Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study

Abstract Exposure to childhood adversity is a powerful risk factor for psychopathology. Despite extensive efforts, we have not yet identified effective or scalable interventions that prevent the emergence of mental health problems in children who have experienced adversity. In this modified Delphi study, we identified intervention strategies for effectively targeting both the neurodevelopmental mechanisms linking childhood adversity and psychopathology – including heightened emotional reactivity, difficulties with emotion regulation, blunted reward processing, and social information processing biases, as well as a range of psychopathology symptoms. We iteratively synthesized information from experts in the field and relevant meta-analyses through three surveys, first with experts in intervention development, prevention, and childhood adversity (n = 32), and then within our study team (n = 8). The results produced increasing stability and good consensus on intervention strategy recommendations for specific neurodevelopmental mechanisms and symptom presentations and on strength of evidence ratings of intervention strategies targeting youth and parents. More broadly, our findings highlight how intervention decision making can be informed by meta-analyses, enhanced by aggregate group feedback, saturated before consensus, and persistently subjective or even contradictory. Ultimately, the results converged on several promising intervention strategies for prevention programming with adversity-exposed youth, which will be tested in an upcoming clinical trial.

[1]  D. Barch,et al.  Neural Indicators of Anhedonia: Predictors and Mechanisms of Treatment Change in a Randomized Clinical Trial in Early Childhood Depression , 2020, Biological Psychiatry.

[2]  B. Chorpita,et al.  The value of a modular, multi-focal, therapeutic approach to addressing child maltreatment: Hope for Children and Families Intervention Resources - a discussion article. , 2020, Child abuse & neglect.

[3]  J. Weisz,et al.  A Second and Third Look at FIRST: Testing Adaptations of A Principle-Guided Youth Psychotherapy , 2020, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[4]  S. U. Hamdani,et al.  Implementation and effectiveness of adolescent life skills programs in low- and middle-income countries: A critical review and meta-analysis. , 2020, Behaviour research and therapy.

[5]  B. Hankin.  Screening for and Personalizing Prevention of Adolescent Depression , 2020, Current directions in psychological science.

[6]  T. Campbell.  Screening for Adverse Childhood Experiences (ACEs) in Primary Care: A Cautionary Note. , 2020, JAMA.

[7]  David G. Weissman,et al.  Mechanisms linking childhood trauma exposure and psychopathology: a transdiagnostic model of risk and resilience , 2020, BMC Medicine.

[8]  Chai-Hyung Kim.  Foreword , 2020, Semigroup Forum.

[9]  James Thomas,et al.  School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis , 2019, The lancet. Psychiatry.

[10]  M. Bakermans-Kranenburg,et al.  Annual Research Review: Umbrella synthesis of meta‐analyses on child maltreatment antecedents and interventions: differential susceptibility perspective on risk and resilience , 2019, Journal of child psychology and psychiatry, and allied disciplines.

[11]  S. Whiteside,et al.  A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management , 2019, Clinical Child and Family Psychology Review.

[12]  M. Bellis,et al.  Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis , 2019, The Lancet. Public health.

[13]  G. Bakker.  A new conception and subsequent taxonomy of clinical psychological problems , 2019, BMC psychology.

[14]  N. Tottenham,et al.  Mechanisms linking childhood adversity with psychopathology: Learning as an intervention target. , 2019, Behaviour research and therapy.

[15]  D. Barch,et al.  RETRACTED: Neural Indicators of Anhedonia: Predictors and Mechanisms of Treatment Change in a Randomized Clinical Trial in Early Childhood Depression , 2019, Biological Psychiatry.

[16]  S. Lilienfeld.  Reflections on clinical judgment and the dimensional-categorical distinction in the study of personality disorders: Comment on Bornstein (2019). , 2019, Personality disorders.

[17]  Brad J. Nakamura,et al.  A History of Child and Adolescent Treatment Through a Distillation Lens: Looking Back to Move Forward , 2019, The Journal of Behavioral Health Services & Research.

