Childhood Maltreatment: Emotional Consequences and Potential Intervention

儿童期虐待，包括对儿童和青少年的虐待和忽视，是世界各国都存在的重大问题。早期虐待会对个人的健康和福祉造成严重、持久的后果，但也会影响经济增长。对儿童期虐待盛行率的大多数估计来自于在高收入国家进行的调查，关于低收入国家以及这些国家内最弱势群体中虐待和忽视儿童的性质和程度的悬而未决的问题仍然存在。证据基础很差，因为与儿童期虐待有关的文化污名，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，这些国家的经济状况使得在劳动力中普遍剥削儿童成为可能。这不仅可能增加其他形式的滥用和忽视的可能性，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童工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预防暴力侵害儿童行为提出具体建议，这些建议是世界卫生组织和联合国目前的主要优先事项。在当地传播我们的调查结果还将使态度和观念逐步改变，改变文化规范和做法。尽管童年虐待对晚年健康和功能的影响已经有了很好的记录，但早期生活中的逆境增加了对这些负面后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，特别是大脑对压力的反应和管理。我们不太清楚这些对大脑的影响如何影响我们处理情绪信息和思考世界的方式--尽管认知因素是心理治疗的直接目标。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，这会影响受害者处理威胁信息(对威胁线索保持警惕)和评估模糊信息(显示出倾向于负面或怀有敌意地解释情况)的方式。这些消极的思维模式可能会增加焦虑、抑郁和对压力事件做出攻击性反应的可能性，甚至会强化这些消极的问题。尽管据报道，这些精神错乱的思维模式在遭受身体虐待的儿童和年轻人中也有报道，但这些研究主要是在高收入国家进行的。在低收入国家遭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，直接针对来自这些较贫穷国家的年轻人的这些消极思维模式奠定了基础。开发和试验一种新的训练干预工具，以鼓励更适应的方式处理情绪信息是我们研究的第三个主要目标。具体地说，认知偏差修正是一种用于纠正负面思维模式的技术，从而纠正对压力的负面反应。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。我们将把这一计划用于受虐待的年轻人，并测试该计划是否改变了负面思维模式，并在这样做的过程中，使功能失调的大脑回路正常化，使其与未受虐待的年轻人的大脑回路相似。

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.