Psychopharmacologic Treatment of Children Prenatally Exposed to Drugs of Abuse

Objective This pilot study compared the pharmacologic treatment history and clinical outcomes observed in pediatric outpatients with psychiatric disorders exposed to drugs of abuse in utero to those of an age-matched, sex-matched and psychiatric disorder-matched, non-drug-exposed group. Methods In this matched cohort study, medical records of children treated at an academic, child and adolescent psychiatry outpatient clinic were reviewed. Children with caregiver-reported history of prenatal drug exposure were compared with a non-drug-exposed control group being cared for by the same providers. Patients were rated with the Clinical Global Impressions—Severity scale (CGI-S) throughout treatment. The changes in pre-treatment and post-treatment CGI-S scores and the total number of medication trials were determined between groups. Results The drug-exposed group (n = 30) had a higher total number of lifetime medication trials compared with the non-drug-exposed group (n = 28) and were taking significantly more total medications, at their final assessment. Unlike the non-drug-exposed group, the drug-exposed group demonstrated a lack of clinical improvement. Conclusions These results suggest that in utero drug-exposed children may be more treatment-refractory to or experience greater side effects from the pharmacologic treatment of psychiatric disorders than controls, although we cannot determine if early environment or drugs exposure drives these findings

Comportamentos de vinculação indiscriminado em crianças em acolhimento institucional : riscos pré-institucionais

Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia Clinica e Saúde)O presente estudo teve como objetivo principal estudar os fatores etiológicos préinstitucionais associados ao comportamento indiscriminado de vinculação, numa amostra de crianças em acolhimento institucional em idade pré-escolar. Foi, ainda, avaliada a validade do Rating of Infant and Stranger Engagement (RISE; Riley, Atlas-Corbett & Lyons-Ruth, 2005), medida observacional para a idade do pré-escolar, com base no Procedimento Situação Estranha (Ainsworth, Blehar, Waters, & Wall, 1978). Recorreu-se a uma amostra de 60 crianças institucionalizadas em idade pré-escolar e às respetivas cuidadoras. Foram utilizados questionários sociodemográficos como forma a aceder às experiências pré-institucionais. Crianças institucionalizadas exibiram elevada frequência de comportamento indiscriminado. O abuso de drogas materno e o risco pré-natal mostraram-se associados à manifestação de comportamento indiscriminado. Ademais, quer o risco pré-natal como a psicopatologia materna revelaram-se preditores significativos na explicação do fenómeno em estudo. Por fim, estes resultados remeterão para a possibilidade de que a extrema indisponibilidade emocional materna para atender às necessidades da criança seja foco de atenção fulcral na compreensão da manifestação desta forma perturbada de vinculação.The present study has as main purpose to study the etiological factors pre-institutional associated with indiscriminate attachment behavior on a sample of children in institutional care at preschool. It was also evaluated the validity of the Rating of Infant and Stranger Engagement (RISE; Riley, Atlas-Corbett & Lyons-Ruth, 2005), observational measure the age of preschool, based on the Strange Situation Procedure (Ainsworth, Blehar, Waters, & Wall, 1978). We used a sample of 60 institutionalized children at preschool age and respective caregivers. Sociodemographic questionnaires were used to assess pre-institutional experiences. Institutionalized children exhibited high frequency of indiscriminate behavior. Maternal drug abuse and prenatal risk were associated with the manifestation of indiscriminate behavior. Moreover, prenatal risk and maternal psychopathology are significant predictors in explaining the phenomenon under study. Finally, these results will refer to the possibility of extreme maternal unavailability for the needs of the child as the central focus of understanding the manifestation of this kind of disturbed attachment.Fundação para a Ciência e a Tecnologia (FCT) - Bolsa de Investigação PTDC/PSI-PCL/ 101506/2008; P.I.: Isabel Soare

