Traumatic Violence Prevention, 2016). Given the intergenerational
Traumatic experiences and chronic stress or adversity inchildhood are known to impact functioning across domains throughout thelifespan, including interpersonal, educational, vocational, and familialfunctioning and physical and mental health across the lifespan.
Suchexperiences, when measured using the Adverse Childhood Experiences (ACEs) scaleor one of its offspring, have been shown to predict physical, psychological,and social outcomes and to have a cumulative effect in that the more childhoodadversity a person reports experiencing, the greater likelihood and number oflater functional issues they experience (Feletti et al., 1998; Violence Prevention, 2016).Given the intergenerational transmission of trauma effects through perpetuationby adults who themselves experienced trauma and the impact of corollarystressors (such as physical and emotional health problems) that adults who haveACEs often develop, it is reasonable to expect that parents with higher ACEswould be more likely to have children who themselves have high ACEs. However,direct exposure to adverse experiences is not the only possible mechanism bywhich trauma impacts of parental ACEs may be transmitted intergenerationally.
Firstly, there is very little work on the possible directimpact of parental ACEs on child social-emotional learning (SEL) or behavioraldifficulties that controls for child experiences of adversity. In addition, parentalresilience, or the ability to “bounce back” in the face of stress or adversity (Smithet al., 2008), could alter the impact of parental ACEs either by reducing theimpact of the parent’s ACEs, reducing the likelihood the child has experiencedACEs, or both. This study aims to explore the possible relationship betweenparental experiences of childhood adversity as measured by ACEs on childsocial-emotional learning and internalizing and externalizing behaviordifficulties while controlling for ACEs in the life of the child. The possiblemediating effect of parental resilience will also be explored.
Trauma Psychologicaltrauma is “the unique individual experience of an event or enduring conditions,in which: the individual’s ability to integrate his/her emotional experience isoverwhelmed, or the individual experiences a subject sense of threat to life,bodily integrity, or sanity (Pearlman & Saakvitne, 1995, p. 60).” Traumaticexperiences in childhood, also called early life stress in the literature, havebeen studied from a variety of perspectives and linked with changes inneurobiology, poorer interpersonal functioning, increased risk of physical andmental health problems, reduced telomere length, and long-term negativeoutcomes across functional domains (Kendall-Tackett, 2009; Mersky , 2010; Nemeroff, 2016). Specifically, increases in somatic complaintsand major illnesses such as heart disease, asthma, inflammatory responses,chronic pain issues, and diabetes as well as increased incidence of substanceuse, anxiety and mood disorders, psychosis, self-injury, and suicide have beenfound. Trauma also predicts lower socioeconomic status, less educational attainmentand IQ, and higher reported life stress (Elliot& Vaitilinham, 2008; Perez& Spatz Widom, 1994; Tarullo, 2012). Socially, increasedengagement in violence and delinquency (Gold, Wolan Sullivan, & Lewis,2011; Mersky & Topitzes, 2010; Xiamong & Corso, 2007) and poor socialskills (Perry, 2012) have been found in samples with childhood traumaexperiences. Neurologicalchanges associated with trauma and chronic stress, or the response to emotionalpressure suffered for a prolonged period of time in which an individualperceives he or she has little or no control (McEwen, 2007), include changes infunctionality, volume, and connectivity in the amygdala, corpus collosum,hippocampus, and hypothalamus-pituitary-adrenal axis, increased corticosteroidlevels, and altered frontal lobe volume and activity (Lupien, McEwen, Guunar,& Heim, 2009; McCrory, Dr Brito, & Viding, 2010; Nemeroff, 2016). Theseareas of the brain are specifically associated with mood regulation, threatassessment and response, the stress response, behavioral inhibition, andexecutive functioning.
