Network News
Annual conference to shed light on approaches for boosting child protection
Sep 23, 2015The Penn State Child Maltreatment Solutions Network’s fourth annual conference will showcase recent advances in research on the long-term effects of early-life stress, maltreatment and trauma. “This year’s conference will look at the biological aspects of child maltreatment, with a highlighted discussion of resilience and reversibility,” said Sandee Kyler, assistant director of the Network. The trauma and stress of child maltreatment has a profound impact on the human body that can carry on throughout one’s life and even impact the next generation, Kyler said, adding that this makes exploring reversibility more crucial than ever. The “New Frontiers in the Biology of Stress, Maltreatment and Trauma: Opportunities for Translation, Resilience, and Reversibility” conference, scheduled for Sept. 30 to Oct. 1 at the Nittany Lion Inn, will bring together 15 top researchers in fields of psychology and neurosciences from Penn State, Harvard, New York University and other institutions around the world. They will share their findings about the ways stress “gets under the skin,” according to the Network’s website. Four sessions will cover endocrinology and immunology, brain development, genomics and resilience and reversibility. Each session will be followed by an integrative “translation” component where speakers will discuss connections in all the studies presented. The conference will culminate with a panel discussion, allowing for interaction between speakers and participants. The Network was created to advance Penn State’s academic mission of teaching, research and engagement in the area of child maltreatment. Since the Network was launched in Fall 2012, its conferences have established a concrete frontier of understanding child maltreatment through advanced research. As part of a partnership between the Network and Penn State’s College of Communications, senior journalism student Taylor Clayton has been blogging about this year’s conference. Penn State faculty and staff can attend the conference for $15 a day or $25 for both days, and students can attend for free. Online registration is available through 5 p.m. on Thursday, Sept 24. Space permitting, participants can also register at the conference from 7:30 to 8:30 a.m. on Sept. 30. For more information, visit the Network’s website.
Unreported past child maltreatment may contaminate research results
Aug 28, 2015Researchers may unknowingly be overlooking a critical factor that could aid in more consistent results in studies involving child abuse. Penn State Child Maltreatment Solutions Network faculty member Chad Shenk is opening the door to more precise results in the realm of child abuse and maltreatment and is hoping to use his findings to strengthen the research process as a whole. Shenk, assistant professor of human development and family studies, used data from a five-year study to determine whether research contamination leads scientists to reach different conclusions about the effects of child maltreatment. The study was published in the March 2015 issue of the Journal of Pediatric Psychology. Contamination occurs when the comparison group includes — unknown to the researcher — subjects who have come into contact with the variable that is being studied. In this case, that variable is abuse and maltreatment. The presence of contamination can be a serious issue regarding the validity of any study. “Contamination can limit your ability to detect a difference between two groups,” Shenk said. He found that when contamination is present and left uncontrolled, the effects of maltreatment are diminished, making the results appear closer to those of the experimental group. This can lead researchers to believe there is no connection between the cause and effect when — without this contamination — there may be. Shenk’s study observed the health status of female adolescents, ages 14 to 19, following an instance of child maltreatment. He focused on four outcomes — teenage pregnancy, obesity, major depression and cigarette use within the past month — with the goal of discerning how contamination can impact research results. Participants were recruited into two groups. One group, the experimental group, was referred by Child Protective Services (CPS) and had been exposed to substantiated child maltreatment in the past year. The comparison group reported not having any CPS involvement. Shenk ran the data in two different ways. The first time around, he analyzed the data based solely on how the two groups were recruited. This is considered the more “common” research approach. Shenk then screened the comparison group a second time using two different methods to ensure no prior history of maltreatment. In addition to the preliminary screening, participants in the comparison group were asked to self-report any maltreatment and CPS was consulted for records of abuse or maltreatment. Shenk found that almost 45 percent of participants in the comparison group did, in fact, have a history of child abuse or maltreatment, providing a striking example of the prevalence of contamination in research. “Approximately 40 percent of people who experience substantiated child maltreatment fail to report this information during a research study,” Shenk