[18]  B. Chorpita,et al.  Treatment Features Associated with Youth Cognitive Behavioral Therapy Follow-Up Effects for Internalizing Disorders: A Meta-Analysis , 2019, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[19]  G. Overbeek,et al.  Meta-Analyses: Key Parenting Program Components for Disruptive Child Behavior. , 2019, Journal of the American Academy of Child and Adolescent Psychiatry.

[20]  R. Shapiro,et al.  Integration of the Safe Environment for Every Kid (SEEK) Model Across Primary Care Settings , 2018, Clinical pediatrics.

[21]  D. Barch,et al.  A Randomized Controlled Trial of Parent-Child Psychotherapy Targeting Emotion Development for Early Childhood Depression. , 2018, The American journal of psychiatry.

[22]  C. Witteman.  Concluding Commentary: Clinical Decision Making , 2018 .

[23]  C. E. van der Put,et al.  UvA-DARE ( Digital Academic Repository ) Identifying effective components of child maltreatment interventions : A meta-analysis , 2017 .

[24]  Jonathan S. Comer,et al.  The Effectiveness of School-Based Mental Health Services for Elementary-Aged Children: A Meta-Analysis. , 2017, Journal of the American Academy of Child and Adolescent Psychiatry.

[25]  M. Pardee,et al.  Current state of screening high‐ACE youth and emerging adults in primary care , 2017, Journal of the American Association of Nurse Practitioners.

[26]  D. Marschall,et al.  Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System , 2017, Journal of Clinical Psychology in Medical Settings.

[27]  York Hagmayer,et al.  Clinicians’ Personal Theories of Developmental Disorders Explain Their Judgments of Effectiveness of Interventions , 2017, Clinical psychological science : a journal of the Association for Psychological Science.

[28]  Ernestine C. Briggs,et al.  Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events , 2017, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[29]  K. McLaughlin,et al.  Child Trauma Exposure and Psychopathology: Mechanisms of Risk and Resilience. , 2017, Current opinion in psychology.

[30]  J. Weisz,et al.  Little Treatments, Promising Effects? Meta-Analysis of Single-Session Interventions for Youth Psychiatric Problems. , 2017, Journal of the American Academy of Child and Adolescent Psychiatry.

[31]  J. Weisz,et al.  What Five Decades of Research Tells Us About the Effects of Youth Psychological Therapy: A Multilevel Meta-Analysis and Implications for Science and Practice , 2017, The American psychologist.

[32]  J. Weisz,et al.  Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents , 2017, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[33]  M. Cary,et al.  The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. , 2016, Health technology assessment.

[34]  G. Miller,et al.  Association of Reports of Childhood Abuse and All-Cause Mortality Rates in Women. , 2016, JAMA psychiatry.

[35]  A. Karch,et al.  Measuring inter-rater reliability for nominal data – which coefficients and confidence intervals are appropriate? , 2016, BMC Medical Research Methodology.

[36]  Terry K Koo,et al.  A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. , 2016, Journal Chiropractic Medicine.

[37]  Katie A. McLaughlin,et al.  Future Directions in Childhood Adversity and Youth Psychopathology , 2016, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[38]  L. Zeltzer,et al.  Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis. , 2015, JAMA pediatrics.

[39]  Anthony F Jorm,et al.  Identifying prevention strategies for adolescents to reduce their risk of depression: A Delphi consensus study. , 2015, Journal of affective disorders.

[40]  Anthony F Jorm.  Using the Delphi expert consensus method in mental health research , 2015, The Australian and New Zealand journal of psychiatry.

[41]  N. Robinson,et al.  Delphi methodology in health research: how to do it?☆ , 2015 .

[42]  H. Dubowitz.  The Safe Environment for Every Kid model: promotion of children's health, development, and safety, and prevention of child neglect. , 2014, Pediatric annals.

[43]  Donna B. Pincus,et al.  Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population , 2014, Clinical child and family psychology review.

[44]  Oliver Lindhiem,et al.  Client preferences affect treatment satisfaction, completion, and clinical outcome: a meta-analysis. , 2014, Clinical psychology review.

