Date Published: August 2, 2017
Publisher: Public Library of Science
Author(s): Daniel S. Schechter, Dominik A. Moser, Tatjana Aue, Marianne Gex-Fabry, Virginie C. Pointet, Maria I. Cordero, Francesca Suardi, Aurelia Manini, Marylène Vital, Ana Sancho Rossignol, Molly Rothenberg, Alexandre G. Dayer, Francois Ansermet, Sandra Rusconi Serpa, Soraya Seedat.
The aim of this study was to examine the relationship of maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD), associated neural activity in response to mother-child relational stimuli, and child psychopathology indicators at child ages 12–42 months and one year later. The study tested the hypothesis that decreased maternal neural activity in regions that subserve emotion regulation would be associated with child symptoms associated with emotional dysregulation at both time points. Functional magnetic resonance imaging of 42 mothers with or without violence-exposure and associated IPV-PTSD were assessed. Their child’s life-events and symptoms/behaviors indicative of high-risk subsequent PTSD diagnosis on a maternal-report questionnaire were measured one year later. Maternal IPV-PTSD severity was significantly associated with decreased ventromedial prefrontal cortex (vmPFC) activation in response to mother-child relational stimuli. Maternal IPV-PTSD severity and decreased vmPFC activation were then significantly associated with a child attachment disturbance at 12–42 months and symptoms/behaviors one year later, that were correlated with emotional dysregulation and risk for child PTSD. Maternal IPV-PTSD and child exposure to IPV were both predictive of child PTSD symptoms with maternal IPV-PTSD likely mediating the effects of child IPV exposure on child PTSD symptoms. These findings suggest that maternal IPV-PTSD severity and associated decreased vmPFC activity in response to mother-child relational stimuli are predictors of child psychopathology by age 12–42 months and one-year later. Significant findings in this paper may well be useful in understanding how maternal top-down cortico-limbic dysregulation promotes intergenerational transmission of IPV and related psychopathology and, thus should be targeted in treatment.
The relational model of posttraumatic stress disorder (PTSD)  supports the notion that the parent-child relationship can either buffer the child from risk or increase the risk of subsequent developmental psychopathology in the face of the child-parent exposure to violent trauma. Recently, Scheeringa and Zeanah  gave evidence for their model’s validity with empirical findings that maternal PTSD and co-morbid psychopathology mediate the effects of traumatic exposures on the development of PTSD in young children. Particularly salient as a predictor of child PTSD symptom development and severity was maternal self-report of avoidance as a coping strategy . The authors of the present paper have similarly cited examples when traumatized mothers reported that when their infant or toddler was distressed, they would put on headphones and listen to music, go out into the hall to smoke, retreat into the bathroom, or put their child in his room and close the door when the child cried rather than approaching him, thereby demonstrating impairment in age-appropriate limit-setting [3, 4].
A screening session was followed by two visits, T1a and T1b, separated by 1 to 2 weeks. This was followed by the MRI scan (T1c) approximately 1 to 3 weeks later. During the screening session, following informed written consent, mothers were given a socio-demographic and life-events interview. During T1a, mothers were interviewed without their child, with a focus on the mother’s mental representations of her child, mother-child relationship, her traumatic life-events, and her psychopathology. During T1b, mothers brought their child for a parent-child laboratory procedure, followed by additional measures about the child. One year later (T2), mothers received a letter inviting them to complete attached questionnaires to inquire into their children’s subsequent life-events, symptoms and behaviors. After each visit, mothers received 50 Swiss francs (approximately $50) along with a book or toy for their child. Interview guides for visits T1a and T1b can be found in the supplementary information.
As expected, IPV-PTSD mothers and children differed from non-PTSD controls across a number of key variables (Table 1). Fig 1 shows the distribution of children’s exposure to violence by maternal report.
Upon testing our first hypothesis, we found a) that maternal IPV-PTSD severity was significantly associated with the disturbance of attachment characterized as a “secure base distortion” (SBD) at T1 and b) that maternal IPV-PTSD severity was significantly associated with the severity of child symptoms and behaviors on the CBCL-PTSD subscale indicative of significant risk for PTSD at T2. This finding is particularly important because we know that the majority of children of IPV-PTSD affected mothers’ experienced family violence, making the risk for PTSD among the children by T2 much higher. That being said, the limited verbal capacity of most children at ages 24–36 months is such that we prefer to say that these children are at significant risk for PTSD since not all are able to confirm that their symptoms are linked to their specific violent life-events. The degree of maternally reported CETV also predicted these at-risk child symptoms/behaviors. In support of the relational PTSD model [1, 3], we found that maternal IPV-PTSD may mediate the effects of CETV on subsequent child symptoms/behaviors on the CBCL-PTSD Subscale. The present study also echoes previous findings from studies of high-risk samples in which maternal IPV-PTSD predicted child dysregulated aggression, avoidance and hypervigilance on story-stem completion, as well as internalizing and externalizing symptoms although none of those previous studies examined the relationship between maternal neural activity as correlated with maternal IPV-PTSD and child symptoms [8, 9, 38].
We have demonstrated that maternal IPV-PTSD is a possible predictor of child psychopathology and of child symptoms and behaviors associated with risk for PTSD even after controlling for child direct exposure to family violence, which among children of mothers with IPV-PTSD was noted to occur in over 85% of cases [1, 2]. Moreover, we have found a potentially specific maternal indicator (i.e. decreased mPFC activity in the separation-play fMRI paradigm) for mother-toddler relational disturbance and subsequent child psychopathology that may be useful for examining treatment effects on affected mother-child dyads. The paper lends all the more weight to the importance of addressing family violence and actively treating parental PTSD as early as possible in order to interrupt intergenerational cycles of IPV and related psychopathology.