Identifying Sensitive Periods for the Impact of Physical Abuse on Psychopathology Symptoms

Identifying Sensitive Periods for the Impact of Physical Abuse on Psychopathology Symptoms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identifying Sensitive Periods for the Impact of Physical Abuse on Psychopathology Symptoms Xingyao Xiao, Li Zhu, Yunting Liu, Yihong Cheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4579176/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Extant research lacks completeness and accuracy in identifying the timing of sensitive periods for physical abuse across childhood. Utilizing data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) following more than one thousand children from early childhood into adulthood, the present study employed a novel, granular approach to indicate physical abuse timing, develop growth curve models that incorporated linear and quadratic terms of the age variable, and more completely and accurately revealed sensitive periods for physical abuse. Results showed that late childhood (8–10 years) and adolescence (14–17 years) are sensitive periods when physical abuse more severely impacts internalizing issues. Additionally, middle to late childhood (6–10 years) and adolescence (12–16 years) are sensitive periods when physical abuse more severely impacts externalizing problems. Overall, this study provides empirical support for theories of sensitive periods across childhood and offers valuable reference for mental health workers to timely intervene. physical abuse internalizing behavior problem externalizing behavior problem growth curve analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Physical Abuse as a Major Risk Factor for Internalizing and Externalizing Problems Two major strands of mental health problems are internalizing problems and externalizing problems. Internalizing problems refer to negative emotional experiences such as anxiety, depression, panic, and social withdrawal; externalizing problems refer to a series of extraverted behaviors in which individuals respond negatively to the external environment, such as high aggression and disobedience (Achenbach et al., 2016 ). Empirical studies have shown that internalizing and externalizing problems significantly negatively impact children's personal growth and social adaptation. Specifically, children with high levels of internalizing and externalizing problems are more likely to have maladaptive problems such as difficulty in peer interaction, academic problems, and psychological disorders (Jia et al., 2024 ; Hu et al., 2023). One of the main risk factors for children's internalizing and externalizing problems is childhood maltreatment (Liu et al., 2018 ; Oshri et al., 2017 ; Huh et al., 2020 ; Wang et al., 2017 ). Among the different types of maltreatment, children are especially likely to experience physical abuse (i.e., violent acts executed by caregivers that cause physical harm to children through beating, biting, burning, and other hostile actions; Stoltenborgh et al., 2015 ) due to a chain reaction between children's personal attributes, atmosphere of family environment, and sociocultural factors, according to Bronnfenbrenner's (2006) ecological theory of human development. Physical abuse is associated with a higher likelihood of internalizing problems. as it heavily disrupts the operation and development of stress control-related neural circuits in cortical limbic layers (Zhu et al, 2023 ), thereby weakening children's ability to cope with environmental adverse conditions, making them more likely to develop internalizing problems (Malave et al., 2022 ; Yoon et al., 2018 ; Benedini et al., 2018). Also, as suggested by emotional security theory, exposure to physical abuse reduces children's level of trust in the safety of the family environment, which causes them to develop increased anxiety and depression (Davies & Cummings, 1994 ). Experiences of physical abuse are also linked to a higher likelihood of developing externalizing issues, such as aggression and delinquency (Haahr-Pedersen, 2021; Lansford et al., 2002 ; Loeber et al., 2009 ), risky sexual behaviors (Yoon et al, 2018 ), and substance abuse (Benedini et al., 2018). This association stems from the negative neurological impact of physical abuse on an individual's ability to control attention, as well as increased challenges in managing emotions and behaviors (Zhang et al., 2024). Also, children who have experienced physical abuse are more likely to rationalize and internalize violence, which results in the adoption of aggressive behaviors themselves (Bozzay et al., 2017 ; Bandura, 1978 ). Sensitive Periods for Physical Abuse Despite extensive discussions about how physical abuse impacts internalizing and externalizing problems, few studies have explored how the timing of such abuse might influence its effects. Moreover, these studies often suffer methodological limitations, and the findings they reach are mixed. To address these challenges, this study aims to more fully and accurately identify sensitive periods across childhood during which children are more vulnerable to the impact of physical abuse. Sensitive periods refer to specific times during development when exposure to certain stimuli or experiences has a more profound impact than at other times, presumably influencing long-term outcomes (Kuh et al., 2003 ). These periods signify unique interactions between the timing of exposure and developmental effects. Neuroscience studies explained why physical abuse experiences during sensitive periods have more profound effects than during other times. Neural circuits are particularly susceptible to the influence of experiences during sensitive periods when the circuits are maturing. The molecular and cellular mechanisms facilitating neural plasticity during a sensitive period exhibit heightened activity, enabling circuits to be modified greatly in response to experiences such as physical abuse (Knudsen et al., 2006 ). Specifically, children who are physically abused during sensitive periods experience a pattern of cortisol suppression in situations of stress that causes them to develop stronger internalizing problems (Hart et al., 1995 ). They are also likely to experience atypical alterations in the volume and activity of the prefrontal cortex, amygdala, and hippocampus, which increases their externalizing problems (McCrory et al., 2011 ). Sensitive periods are not just “windows of vulnerability or susceptibility” when physical abuse exposure has an increased likelihood of negative consequences on individual development, but also “windows of opportunity” during which clinical interventions may provide maximal benefits to minimize or preempt long-term consequences of childhood adversity (Zhu et al., 2023 ; Heim et al., 2012). Therefore, identifying sensitive periods has significant practical implications for clinical intervention, such as deciding on which populations to distribute more resources on and when. Inconsistent Findings on How Timing Affects the Effect of Physical Abuse A growing number of studies are examining how the timing of physical abuse affects children's well-being. However, most of them primarily concentrate on the onset of abuse—the initial exposure to abuse. This study aims to investigate sensitive periods by focusing on the timing of each abuse occurrence, rather than just the onset. Although there is an increasing interest in the sensitive periods of maltreatment such as physical abuse, the research remains limited and has yet to reach a consensus on when these sensitive periods are. In terms of internalizing problems, some studies found early childhood to be a time when the occurrence of maltreatment has a stronger effect. For example, Keiley and colleagues found that children who were maltreated earlier in life (before 5 years old) consistently showed more internalizing problems, compared with those experiencing maltreatment in later stages (5–14 years old; Keiley et al., 2001 ). Thompson and colleagues found that maltreatment experiences before 4 significantly predicted the severity and growth of children's internalizing problems (Thompson & Tabone, 2010 ). Moss and colleagues found that children who experienced physical abuse for the first time between age 1 and 4 had significantly higher internalizing problems (Moss et al., 2023 ). But other studies reported sensitive periods for maltreatment influencing internalizing problems to be scattered across middle and late childhood. For example, Méndez Leal et al. (2020) found that puberty was a sensitive period during which efforts to intervene and recalibrate internalizing problems could be maximized. Stevens et al. ( 2016 ) found evidence suggesting that there is a sensitive period around age 10 during which children are particularly vulnerable to maltreatment. In terms of externalizing problems, some studies found that sensitive periods of maltreatment occurred during early childhood. For example, Dunn et al. ( 2020 ) found that children whose first experience of physical abuse took place in early childhood had more severe externalizing problems. Sadeghi Bahamani et al. (2016) found that individuals abused before age 5 developed higher levels of externalizing behaviors. However, other studies found that sensitive periods for maltreatment influencing externalizing problems take place during middle childhood or adolescence. For example, Yoon ( 2020 ) found that age 11.5 was a sensitive period with the most prominent effect of maltreatment on externalizing problems. Keiley et al. ( 2001 ) found that children who were abused after age 5 showed a more rapid increase in their externalizing