Children with disrupted attachment histories: Interventions and psychophysiological indices of effects

Diagnosis and treatment of children affected by disruptions of attachment (out of home placement, multiple changes of primary caregiver) is an area of considerable controversy. The possible contribution of psychobiological theories is discussed in three parts. The first part relates the attachment theoretical perspective to major psychobiological theories on the developmental associations of parent-child relationships and emotional response. The second part reviews studies of autonomic reactivity and HPA-axis activity with foster children, showing that foster children show more reactivity within physiological systems facilitating fight or flight behaviours rather than social engagement, especially foster children with atypical attachment behaviour. The third part is focused on treatment of children suffering from the consequences of disrupted attachment, based on a psychotherapy study with psychophysiological outcome measures. Implications are discussed for theory, diagnosis, and intervention

Young children with significant developmental delay differentiate home observed attachment behaviour towards their parents

Background: The hallmark of attachment is that contact, proximity and relief from stress are sought from specific individuals, laying important groundwork for healthy socioemotional functioning. This study investigated the extent to which differentiated attachment behaviour can be observed in young children with significant developmental delay (DD). Method: Video-taped observations of the parent–child and stranger–child interaction were conducted at home and complemented with questionnaires in 20 families with a child with significant DD (age 2–7 years with an average DD of 49 months). Results: Children displayed more intense and persistent contact-seeking, contact-maintaining and resistant behaviour in the episodes with their parent compared to the episodes with the stranger. Parent-reported secure attachment behaviour was slightly more characteristic towards mother compared to father. Conclusions: Even children with significant DD develop differentiated attachment behaviour. Detailed observations may support parents in identifying the interactions that make the attachment relationship with their child special

Comparison of Social Valdidity Ratings with the Effects of a Video-feedback Intervention for Communication Partners of Individuals with Deafblindness

The parents, teachers, and professional caregivers of individuals with disabilities may benefit from interventions to enhance their educational skills. In previous studies, positive effects were observed of a video-feedback intervention for caregivers (i.e. parents, teachers, and professional caregivers) on their communication with an individual with congenital deafblindness. The intervention they received, was the High-Quality Communication (HQC) intervention. The aim of the current study was to gain insight into the perceived relevance, feasibility, and effectiveness (i.e., social validity) of the HQC-intervention according to these caregivers, and the correspondence between the social validity ratings and the observational effects of the HQC-intervention. Responses on the Social Validity Scale from 25 caregivers who participated in the High-Quality Communication (HQC) intervention revealed that they considered the HQC intervention to be a relevant, feasible, and effective intervention. Comparing the caregiver ratings with observational effects of the HQC intervention at the individual case level, we found no association between the observed effectiveness of this intervention and caregivers’ opinions about its relevance, feasibility and effectiveness. There was however, an association between the rated feasibility and effectiveness, which suggests that the perceived success of the intervention was influenced by caregivers’ experienced competency in supporting the communication of individuals with CDB. The combination of observational and social validity data enabled a critical analysis of the clinical value of the HQC intervention. We recommend that future studies use multiple data source for social validity assessment

Reliability and Feasibility of Systematic Registration of Coercive Measures in Care for People With Intellectual Disabilities

Policies limit the use of coercive measures as a measure of last resort to protect people from danger. Success of policies can only be determined by registering the use of coercive measures. The reliability of 57 standardized coercive measures was tested. In addition, implementation was investigated of improved registration in a residential care setting. This mixed methods study within a residential care organization for people with intellectual disabilities in the Netherlands included 55 living units and 269 residents. Reliability of 57 standardized coercive measures was tested against other informants (colleague staff, trained outside observer) and results were validated by a panel of stakeholders. Second, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to personal files of 30 residents. Registration of coercive measures yielded reliable data for at least 25 out of 57 types of coercive measures. The second part of the study showed widely varying explanations of unreliable data by stakeholders, including knowledge and awareness of coercive measures of support staff and the influence of contextual factors on the encoding of coercive measures. After implementation, 46% of the coercive measures were registered in the registration system. Comprehensive registration of coercive measures by staff neither appeared feasible nor yielded reliable data. Clearly, multidisciplinary discussion among support staff and professionals is needed to decide whether care practices are restrictive or not. Further research should focus on how these considerations can lead to a reliable and meaningful registration

The impact of childhood trauma and psychophysiological reactivity on at-risk women's adjustment to parenthood

