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Graduate Masters Theses
Doctoral Dissertations and Masters Theses
6-1-2012
Exposure to Potentially Traumatic Events,
Emotional Adjustment, and Social Competence in
Preschoolers Facing Economic Risk
Hillary Hurst
University of Massachusetts Boston
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Hurst, Hillary, “Exposure to Potentially Traumatic Events, Emotional Adjustment, and Social Competence in Preschoolers Facing
Economic Risk” (2012). Graduate Masters Theses. Paper 100.
EXPOSURE TO POTENTIALLY TRAUMATIC EVENTS, EMOTIONAL
ADJUSTMENT, AND SOCIAL COMPETENCE IN PRESCHOOLERS FACING
ECONOMIC RISK
A Thesis Presented
by
HILLARY HURST
Submitted to the Office of Graduate Studies,
University of Massachusetts Boston,
in partial fulfillment of the requirements for the degree of
MASTER OF ARTS
June 2012
Clinical Psychology Program
©2012 by Hillary Hurst
All rights reserved
EXPOSURE TO POTENTIALLY TRAUMATIC EVENTS, EMOTIONAL
ADJUSTMENT, AND SOCIAL COMPETENCE IN PRESCHOOLERS FACING
ECONOMIC RISK
A Thesis Presented
by
HILLARY HURST
Approved as to style and content by:
__________________________________________________
Abbey Eisenhower, Assistant Professor
Chairperson of Committee
__________________________________________________
Joan H. Liem, Special Assistant to the Provost & Professor
Member
__________________________________________________
Alice S. Carter, Director of Graduate Program in Clinical
Psychology & Professor
Member
____________________________________
Alice S. Carter, Director,
Graduate Program in Clinical Psychology
____________________________________
Carol Smith, Acting Chairperson,
Psychology Department
iv
ABSTRACT
EXPOSURE TO POTENTIALLY TRAUMATIC EVENTS, EMOTIONAL
ADJUSTMENT, AND SOCIAL COMPETENCE IN PRESCHOOLERS FACING
ECONOMIC RISK
June 2012
Hillary Hurst, B.A., Wellesley College
M.A. University of Massachusetts Boston
Directed by Assistant Professor Abbey Eisenhower
The current study examined the relationship between exposure to potentially
traumatic events (PTEs), emotional adjustment, and social competence in a sample of
economically-disadvantaged, racially and ethnically diverse preschool-aged children
(n=63; 60% female; average age = 52 months, S.D. = 10.30, range: 36-74 months). In
this cross-sectional study, primary relationships between exposure to PTEs and emotional
adjustment, and exposure to PTEs and social competence were examined. Additionally,
parent affective symptoms were tested as a moderator of the relationship between child
exposure to PTEs and emotional adjustment, and emotional adjustment was tested as a
moderator of the relationship between child exposure to PTEs and social competence.
Gender effects of these relationships also were tested, on an exploratory basis. The
results of the current study suggest that exposure to PTEs involving interpersonal
violence are predictive of parent-reported emotional adjustment, and also that teacher-
reported emotional adjustment moderates the relationship between exposure to PTEs and
v
teacher-reported social competence. This research contributes to existing literature,
particularly on the relationship between emotional adjustment and social competence,
which is rarely studied through the lens of economic disadvantage and exposure to PTEs.
vi
ACKNOWLEDGEMENTS
I extend my deepest thanks to Abbey Eisenhower, my research advisor, and to Joan
Liem and Alice Carter, my master’s committee members. Thank you so much for your
thoughtful and insightful feedback, encouragement, and support in my biggest research
undertaking to date! I am so grateful for your research training and guidance, and I look
forward to our future projects. I would also like to thank the past and present members of
the Eisenhower, Carter, and Liem research teams, who are inspiring, supportive, and
wonderful colleagues. I could not imagine a finer group of researchers, mentors,
teachers, and friends.
