THE INFLUENCE OF CHILDHOOD ABUSE ON LONGITUDINAL COURSE OF RECOVERY IN PSYCHIATRIC REHABILITATION

Background: Empirical outcome studies have identified specific symptomatic, cognitive, emotional and functional sequelae of childhood abuse in people with severe mental illness (SMI). These findings illuminate the need for an integrated understanding of biological, psychological, environmental, and developmental aspects of SMI. Purpose: The purpose of the present study includes the following: 1) to examine reliability and validity of the comprehensive child abuse rating system in a sample of individuals with SMI, 2) to examine the influence of childhood abuse severity on recovery of psychotic symptoms, neurocognition and social-cognition, and social functioning in people with SMI during 12 months of inpatient psychiatric rehabilitation, and 3) to examine moderating effects of social cognition on the relationship between severity of different types of child abuse history and social functioning. Results: In Study I (N=171), the child abuse rating system produced reliable ratings and some subtypes of child abuse history were related to poorer premorbid functioning and cognition, higher overall psychiatric symptoms, and lower social functioning. In Study II (N=161), the longitudinal factor pattern invariance of the measures of social functioning, externality, and psychiatric symptoms were confirmed across 3 time points (e.g., at admission, at 6 months, and at 12 months). In addition, significant but varied linear relationships between subtypes of child abuse and each level of assessment of functioning were identified. In Study III (N=143), the results showed that higher baseline social inference, independent of history of child physical abuse (CPA), played a protective role in improvements in social functioning. High externality appeared to be counter-therapeutic for individuals with no history of CPA but protective for individuals with a more severe history of CPA. Conclusion: The child abuse rating system appears to provide reliable and valid assessment of subtypes of child abuse history of individuals with SMI. Considering the extreme heterogeneity in both SMI and child maltreatment, the current finding sheds light on providing individualized treatment and assessment planning for individuals with SMI and a history of childhood abuse.

The Quality of Spousal Social Support as a Moderator of the Associations Between Child Maltreatment Severity and Adult Trauma Symptoms

Child maltreatment has been linked to a myriad of long-term difficulties, including trauma symptomatology. However, not all victims experience long-term distress. Thus, a burgeoning area of research focuses on factors that may impede or facilitate resiliency to the psychological correlates of child maltreatment. Specifically, the severity of the abusive acts may be associated with greater long-term difficulties. To date, however, with the exception of child sexual abuse, few studies have examined the severity of maltreatment as a risk factor in the development of trauma symptoms. In contrast, social support has been theorized to contribute to resiliency following abuse. However, to date, the majority of studies examining positive social support as a protective factor have relied on self-report measures of perceived social support, rather than observational measures of received social support. Moreover, no study to date has examined the role that negative social support (i.e, blaming, criticizing) may play in potentiating trauma symptoms among victims of child maltreatment. Because child maltreatment involves serious boundary violations by a trusted person, a marital relationship is an important domain in which to examine these constructs. That is, it may serve as an arena for the manifestation of psychological disturbances related to maltreatment. Thus, the present study examined whether observationally measured positive and negative spousal social support moderated the relationship between child maltreatment severity (i.e., sexual, physical, psychological abuse; neglect) and trauma symptomatology in women and men. Results indicated that the severity of each type of child maltreatment significantly predicted increased adult trauma symptomatology. Contrary to hypothesized outcomes, positive spousal social support did not predict decreased trauma symptomatology. However, negative spousal social support generally did predict increased trauma symptomatology. There were no consistent patterns of interactions between child maltreatment severity and either type of social support. Future directions for research will be discussed and clinical implications with regard to the intrapersonal and interpersonal functioning of child maltreatment victims will be highlighted.

Parental Ethnotheories of Child Development: Looking Beyond Independence and Individualism in American Belief Systems

