International Society for Traumatic Stress Studies

Maltreatment and Trauma in Adolescence: A Time of Heightened Risk and Potential Resilience

Posted 20 January 2014 in StressPoints by Patricia K. Kerig, PhD

Although the term “child maltreatment” may conjure for many the image of a hurt small child, there is increasing recognition among researchers, clinicians, and policy makers that adolescence is a time of heightened risk for abuse (Becker-Blease & Kerig, in press; Kerig & Becker, in press). National incidence studies in the US show that adolescents experience the highest rates of certain forms of maltreatment, including sexual abuse and—surprisingly—neglect (Finkelhor, Turner, Ormrod, & Hamby, 2009; Sedlak, 2010; Trickett, Negriff, Ji, & Peckins, 2011). Adolescents also are particularly vulnerable to certain hidden forms of maltreatment, including exploitation (Barnett, Manly, & Cicchetti, 1993; World Health Organization, 2006), such as occurs in the contexts of child labor, child soldiering, indentured servitude, or sex trafficking. Further exacerbating the problem, maltreated youth may be alleged to be—and may in fact become—criminals themselves. For example, youth who are engaged in sex trafficking frequently are perceived by the social welfare and juvenile justice systems as being perpetrators of crime rather than, more accurately, as victims of commercial sexual exploitation and abuse (Mitchell, Finkelhor, & Wolak, 2010). On the other hand, youth’s attempts to cope with or escape parental abuse may put them on the wrong side of the law. Running away from home is prevalent among maltreated youth (Haynie, Petts, Maimon, & Piquero, 2009; Kim, Tajima, Herrenkohl, & Huang, 2009; Tyler, Johnson, & Brownridge, 2008) and living on the streets increases the likelihood that youth will end up committing “survival crimes”, such as theft, prostitution, or drug dealing (Kerig & Becker, 2012).

In addition, there is compelling research to suggest that maltreatment that begins or extends into the adolescent years has the most negative impact on youth adjustment (Ireland, Smith, & Thornberry, 2002; Stewart, Livingston, & Dennison, 2008). In this regard, a particularly strong association has been established between maltreatment and juvenile delinquency (Ford, Chapman, Mack, & Pearson, 2006; Kerig, 2013; Kerig & Becker, 2010; Kerig & Becker, 2012). For example, youth who have reached adolescence when they first come to the attention of child welfare authorities are at higher risk of entering into delinquency at a young age (Ireland et al., 2002) and for continuing on an antisocial pathway (Ryan et al., 2013) than those who enter the child welfare system earlier in life. Other methodologically rigorous prospective longitudinal studies include that of Stouthamer-Loeber and colleagues (2002) which followed 503 boys with substantiated maltreatment over the course of 7 years and found that almost 50% were involved in serious persistent delinquency by age 13, in contrast to 19% of the matched controls. Similarly, data from the Add Health Study following over 11,000 school-age children over the course of 6 years indicated that each unit increase in family or caregiver physical abuse raised the probability of contact with the criminal justice system by 15% (Haynie et al., 2009). Further, using data from a New Zealand birth cohort of close to 1,000 children followed from birth to age 25, Fergusson and colleagues (2013) found that exposure to self-reported sexual and physical abuse in childhood was associated with a wide variety of negative outcomes, including conduct disorder and antisocial personality traits. Parallel findings emerger from Widom (2003) and her colleagues’ prospective studies, which found that those abused or neglected as children had 55% higher rates of arrest for non-violent crimes and 96% higher rates of arrest for violent crimes than did those in the control group. A subsequent replication and extension of this work found that that those who were abused or neglected in childhood were 4.8 times more likely than nonabused youth to be arrested as juveniles, 2 times more likely to be arrested in adulthood, and 11 times more likely to commit a violent crime (English, Widom, & Brandford, 2002). In addition, studies focused on all-female samples have shown that childhood physical and sexual abuse are associated with an increased severity of delinquency (Cernkovich, Lanctôt, & Giordano, 2008) and that sexual abuse predicts girls’ heightened risk for later delinquency into adolescence and adulthood (Trickett, Noll, & Putnam, 2011).

Why are adolescents especially vulnerable to the effects of maltreatment?

