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PubMedDate not supplied

Malnutrition, nutritional indices, and early enteral feeding in critically ill children.

We measured the incidences of protein and fat depletions and the frequencies of acute and chronic protein-energy malnutrition during stress states in children and investigated the influence of early enteral feeding on nutrition indices and acute-phase proteins. Seventy-one, consecutively enrolled, critically ill children received early enteral feeding (energy intakes equal to 0.50, 1, 1.25, 1.5, and 1.5 of the predicted basal metabolic rates on days 1 through 5, respectively) through nasogastric tubes. On the first day of the study, 16.7% of the patients already were depleted of protein and 31% of fat stores. Overall, 16.9% were at risk for chronic protein-energy malnutrition and 21.1% for acute protein-energy malnutrition, whereas 4.2% and 5.6% already had chronic and acute, respectively protein-energy malnutrition. Only 22.7% of patients without protein deficiencies versus 37% of those at risk or already deficient developed multiple-organ system failure. Transferrin and prealbumin levels improved at the end of the period of early enteral feeding (187 +/- 6.6 versus 233 +/- 7 mg/dL, P < 0.0001; 15.1 +/- 2 versus 21.9 +/- 2.9 mg/dL, P < 0.0001; respectively); survivors had higher prealbumin levels than non-survivors (22.3 versus 15.5 mg/dL). With logistic regression analysis, only repleted energy, not anthropometric or nutrition indices, was independently associated with survival (P = 0.05). These results reinforce the observation that critically ill children are at risk for fat or protein depletion and development of malnutrition, which is associated with increased morbidity and mortality. We conclude that early enteral nutrition improves nutrition indices and outcomes.

Acute-Phase Proteins↗
PubMed1999

Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae.

During the past 10 years nearly 80 studies on disorganized attachment involving more than 6,000 infant-parent dyads have been carried out. The current series of meta-analyses have established the reliability and discriminant validity of disorganized infant attachment. Although disorganized attachment behavior is necessarily difficult to observe and often subtle, many researchers have managed to become reliable coders. Furthermore, disorganized attachment shows modest short- and long-term stability, in particular in middle class environments, and it is not just a concomitant of constitutional, temperamental, or physical child problems. The predictive validity of disorganized attachment is established in terms of problematic stress management, the elevated risk of externalizing problem behavior, and even the tendency of disorganized infants to show dissociative behavior later in life. In normal, middle class families, about 15% of the infants develop disorganized attachment behavior. In other social contexts and in clinical groups this percentage may become twice or even three times higher (e.g., in the case of maltreatment). Although the importance of disorganized attachment for developmental psychopathology is evident, the search for the mechanisms leading to disorganization has just started. Frightening parental behavior may play an important role but it does not seem to be the only causal factor involved in the emergence of disorganized attachment.

Adolescent↗
PubMed2004

Associations between parental and child attachment representations.

In the present article on intergenerational transmission of attachment representations, we use mothers' and fathers' Adult Attachment Interview classifications to predict a 3-year-old's responses to the Attachment Story Completion Task (ASCT). We present a Q-sort coding procedure for the ASCT, which was developed for children as young as three. The Q-sort yields scores on four attachment dimensions (security, deactivation, hyperactivation, and disorganization). One-way ANOVAs revealed significant mother-child associations for each dimension, although results for the hyperactivation and disorganization dimensions were significant only according to contrast tests. Conversely, no father-child association was found, regardless of the dimension considered. Findings are discussed in terms of the respective part played by each parent in their children's emotional development.

Adult↗
PubMed2002

Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood.

BACKGROUND: The past 10 years have seen a fruitful line of enquiry building on identification of previously unclassifiable patterns of infant-mother interaction. A critical review of these new findings in attachment theory, highlighting their potential relevance to child psychopathology, is presented. METHOD: Selective literature review relating to disorganised attachment in childhood. RESULTS: Disorganised patterns of attachment have only relatively recently been described. They show characteristic patterns of evolution in development. There is evidence that disorganised attachments are associated with specific forms of distorted parenting, which are distinct from general parental insensitivity and are associated with unresolved loss or trauma in the caregiver. There are also links with aspects of neurodevelopment vulnerability in the child. Attachment disorganisation is a powerful predictor of a range of later social and cognitive difficulties and psychopathology. CONCLUSIONS: The identification of disorganised attachment has greatly increased the potential relevance of attachment theory to general clinical work. However, the concept raises many methodological and theoretical issues. Among issues needing further exploration is the way in which attachment disorganisation relates to children's general mental states and may be affected by cognitive functioning and developmental impairment.

Adolescent↗
PubMed2000

On the vicissitudes of early primary surrogate mothering II: loss of the surrogate mother and arrest of mourning.

Among the catastrophic events experienced by infants and young children, one of the most frequent is the loss of an early primary surrogate mother (EPSM). Usually permanent, the loss is often followed by the advent of a new, "replacement" caregiver. One aspect of the emotional environment is unique to this kind of caregiving situation: that parents are often unable to validate the true nature of their child's relationship with the EPSM or, ultimately, the trauma experienced by the child when the EPSM leaves. The marked discrepancy between the parent's and the infant or child's experience of the surrogate mothering leads to an arrest of the child's mourning process, with the potential for serious developmental consequences. Issues related to EPSM loss and its aftermath are examined in the light of two examples. Further exploration of the environment of this kind of caregiving directs attention to the critical need to nurture and protect the attachments of both the infant or child and the parent to the ESPM.

Adult↗
PubMed2004

Psychoeducational treatment of children with autism and reactive attachment disorder.

