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PubMed1995

Aggressivity among sons of substance-abusing fathers: association with psychiatric disorder in the father and son, paternal personality, pubertal development, and socioeconomic status.

An association between childhood aggression and risk for subsequent development of a substance abuse disorder is now well-accepted. In order to better understand the relationship between the presence of paternal substance abuse and aggression among their offspring, 10-12 year old sons of fathers with (n = 34) and without (n = 39) a history of a substance abuse disorder were contrasted on demographics, aggressivity, biological indices of reproductive maturation, and the presence of psychiatric diagnoses. In addition, personality factors, the potential for physical abuse, and psychiatric diagnoses were also ascertained among their fathers. Sons of substance-abusing fathers were found to be significantly more aggressive than sons of nonsubstance abusers. However, they also differed from comparison boys on the basis of SES and school grade attained, as well as the proportion with specific psychiatric disorders. Substance-abusing fathers differed from nonsubstance-abusing men in terms of personality factors and the presence of specific psychiatric disorders, including antisocial personality. They also showed significantly higher child abuse potential scores. A multiple regression analysis of factors contributing to aggression in the boys revealed that a paternal personality factor characterized by stress reactivity, alienation, and aggression was the most robust contributor to aggression among the boys. The boys' diagnoses of attention deficit disorder, oppositional defiant disorder, and lower household socioeconomic status were also significant predictors of aggressivity. Contrary to expectations, paternal, psychiatric diagnoses, substance abuse status, and potential for physical abuse were noncontributory. The results suggest potential mechanisms by which both aggression and risk for substance abuse may be transmitted from father to son.

Aggression↗
PubMed2006

Examining the role of parental frightened/frightening subtypes in predicting disorganized attachment within a brief observational procedure.

Following Main and Hesse's hypothesis, several investigators have affirmed that frightened/frightening (FR) as well as particular atypical maternal behaviors are associated with infant disorganized and adult unresolved attachment. Here, for the first time, FR behavior was observed in (a) middle-class father-infant (n = 25) and independent mother-infant dyads (n = 50) and (b) a brief laboratory play session. In addition, relations between disorganization, unresolved attachment, and the six FR system subscales were explored. Paternal and maternal overall FR behavior was related to infant disorganization (n = 75, phi = .61, p < .001), and for a subsample where Adult Attachment Interviews were available (n = 32), to unresolved adult attachment (phi = .59, p < .001). At the subscale level, disorganized-FR behaviors were related to infant disorganization, but only for mother-infant dyads. Across the whole sample, both dissociative-FR and threatening-FR subscales were associated with infant disorganization. The dissociative-FR subscale emerged as the central predictor of infant disorganization and was the only subscale significantly related to unresolved attachment. The appearance of FR behavior in this 18-min play procedure suggests that FR probably occurs more frequently than previously suspected. The possible role of dissociative processes in unresolved adult attachment, disorganized attachment, and FR parental behavior is discussed.

Adult↗
PubMed2006

Attachment, psychotherapy, and assessment: a commentary.

This article, a commentary, discusses questions and issues generated by 7 articles on the relationship between attachment theory and research, and psychotherapy and clinical assessment. The issues include the following: attachment-based therapeutic interventions for adults and child-caregiver dyads, change in attachment status as an outcome goal of therapeutic intervention, attachment pattern as a moderator of treatment outcome and therapeutic approach, clinical use of attachment measures, narrative/discourse and self-report measures of attachment patterns, and application of attachment theory to new areas. In the discussion of each of these issues, suggestions are made for future research.

Adult↗
PubMed1989

Hyperferritinemia in malignant histiocytosis, virus-associated hemophagocytic syndrome and familial erythrophagocytic lymphohistiocytosis. A survey of pediatric cases.

