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Trauma Symptoms in Very Young Children Following Repeated Loss or Separation From Caregivers

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Importance: Profoundly negative effects on mental health are established among young children who have experienced traumatic losses such as institutionalization (Zeanah et al., 2009), parental death or abandonment (Lieberman, Compton, Van Horn, Ghosh, & Ippen, 2003), or separation from parents due to war (Feldman & Vengrober, 2011). Less extreme experiences of loss/separation of caregivers may also adversely affect young children. Loss/separation may co-occur with exposure to violence or non-interpersonal trauma, but whether loss/separation has unique effects on young children independent of these other adversities is unknown. Objective: This study examined whether loss/separation is associated with elevations in trauma-related symptoms, psychiatric disorders, and other indicators of impairment in 1- to 3-year-old children independent of other traumatic and socio-economic adversities. Design: We analyzed data from a cross-sectional cohort collected between 2003 and 2007. Recruitment occurred in pediatric primary care, mental health, and developmental services sites. Participants: Children’s mean age was 31.3 months (Std = 9.2). Children (35% female) were heterogeneous in ethnic background (54% minority) and family socioeconomic status (45% living in poverty). Children with neurodevelopmental conditions were ineligible. Measures: Loss/separation was defined as child experience of death of an adult loved one, separation from a parent for a week or longer, parental divorce/separation, parental hospitalization (> 24 hours), caregiver arrest, or the permanent loss of a significant relationship. A cumulative loss/separation variable was generated (none, one type, multiple types). Loss/separation and trauma exposures were assessed with the Preschool-Age Psychiatric Assessment (PAPA; Egger, et al., 2006) and Child Life Events Scale (CLES; Carter & Briggs-Gowan, 1998). (Table 1). The presence of any disorder was derived from the PAPA. Caregivers completed the Trauma Related Symptoms Scales (TRSS) of the Infant-Toddler Social and Emotional Assessment (ITSEA) (Briggs-Gowan, et al., 2010; Mongillo, Briggs-Gowan, Ford, & Carter, 2009) and the Family Life Impairment Scale (FLIS; Mian, Soto, Briggs-Gowan, & Carter, 2018). Results: Primary caregiver loss/separation was common: 28.6% single type, 16.3% multiple types. Loss/separation was elevated amongst violence exposed children: 85.3% of violence-exposed children had experienced loss/separation. However, only 23.4% of those who had experienced primary caregiver loss/separation were violence-exposed. In regression models that controlled for age, poverty, violence exposure, and non-interpersonal trauma, loss/separation was associated with significant elevations in total trauma-related symptoms and functional impairment. These effects were primarily due to marked elevations among children with multiple losses/separations (Figures 1a & 1b). Clinically-significant trauma-related symptoms were more than twice as common in children who had experienced multiple losses/separations relative to other children, controlling for age, poverty status and other trauma exposures (Odds Ratio = 2.37, 95% Confidence Interval = 1.05-5.35, p=.0377). Multiple losses/separations also were associated with increased likelihood of a psychiatric disorder (OR = 3.58, CI=1.48-8.65), but this effect was attenuated when violence exposure was controlled (p=.1081). Conclusion. It is important to raise awareness among pediatric primary care and mental health professionals that an accumulation of primary caregiver losses/separations in early childhood, irrespective of violence and other traumatic exposure, increases risk for clinically significant trauma-related symptoms, impairment, and psychiatric disorder.

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