Adverse childhood experiences (ACEs) have an impact on women's adaptation to parenthood, but mechanisms are poorly understood. Autonomic nervous system reactivity was tested as a potential mediating mechanism in a sample of 193 at-risk primiparous women. ACEs were measured retrospectively during pregnancy. A baby cry-response task was administered during pregnancy while indicators of sympathetic reactivity (pre-ejection period; PEP) and parasympathetic reactivity (respiratory sinus arrhythmia; RSA) were recorded. Parenting self-efficacy, anxiety, and depressive symptoms were measured during pregnancy and 1 year after giving birth. Harsh discipline was measured 2 years after giving birth. Structural equation modeling was employed to test whether baseline PEP and RSA and reactivity mediated links between ACEs and postnatal outcomes, adjusted for prenatal variables. High ACEs predicted less RSA reactivity (p =.02), which subsequently predicted increases in depressive symptoms (p =.03). The indirect effect was not significant (p =.06). There was no indirect link between high ACEs and harsh parenting through PEP nor RSA (n = 98). The parasympathetic nervous system may be involved in negative affective responses in the transition to parenthood among women exposed to childhood trauma

Exploring the Application of NLP in Narrative Patterns of Adult Attachment

The Adult Attachment Interview (AAI) is a protocol-based, semi-structured interview method widely used to measure adults’ states of mind with respect to attachment. Recently, transcripts of this interview have been used to code secure base script knowledge, which is script-like knowledge related to the way parents dealt with their distress during childhood (ie., child went to parent for comfort, parent provided instrumental and emotional support, child went back to play). Manually coding the verbatim transcripts is labor-intensive and requires a lot of centralized training. The potential integration of machine learning and natural language processing (NLP) techniques may automate certain aspects of AAI analysis, potentially optimizing the process. The aim of this research project is to explore the practical application of these technologies in analyzing AAI transcripts.The project uses data from a pooled set of 12 studies originating from four countries. Upon reviewing the 1,410 AAI transcripts in this set (conducted in three languages), notable discrepancies in the administration of the interviews emerged, some of which may affect the suitability of the interview to assess secure base script knowledge. The first focus of this research project is therefore to develop a model to automatically assess the quality of the transcripts, first for English studies and then for all studies and languages. This model will prioritize evaluating interview characteristics, including instances of unintelligibility and non-adherence to the prescribed AAI protocol. As a next step in the project, employing sentiment analysis will enable an investigation into the correlation between participant-provided adjectives and their corresponding narratives. Finally, this research project will explore the possibility of automatically coding secure base script knowledge in AAI transcripts. By combining technological advances with nuanced human insights, this research project not only provides a pathway toward research studies at scale, but also presents an opportunity to achieve a deeper understanding of emotional and cognitive dimensions within attachment narratives.<br/

Loneliness in young adults with a visual impairment:Links with perceived social support in a twenty-year longitudinal study

Background: Young people with disabilities are more at risk of experiencing loneliness in later life than their typically developing peers. Aim: To identify those who become lonely in later life, trajectories of perceived parent and peer support from adolescence to adulthood of young people with a visual impairment were studied. Methods: A total of 316 adolescents (M = 18 years; SD = 6.5) enrolled in a cohort study in 1996; 205 of them participated in 2005, 178 in 2010, and 161 in 2016. Latent growth curve models were fitted to the data. Results: Perceived parent support followed a linear decreasing course. No association was found between perceived parent support and loneliness in later life. For perceived peer support a quadratic growth pattern was found, with an increase in peer support up to age 27, and thereafter a decrease. Both the initial level and the rate of change in perceived peer support significantly predicted loneliness in adulthood. Conclusions: The course of peer support is a better indicator for the risk of loneliness in later life than support from parents. Normative life transitions may affect the already vulnerable social support for young people with a visual impairment. This study highlights the importance of establishing and maintaining peer relationships throughout life

Impact of Research About the Early Development of Children With Intellectual Disability: A Science Mapping Analysis

The “Warnock Report” (Department for Education and Science, 1978) underlined the importance of early intervention for children with a range of special educational needs and the importance of partnership with families. This paper focuses on young children with intellectual disability to describe the longitudinal research on early development that has emerged since the report, and to describe the scholarly literature that has been impacted by this longitudinal work. First, we conducted a systematic literature search for primary reports of longitudinal studies on the early development of children with intellectual disability. Included studies were those that measured dependent (i.e., developmental outcomes) and independent variables (i.e., risk and resilience factors) on at least two measurement occasions (i.e., truly longitudinal), starting before the end of the 7th year of life, with samples including children with intellectual disability (or related terms). The topics of these studies, and of the publications that have cited these longitudinal studies, were extracted from titles and abstracts using machine reading and subjected to multidimensional clustering (VOSviewer; Van Eck and Waltman, 2016). The resulting body of 101 research studies (about 2.5 studies per year) covered a scattering of topics without a dominant focus. The literature that was impacted by these longitudinal studies consisted of 3,491 scientific publications. Three clusters of topics emerged from mapping the terms used in these publications, which were dominated by (1) syndrome and disorder related terms; (2) autism-related terms; and (3) disability and parent related terms. Topics related to autism and, to a lesser extent, parents showed the strongest increase over time. Topics related to intervention and programmes were mostly linked to the topics disability and parents. Taking into account the science mapping as well as features of the context in which research on intellectual disability takes place, we suggest a collaborative research agenda that systematically links topics relevant for intervention with longitudinal research, in co-creation with families

