Prospective vs Retrospective Assessments

Retrospective recall and prospective observation of childhood adversity: challenges and opportunities in their use in health and aging research

This workgroup is organized to improve the sensitivity and specificity of ascertainment of early adversity in relation to both incidence of ill health as well as clinical course and response to treatment. With respect to incidence we ask two questions. First, what is the relationship between prospectively and retrospectively ascertained cohorts? That is, are these largely the same cohorts or do these two methods define two separate groups of individuals both of which may be at risk but for different reasons? Second, for adults, how can we ascertain a history of adversity among adults who do not report it and, correspondingly, can we identify adults who believe they have suffered adversity but where there is a very substantial chance that they have not?

We also seek to understand the effects of early adversity on clinical course as well as adversity's effect on response to treatment for established illness. With this group there are three distinctive problems. First, they are already ill; might that circumstance enhance bias in retrospective reporting? Second, prospective studies will be uniquely difficult to conduct because of the relative rarity of any specific illness whose course and treatment are of interest. Third, clinical course and response to treatment may reflect, in very large measure, behavioral and personality features relevant to self-care, adherence to medical regimens and health behaviors more generally. For example, a large, prospectively ascertained sample showed that early child maltreatment anticipates drug addiction in adulthood via a mediating path defined by prostitution, homelessness, delinquency and school problems. Are there aspects of early adversity uniquely linked to these adverse behavioral sequelae and do they pose special problems in their ascertainment? We seek approaches and strategies to address these dilemmas. For example, are there ways to leverage large-scale prospective studies to focus on more adequate ascertainment of the timing of onset of illness in relation to retrospective reports of childhood adversity?

Mini-project

Mapping the overlap between experiences and memories of childhood adversity and their impact on health