Feeding and attachment in infants with and without orofacial clefts

Do the many feeding problems associated with isolated cleft palate (CP) and cleft lip and palate (CLP) adversely affect the emotional bond between mother and infant? This question was addressed by observing the feeding interactions of 126 mother-infant pairs (57 infants with CLP or CP) at 3 and 12 months of age. Infants with CLP were found to be less communicative during feeding at 3 month than comparison group infants. However, by 12 months, the CLP group had improved to a level indistinguishable from the CP and comparison groups. This change was unrelated to the timing of cleft palate surgery. Although maternal sensitivity during feeding at 3 months did not predict the attachment quality of infants with clefts, maternal sensitivity at 12 months was concurrently related to attachment. Change in maternal sensitivity between 3 and 12 months was also predictive of attachment in the cleft groups, with mothers of avoidant infants showing greater attenuation in maternal sensitivity than the mothers of secure infants.     

Incidence of neurological soft signs in children with isolated cleft of the lip or palate

The purpose of this study was to assess neurological soft signs in children and adolescents with isolated cleft of the lip or palate (iCL/P) compared with healthy controls. Children with iCL/P were recruited through the university cleft clinic. Control subjects were recruited through advertisements. Of the 166 subjects who participated (age range 7 to 17 years, M = 12.5, SD = 3.2), 77 had iCL/P (48 male) and 89 were healthy controls (44 male). All participants took the Physical and Neurological Examination of Subtle Signs and selected tests of motor coordination. A multivariate analysis of variance assessed differences between subjects with and without iCL/P. Also, a Pearson correlation estimated the relationship between the neurological soft signs and age. Subjects with iCL/P scored significantly higher on all neurological soft signs variables. These higher scores were associated with younger age. Findings lend support to the hypothesis of aberrant brain development in children with iCL/P.     

Peer harassment and satisfaction with appearance in children with and without a facial difference

This study investigated associations between perceived peer harassment and satisfaction with appearance in the presence or absence of a facial difference. A cross-sectional sample of 661 children aged 10 or 16, with a cleft lip and/or palate, completed measures of satisfaction with appearance and peer harassment. Results indicated that the presence of a visible versus a nonvisible cleft was not associated with appearance dissatisfaction or higher levels of peer harassment for children aged 10 or for adolescent boys. Peer harassment was related to dissatisfaction with appearance in both age groups. In the adolescent group, there was an interaction between cleft visibility and gender, girls with a visible cleft being least satisfied with appearance. However, the association between cleft visibility and satisfaction with appearance was fully mediated by experiences of peer harassment. The results highlight the need to further explore the role of social interactions for subjective perceptions of appearance.     

Parenting and attachment among toddlers with congenital anomalies: Examining the Strange Situation and attachment Q‐sort

This study assessed parent and child predictors of attachment in a sample of 72 toddlers with neurological (e.g., cerebral palsy) and non‐neurological (e.g., cleft lip and palate) birth defects and their mothers. Parenting quality (e.g., sensitivity) was expected to be more important in predicting the attachment relationship than type and severity of child medical condition. Parenting and indices of severity of child condition were measured via researcher observation. Attachment was measured via the Strange Situation and parent reported Attachment Q‐sort. Parenting quality was better for children with more severe appearance disfigurements. Strange Situation and Q‐sort assessments of attachment were not significantly related. Children with neurological impairments were at greater risk for developing insecure attachments than were children with non‐neurological conditions. Parenting quality also directly predicted Strange Situation assessed attachment security and Q‐sort comfort seeking/exploration but not standard Q‐sort criterion scores. Parenting quality partially mediated the relation between child medical condition and attachment security. Results suggest child medical factors influence parenting, and thereby, child attachment. ©2002 Michigan Association for Infant Mental Health.     

ATTACHMENT IN INFANTS WITH CLEFT LIP AND/OR PALATE: MARGINAL SECURITY AND ITS CHANGES OVER TIME

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent–infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old—which can be considered marginally secure at that age—may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.     

Test Review: Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV)

Objective: Evaluate neuropsychological functioning in children with non-syndromic cleft of the lip and/or palate (NSCL/P) through profile variance within type of cleft and comparisons to controls.

Methods: Children ages 7 to 17 years participated; 66 had a diagnosis of NSCL/P and 87 were healthy controls. Neuropsychological tests of language, visual-perceptual, executive functioning, and memory skills were administered. Between- and within-group differences were assessed.

Results: Within cleft types, children with NSCLP had an even profile with equal Verbal and Performance IQ (VIQ and PIQ, respectively). Children with non-syndromic cleft palate only (NSCP) had significantly lower VIQ than PIQ, while children with non-syndromic cleft lip only (NSCL) showed a nonsignificant trend for higher VIQ than PIQ. Overall, subjects with NSCL/P performed lower on measures of expressive language and verbal memory than controls.