Appropriate assessment of and response to theenvironment and self are necessary skills for self-regulation and appropriatesocial behavior as well as responsible decision making. Such skills, inaddition to the ability to direct and maintain attention, plan appropriateactions, and understand consequences are necessary for appropriate decisionmaking and successful social, academic, and vocational functioning. There is some evidence that these changesimpact caregiving behaviors and potentially even alter hormone and neuropeptidefunctioning at an epigenetic level, leading to intergenerational transmissionthrough genetic and behavioral pathways (Bos, 2017).
Thus, traumatic events andchronic life stressors during early life are not only associated with a varietyof negative outcomes in physical and mental health and social, academic, andvocational functioning, but also result in neurobiological changes that mayunderlie much of the difficulty. Adverse ChildhoodExperiences (ACEs).Traditionally,various adversities, such as poverty, physical abuse, or parental divorce,would be studied individually to assess their impact on short- and long- termoutcomes. Adverse Childhood Experiences (ACEs) were conceptualized by theCenters for Disease Control as a way of looking at the prevalence, impact, andinterrelationships between each form of adversity (Violence Prevention, 2016).
ACEswere first introduced to the epidemiological literature by the Kaiser-Centersfor Disease Control Adverse Childhood Experiences Study that ran from 1995 to1997 in which it was found that ACEs predicted a multitude of health relatedbehaviors and outcomes from smoking and substance use to obesity, autoimmunedisorder incidence, and early death (Feletti et al., 1998; Violence Prevention,2016). Such findings have been replicated and expanded across multiple studieswith a variety of populations both in the United States and internationally.
Muchas childhood trauma more generally has been found to do, ACEs score predictsincreased substance issues including alcoholism and alcohol abuse, smoking,earlier initiation of smoking/alcohol use, and illicit drug use (Felitti , 2010; Merrick et al., 2017) as well as sexual and relational healthproblems including intimate partner violence, increased number of sexualpartners, early and unintended pregnancy, early initiation of sexualexperience, 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 alsofound (Edwards, Holden, Felitti, & Anda, 2003; Felitti & Anda, 2010;Merrick et al.
, 2017) Moreover, ACEs show strong, graded correlations withlikelihood of serious job-related problems, high absenteeism, and ongoingfinancial instability (Anda & Felitti, 2004). In addition, and perhapsbecause of, the increase in these outcomes in adulthood, maternal ACEs predictdevelopmental concerns among their children, including social-emotional,behavioral, cognitive, and physical health (Folger et al., 2017; McDonnell andValentino, 2016; Sun et al., 2017). While the exact categories included in ACEs questionnairesvary somewhat based on likelihood of certain events (e.g. the InternationalQuestionnaire the World Health Organization uses includes exposure to war,forced migration, genital mutilation, and other community stressors rare in thedomestic US population), such questionnaires generally include assessment ofchildhood experience of physical, sexual, or emotional abuse, physical oremotional neglect, and household dysfunction in the form of substance use,mental illness, or incarceration of a family member, parental separation, anddomestic violence in the home (Bethel et al.
, 2017). ACESare common and interrelated. Indeed, Dong et al. (2004) found with the originalstudy population of 8,629 adults in the United States that two-thirds reportedat least one ACE with 81-89% of those reporting one ACE reporting at least oneadditional ACE (Dong et al., 2004). ACEs score, both in cumulative format andwhen broken down into sub-scales of abuse/neglect and household dysfunction,have implications beyond predicting risky health behaviors and physicalillness. The original study was replicated and expanded by the Behavioral RiskFactor Surveillance System (BRFSS) over several years with the most recentavailable data being from 2010 as well as several additional independentstudies in the United States and internationally.
Some studies have found thatongoing relationship problems, substance use, somatic symptoms, and emotionaldistress mediate relationships between ACEs and outcomes in a variety ofdomains (Anda & Felitti, 2004; Folger et al., 2017). Indeed, ongoingdifficulties with emotional well-being, unstable or dysfunctional relationshipdynamics, increased risk behavior, and physical health problems appear tofunction in complex interrelated ways to mediate many of the findingsassociated with increased ACEs scores.
