Externalizing problems and delinquent behaviors in residential-care male adolescents: associations with peer attachment and alexithymia

Male teenagers in residential-care (RC) show high rates of externalizing problems, such delinquent behaviors. Research findings underlined that peer attachment may have a protective role on the social adjustment of adolescents, while higher levels of alexithymia \u2014defined as an emotional regulation disorder (Taylor, 2004)\u2014 may be a risk factors for externalizing problems. Due to their previous adverse experiences, RC adolescents may show difficulties in both, although they live with peers. As no study done it before, this pilot study investigated the associations among peer attachment, alexithymia and externalizing and delinquent problems in 21 boys aged 13-18 years (M = 16.33, SD = 1.4) placed in residential-care. Measures were: 1) the Youth Self Report 11/18 (YSR) to measure Externalizing problems and delinquent behaviors; 2) the Inventory of Peer and Parent Attachment (IPPA) to assess the levels of Peer attachment, and 3) The Toronto Alexithymia Scale (TAS-20) to detect alexithymia. Results showed expected associations among higher levels of alexithymia and Externalizing (rs = .447, p = .04) and delinquent (rs = .464, p = .03) problems, which show unexpected positive correlations also with peer attachment (Externalizing: rs = .600, p = .009; delinquent: rs = .629, p = .005). In addition, a multiple regression accounted only peer attachment as predictor of higher levels of externalizing problems (adjusted-R2 = .36 p = .005) and delinquent behaviors (adjusted-R2 = .32 p = .009). Authors discussed the potential utility to monitoring the quality of peer-attachment in potentially high-risk contexts like residential ones, whereas it may elicit or perpetuate delinquent conducts among adolescents instead of promoting social adjustment. The role of attachment and emotional regulation for residential adolescents psychopathology is deepen investigate into this larger study, using also clinical interviews such FFI and TSIA

Attachment Representations and Emotion Regulation Strategies in Parents of Children with Disruptive Behaviour Disorders

Although a growing body of research suggests a robust association between insecure attachment, emotion regulation problems and externalizing problems, as Disruptive Behaviour Disorders (DBD), in children, only a few studies have explored these constructs in their parents. Moreover, the role of the father is often neglected. The current study aimed to investigate attachment representations and emotion regulation strategies in parents with DBD children (considering mothers and father separately), compared with a comparison group. The research involved 100 Italian parents: 36 clinical parents (18 mothers and 18 fathers) of children aged 8-12 years with a diagnosis of DBD, and 64 parents (32 mothers and 32 fathers) of children with no clinical symptoms. Parents\u2019 attachment representations were assessed through the Adult Attachment Interview and their emotional regulation strategies through the Emotion Regulation Questionnaire. The clinical status of children was the result of an evaluation by two mental health experts and a compilation by both parents of the Child Behavior Checklist 6-18 Version. Our results pointed to a greater presence of Insecure-Entangled attachment in DBD mothers and a lower level of Cognitive Reappraisal in DBD fathers compared with comparison parents. Nevertheless, maternal Insecure and paternal Cognitive Reappraisal did not together predict children DBD as the outcome. These preliminary findings make a significant contribution to the topic of emotional functioning of DBD parents, suggesting the importance to further deepen the quality of parenting in the context of DBD children

Prenatal attachment, distress symptoms and psychosocial variables in a sample of Italian first-time parents

Background. The term prenatal attachment refers to the bonding that parents develop towards the unborn baby. It is considered a precursor of the care-giving system and there is evidence that it could affect the parent-child relationship. Literature provides the knowledge of predictors of poor maternal prenatal attachment. However, paternal prenatal attachment is rarely studied and few studies have investigated prenatal attachment in couples. Aim: The study aims at evaluating the relationship between prenatal attachment, distress symptoms and selected psychosocial variables in couples in the third trimester of pregnancy. Methods: First-time parents attending public antenatal clinics were recruited into the study. A set of questionnaires investigated: sociodemographic, psychosocial and pregnancy related variables, depression and anxiety symptoms, distress and prenatal attachment. Results: Multiple linear regression showed that the woman\u2019s worries about pregnancy, her perceived social support, age and disappointment with the child\u2019s gender were independent predictors of maternal prenatal attachment. The degree of involvement toward the fetus by the father, his perception of the partner\u2019s attitude towards him during pregnancy and the impact of distress were independent predictors of paternal prenatal attachment. The results indicate several areas amenable to intervention by healthcare professionals to support couples in the transition of parenthood

A Long-term Psychological Observation in an Adolescent affected with Gardner Diamond Syndrome

Gardner-Diamond syndrome (GDS) is an uncommon disease clinically characterized by a wide spectrum of psycho-emotive symptoms associated with painful ecchymoses/purpuric lesions and positivity of auto-erythrocyte sensitization skin test. Herein, a perspective clinical and psychological observation of an adolescent GDS is firstly reported focusing on her psychological features long-term monitored for a 1-year period. The administration of a standardized tools battery allowed us to define psychological features of the young patient over time and to monitored clinical course and response to treatment

