J Abnorm Child Psychol DOI 10.1007/s10802-014-9868-7
Trauma, Adversity, and Parent–Child Relationships Among Young Children Experiencing Homelessness Janette E. Herbers & J. J. Cutuli & Amy R. Monn & Angela J. Narayan & Ann S. Masten
# Springer Science+Business Media New York 2014
Childhood adversity and potentially traumatic experiences have been associated with increased risk for emotional and behavioral problems (Davies et al. 2006). Psychological trauma occurs when an individual faces a situation that is lifethreatening or causes terror to the extent that it disrupts functioning, requiring a righting response (Kiser and Black 2005; Van der Kolk 2003). When young children face overwhelming threats to their safety or security without counteracting influences, the impacts can disrupt development across levels of functioning with long-term consequences for behavior, physiology, emotion regulation, cognitive processes, social relationships, and health (Shonkoff et al. 2009; Van der Kolk 2003). However, many children who experience significant adversity demonstrate resilience, functioning well in spite of the risks (Rutter 2013). Understanding how resilient children navigate potentially traumatic experiences can inform efforts to intervene and prevent negative outcomes for others in similar circumstances. This study examined exposure to potentially traumatic events among children residing in emergency housing with their families. There were three main goals of the study: to describe the experiences of these children; to examine the associations between cumulative adversity, trauma symptoms, emotional/behavior problems, and executive functioning; and to test parenting quality observed in parent–child interactions as a correlate and moderator of these outcomes. J. E. Herbers (*) Department of Psychology, Villanova University, 800 E. Lancaster Avenue, Villanova, PA 19085, USA e-mail: [email protected] J. J. Cutuli Department of Psychology, Rutgers University - Camden, Armitage Hall, Room 308, 311 North 5th Street, Camden, NJ 08102, USA A. R. Monn : A. J. Narayan : A. S. Masten Institute of Child Development, University of Minnesota, 51 E. River Parkway, Minneapolis, MN 55455, USA
Children who experience homelessness fall at the high end of a continuum of poverty-related risk (Masten et al. 1993; Samuels et al. 2010). In addition to the risks associated with extreme poverty, homeless children face residential instability and higher rates of recent stressful and potentially traumatic life events than children who are poor but stably housed (Masten et al. 1993; Miller 2011). Homeless children also tend to show difficulty with self-regulation skills and have higher rates of behavioral and emotional problems compared to non-homeless peers (Buckner et al. 2003; Samuels et al. 2010). These risks likely are related, such that stressful life events occurring within a context of unremitting povertyrelated risk result in prolonged activation of the body’s stress-response systems, disrupting neurocognitive, behavioral, and emotional development (Cutuli et al. 2010; Shonkoff et al. 2009). With high rates of family homelessness in recent years (U.S. Department of Housing and Urban Development 2013) many children are at risk for experiencing trauma in the context of homelessness and poverty. Resilience science in general, and efforts to intervene with homeless children in particular, can benefit from a better understanding of how trauma negatively impacts young children experiencing homelessness and how protective factors may mitigate these risks. Trauma reactions in children often are complex. Children can be traumatized by events that directly threaten their own safety or integrity, such as maltreatment, natural disaster, or injury (Lieberman and Knorr 2007; Van der Kolk 2003). Exposure to trauma is associated with a range of difficulties in children, including specific symptoms of post-traumatic stress disorder, general symptoms such as separation anxiety, hyperactivity, and irritability, and problems with cognitive control or executive functions, including poor executive attention and inhibitory control (Blair and Raver 2012; Davies et al. 2006; DePrince et al. 2009; Evans and English 2002; Van der Kolk 2003). For young children, the impacts of trauma exposure occur within the family context (David
J Abnorm Child Psychol