[45]  S. Lilienfeld,et al.  Errors/Biases in Clinical Decision Making , 2014 .

[46]  E. Perrin,et al.  The Integration of Behavioral Health Interventions in Children's Health Care: Services, Science, and Suggestions , 2014, Journal of Clinical Child & Adolescent Psychology.

[47]  L. A. Valle,et al.  Components Associated with Home Visiting Program Outcomes: a Meta-analysis , 2022 .

[48]  M. Tisminetzky,et al.  A Collaborative Care Model to Improve Access to Pediatric Mental Health Services , 2013, Administration and Policy in Mental Health and Mental Health Services Research.

[49]  Timothy F Chen,et al.  Interrater agreement and interrater reliability: key concepts, approaches, and applications. , 2013, Research in social & administrative pharmacy : RSAP.

[50]  R. Kessler,et al.  Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. , 2012, Archives of general psychiatry.

[51]  M. Zimmer‐Gembeck,et al.  Parent–Child Interaction Therapy , 2012, Child maltreatment.

[52]  L. Magder,et al.  The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population? , 2012, Academic pediatrics.

[53]  Bruce S. McEwen,et al.  Adverse childhood experiences, allostasis, allostatic load, and age-related disease , 2012, Physiology & Behavior.

[54]  J. Luby,et al.  A novel early intervention for preschool depression: findings from a pilot randomized controlled trial. , 2012, Journal of child psychology and psychiatry, and allied disciplines.

[55]  Katherine M Keyes,et al.  Childhood maltreatment and the structure of common psychiatric disorders , 2012, British Journal of Psychiatry.

[56]  J. Shonkoff,et al.  Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health , 2012, Pediatrics.

[57]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[58]  C. Stover,et al.  The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD. , 2011, Journal of child psychology and psychiatry, and allied disciplines.

[59]  K. Dodge,et al.  Development and validation of the social information processing application: a Web-based measure of social information processing patterns in elementary school-age boys. , 2011, Psychological assessment.

[60]  J. Luby,et al.  Parent–child interaction therapy emotion development: a novel treatment for depression in preschool children , 2011, Depression and anxiety.

[61]  S. Iyengar,et al.  Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. , 2011, Archives of pediatrics & adolescent medicine.

[62]  David R. Williams,et al.  Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys , 2010, British Journal of Psychiatry.

[63]  Y. Bar-Haim.  Research review: Attention bias modification (ABM): a novel treatment for anxiety disorders. , 2010, Journal of child psychology and psychiatry, and allied disciplines.

[64]  D. Cicchetti,et al.  Developmental cascades , 2010, Development and Psychopathology.

[65]  R. Kessler,et al.  Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. , 2010, Archives of general psychiatry.

[66]  K. Conron,et al.  Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults , 2009, Psychological Medicine.

[67]  H. Tiemeier,et al.  Childhood Experiences and the Risk of remature Mortality , 2009 .

[68]  M. Medina-Mora,et al.  Descriptive epidemiology of chronic childhood adversity in Mexican adolescents. , 2009, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[69]  Cinnamon A. Stetler,et al.  A Meta-Analytic Review of the Effects of Childhood Abuse on Medical Outcomes in Adulthood , 2009, Psychosomatic medicine.

[70]  R. Reading.  Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) model , 2009 .

[71]  J. Tracy,et al.  Screening for harsh punishment in a pediatric primary care clinic. , 2009, Child abuse & neglect.

[72]  Scott Weich,et al.  Family relationships in childhood and common psychiatric disorders in later life: systematic review of prospective studies , 2009, British Journal of Psychiatry.

[73]  H. Dubowitz,et al.  Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model , 2009, Pediatrics.

[74]  Matthew K Nock,et al.  The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors. , 2008, Behavior therapy.

[75]  E. Zigler,et al.  The Parents as Teachers Program and School Success: A Replication and Extension , 2008, The Journal of Primary Prevention.

