Tracking the impact of childhood

adversity
Barbara Maughan
MRC SGDP, King’s College London
Institute of Psychiatry
Continuities in disorder / distress and
‘maladjustment’

• involve both inter- and intra-generational continuities

– Impact of childhood adversity on later mental health
Issues
• which aspects of childhood environment most salient /
deleterious?
• how are effects mediated?
• mechanisms / processes
– how does the environment ‘get under the skin’?
• how are effects carried forward across development?
Early environment and later mental
health
Aspects of mental health vary with
• Prenatal environment
– maternal stress, smoking, alcohol consumption
• Postnatal environment
– neighbourhood, school
– peers
– family SES, material circumstances
– family climate and functioning
– parents’ characteristics
– parental relationships (eg discord, divorce)
– parent-child relationships
– parenting – including neglect and abuse
Which aspects of early environment
most salient?

Challenges
• many adversities overlap
• confounding
• distal vs proximal effects
 community

school

family

material
SES parents child parenting
circs

peers

neighbourhood

culture
 community

school

family

material
SES parents child parenting
circs

peers

neighbourhood

culture
 community

school

family

material
SES parents child parenting circs

peers

neighbourhood

culture
Which aspects of early environment
most salient?

Challenges
• many adversities overlap
• confounding
• distal vs proximal effects

• are effects environmentally

mediated…?
 Role of genes?
Genetic effects implicated in continuities
• most psychiatric disorders at least moderately
heritable
• many ‘environmental’ indicators also influenced
by genes
• parents’ heritable traits influence the environments they
provide for children
• maternal depression, parental antisocial behaviour
 children’s heritable traits elicit / ’select’ environments
The E-risk Longitudinal Study of environmental risks

Moffitt & Caspi

 Mothers’ Expressed Emotion

• Are MZ twin differences

in the experience of
maternal expressed
emotion correlated
with….
• MZ twin differences in
antisocial behaviour?

Caspi et al., Developmental Psych. 2004

 Competing hypotheses

• EE has a causal influence

Versus…

• Child effects:
children’s genetically-influenced
behaviour problems elicit negative EE
 The MZ twin receiving more maternal negativism at age 5
has more behaviour problems at age 7, according to teachers

9
8
7
Sample mean
Teacher Ratings

6
5
4
3
2
1
0
MZ twin w/ more negativism MZ twin w/ less negativism

Maternal Negativism

Caspi et al., 2004

Early environment and later mental
health

Most salient aspects

• prenatal exposures
• lack/loss of committed, harmonious
relationships
• disorganized, unpredictable
• harsh and punitive
• dangerous / anxiety-provoking
• severely lacking in stimulation
• lacking sensitive responding to children’s needs
 Some pathways for effects of early
psychosocial adversity

• Environmental continuities
– increased risk exposure later in life
• Disorder / pathogenic processes in
childhood
– long-term health sequelae
• Development of ‘health capital’ -
biological, psychological & social
– resilience / vulnerability to later risk
 Developmental-contextual
model of
psychosocial adjustment: BCS70

behaviou behaviou behaviou

r r r
problem problem problem
depresse
s s s
d mood
parental
social
class
social
status

social social social

risk risk risk

birt Age Age Age 16 Age 30

h 5 10
Schoon et al, 2003
 Developmental-contextual
model of
psychosocial adjustment: BCS70

behaviou behaviou behaviou

r r r
problem problem problem
depresse
s s s
d mood
parental
social .
class 12
social
. status
89
social social social .
risk . risk . risk 47
96 97

birt Age Age Age 16 Age 30

h 5 10
Schoon et al, 2003
 Developmental-contextual
model of
psychosocial adjustment: BCS70

behaviou behaviou behaviou

r r r
. problem problem problem
22 depresse
s s s
d mood
parental
social .
class 12
social
. status
89
social social social .
risk . risk . risk 47
96 97

birt Age Age Age 16 Age 30

h 5 10
Schoon et al, 2003
 Developmental-contextual
model of
psychosocial adjustment: BCS70
. .
behaviou 56 behaviou 53 behaviou .
r r r
. problem problem problem
30
22 depresse
s s s
d mood
parental
social .
class 12
social
. status
89
social social social .
risk . risk . risk 47
96 97

birt Age Age Age 16 Age 30

h 5 10
Schoon et al, 2003
 Developmental-contextual
model of
psychosocial adjustment: BCS70
. .
behaviou 56 behaviou 53 behaviou .
r r r
. problem problem problem
30
22 depresse
s s s .
d mood
parental 15
social .
class 12
social
. status
89
social social social .
risk . risk . risk 47
96 97

birt Age Age Age 16 Age 30

h 5 10
Schoon et al, 2003
 Developmental-contextual
model of
psychosocial adjustment: BCS70
. .
behaviou 56 behaviou 53 behaviou .
r r r
. problem problem problem
30
22 depresse
s s s .
d mood
parental 15
. .
social .
class
09 08
. 12
social
16 status
.
89
social social social .
risk . risk . risk 47
96 97

birt Age Age Age 16 Age 30

h 5 10
Schoon et al, 2003
 Life course pathways for effects of
childhood adversity on risk for
depression in women
OUTER WORLD

Social Social Stress / life

deprivati vulnerabilit events
on y

Lack of Care Early Depression

pregnanc
y

CHILDHOOD ADULTHOOD

After Brown, Harris, & Bifulco, 1986

 Life course pathways for effects of
childhood adversity on risk for
depression in women
OUTER WORLD

Social Social Stress / life

deprivati vulnerabilit events
on y

Lack of Care Early Depression

pregnanc
y
Emotiona
Psychologic
l
al
deprivati
vulnerability
INNER WORLDon

CHILDHOOD ADULTHOOD

After Brown, Harris, & Bifulco, 1986

 Some pathways for effects of early
psychosocial adversity

• Environmental continuities
– increased risk exposure later in life
• Psychological vulnerabilities
– dysfunctional views of self & relationships
– coping styles
• Physical effects
– chronic exposure to early stress effects on
• cardiovascular system, immune system, neurobiological
functioning
 Some pathways for effects of early
psychosocial adversity

• Specificity?
• Timing?
– not confined to early childhood
• Individual differences in response
– gene- environment interplay
– genetic factors influence sensitivity to environmental
risk
– experiences influence gene expression