et al. 2012; Scheeringa and Zeanah 2001; Van der Kolk 2003). Young children depend on their caregivers to provide basic care, structure, protection, and assistance in understanding their experiences (Sroufe et al. 2005). Thus children’s adjustment following trauma partly depends on responses of caregivers (Kiser and Black 2005; Lieberman and Knorr 2007; Scheeringa and Zeanah 2001). Often, the relationship between traumatic experiences and child symptoms or executive functioning is mediated entirely or partially through parent stress or caregiving behavior (Blair et al. 2011; Briggs‐Gowan et al. 2010; Lieberman and Knorr 2007; Scheeringa and Zeanah 2001). Children also may be traumatized by events that threaten their caregivers, such as a parent injured by another person or compromised by mental health problems (DePrince et al. 2009; Kiser and Black 2005; Scheeringa and Zeanah 2001). Events that interfere with caregivers’ ability to provide sensitive parenting, or respond to heightened needs of a distressed child, appear to place children at the highest level of risk for a variety of problems (Cook et al. 2005; Margolin and Vickerman 2007; Scheeringa and Zeanah 2001). Conversely, a parent who copes effectively with distress and maintains structured parenting and appropriate responsiveness to her child can provide a buffer, rendering the stress tolerable and protecting critical developmental processes (Martinez‐Torteya et al. 2009; Shonkoff et al. 2009). Parenting characterized by warmth, structure, and responsiveness is consistently associated with positive child outcomes, such as better self-regulation, executive functioning, and fewer behavioral and emotional problems in both high and low risk contexts (Bernier et al. 2010; Dennis 2006; Evans and Kim 2012; Gilliom and Shaw 2004). This association likely reflects processes of parent–child co-regulation, in which a parent and child alter their behaviors in response to and anticipation of each other’s behavior (Fogel 1993). The caregiver defines the quality of parent–child interactions by responding to the child’s behavioral cues and physical and emotional needs; the child then internalizes these experiences, creating a foundation for a sense of safety, trust, and selfefficacy as well as the developing capacity for self-regulation (Calkins and Hill 2007; Sroufe et al. 2005). Children in caregiver relationships marked by more positive coregulation are expected to navigate developmental tasks and manage stress more effectively than children whose experiences are less nurturing and responsive. Positive co-regulation with caregivers could serve as a powerful protective factor for children in contexts of chronic and acute stress related to homelessness, including experiences of trauma. Children experiencing homelessness and other potentially traumatic events without adequate support from caregivers face increased risk for poor executive functioning and emotional/behavior problems. In the present study, we expected a cumulative score of children’s adverse
experiences to predict child trauma symptoms, emotional/behavior problems, and executive functioning. We expected positive co-regulation within the parent– child relationship to relate directly to better functioning, consistent with a promotive effect, and to moderate the impact of trauma on child outcomes, consistent with a protective effect.
Method Participants and Procedures Participants were recruited from three emergency shelters for families in a large urban area during the summers of 2008 and 2009. Children ages 4 to 6 years (M=5 years, 9 months, SD=7 months) participated with their primary caregivers (N=138). Eligible children were entering kindergarten or first grade the subsequent fall, children and caregivers spoke English, and children did not have identified developmental delays that would interfere with cognitive assessments. Overall, 72 % of eligible families participated. The mean child age was 5 years, 9 months (SD=7 months) and 78 (56 %) were female. The majority of children were African American (66.6 %) or Multiracial (15.9 %); the remaining children were White (6.3 %), American Indian (6.3 %), or some other race (6.3 %). Most families were headed by single parents, and most primary caregivers were biological mothers (92.7 %). Research staff met with each family onsite in shelter. Each child completed a series of cognitive assessments with standardized administration lasting about one hour while the parent completed an interview in a separate room. Next, the parent and child participated together in a series of eight structured interaction tasks that were video-recorded for later coding. The tasks presented a variety of situations for observing parenting, including free play, clean-up, problem-solving discussions, teaching tasks, and games. Detailed descriptions of the parent–child interaction tasks are available elsewhere (Herbers 2011).
Measures Adversity Primary caregivers responded to a list of 20 negative lifetime events, indicating whether their children had ever been victims of violence or accidents, witnessed violence in their families or communities, experienced deaths in the family or mental or physical illness of parents, among others (See Table 1: Masten et al. 1993). The total number of different events endorsed for each child formed an index of potentially traumatic experiences.
