Background Offspring from families exposed to interpersonal violence (IPV) are at an elevated risk of engaging in violent relationships during adolescence and adulthood with display of externalizing symptoms. However, psycho-physiological mechanisms underlying this phenomenon in families are not yet fully understood. Aim We specifically investigated externalizing symptoms and psycho-physiological stress regulation profiles (i.e., cortisol, subjective stress) of school-aged children with mother suffering from IPV-related posttraumatic stress disorder (IPV-PTSD). Methods 49 children (divided into healthy control (HC) group, n = 21 and IPV-PTSD group, n = 28) aged 5–9 participated in the study. Externalizing symptoms were assessed through clinical interview, self-report and maternal report. Stress physiology profile was measured via saliva samples to extract cortisol on two different days (5x a day, diurnal pattern) as well as across a stress task (i.e., Trier Social Stress Test for Children – TSST-C). Subjective stress during the TSST-C was reported through a Visual Analogue Scale. Results Children of mothers with IPV-PTSD had more externalizing symptoms, in comparison to children of HC mothers, and showed a positive, significant association between externalizing symptoms and subjective stress during the TSST-C. No consistent between-group differences were observed in baseline cortisol stress levels or reactivity during the TSST-C at this level of analysis. Conclusion Longitudinal findings in the present study support the hypothesis of an intergenerational transmission of externalizing symptoms within the context of interpersonal violence-related trauma. Future research is needed to delve deeper into the psychobiological underpinnings of these intergenerational associations.

Disruptive behavior disorders among youth are a pressing public-health concern and a key pathway of intergenerational risk. In the 8-year longitudinal Geneva Early Childhood Stress Study, we tested whether maternal psychological, behavioral, and neurobiological factors assessed in toddlerhood predicted peri-pubertal disruptive behaviors. Mother–child dyads (n = 28; child age at Phase 1 = 12–44 months; Phase 3 = 9–15 years) completed clinical interviews; mothers underwent fMRI while viewing emotion-related (prosocial/romantic and threatening vs neutral) and threat-related (threatening vs prosocial/romantic) adult interactions; maternal sensitivity (MS) was coded from filmed play; child disruptive symptoms were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) at follow-up. Ten a priori neural clusters were reduced via principal components analysis, yielding a theory-consistent Neural-Threat component and a Neural-Preoccupation component reflecting precuneus activity. Using exploratory forward stepwise regression adjusted for child age, sex, and socioeconomic status, Neural-Threat and MS each uniquely predicted fewer disruptive behaviors (protective), whereas Neural-Preoccupation predicted more symptoms (risk). A planned moderation test showed that MS buffered the Neural-Threat–behavior association, with stronger protection at higher sensitivity. Maternal posttraumatic stress severity in early childhood showed no direct association with later disruptive behaviors. These findings suggest that stress-responsive maternal brain function relates to children’s disruptive outcomes and that sensitive caregiving may potentiate protective neural processes. Results are preliminary and warrant replication in larger, more representative samples, but they highlight neurobehavioral targets for early, trauma-informed prevention, i.e., enhancing maternal sensitivity and supporting adaptive threat monitoring in mothers.

This pilot study aimed to understand the moderating role of context processing (i.e. encoding and memorizing) when mothers are confronted with threatening stimuli and undergo physiologic monitoring in order to understand a possible mechanism favoring intergenerational transmission of posttraumatic stress. Thirty-one mothers (M age = 33.87 years, SD = 4.14) and their toddlers (M age = 22.66 months, SD = 7.01) participated in the study. Mothers reported adverse life events (ALE), their current posttraumatic stress symptoms (PTSS), as well as regulatory problems of their toddler. Mothers performed a context-encoding and -memory (CEM) task including emotional facial expressions (especially angry faces considered as threatening stimuli) embedded into photo-backgrounds, after which they were asked to recognize both the faces and contexts. Maternal heart rate variability (HRV) was measured during resting state. Maternal current PTSS, but not ALE, had impact on child dysregulation only for mothers with poor context processing (beta = 0.014, p = .017). Baseline HRV was negatively correlated with the recognition of contexts previously associated with angry faces (rho = -.53, p = .006), and marginally with the recognition of angry faces (rho = -.37, p = .059). This pilot study identifies psychophysiological markers (i.e. CEM, HRV) that may influence the intergenerational transmission of posttraumatic stress. This may open new avenues in early identification and intervention with traumatized mothers and their toddlers.