The effectiveness of a trauma-focused psycho-educational secondary prevention program for children exposed to interparental violence: study protocol for a randomized controlled trial

Background: Children who witness interparental violence are at a heightened risk for developing psychosocial, behavioral and cognitive problems, as well as posttraumatic stress symptoms. For these children the psycho-educational secondary prevention program 'En nu ik...!' ('It's my turn now!') has been developed. This program includes specific therapeutic factors focused on emotion awareness and expression, increasing feelings of emotional security, teaching specific coping strategies, developing a trauma narrative, improving parent-child interaction and psycho-education. The main study aim is to evaluate the effectiveness of the specific therapeutic factors in the program. A secondary objective is to study mediating and moderating factors. Methods/design: This study is a prospective multicenter randomized controlled trial across cities in the Netherlands. Participants (N = 140) are referred to the secondary preventive intervention program by police, social work, women shelters and youth (mental health) care. Children, aged 6-12 years, and their parents, who experienced interparental violence are randomly assigned to either the intervention program or the control program. The control program is comparable on nonspecific factors by offering positive attention, positive expectations, recreation, distraction, warmth and empathy of the therapist, and social support among group participants, in ways that are similar to the intervention program. Primary outcome measures are posttraumatic stress symptoms and emotional and behavioral problems of the child. Mediators tested are the ability to differentiate and express emotions, emotional security, coping strategies, feelings of guilt and parent-child interaction. Mental health of the parent, parenting stress, disturbances in parent-child attachment, duration and severity of the domestic violence and demographics are examined for their moderating effect. Data are collected one week before the program starts (T1), and one week (T2) and six months (T3) after finishing the program. Both intention-to-treat and completer analyses will be done. Discussion: Adverse outcomes after witnessing interparental violence are highly diverse and may be explained by multiple risk factors. An important question for prevention programs is therefore to what extent a specific focus on potential psychotrauma is useful. This trial may point to several directions for optimizing public health response to children's exposure to interparental violence

Marital conflict strategies predict child abuse potential in Dutch families from low socioeconomic backgrounds

'Der Beitrag untersucht den Zusammenhang zwischen Partnerschaftskonflikten und dem Potential zur physischen Misshandlung von Eltern aus N=86 Unterschichtfamilien in den Niederlanden. 17% der Eltern erreichten eine Punktzahl auf Milner's Child Abuse Potential Inventory, die dessen obere 5% Grenze überschritt. Niedrigerer sozialökonomischer Status, relativ unangemessene eheliche Konfliktstrategien und weniger Ehekonflikte erklärten statistisch ein höheres Misshandlungspotential. Von allen Konfliktstrategien trugen physische Aggression gegenüber dem Partner, Konfliktvermeidung und eisiges Schweigen zur Erklärung des Zusammenhangs bei. Obwohl bessere Konfliktlösungen positiv korrelierten mit geringerem Misshandlungspotential konnten sie die Erklärungskraft der Konfliktstrategien nicht übertrumpfen. Wir gelangten zum Schluss, dass Konfliktverhalten in der Partnerschaft und die Neigung von Eltern zur physischen Misshandlung in derselben Inkompetenz im Umgang in intimen Beziehungen liegen kann.' (Autorenreferat)'We examined the association between marital conflict and child abuse potential in N=86 Dutch families from low socioeconomic backgrounds. The percentage of parents who exceeded the upper 5 percent cut-off score an Milner's Child Abuse Potential Inventory was 17%. It was found that lower socioeconomic status, relatively inadequate marital conflict strategies, and fewer marital conflicts predicted higher child abuse potential. In particular physical aggression towards the partner, avoidance of conflicts, and stonewalling contributed to increased child abuse potential. Although more positive marital conflict resolutions were associated with lower child abuse potential, they did not predict abuse potential beyond the contribution of conflict strategies. We suggested that child abuse may be one of many manifestations of difficulties in coping with the conflicts and problems that are intrinsic to close and affective relationships.' (author's abstract