J Abnorm Child Psychol Table 1 Endorsement rates of stressful lifetime events and trauma symptoms
Life event Lived in home with fights or severe relationship problems between adults Had a parent in prison Divorce or permanent separation of parents Separated from parents for more than two weeks Seen violence happening to people Hospitalized Seen parent injured by another person Lived with parent who had a mental illness Lived with parent who had a serious drug/alcohol problem Been in a serious accident (car, bike, boat) or nearly drowned Lived with parent who had a serious physical illness
n 48 45 41 39 35 34 28 27 17 14 13
% 34.8 32.6 29.7 28.3 25.4 24.6 20.3 19.6 12.3 10.1 9.4
Witnessed a serious accident involving a car, plane, or boat Been attacked by an animal Been in a house fire Lived in a foster home Victim of physical violence Experienced a natural disaster Death of parent Death of sibling Been kidnapped Trauma symptom Talk repeatedly about event Worry about something terrible happening Startle easily or seem jumpy Nightmares Extremely frightened by reminders of event Avoid reminders of event Playing games about event
10 10 9 7 7 7 3 3 2 n 33 32 23 19 19 14 5
7.2 7.2 6.5 5.1 5.1 5.1 2.2 2.2 1.4 % 23.9 23.2 16.7 13.8 13.8 10.1 3.6
Trauma Symptoms For children who experienced any negative lifetime event (n=126), caregivers responded to seven items designed to measure traumatic stress symptoms (e.g., becomes very frightened when reminded of something bad that happened, talks repeatedly about something bad that happened; see Table 1). Cronbach’s alpha for the seven items was 0.67. The number of trauma symptoms endorsed was summed for each child, ranging from 0 to 7. Emotional/Behavior Problems Primary caregivers also completed the Child Behavior Checklist (CBCL: Achenbach and Rescorla 2001), to indicate whether each child never, sometimes, or often demonstrated any on a diverse list of psychiatric symptoms. Either of two different forms of the CBCL was used as appropriate (1.5–5 year-old form versus 6–18 year-old form), and a within-form total problems z-score was computed for each
child depending upon the form that was administered. These z-scores were then merged across study participants. Cronbach’s alpha for the total problems scale was approximately 0.93 within the sample. Positive Co-regulation (PCR) Parent and child behavior during interaction tasks were coded separately by two teams of raters, then durations of each combination of parent and child behaviors were calculated using Gridware 1.1 and state space grid methodology (Hollenstein 2007; Lamey et al. 2004). All parent behaviors were coded into four mutually exclusive categories: positive control, negative control, non-directive responsiveness, and disengaged. Positive control behaviors included parent efforts to guide, teach, or direct the child with positive or neutral affect. Negative control behaviors were those with negative affect or other hostile, intrusive, or rejecting behavior towards the child. Non-directive responsiveness included behaviors that were responsive and warm or neutral in tone but not
J Abnorm Child Psychol Table 2 Results of hierarchical linear regressions Trauma symptoms β
Total problems β
Executive functioning β
Age Sex IQ ΔR2
0.10 −0.09 0.12 0.04
0.01 0.14 −0.14 0.04
0.33* −0.10 0.42* 0.34*
Age Sex IQ Adversity ΔR2 Age Sex IQ Adversity PCR ΔR2 Age Sex IQ Adversity PCR PCRxAdversity ΔR2
0.08 −0.08 0.06 0.41* 0.16* 0.08 −0.07 0.09 0.42* −0.17** 0.03** 0.10 −0.10 0.06 0.47* −0.17** −0.17† 0.03**
−0.02 0.14 −0.19** 0.37* 0.13* 0.01 0.16** −0.13 0.40* −0.40* 0.15* 0.02 0.14 −0.15* 0.45* −0.40* −0.17** 0.03**
0.32* −0.10 0.40* 0.14† 0.02 0.30* −0.12 0.35* 0.12 0.30* 0.09* 0.31* −0.14 0.33* 0.15** 0.30* −0.14** 0.02†
0.26*
0.35*
0.47*
Total R2
*p
Trauma, Adversity, and Parent–Child Relationships Among Young Children Experiencing Homelessness Janette E. Herbers & J. J. Cutuli & Amy R. Monn & Angela J. Narayan & Ann S. Masten