problem. Moreover, the varied findings that suggest either early childhood or later stages as sensitive periods are further complicated by studies reporting gender differences in these periods or even suggesting the absence of sensitive periods altogether. Dunn et al. ( 2023 ) found age 9 was a sensitive period for harsh physical discipline among girls while age 5 was a sensitive period among boys. Zhang and Marshall ( 2023 ) found that puberty was a unique sensitive period for trauma-related violent behavior among women, whereas any time during or prior to puberty predicted men’s increased violent behavior in adulthood. Furthermore, adding to the confusions, some also reported no sensitive periods. Edwards et al. ( 2017 ) analyzed the effect of timing of parental physical abuse and found that there was no significant difference between adolescents abused at different developmental stages in terms of increase in their risks of externalizing problems. Duprey et al. ( 2023 ) found that compared with the timing of occurrence, chronicity of maltreatment is more predictive of children’s internalizing and externalizing problems. Methodological Limitations of the Previous Studies The observed inconsistency in research findings could be attributed, in part, to variations in childhood adversity, ranging from harsh physical discipline to physical abuse. Furthermore, the use of rudimentary methods for assessing the timing of exposure was a major methodological limitation (Khan et al., 2015 ; Schaefer et al., 2022 ). Specifically, many earlier studies that investigated sensitive periods related to physical abuse or other forms of maltreatment oversimplified the timing of exposure. They often divided childhood —or portions of it—into just early and late periods, using a dichotomous division, or grouped subjects into a few developmental stages, using a polytomous division. For example, studies that employed dichotomous divisions in studies include Moss and colleagues’ ( 2023 ) study, which divided early childhood into age groups of 0–1 and 1–4 years old, Keiley and colleagues’ ( 2001 ) study, which split childhood into 0–5 and 5–14 years old, and Thompson and colleagues’ (2010) study, which categorized childhood into 0–4 and 5–10 years olds. Examples of polytomous studies include Dunn and colleagues’ ( 2020 ) study which divided childhood into four categories: very early (0 to 3 years old), early (4 to 5 years old), middle (5 to 7 years old), and late (8 to 10 years old). Similarly, Kaplow ( 2007 ) also divided childhood into four categories: infancy (from 0 to 2 years old), preschool (from 3 to 5 years old), early school (from 6 to 8 years old), and late school (from 9 to 11 years old). These approaches that collapse the timing of abuse occurrences into either dichotomous or polytomous categories have been found inadequate in identifying sensitive periods (Khan et al., 2015 ; Schaefer et al., 2022 ) for two main reasons. Firstly, neuroimaging research indicates that sensitive periods for maltreatment may be extremely brief and scattered across childhood (Choi et al., 2012 ; Tomoda et al., 1993) and thus, are not fully captured by dividing exposure time into a few categories (Khan et al., 2015 ). Secondly, studies in neuroscience suggest the existence of both early and late windows of vulnerability. Although the sensitive periods for most lower-level neural circuits conclude before age 12, for certain higher-level circuits, these periods persist into adulthood (Knudsen et al., 2006 ). Consequently, there is a need for more sophisticated methods to accurately identify potentially brief and multiple sensitive periods across different stages of development. To resolve the limitations mentioned above, this study takes a more granular approach of reflecting timing of abuse occurrence. This approach will be introduced in the Methods section in detail. Adopting this approach, this study aims to answer the following research questions: RQ1: What are the sensitive periods, if any, between age 4 and 17 with a stronger impact of physical abuse on internalizing problems? RQ2: What are the sensitive periods, if any, between age 4 and 17 with a stronger impact of physical abuse on externalizing problems? This investigation controls for demographic factors (e.g., gender, ethnicity) and other forms of abuse (i.e., sexual abuse, emotional abuse/neglect and drug). Methods Participants and Procedure The Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) recruited children at varying levels of risk of maltreatment and followed them into adulthood. The datasets contain variables collected from the children, their caregivers, teachers, and Child Protective Services (CPS) and Central Registry records. Children were enrolled when they were 4 years old or younger, and in-depth face-to-face interviews with the child and their primary caregiver were conducted at ages 4, 6, 8, 12, 14, 16, and 18. The LONGSCAN samples included five pooled cohort samples, each with different selection criteria, representing varying levels of risk or exposure to maltreatment. Five sites included the East (EA), Midwest (MW), Northwest (NW), Southwest (SW) and South (SO), each site recruited between 245 and 330 children and collected a common set of measures as well as some measures that were specific to each site’s objectives. Different selection criteria were used: three of the sites (EA, SO, SW) recruited their samples from pre-existing samples of high-risk children who had been followed between birth and 18 months of age. The MW sample consisted of three groups of newly recruited 3- to 18-month-old infants from families reported to CPS, half of which received comprehensive services and the other half received CPS intervention only. The NW sample was drawn from a pool of children, aged 0 to 4, who were judged to be at moderate risk following a report to Child Protective Services for suspected child maltreatment. The LONGSCAN baseline sample consisted of 1,354 children. In the current study, participants with ‘other’ ethnicity were removed from the sample (leaving N = 1,333 participants), as one of our main focuses was to tease out the effect of race in problematic behaviors. The data collected from age 18 was removed as the sample size for this wave was too small. Among the sample, 51% were female, 54% were Black, 27% were Caucasian, 12% were mixed race, and 7% were Hispanic. A flowchart of the complete sampling procedure is shown in Fig. 5 . Measures In terms of the measures, several instruments, including questionnaires and interviews, were used. Face-to-face interviews were conducted (or planned) with primary caregivers and children at ages 4, 6, 8, 12, 14, 16, and 18. The measures from the interviews were primarily related to child maltreatment, risk and protective factors, health, school performance, and behavior problems. Beginning at age 6, information about children’s academic performance and social adjustment were collected from their teachers. Periodically, Child Protective Services case narratives and Central Registry records were reviewed. Brief, yearly telephone contacts were initiated with the caregivers to enhance subject retention and collect data about service utilization, life events, and child behavior problems. Timing of Physical Abuse Exposure. In terms of the maltreatment measure, maltreatment history was coded through the Modified Maltreatment Classification System (MMCS; Barnett et al., 1993 ; English et al., 1998), obtaining both allegations and substantiations. The MMCS has been used extensively in coding maltreatment data across studies and accepted as a reliable classification of maltreatment experiences based on CPS records (Dubowitz et al., 2005 ; English et al., 2005 ; Litrownik et al., 2005 ). The present study used the code from the allegation narrative rather than the substantiation narrative because the former usually provides more explicit information about the child’s actual experiences compared to the CPS label (Jones et al., 2010 ). Using this dataset, eight binary variables were constructed to indicate whether participants experienced physical abuse during specific age intervals. For instance, the indicator variable "HasPhyAbuAge_4" represents exposure to physical abuse between the ages of 4 and 6, covering ages 4 and 5, with a value of 1 denoting exposure and a value of 0 indicating no exposure. For a detailed explanation on the construction of these indicator variables, please refer to the Appendix . Internalizing and externalizing behavior problems. Internalizing and externalizing behavior problems were assessed through Child Behavior Checklist/4–18 (CBCL 4–18). CBCL is a well-established measure of child internalizing and externalizing problems. A child’s CBCL score is determined by how their caregivers indicate the extent to which each of 113 behaviors is characteristic of the child. Scoring includes raw and standardized (T-scores) versions for two broadband groupings of symptoms (internalizing and externalizing). T-scores were utilized for the current study. T-scores of 60 and lower for internalizing are considered normal, 60–63 is considered borderline, and scores greater than 63 are in the clinical range. CBCL has good psychometric properties with regard to test-retest reliability, inter-rater agreement, and validity (Achenbach et al., 1991). Statistical Analyses To identify sensitive periods of physical abuse on affecting internalizing and externalizing problems among children aged between 4 and 17, we used statistical methods to control for factors like gender, ethnicity, and other types of maltreatment such as sexual abuse. Instead of utilizing the original variable tracking