Children’s mental representations with respect to caregivers and post-traumatic symptomatology in Somatic Symptom Disorders and Disruptive Behavior Disorders

Introduction: In line with literature, the quality of adult-infant interactions and mental representations of the caregivers play an essential role in influencing the children's well-being. Many studies focused the attention on the role of attachment for a better evaluation of child psychopathological outcomes. The flexibility of the child's attachment model gives the opportunity to parents to be helped in modifying their own caregiving quality, encouraging the reflection on the children's state of mind with respect to attachment. The aims of this study were to evaluate: (1) the attachment models in young patients diagnosed with Disruptive Behavior Disorders (DBDs) and Somatic Symptoms Disorders (SSDs); (2) the levels of post-traumatic symptomatology; (3) the association between the attachment models and post-traumatic symptomatology. Methods: Forty Italian patients, aged from 8 to 15, recruited at Gaslini Paediatric Hospital of Genoa, previously diagnosed with SSD (N = 20) and DBD (N = 20) were assessed using the Child Attachment Interview (CAI), the Separation Anxiety Test (SAT), the Trauma Symptom Checklist for Children (TSCC-A). Socio-demographic data were collected. Results: In both the clinical samples, the findings on the distribution of attachment models showed a significant presence of insecure attachment with respect to both parents in more than a half of the patients and high levels of disorganized attachment. No significant differences between DBD and SSD samples were found on post-traumatic symptomatology (Post-Traumatic Stress and Dissociation). Significant differences were found on Depression, Anxiety, and Fantasy subscales. Discussion: This study can provide a detection of dysfunctional aspects in clinical populations. The findings suggest that the quality of the attachment to parents may be a fundamental element to better assess SSD and DBD in children and adolescents. Clinical implications of this study aimed at improving parental caregiving are highlighted

Nocebo Effect in patients with Adverse Drug Reactions: The Role of Emotion Regulation

open4Patients who have experienced adverse drug reactions (ADRs) can show some psychological problems both pre-existing than consequently the reactions. Anxiety, depression, somatization, as well as a minor capability of expressing emotions, have been demonstrated in some of these subjects. Nevertheless, a negative expectation toward a new drug administration related to some nocebo reactions can complicate the evaluation of these patients. This study aims to investigate the link between the nocebo effect and emotional functioning in ADRs patients to better understanding the psychological mechanisms involved in this phenomenon. Therefore, patients who have manifested or not (non responders) a nocebo reaction following the administration of an inert substance (placebo) have been compared. One hundred twenty patients (N = 30 with nocebo reactions; N = 90 non responders) completed the Difficulties in Emotion Regulation Scale, Emotion Regulation Questionnaire, and Toronto Alexithymia Scale-20. ADRs patients with nocebo reactions showed: 1) higher level of Cognitive Reappraisal than non responders; 2) associations between higher level of emotion dysregulation and not immediate drug reactions; 3) associations between higher level of alexithymia, Expressive Suppression and more frequent access to healthcare services; 4) alexithymia and Expressive Suppression as predictors of more frequent access to healthcare services, evident in 35% of the sample. The clarification of some psychological mechanisms involved in the nocebo effect is a basic prerequisite to better understand and manage these patients.openMara Donatella Fiaschi; Susanna Voltolini; Patrizia Velotti; Fabiola BizziDonatella Fiaschi, Mara; Voltolini, Susanna; Velotti, Patrizia; Bizzi, Fabiol

Emerging adults facing the COVID-19 pandemic: emotion dysregulation, mentalizing, and psychological symptoms

Settled in the context of the COVID-19 pandemic, the present short-term longitudinal study aims to investigate the relation between emotion dysregulation, mentalizing (both certainty and uncertainty about mental states), and psychological symptoms in a sample of 83 emerging adults (M-age = 22.18 years, SD = 4.36) over a continuous period started with COVID-19 spreads. Results display significant positive associations between psychological symptoms and both emotion dysregulation and uncertainty about mental states, while an inverse association with certainty about mental states was found. A moderation model was also performed, showing a significant negative association between emotion dysregulation and psychological symptoms at low levels of uncertainty about mental states. Conversely, a marginally significant positive association occurs at high levels of uncertainty about mental states. In other words, the presence of individual impairments in perceiving one's own/others mind may increase the negative consequences of emotion dysregulation on reported psychological symptoms. To sum up, our findings highlight the importance of considering mentalizing as a possible key factor for the promotion of emerging adults' mental health also in the context of the ongoing COVID-19 pandemic

Tension-Type Headache in Early Adolescents: Exploring the Predictive Role of Anxiety and Alexithymia