Over the past several decades, the topic of child development in a cultural context has received a great deal of theoretical and empirical investigation. Investigators from the fields of indigenous and cultural psychology have argued that childhood is socially and historically constructed, rather than a universal process with a standard sequence of developmental stages or descriptions. As a result, many psychologists have become doubtful that any stage theory of cognitive or socialemotional development can be found to be valid for all times and places. In placing more theoretical emphasis on contextual processes, they define culture as a complex system of common symbolic action patterns (or scripts) built up through everyday human social interaction by means of which individuals create common meanings and in terms of which they organize experience. Researchers understand culture to be organized and coherent, but not homogenous or static, and realize that the complex dynamic system of culture constantly undergoes transformation as participants (adults and children) negotiate and re-negotiate meanings through social interaction. These negotiations and transactions give rise to unceasing heterogeneity and variability in how different individuals and groups of individuals interpret values and meanings. However, while many psychologists—both inside and outside the fields of indigenous and cultural psychology–are now willing to give up the idea of a universal path of child development and a universal story of parenting, they have not necessarily foreclosed on the possibility of discovering and describing some universal processes that underlie socialization and development-in-context. The roots of such universalities would lie in the biological aspects of child development, in the evolutionary processes of adaptation, and in the unique symbolic and problem-solving capacities of the human organism as a culture-bearing species. For instance, according to functionalist psychological anthropologists, shared (cultural) processes surround the developing child and promote in the long view the survival of families and groups if they are to demonstrate continuity in the face of ecological change and resource competition, (e.g. Edwards & Whiting, 2004; Gallimore, Goldenberg, & Weisner, 1993; LeVine, Dixon, LeVine, Richman, Leiderman, Keefer, & Brazelton, 1994; LeVine, Miller, & West, 1988; Weisner, 1996, 2002; Whiting & Edwards, 1988; Whiting & Whiting, 1980). As LeVine and colleagues (1994) state: A population tends to share an environment, symbol systems for encoding it, and organizations and codes of conduct for adapting to it (emphasis added). It is through the enactment of these population-specific codes of conduct in locally organized practices that human adaptation occurs. Human adaptation, in other words, is largely attributable to the operation of specific social organizations (e.g. families, communities, empires) following culturally prescribed scripts (normative models) in subsistence, reproduction, and other domains [communication and social regulation]. (p. 12) It follows, then, that in seeking to understand child development in a cultural context, psychologists need to support collaborative and interdisciplinary developmental science that crosses international borders. Such research can advance cross-cultural psychology, cultural psychology, and indigenous psychology, understood as three sub-disciplines composed of scientists who frequently communicate and debate with one another and mutually inform one another’s research programs. For example, to turn to parental belief systems, the particular topic of this chapter, it is clear that collaborative international studies are needed to support the goal of crosscultural psychologists for findings that go beyond simply describing cultural differences in parental beliefs. Comparative researchers need to shed light on whether parental beliefs are (or are not) systematically related to differences in child outcomes; and they need meta-analyses and reviews to explore between- and within-culture variations in parental beliefs, with a focus on issues of social change (Saraswathi, 2000). Likewise, collaborative research programs can foster the goals of indigenous psychology and cultural psychology and lay out valid descriptions of individual development in their particular cultural contexts and the processes, principles, and critical concepts needed for defining, analyzing, and predicting outcomes of child development-in-context. The project described in this chapter is based on an approach that integrates elements of comparative methodology to serve the aim of describing particular scenarios of child development in unique contexts. The research team of cultural insiders and outsiders allows for a look at American belief systems based on a dialogue of multiple perspectives.

A Culture of Relationships: Early Care for Italian and American Children

A culture of childhood is a shared vision – an agreed upon vision – of the needs and rights of children, including ideas about how the people of the community can collectively nurture them and at the same time be renewed by them. In other words, it is a set of values, beliefs, and practices that people have created to guide their way of nurturing young children and their families. The vision is about investing in young children and investing in the supports and relationships that children need to learn and grow, both for the reason that children carry our future and because they carry our hopes and dreams for the future. These hopes and dreams begin with birth. Sensitive, emotionally available parents create the framework for interaction with their children by responding to the baby’s cues, engaging the baby in mutual gazes, and imitating the baby. The baby, born with a primary ability to share emotions with other human beings eagerly joins the relationship dance. The intimate family circle soon widens. Providers, teachers, and directors of early childhood programs become significant figures in children’s lives—implicit or explicit partners in a "relationship dance" (Edwards & Raikes, 2002). These close relationships are believed to be critical to healthy intellectual, emotional, social, and physical development in childhood and adolescence as well. These conclusions have been documented by diverse fields of science, ranging from cognitive science to communication studies and social and personality psychology. Close relationships contribute to security and trust, promote skill development and understanding, nurture healthy physical growth, infuse developing self-understanding and self-confidence, enable self-control and emotion regulation, and strengthen emotional connections with others that contribute to prosocial motivation (Dunn, 1993; Fogel, 1993; Thompson, 1996). Furthermore, many studies showing how relationship dysfunction is linked to child abuse and neglect, aggression, criminality, and other problems involving the lack of significant human connections (Shankoff & Meisels, 2000). In extending the dance of primary relationships to new relationships, a childcare teacher can play a primary role. The teacher makes the space ready--creating a beautiful place that causes everyone to feel like dancing. Gradually, as the dance between them becomes smooth and familiar, the teacher encourages the baby to try out more complex steps and learn how to dance to new compositions, beats, and tempos. As the baby alternates dancing sometimes with one or two partners, sometimes with many, the dance itself becomes a story about who the child has been and who the child is becoming, a reciprocal self created through close relationships.