The Geneva Early Childhood Stress Project: The effects of maternal interpersonal violence-related posttraumatic stress on the parent-toddler relationship and subsequent child social-emotional development

Schechter, D. S., Suardi, F., Manini, A., Cordero, M., Sancho Rossignol, A., Gex-Fabry, . . . Rusconi Serpa, S. (2014). How do maternal PTSD and alexithymia interact to impact maternal behaviour? Child Psychiatry and Human Development 46(3):406-417.

Moser, D.A., Aue, T., Favez, N., Kutlikova, H., Suardi, F., Cordero, M.I., Rusconi, S., Schechter, D.S. (2015). Violence-related PTSD and neural activation when seeing emotional male-female interactions. Social, Cognitive, and Affective Neuroscience 10(5):654-653.

Schechter, D.S., Moser, D.A., Reliford, A., McCaw, J.E., Coates, S.W., Turner, J.B., Rusconi, S., Willheim, E. (2015 epub Feb 20). Negative and distorted attributions towards child, self, and primary attachment figure, among posttraumatically stressed mothers: What changes with Clinical Assisted Videofeedback Exposure Sessions (CAVES)? Child Psychiatry and Human Development, 46(1), 10-20.

Schechter, D.S., Rusconi-Serpa, S. (2014). Understanding how traumatized mothers process their toddlers' affective communication under stress: Towards preventive intervention for families at high risk for intergenerational violence. In Emde R, M & Leuzinger-Bohleber (Eds). Early Parenting Research and Prevention of Disorder: Psychoanalytic Research at Interdisciplinary Frontiers (pp. 90-118). London: Karnac Books.

Brief Summary

The Geneva Early Childhood Stress Project (GECS-Pro) Phase 1 was officially launched in 2010 at the Research Unit of the Child and Adolescent Psychiatry Service, Department of Pediatrics, University of Geneva Hospitals and Faculty of Medicine. The GECS-Pro is funded by the Swiss National Science Foundation as part of the National Center for Competence in Research on the Synaptic Bases of Mental Disorders (NCCR-SYNAPSY) as well as the Gertrude von Meissner, Prim’Enfance and the Oak Foundations. The GECS-Pro is a prospective longitudinal study that in Phase I (2010-2014) has included over 100 mothers of children ages 12-42 months.  The study focus is to understand how maternal interpersonal violence exposure and related posttraumatic stress disorder (PTSD) affects the mother-child relationship particularly with respect to mutual affect regulation and the development of self-regulation of affect, arousal, and aggression in the child.  The project examines psychological, behavioral physiologic, neuroimaging, and epigenetic data of both mother and children individually and in interaction in an effort to identify potential endophenotypic differences that contribute to the intergenerational transmission of violence and related psychopathology.  A second focus of the GECS-Pro is to understand how child displays of negative affect, helplessness, and dysregulation impact the traumatically stressed parent, her mental representations of the child marked by her attributions to the child’s personality, and her caregiving behavior.  Related to this second focus, we have further developed an experimental intervention technique the Clinician Assisted Videofeedback Exposure Session(s) or « CAVES » that had been developed as part of the principal investigators prior IPA-funded research in New York.  This intervention is being further developed into a 12-16-session manualized brief psychotherapy the Clinician Assisted Videofeedback Exposure-Approach Therapy or « CAVEAT ».  While the GECS-Pro Phase 1 will be ending recruitment in December, 2014, Phase 2 will be beginning in the spring, 2015 which will focus on longitudinal follow-up the children from Phase 1 at ages 5-9 years in an effort to identify individual differences with respect to aggressive versus anxious-depressed behaviors and symptoms.  A second planned project within Phase 2 involves a controlled trial of the CAVEAT with a new cohort of 30 mothers and children ages 12-42 months.

Methods / Design

In Phase 1, Each mother-child pair was evaluated and videotaped over the course of a screening session plus 2 evaluation sessions and the CAVES session.

Measures included

Screening visit : Geneva Socio-Demographic and Treatment History Questionnaire, Traumatic Life Events Questionnaire, Brief Physical and Sexual Abuse Questionnaire, Symptom Checklist-90

Maternal interview :  Working Model of the Child Interview with Reflective Functioning Probes (WMCI-RF), Clinician Administered PTSD Scale (CAPS), Structured Interview for the DSM-IV (SCID) Mood Disorders Module, PTSD Symptom Checklist-Short Version, Beck Depression Inventory-II, Hopkins Dissociative Symptom Checklist

Mother-child visit :  Modified Crowell Parent-Child Interaction Procedure with serial salivary cortisol and DNA sampling and coding via the CARE-Index (done) and AMBIANCE (planned), Infant-Toddler Social-Emotional Assessment (ITSEA), Disturbances of Attachment Interview, Parenting Stress Index—Short Form, Ages and Stages Questionnaire

CAVES :  CAVES Semi-structured Interview,  Maternal Attributions Rating Scale (MARS), WMCI-RF selected items, the Personality Disorders Questionnaire-4 (PDQ-.4)

The majority of mothers were eligible for and participated also in an fMRI scanning session that included a Hamilton Anxiety Scale and a Post-MRI Interview about their reaction to fMRI silent film stimuli. 