said. He also said that there are a number of reported CPS cases that are never confirmed, leaving a child record-free, but with a history of maltreatment. To add to this, some abuse cases are never reported and some children are being abused, but never receive any official aid. Without careful analysis, this contamination could alter a researcher’s end results. Once Shenk controlled contamination in the comparison group, the results changed measurably. With contamination in the comparison group, Shenk found child maltreatment in adolescent females only was able to significantly predict the prevalence of teenage births and past-month cigarette use. When contamination was identified and controlled, he discovered that child maltreatment not only significantly predicted teenage births and past-month cigarette use, but also obesity and major depression. With contamination restricted, the rates for these health outcomes more closely matched national averages. These results are only true when safeguarding for contamination in the form of both CPS reports and self-report methods, he said. When screening for only one or the other, the results appeared similar to the contaminated analysis, highlighting the importance of a thorough contamination check. This study is among the first of its kind to address the effect of contamination on research results. Shenk’s findings could mean that child maltreatment has stronger and more far-reaching effects than researchers previously thought. Shenk will continue his quest for an explanation with graduate students from Penn State. They plan to run models from a five-site longitudinal study in hopes of replicating Shenk’s previous work. This time, however, the group of adolescents is more representative of the national population, with more variation in race, background and socioeconomic status. His overall goal, Shenk said, is to make the research process more reliable and receive results that can be easily and accurately replicated. The framework for Shenk’s new study is in place and he hopes to make the results public by the end of the year.
Penn State offers new minor in Child Maltreatment and Advocacy Studies
Aug 28, 2015This fall, Penn State students have the opportunity to delve deeper into the concentration of child protection with a new, intercollege minor in Child Maltreatment and Advocacy Studies (CMAS). The minor, approved July 17 by the University's Board of Trustees, was created and facilitated by the Penn State Child Maltreatment Solutions Network and was developed by a team of faculty members from eight different colleges with a wide variety of academic specializations. The goal of the minor is to create a foundational knowledge of the causes, detection and reporting processes of child maltreatment in order to better prepare students for careers that serve children in many settings. The interdisciplinary curriculum focuses on a theoretical and practical understanding of maltreatment and advocacy. Students who complete the minor will receive a formal Child Advocacy Studies (CAST) certification. The CAST certificate is widely recognized in the field as enhancing competitiveness for positions within child-welfare agencies, and can also be an advantage for students applying to graduate programs. “The CMAS minor is an unprecedented educational opportunity that will help equip undergraduates to be competitive for entry-level jobs in the child welfare system as well as a multitude of graduate programs,” said Jennie Noll, professor in human development and family studies and director of the Child Maltreatment Solutions Network. “We hope to help train the next generation of those who work to protect and advocate for the safety of children.” The minor is open to all undergraduate students, but may be of particular interest to those in education, psychology, law enforcement, social services or medical professions — fields that commonly come into contact with children. Penn State is the first school in the Big Ten and one of the first in the nation to devote 18 credits to an undergraduate minor of this kind. The CMAS minor offers expertise from a diverse range of departments. Courses were designed in collaboration with biobehavioral health; human development and family studies; psychology; sociology and criminology; education psychology, counseling, and special education; forensic science; agricultural economics; nursing; medicine; and the Office of Undergraduate Education. Four core courses, adding up to 12 credits, provide an educational base for understanding the issues and actions surrounding child maltreatment. The final six credits, two elective courses, allow a student to explore more specific options that may align with their professional goals. The minor will be rounded off with a capstone course in which students will apply their knowledge to field work, research or other areas that engage child services. “We are excited to offer this new intercollege minor that is specifically focused on child protection. Our aim is to help students further their educational goals and explore their interests while helping to promote child advocacy,” said Sandee Kyler, assistant director at the Network. Registration for the minor will soon be available on eLion and interested students can find more information and a list of courses here.