Resilience.Resilienceis defined in this study as the ability to “bounce back” in the face ofadversity or trauma (Smith et al., 2008). Resilience is generally related to the ability to adapt tochanging circumstances and persist in the face of challenges, and is both acharacteristic and a process (Zellars, Justice, & Beck, 2011); contentanalysis has identified the areas of positive coping, social support, and personalcompetence as potentially underlying resilience.
Resilient people are able toform strong relationships and access them for support when needed, to formshared goals and work with others to achieve them (Rutter, 1985). Moreover,they can tolerate negative emotions while remaining humorous, optimistic, andpatient, with strong self-efficacy and self-esteem, and an action orientationto problem solving (Rutter, 1985). Resiliencepredicts a variety of improved outcomes among individuals who experiencedtrauma or early adversity. Negative impacts of trauma on physical healthoutcomes, such as decreased longevity and increased heart disease, are found tobe mitigated by resilience (Connor, 2003, 2006; Lazarus, 1993; Tugade, Fredrickson, & Barrett,2004). Improvedwell-being, performance, and satisfaction in the vocational domain is alsopredicted 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 hasalso been found to mitigate the impact of adverse childhood experiences onphysical and mental health outcomes and to increase health related quality oflife (Banyard, Hamby, & Grych, 2017).
Justas trauma and ACEs have neurobiological effects, there is evidence ofneurobiological and genetic correlates of resilience as well. The beneficialtraits and abilities reported by Rutter (1985) appear to be related tounderlying neurological systems relating to fear and threatassessment/response, social behaviors such as bonding and teamwork, and rewardsystems (Charney, 2004). Several neurobiological responses and mechanisms appearassociated with resilience and vulnerability, including: hormones such ascortisol and dopamine that may make resilience more dfficult and severalneurochemicals that may function protectively and thus increase resilience(serotonin, testosterone, estrogen, galanin, dehydroepiandrosterone,neuropeptide Y, and benzodiazepine receptors) may ultimately promoteresilience, while the release of others (corticotropin-releasing hormone andthe locus ceruleus-norepinephrine system) (Charney, 2004). The tendency to develop anxiety disorders andtrauma-related psychological disorders such as PTSD may also be partiallymediated by genetic factors (True, 1993). Social-Emotional Learning Social-emotionallearning is vital to successful functioning across settings in a child oradult’s life. Social-emotional learning (SEL) is a construct including behavioral,cognitive, and affective capacities that promote identification and regulationof the self, recognize and empathize with the internal life of others, buildpositive relationships, act responsibly in his or her own life, and use soundjudgement (CASEL, 2015). These skills underlie successfulfunctioning across the lifespan and across environments including home, school,peer groups, and, eventually, romantic and career contexts. Social-emotionallearning is particularly important in academic settings where classroomfunctioning, peer relationships, academic performance, attitudes towardsschool, and responsible decision making can be predicted (Zins, Bloodworth, Weissberg, & Walberg, 2004).
A meta-analysis by Zin and Elias (2007) foundthat of the 11 categories with the greatest influence on overall learning, 8were directly related to SEL and a failure to develop those skills were a riskfactor for difficulties in a variety of domains across the lifespan (Zins et al., 2004). Social-EmotionalLearning Competencies Identified by CASEL.The Collaborativefor Social-emotional Learning (CASEL; CASEL, 2015) developed a framework offive competency areas in the domain of social-emotional learning that underliesuccessful functioning across environments: self-awareness (identifying one’sown thoughts, emotions, and values), self-management (managing thoughts,feelings, and behaviors, including inhibitory control and goal-directedplanning and behavior), social-awareness (empathy and perspective taking,recognizing and following social rules, and cross-cultural awareness ofemotions and points of view), relationship skills (understanding and skills tobuild and maintain healthy, positive interpersonal relationships such as activelistening, conflict resolution, sharing, and asking for help), and responsibledecision-making (understanding and using ethics, social expectations, andconsequences to make appropriate judgements and decisions) (Dymnicki, Sambolt, & Kidron, 2013).
