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Objective Maternal stress in humans influences behavior of children and can be assessed using biological markers. Mothers and their one-month-old infants were recruited from an existing study to examine baseline maternal serum oxytocin and hypothalamic-pituitary-adrenal axis response to infant blood heel stick stress as measured by salivary cortisol in the dyads. Objectives were to explore (1) relationships between mother and infant cortisol levels, (2) gender differences in infant biologic cortisol response, and (3) the association of cortisol levels in the dyads and maternal oxytocin levels Methods Forty-two mother–infant dyads provided biologic samples and self-report data. Maternal oxytocin samples were obtained. Initial salivary cortisol was assessed in both the mother and infant, followed by a heel stick blood draw. Twenty minutes later, salivary cortisol was collected again from dyads. Results Self-report measures were negative for depression and risk for childhood neglect. Although oxytocin and baseline cortisol in the infants was higher in mothers that did some breast-feeding, there was no statistically significant difference ( p = 0.2 and p = 0.1, respectively). Analyses showed (a) higher baseline cortisol in mothers was related to higher baseline cortisol in infants ( p ≤ 0.0001), (b) following the stressor, female infants had a larger positive change in cortisol, after adjusting for baseline cortisol ( p = 0.045), and (c) there was no relationship between dyad cortisol levels and maternal oxytocin. Conclusions Maternal and infant biologic stress measures are related. Female infants have a larger hypothalamic-pituitary-adrenal response to a blood draw stressor as measured by salivary cortisol than male infants.

The Bullying and Ostracism Screening Scale (BOSS) is a brief self-report measure for detecting bullying and ostracism in pediatric populations. Preliminary psychometric studies with 426 children 10–14 years old from pediatric clinics and schools yielded a promising measure with screening sensitivity superior to parent report. Additional analyses with 1076 students support BOSS factor structure and utility. Bullying and ostracism were significantly correlated with self-reported depression and threats to self-esteem, belonging, control, and meaningful existence. The BOSS is a cost-effective instrument for health care professionals wishing to screen for bullying and ostracism in pediatric populations with somatic, academic, emotional, and behavioral issues.

Child maltreatment appears to be the single most preventable cause of mental illness and behavioral dysfunction in the United States. Few published studies examine the developmental and the psychobiological consequences of sexual abuse. There are multiple mechanisms through which sexual abuse can cause post-traumatic stress disorder, activate biological stress response systems, and contribute to adverse brain development. This article will critically review the psychiatric problems associated with maltreatment and the emerging biologic stress system research with a special emphasis on what is known about victimization by sexual abuse.

Long-term changes in the hypothalamic-pituitary-adrenal (HPA) axis as a result of early life stress could be related to the development of substance use disorders during adulthood. In this study, the neuroendocrine, physiologic (HR), and subjective responses to corticotropin releasing hormone (CRH) and the Trier Social Stress Task (TSST) in individuals with cocaine dependence, with (n=21)/without early life stress (n=21), non-dependent individuals with early life stress (n=22), and a control group were examined (n=21). CRH increased cortisol and ACTH levels in all groups. However, a significant effect of early life stress on ACTH was observed indicating that the increase in ACTH was greatest in subjects with a history of childhood stress. Post hoc analysis indicated the early life stress/non-cocaine dependent individuals exhibited significantly higher levels of ACTH as compared to the early life stress/cocaine-dependent group. Despite the elevated ACTH response there was no difference between the groups in the cortisol response to CRH. The TSST produced a significant elevation in ACTH and cortisol all study groups. No significant group differences were observed. The subjective stress and peak heart rate responses to the TSST were greatest in cocaine-dependent subjects without early life stress. In response to CRH, subjective stress and craving were positively correlated in cocaine-dependent subjects regardless of early life stress history, while stress and craving following the TSST were correlated only in cocaine-dependent subjects without a history of early life stress. Findings support previous studies demonstrating that subjects with a history of childhood adversity exhibit elevated ACTH and blunted cortisol levels in response to stress. In contrast, HR and subjective stress in response to the TSST were greatest in cocaine-dependent subjects without a history of early life stress, suggesting that childhood adversity may desensitize autonomic and subjective responding to social stress in adults with cocaine dependence.

Objective: A strong association between a history of child abuse and subsequent psychiatric disorders including substance use has been demonstrated. However, few studies have examined the relationship between child abuse and cigarette smoking in individuals without co-occurring psychiatric disorders. In this study, the relationship between severe childhood abuse and smoking were examined in a group of adults without significant psychopathology. Methods: Participants ( N = 57) represent the control group of a larger study of substance dependence. Participants were without major DSM-IV psychopathology, including substance use disorders, major depression, or posttraumatic stress disorder. The Early Trauma Inventory [20] assessed history of exposure to traumatic events prior to age 18. Results: The majority of individuals with, as compared to without, a history of severe child abuse (79% vs. 47%, p = .02) were current cigarette smokers. The odds of smoking was four times as high in participants with versus without a severe childhood abuse history (OR = 4.0, p = 0.04). Conclusions: Although preliminary, the findings demonstrate a strong link between early childhood trauma and later adult cigarette smoking among individuals without significant substance use or other psychopathology.