physical abuse that varied with age from 4 to 17, we employed a multi-part method to construct variables (see Appendix for details). These derived variables enabled us to investigate how the presence or absence of physical abuse at different age intervals contributed to the variability observed in internalizing and externalizing problems across ages 4 to 17 with a two-year interval. By examining the coefficients associated with these variables, we gained valuable insights into the nature and magnitude of these relationships, offering nuanced perspectives on the developmental trajectories of psychological outcomes, including considerations of both the timing of physical abuse. Moreover, we employed growth curve models that incorporated linear and quadratic terms of the age interval variable, with internalizing and externalizing problems serving as outcome variables. This analytical framework also included control variables such as gender, ethnicity, and other forms of abuse. By leveraging these models, we were able to comprehensively explore the developmental trajectories of internalizing and externalizing problems, while simultaneously accounting for the influence of physical abuse across various age intervals. Results Descriptive Statistics The dataset encompasses a longitudinal design, comprising 7,222 level-1 observations. These observations span multiple time points, capturing the developmental trajectory across various ages for 1,333 children at level 2. Regarding the distribution of observations per child, the cluster sizes range from 1 to 7, with a mean of 5.37. Supplemental Table 1 presents descriptive statistics for continuous variables, while Supplemental Table 2 displays the percentage distribution of categorical explanatory variables. Sensitive Periods of Physical Abuse In this section, we present our findings regarding sensitive periods concerning physical abuse and its influence on internalizing and externalizing problems. Internalizing Problems Results Baseline Concave Trend. The Growth Curve Model (GCM) analysis revealed a significant linear increase and quadratic decrease in internalizing problems across the investigated age range (β AGEYRS since 4 = 0.66 and β (AGEYRS since 4) 2 = -0.07, both with p < 0.001, as presented in Supplemental Table 3), while controlling for gender, ethnicity, and other forms of abuse. Figure 1 illustrates the mean internalizing scores for baseline children, indicating a concave trend characterized by an initial increase from ages 4 to 8, followed by a decline from ages 10 to 16. Sensitive Periods. Our analyses revealed significant associations between physical abuse and internalizing problems at specific ages, after controlling for gender, ethnicity, and other forms of abuse. Notably, exposure to physical abuse at ages 8–10, 14–16, and 16–17 was significantly linked with heightened internalizing problems. Coefficients for physical abuse at age 8–10 (β = 3.59, p < 0.001), age 14–16 (β = 3.27, p = 0.002), and age 16–17 (β = 7.67, p < 0.001) indicated substantial increases in internalizing problems. Figures 1 and 2 provide a visual representation of the mean differences in internalizing levels between children with and without physical abuse, with the most pronounced differences observed at age 16–17, highlighting the significant impact of physical abuse during this developmental period. Externalizing Problems Results Baseline Convex Trend. Our analysis revealed a significant linear decrease and quadratic increase in externalizing problems across the investigated age range (β AGEYRS since 4 = -0.41 and β (AGEYRS since 4) 2 = 0.02 both with p < 0.001, as presented in Supplemental Table 3), while controlling for gender, ethnicity, and other forms of abuse. Figure 3 illustrates a convex trend for mean externalizing scores among baseline children, characterized by an initial decrease from ages 4 to 12, followed by a steadier increase from ages 14 to 16. Sensitive Periods. Significant associations between physical abuse and externalizing problems at specific ages were revealed by our analyses, after controlling for gender, ethnicity, and other forms of abuse. Exposure to physical abuse at ages 6–8, 8–10, 12–14, and 14–16 was significantly linked to heightened externalizing problems, as indicated by coefficients for physical abuse at age 6–8 (β = 1.80, p < 0.016), age 8–10 (β = 2.81, p < 0.001), age 12–14 (β = 1.54, p = 0.048), and age 16–17 (β = 2.20, p = 0.001). These findings underscored sensitive periods for the manifestation of externalizing problems. Notably, Fig. 4 indicates that the effect size of 14-16-year-olds was the most significant. Discussion Using the growth curve model and a devised variable construction approach, this study identifies different trajectories of pathological development: internalizing problems increased from age 4 to 8 and decreased afterward, presenting an inverse U-shaped curve; externalizing problems declined from age 4 to 12 and slightly increased afterward, which yielded a U-shaped curve. This finding aligns with previous studies that reported varied trajectories for internalizing and externalizing problems (Kim et al., 2009 ; Godinet et al., 2014 ). The main conclusion of the study is that late childhood (8–10 years) and adolescence (14–16 and 16–17 years) are sensitive periods when physical abuse impacts internalizing issues. Additionally, middle to late childhood (6–8 and 8–10 years) and adolescence (12–14 and 14–16 years) are sensitive periods when physical abuse affects externalizing problems. The intervals of 8–10 and 14–16 years old are sensitive periods for both internalizing and externalizing issues, although there are distinct sensitive periods unique to each type of problem. These findings on sensitive periods for internalizing problems are consistent with previous studies showing that ages 14–15 and 16–17 (Khan et al., 2015 ; Gerke et al., 2018 ) to be a sensitive period during which maltreatment maximally worsened children’s internalizing problems, and that initial exposure to physical abuse between age 6 and 10 have stronger effects on children's internalizing problems (Dunn et al., 2018 ). These findings on externalizing problems are also consistent with earlier studies, which have shown that children abused after age 5 exhibit a more rapid increase in externalizing problems (Keiley et al., 2001 ). Additionally, the ages of 11.5 and the period between 14–16 years old (Yoon et al., 2020; Andersen et al., 2019) have been identified as the most sensitive times for physical abuse to impact externalizing problems. Several factors explain why late childhood (8–10 years) and adolescence (14–16 and 16–17 years) are sensitive periods during which physical abuse impacts internalizing issues. Neurologically, between the ages of 8.4 and 10, there is typically less thinning in the orbital frontal cortex, which correlates with an increase in internalizing problems (Whittle et al., 2020 ). During adolescence, particularly between 14 and 17 years, alterations in the volumes of the putamen and caudate are observed, which are associated with diminished emotion processing capabilities and heightened general anxiety (Lago et al., 2017 ). Additionally, this period is marked by enhanced amygdala function, leading to elevated internalizing problems (Teicher et al., 2016 ). Moreover, this phase experiences rapid, significant shifts in the hypothalamic-pituitary-gonadal (HPG) axis, disrupting the secretion of testosterone in males and estradiol in females, thereby exacerbating internalizing issues (Walker et al., 2004 ). These neurodevelopmental changes provide a biological foundation for the heightened vulnerability to internalizing problems following physical abuse during late childhood (8–10 years) and adolescence (14–16 and 16–17 years). Our findings regarding intervals of 8–10 and 14–16 years old being sensitive periods for externalizing problems are also supported by a body of neurological research that elucidates the mechanisms underlying the development of these issues. This research spans various aspects of brain development and hormonal changes that coincide with these sensitive periods. Studies have shown that physical abuse exacerbates externalizing problems through triggering atypical development of the hypothalamic-pituitary-adrenal (HPA) axis which matures between age 6 and 9, with adrenarche beginning in late childhood but continuing to rise throughout adolescence. McCrory and colleagues ( 2011 ) highlight that adolescence is a critical period characterized by atypical development in the hypothalamic–pituitary–adrenal (HPA) axis and changes in the volume and activity of key brain regions such as the prefrontal cortex, amygdala, and hippocampus. These neurobiological alterations increase the risk of externalizing problems during this developmental stage. Adding to this, Blakemore and colleagues ( 2010 ) found that adrenal androgens, including dehydroepiandrosterone and its sulfate, begin to increase between ages 6 to 9, continuing to rise through adolescence until peaking at age 20. This hormonal surge corresponds with the onset and progression of externalizing behaviors. Byrne and colleagues ( 2017 ) provided further insight by associating adrenarche, an early phase of pubertal development, with a rapid increase in androgen levels secreted by the adrenal cortex, which they linked to a higher risk of developing externalizing problems. Additionally, Sisk and Foster ( 2004 ) observed that gonadarche, which typically begins between ages 9 and 11, involves the reactivation of the hypothalamic-pituitary-gonadal (HPG) axis, a process integral to puberty and related behavioral