I would also like to thank Dr. Kerim Munir for his generous financial support that
allowed me to work on this thesis in the summer of 2011 and to receive advanced
statistics training. Thanks are also due to Beverley Gilligan, who coordinated this
support and my involvement with Children’s Hospital. The current study was supported
in part by NIMH/NIH R25 MH071286 (Dr. Kerim Munir, PI) at the Division of
Developmental Medicine, Children’s Hospital, Boston.
Finally, I would like to thank my parents, Louise and Peter, my grandmother, Neska,
and my partner, Devon, for their unconditional encouragement, support, and love during
the writing process, and always.
vii
TABLE OF CONTENTS
ACKNOWLEDGMENTS …………………………………………………………………..
vi
LIST OF TABLES
……………………………………………………………………………..
ix
LIST OF FIGURES ……………………………………………………………………………
xv
CHAPTER Page
1. BACKGROUND AND SIGNIFICANCE
……………………………….
1
Preschool-Age Children’s Exposure
and Reactions to PTEs ………………………………………………
1
Social Competence………………………………………………………..
3
Emotional Adjustment …………………………………………………..
5
Parent Affective Symptoms as a Moderator
of Exposure to PTEs and Emotional Adjustment ………….
6
Specific Aims and Conceptual Models
…………………………….
9
2. RESEARCH DESIGN AND METHODS ……………………………….
12
Participants
………………………………………………………………….
12
Procedures
…………………………………………………………………..
14
Assessments ………………………………………………………………..
15
Data Procedures …………………………………………………………..
21
3. RESULTS …………………………………………………………………………
24
Rates of Exposure to Potentially Traumatic
Events (PTEs) …………………………………………………………
24
Relations Among Variables of Interest
…………………………….
27
Tests of Specific Aim 1: PTE Exposure, Emotional
Adjustment, and Social Competence ………………………….
31
Tests of Specific Aim 2: PTE Exposure and Emotional
Adjustment Moderated by Parent Affective Symptoms ..
41
Tests of Specific Aim 3: PTE Exposure and Social
Competence, Moderated by Emotional Adjustment
……..
51
Tests of Specific Aim 4: Exploring Potential Moderating
Effect of Child Gender on PTE Exposure, Emotional
Adjustment, and Social Competence ………………………….
77
4. DISCUSSION ……………………………………………………………………..
79
Strengths and Limitations ………………………………………………
83
Future Directions ………………………………………………………….
84
viii
APPENDIX
A. TRAUMATIC EVENTS SCREENING INVENTORY –
PARENT REPORT REVISED (TESI-PRR)….……………. 87
REFERENCES…………………………………………………………….. 90
ix
LIST OF TABLES
Table Page
1. Rates of Child Exposure to Potentially Traumatic Events
(PTEs) by Category………………………………………………………………….
25
2. Descriptive Statistics of Emotional Adjustment,
Social Competence, and Parent Affective Symptoms Variables ……. 28
3. Correlation Coefficients for the Three Measures
of Child Emotional Adjustment ………………………………………………… 29
4. Correlation Coefficients for the Three Measures
of Child Social Competence …………………………………………………….. 29
5. Correlation Coefficients for the Three Measures
of Parent Affective Symptoms
………………………………………………….. 30
6. Summary of Linear Regression Analysis for Total
PTE Exposure Predicting Parent-Reported Total Problems
T Score on the CBCL
………………………………………………………………. 32
7. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure Predicting Parent-Reported Total Problems
T Score on the CBCL
………………………………………………………………. 33
8. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure Predicting Parent-Reported
Total Problems T Score on the CBCL ……………………………………….. 34
9. Summary of Linear Regression Analysis for PTE Exposure
Predicting Teacher-Reported Total Problems T Scores
on the CTRF
…………………………………………………………………………… 35
10. Summary of Linear Regression Analysis for PTE Exposure
Predicting Dysregulation …………………………………………………………. 36
11. Summary of Linear Regression Analysis for PTE Exposure
Predicting Parent-Reported Social Skills Standard Score
on the SSRS …………………………………………………………………………… 37
12. Summary of Linear Regression Analysis for Total PTE
Exposure Predicting Teacher-Reported Social Skills
Standard Score on the SSRS …………………………………………………….. 38
x
Table Page
13. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure Predicting Teacher-Reported Social Skills
Standard Score on the SSRS …………………………………………………….. 38
14. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure Predicting Teacher-Reported Social
Skills Standard Score on the SSRS
……………………………………………. 39
15. Summary of Linear Regression Analysis for PTE Exposure
Predicting Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 40
16. Summary of Linear Regression Analysis for Total PTE
Exposure and Parent Affective Symptoms Variables Predicting
Parent-Reported Total Problems T Score on the CBCL
……………….. 42
17. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and Parent Affective Symptoms Variables
