Multidimensional assessment of neuroendocrine and psychopathological profiles in maltreated youth.

Vanessa B Puetz,Kerstin Konrad,Jana Zweerings,Beate Herpertz-Dahlmann,Wolfgang Scharke,Brigitte Dahmen,Caroline Ruf

doi:10.1007/s00702-016-1509-6

Abstract

It has been debated whether children who have experienced early life stress (ELS), such as early caregiver separation show elevated risk for stress-related psychiatric disorders and a multi-symptom psychopathological profile that is not fully reflected in categorical assessments. In this study, we investigated dimensional measures of stress-related psychopathology in children in permanent out-of-home care, taking into account potential neuroendocrine interactions. In the current study, 25 children who had been placed in permanent out-of-home care before age 3 (years) and 26 controls (aged 10.6 ± 1.75 years) were investigated with categorical (DSM-IV) and dimensional assessments (CBCL) of psychopathology and diurnal salivary cortisol levels were assessed. Semi-structured interviews (K-DIPS) revealed no significant group differences in full-scale psychiatric diagnoses, whereas dimensional assessment (CBCL) revealed significant group differences in externalizing and total problem behaviours within the clinical range for children with ELS. Only children with ELS showed a combined symptom profile of clinical-range internalizing and externalizing problems. Lower morning cortisol values and subsequent flatter decline was found in subjects with ELS children compared to controls, showing group differences in diurnal cortisol secretion. Lower morning cortisol values were associated with more problem behaviour in the ELS group. Results show that ELS children exhibited increased psychopathological symptom severity and complexity associated with lower morning cortisol levels, which was not fully reflected in categorical assessments. This highlights the importance of incorporating dimensional assessments and neurobiological factors into psychopathological evaluations of children in out-of-home care in order to facilitate early identification of children at high risk for stress-related disorders.

Highlights

Children who have experienced adversity in the form of maltreatment, neglect and subsequent caregiver separation have been exposed to severe early life stress (ELS), likely affecting neurobiological and neuroendocrine systems involved in stress-regulation
It has been shown that trauma-related stress is associated with the development of several psychiatric disorders such as major depressive disorder (MDD), post-traumatic stress disorder (PTSD), anxiety disorders and conduct disorder (CD)
The diagnostic classification according to DSM-IV criteria (APA 1994) revealed 9 youths in the ELS group (36 %) that met the diagnostic criteria for either ADHD (DSM-IV 314.0, n = 6), conduct disorder (DSM-IV 312.81, n = 1); dyslexia/dyscalculia (DSM-IV 315.0, n = 1) or enuresis (DSM-IV 307.6, n = 1)

Summary

Introduction

Children who have experienced adversity in the form of maltreatment, neglect and subsequent caregiver separation have been exposed to severe early life stress (ELS), likely affecting neurobiological and neuroendocrine systems involved in stress-regulation. Trauma-related stress early in life has been associated with certain types of behaviour, such as impaired regulation of emotion, low self-efficacy and aggression, and has variable consequences at different developmental stages of the individual, resulting in age-related psychopathological symptoms (Van der Kolk 2005), e.g. regulatory and attachment disorders in infancy, conduct disorder at school age and personality disorders and substance abuse once maltreated individuals reach adolescence (Dahmen et al 2012; Lo and Cheng 2007; Ouyang et al 2008; Vaughn et al 2007; Zeanah et al 2004). It has been suggested that the increased symptom complexity across several psychopathological domains is a specific pattern of psychopathology that should be considered in its entirety when assessing individuals with early adverse experiences to facilitate early detection and intervention (Oswald et al 2010; Tarren-Sweeney 2008; Van der Kolk et al 2005)

Methods

Results

Conclusion