Childhood Maltreatment: Emotional Consequences and Potential Intervention

Childhood maltreatment, which includes the abuse and neglect of children and young people, is a significant problem that occurs in all countries in the world. Early maltreatment has serious, long-lasting consequences on an individual's health and well-being, but can also impact economic growth. Most estimates of the prevalence of childhood maltreatment have come from surveys conducted in high-income countries, with outstanding questions remaining on the nature and extent of child abuse and neglect among lower-income countries and, within these countries, among the most disadvantaged sectors. The evidence base is poor because of cultural stigma associated with childhood maltreatment and cultural norms around the acceptability of abuse as a form of discipline and punishment. Moreover, the economic context of these countries enables the general exploitation of children in the labour force. This could not only increase the likelihood of other forms of abuse and neglect but also make their presence less transparent. The first major goal of our research is to study the frequency of different forms of abuse and neglect among working children and young people in North India and Nepal. This work will directly contribute to our understanding of the scope of the problem and facilitate, among governmental and non-governmental organisations, specific recommendations for preventing violence against children, which are key ongoing priorities for the World Health Organisation and United Nations. Dissemination of our findings locally will also enable gradual change in attitudes and perceptions, shifting cultural norms and practices. Although the effects of childhood maltreatment on later-life health and functioning are well-documented, the pathways by which early-life adversity increases vulnerability on these negative outcomes are less well-understood. Prior research suggests that early adversity affects how the brain develops, particularly how it responds to, and manages stress. We do not know much about how these effects on the brain affect the way we process emotional information and think about the world - even though cognitive factors are directly targeted in psychological therapies. The second major goal of our research is to investigate how childhood abuse and neglect alters the processing of emotional information. We expect that as early maltreatment can leave scars on the developing brain, this affects the way that its victims attend to threatening information (showing vigilance for threat cues) and appraise ambiguous information (showing a tendency to interpret situations negatively or with hostile intent). These negative patterns of thinking may then increase the likelihood of developing anxiety, depression and aggressive responses towards stressful events - and even reinforce these negative problems. Although these disturbed patterns of thinking have been reported in physically abused children and young people, these studies have largely been conducted in high-income countries. Identifying these cognitive-emotional disturbances in maltreated young people from lower-income countries lays the foundation for developing a novel treatment tool to directly target these negative thought patterns in young people from these poorer countries.
Developing and piloting a novel training intervention tool to encourage more adaptive ways of processing emotional information is the third major goal of our research. Specifically, cognitive bias modification is a technique used to correct negative thinking patterns, and therefore negative responses towards stress. It has been successfully used in adults with mood and anxiety problems, and in children and young people with emotional and aggressive problems. We will adapt this programme for use in maltreated young people and test whether this programme modifies negative thought patterns and, in doing so, normalises dysfunctional brain circuits, so that they resemble those of non-abused young people.

Childhood maltreatment is a significant global problem. Most estimates of prevalence are from surveys in high-income countries with less known about the scope of childhood maltreatment in lower income countries. The first objective of our research is to investigate the frequency of different forms and severity of child abuse and neglect and co-occurring psychopathology in India and Nepal. We will target child and adolescent labourers, as these represent one of the most disadvantaged sectors of society, with high rates of maltreatment. The second objective of our research is to extend our understanding of the cognitive phenotype of childhood maltreatment. Prior work (mostly from high-income countries) finds that child maltreatment - in particular physical abuse - are associated with greater attention capture by, and difficulties directing attention away from threatening cues. Physically-abused youth also show distorted appraisal styles, selecting more threatening or hostile interpretations of ambiguous information. Many of these studies do not consider the confounding effects of mood, anxiety or trauma symptoms. We will investigate whether in Indian and Nepalese youth, physical abuse is also associated with differences in attention and appraisal biases relative to their non-physically abused peers after controlling for co-occurring psychopathology. These data lay the groundwork for considering novel strategies for targeting distorted information-processing in physically abused youth. Cognitive bias modification (CBM) training has been used successfully to reduce attention and appraisal differences among anxious and aggressive children and young people, with changes in behaviour. In adults, training has resulted in brain-based changes in regions involved in emotion. Our last objective is to extend CBM investigations to physically-abused youth in the UK, India and Nepal and investigate the neural substrates of training changes.

The cumulative economic and social burden of childhood maltreatment is extremely high. In addition to the costs associated with the immediate effects on children and young people such as hospitalisation, there are major indirect long-term effects of child abuse and neglect, including but not limited to mental health and health care, juvenile delinquency and the adult criminal justice system, poor family relationships, and lost productivity to the society. The knowledge gained from this project will throw new light on the kind and frequency of abuse and neglect of child labourers belonging mostly to poor families (a disadvantaged sector of the society) and the negative cognitive and emotional consequences that follow significant physical (and possibly other kinds of) abuse. The availability, through this project, of a novel, ecologically-valid, easily accessible cognitive bias modification training programme capable of challenging emotional disturbances that very likely mediate the effects of early physical abuse on later mental health and problem behaviours in physically abused adolescents will be a major development with positive implications for victims and their families/care givers. However, in order to fully realise the study's findings and implications, a plan to effectively communicate and disseminate our findings to health and educational professionals, various local, national and international organisations concerned with child development and welfare, and the whole society will be needed. If funded, we are fully committed to maximising the impact of our research and ensuring effective channels of dissemination to all potential beneficiaries.

Studies 1 and 2, which investigate the scale and nature of abuse and neglect in child and adolescent labourers in India and Nepal, will be of interest to public health scientists and basic cognitive neuroscientists as (i) they fill a gap in our knowledge of the incidence of childhood maltreatment from low-income countries and (ii) extend our understanding of the cognitive-emotional disturbances that occur in the aftermath of early-life adversity. Our findings will also hold practical significance for non-governmental and governmental organisations involved in policies about child welfare, preventing violence against children and the use of children and young people in the labour force. We will work with these bodies to ensure maximal awareness of our findings, which in the long-run will gradually eliminate stigma and cultural norms that enable abuse and neglect to be hidden.

Studies 3 and 4 which investigate the effectiveness of a novel, cognitive training intervention will be relevant to scientists involved in the development and trialling of effective, easily-accessible therapeutic tools - and to those with an interest in neuroplasticity during development. As well as these academic channels, we aim to increase the dissemination of our findings to those who may be involved in directly translating these in clinical or educational settings.

Given the subject matter, we anticipate that the findings of studies 1-4 will attract interest, debate, and campaigning among the general public and insight for children and young people who have mental health problems or who have been exposed to early abuse and neglect. Engaging the general public and young people in particular in the science of child maltreatment is one of our major priorities.