The Correlates ofSocial-Emotional Learning.Social-emotionallearning is foundational for academic success (Payton etal., 2008AG1 ) and teachingsocial-emotional learning has a demonstrated positive effects on multipleaspects of a child’s functioning including ethical understanding, teacher-childrelationships, conflict resolution skills, and self-esteem as well as decreasedengagement in risk-taking behaviors (Zins & Elias, 2006; Zins,Elias, & Greenberg, 2003). Receiving social-emotional skill trainingcan improve school achievement and improve school related behaviors such asparticipation and attendance as well as attitudes towards the schoolenvironment (Durlak, Weissberg, Dymnicki, Taylor, &Schellinger, 2011). School-wide SEL programs have beenassociated with improved school outcomes across domains and cost-benefitanalyses indicate that benefits far outweigh the cost of implementation (Belfield et al., 2015) in terms of reduced disciplinary issuesand increased academic outcomes. Children and adolescents with better SELskills are less likely to use substances, be truant, fail to complete theirbasic education, or become pregnant and have greater resilience to peerpressure (Elias et al.
, 1997). Moreover, much likeadverse childhood experiences discussed previously, SEL can predict engagementin 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 ExternalizingBehavior Internalizing andexternalizing behavior are categories used to classify behavior problems. Particularly in children and adolescents.
They are sometimes used within the broader special education category ofemotional disturbance, also referred to as emotional and behavioral disorders (Jacob,Decker, & TimmermanLugg, 2016); these labelsclassify such difficulties more broadly as being either directed inward, as indepression or anxiety, or outward, as in oppositional defiance or conduct disorder. The classification ofemotional/behavioral disorder requires that a child have: a learning difficulty not explained by intellectual, sensory, or health factors; difficulty building or maintaining relationshipswith peers and/or teachers; inappropriatebehaviors or feelings towards self or others (expressesthe need to harm self or others, low self-worth, etc.); a pervasive moodof unhappiness or depression; and/or a tendency to develop physical symptoms or fearsassociated with personal or school problems(as cited in Jacob, Decker, & Timmerman Lugg, 2016). Theclassification of emotional and behavioral disorders has obvious utility forchildren given the impact of federal law such as IDEA 2004 on service access.
Internalizing and externalizing behavior, and combined disturbance across thesecategories, provides a useful distinction between pathologies for research andclinical contexts as well. Maladaptive behavior can in this framework be understood asexternalizing, which involve problems with conduct, aggression, poorsocialization, under-controlled behavior, and attention deficits, andinternalizing, which involve interpersonal hypersensitivity, anxiety,depression, overcontrolled behavior, and social withdrawal(Rapport, Denney,Chung & Hustace, 2001). Indeed, poor regulation and inhibition ofattention, cognitive processing, and behavior have been directly linked toexternalizing problems (Rubin, Burgess, Dwyer, & Hastings, 2003; Eisenberget al., 2000; Fagot, & Leve, 1998). More mixed results have been found forinternalizing behaviors, where some studies support early problems predictinglater internalizing disorders and some do not (Fischer, Rolf, Hasazi, &Cummings, 1984; Lavigne et al., 1998). Adverse Childhood Experiences have beenfound to predict greater likelihood of both internalizing and externalizingbehavior problems as early as age 9, with a stronger predictive value forexternalizing behaviors and likelihood of clinically significant problemsincreasing when 3 or more ACEs have been experienced (Hunt, Slack, &Berger, 2017).
Internalizing andexternalizing behaviors have been found in some samples to decrease with time(Bongers et al. 2003) but individual characteristics can predict greaterstability in these problems over time. Internalizing/emotional andexternalizing/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 andexternalizing behavior problems ranged from r=.51to r=.