Predicting Parent-Reported Total Problems T Score
on the CBCL ………………………………………………………………………….. 43
18. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and Parent Affective Symptoms
Variables Predicting Parent-Reported Total Problems
T Score on the CBCL
………………………………………………………………. 44
19. Summary of Linear Regression Analysis for Total PTE
Exposure and Parent Affective Symptoms Variables
Predicting Teacher-Reported Total Problems
T Score on the CTRF ………………………………………………………………. 45
20. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and Parent Affective Symptoms Variables
Predicting Teacher-Reported Total Problems T Score
on the CTRF
…………………………………………………………………………… 46
21. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and Parent Affective Symptoms
Variables Predicting Teacher-Reported Total Problems
T Score on the CTRF ………………………………………………………………. 47
xi
Table Page
22. Summary of Linear Regression Analysis for Total PTE
Exposure and Parent Affective Symptoms Variables
Predicting Dysregulation …………………………………………………………. 48
23. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and Parent Affective Symptoms Variables
Predicting Dysregulation …………………………………………………………. 49
24. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and Parent Affective Symptoms
Variables Predicting Dysregulation …………………………………………… 50
25. Summary of Linear Regression Analysis for Total PTE
Exposure and CBCL Total T Score Predicting Parent-Reported
Total Social Skills Standard Score on the SSRS …………………………. 52
26. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and CBCL Total T Score Predicting Parent-
Reported Total Social Skills Standard Score on the SSRS
……………. 53
27. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and CBCL Total T Score Predicting
Parent-Reported Total Social Skills Standard Score on the SSRS …. 54
28. Summary of Linear Regression Analysis for Total PTE
Exposure and CTRF Total T Score Predicting Parent-Reported
Total Social Skills Standard Score on the SSRS …………………………. 55
29. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and CTRF Total T Score Predicting Parent-
Reported Total Social Skills Standard Score on the SSRS
……………. 56
30. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and CTRF Total T Score Predicting
Parent-Reported Total Social Skills Standard Scores
on the SSRS …………………………………………………………………………… 57
31. Summary of Linear Regression Analysis for Total PTE
Exposure and Dysregulation Predicting Parent-Reported
Total Social Skills Standard Score on the SSRS …………………………. 58
xii
Table Page
32. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and Dysregulation Predicting Parent-Reported
Total Social Skills Standard Score on the SSRS …………………………. 59
33. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and Dysregulation Predicting Parent-
Reported Total Social Skills Standard Score on the SSRS
……………. 60
34. Summary of Linear Regression Analysis for Total PTE
Exposure and CBCL Total T Score Predicting Teacher-Reported
Total Social Skills Standard Score on the SSRS …………………………. 61
35. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and CBCL Total T Score Predicting Teacher-
Reported Total Social Skills Standard Score on the SSRS
……………. 62
36. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and CTRF Total T Score Predicting
Teacher-Reported Total Social Skills Standard Score
on the SSRS …………………………………………………………………………… 63
37. Summary of Linear Regression Analysis for Total PTE
Exposure and Dysregulation Predicting Teacher-Reported
Total Social Skills Standard Score on the SSRS …………………………. 65
38. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and Dysregulation Predicting Teacher-
Reported Total Social Skills Standard Score on the SSRS
……………. 66
39. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and Dysregulation Predicting Teacher
Reported Total Social Skills Standard Score on the SSRS
……………. 67
40. Summary of Linear Regression Analysis for Total
PTE Exposure and CBCL Total T Score Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 68
41. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and CBCL Total T Score Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 69
xiii
42. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and CBCL Total T Score Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 70
43. Summary of Linear Regression Analysis for Total PTE
Exposure and CTRF Total T Score Predicting Child-Reported
Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 71
44. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and CTRF Total T Score Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 72
45. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and CTRF Total T Score Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 73
46. Summary of Linear Regression Analysis for Total
PTE Exposure and Dysregulation Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 74
47. Summary of Linear Regression Analysis for Interpersonal
PTE Exposure and Dysregulation Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 75
48. Summary of Linear Regression Analysis for Interpersonal
Violence PTE Exposure and Dysregulation Predicting
Child-Reported Social Adjustment Raw Score on
BPI Peer Acceptance and Rejection Scale
………………………………….. 76
49. Summary of Significant Findings for Specific Aims…………………… 78
xiv
LIST OF FIGURES
Figure
Page
1. Child Exposure to PTEs Will Be Tested for Main
Effects on Child Emotional Adjustment and
Child Social Competence………………………………………………… 10
2. Parent Affective Symptoms Will Be Tested as a
Moderator of the Relationship Between Child
Exposure to PTEs and Child Emotional Adjustment.…………………….
10
3. Child Emotional Adjustment Will Be Tested as a
Moderator of the Relationship Between Child
Exposure to PTEs and Child Social Competence …………………………..
11
4. On an Exploratory Basis, Child Gender Will Be Tested
as a Moderator of the Relationship Between Child
Exposure to PTEs, and Child Emotional Adjustment
and Child Social Competence
……………………………………………………..
11
5. Interaction Between Interpersonal Violence PTE Exposure
and CTRF Total T Score Predicting Teacher-Reported
Total Social Skills Standard Score on the SSRS ……………………………
64
1
CHAPTER 1
BACKGROUND AND SIGNIFICANCE
Preschool-Age Children’s Exposure and Reactions to PTEs
While it was previously believed that very young children are too young to be
affected by potentially traumatic events (PTEs), a growing body of literature suggests
that they are both at risk for exposure to PTEs and for developing an array of
developmental problems following such exposures (Brom et al., 2009; Mongillo et al.,
2009). In a recent study with a diverse, representative sample of urban and suburban
families, more than one-quarter of children between the ages of 24 and 48 months had
experienced at least one PTE; however, this rate jumped to 49 percent among those living
in poverty (Briggs-Gowan et al, 2010b). Facing economic risk, along with living in a
single-parent household and having a parent with depressive symptoms, are powerful
predictors of exposure to PTEs for preschool-age children (Linares et al., 2001). While
economically-disadvantaged children are already at risk for negative behavioral and
socio-emotional outcomes, exposure to PTEs may be associated with concurrent and
future child symptomatology above and beyond the effects of living in poverty (Briggs-
Gowan et al., 2010a; Margolin et al., 2010).
Different categories of PTEs, such as interpersonal trauma, non-interpersonal trauma,
and traumatic loss, may result in distinct emotional and behavioral responses (Briggs-
Gowan et al., 2010b). Depending on the type of PTE exposure, preschool-age children
2
are likely to follow differential trajectories of psychopathology and resilience (Graham-
Bermann et al., 2008; Briggs-Gowan et al., 2010a; Margolin et al., 2010). For example,
PTEs that entail interpersonal violence – such as being the victim of physical assault, or
witnessing domestic or community violence – are strongly predictive of depression,
separation anxiety, PTSD, and conduct problems, and marginally predictive of ADHD
symptoms in preschool-age children while non-interpersonal PTEs – such as
experiencing a natural disaster or transportation accident – may be predictive of specific
phobias only (Briggs-Gowan et al., 2010a). Related research suggests that interpersonal
PTEs and PTEs involving family members are the most likely to be associated with
PTSD symptomatology in young children (Luthra et al., 2009; Graham-Bermann et al.,
2008). In a sample of middle-class, school-age children, exposure to domestic violence
was associated with externalizing but not internalizing behavior problems while exposure
to community violence was associated with internalizing problems, externalizing
problems, and depressive symptoms (Malik, 2008). Given the high incidence of both
community violence exposure and domestic violence exposure among preschoolers living
in urban areas who face economic risk, similar research focused specifically on this
population is necessary. While some researchers focus specifically on exposure to one
type of PTE (for example, intimate partner violence), this study will contribute to the
field by considering children’s exposure to a wide range of PTEs.
