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Results for “Reactive Attachment Disorder”

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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↗

PubMed2004

[Attachment styles in German alcoholics with or without attention-deficit hyperactivity disorder (ADHD)].

INTRODUCTION: Attachment theory yields empirical constructs for development of human self, personality and cognition. Insecure attachment strategies were associated with various psychiatric disorders. METHOD: We investigated distribution of attachment styles in 368 adult alcoholics of German descent with or without persistent symptoms of attention-deficit hyperactivity disorder (ADHD) and in 402 healthy individuals. RESULT: Insecure attachment styles were significantly overrepresented compared to healthy controls. The subgroup of alcoholics with ADHD showed significantly more frequent enmeshed (74.1 %), the subgroup of alcoholics without persistent ADH-associated symptoms showed more frequent dismissing (35 %) attachment strategies. CONCLUSION: In our sample, insecure attachment styles are associated with alcoholism. The subgroup of alcoholics with persistent ADHD shows a specific attachment behavior that could contribute to different therapy response or to early onset or severity of alcoholism.

Adult↗

PubMedDate not supplied

[How postmodern youths find their way into life--views on imaginative psychotherapy of adolescents].

The author describes the course of an adolescent psychotherapy with guided affective imagery (Leuner 1985) using the therapeutic material of a 15 year old female adolescent with a severe depression und automutilative behaviour. She considers this therapeutic method as very useful especially for severely disturbed adolescents, because the method enhances the creativity of the patient and enables him to express traumatizing experiences in a symbolical form thus facilitating their integration.

Adolescent↗

PubMed2004

Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees.

Associations between experiences and outcomes could be due to (a) continuation of adversity or (b) organismic changes, including experience-expectant and experience-adaptive developmental programming. The adoption into British families of children who had been reared in profoundly depriving institutions in Romania presented an opportunity to test mechanisms. Romanian children reared from infancy in very depriving institutions for periods up to 42 months were compared with 52 nondeprived UK-born children placed into adoptive families before the age of 6 months. The results at 6 years of age showed substantial normal cognitive and social functioning after the provision of family rearing but also major persistent deficits in a substantial minority. The pattern of findings suggests some form of early biological programming or neural damage stemming from institutional deprivation, but the heterogeneity in outcome indicates that the effects are not deterministic.

Adoption↗

PubMed2002

Attachment disturbances in young children. I: The continuum of caretaking casualty.

OBJECTIVE: To determine whether signs of disordered attachment were greater in young children being reared in more socially depriving caregiving environments. METHOD: Three groups of children were studied by means of structured interviews with caregivers that were administered over several months in Bucharest, Romania, in 1999: (1) 32 toddlers living in a typical unit (standard care) in a large institution in Bucharest; (2) 29 toddlers living in the same institution on a 'pilot unit" designed to reduce the number of adults caring for each child; and (3) 33 toddlers living at home who had never been institutionalized. The presence of attachment disorders and other behavioral problems was assessed by caregiver/ parent report. RESULTS: Children on the typical unit (standard care) had significantly more signs of disordered attachment than children in the other two groups. Both the emotionally withdrawn and the indiscriminately social pattern of attachment disorder were apparent in these children, but cluster analysis suggested that mixed patterns are more typical. CONCLUSIONS: The continuum of caretaking casualty is reflected by increasing signs of disordered attachment in toddlers living in more socially depriving environments.

Caregivers↗

PubMedDate not supplied

Interparental discord and child adjustment: prospective investigations of emotional security as an explanatory mechanism.

Advancing the process-oriented study of links between interparental discord and child adjustment, 2 multimethod prospective tests of emotional security as an explanatory mechanism are reported. On the basis of community samples, with waves spaced 2 years apart, Study 1 (113 boys and 113 girls, ages 9-18) identified emotional security as a mediator in a 2-wave test, whereas Study 2 (105 boys and 127 girls, ages 5-7) indicated emotional security as an intervening mechanism in a 3-wave test. Relations between discord and emotional security increased as children moved into adolescence in Study 1. Emotional security was identified as an explanatory mechanism for both internalizing and externalizing problems in children.