First course in Child Maltreatment and Advocacy Studies minor offered this fall
Aug 17, 2015Penn State’s new, undergraduate minor in Child Maltreatment and Advocacy Studies (CMAS) is fully developed and the inaugural course will debut this fall. The course and minor look to deliver critical training to a wide variety of professions from education to medicine. The course (HDFS 297A), Introduction to Child Maltreatment and Advocacy Studies, will give students a comprehensive look at child maltreatment with a focus on its prevalence, causes and consequences. Additionally, the course will examine the legal processes and reporting of child abuse and neglect cases; forensic and medical assessments; the Child Protective Services system; and psychological treatment methods. Students will also have the ability to study past child maltreatment cases, the laws that govern them and their outcomes. The course is an indicator of what the CMAS minor will entail, and it will examine issues and provide information related to a number of professional fields, including areas ranging from education, law enforcement and criminology to medicine and social sciences. Specialists in these professions will likely come into contact with children on a regular basis, and this course, as well as the CMAS minor, intend to prepare students for a multitude of post-graduate opportunities. CMAS also sheds light on a pervasive societal problem that requires more advanced knowledge, practice, education and outreach to prevent. “This course will be of great value to any student who plans to work with children in a variety of career paths,” said course instructor Chad Shenk, assistant professor of human development and family studies. “It was developed to provide an expansive overview of the issue of child maltreatment for all students, promote the recognition and reporting of child maltreatment, while giving the essential background needed to those students who wish to pursue the advanced courses required for successful completion of the CMAS minor.” Shenk’s background focuses on the long-term effects of child maltreatment, the causal pathways of adverse health outcomes and the development and testing of behavioral interventions for sufferers of abuse and maltreatment. The creation of an undergraduate minor in CMAS was approved recently by the Penn State Board of Trustees. The minor is part of the University’s efforts to address the widespread and serious problem of child maltreatment, bringing together experts in the field from across a broad spectrum. This coming semester, the course will take place on Tuesdays and Thursdays, beginning at 4:15 p.m. HDFS 297A is currently open in Penn State's schedule of courses and students are still being accepted. For more information, contact Sandee Kyler. By Noelle Rosellini
Faculty work to change treatment for sexual behavior problems
Jul 13, 2015Penn State Child Maltreatment Solutions Network faculty member Brian Allen is exploring new frontiers in a field of child mental health that are often underexamined, underfunded and overlooked. Allen, a clinical child psychologist practicing at Penn State Hershey Medical Center, hopes to change the conversation -- or lack thereof -- surrounding child sexual behavior problems with help from a Children’s Miracle Network grant. More than 9 percent of children and preteens struggle with some form of sexual behavior problems (SBP). SBP in children are typically recognized as sexual actions perpetrated by a child that are developmentally inappropriate or harmful, either to themselves or to other children. Allen says that a common misconception associated with this issue is that children with SBP have been sexually abused, when in fact around 60 percent of children with SBP have no sexual abuse history. Though untrue, this misconception is widespread, leading many to attempt to treat SBP in the same way that one would treat a victim of sexual abuse, maltreatment or posttraumatic stress disorder. Additionally, sexual behavior problems in children have received minimal attention in research. The only treatment models that have been specifically targeted and tested for SBP are group treatments, with few completed clinical trials. In addition, only one of these clinical trials obtained follow-up data. “Evidence tells us that a minority of children with sexual behavior problems have a sexual abuse history, and there are no individual treatment models beyond sexual abuse for this population,” Allen said. While the group treatment model has proven effective in a small number of trials, Allen claims it is a less feasible method overall. “The probability of getting a large enough group of children with SBP in one area who are entering treatment at the same time is low, especially in smaller communities,” Allen said. This logistical issue can often render group therapies impractical. For this reason, Allen and his team are creating and testing a first-of-its-kind, individual treatment model for children with SBP. This type of therapy will be one-on-one, making it more accessible to all children who need it, regardless of whether or not there are others grappling with similar issues in their community. Allen’s research aims to be a groundbreaking step toward making treatment