Data on 28 patients with malignant histiocytosis (MH), fourteen patients with virus-associated hemophagocytic syndrome (VAHS) and two patients with familial erythrophagocytic lymphohistiocytosis (FEL) were collected from 21 hospitals in Japan to study the serum ferritin levels and clinical features. At diagnosis, the serum ferritin values were a median of 3,000 ng/ml (range, 59-270,000 ng/ml) in MH and 10,500 ng/ml (range, 44-68,600 ng/ml) in VAHS/FEL. Clinical signs and symptoms were not substantially different between MH and VAHS/FEL. Thus, serum ferritin markedly increased in the majority of MH/VAHS/FEL patients and should be a useful marker of disease activity in either neoplastic or reactive histiocytic proliferative disorders.

Adolescent↗
PubMed2002

Growth and micronutrient disturbances in stable, HIV-infected children in Cape Town.

This prospective study of 60 stable, HIV-infected children in an economically deprived setting was designed to document anthropometric and micronutrient disturbances. Investigations included CD4+ counts, anthropometry and plasma levels of albumin, transthyretin, retinol-binding protein (RBP), vitamins A, B6, E and B12, and folate, zinc and copper. The median age was 25 months. Thirty-two per cent had mild, 48% moderate and 20% severe clinical features, and 80% were moderately or severely immunosuppressed. Twenty-eight per cent had a weight Z-score <-2.0 and 58% a height Z-score <-2.0. Many children had micronutrient deficiencies: albumin (70%), transthyretin (100%), RBP (85%), vitamins A (80%), B6 (37%), E (37%) and B12 (5%), zinc (20%) and copper (25%). Sixty-two per cent had two or more trace element or vitamin deficiencies. There was a weak association between micronutrient status and disease status. Micronutrient concentrations did not correlate with chronological age, height-for-age or weight-for-age. CRP was elevated in 53% but did not correlate with any of the micronutrient concentrations. Micronutrient deficiencies were more common and micronutrient concentrations lower in children over 24 months of age.

Anthropometry↗
PubMed2004

Forming attachments in foster care: infant attachment behaviors during the first 2 months of placement.

This study investigated the development of attachment relationships in 38 foster infant-caregiver dyads over the first 2 months of placement. We used the Parent Attachment Diary to measure foster infants' daily attachment behaviors, the Adult Attachment Interview to examine foster parents' attachment states of mind, and Ainsworth's Strange Situation to capture attachment classifications. We examined differences in diary scales (secure, avoidant, resistant, and coherence) as they related to age at placement and foster parent attachment, using hierarchical linear modeling and analyses of variance. The results indicated infants with autonomous foster parents and infants placed at younger ages showed higher early and overall levels of secure behavior, less avoidant behavior, and more coherent attachment strategies compared to infants placed with nonautonomous foster parents. Changes in attachment behaviors over time were not predicted by the models; however, there was a significant decrease in the daily coherence of attachment behaviors associated with Strange Situation disorganization. Finally, we found significant concordance between the diary and Strange Situation scales for secure and avoidant behaviors.

Age Factors↗
PubMed2005

Adverse life events and pediatric bipolar disorder in a community mental health setting.

OBJECTIVE: To determine the frequency and effects of exposure to adverse events in pediatric bipolar disorder. METHOD: Charts of youths with bipolar disorder were retrospectively reviewed. RESULTS: Thirty-five of 66 (53%) had experienced maltreatment. Most (90.9%) had divorced or separated parents and 31.8% were adopted or in foster care. Exposure to adverse events was associated with delay of diagnosis (p = .010), psychiatric hospitalization (p = .035), residential treatment (p = .003) and a decreased response to treatment (p = .006). CONCLUSIONS: Exposure to adverse events may be common among pediatric bipolar patients and have a negative impact on prognosis.

Adolescent↗
PubMed2003

["Beware of coming too close to me"--development-oriented psychotherapy of a dangerous aggressive boy with early complex trauma experiences].