Birth Defects Res

Background.The teratogenic effects of prenatal alcohol exposure (PAE) have been extensively documented over the course of 45 years of research and psychiatric problems are pervasive in this population. In adults with PAE, suicidal risk is high but less is known about the suicidal risk in adolescents with Fetal Alcohol Spectrum Disorders (FASD). This study describes the prevalence of suicidal ideation and serious suicide attempts in a sample of 54 adolescents between the ages of 13 and 18 years with FASD.Methods.Adolescents were diagnosed with FASD using the Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. The Children\u2019s Interview for Psychiatric Syndromes was used to identify those adolescents who experienced suicidal ideation and/or who had made a serious suicide attempt in the last 12 months.Results.The prevalence of suicidal behaviors in this sample was high with 35.2% of teens reporting incidences of suicidal ideation and 13.0% reporting at least one serious suicide attempt in the past year. This finding is in contrast to the 17.2% and 2.4% for ideation and serious attempts, respectively, reported in the general U.S. adolescent population. Alarmingly, 29.2% of males with FASD reported a serious suicide attempt which was 19 \ubd times higher than national norms for males. No females reported attempts. Number of home placements and the presence of a depressive disorder contributed to study outcomes.Conclusions.Findings suggest the need for health practitioners to be aware of the significant risk for suicidality in this population, particularly in adolescent males, and to assess and treat this life threatening behavior.R01 AA025066/AA/NIAAA NIH HHS/United StatesU84 DD000504/DD/NCBDD CDC HHS/United States2020-07-15T00:00:00Z30677250PMC66503077983vault:3351

A short-term longitudinal study of correlates and sequelae of attachment security in autism

In this short-term longitudinal study, thirty preschool-aged children with autism were first observed in Ainsworth’s Strange Situation procedure and, separately, interacting with the primary caregiver in the home. One year later, each child completed both a developmental assessment and an observational assessment of empathic responding. Behaviors typical for children with autism were distinguished from behaviors suggestive of relationally based attachment disorganization. Forty five percent of the children were classified as securely attached. The secure group demonstrated language skills superior to those of the insecurely attached group, concurrently and during the follow-up. Compared to parents of children who were insecurely attached, parents of securely attached children were rated as more sensitive. Compared to both organized insecure and disorganized children, secure children were rated as more responsive to an examiner’s apparent distress during the follow-up relative to their ratings at intake, whereas empathy ratings of children with insecure classifications did not increase. Importantly, attachment security was associated with empathy above and beyond the contribution of children’s language level. These results indicate that the sequelae of attachment security in autism may be similar to those documented for typically developing children.This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute on Deafness and Other Communication Disorders, as part of the Collaborative Programs of Excellence in Autism: [Program Project Grant Number HD-DCD35470] and Wellcome Trust: [Grant Number WT103343MA]

Alcohol Clin Exp Res

Background:Project Step Up proposed to reduce alcohol consumption and alcohol-related negative outcomes in adolescents with fetal alcohol spectrum disorders (FASD).Methods:The 54 participants (30 females, 24 males) were assigned to either Project Step Up Intervention (SUI) or Control conditions and were assessed prior to intervention, immediately following intervention, and at 3-month follow-up. Adolescents in the SUI condition participated in a 6-week, 60-minute group intervention that provided alcohol education and promoted adaptive responses to alcohol-related social pressures. Caregivers attended concurrent but separate sessions on the effects of prenatal alcohol exposure on the brain and how to handle parenting challenges associated with alcohol use in teens with FASD.Results:Thirty-three percent (n = 18) of adolescents were classified as light/moderate drinkers, and 67% (n = 36) were abstinent/infrequent drinkers based on their lifetime drinking histories. Results revealed a significant decrease in self-reported alcohol risk and in alcohol-related negative behaviors (Cohen\u2019s d = 1.08 and 0.99) in light/moderate drinkers in the SUI compared to the Control group. These results were partially sustained at 3-month follow-up. Furthermore, adolescents in the abstinent/infrequent group exhibited no increase in alcohol-related outcomes suggesting that the group intervention used in this study was not iatrogenic.Conclusions:The success of this treatment development study provides preliminary support for effective treatment of adolescents with FASD to prevent or reduce alcohol use and its negative consequences in this high risk population.U84 DD000504/DD/NCBDD CDC HHSUnited States