more substantive and accessible to those facing SBP. The $37,000 grant that Allen received will fund the creation of this therapy; a clinical trial involving 15 children, 5 to 12 years old; and a post-pilot analysis of the effectiveness of the treatment. The model will be based on popular cognitive behavior techniques from the Children with Problematic Sexual Behavior–Cognitive Behavioral Therapy out of Oklahoma University Health Science Center, often referred to as the Oklahoma model. Throughout the study, Allen will evaluate the frequency, severity and number of instances of SBP in the children. The study will be run through the Stine Foundation Transforming Lives of Children (TLC) Clinic at Penn State Hershey. TLC is an evidence-based specialty clinic and part of its mission is to serve as a research lab for the Child Maltreatment Solutions Network. It is the only mental health clinic within the Network that provides treatment services to children. Allen’s research requires a significant amount of work in an unexplored territory. Other members of the research team include network faculty member Chad Shenk, assistant professor of human development and family studies and co-investigator on the grant, and Lucy Berliner, a licensed clinical social worker and a foremost authority on SBP, who will be a consultant during the development process. This yearlong pilot investigation began July 1 with children already presenting for treatment and some referred from the Children's Resource Center in Harrisburg. If this trial goes as planned, the team will continue their research with the intention of providing a sustainable treatment model effective enough for widespread use on children with SBP. The outcome of this could be considerable, since children with SBP have higher rates of school problems, depression, sexual risk-taking and involvement with the justice system, among other things -- all of which could be reduced with appropriate treatment.
New Screening Approach Helps Doctors Identify Potential Child Abuse Cases
May 5, 2015Twenty years ago, child abuse pediatrician Kent Hymel worked with Carole Jenny on a case involving a child who had suffered severe head trauma. This child had been evaluated nine times before he was correctly diagnosed with head trauma resulting from child abuse. This case motivated Dr. Hymel to create an evidence-based screening approach that could help pediatricians miss or misdiagnose fewer children with abusive head trauma. As they looked into the diagnostic and screening challenges associated with abusive head trauma, Drs. Jenny and Hymel found that 30 percent of their local cases of abusive head trauma had been missed or misdiagnosed. While those numbers have very likely improved since the 1990s, there is still an unacceptably high rate of screening and diagnostic errors. Dr. Hymel, a co-funded faculty member with the Child Maltreatment Solutions Network and Penn State Hershey Children’s Hospital, noted that missing these cases can have severe consequences. “Many of the children whose cases were missed went on to suffer more abuse,” he said. “Five children with missed cases died. Four could have been prevented. A gold standard for the diagnosing of abusive head trauma does not exist. When I considered these numbers, it became my motivation to reduce these tragedies.” To avoid missing cases, Dr. Hymel set out to create a clinical prediction rule—that is, an effective screening test that would help identify abuse among head trauma victims. He and his co-investigators identified four predictor variables that effectively “screen in” the diagnosis. According to Dr. Hymel, a child who is admitted to an intensive care unit and meets any of the following criteria should be thoroughly evaluated for child abuse: (1) Did the child stop breathing? (2) Was there bruising on the torso, ears, or neck? (3) Was there subdural bleeding? (4) Were there complex skull fractures? “Using the prediction rule, we can assign an evidence-based estimate on the probability of abuse,” Dr. Hymel said. “However, this is a screening, not a diagnostic test. It’s designed to cast a wide net so doctors don’t miss cases. If the test is applied accurately, the patients can be carefully assessed through the medical and child protection systems to see if abuse is substantiated.” To test the performance of their new screening tool approach, Dr. Hymel and his co-investigators collected clinical, historical, and radiologic data on 291 additional, acutely head-injured children from 14 pediatric intensive care units (PICU). Their analyses revealed that their clinical prediction rule (i.e., if any of the four criteria are present in the ICU) accurately predicted 98 percent of the cases where abusive head trauma was ultimately diagnosed. Some children who did not experience abuse were identified as potential victims of abusive head trauma (called a false positive result). However, the goal of Dr. Hymel’s rule is to avoid missing the abuse cases. Even though the screening may result in false positive abuse predictions, it is better to error on the side of caution. “No screening approach is ever completely accurate in its predictions. We use them to help focus clinical attention and to improve the accuracy of the screening