[76]  H. Dubowitz,et al.  Screening for Intimate Partner Violence in a Pediatric Primary Care Clinic , 2008, Pediatrics.

[77]  John Dixon,et al.  An exploration of the use of simple statistics to measure consensus and stability in Delphi studies , 2007, BMC medical research methodology.

[78]  J. Tracy,et al.  Screening for parental substance abuse in pediatric primary care. , 2007, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[79]  Chia-Chien Hsu,et al.  The Delphi Technique: Making Sense of Consensus , 2007 .

[80]  Kenneth Blackman,et al.  Screening for Depression in an Urban Pediatric Primary Care Clinic , 2007, Pediatrics.

[81]  M. Zimmer‐Gembeck,et al.  Behavioral Outcomes of Parent-Child Interaction Therapy and Triple P—Positive Parenting Program: A Review and Meta-Analysis , 2007, Journal of abnormal child psychology.

[82]  Edmund A. Mennis.  The Wisdom of Crowds: Why the Many Are Smarter than the Few and How Collective Wisdom Shapes Business, Economies, Societies, and Nations , 2006 .

[83]  J. Durlak,et al.  Promoting and protecting youth mental health through evidence-based prevention and treatment. , 2005, The American psychologist.

[84]  S. Timmer,et al.  Parent-child interaction therapy: application to maltreating parent-child dyads. , 2005, Child abuse & neglect.

[85]  J. Abela,et al.  A TEST OF THE INTEGRATION OF THE RESPONSE STYLES AND SOCIAL SUPPORT THEORIES OF DEPRESSION IN THIRD AND SEVENTH GRADE CHILDREN , 2004 .

[86]  L. A. Valle,et al.  Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. , 2004, Journal of consulting and clinical psychology.

[87]  R. Steer,et al.  A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[88]  E. Zigler,et al.  A life lived at the crossroads of knowledge and children's policy. , 2002, New directions for child and adolescent development.

[89]  J. Brown,et al.  Child abuse and neglect and the development of mental disorders in the general population , 2001, Development and Psychopathology.

[90]  D. Cicchetti,et al.  Dimensions of child maltreatment and children's adjustment: Contributions of developmental timing and subtype , 2001, Development and Psychopathology.

[91]  M Y Wong,et al.  Childhood abuse and lifetime psychopathology in a community sample. , 2001, The American journal of psychiatry.

[92]  E. Zigler,et al.  Extended childhood intervention prepares children for school and beyond. , 2001, JAMA.

[93]  M. Roland,et al.  Defining quality of care. , 2000, Social science & medicine.

[94]  S. Eyberg,et al.  Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. , 1998, Journal of clinical child psychology.

[95]  D. Williamson,et al.  Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. , 1998, American journal of preventive medicine.

[96]  Roy C. Schmidt,et al.  MANAGING DELPHI SURVEYS USING NONPARAMETRIC STATISTICAL TECHNIQUES , 1997 .

[97]  J. Garber,et al.  Display rules for anger, sadness, and pain: it depends on who is watching. , 1996, Child development.

[98]  D Cicchetti,et al.  A developmental psychopathology perspective on child abuse and neglect. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[99]  C. Carver,et al.  Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS Scales , 1994 .

[100]  E. Zigler.  Reshaping early childhood intervention to be a more effective weapon against poverty , 1994, American journal of community psychology.

[101]  Brian Parker,et al.  Quantitative Applications in the Social Sciences , 1983 .

[102]  Amanda Van Scoyoc,et al.  Evidence-based programs in "real world" settings: Finding the best fit , 2015 .

[103]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[104]  Guidelines for prevention in psychology. , 2014, The American psychologist.

[105]  J. Borrego,et al.  Parent–child interaction therapy, 2nd ed. , 2010 .

[106]  D. Cicchetti,et al.  A developmental psychopathology perspective on adolescent depression. , 2009 .

[107]  Allan J. Rossman,et al.  Measures of Spread , 1998 .

[108]  D. Cicchetti.  Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology. , 1994 .

[109]  H. Weisberg.  Measures of Spread , 1992 .