changes. Finally, Andersen and colleagues ( 2008 ) contribute to this narrative by demonstrating how brain structure responds to early life experiences. They found that hippocampal volume was most strongly affected by abuse occurring between ages 3 and 5, and again between 11 and 13 years old. Moreover, they noted that the area of the corpus callosum was impacted by abuse at ages 9–10, and changes in the frontal cortex were linked to abuse during ages 14–16. Conclusion This study identified a series of sensitive periods across childhood during which children’s internalizing and externalizing problems were more severely impacted by physical abuse. By adopting a novel, granular approach, this study successfully identified brief sensitive periods overlooked by studies segmenting developmental stages into broader categories. Practically speaking, our findings contribute to better capturing how the timing of physical abuse impacts children’s pathological development, such that targeted interventions could be implemented during the windows of maximal opportunity. Theoretically speaking, this study provides additional support for extant neurological studies that elucidate mechanisms of neurodevelopmental changes and hormonal fluctuations that contribute to the heightened vulnerability during these sensitive periods. Declarations Author Contribution X.X. and Y.L. wrote primarily the Results and Methods sections. L.Z. and Y.C. wrote primarily the Introduction, Discussion, and Conclusion sections. All authors reviewed the manuscript. Data Availability All data that support the findings of this study are publicly accessible at the National Data Archive on Child Abuse and Neglect (https://www.ndacan.acf.hhs.gov/datasets/dataset-details.cfm?ID=170). References Achenbach TM, Edelbrock C (1991) Child Behavior Checklist. Burlingt (Vt) 7:371–392 Achenbach TM, Ivanova MY, Rescorla LA, Turner LV, Althoff RR (2016) Internalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications. 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Child Abuse Negl 34(12):907–916. https://doi.org/10.1016/j.chiabu.2010.06.006 Tomoda A, Polcari A, Anderson CM, Teicher MH (2012) Reduced Visual Cortex Gray Matter Volume and Thickness in Young Adults Who Witnessed Domestic Violence during Childhood. PLoS ONE 7(12):e52528. https://doi.org/10.1371/journal.pone.0052528 Walker EF, Sabuwalla Z, Huot R (2004) Pubertal neuromaturation, Stress sensitivity, and Psychopathology. Dev Psychopathol 16(04). https://doi.org/10.1017/s0954579404040027 Wang X, Yang L, Gao L, Yang J, Lei L, Wang C (2017) Childhood Maltreatment and Chinese Adolescents’ Bullying and defending: the Mediating Role of Moral Disengagement. Child Abuse Negl 69:134–144. https://doi.org/10.1016/j.chiabu.2017.04.016 Whittle S, Vijayakumar N, Simmons JG, Allen NB (2020) Internalizing and Externalizing Symptoms Are Associated with Different Trajectories of Cortical Development during Late Childhood. J Am Acad Child Adolesc Psychiatry 59(1):177–185. https://doi.org/10.1016/j.jaac.2019.04.006 Yoon S, Voith LA, Kobulsky JM (2018) Gender Differences in Pathways from Child Physical and Sexual Abuse to Adolescent Risky Sexual Behavior among high-risk Youth. J Adolesc 64:89–97. https://doi.org/10.1016/j.adolescence.2018.02.006 Yoon Y (2020) Time Dimension of Childhood Adversities and Externalizing Behavior Among Children of Teen Mothers: Sensitive Period Hypothesis vs. Accumulation Hypothesis. Child Maltreat 107755952098424. https://doi.org/10.1177/1077559520984249 Zhang W, Wang Z (2024) The Longitudinal Relationship between Childhood Trauma and adolescents’ Externalizing problems: a Moderated Mediation Model. Child Abuse Negl 149:106646. https://doi.org/10.1016/j.chiabu.2024.106646 Zhang ZZ, Marshall AD (2023) Developmental Timing of Trauma Exposure Relative to Puberty and Violent Behavior in Adulthood. J Aggress Maltreatment Trauma 1–18. https://doi.org/10.1080/10926771.2023.2241024 Zhu J, Anderson CM, Ohashi K, Khan A, Teicher MH (2023) Potential sensitive period effects of maltreatment on amygdala, hippocampal and cortical response to threat. Mol Psychiatry. https://doi.org/10.1038/s41380-023-02002-5 Additional Declarations No competing interests reported. Supplementary Files Appendix.docx 061424supplementaltables1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4579176","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320426232,"identity":"14ef17b5-5811-45d4-a0a2-684545a9d332","order_by":0,"name":"Xingyao Xiao","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Xingyao","middleName":"","lastName":"Xiao","suffix":""},{"id":320426233,"identity":"0ea1a823-f72d-4aca-b9ed-26bdf677bc23","order_by":1,"name":"Li Zhu","email":"","orcid":"","institution":"Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhu","suffix":""},{"id":320426234,"identity":"c7dea51e-53af-4f46-babc-d27a596fb0ec","order_by":2,"name":"Yunting Liu","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Yunting","middleName":"","lastName":"Liu","suffix":""},{"id":320426235,"identity":"4f9c3154-c87c-4b56-88b1-1760901b8fff","order_by":3,"name":"Yihong Cheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABSUlEQVRIie2RMUvDQBTH7wgky6tdX4gaP0JKIRas9KskFOoSpCA4FTwoXJdq536LuhTHloNkSfeUuhQhUwdFClUzmIuD0NTiKJgfx+P+j/fjDh4hBQV/EpAFbwZad0KIVUsDZfJIrD1KnQ77vpPOYJp/p7ToKPLkAH7lfYoVzKZP7XehkDBcjzZtJI2y4Mv1gzCJ1h0j6TzmlPCyWR3eCZX2bsfzvvwYur3qUSgqDPxrJH6cUyKwjVJfgAKzcQSZQrmhc0EZejZSJnYopx+pgip68TyRSnmaKQ1mrn5SbAU2LQvQUxfZK8Tl+gsXLkPYqeihVzVKrO4g+Pbi0EKAyOUG5RdNDq2rmuPnlIMgrLxCgk4j6MbzVVI/1gZBrL/xs/OBJu6j505OOZnILfDvRrYWRVZV3pxtgRCTyZpsdekmP1lQUFDwf/kE1pNxs64/gQUAAAAASUVORK5CYII=","orcid":"","institution":"Tsinghua University","correspondingAuthor":true,"prefix":"","firstName":"Yihong","middleName":"","lastName":"Cheng","suffix":""}],"badges":[],"createdAt":"2024-06-14 03:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4579176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4579176/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60185797,"identity":"9a354ca0-7d03-4a34-a847-934b187509ee","added_by":"auto","created_at":"2024-07-12 18:43:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66318,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eInternalizing problems by age and history of physical abuse\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/0fcc0e2ad6c9c544f71fd923.png"},{"id":60185796,"identity":"6e308c84-21e2-4b61-8228-e6c72e2f16c2","added_by":"auto","created_at":"2024-07-12 18:43:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57047,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCoefficient estimates with 95% confidence intervals\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/ede8edc887e098084f4bf8bb.png"},{"id":60185800,"identity":"e1cf4cfe-650a-4a0a-8d80-07aac8214ae4","added_by":"auto","created_at":"2024-07-12 18:43:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52628,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eExternalizing problems by age and history of physical abuse\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/144675b800b6d931784c86e3.png"},{"id":60185799,"identity":"113a35a7-ced1-469f-b4be-64a585a1b965","added_by":"auto","created_at":"2024-07-12 18:43:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":57816,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCoefficient estimate with 95% confidence intervals\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/549558c87b23308840763084.png"},{"id":60186374,"identity":"2b85b9d1-1d09-47c9-b918-ec079e07a19f","added_by":"auto","created_at":"2024-07-12 18:51:44","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":119598,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSelection of participants and reasons for non-inclusions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote 1.\u003c/strong\u003e These figures illustrate the impact of physical abuse on internalizing (Figures 1 and 2) and externalizing (Figures 3 and 4) problems across different age intervals. In Figures 1 and 3, each dot represents the mean internalizing or externalizing score for children with a history of physical abuse, while triangles represent those without such history, at specific age intervals (x-axis represents age interval, with 'x' indicating ages x to x+2). The connecting lines between the points provide a visual representation of differences. Notably, asterisks indicate significant disparities in internalizing or externalizing scores between children with and without physical abuse, highlighting sensitive periods for the manifestation of internalizing or externalizing problems. Figures 2 and 4 complement Figures 1 and 3 by presenting the effect sizes and displaying the coefficient estimates with 95% Confidence Intervals corresponding to each age interval. The error bars represent statistical significance, with non-zero bars indicating significant effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote 2.\u003c/strong\u003e Our analysis, which includes gender and ethnicity variables, aims to foster a comprehensive understanding rather than marginalize or exclude specific groups. However, for clarity in visualization, these figures only presents data pertaining to the reference group, consisting of white males without any history of other types of abuse. Our baseline cohort in analyses comprises white males devoid of any history of physical abuse or other forms of abuse.