Gender effects, particularly differential rates of exposure to PTEs and associated
outcomes for boys and girls, are of interest to many preschool trauma researchers.
However, Graham-Bermann et al. (2009) concluded that the findings to date, at least in
regard to exposure to intimate partner violence, have been inconclusive. Similarly,
3
Crusto et al. (2010) and Mitchell et al. (2009) found no difference in rates of PTE
exposure or posttraumatic stress between preschool-age boys and girls. On the other
hand, previous work also suggests that school-age boys may experience more
externalizing behaviors and girls more internalizing behaviors following severe trauma
exposure (Dulmus & Hilarski, 2006). Commonly, researchers explore gender effects of
exposure to PTEs without putting forth a formal hypothesis (e.g., Schwartz & Proctor,
2000) and a similar approach will be taken in the current study. In doing so, particularly
within a sample of low-income preschoolers, the present study will contribute to the
exploration of gender-based PTE differences.
Social Competence
While social skills are specific behaviors that are acquired and performed, social
competence is a broader construct that encompasses the environments, values, and
judgments – the context – in which social skills are enacted (Gresham et al., 2001). In
other words, social competence is not merely possessing social skills, but making good
decisions about when and how to apply them to specific situations, like at home and in
the classroom. Consistent with this definition, Lillivist et al. (2009) found that Swedish
preschool teachers identified intrapersonal skills, including self-esteem, empathy,
autonomy, participation/engagement, and problem-solving, and interpersonal
relationships, including interaction, popularity, peer-group leadership status, and
communication, as the main components of social competence. It is critical to assess
social competence in young children because of its persisting and predictive properties
(Eisenberg et al., 1997). In a recent study of economically disadvantaged Latino
preschoolers, social competence was strongly associated with future academic
4
achievement (Oades-Sese et al., 2011); moreover, children who have positive social
experiences in daycare and preschool are more likely than those who have had negative
experiences to be less aggressive, to have more friends, and to be considered popular in
the 3rd grade (NICHD, 2008). The benefits of early social competence extend into later
childhood, adolescence, and even adulthood, and include desirable vocational outcomes,
educational attainment, self-regulatory skills, and mental health (Caspi et al., 1998;
Hebert-Myers et al., 2006; Obradović et al., 2010).
Given the long-term impact of social competence at an early age, it is important to
understand how it might be related to early exposure to PTEs, particularly for children
who already face a significant degree of economic risk. As discussed earlier, children’s
exposure to PTEs is associated with internalizing and externalizing symptomatology in
ways that inhibit children’s social development. Internalizing problems, like anxiety,
might inhibit prosocial behavior and age-appropriate peer interactions; similarly,
externalizing behavior problems like tantrums might negatively influence the way that
children are regarded and included in play activities by peers. However, not all children
who experience PTEs go on to develop behavior problems. Thus, emotional adjustment,
including both internalizing and externalizing domains, will be explored as a potential
moderator of the relationship between exposure to PTEs and social competence outcomes
in young children.
It is important to note here that social competence is a strengths-based construct.
Some research purports to study social competence while including weakness-based
components within it, such as social problems, negative peer interactions, externalizing
behavior, or social withdrawal (Katz et al., 2007; Diener & Kim, 2004). While social
5
competence might involve the absence of some negative behaviors, the absence of such
behaviors by itself does not constitute social competence. The proposed study will
capture children’s social behaviors on a continuum and assess social competence using
strengths-based measures.
