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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↗
PubMed1999

Frightening maternal behavior linking unresolved loss and disorganized infant attachment.

Main and Hesse's (1990) model in which frightening (threatening, frightened, or dissociated) parental behavior explains why infants of parents with unresolved loss develop disorganized attachment relationships was tested. Unresolved loss using the Adult Attachment Interview in a nonclinical middle-class sample of 85 mothers who had experienced the loss of someone important was assessed. Disorganized attachment was examined in the Strange Situation. Parental behavior was recorded during 22-hr home visits. The model applied to mothers with currently insecure attachment representations. Secure mothers with unresolved loss displayed less frightening behavior than other mothers, and unresolved loss in secure mothers did not predict disorganized attachment of their infants. Frightening behavior predicted infant disorganized attachment irrespective of maternal security.

Adult↗
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↗
PubMed2003

[Early, repeated traumatization, attachment organization and developmental psychopathology--selected findings and clinical options].

Self-Psychology, as a segment of contemporary psychoanalysis, can claim merit as to having included the vastly accrued body of knowledge of pertinent fields of the human sciences into their clinical reasoning. This, in turn, has set forth a rebound effect which eventually has contributed to Psychoanalysis' still ongoing exodus from its long-lasting "splendid isolation". By presenting selected findings pertaining to attachment- and neuroscientific trauma-research, the author aims at hypothesizing with reference to the interface of early ontogenic attachment disorganization, onset of dissociative disorders and graded traumatic impact. Finally, in considering clinical relevance of the data, the author opts for composite strategies i.e. measures embedded in an overall psychodynamic treatment stance inclusive of occasional employ of EMDR and hypnotherapeutic interventions.

Adolescent↗
PubMed2002

Occupational assault among community care workers.

The author presents the findings of a study that attempted to analyze the frequency, trend, and pattern of workplace assaults among community care workers who provide care for severely emotionally and behaviorally disturbed children in a state government agency in Australia between 1997 and 2000. He identifies the high risk groups and discusses activities for prevention opportunities.

Adolescent↗
PubMed2006

Falling forever: the price of chronic shock.

Manifestations of chronic shock and annihilation anxiety-including autistic defenses, chaotic relationships, disorganized attachment, split-off affective states, and vulnerability to disintegration--exist side by side with apparent ego strength and high functioning, even in nonabused patients. Chronic shock stemming from uncontained distress and failed dependency during childhood can persist throughout the lifespan, creating ripples of dysfunction that mask as character distortion and contribute to therapeutic impasse. Patients rely on omnipotent defenses to provide a sense of "having skin" in the face of the fear of breakdown, striving to avoid vulnerability, and trying to insulate themselves from shock experience. Although the relinquishment of autistic defenses and subsequent integration of disowned affect states are overwhelming and painful, patients can emerge from this process with significant shifts in intrapsychic, interpersonal, and existential/spiritual functioning. Clinical material from one psychodynamic psychotherapy group tracks the group process and growth trajectories of seven group members struggling with chronic shock. The ability to recognize subtle dissociative states is a valuable tool in the repertoire of the group psychotherapist.

Adaptation, Psychological↗
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↗
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↗
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↗
PubMed2002

Joint attention and disorganized attachment status in infants at risk.

The development of joint attention skills is a major milestone of infancy. Recent research suggests that the development of these skills may be affected by disorganized (D) attachment. This hypothesis was examined in a longitudinal study of attachment and joint attention skill development in a sample of infants at risk for developmental-behavioral morbidity. The results revealed that toddlers with D classifications initiated joint attention with an experimenter significantly less often than did secure, or even other insecure, toddlers. However, no group differences in the capacity to respond to the joint attention bids of others were observed in this study. These data suggest that a disturbance in the tendency to initiate episodes of joint attention with others may be indicative of early social-cognitive and social-emotional disturbance among infants affected by disorganized attachment status. Theory and research is reviewed to suggest that an early impairment in joint attention facility may make a significant contribution to risk for negative cognitive and emotional outcomes among these infants.

Attention↗
PubMed2006

The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: a randomized preventive trial.