process. Our goal was to miss fewer cases” said Dr. Hymel. “In addition to missing fewer cases of abuse, there are several reasons for physicians to use this new screening tool. Perhaps most importantly, the prediction rule provides objective data that will help physicians be more accurate when deciding to proceed with an evaluation for child abuse. It promotes a consistent process that is backed by evidence and addresses a complex problem.” Dr. Hymel added that without this clinical prediction rule, there is no data driving the decision to launch or forgo an evaluation for child abuse. Instead, he says, “there is intuition and the doctor’s experience or, in many cases inexperience, but no data. That is the void we are trying to fill.” Because the screening performance of Dr. Hymel’s clinical prediction rule has now been validated in a new patient population, the next step is to measure its clinical impact when doctors begin to use it in actual practice. Dr. Hymel has begun work on an impact study that will measure the tool’s screening performance in actual clinical practice, and determine the best approaches for getting physicians to adopt the rule as a screening tool. Dr. Hymel leads the Pediatric Brain Injury Research Network, a group of pediatric investigators that assisted in this research. Dr. Hymel can be contacted at khymel@hmc.psu.edu and this study can be found in the December 2014 issue of Pediatrics.
A Report of Childhood Sexual Abuse is Made. What Happens Next?
Apr 24, 2015Penn State’s Child Maltreatment Solutions Network and the Children’s Advocacy Center of Centre County hosted an event on April 21 acknowledging National Child Abuse Prevention month.A panel of national and local experts convened to discuss what happens once a report of child abuse is made. When a child steps forward and reports abuse, we can step up and help by having the courage and knowledge to take action. Teresa Huizar, Executive Director of the National Children’s Alliance, said 20 years ago she often met teachers and officials who did not know what to do and what happened next after abuse or neglect was reported. She wanted to create a better response. Huizar works hard to eliminate the reluctance individuals may have when a report should be made. First, she wants people to know that reporting a situation is almost always better than not reporting one. She has heard from many adult survivors who wished someone had had the courage to make a report. Huizar acknowledges “It takes courage for survivors to report and for reporters to say something. When children are heard and adults believe their stories, then the healing process can begin.” Even though the public’s awareness of child abuse and neglect has improved over the past 20 years, roadblocks still remain. Many individuals do not know what happens after a report is made. What will happen to the child? What are the ongoing responsibilities for the reporter? Will making a report ruin lives? Everyone in a community is responsible to report situations or suspicions of child abuse. It is important for reporters to know that it is not their responsibility to substantiate the abuse. If you suspect a child is experiencing neglect or abuse, call ChildLine at 1-800-932-0313 to file a report. Reports can be done anonymously. “You do not make the decision about whether it’s abuse,” Jennie Noll, Network Director and Professor of Human Development and Family Studies. “You make the call and a well trained team of professionals will take it from there. Our community is very well equipped and resourced to handle these situations.” Nearly 2.4 million children have gone through U.S. children’s advocacy centers. There are 770 centers across the nation, and that number is growing. Kristina Taylor-Porter is the director of the Children’s Advocacy Center of Centre County, which opened in 2014. The CAC provides a compassionate approach to ensure that the child’s voice is heard by bringing together the professionals needed to identify, intervene, and treat child abuse. Taylor-Porter outlined a number of system improvements that have made the reporting process efficient and straightforward for all parties, which has been integral in keeping children safe. Social services and law enforcement agencies participate in a child-centered environment. The CAC offers a friendly, comfortable, and highly supportive environment for the child. The more than 350 children who have come through the center since it opened last year are approached in a developmentally appropriate level, and are in a physical space that is warm and welcoming. Everything is “focused on the child." In the past, children were often brought to law enforcement agencies. “Have you ever walked into a police station? It can be very intimidating for adults, let alone children,” Taylor-Porter said. To further enhance services to the public, there are now more CACs than ever before. Prior to the creation of the center in the county, children and their families had to travel nearly two hours to the nearest CAC for consultation or treatment. “There was a gap in services for us in Centre County,” said Anne Ard, event speaker and director of the Centre County Women’s Resource Center. We needed to look at the family unit as a whole