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/3fd7a00a46e137594aef8cdc.png"},{"id":60186684,"identity":"3fc8329b-7267-490c-930b-0592b7f34fde","added_by":"auto","created_at":"2024-07-12 18:59:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":858185,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/20d4341d-f861-4a46-9756-90b42fb7375b.pdf"},{"id":60185795,"identity":"f99bb695-3bf1-4f3c-81bc-abb6ea90c79e","added_by":"auto","created_at":"2024-07-12 18:43:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14576,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/6519e2793c8ea20cce6d1014.docx"},{"id":60185801,"identity":"3a9f7470-80c7-46a1-8482-bf17a18fd71d","added_by":"auto","created_at":"2024-07-12 18:43:44","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19792,"visible":true,"origin":"","legend":"","description":"","filename":"061424supplementaltables1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4579176/v1/7e3f9fa09dd9b3e10acd502f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identifying Sensitive Periods for the Impact of Physical Abuse on Psychopathology Symptoms","fulltext":[{"header":"Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003ePhysical Abuse as a Major Risk Factor for Internalizing and Externalizing Problems\u003c/h2\u003e \u003cp\u003eTwo major strands of mental health problems are internalizing problems and externalizing problems. Internalizing problems refer to negative emotional experiences such as anxiety, depression, panic, and social withdrawal; externalizing problems refer to a series of extraverted behaviors in which individuals respond negatively to the external environment, such as high aggression and disobedience (Achenbach et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Empirical studies have shown that internalizing and externalizing problems significantly negatively impact children's personal growth and social adaptation. Specifically, children with high levels of internalizing and externalizing problems are more likely to have maladaptive problems such as difficulty in peer interaction, academic problems, and psychological disorders (Jia et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Hu et al., 2023).\u003c/p\u003e \u003cp\u003eOne of the main risk factors for children's internalizing and externalizing problems is childhood maltreatment (Liu et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Oshri et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Huh et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Among the different types of maltreatment, children are especially likely to experience physical abuse (i.e., violent acts executed by caregivers that cause physical harm to children through beating, biting, burning, and other hostile actions; Stoltenborgh et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) due to a chain reaction between children's personal attributes, atmosphere of family environment, and sociocultural factors, according to Bronnfenbrenner's (2006) ecological theory of human development.\u003c/p\u003e \u003cp\u003ePhysical abuse is associated with a higher likelihood of internalizing problems. as it heavily disrupts the operation and development of stress control-related neural circuits in cortical limbic layers (Zhu et al, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), thereby weakening children's ability to cope with environmental adverse conditions, making them more likely to develop internalizing problems (Malave et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Yoon et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Benedini et al., 2018). Also, as suggested by emotional security theory, exposure to physical abuse reduces children's level of trust in the safety of the family environment, which causes them to develop increased anxiety and depression (Davies \u0026amp; Cummings, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1994\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eExperiences of physical abuse are also linked to a higher likelihood of developing externalizing issues, such as aggression and delinquency (Haahr-Pedersen, 2021; Lansford et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Loeber et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), risky sexual behaviors (Yoon et al, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and substance abuse (Benedini et al., 2018). This association stems from the negative neurological impact of physical abuse on an individual's ability to control attention, as well as increased challenges in managing emotions and behaviors (Zhang et al., 2024). Also, children who have experienced physical abuse are more likely to rationalize and internalize violence, which results in the adoption of aggressive behaviors themselves (Bozzay et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Bandura, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1978\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSensitive Periods for Physical Abuse\u003c/h2\u003e \u003cp\u003eDespite extensive discussions about how physical abuse impacts internalizing and externalizing problems, few studies have explored how the timing of such abuse might influence its effects. Moreover, these studies often suffer methodological limitations, and the findings they reach are mixed. To address these challenges, this study aims to more fully and accurately identify sensitive periods across childhood during which children are more vulnerable to the impact of physical abuse.\u003c/p\u003e \u003cp\u003eSensitive periods refer to specific times during development when exposure to certain stimuli or experiences has a more profound impact than at other times, presumably influencing long-term outcomes (Kuh et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). These periods signify unique interactions between the timing of exposure and developmental effects. Neuroscience studies explained why physical abuse experiences during sensitive periods have more profound effects than during other times. Neural circuits are particularly susceptible to the influence of experiences during sensitive periods when the circuits are maturing. The molecular and cellular mechanisms facilitating neural plasticity during a sensitive period exhibit heightened activity, enabling circuits to be modified greatly in response to experiences such as physical abuse (Knudsen et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Specifically, children who are physically abused during sensitive periods experience a pattern of cortisol suppression in situations of stress that causes them to develop stronger internalizing problems (Hart et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). They are also likely to experience atypical alterations in the volume and activity of the prefrontal cortex, amygdala, and hippocampus, which increases their externalizing problems (McCrory et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSensitive periods are not just \u0026ldquo;windows of vulnerability or susceptibility\u0026rdquo; when physical abuse exposure has an increased likelihood of negative consequences on individual development, but also \u0026ldquo;windows of opportunity\u0026rdquo; during which clinical interventions may provide maximal benefits to minimize or preempt long-term consequences of childhood adversity (Zhu et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Heim et al., 2012). Therefore, identifying sensitive periods has significant practical implications for clinical intervention, such as deciding on which populations to distribute more resources on and when.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInconsistent Findings on How Timing Affects the Effect of Physical Abuse\u003c/h2\u003e \u003cp\u003eA growing number of studies are examining how the timing of physical abuse affects children's well-being. However, most of them primarily concentrate on the onset of abuse\u0026mdash;the initial exposure to abuse. This study aims to investigate sensitive periods by focusing on the timing of each abuse occurrence, rather than just the onset. Although there is an increasing interest in the sensitive periods of maltreatment such as physical abuse, the research remains limited and has yet to reach a consensus on when these sensitive periods are.\u003c/p\u003e \u003cp\u003eIn terms of internalizing problems, some studies found early childhood to be a time when the occurrence of maltreatment has a stronger effect. For example, Keiley and colleagues found that children who were maltreated earlier in life (before 5 years old) consistently showed more internalizing problems, compared with those experiencing maltreatment in later stages (5\u0026ndash;14 years old; Keiley et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Thompson and colleagues found that maltreatment experiences before 4 significantly predicted the severity and growth of children's internalizing problems (Thompson \u0026amp; Tabone, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Moss and colleagues found that children who experienced physical abuse for the first time between age 1 and 4 had significantly higher internalizing problems (Moss et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBut other studies reported sensitive periods for maltreatment influencing internalizing problems to be scattered across middle and late childhood. For example, M\u0026eacute;ndez Leal et al. (2020) found that puberty was a sensitive period during which efforts to intervene and recalibrate internalizing problems could be maximized. Stevens et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) found evidence suggesting that there is a sensitive period around age 10 during which children are particularly vulnerable to maltreatment.