Early maltreatment of children can lead to severe disorders in the regulation of behaviour and affect, alterations in awareness and distorted perception. In development-oriented psychotherapy, therapeutic interventions which are directed to regulating processes, decentration or mentalization, desomatization and symbolization of enacted messages play a central role. The results of early traumatization and of therapeutic interventions are portrayed, examining the multi-dimensional diagnosis and therapy of a dangerously aggressive 12-year-old boy as an example. From this, it becomes clear how, through new experiences with regulating others, he gradually surfaces from a world of annihilation and destruction and learns to survive and to live.

Adolescent↗
PubMed1998

Attachment disorders in infancy and early childhood: a preliminary investigation of diagnostic criteria.

OBJECTIVE: The primary purpose of this study was to compare the reliability of differing sets of criteria for attachment disorders by using a retrospective case review. METHOD: Forty-eight consecutive clinical case summaries from an infant behavior clinic were reviewed by four experienced clinicians. Attachment disorders were coded as present or absent by using competing criteria and were scored by using a continuous scale of relationship functioning. RESULTS: The reliability of alternative criteria was acceptable, but the reliability of DSM-IV criteria in diagnosing attachment disorders was marginal. Preliminary validity for the criteria was demonstrated by the fact that more severe relationship disturbances were seen in infants diagnosed with attachment disorders than in infants diagnosed with other disorders. CONCLUSIONS: Standardized assessments of at-risk populations should be used to replicate these preliminary results; revision of DSM-IV criteria may be necessary to obtain adequate reliability for diagnosing attachment disorders.

Adult↗
PubMed1982

The relative timing of psychiatric disorder in parents and children.

The high incidence of psychiatric disorder in parents of disturbed children is usually explained in reactive terms implying a relationship in time. The records of children attending a child psychiatric service and the psychiatric records of their parents were examined and the time between episodes of illness in parent and child were calculated. Fathers' illnesses preceded those of their daughters, but in general, there was little evidence of any close relationship.

Age Factors↗
PubMed1994

Nutritional status of children with leukemia.

Children with cancer represent a high-risk group for protein-energy malnutrition due to side effects associated with treatment. Assessment of nutritional status at the time of diagnosis and during treatment is, therefore, essential for planning nutritional intervention. We studied the nutritional status of 25 children with leukemia [9 newly diagnosed/relapsed (D/R) leukemic patients and 16 children with leukemia in remission (REM)]. Plasma proteins (prealbumin, PA; albumin, Alb; transferrin, Tr; retinol-binding protein, RBP) and acute phase-reactant proteins (alpha 1-acid glycoprotein, AGP; C-reactive protein, CRP; ceruloplasmin, CER) were measured by radial immunodiffusion. Results show that there were no significant deficits in anthropometric measurements among leukemic children. In contrast, the mean levels of all plasma proteins, especially PA (P < 0.005), were significantly lower in the D/R group than in the REM group. All D/R children, compared to 59% of those in remission, had PA levels < 20 mg/dl. Only the D/R group had abnormal levels of RBP, Tr, and Alb. Children who were treated with prednisone had significantly higher mean levels of PA, RBP, and AGP than those who were not receiving prednisone. The mean levels of acute phase-reactant proteins in these leukemic children were comparable to those of healthy children. We conclude that mild/moderate malnutrition is common in leukemic patients at D/R and that PA seems to be the most sensitive indicator of visceral protein status.

Adolescent↗
PubMed2004

Naïve observers' perceptions of family drawings by 7-year-olds with disorganized attachment histories.

Previous research has succeeded in distinguishing among drawings made by children with histories of organized attachment relationships (secure, avoidant, and resistant); however, drawings of children with histories of disorganized attachment have yet to be systematically investigated. The purpose of this study was to determine whether naïve observers would respond differentially to family drawings of 7-year-olds who were classified in infancy as disorganized vs. organized. Seventy-three undergraduate students from one university and 78 from a second viewed 50 family drawings of 7-year-olds (25 by children with organized infant attachment and 25 by children with disorganized infant attachment). Participants were asked to (1) circle the emotion that best described their reaction to the drawings and (2) rate the drawings on 6 bipolar scales. Drawings from children classified as disorganized in infancy evoked positive emotion labels less often and negative emotion labels more often than those children classified as organized. Furthermore, drawings from children classified as disorganized in infancy received higher ratings on scales for disorganization, carelessness, family chaos, bizarreness, uneasiness, and dysfunction. These data indicate that naive observers are relatively successful in distinguishing selected features of drawings by children with histories of disorganized vs. organized attachment.