A number of hypotheses have been proposed to help explain adolescents’ increased vulnerability to the negative effects of maltreatment. For example, Smith and colleagues (2004) propose that children may be more ‘‘developmentally resilient’’ than adolescents. Younger children may be detected earlier in the abuse cycle and referred sooner to treatment, in which case the short-term negative effects of abuse and neglect may resolve more readily; alternatively, child abuse prevention and intervention may be both more available and more effective with younger children than with adolescents. In turn, Stewart and colleagues (2008) suggest that adolescence represents a time of particular vulnerability given the additional stresses and developmental challenges associated with that phase of life. Normative changes, including dramatic hormonal fluctuations, the advent of sexuality, experimentation with risky behaviors, and the stresses of negotiating increasingly complex social and vocational expectations, all conspire to make adolescence a challenging developmental stage. Youth who endure the additional burden of maltreatment while attempting to navigate the difficult transitions of this time of life may experience disruptions in their access to important sources of resilience, such as academic success and peer relationships, which in turn increase their risk of antisocial behavior and delinquency.

In contrast, Ryan and colleagues (2013) propose that maltreatment in adolescence is a different entity from childhood maltreatment, one that has distinct implications for development. For example, in the case of neglect, the kinds of parental disregard that would draw the attention of child welfare authorities are likely to be more severe in the case of an adolescent than would be the typical kinds of inadequate supervision that constitute neglect of a young child. In other words, whereas neglect of a young child might involve an act of omission —a parent failing to provide adequate food or care, for example—neglect of an adolescent—such as a parent locking the child out of the home after a heated argument—might be better construed as an act of commission. Furthermore, Ryan and colleagues point out, “at the agency level, social service systems would respond to these scenarios differently, as young children are often viewed as troubled and older children are more often viewed as troublesome” (p. 462).

Suggestive evidence in support of this idea is offered by Ryan and colleagues (2007), who found in a large archival database that youth who entered the juvenile justice system from child welfare were significantly more likely than other youth to be sentenced to correctional institutions rather than probation, even after controlling for the severity of their offenses. Of additional concern was the overrepresentation of African-American youth within this group. And there are many such “crossover” (Herz, Ryan, & Bilchik, 2010) youth involved in both the child welfare and juvenile justice systems. Unfortunately, prospective studies of large-scale data bases show that placement in foster care significantly exacerbates the risk of juvenile incarceration, at a level of fivefold amongst boys and an astonishing tenfold amongst girls (Jonson-Reid & Barth, 2000). Unstable foster placements further increase the risk for delinquency, particularly for boys (Ryan & Testa, 2005).

The developmental psychopathology perspective

What are the underlying developmental processes that account for this maltreatment—delinquency link? From the developmental psychopathology perspective, abuse and neglect are viewed as violations of the average expectable environment (Cicchetti & Valentino, 2006) that is needed to support a child’s healthy biological, emotional, social, and cognitive development. In particular, the “safe base” provided by a secure attachment relationship is seen as fundamental to the child’s ability to acquire a number of fundamental developmental capacities that protect against the development of problem behavior. These include, among others, capacities for basic trust, ego resilience, self-control, emotion regulation, empathy, perspective-taking, social understanding, interpersonal problem-solving, mastery motivation, executive functions, and moral judgment, all of which are compromised by abuse and neglect (Cicchetti & Toth, 2005; Kerig, Ludlow, & Wenar, 2012). Such developmental injuries have increasingly negative “cascading” effects across the lifespan as they interfere with youths’ ability to successfully navigate the stage-salient issues associated with each successive life transition. For example, youth whose affect regulation skills have been disrupted by physical abuse or whose social skills have been blunted by neglect may be perceived negatively and rejected by peers (Kim & Cicchetti, 2010). Peer rejection may, in turn, provoke youth to withdraw from prosocial environments such as school (Ladd, Herald-Brown, & Reiser, 2008) and thus lose opportunities to acquire important academic, interpersonal, and vocational skills that could provide sources resilience (Fergusson, Swain-Campbell, & Horwood, 2002).

Developmental traumatology

Although in many respects encompassed within the larger umbrella of developmental psychopathology, trauma-specific theories have been posited regarding how posttraumatic reactions following experiences such as maltreatment might lead to antisocial behavior (Ford, 2002; Ford & Blaustein, 2013; Ford et al., 2006; Kerig & Becker, 2010). Posttraumatic reactions—including hypervigilience to threat, traumatic intrusions, dysphoric arousal, and numbing of emotions—have been implicated in the dysregulation of affect and behavior that contribute to antisocial behavior (Bennett, Kerig, Chaplo, McGee, & Baucom, in press; Kerig, Vanderzee, Becker, & Ward, 2013; Stimmel, Cruise, Ford, & Weiss, 2013). Of particular interest are symptoms that have been only recently highlighted in the new DSM-5 diagnosis of posttraumatic stress disorder, including the ways some traumatized young people throw themselves heedlessly into risky, dangerous, or self-destructive activities (Pat-Horenczyk et al., 2007; Pynoos et al., 2009). Whether such behaviors emerge as a function of a posttraumatic defiance against acknowledging vulnerability (Ford et al., 2006) or an inhibited capacity to recognize risk amongst those who have been victimized (Orcutt, Erickson, & Wolfe, 2002) will be an important question for future research.