# Springer Science+Business Media New York 2014
Childhood adversity and potentially traumatic experiences have been associated with increased risk for emotional and behavioral problems (Davies et al. 2006). Psychological trauma occurs when an individual faces a situation that is lifethreatening or causes terror to the extent that it disrupts functioning, requiring a righting response (Kiser and Black 2005; Van der Kolk 2003). When young children face overwhelming threats to their safety or security without counteracting influences, the impacts can disrupt development across levels of functioning with long-term consequences for behavior, physiology, emotion regulation, cognitive processes, social relationships, and health (Shonkoff et al. 2009; Van der Kolk 2003). However, many children who experience significant adversity demonstrate resilience, functioning well in spite of the risks (Rutter 2013). Understanding how resilient children navigate potentially traumatic experiences can inform efforts to intervene and prevent negative outcomes for others in similar circumstances. This study examined exposure to potentially traumatic events among children residing in emergency housing with their families. There were three main goals of the study: to describe the experiences of these children; to examine the associations between cumulative adversity, trauma symptoms, emotional/behavior problems, and executive functioning; and to test parenting quality observed in parent–child interactions as a correlate and moderator of these outcomes. J. E. Herbers (*) Department of Psychology, Villanova University, 800 E. Lancaster Avenue, Villanova, PA 19085, USA e-mail: [email protected] J. J. Cutuli Department of Psychology, Rutgers University - Camden, Armitage Hall, Room 308, 311 North 5th Street, Camden, NJ 08102, USA A. R. Monn : A. J. Narayan : A. S. Masten Institute of Child Development, University of Minnesota, 51 E. River Parkway, Minneapolis, MN 55455, USA
Children who experience homelessness fall at the high end of a continuum of poverty-related risk (Masten et al. 1993; Samuels et al. 2010). In addition to the risks associated with extreme poverty, homeless children face residential instability and higher rates of recent stressful and potentially traumatic life events than children who are poor but stably housed (Masten et al. 1993; Miller 2011). Homeless children also tend to show difficulty with self-regulation skills and have higher rates of behavioral and emotional problems compared to non-homeless peers (Buckner et al. 2003; Samuels et al. 2010). These risks likely are related, such that stressful life events occurring within a context of unremitting povertyrelated risk result in prolonged activation of the body’s stress-response systems, disrupting neurocognitive, behavioral, and emotional development (Cutuli et al. 2010; Shonkoff et al. 2009). With high rates of family homelessness in recent years (U.S. Department of Housing and Urban Development 2013) many children are at risk for experiencing trauma in the context of homelessness and poverty. Resilience science in general, and efforts to intervene with homeless children in particular, can benefit from a better understanding of how trauma negatively impacts young children experiencing homelessness and how protective factors may mitigate these risks. Trauma reactions in children often are complex. Children can be traumatized by events that directly threaten their own safety or integrity, such as maltreatment, natural disaster, or injury (Lieberman and Knorr 2007; Van der Kolk 2003). Exposure to trauma is associated with a range of difficulties in children, including specific symptoms of post-traumatic stress disorder, general symptoms such as separation anxiety, hyperactivity, and irritability, and problems with cognitive control or executive functions, including poor executive attention and inhibitory control (Blair and Raver 2012; Davies et al. 2006; DePrince et al. 2009; Evans and English 2002; Van der Kolk 2003). For young children, the impacts of trauma exposure occur within the family context (David
J Abnorm Child Psychol
et al. 2012; Scheeringa and Zeanah 2001; Van der Kolk 2003). Young children depend on their caregivers to provide basic care, structure, protection, and assistance in understanding their experiences (Sroufe et al. 2005). Thus children’s adjustment following trauma partly depends on responses of caregivers (Kiser and Black 2005; Lieberman and Knorr 2007; Scheeringa and Zeanah 2001). Often, the relationship between traumatic experiences and child symptoms or executive functioning is mediated entirely or partially through parent stress or caregiving behavior (Blair et al. 2011; Briggs‐Gowan et al. 2010; Lieberman and Knorr 2007; Scheeringa and Zeanah 2001). Children also may be traumatized by events that threaten their caregivers, such as a parent injured by another person or compromised by mental health problems (DePrince et al. 2009; Kiser and Black 2005; Scheeringa and Zeanah 