This study investigated the link between exposure to early life trauma, sensitivity to current daily stressors, and cocaine dependence. Individuals with (n = 105) or without (n = 53) cocaine dependence completed the Early Trauma Inventory and the Daily Hassles Scale. In comparison to controls, cocaine-dependent individuals reported almost twice as many daily hassles and perceived those hassles more negatively (p < .001). For participants with cocaine dependence, a significant relationship between exposure to early life trauma and negative perception of current daily hassles was observed (p < .01), whereas no such relationship was observed for participants without cocaine dependence. Adverse childhood events may lead to an altered view of the environment that contributes to increased irritability with daily life events among cocaine-dependent individuals.

Parenting stress (PS) and its correlates were examined in four pediatric outpatient and clinical research samples in children ages 4 through 12, who had a variety of health, developmental, behavioral, and neurological problems (designated children with special needs [CSN]). Participants came from four different clinic samples: (a) an interdisciplinary clinic for children with combined developmental, behavioral, neurological, and emotional problems (DBC, n = 57); (b) children with intraventricular hemorrhage documented at birth (IVH, n = 70); (c) children with learning and/or attention problems (LD/ADHD, n = 54); and (d) children with neural tube defects (NTD, n = 45). In multiple regression analyses, externalizing, and/or internalizing behavior problems emerged as consistent, and in some cases, the sole correlates of overall PS and parental distress. Perceived inadequacy of family resources and maternal support were also related to PS in some samples. In the DBC, IVH, and NTD samples, analyses of variance revealed PS to be highest in parents of children with behavior problems only or combined cognitive deficits and behavior problems. Having a child with neither behavior problems nor cognitive impairment, or cognitive impairment alone was associated with lower PS. There is a need for collaboration and consultation between clinics serving CSN and qualified mental health professionals if PS in these families is to be adequately evaluated and treated.

Hypothalamic pituitary adrenal (HPA) axis and subjective stress response to a cold-water immersion task, the cold pressor task (CPT), in individuals (N=89) with post-traumatic stress disorder (PTSD) were examined. All tests were conducted at 08:00h after an overnight hospital stay. Plasma adrenocorticotrophin hormone (ACTH), cortisol, and subjective stress were examined at baseline and five post-task time points in controls (n=31), subjects with PTSD as a result of an index trauma during childhood (i.e. before age 18; n=25), and subjects with PTSD as a result of an index trauma as an adult (n=33). Approximately, 50% of individuals in both trauma groups were alcohol dependent, and the impact of this comorbidity was also examined. Subjects with PTSD, regardless of age of index trauma, had a less robust ACTH response as compared to controls. Regardless of the presence or absence of comorbid alcohol dependence, subjects with childhood trauma had lower cortisol at baseline and at all post-task measurement points and did not demonstrate the decrease in cortisol over the course of the 2h monitoring period seen in subjects with adult index trauma and controls. The findings reveal differences in the neuroendocrine response to the CPT in individuals with PTSD compared to control subjects, and differences in PTSD subjects when examined by age of index trauma.

Physically abused children often require medical and mental health services. Professionals from both disciplines should be aware of critical issues related to child physical abuse (CPA) and ways in which they may work collaboratively to identify and treat abuse. In this article we present an overview of prevalence, etiology. identification, and common sequelae associated with CPA. Current psychosocial treatment models are reviewed and challenges and future directions regarding identification and treatment of physical abuse are discussed. The need for collaborative efforts between medical and mental health professionals is emphasized

Little has been written about evaluation and intervention services for children with a combination of behavioral and developmental needs. Two multidisciplinary clinic populations were compared, a traditional Developmental Disabilities (DD) clinic and a Behavioral-Developmental Problems (BDP) Clinic that had the additional services of a child psychiatrist. The BDP clinic children had lower IQ's and more severe overall behavioral problems than children in the traditional DD clinic, but differences were not statistically significant. Children with Attention Deficit Hyperactivity Disorder (ADHD) and other psychiatric diagnoses were referred to both clinics at comparable rates. The effort to involve qualified mental health professionals in all aspects of professional training and clinical service for the DD population should be accelerated.

In this study, 15 male and 15 female patients with serious eating disorders were compared. The two groups were similar in terms of demographics, comorbid conditions, and physiological complications. All three males who had bone density assessed had significant osteopenia. Abuse histories were obtained from 10 males and 10 females; childhood sexual abuse was as common among males as among females, and physical and verbal abuse was more common among the males. Abuse of others or of self was correlated, in every case, with a history of physical, sexual, or verbal abuse. Outcome was similar, with one-third to one-half of both groups significantly improved.

Objective: It is common in health care settings for adolescent patients to report physical symptoms that are unexplained by physical disease or pathophysiologic processes. The diagnosis of conversion disorder is difficult to make as many of these patients present to primary care with complex, difficult-to-understand medical symptoms. Patients can present with a medical dilemma and a symptom model consistent with a conversion disorder, but there is a danger of misdiagnosis without a thorough medical work up. Method: This case report describes a patient where the misdiagnosis of conversion disorder could have had devastating long-lasting neurologic sequelae. It appeared as if an unconscious conflict was being expressed through physical symptoms as she had ongoing family stressors prior to the onset of mysterious symptoms. Conclusions: The patient was found to have a spinal cord arteriovenous malformation. This condition is relatively uncommon in the pediatric age group, and early diagnosis is rarely made.