyses indicate that benefits far outweigh the cost of implementation (Belfield et al., 2015) in terms of reduced disciplinary issues
and increased academic outcomes. Children and adolescents with better SEL
skills are less likely to use substances, be truant, fail to complete their
basic education, or become pregnant and have greater resilience to peer
pressure (Elias et al., 1997). Moreover, much like
adverse childhood experiences discussed previously, SEL can predict engagement
in the community, health outcomes, career trajectory, affective disorders,
violent behavior, general maladjustment, and violent behavior (Elias et al., 1997; Zins et al., 2004; Zins &
Elias, 2006).  

Child Internalizing and Externalizing
Behavior

            Internalizing and
externalizing behavior are categories used to classify behavior problems. Particularly in children and adolescents.
They are sometimes used within the broader special education category of
emotional disturbance, also referred to as emotional and behavioral disorders (Jacob,
Decker, & Timmerman
Lugg, 2016); these labels
classify such difficulties more broadly as being either directed inward, as in
depression or anxiety, or outward, as in oppositional defiance or conduct disorder. The classification of
emotional/behavioral disorder requires that a child have: a learning difficulty not explained by intellectual, sensory, or health factors; difficulty building or maintaining relationships
with peers and/or teachers; inappropriate
behaviors or feelings towards self or others (expresses
the need to harm self or others, low self-worth, etc.); a pervasive mood
of unhappiness or depression; and/or a tendency to develop physical symptoms or fears
associated with personal or school problems
(as cited in Jacob, Decker, & Timmerman Lugg, 2016).

The
classification of emotional and behavioral disorders has obvious utility for
children given the impact of federal law such as IDEA 2004 on service access.
Internalizing and externalizing behavior, and combined disturbance across these
categories, provides a useful distinction between pathologies for research and
clinical contexts as well. Maladaptive behavior can in this framework be understood as
externalizing, which involve problems with conduct, aggression, poor
socialization, under-controlled behavior, and attention deficits, and
internalizing, which involve interpersonal hypersensitivity, anxiety,
depression, overcontrolled behavior, and social withdrawal
(Rapport, Denney,
Chung & Hustace, 2001). Indeed, poor regulation and inhibition of
attention, cognitive processing, and behavior have been directly linked to
externalizing problems (Rubin, Burgess, Dwyer, & Hastings, 2003; Eisenberg
et al., 2000; Fagot, & Leve, 1998). More mixed results have been found for
internalizing behaviors, where some studies support early problems predicting
later internalizing disorders and some do not (Fischer, Rolf, Hasazi, &
Cummings, 1984; Lavigne et al., 1998). Adverse Childhood Experiences have been
found to predict greater likelihood of both internalizing and externalizing
behavior problems as early as age 9, with a stronger predictive value for
externalizing behaviors and likelihood of clinically significant problems
increasing when 3 or more ACEs have been experienced (Hunt, Slack, &
Berger, 2017).

Internalizing and
externalizing behaviors have been found in some samples to decrease with time
(Bongers et al. 2003) but individual characteristics can predict greater
stability in these problems over time. Internalizing/emotional and
externalizing/conduct problems were highly comorbid in epidemiological and clinical samples (Achenbach and Rescorla, 2001; Gould, Bird, & Jaramillo, 1993; Harrington, Fudge, Rutter, Pickles,
& Hill, 1991; Verhulst & van der Ende, 1993; Weiss & Catron, 1994;
Zoccolillo, 1992). One study found that covariance between internalizing and
externalizing behavior problems ranged from r=.51
to r=.58 and this was primarily
accounted for by environmental factors (Gjone and Stevenson, 1997); those whose
behavior fell into only one category had greater genetic influences than those
who had both. Both internalizing and externalizing behaviors are associated
with hyper- and hypo- arousal in the HPA axis, autonomic nervous system
arousal, and cortisol response (Chen, Raine, Soyfer, & Granger, 2015;
Ruttle et al., 2011); this may be because diurnal patterns of HPA arousal and
release of cortisol are atypical in both internalizing and externalizing
behavior issues but in slightly different ways. Such behavior problems have
been associated with increased inflammatory responses and greater physical
health problems in adulthood (Slopen, Kubzansky, & Koenen, 2013). In
addition, internalizing and externalizing
behavior are strongly correlated with DSM diagnosis of anxiety, depression,
conduct disorder, oppositional disorder, and attention deficit hyperactivity
disorder (Edelbrook & Costello, 1988; Gould, Bird, & Jaramillo, 1993). They also predict likelihood of
long-term problems with interpersonal relationships, greater peer rejection,
lower self-esteem, and poorer academic achievement (Ansary & Luther, 2009; Aunola et al., 2000; Hymel et al., 1990; Pederson et al., 2007; Ruttle et al., 2011).