Affect↗
PubMedDate not supplied

Attachment for infants in foster care: the role of caregiver state of mind.

The concordance between foster mothers' attachment state of mind and foster infants' attachment quality was examined for 50 foster mother-infant dyads. Babies had been placed into the care of their foster mothers between birth and 20 months of age. Attachment quality was assessed between 12 and 24 months of age, at least 3 months after the infants' placement into foster care. The two-way correspondence between maternal state of mind and infant attachment quality was 72%, kappa = .43, similar to the level seen among biologically intact mother-infant dyads. Contrary to expectations, age at placement was not related to attachment quality. Rather, concordance between maternal state of mind and infant attachment was seen for relatively late-placed babies, as well as early placed babies. These findings have two major implications. First, following a disruption in care during the first year and a half of life, babies appear capable of organizing their behavior around the availability of new caregivers. Second, these data argue for a nongenetic mechanism for the intergenerational transmission of attachment.

Adult↗
PubMed2000

The development and organization of attachment: implications for psychoanalysis.

As a result of John Bowlby's breach with the British Psychoanalytic Society nearly forty years ago, his work, specifically the development of attachment theory, was until recently largely expunged from the psychoanalytic record. However, thanks to developments in both psychoanalytic and attachment theories, a rapprochement has been forged, and a number of scholars are now seeking to integrate these two complementary perspectives. In this paper, the fundamental premises of attachment theory are discussed in light of their relation to psychoanalytic theory. In addition, their application to the clinical situation in both adult and child treatment is discussed.

Adult↗
PubMed1991

Revised understandings of psychogenic autism.

The author suggests that, in the light of observational findings from babies, it is no longer tenable to postulate a normal autistic phase in infancy, and to view pathological autism as a halt at, or a regression to, such a phase. This has been a commonly held psychoanalytic view concerning the aetiology of autism, and she has subscribed to it. In this paper, the author presents a revision of these views, in that she now reserves the term autism to refer solely to pathological conditions. Her present view is that autism is a system of protective, but alienating auto-sensual aberrations which have developed to deal with an infantile trauma of seeming to be wrenched away from a mothering person's body. She suggests that in an unduly fused nursing situation, mother and child had felt undifferentiated from each other. Thus, the infant had taken it for granted that the mother's body was a permanent part of 'its' body. It was an unbearable shock when this was found to be not so. The author suggests that autistic reactions to this shock are the source of the autistic child's many deficits. Based on clinical material presented in her other books and papers, she has attempted to describe and conceptualize the protective auto-sensual reactive aberrations which develop to deal with this traumatic awareness of bodily separateness.

Autistic Disorder↗
PubMed1995

Nonrheumatic conditions in children including infectious diseases and syndromes.

Often, a child is referred for evaluation to a pediatric rheumatologist and found to have a nonrheumatologic disorder. Infections constitute an important group of disorders with potential musculoskeletal system involvement. Reactive arthritis subsequent to infection with Yersinia is discussed, as well as reactive arthritis seen in the course of cystic fibrosis. Musculoskeletal manifestations of tuberculosis and brucellosis are reviewed. The continued presence of acute rheumatic fever in the United States has been documented, but the clinical spectrum of the disease appears to be changing over time. A variety of inherited syndromes may involve the musculoskeletal system, either primarily or as a minor manifestation. The bony dysplasias, another group of disorders, result from abnormal collagen structure and affect musculoskeletal development; clinical findings and new genetic information is reviewed. Descriptions of several rare syndromes (eg, hyaline fibromatosis and hypertrophic osteoarthropathy) also are reviewed here.

Arthritis, Reactive↗