Charlotte Cecil Molecules of Happiness: Why Love Matters for Vulnerable Children

1. Double Disadvantage:The impact of childhood maltreatment and community violence exposure on adolescent mental health Charlotte Cecil Molecules of Happiness: Why Love Matters for Vulnerable Children London, 26th September 2013

2. Background • Childhood maltreatment

3. Background • Maltreatment prevalence • Affects millions of children worldwide • Difficult to estimate true prevalence • Many cases never come to light • Existing estimates vary widely • Community studies vs. official reports • UK: up to 1 in 5 experience severe maltreatment (NSPCC; Radford et al., 2011)

4. Background • Maltreatment effects • Childhood • Child fatality • 1 in 10 injury-related child fatalities worldwide (WHO; Pinheiro et al., 2006) • Increased risk of mental health and adjustment difficulties • Emotional, behavioural, interpersonal domains (Cicchetti & Toth, 2005) • Underpinned by biological changes in brain structure, function, and stress response (McCrory et al, 2010)

5. Background • Maltreatment effects • Childhood • Child fatality • 1 in 10 injury-related child fatalities worldwide (WHO; Pinheiro et al., 2006) • Increased risk of mental health and adjustment difficulties • Emotional, behavioural, interpersonal domains (Cicchetti & Toth, 2005) • Underpinned by biological changes in brain structure, function, and stress response (McCrory et al, 2010) • Adulthood • Increased susceptibility to psychiatric and medical disorders • E.g. mood and personality disorders, obesity, diabetes, chronic pain (Oswald et al., 2010) • Decreased life opportunities • E.g. education, employment, earnings (Currie & Widom, 2010)

6. Background 2. Community violence exposure (CVE)

7. Background • Community Violence Exposure (CVE) • Characteristics • Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder • Levels of exposure: Hearing about, witnessing, directly experiencing • Most chronic and prevalent form of violence exposure • Rates of exposure remain constant across years (Fowler et al., 2009) • 50%+ of urban youth affected (Buka et al, 2001) • 4-70% witness stabbing/shooting • 1-47% witness murder • CVE impact • Mental health & behaviour (Margolin & Gordis, 2000) • PTSD, Aggression

8. Background • Community Violence Exposure (CVE) • Characteristics • Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder • Levels of exposure: Hearing about, witnessing, directly experiencing • Most prevalent and chronic form of violence exposure • 50%+ of urban youth affected (Buka et al, 2001) • Rates of exposure remain constant across years (Fowler et al., 2009) • CVE impact • Mental health & behaviour (Margolin & Gordis, 2000) • PTSD, Aggression

9. Background • Community Violence Exposure (CVE) • Characteristics • Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder • Levels of exposure: Hearing about, witnessing, directly experiencing • Most chronic and prevalent form of violence exposure • Rates of exposure remain constant across years (Fowler et al., 2009) • 50%+ of urban youth affected (Buka et al, 2001) • CVE impact • Mental health & behaviour (Margolin & Gordis, 2000)

10. FREQUENTLY CO-OCCUR

11. YET, EXAMINED SEPARATELY

13. Kids-Co/UCL Project • Sample • 204 inner city youth from the community • 16-24 year olds, males and females • Multiple recruitment channels • 50% Kids Company • 50% Inner city London schools and internet websites • Matched for age, sex, ethnic background, IQ and neighbourhood deprivation • Measures • Developmental adversity (self-report) • Childhood maltreatment • Current exposure to community violence • Mental health functioning (multi-rater reports) • Internalizing difficulties (anxiety, depression) • Externalizing difficulties (conduct problems, ASB) • Trauma symptoms (anger, PTSD, dissociation)

14. Kids-Co/UCL Project • Sample • 204 inner city youth from the community • 16-24 year olds, males and females • Multiple recruitment channels • 50% Kids Company • 50% Inner city London schools and internet websites • Matched for age, sex, ethnic background, IQ and neighbourhooddeprivation • Measures • Developmental adversity (self-report) • Childhood maltreatment • Current exposure to community violence • Mental health functioning (multi-rater reports) • Internalizing difficulties (anxiety, depression) • Externalizing difficulties (conduct problems, ASB) • Trauma symptoms (anger, PTSD, dissociation)

15. Outline • Part I: Characterizing levels of exposure • Part II: The impact of maltreatment and CVE • Part III:The influence of individual maltreatment types

16. Part I: Characterizing levels of exposure

17. Part I: Levels of exposure Childhood maltreatment

18. Part I: Levels of exposure Childhood maltreatment: Any exposure* KIDS COMPANY: 84% COMPARISON: 56% VS. *Statistically significant difference = p < .01