The development of insecure attachment relationships in the offspring of mothers with major depressive disorder (MDD) may initiate a negative trajectory leading to future psychopathology. Therefore, the provision of theoretically guided interventions designed to promote secure attachment is of paramount importance. Mothers who had experienced MDD since their child's birth were recruited (n = 130) and randomized to toddler-parent psychotherapy (DI) or to a control group (DC). Nondepressed mothers with no current or history of major mental disorder and their toddlers also were recruited for a nondepressed comparison group (NC; n = 68). Children averaged 20.34 months of age at the initial assessment. Higher rates of insecure attachment were present in both the DI and the DC groups at baseline, relative to the NC group. At postintervention, at age 36 months, insecure attachment continued to predominate in the DC group. In contrast, the rate of secure attachment had increased substantially in the DI group and was higher than that for the DC and the NC groups. These results demonstrate the efficacy of toddler-parent psychotherapy in fostering secure attachment relationships in young children of depressed mothers.

Adult↗
PubMed2000

Dopamine D4 receptor (DRD4) gene polymorphism is associated with attachment disorganization in infants.

About 15% of one-year-old infants in non-clinical, low-risk and up to 80% in high-risk (eg maltreated) populations show extensive disorganized attachment behavior(1,2) in the Strange Situation Test.(3) It has also been reported that disorganization of early attachment is a major risk factor for the development of childhood behavior problems.(4) The collapse of organized attachment strategy has been explained primarily by inappropriate caregiving, but recently, the contribution of child factors such as neurological impairments and neonatal behavioral organization(6) has also been suggested. Here we report an association between the DRD4 III exon 48-bp repeat polymorphism and attachment disorganization. Attachment behavior of 90 infants was tested in the Strange Situation and they were independently genotyped for the number of the 48-bp repeats by polymerase chain reaction (PCR). The 7-repeat allele was represented with a significantly higher frequency in infants classified as disorganized compared to non-disorganized infants: 12 of 17 (71%) vs 21 of 73 (29%) had at least one 7-repeat allele (chi2 = 8.66, df = 1, P < 0.005). The estimated relative risk for disorganized attachment among children carrying the 7-repeat allele was 4.15. We suggest that, in non-clinical, low-social-risk populations, having a 7-repeat allele predisposes infants to attachment disorganization.

Adult↗
PubMed2002

[Attachment representation of adolescents in residential care].

In this investigation the attachment representations of adolescents in residential care were examined for the first time. 72 adolescents were interviewed by using the Adult Attachment Interview (AAI). At the same time the degree of adolescent psychopathology was recorded. For this purpose the caregivers completed Achenbach's Child Behavior Checklist (CBCL), the adolescents themselves answered Achenbach's Youth Self Report (YSR). The adolescents in this sample proved to be severely burdened in psychopathological terms. They had access to only an insecure and, in many cases, an extremely insecure attachment representation. For a sub-group of adolescent mothers the early infant-mother attachment was examined using Ainsworth's Strange Situation. The findings show an intergenerational transmission of insecure attachment relationships. The implications of these results for the practice of residential care inspired by attachment theory are discussed.

Adolescent↗
PubMed2006

Attachment and behavior problems in middle childhood as reported by adult and child informants.

The predictive relation between attachment and mother, teacher, and self-reported psychopathology was examined for a diverse socioeconomic status French Canadian sample of 96 children. Attachment classifications were assigned on the basis of reunion behavior with mother when the children were approximately 6 years old, and child problem behavior was assessed 2 years later using the Child Behavior Checklist (mother report), the Social Behavior Questionaire (teacher report), and the Dominic Questionnaire (child self-report). Results indicated that both insecure/ambivalent and insecure/controlling children children were rated higher than secure children on a composite measure of externalizing problems. Concerning internalizing problems, only the controlling group was significantly higher on both a composite adult (teacher and mother) and self-report measure of internalizing problems. Analyses of clinical cutoff scores showed that only the controlling group had a significantly greater likelihood of overall problem behavior than other children.

Adult↗
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↗
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↗