and help address their needs. “If you’re worried you’re not going to be able to feed your kids, you’re not going to prioritize going to a CAC to get an exam when it is four hours roundtrip.” Approaches in interviewing children have improved dramatically. Perhaps the most important role of the CAC is limiting the amount of times a child must retell his or her abuse story. It had been reported that children could retell their story between seven and 21 times, according to Taylor-Porter. Today, child protection professionals can monitor a single interview from another room while a child shares what happened once. This not only helps legal professionals conduct an investigation, it also helps by not re-traumatizing the child. Another improvement in child abuse prevention is education. Speaker Teresa Smith, coordinator of outreach and training at the Northeast Regional Children’s Advocacy Center, said expanding educational opportunities at the undergraduate and graduate levels is key to preparing students for professional roles in child abuse protection and prevention. Penn State is making plans to offer an interdisciplinary minor in child maltreatment and advocacy studies that may be available this fall. “I am excited about the minor and the training of the next generation,” she said. “I am happy that there are more opportunities for education and training today.” To learn more about child maltreatment and advocacy visit the Child Maltreatment Solutions Network and Child Advocacy Center of Centre County websites for more information. Penn State's Daily Collegian also covered the story. You can read their article here.
National Child Abuse Prevention Month Event to Discuss Reporting Process
Apr 14, 2015Child abuse and neglect are substantiated in more than 1.2 million children each year in the United States. As a part of National Child Abuse Prevention Month, Penn State’s Child Maltreatment Solutions Network is teaming up with the Child Advocacy Center of Centre County (Mount Nittany Health) to raise awareness about the importance of child abuse reporting with hopes of significantly lowering that total. “Stand Up, Step Forward to Keep Children Safe: Why Child Abuse Reporting Matters” will feature a panel of experts and advocates who will discuss what it means to be a reporter of child abuse. The community event will be at 7:00 p.m. on April 21, 2015 in the Ruth Pike Auditorium (22 Biobehavioral Health Building). Keynote speaker Teresa Huizar, Executive Director of the National Children’s Alliance, will lead the discussion on how everyone in a community plays an important role in keeping children safe. Speakers will overview the reporting process and answer questions about what to do, what not to do, who to call, and what happens after they make a report. The speakers will also talk about how multidisciplinary investigative teams are created and how important these teams are to the safety of abused and/or neglected children. The event is free and open to the public. There will be a reception preceding the event at 6:30 p.m. Joining Huizar on stage for this important community event are: Kristina Taylor-Porter, Director of the Children's Advocacy Center of Centre County Jennie Noll, Professor of Human Development and Family Studies and Director of the Child Maltreatment Solutions Network Anne Ard, Director of the Centre County Women's Resource Center Teresa Smith, Coordinator of Outreach and Training at the Northeast Regional Children's Advocacy Center
Network Faculty Member Earns Award Lecture
Mar 26, 2015Christine Heim, Professor of Biobehavioral Health and Child Maltreatment Solutions Network faculty member, recently received the Patricia R. Barchas Award Lecture at the 2015 Annual American Psychosomatic Society Meeting. The award recognizes outstanding contributions to the field of Sociophysiology, which is the study of the reciprocal relationships between social behavior and physiology. Dr. Heim’s lecture entitled “Neurobiological Consequences of Early-Life Adversity," explored how social-emotional adversity in early life, such as child abuse and neglect, is a well-established risk factor for developing a range of psychiatric and medical disorders later in life. Specifically, Dr. Heim’s research has found that childhood trauma is associated with sensitization of the neuroendocrine and autonomic stress response, glucocorticoid resistance, decreased oxytocin activity, inflammation, reduced hippocampal volume, and changes in cortical fields that are implicated in the perception or processing of abuse. These biological changes are moderated by genetic factors and mediated by epigenetic changes in genes relevant for stress regulation. Epigenetics changes are chemical reactions that activate and deactivate parts of the genome at strategic times and in specific locations. Dr. Heim studies long-term consequences of childhood trauma by intersecting clinical and developmental psychobiology. She uses a multidisciplinary approach, combining psychology, neuroscience, and developmental science to study the effects of childhood trauma. Her work is aimed at identifying new approaches for the diagnosis, prevention, and treatment of adverse outcomes stemming from early trauma. You can contact Dr. Heim at cmh417@psu.edu.