Emotional Adjustment
It is widely believed that exposure to PTEs may result directly in negative emotional
and behavioral outcomes among children of all ages. While this effect may be especially
significant for very young children who face economic risk, some studies (e.g., Katz et
al., 2007) test only future emotional adjustment and not emotional adjustment concurrent
with the PTE exposure. In the current study, emotional adjustment will be studied for a
possible direct relationship with exposure to PTEs, as well as for a potential moderating
effect on the relationship between exposure to PTEs and social competence. Emotional
adjustment, including emotional expressiveness, emotion knowledge, and emotion
regulation, has been studied widely as a predictor of concurrent and future social
competence in preschool-age children (Denham, 2003). A hallmark study by Eisenberg
et al. (1997) revealed that high levels of emotional regulation, paired with low levels of
non-constructive coping, negative emotionality, and emotional intensity, were associated
with concurrent and future social competence. While this relationship has been widely
studied in normative samples, it is understudied among preschoolers who face economic
risk and PTE exposure.
Traditionally, researchers have tested components of emotional adjustment, including
emotional regulation and emotional awareness, as mediators – not moderators – of the
relationship between exposure to types of PTEs and social competence (Katz et al., 2007;
6
Schwartz & Proctor, 2000). These researchers are guided by the well-researched
understanding that exposure to PTEs may pose a threat to children’s emotional
adjustment and result in internalizing and externalizing behavior problems (Shahinfar et
al., 2000). In turn, the behavior problems associated with poor emotional adjustment
(Howell et al., 2010) may lead to difficulty approaching peers, gaining peer acceptance,
and interacting with peers in an age-appropriate manner. However, the relationship
between exposure to PTEs and emotional and behavioral dysregulation is not
deterministic: resilience studies have suggested that some children who are exposed to
PTEs and other risk factors, like poverty, demonstrate positive emotional adjustment and
social competence, in spite of the exposure (Masten & Coatsworth, 1998; Kim-Cohen et
al., 2004; Howell et al., 2010; Scheeringa & Zeanah, 2001). In a recent study by Howell
et al. (2010), prosocial skills and emotional regulation were studied together as
“resilience” in young children who had been exposed to intimate partner violence; factors
such as strong parenting skills were found to promote resilience. The results of this study
demonstrate that young children might be exposed to PTEs and contextual risk factors
and yet demonstrate age-appropriate emotional adjustment. In light of these findings,
emotional adjustment will be tested as a moderator of the relationship between exposure
to PTEs and social competence in the current study.
Parent Affective Symptoms as a Moderator of Exposure to PTEs and Emotional
Adjustment
Previous research has demonstrated the importance of considering parent-level
factors when assessing the relationship between preschoolers’ exposure to PTEs and
subsequent child emotional adjustment. In fact, parent affective symptoms may have a
7
greater impact than characteristics of the PTE itself on child outcomes following
exposure among very young children (Schecter & Wilheim, 2009). Hussey et al. (2006)
point out that children typically learn basic trust and social reciprocity from their
caregivers, which they apply to all future relationships. However, exposure to PTEs at a
very early age can threaten their capacity to develop social reciprocity, which can lead to
maladaptive attempts to control relationships and environments (Hussey et al., 2006).
Scheeringa and Zeanah (2001) found support for several models that explain the role of
parental factors in the relationship between child exposure to PTEs and child emotional
adjustment. In the “minimal” model, preschool-age children are directly exposed to
PTEs but do not experience any subsequent maladaptive adjustment; they are resilient. In
the “vicarious traumatization” model, the parent is exposed to a PTE that the child is not.