Adaptation, Psychological↗

PubMedDate not supplied

Level of prenatal cocaine exposure and infant-caregiver attachment behavior.

The objective of this longitudinal prospective cohort study was to determine whether level of prenatal cocaine exposure, or the interaction between level of prenatal cocaine exposure and contextual risk variables, was associated with a higher rate of infant-caregiver insecure attachment and disorganized attachment, or with alterations in infant crying or avoidant behavior, after controlling for prenatal exposure to alcohol, tobacco, and marijuana, the quality of the proximal caregiving environment, and other covariates. Subjects were 154 full-term 12-month-old infants (64 unexposed, 61 with lighter cocaine exposure, 29 with heavier cocaine exposure) and their primary caregivers from low-income, urban backgrounds. Exposure status was determined in the maternity ward by biologic assay (infant meconium and/or maternal or infant urine) and maternal self-report. At the 12-month follow-up visit, infants were videotaped with their primary caregiver in Ainsworth's Strange Situation. Reliable coders masked to exposure status scored videotapes for attachment variables, amount of crying, and level of avoidance. Contrary to popular perceptions, level of prenatal cocaine exposure was not significantly related to secure/insecure attachment status, disorganized attachment status, or rated level of felt security. Foster care status also was not associated with attachment status. However, heavier prenatal cocaine exposure, in interaction with maternal contextual variables (public assistance or multiparity) was associated with alterations in infant socio-affective behavior, including a higher level of behavioral disorganization, more avoidance of the caregiver, and less crying.

Alcoholism↗

PubMed2003

[Pathological protective and defensive reactions in early childhood].

A group of pathological defenses has been observed in infants between three and eighteen months of age who have experienced danger and deprivation to an extreme degree. The early defenses, "avoidance", "freezing", and "fighting", are apparently summoned from a biological repertoire on the model of "flight or fight". Before there ist an ego, pain ca bei transformed into pleasure of obliterated from consciousness while a symptom stands in place of the original conflict.

Aggression↗

PubMed2002

Attachment theory, metacognitive functions and the therapeutic relationship in eating disorders.

J. Bowlby's attachment theory is used to explore a fundamental motivational force in human behaviour, namely the search for physical and emotional protective intimacy according to an integrated viewpoint remote from Freud's drive-based approach. This theory has received contributions from ethology, the neurosciences, psychoanalysis, cognitive psychology and evolutionary epistemology. Attachment patterns or styles express both the mental and behavioural strategies adopted by individuals to cope with their attachment needs, and their relational history in this area. Experiences of adequate quality promote metacognitive functions, namely a set of mental processes whose role is to protect the individual from psychopathological suffering and construct and articulate a sense of self. Attachment theory and metacognition are the underlying assumptions of reflections on the dynamics marking the development of sometimes very difficult relationships between therapists and eating disorder (ED) patients, who are being increasingly classed as "severe patients" on account of their interpersonal characteristics.

Defense Mechanisms↗

PubMed2002

Mother-infant and father-infant attachment among alcoholic families.

This study examined the association between fathers' alcoholism and other risk factors such as parental depression, family conflict, infant temperament, and parent-infant attachment. The quality of parent-infant interactions was hypothesized to be a proximal mediator of the associations among alcoholism and other risk factors and attachment. The participants were 223 families (104 nonalcoholic families and 119 alcoholic families) with 12-month-old infants recruited through birth records. Infants in families with two parents with alcohol problem had significantly higher rates of insecure attachment with both parents. Structural Equations Modeling indicated that the fathers' alcohol problem was associated with lower paternal sensitivity (higher negative affect, lower positive engagement, and lower sensitive responding) during father-infant play interactions, and this in tum was associated with higher risk for infant attachment insecurity with fathers. The association between the fathers' alcohol problem and infant attachment security with the mother was mediated by matemal depression, and matemal alcohol problems and family conflict were associated with maternal sensitivity during play interactions. These results indicate that the fathers' alcoholism is associated with higher family risk including the quality of the parent-infant relationship; infant attachment develops in a family context; and this context has a significant association with attachment security.