2001). Events that interfere with caregivers’ ability to provide sensitive parenting, or respond to heightened needs of a distressed child, appear to place children at the highest level of risk for a variety of problems (Cook et al. 2005; Margolin and Vickerman 2007; Scheeringa and Zeanah 2001). Conversely, a parent who copes effectively with distress and maintains structured parenting and appropriate responsiveness to her child can provide a buffer, rendering the stress tolerable and protecting critical developmental processes (Martinez‐Torteya et al. 2009; Shonkoff et al. 2009). Parenting characterized by warmth, structure, and responsiveness is consistently associated with positive child outcomes, such as better self-regulation, executive functioning, and fewer behavioral and emotional problems in both high and low risk contexts (Bernier et al. 2010; Dennis 2006; Evans and Kim 2012; Gilliom and Shaw 2004). This association likely reflects processes of parent–child co-regulation, in which a parent and child alter their behaviors in response to and anticipation of each other’s behavior (Fogel 1993). The caregiver defines the quality of parent–child interactions by responding to the child’s behavioral cues and physical and emotional needs; the child then internalizes these experiences, creating a foundation for a sense of safety, trust, and selfefficacy as well as the developing capacity for self-regulation (Calkins and Hill 2007; Sroufe et al. 2005). Children in caregiver relationships marked by more positive coregulation are expected to navigate developmental tasks and manage stress more effectively than children whose experiences are less nurturing and responsive. Positive co-regulation with caregivers could serve as a powerful protective factor for children in contexts of chronic and acute stress related to homelessness, including experiences of trauma. Children experiencing homelessness and other potentially traumatic events without adequate support from caregivers face increased risk for poor executive functioning and emotional/behavior problems. In the present study, we expected a cumulative score of children’s adverse
experiences to predict child trauma symptoms, emotional/behavior problems, and executive functioning. We expected positive co-regulation within the parent– child relationship to relate directly to better functioning, consistent with a promotive effect, and to moderate the impact of trauma on child outcomes, consistent with a protective effect.
Method Participants and Procedures Participants were recruited from three emergency shelters for families in a large urban area during the summers of 2008 and 2009. Children ages 4 to 6 years (M=5 years, 9 months, SD=7 months) participated with their primary caregivers (N=138). Eligible children were entering kindergarten or first grade the subsequent fall, children and caregivers spoke English, and children did not have identified developmental delays that would interfere with cognitive assessments. Overall, 72 % of eligible families participated. The mean child age was 5 years, 9 months (SD=7 months) and 78 (56 %) were female. The majority of children were African American (66.6 %) or Multiracial (15.9 %); the remaining children were White (6.3 %), American Indian (6.3 %), or some other race (6.3 %). Most families were headed by single parents, and most primary caregivers were biological mothers (92.7 %). Research staff met with each family onsite in shelter. Each child completed a series of cognitive assessments with standardized administration lasting about one hour while the parent completed an interview in a separate room. Next, the parent and child participated together in a series of eight structured interaction tasks that were video-recorded for later coding. The tasks presented a variety of situations for observing parenting, including free play, clean-up, problem-solving discussions, teaching tasks, and games. Detailed descriptions of the parent–child interaction tasks are available elsewhere (Herbers 2011).
Measures Adversity Primary caregivers responded to a list of 20 negative lifetime events, indicating whether their children had ever been victims of violence or accidents, witnessed violence in their families or communities, experienced deaths in the family or mental or physical illness of parents, among others (See Table 1: Masten et al. 1993). The total number of different events endorsed for each child formed an index of potentially traumatic experiences.