Conclusions: While deficits in verbal and memory skills for children with NSCL/P remain apparent, there is still uncertainty around the possible influence of cleft type on the pattern of deficits.     

Maternal interactive behaviour towards children with and children without cleft lip and palate

The present study examined qualitative and quantitative differences in maternal interactive behaviour towards infants with and without cleft lip and palate (CLP). Thirty-three mother-child pairs with CLP and 34 pairs without CLP were videotaped at 3, 6, 9, and 12 months of age in two sorts of play situations at home. In addition, the mothers were questioned by letter about their ability to recognize and interpret the child's signals; their willingness to respond to such signals; and the duration of shared daily activities in the context of feeding and play. The results showed that mothers of CLP children are somewhat less sensitive than other mothers. In addition, it appeared that CLP children play less with other people. Longer feeding times for CLP children appeared to be restricted to the age of 3 months. It is suggested that mothers of CLP children may be comparatively directive and stimulating because of uncertainty about additional deficiencies. Furthermore, they may be inclined to keep their children away from the outside world.     

Worry in children is related to perceived parental rearing and attachment

In a sample of 159 primary school children, the relationship between perceived parental rearing behaviours and self-reported attachment style, on the one hand, and worry, on the other hand, was investigated. Children completed (a) the EMBU, a questionnaire measuring perceptions of parental rearing behaviours, (b) a single-item measure of attachment style, and (c) the Penn State Worry Questionnaire for Children (PSWQ-C), an index of severity of worrying. Results showed that parental rearing behaviours, in particular rejection and anxious rearing, were positively associated with worry. Thus, children who perceived their parents as more rejective and anxious reported higher levels of worry. Furthermore, self-reported attachment style appeared to be related to worry. More specifically, children who classified themselves as avoidantly or ambivalently attached displayed higher levels of worry than did children who classified themselves as securely attached. These findings are consistent with the notion that family environment factors such as parental rearing and attachment style contribute to the severity of anxiety symptoms in children.     

应用自然辩证法原理指导唇腭裂畸形的序列治疗

唇腭裂畸形是人类最常见的先天发育性缺陷之一.序列治疗的方法是治疗唇腭裂畸形的有效方法.但是由于其中存在着许多矛盾,使得序列治疗变得很复杂.使用自然辩证法的基本原理来为患者设计治疗计划,有助于简化治疗方案,选择最优方案,从而实现无论在形态与功能,还是心理上,均能使患者达到与正常人一样或接近一致的治疗目的.     

Is early attachment security carried forward into relationships with preschool peers?

The association between early parent‐child attachment security and peer rejection among preschool children was examined. Children in three preschool classrooms (N = 37) participated. Mothers rated their children's attachment security at age 3 years on the Attachment Q‐Set (Waters, 1987). Sociometric ratings were collected from classmates at age 4 years through individual picture interviews. Teachers rated externalizing and internalizing behaviour exhibited at preschool. Lower attachment security was associated with greater subsequent peer rejection and higher externalizing and internalizing behaviour scores. An exploratory path model suggested that the linkage between early insecure attachment and later peer rejection may be mediated by externalizing behaviour.     

流动儿童的亲子依恋与其城市适应的关系:心理韧性的中介作用

本研究旨在探讨流动儿童的亲子依恋与城市适应的关系,并探讨心理韧性在其中是否起到了中介作用。采用城市适应问卷、亲子依恋问卷、心理韧性量表,对北京市3所小学三到六年级的665名流动儿童进行了调查。经分析发现：（1）女生、低年级、父母教育水平高、公立学校、未转学的流动儿童能更好地城市适应;（2）亲子依恋、城市适应和心理韧性各维度两两相关;（3）亲子依恋中的自我模型和父母模型对城市适应均有直接预测效应。亲子依恋中的自我模型通过心理韧性进而间接影响城市适应;亲子依恋中的父母模型通过心理韧性进而间接影响城市适应;亲子依恋中的自我模型和父母模型可以共同通过心理韧性进而间接影响城市适应;心理韧性在其中均起到显著的部分中介作用。总的来说,亲子依恋可以直接影响城市适应,也可以通过心理韧性的中介作用间接影响城市适应。     

Attachment at school age and academic performance.

The association between attachment and school-related cognitive functioning was longitudinally examined for a French Canadian sample of 108 school-age children. The affective quality of mother-child interaction patterns, child cognitive engagement, and quality of child attachment to mother were evaluated during a laboratory visit that included a separation-reunion procedure occurring when the children were approximately 6 years of age. Children's mastery motivation and academic performance were assessed 2 years later (at age 8). Analyses indicated that secure children had higher scores than their insecure peers on communication, cognitive engagement, and mastery motivation. Controlling children were at greatest risk for school underachievement, with the poorest performance on all measures except mastery motivation. Avoidant and ambivalent children were lowest on mastery motivation. Results of mediational analyses support the salience of mother-child interactional processes and child cognitive engagement at school age in explaining relations between attachment and cognitive functioning in school.     