All mothers were recontacted one year after their participation in the study to complete the Reflective-functioning Questionnaire and the Child Behavior Checklist

Methods/design : In Phase 2, Each child will be evaluated and videotaped over the course of 2 evaluation sessions.  Measures will included : The MacArthur Story-Stem Battery with Mentalization Subscale, the Test for Emotional Comprehension, the Traumatic Events Screening Inventory—Child Version (TESI-C), the Schizophrenia and Affective Disorders Schedule—Child Version (K-SADS), the Child Dissociative Checklist, the Trier Social Stress Test for Children with salivary cortisol and DNA sampling, EEG with affect matching task, the Victim-Bullying Questionnaire

Results of GECS-Pro Phase 1

Most recently, the Geneva Early Childhood Stress Project  (Schechter et al., 2014; Moser et al., 2014 ; Schechter & Rusconi-Serpa, 2014) has  found the following:

1. Maternal IPV-PTSD severity is correlated with maternal alexithymia and that both are positively correlated with parenting stress and negatively correlated with maternal sensitivity (Schechter et al., 2014).

2. Both maternal IPV-severity and parenting stress are negatively correlated with the mean percentage of methylation of the NR3C1 gene for the glucocorticoid receptor (Schechter et al., submitted).

3. Low cortisol baselines in mothers  and low cortisol reactivity to laboratory stressors (i.e. separation and exposure to novelty) in the children (ages 12-42 months) (Preliminary analyses reported: Schechter DS.  Understanding how traumatized mothers process their toddlers' affective communication under stress: Towards preventive intervention for families at high risk for intergenerational violence.  Symposium on Attachment and Psychopathology in Families at Risk (Ute Ziegenhain, Chair; Klaus Schmeck, discussant).  European Congress of Developmental Psychology, Lausanne, 6-9-2013.  Final analyses are pending.

4. IPV-PTSD mothers' toddlers show a significantly lower stress response than those of non-PTSD mothers (ref).  And IPV-PTSD mothers' neural activity in response to a) child-parent separation vs. play and b) adult male-female interactions  that are menacing vs. neutral vs. prosocial both reflect cortico-limbic dysregulation with less ventro-medial prefrontal cortical activity among PTSD mothers than non-PTSD mothers (Moser et al., submitted; Moser et al., 2014). 

5. Children of  IPV-PTSD mothers vs. non-PTSD mothers from 12-42 months and then from 24-54 months, show a) greater attachment disturbances, and b) less cooperativeness during play with mother on observational measures, and c) greater internalizing and externalizing behavior on maternal report measures.  (Preliminary analyses reported: Schechter DS.  Understanding how traumatized mothers process their toddlers' affective communication under stress: Towards preventive intervention for families at high risk for intergenerational violence.  Symposium on Attachment and Psychopathology in Families at Risk (Ute Ziegenhain, Chair; Klaus Schmeck, discussant).  European Congress of Developmental Psychology, Lausanne, 6-9-2013.  Final analyses are pending.

6.  Maternal PTSD severity is correlated significantly with negativity of maternal attributions towards her child, her primary attachment figure from childhood, and herself with only a significant decrease in negativity of attributions towards her child over the course of the 3-session evaluation that includes a CAVES (single-session) (see Schechter et al., 2014)

Discussion

We are using an approach towards evaluating  violence and maltreatment-exposed mothers and their children from early childhood on that involves an integration of psychoanalytically-informed, psychiatric, and developmental neuroscientific measures in order to characterize risk and resilience with respect to theintergenerational transmission of violence and related psychopathology and determinants of individual differences.  We are also developing and evaluating parent-child videofeedback-based interventions that are targeted to supporting maternal affect regulation and reflective functioning upon clinician-assisted exposure to child negative affect, helpless states, and distress that in the context of maternal PTSD might well otherwise have been avoided. Outcomes include change of the quality of maternal attributions.

Contact

Daniel S. Schechter (PI), Sandra Rusconi Serpa (Co-PI), Francesca Suardi, Aurelia Manini, Ana Sancho Rossignol, Axelle Kreis, Gaëlle Merminod,  Dominik A. Moser, Tatjana Aue, Virginie Pointet, Isabel Maria Cordero, Ariane Giacobino, Ludwig Stenz, Wafae Adouan, Alexandre G. Dayer, Christoph Michel, Michel Rossier, François Ansermet (Department Chair)

Email: daniel.schechter@hcuge.ch

Email: sandra.rusconi-serpa@hcuge.ch