Internalizing Behavior.

Internalizing problems represent overcontrol
of behavior and difficulty regulating negative affect so there is a higher
endorsement of negative affective states more generally (Derryberry & Rothbart,
1988; Edelbrook & Costello, 1988; Eisenberg
et al., 2001; Gould, Bird,
& Jaramillo, 1993); problems with decreased attentional
control and increased rumination may be associated with this increased negative
affect. Internalizing behavior appears to worsen with age and children with
internalizing behavior problems have more conduct problems, poorer school
achievement, poor social self-efficacy, poor perception of social competence by
others, increased learning problems, and poor social skills generally (Asendorpf &van Aken, 1999; Hymel,
Rubin, Rowden, & LeMare, 1990; Rapport, Denney, Chung & Hustace, 2001; Robins et al., 1996).
Those children who had
internalizing behaviors in middle childhood were more likely to have had early
problems with perceived social competence including lack of peer acceptance and
isolation (Hymel, Rubin, Rowden, & LeMare, 1990).

Children with internalizing problems have shown higher cortisol
reactivity and associated social anxiety and withdrawal during social
engagement tasks in the laboratory as well as greater inhibited
behavior, poor self-efficacy, and an external locus of control in social
situations (Granger, Weisz, & Kauneckis, 1994). Internalizing problems are
associated with poor attentional control and related higher levels of rumination, sadness, anxiety, and
depression (Derryberry & Rothbart, 1988; Kochanska, Coy, Tjebkes, &
Husarek, 1998; Rothbart, Ziaie, & O’Boyle, 1992; Vasey, El-Hag, &
Daleiden, 1996). These children also tend to be rigid and unspontaneous in the
behavior and to have less adaptive flexibility in their behavior (Eisenberg
& Fabes, 1992).  Moreover, children
who show overcontrolled behavior more generally are more likely to display
social withdrawal (Asendorpf & van Aken, 1999) and to develop internalizing
problems (Robins et al., 1996).

Externalizing Behavior.

Those children with externalizing disorders tend to be under-controlled
in their regulation of attention, emotion, and behavior. Indeed, deficits in
inhibitory regulation are linked in several studies with externalizing
problems, including deficits in regulating attention and cognition in addition
to problems with emotional and behavioral control (Andersson & Sommerfelt,
2001; Eisenberg et al, 2000; Eisenberg et al., 2001; Fagot, & Leve, 1998; Olson,
Schilling, & Bates, 1999; Oosterlaan & Sergeant, 1996; Rothbart, Posner,
& Hershey, 1995). Thus, impulsivity and
disruptiveness are common in externalizing disorders, in addition to more overt
behaviors such as aggression and rule-breaking. One 24-year longitudinal study
found that less destructive or aggressive externalizing behaviors predict
increased problems in both internalizing and externalizing disorders and
maladjustment in adulthood but that level of difficulty rather than type of
behavior was more predictive of ongoing difficulties (Reef,
Diamantopoulou, van Meurs, Verhulst, der Ende, 2010).

Externalizing behaviors are often linked to a variety of other
difficulties across environments for children. In particular, the school and
peer environments often are fraught. Poor peer relationships, poor school
achievement, and reduced cognitive performance are common and predict increased
delinquency in adolescence and beyond (Fagot & Leve, 1998; Hinshaw, 1992); disruptions in the home environment and with parent-child
relationships are also common. Children with externalizing problems are more
likely to be diagnosed with conduct and oppositional disorders (Edelbrook & Costello,
1988; Gould,
Bird, & Jaramillo, 1993). Such children often endorse high levels of
frustration, anger, and hostility (Casey & Schlosser, 1994; Colder & Stice, 1998; Krueger,
Caspi, Moffitt, White, & Stouthamer-Loeber, 1996; Zahn-Waxler et al., 1994)
and aggressive or uncontrolled outbursts can lead to rejection by peers and
teachers. This peer rejection and increased social incompetence at an early
predict externalizing behavior problems later (Hymel, Rubin, Rowden, &
LeMare, 1990).