J Abnorm Child Psychol Table 1 Endorsement rates of stressful lifetime events and trauma symptoms
Life event Lived in home with fights or severe relationship problems between adults Had a parent in prison Divorce or permanent separation of parents Separated from parents for more than two weeks Seen violence happening to people Hospitalized Seen parent injured by another person Lived with parent who had a mental illness Lived with parent who had a serious drug/alcohol problem Been in a serious accident (car, bike, boat) or nearly drowned Lived with parent who had a serious physical illness
n 48 45 41 39 35 34 28 27 17 14 13
% 34.8 32.6 29.7 28.3 25.4 24.6 20.3 19.6 12.3 10.1 9.4
Witnessed a serious accident involving a car, plane, or boat Been attacked by an animal Been in a house fire Lived in a foster home Victim of physical violence Experienced a natural disaster Death of parent Death of sibling Been kidnapped Trauma symptom Talk repeatedly about event Worry about something terrible happening Startle easily or seem jumpy Nightmares Extremely frightened by reminders of event Avoid reminders of event Playing games about event
10 10 9 7 7 7 3 3 2 n 33 32 23 19 19 14 5
7.2 7.2 6.5 5.1 5.1 5.1 2.2 2.2 1.4 % 23.9 23.2 16.7 13.8 13.8 10.1 3.6
Trauma Symptoms For children who experienced any negative lifetime event (n=126), caregivers responded to seven items designed to measure traumatic stress symptoms (e.g., becomes very frightened when reminded of something bad that happened, talks repeatedly about something bad that happened; see Table 1). Cronbach’s alpha for the seven items was 0.67. The number of trauma symptoms endorsed was summed for each child, ranging from 0 to 7. Emotional/Behavior Problems Primary caregivers also completed the Child Behavior Checklist (CBCL: Achenbach and Rescorla 2001), to indicate whether each child never, sometimes, or often demonstrated any on a diverse list of psychiatric symptoms. Either of two different forms of the CBCL was used as appropriate (1.5–5 year-old form versus 6–18 year-old form), and a within-form total problems z-score was computed for each
child depending upon the form that was administered. These z-scores were then merged across study participants. Cronbach’s alpha for the total problems scale was approximately 0.93 within the sample. Positive Co-regulation (PCR) Parent and child behavior during interaction tasks were coded separately by two teams of raters, then durations of each combination of parent and child behaviors were calculated using Gridware 1.1 and state space grid methodology (Hollenstein 2007; Lamey et al. 2004). All parent behaviors were coded into four mutually exclusive categories: positive control, negative control, non-directive responsiveness, and disengaged. Positive control behaviors included parent efforts to guide, teach, or direct the child with positive or neutral affect. Negative control behaviors were those with negative affect or other hostile, intrusive, or rejecting behavior towards the child. Non-directive responsiveness included behaviors that were responsive and warm or neutral in tone but not
J Abnorm Child Psychol Table 2 Results of hierarchical linear regressions Trauma symptoms β
Total problems β
Executive functioning β
Age Sex IQ ΔR2
0.10 −0.09 0.12 0.04
0.01 0.14 −0.14 0.04
0.33* −0.10 0.42* 0.34*
Age Sex IQ Adversity ΔR2 Age Sex IQ Adversity PCR ΔR2 Age Sex IQ Adversity PCR PCRxAdversity ΔR2
0.08 −0.08 0.06 0.41* 0.16* 0.08 −0.07 0.09 0.42* −0.17** 0.03** 0.10 −0.10 0.06 0.47* −0.17** −0.17† 0.03**
−0.02 0.14 −0.19** 0.37* 0.13* 0.01 0.16** −0.13 0.40* −0.40* 0.15* 0.02 0.14 −0.15* 0.45* −0.40* −0.17** 0.03**
0.32* −0.10 0.40* 0.14† 0.02 0.30* −0.12 0.35* 0.12 0.30* 0.09* 0.31* −0.14 0.33* 0.15** 0.30* −0.14** 0.02†
0.26*
0.35*
0.47*
Total R2
*p