Biological processes as mediators of the association between maltreatment and delinquency

A growing body of research suggests that maltreatment-related trauma may disrupt biological systems that are involved in responding to stress, regulating behavior, and managing emotions in ways that increase the risk of antisocial behavior (Cicchetti, Rogosch, & Thibodeau, 2012; Ford, 2002, 2009; Mead, Beauchaine, & Shannon, 2010). For example, data from the Dunedin, New Zealand longitudinal sample (Caspi et al., 2002) showed that a polymorphism in the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA) moderated the effects of maltreatment on boys’ problem behavior. Maltreated boys with a genotype conferring low levels of MAOA expression were almost 3 times more likely to develop conduct disorder in childhood and almost 10 times more likely to be convicted of a violent crime in adulthood, in comparison to their peers; in contrast, there was no association between maltreatment and offending among boys with the high MAOA activity genotype. Following up these results, Cicchetti and colleagues (2012) investigated gene × environment interactions among maltreated children by collecting assays of three genes: TPHI1, which is involved in the synthesis of serotonin; 5-HTTLPR, which regulates the availability of serotonin in the brain; and MAOA. Their results showed that these genetic polymorphisms were related to an increased risk of antisocial behavior only among children who had experienced sexual and/or physical abuse, but not those who had undergone emotional maltreatment or neglect.

However, other research has indicated that, above and beyond any genetic influences, maltreatment alone predicts an increased risk for delinquency. Jaffe and colleagues (2004) demonstrated this in a study of over 1,000 twin pairs followed from ages 5 to 7, in which they found that physical abuse predicted an increased risk of antisocial behavior in a clear dose-response association. Although there was evidence for a passive gene-environment correlation, in that antisocial parents were those most likely to maltreat their children, and the children of antisocial parents had the highest rates of problem behavior, the effects of maltreatment remained consistent when these factors were controlled.

What about girls?

Cross-sectional studies show that the prevalence of child maltreatment is particularly high amongst juvenile justice-involved girls (e.g., (Cauffman, Feldman, Waterman, & Steiner, 1998; Kerig & Becker, 2012; Kerig et al., 2013; Kerig, Ward, Vanderzee, & Moeddel, 2009). Moreover, some research suggests that maltreatment is more strongly predictive of delinquency amongst girls than boys (Widom & White, 1997). One consideration worth noting is that girls are vastly overrepresented amongst those youth in the juvenile justice system who have experienced one specific form of maltreatment, and that is sexual abuse (e.g., (Abram et al., 2004; Ford, Hartman, Hawke, & Chapman, 2008; Kerig, Arnzen Moeddel, & Becker, 2011; Kerig et al., 2013; Wood, Foy, Layne, Pynoos, & James, 2002); see (Kerig & Becker, 2012) for a review). Longitudinal research suggests that sexual abuse is a form of maltreatment with specific and pernicious effects on youth development (Fergusson et al., 2013; Trickett, Negriff, et al., 2011; Walsh, Galea, & Koenen, 2012), including conduct problems (Cohen, Smailes, & Brown, 2004; Grasso et al., 2013), particularly for girls (Feiring, Miller-Johnson, & Cleland, 2007; Herrera & McCloskey, 2003; Trickett, Noll, et al., 2011). For example, results of telephone surveys conducted as part of the National Survey of Adolescents (Begle et al., 2011), found that, for boys, any form of victimization early in life increased the likelihood of delinquency; in contrast, for girls, sexual abuse alone was associated with a 6 times greater likelihood of engaging in delinquent and risky behaviors.

