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PubMed2004

Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: reactive attachment disorder.

This article explores reactive attachment disorder, a disorder that has been linked to severe and chronic maltreatment. The fundamental concepts of attachment theory are reviewed briefly, and the two types of behaviors associated with reactive attachment disorder in children and adolescents are discussed. Treatment strategies are explored, including the controversial holding or rebirthing strategies.

Adolescent↗
PubMed2005

The role of temperament in the etiology of child psychopathology.

A substantial proportion of children and adolescents come to suffer from psychological disorders. This article focuses on the temperament factors that are involved in the pathogenesis of child psychopathology. It is argued that besides the reactive temperament factor of emotionality/neuroticism, the regulative process of effortful control also plays an important role in the etiology and maintenance of internalizing and externalizing problems in youths. More specifically, vulnerability to child psychopathology is determined by a temperament that is characterized by high levels of emotionality/neuroticism and low levels of effortful control. Models are hypothesized in which reactive and regulative temperament factors either have interactive or additive effects on the development of psychological disorders in children, and conceptualized in terms of a developmental psychopathology perspective. Directions for future research and clinical implications of this temperamental view on psychopathology are discussed.

Adolescent↗
PubMed2002

Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder.

OBJECTIVE: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. METHOD: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. RESULTS: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. CONCLUSIONS: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.

Adolescent↗
PubMed2004

The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months.

We examined the course of maternal depressive symptoms and children's attachment security at 36 months in a large sample of mother-child pairs from 10 sites across the country participating in the NICHD Study of Early Child Care (N = 1077). Maternal depressive symptoms predicted higher rates of insecure attachment. Women who reported intermittent symptoms across the first 36 months had preschoolers who were more likely to be classified as insecure C or D; women with chronic symptoms were more likely to have preschoolers who were classified as insecure D. Symptoms reported only during the first 15 months were not associated with elevated rates of later insecurity. After controlling for potentially confounding demographic variables, maternal sensitivity (observed at 6, 15, 24, and 36 months) did not meaningfully account for links between attachment security and patterns of depressive symptoms. However, the course and timing of maternal depressive symptoms interacted with maternal sensitivity to predict insecurity. Women with late, intermittent, or chronic symptoms who were also low in sensitivity were more likely to have preschoolers who were insecure, in contrast to symptomatic women who were high in sensitivity. These data have implications for understanding the combined impact of maternal depressive symptoms and maternal sensitivity on children's socioemotional development.

Child of Impaired Parents↗
PubMed2005

Thinking about children's attachments.

Disordered parental attachment can commit children to lives characterised by relationship difficulties, behaviour problems, educational failure, and poor self-esteem. It is a major root of trans-generational neglect and abuse and frequently underlies mental health problems, drug and alcohol addiction, homelessness, and crime. Early childhood setting of hypothalamus-pituitary-adrenal axis function appears to contribute to these costly difficulties. More broadly, the concept of attachment can contribute to defining and managing the psychosocial dimension of routine paediatric care. The current under-representation of attachment in paediatric education, practice, and research needs to be rectified.

Adaptation, Psychological↗
PubMed1993

Severe vitamin A deficiency in a rural village in the Hararge region of Ethiopia.

A total of 240 children were examined for vitamin A deficiency in a village in Hararge region of Ethiopia. Night blindness, Bitot's spots, corneal xerosis, corneal ulceration and corneal scars were observed in 69, 16, 2, 15 and 14 children, respectively, based on the most severe eye signs. Blood was collected from 76 children with eye signs and 9 other children selected at random. The concentration of retinol (vitamin A) in serum was < 0.35 mumol/l in 30.2% of children and the median serum retinol-binding protein, iron, transferrin saturation and ferritin levels were low while the parameters of iodine status, total triiodothyronine, total thyroxine and thyrotropin, were all within the normal range. Levels of IgG and IgM were elevated in 78.8% and 82.4% children, respectively, while C-reactive protein levels were elevated in 42.4% of children. There was a higher prevalence of wasting (33%) than stunting (10%) with an additional 8% of children being both stunted and wasted. In the 2 years prior to the study, there were 74 deaths of which 17 were reported to be associated with ruptured corneas. The community had been dependent on relief food aid for the previous 6 years.

Anthropometry↗
PubMed1985

A fatal lymphoproliferative disorder with a suppressor T-cell phenotype. Neoplastic, reactive, or both?

We describe the case of a boy who presented with clinical features of lymphadenitis accompanied by a lymphocytic leukemoid reaction of suppressor/cytotoxic T-cell phenotype. Progressive involvement of the bone marrow, liver, and spleen, and subsequently parotid and lacrimal glands, in the disease process, suggested the alternative diagnosis of malignant lymphoma. An initial dramatic response to Prednisolone was not sustained and he died within 8 weeks of the original onset of symptoms. Postmortem examination revealed extensive lymphocytic infiltration in many organs, and a differential diagnosis of lymphoproliferation is considered. The pathogenesis of this disorder is not established; whether it was essentially neoplastic or reactive is unresolved.

Child↗
PubMedDate not supplied

Trauma severity influences acute stress in young burned children.

The purpose of this study was to assess the role of trauma severity on subsequent symptoms of posttraumatic stress disorder (PTSD) and physiological reactivity in a total of 70 children, ranging from 12 to 48 months of age, who were acutely burned. Parents were interviewed shortly after the child was admitted to the hospital. PTSD symptoms were measured using the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record for Infants and Young Children and the Diagnostic Interview for Children and Adolescents. Nurses completed a questionnaire about the child's symptoms and recorded the child's physiological data throughout the hospital stay. Significant relationships were found between severity of childhood trauma and the total number of PTSD symptoms and physiological reactivity. This study supports the hypothesis that severity of trauma experienced by young children influences psychological and physiological stress indicators after burn injuries. These findings provide new directions for the assessment and prevention of PTSD in this age group.

