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.

Does reward processing moderate or mediate the link between childhood adversity and psychopathology: A longitudinal study

“…Behavioral activation has long been established as an effective treatment for depression in adults (for meta-analysis see Ekers et al, 2014), and has more recently garnered preliminary support as an effective treatment for depression in adolescents (McCauley et al, 2016; for review see Martin & Oliver, 2019). Beyond its promise as a treatment for depression, we have argued that behavioral activation may also be a useful preventive intervention buffering against the development of depression in youth who have experienced adversity in childhood (McLaughlin et al, 2019; Rith-Najarian et al, 2021). We are unaware of empirical research evaluating whether behavioral activation may indeed be effective at preventing depression in youths who have experienced adversity.…”