Adult↗

PubMed2004

Safety and stability for foster children: a developmental perspective.

Children in foster care face a challenging journey through childhood. In addition to the troubling family circumstances that bring them into state care, they face additional difficulties within the child welfare system that may further compromise their healthy development. This article discusses the importance of safety and stability to healthy child development and reviews the research on the risks associated with maltreatment and the foster care experience. It finds: Family stability is best viewed as a process of caregiving practices that, when present, can greatly facilitate healthy child development. Children in foster care, as a result of exposure to risk factors such as poverty, maltreatment, and the foster care experience, face multiple threats to their healthy development, including poor physical health, attachment disorders, compromised brain functioning, inadequate social skills, and mental health difficulties. Providing stable and nurturing families can bolster the resilience of children in care and ameliorate negative impacts on their developmental outcomes. The author concludes that developmentally-sensitive child welfare policies and practices designed to promote the well-being of the whole child, such as ongoing screening and assessment and coordinated systems of care, are needed to facilitate the healthy development of children in foster care.

Adolescent↗

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↗

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↗

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↗

PubMed2004

[A new approach to the attachment process and the child functioning].

Following the introduction dealing with the scientific sources which influenced John Bowlby in his elaborating the theory of attachment, the present article relates some of the major advances Bowlby's theory gave rise to and facilitated in fundamental research, clinical practice and the drawing up of new concepts. The main part of the article is devoted to the concept of core-competency. Indeed, this concept permits to take into account in a combined manner individual development, processes of attachment, and behaviour adjustments, from birth throughout infancy. Core-competencies are organisational nuclei that allow every child to associate, combine, cluster and integrate various pieces of information of the surrounding world by making them compatible with his idiosyncrasies, be they innate or acquired as the days go by, be they biological or psychological. Five core-competencies have emerged from studies about mother-child interactions, from experimental research on the interactions between young children and from ethological observations of groups of children under controlled conditions: sustained visual attention, desire for interaction, affiliative behaviour, imitation and the structured organisation of gestures. The theory of attachment, the data of fundamental research, in particular those concerning core-competencies, and clinical observation lead to a new perspective for interpreting child constructions. The rooting of the child in a secure attachment, the non-thwarted genesis of his/her time organisation and of his/her bio-psychological rhythms, the possibilities given to him/her to appropriate space and its various dimensions, allow him/her to settle in affective security. Hence he/she can release his/her emotions and affects and make his/her core-competencies legible and functional. Conditions are then fulfilled for him/her to release his latent cognitive processes, master his/her cognitive acquisitions and structure his/her imagination.

Child Behavior↗

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↗

PubMed2004

Attachment in infancy and preschool in low socioeconomic status rural Appalachian children: stability and change and relations to preschool and kindergarten competence.

Attachment classifications were obtained from the Strange Situation at 15 months and at 4 years for a sample of 82 low socioeconomic status rural Appalachian children. The rate of secure attachment in infancy was 50.5%, and the majority of insecure infants were disorganized. At 4 years of age 61.2% of children were secure; early secure relationships were likely to be maintained, and about half of the insecure infants changed to a secure classification by 4 years. Overall, there was low but significant stability in attachment at the level of secure/insecure. Comparisons of (a) children who changed from insecure to secure with those who were stable insecure and (b) stable secure children with those who changed from secure to insecure identified contextual, child, and maternal interaction factors associated with attaining secure attachment. Assessments of cognitive and socioemotional competence at 4 years and kindergarten age suggested a protective effect of secure infant attachment but little benefit from secure preschool attachment.

Appalachian Region↗

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↗