Study Finds Exposure to Interpersonal Violence May Affect Treatments for Behavior Disorders
Feb 23, 2015Disruptive behavior disorders (DBD) are some of the most prevalent psychiatric conditions among children and adolescents. Examples of DBDs are conduct disorder, attention deficit disorder, and oppositional defiant disorder. There are a number of established interventions for children with DBD and their families. However, despite positive short-term outcomes, scientists are uncertain about the long-term benefits of interventions. According to previous research, approximately half of children with DBD continued to have or regained symptoms three to five years after they received treatment. Chad Shenk, Assistant Professor of Human Development and Family Studies, wanted to learn more about the factors that accounted for variations in a child’s response to treatment. Why did some children display less problematic behaviors, while others continued to act out? Children with DBD often have a history involving one or more interpersonal violence (IPV) experiences. IPV includes exposures to sexual and physical assault, domestic violence, and violence outside of the home. Researchers know that IPV increases the risk for DBD symptoms, neuroendocrine disruption, and callous-unemotional (CU) traits, which include severe emotional conditions like an extreme lack of empathy or an indifference to rules or laws. Children with CU traits typically have the most severe conduct problems. Dr. Shenk was curious if these IPV experiences were affecting treatment results. “For decades researchers have studied the effectiveness of behavioral interventions and clinical trials that treat DBD,” Dr. Shenk said. “We wanted to see if the differences in outcomes depended on whether the child had been exposed to IPV or not.” Dr. Shenk and his colleagues recruited 66 boys between the ages of 6 and 11, all of whom had received treatment for DBD symptoms. Using a 15-item questionnaire, the research team identified which of the participants had a history of IPV. Fifty-four percent of the participating boys had at least one IPV experience. The research team conducted six treatment evaluations over a three-year period to examine the long-term effects of the treatment. In the evaluations, CU traits, DBD symptoms, and cortisol levels were monitored. Individuals who are exposed to a traumatic event typically have high levels of cortisol, measured using saliva samples. The team predicted that for those boys with an IPV history, treatment would not be as successful over the long term. “We found that the boys who had experienced at least one incident of IPV did far worse in their response to initial treatment,” Dr. Shenk said. “For boys who were not exposed to IPV, treatment successfully reduced symptoms to a significantly greater magnitude when compared to those boys with an IPV history.” The research found that in addition to a lack of emotional symptoms from boys with IPV histories, interventions had little effect on cortisol trajectories for these boys as well, indicating no change in stress levels. These results provide a basis to screen for IPV before conducting interventions for DBDs. There are many evidence-based interventions that treat DBD. These programs aim to reduce emotional and behavioral problems among children by incorporating trauma-informed treatment components into DBD interventions “Once clinicians find out that a child has an IPV history, it’s pretty clear—based on this research—that you need to do something more than the traditional treatment for DBD,” Dr. Shenk said. Future steps include adding these trauma-focused components to interventions that treat DBD. The team will work on implementing the IPV screen into diagnostic practice and monitor its success in improving established interventions.