\u003c/p\u003e \u003cp\u003eIn terms of externalizing problems, some studies found that sensitive periods of maltreatment occurred during early childhood. For example, Dunn et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) found that children whose first experience of physical abuse took place in early childhood had more severe externalizing problems. Sadeghi Bahamani et al. (2016) found that individuals abused before age 5 developed higher levels of externalizing behaviors.\u003c/p\u003e \u003cp\u003eHowever, other studies found that sensitive periods for maltreatment influencing externalizing problems take place during middle childhood or adolescence. For example, Yoon (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) found that age 11.5 was a sensitive period with the most prominent effect of maltreatment on externalizing problems. Keiley et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) found that children who were abused after age 5 showed a more rapid increase in their externalizing problem.\u003c/p\u003e \u003cp\u003eMoreover, the varied findings that suggest either early childhood or later stages as sensitive periods are further complicated by studies reporting gender differences in these periods or even suggesting the absence of sensitive periods altogether. Dunn et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found age 9 was a sensitive period for harsh physical discipline among girls while age 5 was a sensitive period among boys. Zhang and Marshall (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that puberty was a unique sensitive period for trauma-related violent behavior among women, whereas any time during or prior to puberty predicted men\u0026rsquo;s increased violent behavior in adulthood. Furthermore, adding to the confusions, some also reported no sensitive periods. Edwards et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) analyzed the effect of timing of parental physical abuse and found that there was no significant difference between adolescents abused at different developmental stages in terms of increase in their risks of externalizing problems. Duprey et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that compared with the timing of occurrence, chronicity of maltreatment is more predictive of children\u0026rsquo;s internalizing and externalizing problems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMethodological Limitations of the Previous Studies\u003c/h2\u003e \u003cp\u003eThe observed inconsistency in research findings could be attributed, in part, to variations in childhood adversity, ranging from harsh physical discipline to physical abuse. Furthermore, the use of rudimentary methods for assessing the timing of exposure was a major methodological limitation (Khan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Schaefer et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSpecifically, many earlier studies that investigated sensitive periods related to physical abuse or other forms of maltreatment oversimplified the timing of exposure. They often divided childhood \u0026mdash;or portions of it\u0026mdash;into just early and late periods, using a dichotomous division, or grouped subjects into a few developmental stages, using a polytomous division. For example, studies that employed dichotomous divisions in studies include Moss and colleagues\u0026rsquo; (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) study, which divided early childhood into age groups of 0\u0026ndash;1 and 1\u0026ndash;4 years old, Keiley and colleagues\u0026rsquo; (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) study, which split childhood into 0\u0026ndash;5 and 5\u0026ndash;14 years old, and Thompson and colleagues\u0026rsquo; (2010) study, which categorized childhood into 0\u0026ndash;4 and 5\u0026ndash;10 years olds. Examples of polytomous studies include Dunn and colleagues\u0026rsquo; (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) study which divided childhood into four categories: very early (0 to 3 years old), early (4 to 5 years old), middle (5 to 7 years old), and late (8 to 10 years old). Similarly, Kaplow (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) also divided childhood into four categories: infancy (from 0 to 2 years old), preschool (from 3 to 5 years old), early school (from 6 to 8 years old), and late school (from 9 to 11 years old).\u003c/p\u003e \u003cp\u003eThese approaches that collapse the timing of abuse occurrences into either dichotomous or polytomous categories have been found inadequate in identifying sensitive periods (Khan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Schaefer et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) for two main reasons. Firstly, neuroimaging research indicates that sensitive periods for maltreatment may be extremely brief and scattered across childhood (Choi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Tomoda et al., 1993) and thus, are not fully captured by dividing exposure time into a few categories (Khan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Secondly, studies in neuroscience suggest the existence of both early and late windows of vulnerability. Although the sensitive periods for most lower-level neural circuits conclude before age 12, for certain higher-level circuits, these periods persist into adulthood (Knudsen et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Consequently, there is a need for more sophisticated methods to accurately identify potentially brief and multiple sensitive periods across different stages of development.\u003c/p\u003e \u003cp\u003eTo resolve the limitations mentioned above, this study takes a more granular approach of reflecting timing of abuse occurrence. This approach will be introduced in the \u003cspan refid=\"Sec6\" class=\"InternalRef\"\u003eMethods\u003c/span\u003e section in detail. Adopting this approach, this study aims to answer the following research questions:\u003c/p\u003e \u003cp\u003eRQ1: What are the sensitive periods, if any, between age 4 and 17 with a stronger impact of physical abuse on internalizing problems?\u003c/p\u003e \u003cp\u003eRQ2: What are the sensitive periods, if any, between age 4 and 17 with a stronger impact of physical abuse on externalizing problems?\u003c/p\u003e \u003cp\u003eThis investigation controls for demographic factors (e.g., gender, ethnicity) and other forms of abuse (i.e., sexual abuse, emotional abuse/neglect and drug).\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Procedure\u003c/h2\u003e \u003cp\u003eThe Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) recruited children at varying levels of risk of maltreatment and followed them into adulthood. The datasets contain variables collected from the children, their caregivers, teachers, and Child Protective Services (CPS) and Central Registry records. Children were enrolled when they were 4 years old or younger, and in-depth face-to-face interviews with the child and their primary caregiver were conducted at ages 4, 6, 8, 12, 14, 16, and 18.\u003c/p\u003e \u003cp\u003eThe LONGSCAN samples included five pooled cohort samples, each with different selection criteria, representing varying levels of risk or exposure to maltreatment. Five sites included the East (EA), Midwest (MW), Northwest (NW), Southwest (SW) and South (SO), each site recruited between 245 and 330 children and collected a common set of measures as well as some measures that were specific to each site\u0026rsquo;s objectives. Different selection criteria were used: three of the sites (EA, SO, SW) recruited their samples from pre-existing samples of high-risk children who had been followed between birth and 18 months of age. The MW sample consisted of three groups of newly recruited 3- to 18-month-old infants from families reported to CPS, half of which received comprehensive services and the other half received CPS intervention only. The NW sample was drawn from a pool of children, aged 0 to 4, who were judged to be at moderate risk following a report to Child Protective Services for suspected child maltreatment.\u003c/p\u003e \u003cp\u003eThe LONGSCAN baseline sample consisted of 1,354 children. In the current study, participants with \u0026lsquo;other\u0026rsquo; ethnicity were removed from the sample (leaving N\u0026thinsp;=\u0026thinsp;1,333 participants), as one of our main focuses was to tease out the effect of race in problematic behaviors. The data collected from age 18 was removed as the sample size for this wave was too small. Among the sample, 51% were female, 54% were Black, 27% were Caucasian, 12% were mixed race, and 7% were Hispanic. A flowchart of the complete sampling procedure is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eIn terms of the measures, several instruments, including questionnaires and interviews, were used. Face-to-face interviews were conducted (or planned) with primary caregivers and children at ages 4, 6, 8, 12, 14, 16, and 18. The measures from the interviews were primarily related to child maltreatment, risk and protective factors, health, school performance, and behavior problems. Beginning at age 6, information about children\u0026rsquo;s academic performance and social adjustment were collected from their teachers. Periodically, Child Protective Services case narratives and Central Registry records were reviewed. Brief, yearly telephone contacts were initiated with the caregivers to enhance subject retention and collect data about service utilization, life events, and child behavior problems.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTiming of Physical Abuse Exposure.