19. Part I: Levels of exposure Childhood maltreatment: Any exposure* *All group differences statistically significant = p < .01

20. Part I: Levels of exposure Childhood maltreatment: Severe-Extreme* KIDS COMPANY: 38% COMPARISON: 8% VS. *Statistically significant difference = p < .001

21. Part I: Levels of exposure Childhood maltreatment: Severe-Extreme* *All group differences statistically significant = p < .01

22. Part I: Levels of exposure Community violence exposure

23. Part I: Levels of exposure 2. Community violence exposure: Any exposure* KIDS COMPANY: 98% COMPARISON: 95% VS. *Difference not significant

24. Part I: Levels of exposure 2. Community violence exposure: Any exposure* n.s. *Group differences for witnessing and victimization statistically significant = p< .01

25. Part I: Levels of exposure 2. Community violence exposure: Severe acts* * All group differences statistically significant = p < .001

26. Part I: Levels of exposure Single vs. Multi-type

27. Part I: Levels of exposure 3. Single vs. Multi-type: Childhood maltreatment Participants with experience of maltreatment(68% of sample; N = 139)

28. Part I: Levels of exposure 3. Single vs. Multi-type: Community violence exposure Participants with experience of community violence(92% of sample; N = 187)

29. Part I: Levels of exposure Degree of overlap

30. Part I: Levels of exposure Maltreatment (68% of sample)

31. Part I: Levels of exposure Maltreatment (68% of sample) No CVE 97% CVE

32. Part I: Levels of exposure Maltreatment (68% of sample) No CVE 97% CVE Maltreated youth typically experience a DOUBLE DISADVANTAGE

33. Part I: Levels of exposure • Summary • Alarming levels of exposure • Multi-type exposure ‘norm’ • Maltreatment and CVE frequently co-occur

34. Part I: Levels of exposure • Summary • Alarming levels of exposure • Multi-type exposure ‘norm’ • Maltreatment and CVE frequently co-occur

35. Part I: Levels of exposure • Summary • Alarming levels of exposure • Multi-type exposure ‘norm’ • Maltreatment and CVE frequently co-occur

36. Part II: The impact of maltreatment and CVE

37. Part II: Maltreatment & CVE impact ? ? • Aim • What are theirindependent effects? • What are theircombined effects?

38. Part II: Maltreatment & CVE impact Independent effects: Childhood maltreatment CHILDHOOD MALTREATMENT * * * INTERNALIZING (Anxiety, depression) EXTERNALIZING (Conduct problems, ASB) TRAUMA SYMPTOMS (Anger, PTSD, dissociation) * Effects statistically significant = p < .001

39. Part II: Maltreatment & CVE impact Independent effects: Community violence exposure COMMUNITY VIOLENCE EXPOSURE * * INTERNALIZING (Anxiety, depression) EXTERNALIZING (Conduct problems, ASB) TRAUMA SYMPTOMS (Anger, PTSD, dissociation) * Effects statistically significant = p < .01

40. Part II: Maltreatment & CVE impact 2. Combined effects: Additive

41. Part II: Maltreatment & CVE impact • Summary • Both maltreatment and CVE have serious consequences for mental health • Children who experience both forms of adversity are at particularly high risk for mental health problems

42. Part II: Maltreatment & CVE impact • Summary • Both maltreatment and CVE have serious consequences for mental health • Youth who experience double disadvantage are at particularly high risk for mental health problems

43. Part III: The influence of individual maltreatment types

44. Part III: Maltreatment types Sexual Abuse • Aim Physical Abuse Physical Neglect Emotional Neglect Emotional Abuse • Similar or different effects?

45. Part III: Maltreatment types • Findings • All maltreatment types have negative effect* • Driven by what is common to all types *(std. B = .14 – . 69; significant at least p < .05)

46. Part III: Maltreatment types • Findings • All maltreatment types have negative effect • Driven by what is common to all types FEELING UNSAFE AND VULNERABLE?

47. Part III: Maltreatment types • Findings 2. Emotional abuse* • Unique predictive power, over and above all other types *(std. B = .29 – . 76; significant at least p < .01, except externalizing difficulties)

48. Part III: Maltreatment types • Findings 2. Emotional abuse • Unique predictive power, over and above all other types FEELING UNLOVED AND UNSUPPORTED?

49. Conclusions

50. Key findings • Inner city youth are highly vulnerable to violence exposure • Maltreatment and CVE are key developmental risk factors • Emotional abuse unique predictive power