Adverse childhood experiences (ACE) are common risk factors for many psychiatric disorders. Their underlying biological mechanisms may involve oxidative stress (OS), which has deleterious effects on cells through its own actions and through its interactions with inflammation and the stress axes, particularly in the brain. In order to assess the role of OS in the association between ACE and psychopathology, we performed a systematic review of animal and human research (PROSPERO CRD42023378418 and CRD42022378376), funded by the Swiss National Science Foundation (grant number 204033). PubMed, Web of Science, PsycInfo, Scopus and Embase were searched from inception until 31 October 2024. We included 130 studies involving animal models exposed to stressor-paradigms recognized as ACE analogs before they reached adulthood, or human participants with a history of ACE and assessment of psychopathology, and reporting outcomes on OS-related markers. Animal studies overall show increased OS and psychopathology after stress, thus supporting the hypothesis that OS mediates the relationship between ACE and psychopathology. Human studies are heterogeneous and less conclusive. Although the association between ACE exposure and OS, in animals and humans, was likely affected by the nature, the timing, and the intensity of the exposure, these parameters were only evaluated in a small fraction of studies. Similarly, though some studies hinted at sex differences in the OS response to ACE in animals, the majority of studies did not address this issue. Further research, using longitudinal designs and more thorough examination of ACE history in participants, is therefore needed.

Trauma-focused psychotherapies for infants, toddlers, and preschoolers comprise a unique subset of child trauma interventions. Given the developmental age range in question, certain characteristics of these therapies differ significantly from those for older children. This study reviews evidence-based, trauma-focused treatments for young children and their caregivers, followed by evidence-based treatments for trauma-vulnerable families with very young children that do not target trauma directly but rather reinforce attachment-related protective factors such as parental sensitivity and reflective functioning. Directions for further research are discussed.

This article presents a frequent dilemma of treatment-seeking mothers suffering from complex posttraumatic stress disorder (PTSD) that is related to exposure to maltreatment and other forms of interpersonal violence. Namely, that complex PTSD symptoms, including dissociative states in mothers that are triggered by normative child emotion dysregulation, aggression, and distress during early childhood, hinder the development of a productive psychotherapeutic process in more traditional psychodynamic psychotherapies for mothers and children. The article thus presents clinician-assisted videofeedback exposure (CAVE) that characterizes a recently manualized brief psychotherapy for this population, called CAVE-approach therapy (CAVEAT). CAVEAT can be used on its own or to preface a deeper process using child-parent psychotherapy or other non-videofeedback-enhanced psychodynamic models. A clinical illustration is provided.

This study examined whether there is a biological basis in the child’s resting brain activity for the intergenerational link between maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) and child subclinical symptoms. We used high-density EEG recordings to investigate the resting brain activity in a sample of 57 children, 34 from mothers with IPV-PTSD, and 23 from mothers without PTSD. These children were part of a prospective, longitudinal study focusing on the offspring of mothers with and without IPV-PTSD, reporting how the severity of a mother’s IPV-PTSD can impact her child’s emotional regulation and risk for developing mental illness. However, we had not yet looked into potential EEG biomarkers during resting state that might mediate and/or moderate effects of maternal IPV-PTSD severity on child mental health, and in particular the risk for PTSD. The alpha band spectral power as well as the aperiodic exponent of the power spectrum (PLE; power-law exponent) were examined as mediators of maternal IPV-PTSD and child PTSD.While there was no difference in alpha spectral power between the two groups, PLE was significantly reduced in children of mothers with IPV-PTSD compared to control children, indicating cortical hyper-arousal. Interestingly, child PLE was negatively correlated with the severity of maternal IPV-PTSD, suggesting an intergenerational interaction. This interpretation was reinforced by a negative correlation between child PLE and child PTSD symptoms. Finally, causal analyses using structural equation modelling indicated that child PLE mediated the relationship between maternal PTSD severity and child PTSD. Our observations suggest that maternal IPV-PTSD has an intergenerational impact on the child neurobehavioral development through a correlated abnormal marker of brain arousal (i.e. child PLE). These findings are potentially relevant to psychotherapy research and to the development of more effective psycho-neurobehavioral therapies (i.e. neurofeedback) among affected individuals.

Purpose of ReviewThis review aims to outline some consequences that maternal history of trauma with and without related psychopathology, such as posttraumatic stress symptoms (PTSS), can have on their children's development and functioning. It then addresses mechanisms through which intergenerational transmission of interpersonal violence (IPV) and related psychopathology may occur.Recent FindingsFindings include the effects of maternal IPV experience and related psychopathology on child social-emotional and biologically-based outcomes. This includes increased developmental disturbances and child psychopathology, as well as physiological factors. Secondly, the review focuses on psychobiological mechanisms by which maternal experience of IPV and related psychopathology likely trigger intergenerational effects.SummaryMaternal IPV and related psychopathology can have a negative impact on several areas of their child's life including development, interactive behavior, psychopathology, and physiology. This transmission may partially be due to fetal and perinatal processes, genetic and epigenetic effects, and interactions with their parents.