\u003c/b\u003e In terms of the maltreatment measure, maltreatment history was coded through the Modified Maltreatment Classification System (MMCS; Barnett et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1993\u003c/span\u003e; English et al., 1998), obtaining both allegations and substantiations. The MMCS has been used extensively in coding maltreatment data across studies and accepted as a reliable classification of maltreatment experiences based on CPS records (Dubowitz et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; English et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Litrownik et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The present study used the code from the allegation narrative rather than the substantiation narrative because the former usually provides more explicit information about the child\u0026rsquo;s actual experiences compared to the CPS label (Jones et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Using this dataset, eight binary variables were constructed to indicate whether participants experienced physical abuse during specific age intervals. For instance, the indicator variable \"HasPhyAbuAge_4\" represents exposure to physical abuse between the ages of 4 and 6, covering ages 4 and 5, with a value of 1 denoting exposure and a value of 0 indicating no exposure. For a detailed explanation on the construction of these indicator variables, please refer to the \u003cspan refid=\"Sec17\" class=\"InternalRef\"\u003e\u003cb\u003eAppendix\u003c/b\u003e\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInternalizing and externalizing behavior problems.\u003c/b\u003e Internalizing and externalizing behavior problems were assessed through Child Behavior Checklist/4\u0026ndash;18 (CBCL 4\u0026ndash;18). CBCL is a well-established measure of child internalizing and externalizing problems. A child\u0026rsquo;s CBCL score is determined by how their caregivers indicate the extent to which each of 113 behaviors is characteristic of the child. Scoring includes raw and standardized (T-scores) versions for two broadband groupings of symptoms (internalizing and externalizing). T-scores were utilized for the current study. T-scores of 60 and lower for internalizing are considered normal, 60\u0026ndash;63 is considered borderline, and scores greater than 63 are in the clinical range. CBCL has good psychometric properties with regard to test-retest reliability, inter-rater agreement, and validity (Achenbach et al., 1991).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eTo identify sensitive periods of physical abuse on affecting internalizing and externalizing problems among children aged between 4 and 17, we used statistical methods to control for factors like gender, ethnicity, and other types of maltreatment such as sexual abuse.\u003c/p\u003e \u003cp\u003eInstead of utilizing the original variable tracking physical abuse that varied with age from 4 to 17, we employed a multi-part method to construct variables (see \u003cspan refid=\"Sec17\" class=\"InternalRef\"\u003e\u003cb\u003eAppendix\u003c/b\u003e\u003c/span\u003e for details). These derived variables enabled us to investigate how the presence or absence of physical abuse at different age intervals contributed to the variability observed in internalizing and externalizing problems across ages 4 to 17 with a two-year interval. By examining the coefficients associated with these variables, we gained valuable insights into the nature and magnitude of these relationships, offering nuanced perspectives on the developmental trajectories of psychological outcomes, including considerations of both the timing of physical abuse.\u003c/p\u003e \u003cp\u003eMoreover, we employed growth curve models that incorporated linear and quadratic terms of the age interval variable, with internalizing and externalizing problems serving as outcome variables. This analytical framework also included control variables such as gender, ethnicity, and other forms of abuse. By leveraging these models, we were able to comprehensively explore the developmental trajectories of internalizing and externalizing problems, while simultaneously accounting for the influence of physical abuse across various age intervals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Statistics\u003c/h2\u003e \u003cp\u003eThe dataset encompasses a longitudinal design, comprising 7,222 level-1 observations. These observations span multiple time points, capturing the developmental trajectory across various ages for 1,333 children at level 2. Regarding the distribution of observations per child, the cluster sizes range from 1 to 7, with a mean of 5.37. Supplemental Table\u0026nbsp;1 presents descriptive statistics for continuous variables, while Supplemental Table\u0026nbsp;2 displays the percentage distribution of categorical explanatory variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSensitive Periods of Physical Abuse\u003c/h2\u003e \u003cp\u003eIn this section, we present our findings regarding sensitive periods concerning physical abuse and its influence on internalizing and externalizing problems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eInternalizing Problems Results\u003c/h2\u003e \u003cp\u003e \u003cb\u003eBaseline Concave Trend.\u003c/b\u003e The Growth Curve Model (GCM) analysis revealed a significant linear increase and quadratic decrease in internalizing problems across the investigated age range (β\u003csub\u003eAGEYRS since 4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.66 and β\u003csub\u003e(AGEYRS since 4)\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e= -0.07, both with p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, as presented in Supplemental Table\u0026nbsp;3), while controlling for gender, ethnicity, and other forms of abuse. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the mean internalizing scores for baseline children, indicating a concave trend characterized by an initial increase from ages 4 to 8, followed by a decline from ages 10 to 16.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSensitive Periods.\u003c/b\u003e Our analyses revealed significant associations between physical abuse and internalizing problems at specific ages, after controlling for gender, ethnicity, and other forms of abuse. Notably, exposure to physical abuse at ages 8\u0026ndash;10, 14\u0026ndash;16, and 16\u0026ndash;17 was significantly linked with heightened internalizing problems. Coefficients for physical abuse at age 8\u0026ndash;10 (β\u0026thinsp;=\u0026thinsp;3.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), age 14\u0026ndash;16 (β\u0026thinsp;=\u0026thinsp;3.27, p\u0026thinsp;=\u0026thinsp;0.002), and age 16\u0026ndash;17 (β\u0026thinsp;=\u0026thinsp;7.67, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) indicated substantial increases in internalizing problems. Figures\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e provide a visual representation of the mean differences in internalizing levels between children with and without physical abuse, with the most pronounced differences observed at age 16\u0026ndash;17, highlighting the significant impact of physical abuse during this developmental period.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eExternalizing Problems Results\u003c/h2\u003e \u003cp\u003e\u003cb\u003eBaseline Convex Trend.\u003c/b\u003e Our analysis revealed a significant linear decrease and quadratic increase in externalizing problems across the investigated age range (β\u003csub\u003eAGEYRS since 4\u003c/sub\u003e = -0.41 and β\u003csub\u003e(AGEYRS since 4)\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.02 both with p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, as presented in Supplemental Table\u0026nbsp;3), while controlling for gender, ethnicity, and other forms of abuse. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates a convex trend for mean externalizing scores among baseline children, characterized by an initial decrease from ages 4 to 12, followed by a steadier increase from ages 14 to 16.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSensitive Periods.\u003c/b\u003e Significant associations between physical abuse and externalizing problems at specific ages were revealed by our analyses, after controlling for gender, ethnicity, and other forms of abuse. Exposure to physical abuse at ages 6\u0026ndash;8, 8\u0026ndash;10, 12\u0026ndash;14, and 14\u0026ndash;16 was significantly linked to heightened externalizing problems, as indicated by coefficients for physical abuse at age 6\u0026ndash;8 (β\u0026thinsp;=\u0026thinsp;1.80, p\u0026thinsp;\u0026lt;\u0026thinsp;0.016), age 8\u0026ndash;10 (β\u0026thinsp;=\u0026thinsp;2.81, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), age 12\u0026ndash;14 (β\u0026thinsp;=\u0026thinsp;1.54, p\u0026thinsp;=\u0026thinsp;0.048), and age 16\u0026ndash;17 (β\u0026thinsp;=\u0026thinsp;2.20, p\u0026thinsp;=\u0026thinsp;0.001). These findings underscored sensitive periods for the manifestation of externalizing problems. Notably, Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates that the effect size of 14-16-year-olds was the most significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eUsing the growth curve model and a devised variable construction approach, this study identifies different trajectories of pathological development: internalizing problems increased from age 4 to 8 and decreased afterward, presenting an inverse U-shaped curve; externalizing problems declined from age 4 to 12 and slightly increased afterward, which yielded a U-shaped curve. This finding aligns with previous studies that reported varied trajectories for internalizing and externalizing problems (Kim et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Godinet et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main conclusion of the study is that late childhood (8\u0026ndash;10 years) and adolescence (14\u0026ndash;16 and 16\u0026ndash;17 years) are sensitive periods when physical abuse impacts internalizing issues. Additionally, middle to late childhood (6\u0026ndash;8 and 8\u0026ndash;10 years) and adolescence (12\u0026ndash;14 and 14\u0026ndash;16 years) are sensitive periods when physical abuse affects externalizing problems. The intervals of 8\u0026ndash;10 and 14\u0026ndash;16 years old are sensitive periods for both internalizing and externalizing issues, although there are distinct sensitive periods unique to each type of problem.