Objective Child abuse exerts a deleterious impact on a broad array of mental health outcomes. However, the neurobiological mechanisms that mediate this association remain poorly characterized. Here, we use a longitudinal design to prospectively identify neural mediators of the association between child abuse and psychiatric disorders in a community sample of adolescents. Method Structural magnetic resonance imaging (MRI) data and assessments of mental health were acquired for 51 adolescents (aged 13–20; M=16.96; SD=1.51), 19 of whom were exposed to physical or sexual abuse. Participants were assessed for abuse exposure (Time 1), participated in MRI scanning and a diagnostic structured interview (Time 2), and two years later were followed-up to assess psychopathology (Time 3). We examined associations between child abuse and neural structure, and identified whether abuse-related differences in neural structure prospectively predicted psychiatric symptoms. Results Abuse was associated with reduced cortical thickness in medial and lateral prefrontal and temporal lobe regions. Thickness of the left and right parahippocampal gyrus predicted antisocial behavior symptoms, and thickness of the middle temporal gyrus predicted symptoms of generalized anxiety disorder. Thickness of the left parahippocampal gyrus mediated the longitudinal association of abuse with antisocial behavior. Conclusion Child abuse is associated with widespread disruptions in cortical structure, and these disruptions are selectively associated with increased vulnerability to internalizing and externalizing psychopathology. Identifying predictive biomarkers of vulnerability following childhood maltreatment may uncover neurodevelopmental mechanisms linking environmental experience with the onset of psychopathology.

These findings were robust to control subjects for depression and adversity exposure and are consistent with the idea that youths with SI have disrupted emotion regulation, potentially related to differences in recruitment of top-down control regions. In contrast, youths without SI activated regions implicated in emotion regulation even when not directed to effortfully control their emotional response. This is the first study to examine neural function during emotion regulation as a potential neural correlate of risk for SI in adolescents.

Seclusion and restraint are commonly used by residential staff to control unsafe behaviors of youths with disabilities and complex trauma histories. This pilot study examined the effect of a nonrestraining cushion as a calming device and wellness tool in a setting that prohibits supportive physical contact, to see to what extent the cushion might help these youths to better regulate their emotional distress and unwanted behaviors. Volunteers used the cushion for 15 minutes over 24 sessions. Nine students completed the study and reported reduction in anxiety and agitation, and a soothing feeling with residual effects to their daily routines. This pilot study suggests that the use of a nonrestraining, deep-pressure cushion may simulate a secure holding effect for young people with emotional dysregulation. The cushion is a safe and healing wellness tool that empowers youths and provides programs with an alternative to seclusion and restraint.

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