OBJECTIVE:This study aimed to gain a better understanding of bullying as victims and aggressors in youths born with unilateral cleft lip and palate (UCLP). DESIGN:This is an observational study comparing youths with UCLP (ages 8-16) and their parents with a control group (CG) of children in state schools and their parents. PARTICIPANTS:Forty-one youths (43% female; mean age 12.4 ± 2.3 years) and their parents (n = 40) composed the UCLP group and 56 youths (47% female; mean age 12.4 ± 1.2 years) and their parents (n = 33) were in the CG. MAIN OUTCOME MEASURE:The Olweus Bully/Victim questionnaire self- and parent-report was used to assess victims and aggressors involved in bullying behaviors. RESULTS:About 30% of all youths reported being a frequent victim of bullying at least 2-3 times a month and an additional 32.3% were bullied 1-2 times in the last 2-3 months. For the total sample, parents significantly (P < .05) underestimated any bullying, both as a victim (youths 62.5% vs parents 45.7%) and as an aggressor (youths 53.1% vs parents 37.1%). There were no significant group differences in experiencing any bullying between the youths with UCLP (52.5%) and the CG youths (69.6%) or in its perception by their parents (43.2% and 48.5%, respectively). There were no group differences between the combinations of victim and aggressor. CONCLUSIONS:While there were no differences in bullying prevalence in our sample between youths with UCLP and their peers, this study highlights differences in bullying perceptions between parents and their children.

Interpersonal violence–related PTSD (IPV-PTSD) has been associated with mothers’ decreased sensitivity when interacting with their toddlers not yet able to regulate emotion. This study tested if maternal IPV-PTSD has adverse effects on the caregiving environment during sensitive periods for the development of child self-regulation and later psychopathology. This is a longitudinal nested study of 31/84 mothers with and without PTSD and their children with complete data: maternal fMRI scans when kids were 12 to 42 months old (T1) and child self-report measures when 9 to 14 years old (T3). T3 completers did not significantly differ from T1 noncompleters. On fMRI, mothers responded to scenes of emotion: 1) menacing; and 2) prosocial vs neutral adult male-female interactions (Moser et al, 2015). Maternal brain activation (MBA) clusters were selected as regions of interest if linked to lower maternal sensitivity. Regression analyses with the clusters predicted child behavior at T3. Dependent variables were standard child measures of emotion regulation (Emotion Regulation Questionnaire [ERQ]) and awareness (Emotion Awareness Questionnaire [EAQ]), and the Depression, Anxiety and Stress Scale (DASS). Maternal sensitivity (T1) was inversely associated with ERQ (r = -0.51; p = .0006) and DASS-Stress (r = -0.44; p = .018). ERQ was associated with maternal PTSD (lifetime r = 0.36; p = .049). We found a main effect of emotion (emotion > neutral), in which increased bilateral mid-cingulate/supplementary motor area (MC/SMA) (496 voxels), right precuneus, and right inferior temporal gyrus (ITG) all predicted decreased emotional awareness (r = -0.36, p = .049; r = -0.48, p = .006; r = -0.36, p = .044, respectively). The menacing vs prosocial contrast-derived cluster in the mid-cingulum (91 voxels) yielded an interaction of its neural activity*group and EAQ (p = .048). MBA in response to male-female interactions was associated with IPV-PTSD and decreased maternal sensitivity during early sensitive periods for the development of emotion regulation. MBA predicted child difficulty with self-regulation during peripubertal development. Implications for intervention and intergenerational transmission are discussed.

Childhood maltreatment, exposure to family violence, and related PTSD has been found to be associated with changes in parents’ biology and behavior. How do these biobehavioral changes impact children’s social-emotional and cognitive development during early sensitive periods? How do these changes also incur risk to those children’s capacity to parent in adulthood? This Symposium aims to answer these questions. The Symposium will consist of cross-species research presentations ranging from micro-levels of basic neuroscience to macro-levels of clinical observations in order to show how basic and clinical neuroscience research can jointly inform clinical practice and public policy to interrupt intergenerational transmission. The research group of Karlen Lyons-Ruth, PhD, will present data on mother-infant (age 4 months) dyads stratified for the presence of maternal childhood maltreatment. Infant salivary cortisol output during the Still-Face Paradigm, atypical maternal behavior, and structural infant sleeping brain MRI data (ages 4-24 months) were analyzed and associated. Using a rodent animal model of the Lyons-Ruth lab findings, Regina Sullivan, PhD, will present her lab’s findings of a causal link between stress, hyperactive amygdala, and disrupted infant social behavior within attachment. Daniel Schechter, MD, will present prospective, longitudinal data focusing on maternal traumatic experiences and associated PTSD associated with aberrant caregiving and maternal neural activity patterns in response to trauma-related stimuli when children were 1 to 3.5 years old with follow-up of children through age 14 years, with respect to emotion regulation that he will tie into previous findings on glucocorticoid reactivity to social stress. Mary Margaret Gleason, MD, will then discuss her group’s focus on the mother-infant dyad and will present longitudinal data regarding associations between maternal perinatal depression in pediatric settings and child mental health concerns at age 4 years. To conclude the session, Erica Willheim, PhD, a clinician and clinical researcher, will offer her perspective of the research presentations, salient pathways leading to intergenerational transmission, and their relevance to clinical practice and public policy to foster policy before leading a discussion with the audience.