However, a complicating factor in drawing definitive conclusions about gender differences from studies of the association between child maltreatment and delinquency is that girls display delinquent behaviors at lower rates than boys and are thus underrepresented, and sometimes completely absent, from studies of juvenile justice-involved youth. Although rising arrest rates for girls have increased research attention to the factors underlying delinquency (Zahn et al., 2008), some of this research has included only girls in the samples, and thus the question of whether there are gender-specific risks or protective factors for girls’ and boys’ antisocial behavior is still under study (Kerig & Schindler, 2013). The question also has arisen as to whether we are capturing antisocial girls in our net. For example, antisocial behavior in girls may take a more covert form, such as relational aggression, which does not lead to legal sanctions (Maccoby, 2004). Attention to other outcomes than overtly aggressive behavior may be more relevant to the study of girls’ antisociality, including perpetration of harm against intimate partners (Ehrensaft et al., 2003; Feiring, Simon, Cleland, & Barrett, 2013) or other forms of impulse under-control, such as those implicated in self-harming behavior and borderline personality traits (Beauchaine, Klein, Crowell, Derbidge, & Gatzke-Kopp, 2009; Burnette & Reppucci, 2009).

On the other side of the coin is the argument that the misbehaviors for which girls often are labeled delinquent represent not so much a drive toward antisociality but toward survival in abusive contexts (Kerig & Becker, in press). Girls are disproportionately represented amongst those whose violations of the law are characterized as “survival crimes” – running away from home; living on the streets; participating in substance use and drug dealing; engaging in prostitution or petty theft– problem behaviors which are, not coincidentally, predicted by an abusive or neglectful home life (Chesney-Lind & Belknap, 2004; Kaufman & Widom, 1999; Kerig & Becker, 2012; Kerig & Schindler, 2013). As Lanctôt and Le Blanc (2002) point out, girls and women tend toward misbehaviors that put their own safety at risk rather than the safety of others. Although risky behaviors, disregard of one’s own safety, and self-harming have long been recognized as symptoms consequent to trauma (Pat-Horenczyk et al., 2007), particularly among victims of sexual abuse (Orcutt et al., 2002; Weierich & Nock, 2008), as noted previously, only recently has this dimension been included in the diagnostic criteria for PTSD.

Nonetheless, among youth identified as delinquent and adults involved with the criminal justice system, evidence suggests that certain risk factors are more prevalent for females than males, and one of these is childhood victimization (Kerig & Schindler, 2013). As Lancôt and Le Blanc (2002) argue, “The existence of a relationship between child abuse and juvenile delinquency is not a new idea. Despite this link … it is … disturbing, however, how little attention the child-abuse-victim-to-offender link has received and how it has often focused on boys. Consideration of the risk of abuse appears to be essential in order to improve our understanding of females' involvement in deviance. This link between victimization and deviance has been nearly invisible in mainstream and gender-differences criminological theories” (p. 175).

Source of resilience

Of compelling importance to informing interventions is the search for intervening mechanisms that might both explain the link between childhood maltreatment and later delinquency as well as point to sources of resilience. In one of the few studies examining protective factors, the quality of relationships with parents and peers was implicated in Salzinger and colleagues’ (2007) six-year follow-up of a sample of physically abused children who were compared to matched controls. Whereas positive attachments to parents mediated the association between childhood maltreatment and adolescent violence, friendship quality acted as a moderator for abused—but not non-abused—youth.

The study of processes conferring resilience is a promising line of inquiry that warrants further research attention. Just as the stage-salient issues associated with adolescence may confer risk, they also may represent potential sources of resilience (Becker-Blease & Kerig, in press). For example, youth experience important advances in the development of brain structures associated with executive functions, self-control, and complex reasoning, which increase their capacities to regulate their own behavior. Adolescents increasingly are, quite literally, in their own “driver’s seats,” as they gain the mobility and means to make choices regarding their own physical and emotional environments. In turn, expanding and deepening social networks offer adolescents additional options for seeking extrafamilial sources of instrumental and moral support (e.g., teachers, coaches, mentors, spiritual leaders, friends’ parents) when these are not to be found in the home (Kerig & Becker, in press).

About the Author
Patricia K. Kerig, PhD, received her doctorate in clinical psychology from U. C. Berkeley and currently is a professor and the Director of Clinical Training in the Department of Psychology at the University of Utah. In addition to her program of research investigating the mechanisms accounting for the link between trauma and delinquency, she is on the faculty of the Center for Trauma Recovery and Juvenile Justice, a National Child Traumatic Stress Network center funded through a SAMHSA grant, PI Julian Ford, PhD, whose mission is to disseminate trauma-informed assessment and intervention strategies to the juvenile justice system and the youth and families it serves.

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