Self-other similarity, attachment styles, and duration of romantic relationships

Bowlby’s attachment theory states that experiences with primary caregivers and others in early childhood allow one to form internal “working models” of the self and significant others. Studies have shown that an adult’s attachment style is related to his or her attachment history from childhood and subsequent working models about various relationships. An individualistic specific evaluation of one\u27s relationship is related to his or her attachment style (secure, preoccupied, fearful, or dismissive attachment style). Attachment styles may influence both partners’ levels of trust, satisfaction, love, commitment, and other emotions that are characteristically associated with a relationship. The similarity-attraction perspective from the personal attribution theory suggests that seeing oneself as similar to a partner may be associated strongly with attractions and evaluations of relationships. The concept of “self-other similarity” refers to “the evaluation of the extent to which one’s own traits and opinions are shared by others”. In this social comparison process, people negotiate their identities and regulate cognitive distance from significant others. Overestimating the level of self-other similarity allows one to decrease cognitive distance from others and thereby may facilitate assimilation in one’s social surroundings. Underestimating self-other similarity and emphasizing one’s unique traits and opinions allow one to increase cognitive distance and may facilitate differentiation from others. People overestimate or underestimate the level of self-other similarity depending on the extent to which these biases protect or reinforce their own self-view. A person’s attachment style influences the estimation of self-other similarity. This survey found that: (1) people to feel similar to a partner if the partner had a secure attachment style, irrespective the one’s own attachment style; (2) relationships in dyads with the perception of similar attachment styles tended to be more lasting; (3) in secure-secure relationships, perceiving self and the other highly similar, including attachment style, and the security itself may play important roles in relationship endurance; and (4) in lasting insecure-insecure relationships, perceived attachment styles similarity and self-other dissimilarity seemed to have a big influence. It is clear from the findings and other inconsistent findings of this study that more research is needed in the effects of attachment styles on estimation of self-other similarity

Alcohol Clin Exp Res

Background:Children with prenatal alcohol exposure (PAE) have significant social skills deficits and are often treated in community mental health settings. However, it remains unclear whether these children can be effectively treated using manualized, evidence-based interventions that have been designed for more general mental health populations.Methods:To shed light on this issue, the effectiveness of Children\u2019s Friendship Training (CFT) versus Standard of Care (SOC) was assessed for 85 children ages 6 to 12 years with and without PAE in a community mental health center.Results:Children participating in CFT showed significantly improved knowledge of appropriate social skills, improved self-concept, and improvements in parent-reported social skills compared to children in the SOC condition. Moreover, results revealed that within the CFT condition, children with PAE performed as well as children without PAE. Findings indicated that CFT, an evidence-based social skills intervention, yielded greater gains than a community SOC social skills intervention and was equally effective for children with PAE as for those without PAE.Conclusions:Results suggest that children with PAE can benefit from treatments initiated in community settings in which therapists are trained to understand their unique developmental needs, and that they can be successfully integrated into treatment protocols that include children without PAE.U01 DD000041/DD/NCBDD CDC HHSUnited States

Attachment and Social Competence of Children with a Mother Coping with Bipolar Disorder

The purpose of this study was to provide a better understanding of the attachment between a mother diagnosed with bipolar disorder and her child and the subsequent social competence of the child. A descriptive survey design was chosen due to the lack of existent literature in this area and the need to identify problematic areas of attachment and social competence in this identified population. A sample of ten mothers diagnosed with bipolar disorder with at least one school-aged child (between kindergarten and sixth grades), to whom the mother is the primary caregiver, participated in this study. Each participant was given two questionnaires to complete: one assessing attachment between the mother and child and one assessing social competence of the child. Recurrent themes of attachment and social competence were identified based on the participants’ responses. The findings of this study indicate areas of impairment in the attachment and social competence of children of mothers with bipolar disorder. These findings will add to the existent literature in this area and provide a basis for future studies and areas of possible therapeutic mediation

Analysis on the experience of parenting for adults with autism spectrum disorder, An

Includes bibliographical references.2022 Fall.A paucity of research has been conducted into the unique experience of parents with autism spectrum disorder (ASD). This lack of scientific understanding about a parent's lived experience is an obstacle to developing effective psychotherapeutic approaches to parents who have identified awareness of characteristic features of ASD. In this study, we present a qualitative case study of two adults with ASD who are parents. Both parents participated in an extensive interview focused on several domains: impacts resulting from characteristics of ASD, life changes resulting from a diagnosis or recognition of characteristics, impacts on executive functioning related processes, experience as a parent prior to recognition of characteristics or a diagnosis, belief in parenting ability, and insight into recommendations for support. Findings highlighted three main themes: 1) a conscious choice in accepting change, 2) saturation of self, and 3) the necessity for clinicians to adopt a learner's mindset

Specyfika rozwoju dzieci z FASAD w instytucjonalnej pieczy zastępczej

This article presents issues related to the diagnose and therapy children with FASD (Fetal Alcohol Spectrum Disorders) in the foster care system. The following paragraphs describe the disorders that occur in people after prenatal exposure to alcohol, taking into account long-term effects on social functioning. There has been described the mechanism of overlapping various traumatic experiences connected with FASD and livinf in institution. There also are indicated diagnostic and therapeutic difficulties and identified needs in the area of FASD