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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↗
PubMed1990

[The effect of the earthquake in Armenia on the mental health of the pediatric population of the damaged regions].

The authors relate neuropsychic disorders in children and adolescents of Armenia in the acute period and 3 months after the earthquake. The pathological disorders were dependent on the individual reactivity of the child and environmental factors. 3 months after the earthquake 31% of the examines demonstrated marked mental disturbances. The prevalence of mental pathology among the population groups living in the regions damaged by the earthquake demands organization of specialized assistance for the population.

Adolescent↗
PubMed1998

Dyadic psychotherapy for early relationship disorders: a case study.

Specific treatment modalities, such as dyadic psychotherapies, have emerged, based on the notion that in cases of very early relational disorders, the patient is the parent-infant relationship. The aim of this paper is to present a case study of such a relational disorder which took place as the result of a complex interplay between the infant's biological risk factors and the parents' psychological risk factors. The emphasis is on the technique and the course of the dyadic psychotherapy of the mother and her three-year-old child, where the main goal was to change some of the intrapsychic and interpersonal processes specifically related to pathological motherhood. The theoretical background is briefly presented, while emphasizing the criteria for choosing one approach among the different kinds of dyadic psychotherapy.

Adult↗
PubMed2002

Attachment disturbances in young children. II: Indiscriminate behavior and institutional care.

OBJECTIVE: To assess convergence among three different measures of indiscriminate behavior and to assess the relationship of indiscriminate behavior to having an attachment figure and to aggressive behavior among young children living in a Romanian institution. METHOD: Caregivers in the institution were interviewed with semistructured interviews regarding the behavior of 61 children with special emphasis on indiscriminate behavior. The study was conducted in Bucharest, Romania (1999). RESULTS: Substantial convergence among measures of indiscriminate behavior was demonstrated. Indiscriminate behavior was common whether or not these children had a preferred attachment figure. Indiscriminate behavior was independent of aggressive behavior. CONCLUSIONS: Differing explanations for indiscriminate behavior in young children derive from differing interpretations of similar findings rather than different findings with different measures. Indiscriminate behavior was largely independent of aggression in these institutionalized young children. Indiscriminate behavior may represent an independent problem rather than a type of reactive attachment disorder as suggested by DSM-IV criteria.

Aggression↗
PubMed2003

Challenges in treating post-traumatic stress disorder and attachment trauma.

Treating women suffering from trauma poses significant challenges. The diagnostic prototype of post-traumatic stress disorder (PTSD) is based on single-event trauma, such as sexual assault in adulthood. Several effective cognitive- behavioral treatments for such traumas have been developed, although many treated patients continue to experience residual symptoms. Even more problematic is the complex developmental psychopathology stemming from a lifetime history of multiple traumas, often beginning with maltreatment in early attachment relationships. A history of attachment trauma undermines the development of capacities to regulate emotional distress and thereby complicates the treatment of acute trauma in adulthood. Such complex trauma requires a multifaceted treatment approach that must balance processing of traumatic memories with strategies to contain the intense emotions this processing evokes. Moreover, conducting such treatment places therapists at risk for secondary trauma such that trauma therapists also must process this stressful experience and implement strategies to regulate their own distress.

Adult↗
PubMed2004

Plasma C-reactive protein levels among children with sleep-disordered breathing.

INTRODUCTION: Levels of C-reactive protein (CRP), an important serum marker of inflammation with major implications for cardiovascular morbidity and atherogenesis, are elevated among adult patients with sleep-disordered breathing (SDB). We hypothesized that elevated CRP plasma levels would also be present among children with SDB. METHODS: Eighty-one children (mean age: 9.3 +/- 3.7 years) underwent polysomnographic evaluations. Samples for plasma CRP level and lipid profile determinations were drawn the next morning. RESULTS: Because plasma CRP levels were not normally distributed in this cohort, logarithmic transformation was applied. Log plasma CRP levels were significantly higher in the SDB group (obstructive apnea/hypopnea index [AHI] of > or =5), compared with the mild SDB group (AHI of > or =1 and <5) and the control group (AHI of <1). Significant positive correlations were found between log CRP levels and AHI (r =.53) and arousal index (r =.28), whereas an inverse correlation was found between the lowest nocturnal arterial oxygen saturation and log CRP levels (r = -.47). These correlations persisted after exclusion of outliers. Moreover, 94% of the children with elevated log CRP levels reported excessive daytime sleepiness and/or learning problems, compared with 62% of the children with normal log CRP levels. CONCLUSIONS: Plasma CRP levels were increased among some children with SDB and were correlated with AHI, arterial oxygen saturation nadir, and arousal index measures. These changes were particularly prominent among children who were sleepy or presented with neurobehavioral complaints. The intermittent hypoxemia and sleep fragmentation of SDB may underlie inflammatory responses, the magnitude of which may ultimately lead to the cardiovascular, cognitive, and behavioral morbidities of SDB.

Analysis of Variance↗
PubMed2006

Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality.