However, this exposure negatively impacts the parent’s behaviors toward his or her child,
and in turn, the child displays some of the same outcomes, as though he or she had been
exposed to the PTE himself or herself. In the “moderating” model, which is of particular
interest to the current study, the quality of the parent-child relationship moderates the
child’s exposure to PTEs and his or her subsequent adjustment. Additionally, Scheeringa
and Zeanah suggest the “compound” model, which combines the vicarious traumatization
and moderating models. In the current study, parent affective symptoms – an established
predictor of parent-child relationship quality – will be tested as a moderator of the
relationship between child exposure to PTEs and emotional adjustment.
In addition to testing the above models, Scheeringa and Zeanah (2001) were also
concerned with how both parent and child PTSD symptomatology might affect the
parent-child relationship. They put forth three patterns: the
8
withdrawn/unresponsive/unavailable pattern, in which parent PTSD interferes with their
parenting behaviors; the overprotective/constricting pattern, in which a child’s exposure
to PTE(s) traumatizes the parent and in turn, the parent takes drastic and irrational
measures to protect the child from any other harm; and the
reenacting/endangering/frightening pattern, in which the child is exposed to PTE(s), the
parent becomes traumatized and in turn, engages in problematic behaviors (e.g., asking
intrusive questions) that retraumatize the child. These arguments would suggest, then,
that children’s emotional response to traumatic events may be particularly elevated when
their parents are also experiencing psychological distress; alternatively, children whose
parents are emotionally healthy may be better able to cope with PTE exposure in a way
that does not result in emotional maladjustment. When providing support to families in
which a child has been exposed to PTEs, contemporary research emphasizes that the first
line of action should be to address parental PTSD symptoms, if they are present
(Lieberman et al., 2005; Scheeringa & Zeanah, 2001). This is critical because the parent-
child relationship is a primary agent of change for preschool-age children, parents are
more likely to respond to their children in a sensitive manner once their symptoms have
been addressed, and the parent-child relationship is central to how young children
perceive and process their own exposure to PTEs.
Significant research has explored parents’ well-being as both a mediator and a
moderator of the relationship between child exposure to PTEs and emotional adjustment.
Briggs-Gowan et al. (2010a) found support for parent affective symptoms as a mediator:
parental depressive and anxiety symptoms mediated the relationship between child
exposure to violent PTEs and both child depression and conduct problems. Other studies
9
explore the potential moderating effect of parent affective symptoms. For example,
Goldfinch (2009) articulates how compromised parental well-being may moderate the
relationship between child exposure to PTEs and emotional adjustment: “If a parent is
unable to tolerate negative emotion, and becomes distressed by this the child cannot
practice labeling and managing disappointment, frustration or anger… a child who cannot
express negative emotions has no opportunity to practice resolution of the conflict,
sadness or disappointment. This will lead to less skill in emotion management, and less
effective social skills.” Furthermore, Howell et al. (2010) found that parenting practices
and maternal mental health, including depressive and PTSD symptoms, moderated young
children’s prosocial skills and emotional regulation following exposure to intimate
partner violence. In the current study, parent affective symptoms, including symptoms of
depression, anxiety, and PTSD, will be tested as a moderator of the relationship between
children’s exposure to PTEs and their emotional adjustment. Parent affective symptoms
will be tested this way due to their effect on the parent-child relationship and the critical
function of this relationship in light of child exposure to PTEs (Lieberman et al., 2005).
10
Specific Aims and Conceptual Models
1. To determine how child exposure to potentially traumatic events is related to child
emotional adjustment and child social competence.
Figure 1. Child Exposure to PTEs Will Be Tested for Main Effects on Child Emotional
Adjustment and Child Social Competence.
2. To determine whether parent affective symptoms, particularly depressive, anxiety,
and PTSD symptomatology, moderates the relationship between child exposure to
PTEs and child emotional adjustment.
Figure 2. Parent Affective Symptoms Will Be Tested as a Moderator of the Relationship
Between Child Exposure to PTEs and Child Emotional Adjustment.
Child social
competence
Direct rx
Child emotional
adjustment
Child exposure to
PTEs
Direct rx
Parent affective
symptoms
Child
emotional
adjustment
Child
exposure to
PTEs
Moderate