\u003c/p\u003e \u003cp\u003eThese findings on sensitive periods for internalizing problems are consistent with previous studies showing that ages 14\u0026ndash;15 and 16\u0026ndash;17 (Khan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Gerke et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) to be a sensitive period during which maltreatment maximally worsened children\u0026rsquo;s internalizing problems, and that initial exposure to physical abuse between age 6 and 10 have stronger effects on children's internalizing problems (Dunn et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese findings on externalizing problems are also consistent with earlier studies, which have shown that children abused after age 5 exhibit a more rapid increase in externalizing problems (Keiley et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Additionally, the ages of 11.5 and the period between 14\u0026ndash;16 years old (Yoon et al., 2020; Andersen et al., 2019) have been identified as the most sensitive times for physical abuse to impact externalizing problems.\u003c/p\u003e \u003cp\u003eSeveral factors explain why late childhood (8\u0026ndash;10 years) and adolescence (14\u0026ndash;16 and 16\u0026ndash;17 years) are sensitive periods during which physical abuse impacts internalizing issues. Neurologically, between the ages of 8.4 and 10, there is typically less thinning in the orbital frontal cortex, which correlates with an increase in internalizing problems (Whittle et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). During adolescence, particularly between 14 and 17 years, alterations in the volumes of the putamen and caudate are observed, which are associated with diminished emotion processing capabilities and heightened general anxiety (Lago et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additionally, this period is marked by enhanced amygdala function, leading to elevated internalizing problems (Teicher et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Moreover, this phase experiences rapid, significant shifts in the hypothalamic-pituitary-gonadal (HPG) axis, disrupting the secretion of testosterone in males and estradiol in females, thereby exacerbating internalizing issues (Walker et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). These neurodevelopmental changes provide a biological foundation for the heightened vulnerability to internalizing problems following physical abuse during late childhood (8\u0026ndash;10 years) and adolescence (14\u0026ndash;16 and 16\u0026ndash;17 years).\u003c/p\u003e \u003cp\u003eOur findings regarding intervals of 8\u0026ndash;10 and 14\u0026ndash;16 years old being sensitive periods for externalizing problems are also supported by a body of neurological research that elucidates the mechanisms underlying the development of these issues. This research spans various aspects of brain development and hormonal changes that coincide with these sensitive periods. Studies have shown that physical abuse exacerbates externalizing problems through triggering atypical development of the hypothalamic-pituitary-adrenal (HPA) axis which matures between age 6 and 9, with adrenarche beginning in late childhood but continuing to rise throughout adolescence. McCrory and colleagues (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) highlight that adolescence is a critical period characterized by atypical development in the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal (HPA) axis and changes in the volume and activity of key brain regions such as the prefrontal cortex, amygdala, and hippocampus. These neurobiological alterations increase the risk of externalizing problems during this developmental stage. Adding to this, Blakemore and colleagues (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) found that adrenal androgens, including dehydroepiandrosterone and its sulfate, begin to increase between ages 6 to 9, continuing to rise through adolescence until peaking at age 20. This hormonal surge corresponds with the onset and progression of externalizing behaviors. Byrne and colleagues (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) provided further insight by associating adrenarche, an early phase of pubertal development, with a rapid increase in androgen levels secreted by the adrenal cortex, which they linked to a higher risk of developing externalizing problems. Additionally, Sisk and Foster (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) observed that gonadarche, which typically begins between ages 9 and 11, involves the reactivation of the hypothalamic-pituitary-gonadal (HPG) axis, a process integral to puberty and related behavioral changes. Finally, Andersen and colleagues (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) contribute to this narrative by demonstrating how brain structure responds to early life experiences. They found that hippocampal volume was most strongly affected by abuse occurring between ages 3 and 5, and again between 11 and 13 years old. Moreover, they noted that the area of the corpus callosum was impacted by abuse at ages 9\u0026ndash;10, and changes in the frontal cortex were linked to abuse during ages 14\u0026ndash;16.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified a series of sensitive periods across childhood during which children\u0026rsquo;s internalizing and externalizing problems were more severely impacted by physical abuse. By adopting a novel, granular approach, this study successfully identified brief sensitive periods overlooked by studies segmenting developmental stages into broader categories. Practically speaking, our findings contribute to better capturing how the timing of physical abuse impacts children\u0026rsquo;s pathological development, such that targeted interventions could be implemented during the windows of maximal opportunity. Theoretically speaking, this study provides additional support for extant neurological studies that elucidate mechanisms of neurodevelopmental changes and hormonal fluctuations that contribute to the heightened vulnerability during these sensitive periods.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eX.X. and Y.L. wrote primarily the Results and Methods sections. L.Z. and Y.C. wrote primarily the Introduction, Discussion, and Conclusion sections. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data that support the findings of this study are publicly accessible at the National Data Archive on Child Abuse and Neglect (https://www.ndacan.acf.hhs.gov/datasets/dataset-details.cfm?ID=170).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAchenbach TM, Edelbrock C (1991) Child Behavior Checklist. Burlingt (Vt) 7:371\u0026ndash;392\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAchenbach TM, Ivanova MY, Rescorla LA, Turner LV, Althoff RR (2016) Internalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications. 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Mol Psychiatry. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41380-023-02002-5\u003c/span\u003e\u003cspan address=\"10.1038/s41380-023-02002-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"physical abuse, internalizing behavior problem, externalizing behavior problem, growth curve analysis","lastPublishedDoi":"10.21203/rs.3.rs-4579176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4579176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eExtant research lacks completeness and accuracy in identifying the timing of sensitive periods for physical abuse across childhood. Utilizing data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) following more than one thousand children from early childhood into adulthood, the present study employed a novel, granular approach to indicate physical abuse timing, develop growth curve models that incorporated linear and quadratic terms of the age variable, and more completely and accurately revealed sensitive periods for physical abuse. Results showed that late childhood (8\u0026ndash;10 years) and adolescence (14\u0026ndash;17 years) are sensitive periods when physical abuse more severely impacts internalizing issues. Additionally, middle to late childhood (6\u0026ndash;10 years) and adolescence (12\u0026ndash;16 years) are sensitive periods when physical abuse more severely impacts externalizing problems. Overall, this study provides empirical support for theories of sensitive periods across childhood and offers valuable reference for mental health workers to timely intervene.\u003c/p\u003e","manuscriptTitle":"Identifying Sensitive Periods for the Impact of Physical Abuse on Psychopathology Symptoms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 18:43:39","doi":"10.21203/rs.3.rs-4579176/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2b7edfc-4e16-4d09-a5b6-6f4e091864f0","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-12T18:43:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-12 18:43:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4579176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4579176","identity":"rs-4579176","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}