BACKGROUND: Models of attention-deficit/hyperactivity disorder (ADHD) suggest developmental influences may feed into components of the disorder separately from associated disruptive behavior problems. We investigated this in terms of key personality/temperament traits of Reactive and Effortful Control, Resiliency, and Emotionality. METHODS: A sample of 179 children (age 6-12, 63% boys), of whom 92 had ADHD, 52 were Controls, and 35 were borderline or not otherwise specified cases of ADHD, were examined. Dispositional trait scores were derived from parent-completed California Q-sort and the Early Adolescent Temperament Questionnaire. Child ADHD symptoms were evaluated using maternal structured diagnostic interview and teacher-completed symptom ratings. RESULTS: Traits were differentially associated with symptoms. Reactive Control was related to hyperactivity-impulsivity as rated by both parents and teachers. Negative Emotionality was related to oppositional-defiance. Resiliency was primarily related to inattention-disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data. A moderation effect emerged; the relationship between parent-rated Negative Emotionality and teacher-rated ADHD symptoms was stronger for children with high levels of both Reactive and Effortful Control. CONCLUSIONS: Results are interpreted in relation to a two-pathway model of ADHD; regulation problems contribute to the emergence of symptoms of inattention-disorganization, reactive or motivational control problems to the emergence of hyperactivity-impulsivity, and these are distinct from negative affectivity. Children with regulation deficits and a reactive motivational style are especially at risk for the development of ADHD.

Adaptation, Psychological↗
PubMedDate not supplied

Helping children with asthma by repairing maternal-infant bonding problems.

Studies about the psychology of childhood asthma have revealed that parenting difficulties are related to the development of asthma in some children. Disruptions in maternal-infant bonding are highly correlated with pediatric asthma and are presented as a cause for these parenting problems. Bonding problems are known to be caused most often by physical separation at birth or by some recent trauma in the mother's life. By using hypnosis to remove the pain of the separation or trauma in the mother, and by creating a new birth history in her imagination, some children's asthmatic symptoms have been shown to remit or greatly improve. The hypnotic method for this treatment is described.

Adolescent↗
PubMed2006

Unresolved states of mind, anomalous parental behavior, and disorganized attachment: a review and meta-analysis of a transmission gap.

The current meta-analysis examines the links between unresolved representations of attachment, anomalous parental behavior, and disorganized attachment relationships in 12 studies including 851 families. We found moderate effect sizes for the associations between unresolved states of mind and anomalous behavior (r = .26), unresolved states of mind and infant disorganized attachment relationships (r = .21), and anomalous behavior and disorganized attachment relationships (r = .34). Sample characteristics, observational context, and observational measure were not associated with differences in effect sizes. Only a small part of the association between unresolved states of mind and disorganized attachment relationships was explained by the mediation of anomalous parental behavior (.26* .34 = .09). Other factors yet to be uncovered must mediate the influence of unresolved states of mind on infant disorganized attachment; thus, further exploration of infant, parental, ecological, and genetic factors are warranted.

Behavioral Symptoms↗
PubMed2006

Factors that predict infant disorganization in mothers classified as U in pregnancy.

The unresolved (U) state of mind in parents has been validated by its association with infant attachment disorganization (D), yet all studies show a transmission gap, and a proportion of individuals classified as U have infants who are not D. This paper reports on 31 mothers who showed the characteristic lapses in thinking and reasoning of the unresolved/disorganized state of mind in relation to stillbirth (U(sb)), when assessed with the Adult Attachment Interview (AAI) in the pregnancy after stillbirth. Seventeen (55%) of their infants were D at 1 year old. We evaluate social, attachment, and psychiatric variables to establish whether there are differences in U(sb) individuals that will predict infant D. In this population of U mothers, social and attachment factors did not predict infant D, but U(sb) mothers of non-D infants showed significantly higher levels of depression and of intrusive thoughts on the posttraumatic stress disorder (PTSD) scale in pregnancy, and showed higher levels of intrusive thoughts when the infant was 1 year old. We discuss possible interpretations of these findings.

Adjustment Disorders↗
PubMed2006

Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems.

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Children's (APSAC) position and also was endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment.

Child↗
PubMed1976

[Psychiatry of minimal, early-childhood brain damage].

Early psychoorganic syndrome in the child is the result of a diffuse cerebral lesion which usually occurs in pregnancy, during delivery or immediately post partum. In the majority of cases the symptoms are biological, normally of a neurologic character, and serve to underpin the diagnosis. They mainly comprise psychomotor disturbances, linguistic disorders and malregulation of central nervous functions. From the psychic viewpoint both intellectual and emotional disturbances are observable. Intellectually the disorders are chiefly of attention, perception and concentration, and in most cases lead to seriously impaired school performance. They are accompanied by an ideation which is frequently retarded and exhibits a tendency to perseveration. The psychoorganic child's affectivity is marked by pathologic lability, increased irritability and imperfect control of impulse and emotion. Secondary infantilism is nearly always observable. In very many cases reactive, and notably neurotic, disorders are superimposed on the psychoorganic substratum. There are thus a wide variety of clinical pictures. A broad spectrum of therapeutic resources is available, covering education, drugs and psychotherapy of superimposed reactive disorders.

Affective Symptoms↗
PubMed2006

Reactive attachment disorder--a theoretical model beyond attachment.

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic-complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.

Child↗