The aim of the study was to evaluate and compare the efficacy of short-term psychoeducational treatment in children with autism and reactive attachment disorder (RAD). Ten boys with autism aged 24-66 months and 11 children with RAD (nine boys and two girls) aged 30-70 months were included in the study. The Ankara Developmental Screening Inventory was used to monitor progress following a 14-session psychoeducational programme. This focused on establishing a reciprocal-dyadic interaction between children and their caregivers and it also provided an educational programme for emotional, social, and language development. Although both groups showed significant changes on all scales of the ADSI, the children with RAD showed greater improvement than the autism group in their total development score, on the language-cognitive subscale, and in social/self-care abilities.

Autistic Disorder↗
PubMed2000

Attachment and borderline personality disorder.

The author outlines his concept of reflective function or mentalization, which is defined as the capacity to think about mental states in oneself and in others. He presents evidence to suggest that the capacity for reflective awareness in a child's caregiver increases the likelihood of the child's secure attachment, which in turn facilitates the development of mentalization in the child. He proposes that a secure attachment relationship offers the child a chance to explore the mind of the caregiver, and in this way to learn about minds; he formulates this model of the birth of the psychological self as a variation on the Cartesian cogito: "My caregiver thinks of me as thinking and therefore I exist as a thinker." This model is then applied to provide insight into some personality-disordered individuals who were victims of childhood abuse. The author proposes (1) that individuals who experience early trauma may defensively inhibit their capacity to mentalize to avoid having to think about their caregiver's wish to harm them; and (2) that some characteristics of severe borderline personality disorder may be rooted in developmental pathology associated with this inhibition. He offers evidence for and some qualifications of this model, and argues that the therapeutic effect of psychoanalysis depends on its capacity to activate patients' ability to evolve an awareness of mental states and thus find meaning in their own and other people's behavior.

Adult↗
PubMedDate not supplied

Attachment and panic disorder.

A dysfunctional relationship between parents and children can influence cognitive and emotional development and contribute to the development of psychiatric disorders, particularly panic disorder (PD). With the aim of exploring childhood experiences of parenting in PD patients, we compared subjectively perceived climate and objective recall by administering the Parental Bonding Instrument and 10 adjunctive items to 22 out-patients and 22 matched controls. Our analysis showed that DSM-III-R-diagnosed PD patients reported their parents to be significantly less caring than did the control group, while there was no significant difference in objective recall of parenting experiences.

Adult↗
PubMed1991

'Schizoid' personality in childhood and adult life. III: The childhood picture.

The childhood case records of 32 'schizoid' children and 32 matched controls were analysed. 'Schizoid' children were characterised by solitariness, unusual fantasies, special interests, and specific developmental delays, especially of language-related skills. They were of average or above-average IQ, and half presented with other, common, child psychiatric syndromes. It is important to distinguish 'schizoid' children from children with reactive psychiatric disorders.

Adolescent↗
PubMed2004

Temperament and attachment disorders.

Reviewed in this article is research on children with reactive attachment disorder (RAD) who exhibit specific patterns of socially aberrant behavior resulting from being maltreated or having limited opportunities to form selective attachments. There are no data explaining why 2 different patterns of the disorder, an emotionally withdrawn-inhibited pattern and an indiscriminate-disinhibited pattern, arise from similarly aberrant environments. In this article, we consider whether temperamental differences might contribute to the different manifestations of reactive attachment disorder (RAD) in the context of adverse environments. Although the association between attachment and temperament has been studied extensively and has been the subject of spirited debate within the field of child development, there are no extant data on the influence of temperament on the development of attachment disorders. We consider possible directions for research efforts designed to explore the biological underpinnings of the complex phenomenon of attachment disorders.

Adolescent↗
PubMed1975

[Relationships between cerebral organic and reactive disorders in childhood and adolescence].

The causes of psychic disorders must not only be discerned either reactive or organic. The perception of stimuli from the environment, the experiences a child makes, are worked up in the brain, which functions can be divided into a lot of singular abilities. The observation of their organic conditioned disorders shows, how behavioral disorders and mislearning may develop and also, how they will be misunderstood and disapproved by the environment. This fact is as well an explanation for the formation of neuroses on the bottom of an organic brain disfunction as also for the origin of psychoses being secundary disturbances of the relation to reality, considered from a new point of view. Both, neuroses and psychoses originate in constellative interaction of brain organic and reactive factors.

Adolescent↗
PubMed2001

Attachment and depression. Implications for family therapy.

The preceding discussion highlights the use of attachment theory in conceptualizing the interface between normal development and the manifestation of depression from infancy through adolescence. Additional research is needed to delineate better the specific nature of the association between attachment relationships and depression, particularly with regard to factors that mediate and moderate the link. The extant literature informs family-oriented clinical interventions with depressed young people with comorbid attachment problems, with or without a depressed parent. These family interventions are most likely to be effective if they incorporate developmentally informed conceptualizations and techniques and are targeted specifically to the problems of depressed youth and their families. The efficacy of such interventions remains to be determined through the implementation of treatment efficacy and effectiveness studies.

Adolescent↗
PubMed2006

Reactive attachment disorder in maltreated twins follow-up: from 18 months to 8 years.

The best means for the diagnosis and treatment of reactive attachment disorder of infancy and early childhood have not been established. Though some longitudinal data on institutionalized children is available, reports of maltreated young children who are followed over time and assessed with measures of attachment are lacking. This paper presents the clinical course of a set of maltreated fraternal twins who were assessed and treated from 19 months to 30 months of age and then seen in follow-up at 3 and 8 years of age. A summary of the early assessment and course is provided and findings from follow-up assessments of the cognitive, behavioral, and interpersonal functioning of each child is analysed. Follow-up measures, chosen to capture social-cognitive processing of these children from an attachment perspective, are highlighted. Finally, findings from the case are discussed from nosological and theoretical perspectives.

Adoption↗