Abstract Background Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. Methods This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. Results Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. Conclusions sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature—both for mothers as well as children—of the intergenerational transmission of violence and associated psychopathology.

Objective This study examines the psychological well-being of Swiss youths born with a unilateral cleft lip and palate (UCLP), in a multi-dimensional and clinical perspective. Design Retrospective cross-sectional study. Setting Self-report questionnaires completed by youths born with UCLP, followed at a specialized cleft clinic in Switzerland, and by peers without UCLP, recruited in schools of the Vaud county, Switzerland. Participants Youths aged 7.5 to 16, born with UCLP (clinical group, n = 41, 29.2% female) or without UCLP (control group, n = 56, 49.0% female). Outcome measures Adverse life events (ALE; Adverse Life Events), behavioral and emotional symptoms ( Strengths and Difficulties Questionnaire and Post-Traumatic Checklist Scale), bodily self-esteem ( Body Esteem Scale), quality of life ( Kidscreen-27), emotion regulation ( Cognitive Emotion Regulation Questionnaire), social support ( Sarason's Social Support Questionnaire). Results Most outcomes showed no significant group-difference. Compared to matched peers, youths with UCLP reported lower psychological quality of life and social support satisfaction, along with positive factors of fewer ALE and lower non-adaptive emotion regulation. In youths with UCLP, higher scores for ALE were associated with higher total scores for behavioral and emotional symptoms. Higher scores for bodily self-esteem were associated with higher scores for satisfaction of social support and adaptive emotion regulation. Conclusions Youths with UCLP show globally similar psychological well-being as matched peers. We observed some vulnerabilities but also protective factors, which support the need for psychological perspective within multidisciplinary care. The relationships between dimensions suggest specific targets that may have an impact in context of intervention.

This paper marks the 20th anniversary of the terrorist attacks of September 11, 2001. It makes the link between the author's research, which explored the impact of those events on intergenerational trauma and traumatic stress, and the clinical dilemmas that the author encountered in treating Iraqi and Afghan refugees presently. Importantly, the refugee status of these patients was in part linked to the retaliatory actions of the United States in the wake of 9/11. The original hypotheses from the 2003 book, September 11: Trauma and Human Bonds are reviewed with previously unreported clinical vignettes that were a part of the author's research. The impact of the author's own experiences is highlighted as he approaches his psychotherapeutic work with Iraqi and Afghan postwar refugees in Switzerland. The author presents two case examples of patients in psychoanalytically oriented parent-infant psychotherapy. He demonstrates how trauma, attachment, development, and ruptures of intersubjectivity between parent and infant as well as between parent-infant dyad and analyst must be considered in the treatment of these complex cases.

Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum. Methods: One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions. Results: Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p <= .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p <= .001) but only maternal MDD was predictive of infant social withdrawal (p <= .001). Effects of maternal MDD on infant withdrawal were mediated by AMB. Conclusions: At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.

Maternal dissociative symptoms which can be comorbid with interpersonal violencerelated post-traumatic stress disorder (IPV-PTSD) have been linked to decreased sensitivity and responsiveness to children’s emotional communication. This study looked at what the influence of dissociation on neural activation independently of IPV-PTSD symptom severity is when mothers watch video-stimuli of their children during stressful and nonstressful mother-child interactions. Based on previous observations in related fields we hypothesized that more severe comorbid dissociation in IPV-PTSD would be associated with lower limbic system activation and greater neural activity in regions of the emotion regulation circuit such as the medial prefrontal cortex and dorsolateral prefrontal cortex (dlPFC). Twenty mothers (of children aged 12-42 months), with and without IPV-PTSD watched epochs showing their child during separation and play while undergoing fMRI. Multiple regression indicated that when IPV-PTSD diagnosed mothers watched their children during separation compared to play, dissociative symptom severity was indeed linked to lowered activation within the limbic system while greater IPV-PTSD symptom severity was associated with heightened limbic activity. Concerning emotion regulation areas, there was activation associated to dissociation in the right dlPFC. Our results are likely a neural correlate of affected mothers' reduced capacity for sensitive responsiveness to their young child following exposure to interpersonal stress, situationsthat are common in day-to-day parenting.