Age Factors↗
PubMed2003

[Remedial pedagogic developmental intervention with children displaying psychosocial disorders].

What is the significance of theory of attachment for practical remedial therapeutics? It is a current and intensive debate on this issue in the socio-psychological field of work. The intention of the article is to make public the possible applications of attachment theory. To start with, fundamental assumptions of attachment theory will be introduced (following J. Bowlby 1975), then the role of attachment processes in problematic human relationships will be described. The author will attempt to make clear how fundamental remedial-therapeutic concepts of actual treatment can be deduced from the considerations, theory of attachment makes, and how this can be practically applied, illustrated by a case study from actual remedial-therapeutic work with a girl with psycho-social behavioural difficulties and her mother. Thus, the author tries to show a highly promising way from theory of attachment to attachment therapy.

Adult↗
PubMed1983

[Systemic reactive histiocytosis with hemophagocytosis and hemostasis disorders associated with septic granulomatosis].

Authors describe a case of hemophagocytic systemic histiocytosis observed in a child suffering from chronic granulomatous disease, associated with septicemia due to Salmonella typhi murium; outcome was favorable. This type of histiocytic proliferation and activation usually induced by an infectious agent and combined with a congenital or acquired immunological disorder leads to severe clinical and hematological consequences which may contribute to a misleading diagnosis of malignant hematological disease. Moreover, systemic histiocytosis is constantly responsible for early blood clotting abnormalities concerning simultaneously coagulation and fibrinolysis; these changes have to be carefully examined before choosing either heparin or substitutive coagulant fractions.

Blood Coagulation Disorders↗
PubMed2006

Maternal antibrain antibodies in autism.

Autism is a neurodevelopmental disorder of prenatal onset that is behaviorally defined. There is increasing evidence for systemic and neuroimmune mechanisms in children with autism. Although genetic factors are important, atypical prenatal maternal immune responses may also be linked to the pathogenesis of autism. We tested serum reactivity in 11 mothers and their autistic children, maternal controls, and several groups of control children, to prenatal, postnatal, and adult rat brain proteins, by immunoblotting. Similar patterns of reactivity to prenatal (gestational day 18), but not postnatal (day 8) or adult rat brain proteins were identified in autistic children, their mothers, and children with other neurodevelopmental disorders, and differed from mothers of normal children, normal siblings of children with autism and normal child controls. Specific patterns of antibody reactivity were present in sera from the autism mothers, from 2 to 18 years after the birth of their affected children and were unrelated to birth order. Immunoblotting using specific antigens for myelin basic protein (MBP) and glial acidic fibrillary protein (GFAP) suggests that these proteins were not targets of the maternal antibodies. The identification of specific serum antibodies in mothers of children with autism that recognize prenatally expressed brain antigens suggests that these autoantibodies could cross the placenta and alter fetal brain development.

Adolescent↗
PubMed2002

Development of a brief, clinically relevant, scale for measuring attachment disorders.

A 17-item questionnaire for reactive attachment disorders (RAD) was developed and administered to 182 Scottish children living in foster care. The RAD questionnaire had a good test-retest reliability with an intra-class correlation (ICC) of 0.78 and inter-rater reliability with an ICC of 0.81. Cluster analysis showed that the children fell into three groups, two of which corresponded to the two reactive attachment disorder subtypes. High questionnaire scores for attachment disorders were significantly associated with conduct problems, emotional problems, hyperactivity and problems with peer relations and negatively associated with pro-social behaviour. High overall questionnaire scores for reactive attachment disorder were associated with previous sexual abuse, whereas there was no association with previous physical abuse. High scores for the disinhibited subtype were associated with previous neglect.

Adolescent↗
PubMed2005

Long-term developmental, behavioral, and attachment outcomes after international adoption.

Children adopted internationally and their families are a heterogeneous group. Internationally-adopted children have been reported to have a range of developmental and behavioral difficulties. The authors describe the current evidence documenting developmental outcomes for children and common behavioral and mental health concerns including attachment difficulties that may impact children and their families after international adoption. Pediatricians must be thoughtful to individualize the care of adoptive children and not make assumptions shortly after adoption. It is critical to avoid using "standard" parenting advice that may not apply to children who have experienced loss, deprivation, separation, and instability in their early lives. By listening to families, carefully evaluating children, and monitoring progress over time, pediatricians can avoid the pitfall of oversimplifying and underestimating the complexity and challenges that these families face. Instead, pediatric primary care providers can play a key role in maximizing the potential of an internationally adopted child and his or her family.

Adoption↗
PubMed1988

[The typology of reactive depression in young children].

A group of 38 children aged 1.5 to 4 years with reactive depression was under this study. Dependent on features of affective disorders themselves and their age-related peculiarities (masked depressions), two subgroups were established. In each, distinct psychopathologic types of reactive depressive disorders were defined. Age distribution of reactive depressions was noted.

Adjustment Disorders↗
PubMedDate not supplied

[Story stem evaluation in clinical practice with young children].

In the field of developmental research, there is a long tradition of using story completion tasks with play figures for preschoool children. In contrast, story completion tasks are not often used in the clinical assessments of young children. In this paper we will present the MacArthur Story Stem Battery (MSSB), a typical story completion task, which is useful in clinical as well as in research settings. We will give two clinical case examples in order to demonstrate how compelling this method is for young children because they can continue the stories with the help of play figures. In this way the instrument can help to open a window into the inner world of young children.

Aggression↗