58 and this was primarilyaccounted for by environmental factors (Gjone and Stevenson, 1997); those whosebehavior fell into only one category had greater genetic influences than thosewho had both. Both internalizing and externalizing behaviors are associatedwith hyper- and hypo- arousal in the HPA axis, autonomic nervous systemarousal, and cortisol response (Chen, Raine, Soyfer, & Granger, 2015;Ruttle et al., 2011); this may be because diurnal patterns of HPA arousal andrelease of cortisol are atypical in both internalizing and externalizingbehavior issues but in slightly different ways. Such behavior problems havebeen associated with increased inflammatory responses and greater physicalhealth problems in adulthood (Slopen, Kubzansky, & Koenen, 2013). Inaddition, internalizing and externalizingbehavior are strongly correlated with DSM diagnosis of anxiety, depression,conduct disorder, oppositional disorder, and attention deficit hyperactivitydisorder (Edelbrook & Costello, 1988; Gould, Bird, & Jaramillo, 1993). They also predict likelihood oflong-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 overcontrolof behavior and difficulty regulating negative affect so there is a higherendorsement of negative affective states more generally (Derryberry & Rothbart,1988; Edelbrook & Costello, 1988; Eisenberget al., 2001; Gould, Bird,& Jaramillo, 1993); problems with decreased attentionalcontrol and increased rumination may be associated with this increased negativeaffect. Internalizing behavior appears to worsen with age and children withinternalizing behavior problems have more conduct problems, poorer schoolachievement, poor social self-efficacy, poor perception of social competence byothers, 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 hadinternalizing behaviors in middle childhood were more likely to have had earlyproblems with perceived social competence including lack of peer acceptance andisolation (Hymel, Rubin, Rowden, & LeMare, 1990).Children with internalizing problems have shown higher cortisolreactivity and associated social anxiety and withdrawal during socialengagement tasks in the laboratory as well as greater inhibitedbehavior, poor self-efficacy, and an external locus of control in socialsituations (Granger, Weisz, & Kauneckis, 1994). Internalizing problems areassociated with poor attentional control and related higher levels of rumination, sadness, anxiety, anddepression (Derryberry & Rothbart, 1988; Kochanska, Coy, Tjebkes, &Husarek, 1998; Rothbart, Ziaie, & O’Boyle, 1992; Vasey, El-Hag, , 1996). These children also tend to be rigid and unspontaneous in thebehavior and to have less adaptive flexibility in their behavior (Eisenberg& Fabes, 1992). Moreover, childrenwho show overcontrolled behavior more generally are more likely to displaysocial withdrawal (Asendorpf & van Aken, 1999) and to develop internalizingproblems (Robins et al.
, 1996). Externalizing Behavior.Those children with externalizing disorders tend to be under-controlledin their regulation of attention, emotion, and behavior. Indeed, deficits ininhibitory regulation are linked in several studies with externalizingproblems, including deficits in regulating attention and cognition in additionto 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 anddisruptiveness are common in externalizing disorders, in addition to more overtbehaviors such as aggression and rule-breaking. One 24-year longitudinal studyfound that less destructive or aggressive externalizing behaviors predictincreased problems in both internalizing and externalizing disorders andmaladjustment in adulthood but that level of difficulty rather than type ofbehavior was more predictive of ongoing difficulties (Reef,Diamantopoulou, van Meurs, Verhulst, der Ende, 2010).
Externalizing behaviors are often linked to a variety of otherdifficulties across environments for children. In particular, the school andpeer environments often are fraught. Poor peer relationships, poor schoolachievement, and reduced cognitive performance are common and predict increaseddelinquency in adolescence and beyond (Fagot & Leve, 1998; Hinshaw, 1992); disruptions in the home environment and with parent-childrelationships are also common. Children with externalizing problems are morelikely to be diagnosed with conduct and oppositional disorders (Edelbrook & Costello,1988; Gould,Bird, & Jaramillo, 1993). Such children often endorse high levels offrustration, 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 andteachers. This peer rejection and increased social incompetence at an earlypredict externalizing behavior problems later (Hymel, Rubin, Rowden, , 1990).