Childhood Maltreatment: Emotional Consequences and Potential Intervention

儿童虐待，包括对儿童和青少年的虐待和忽视，是世界上所有国家都存在的一个重大问题。早期虐待会对个人的健康和福祉造成严重而持久的后果，但也会影响经济增长。关于儿童虐待普遍程度的大多数估计来自于在高收入国家进行的调查，在低收入国家以及在这些国家内，在处境最不利的部门中，虐待和忽视儿童的性质和程度仍然存在悬而未决的问题。证据基础薄弱，因为与儿童虐待有关的文化耻辱，以及围绕虐待作为一种纪律和惩罚形式的可接受性的文化规范。此外，这些国家的经济环境使童工在劳动力中普遍受到剥削成为可能。这不仅会增加其他形式的虐待和忽视的可能性，而且还会使他们的存在不那么透明。我们研究的第一个主要目标是研究北印度和尼泊尔的工作儿童和年轻人中不同形式的虐待和忽视的频率。这项工作将直接有助于我们了解问题的范围，并促进政府和非政府组织就防止暴力侵害儿童提出具体建议，这是世界卫生组织和联合国目前的主要优先事项。在当地传播我们的研究结果也将使态度和观念逐渐改变，改变文化规范和做法。虽然童年虐待对晚年健康和功能的影响有充分的文献记载，但早期生活逆境增加对这些负面结果的脆弱性的途径却不太清楚。先前的研究表明，早期的逆境会影响大脑的发育，尤其是大脑对压力的反应和管理。尽管认知因素是心理治疗的直接目标，但我们对这些对大脑的影响如何影响我们处理情感信息和思考世界的方式知之甚少。我们研究的第二个主要目标是调查童年虐待和忽视如何改变情绪信息的处理。我们预计，由于早期虐待会在发育中的大脑上留下伤疤，这影响了受害者处理威胁信息（对威胁线索表现出警惕）和评估模糊信息（表现出消极或怀有敌意解读情况的倾向）的方式。这些消极的思维模式可能会增加焦虑、抑郁和对压力事件的过激反应的可能性，甚至会加剧这些消极问题。虽然在身体受虐待的儿童和年轻人中有过这种思维模式紊乱的报道，但这些研究主要是在高收入国家进行的。在低收入国家受虐待的年轻人中发现这些认知情绪障碍，为开发一种新的治疗工具奠定了基础，这种工具可以直接针对这些较贫穷国家年轻人的这些消极思维模式。我们研究的第三个主要目标是开发和试验一种新的训练干预工具，以鼓励更多的适应性方式处理情绪信息。具体来说，认知偏差修正是一种用于纠正消极思维模式的技术，因此对压力的消极反应。它已经成功地用于有情绪和焦虑问题的成年人，以及有情绪和攻击性问题的儿童和年轻人。我们将把这个程序应用于受虐待的年轻人，并测试这个程序是否能改变消极的思维模式，从而使功能失调的大脑回路正常化，使它们与未受虐待的年轻人相似。

Childhood maltreatment, which includes the abuse and neglect of children and young people, is a significant problem that occurs in all countries in the world. Early maltreatment has serious, long-lasting consequences on an individual's health and well-being, but can also impact economic growth. Most estimates of the prevalence of childhood maltreatment have come from surveys conducted in high-income countries, with outstanding questions remaining on the nature and extent of child abuse and neglect among lower-income countries and, within these countries, among the most disadvantaged sectors. The evidence base is poor because of cultural stigma associated with childhood maltreatment and cultural norms around the acceptability of abuse as a form of discipline and punishment. Moreover, the economic context of these countries enables the general exploitation of children in the labour force. This could not only increase the likelihood of other forms of abuse and neglect but also make their presence less transparent. The first major goal of our research is to study the frequency of different forms of abuse and neglect among working children and young people in North India and Nepal. This work will directly contribute to our understanding of the scope of the problem and facilitate, among governmental and non-governmental organisations, specific recommendations for preventing violence against children, which are key ongoing priorities for the World Health Organisation and United Nations. Dissemination of our findings locally will also enable gradual change in attitudes and perceptions, shifting cultural norms and practices. Although the effects of childhood maltreatment on later-life health and functioning are well-documented, the pathways by which early-life adversity increases vulnerability on these negative outcomes are less well-understood. Prior research suggests that early adversity affects how the brain develops, particularly how it responds to, and manages stress. We do not know much about how these effects on the brain affect the way we process emotional information and think about the world - even though cognitive factors are directly targeted in psychological therapies. The second major goal of our research is to investigate how childhood abuse and neglect alters the processing of emotional information. We expect that as early maltreatment can leave scars on the developing brain, this affects the way that its victims attend to threatening information (showing vigilance for threat cues) and appraise ambiguous information (showing a tendency to interpret situations negatively or with hostile intent). These negative patterns of thinking may then increase the likelihood of developing anxiety, depression and aggressive responses towards stressful events - and even reinforce these negative problems. Although these disturbed patterns of thinking have been reported in physically abused children and young people, these studies have largely been conducted in high-income countries. Identifying these cognitive-emotional disturbances in maltreated young people from lower-income countries lays the foundation for developing a novel treatment tool to directly target these negative thought patterns in young people from these poorer countries. Developing and piloting a novel training intervention tool to encourage more adaptive ways of processing emotional information is the third major goal of our research. Specifically, cognitive bias modification is a technique used to correct negative thinking patterns, and therefore negative responses towards stress. It has been successfully used in adults with mood and anxiety problems, and in children and young people with emotional and aggressive problems. We will adapt this programme for use in maltreated young people and test whether this programme modifies negative thought patterns and, in doing so, normalises dysfunctional brain circuits, so that they resemble those of non-abused young people.