Introduction: Primary Headache, including Tension-Type Headache (TTH), represents one of the most common somatic disorders in children and adolescents with a strong impact on quality of life. Several risk factors, as environmental, familiar, and psychological features, including personality traits, are related to the development of Primary Headache. However, studies on specific subgroups of TTH are relatively few in early adolescents. Objectives: Therefore, this cross-sectional pilot study aims at exploring the role of anxiety and alexithymia in early adolescents with and without TTH. Methods: A sample of 70 early adolescents (Mage=14.59, SD=1.85; 71% females) consisting of a clinical group (31 with TTH) enrolled in an Italian Child Neuropsychiatry Clinic and a comparison group (38 without TTH) enrolled in schools, matched on gender and age, completed: 1) Multidimensional Anxiety Scale for Children (MASC) to detect the Total levels of Anxiety, also in their factor of Physical Symptoms, Social Anxiety, Harm Avoidance, and Separation Anxiety; 2) the Toronto Alexithymia Scale (TAS-20) to detect the Total levels of Alexithymia, also in their factor of Difficulty to Identifying and to Describing Feelings and Externally Oriented Thinking. Results: TTH outcome positively correlated with Harm Avoidance (rho=.68, p<.001) and Total Alexithymia (rho=.72, p<.001). In a logistic regression, Harm Avoidance and Total Alexithymia predicted 69% of the variance in TTH outcome (p<.032). Conclusions: This disorder may be a maladaptive strategy to cope with problems and feeling emotions, then early adolescents could be fostered in the acquisition of more adaptive emotion regulation abilities

Multimethod Assessment of Mentalizing and its relations with Somatic Symptoms in Adolescents with Primary Headache

Introduction: Difficulties in mentalizing (i.e., the ability to reflect on self and others’ internal mental states, operationalized as reflective functioning [RF]; Fonagy et al., 2012) have been associated with psychological symptoms (Luyten et al., 2020), including somatic symptoms (Bizzi et al., 2019). Therefore, the assessment of its dimensions may be clinically relevant for young patients with somatic symptoms, as with Primary Headache (PH), representing one of the most common somatic complaints in children and adolescents. Objectives: This study aimed to assess RF with a multi-method approach, exploring its relation with somatic symptoms. Methods: 48 adolescents diagnosed with PH (Mage=14.83, SD=2.81; 67% females) were recruited from an Italian Child Neuropsychiatry Clinic. RF was measured both through the Child and Adolescent Reflective Functioning (CRFS) applied to the Child Attachment Interview transcripts and the self-report Reflective Functioning Questionnaire (RFQ), while the Children’s Somatization Inventory (CSI-24) was used to measure the perceived severity of somatic symptoms. Results: Different relations with somatic symptoms depended on the method used to evaluate RF: no significant correlations were found with the CRFS subscales (General, Other, Self), while a negative significant correlation was found with the RFQ subscale Certainty about mental states (RFQ_C) (r=-.46, p=.016). All subscales of CRFS were negatively correlated with RFQ_C (p=.05), but not with the other RFQ subscale (Uncertainty about mental states; RFQ_U). Conclusions: This suggests that two measures may lead to different dimensions of the same construct, thus a multi-method assessment of RF would be advisable in clinical practice

Advancement in the child attachment interview and the child and adolescent reflective functioning scale using a PDM-2 framework: case reports

open5siThe Child Attachment Interview (CAI) is a well-established semi-structured interview, widely used to identify attachment representations in middle childhood and adolescence. The application of the Child and Adolescent Reflective Functioning Scale (CRFS) to CAI narratives allows for an assessment of child mentalization, considered a strong predictor of attachment security. The 2nd edition of the Psychodynamic Diagnostic Manual (PDM-2) includes CAI and CRFS as valid and reliable assessment measures in order to assess the dominion of the Mental Functioning axis. The aim of the present paper is to investigate the informative power of CAI and CRFS for the overall understanding of mental functioning and personality in a PDM-2 framework. The present report includes the discussion of two clinical cases of school-aged children in applying the Psychodiagnostic Chart-Second Edition (PDC-2) to the CAI transcript. The first case concerns a young male, aged 10, suffering from Oppositional-Provocative Disorder (externalizing disorder), while the second case concerns a young female, aged 15, suffering from Somatic Symptoms Disorder (internalizing disorder). PDC-2 for children and adolescents was used. Data from the scoring of CAI and CRFS were combined with a systematic evaluation of the qualitative contents emerging from CAI transcripts. A detailed analysis suggests that both the CAI and CRFS are useful attachment-oriented measures, able to explore a child's mental states, and together with the application of PDC-2 they provide an essential contribution in the understanding of developmental psychopathology. Implications of this innovative approach for clinical assessment, treatment design, and interventions are further discussed.openBizzi, Fabiola; Locati, Francesca; Parolin, Laura; Shmueli-Goetz Yael; Brusadelli, EmanuelaBizzi, Fabiola; Locati, Francesca; Parolin, Laura; Shmueli-Goetz, Yael; Brusadelli, Emanuel