Maternal representations during pregnancy and early infant-mother interactions

This paper deals with the influence of maternal representations during pregnancy on the subsequent mother-infant relationship and the infant's style of attachment at 1 year of age. Psychoanalytic thinking, beginning with Freud to the most recent contributions, has considered the great importance of the mental dynamics between parents and children to which empirical research according to Bowlby's theoretical perspective has contributed. The current research project was planned in order to study the intergenerational processes. Starting during pregnancy, the woman was interviewed specifically to study maternal representations of herself as a mother and of the future baby. When the child was 1 year old, the style of attachment was studied during the Ainsworth Strange Situation paradigm and, at the same time, the mother was given the Adult Attachment Interview. Case studies are presented to illustrate, from the clinical point of view, the mental dynamics during pregnancy and the influence on the style of attachment of the baby. The clinical implications are discussed especially in terms of the fantasies in pregnancy and their relevance for the subsequent mother-infant relationship.     

Parenting young children with challenging behaviour

Previous research has established the link between harsh parenting and poor outcomes in children, although little attention has been paid to the concurrent protective factors which may exist. The relationship between parenting behaviours and childhood externalizing behaviours was investigated in a sample of 60 parents of young children (ages 2–5 years). Thirty families were selected for participation based on teacher‐reported externalizing behaviour in their young child which exceeded normal limits and matched with a sample of 30 parents of children without externalizing behaviour problems. Results found that parents of young children with externalizing behaviours tended to use more frequent verbal and corporal punishment with their young children, and reported more behaviour problems with their young children when compared with a control group. However, no significant differences were found between groups with respect to positive, nurturing behaviours, or utilizing appropriate developmental expectations. Implications for prevention are discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

The Role of Attachment Representation in the Relationship Between Depressive Symptomatology and Social Withdrawal in Middle Childhood

We investigated the relationships among attachment representation, social withdrawal, and depressive symptomatology in childhood. A total of 326 children aged 8 to 10 years participated in the study. Children completed a family drawing procedure to assess attachment representation, the Children's Depression Inventory and the Social Withdrawal subscale of the Personality Inventory for Youth. Social withdrawal and attachment representations indicative of attachment dysfunction were each found to be positively correlated with depressive symptomatology. Further, attachment representation was found to significantly moderate the relationship between withdrawal and depression such that the positive relationship between withdrawal and depression was attenuated in the absence of attachment representations indicative of attachment dysfunction.     

Problematic eating behaviors and nutritional status in 7 to 12 year-old Chilean children

Overweight and obesity are medical conditions that require a multidisciplinary analysis of their causes and treatment. In Chile a sustained increase in the presence of obesity and excess weight has been observed in children. However, the amount and the dynamics of the aforementioned problematic eating behaviours in Chilean children are unknown. The aim of this study was to assess the relationship between restrained, external, and emotional eating, and variations in body mass index (BMI) in Chilean children. Consequently, 453 children from 7 to 12 years of age responded to the Children's Dutch Eating Behaviour Questionnaire, Spanish version. In addition, their anthropometric data were obtained. A positive association was found between restrained eating and BMI, and a negative correlation between external eating and BMI. Emotional eating demonstrated a modest inverse relationship with BMI. A significant interaction between problematic behaviour and nutritional status (normal-weight, overweight, obese) was revealed. Restrained eating was characteristic of obese children whereas external eating of normal-weight children. These results suggest that problematic eating behaviours and their relationship with body weight are similar to those described in studies in Europe.     

Peer interaction and maltreated children: Social network and epigenetic models

The epigenetic and social network models of social development are discussed. The relative efficacy of the two approaches is put to empirical test by examining the relationship between inadequate attachment relationships and subsequent peer interaction. Infants in a day care center who either had or had not experienced maltreatment were observed with their mothers and with peers. The social network model was supported in that there were few differences between maltreated and non-maltreated infants on peer interaction behavior while the expected differences obtained on mother-infant interaction variables. The use of day care for maltreated children is recommended.     

Bidirectional influences in mother–toddler dyads: an examination of the relative influence of mothers' and children's behaviours

This study examined bidirectional relationship between mothers' lax and overreactive discipline and children's misbehaviour and negative effect. We examined the moment‐to‐moment stability of mothers' and children's behaviours (actor effects) and mothers' and children's influence on their partners' subsequent behaviours (partner effects). Participants were 71 mothers and their 24‐ to 48‐month‐old children observed during a 30‐min interaction. Both children and mothers exhibited stability in their own behaviours and influenced the subsequent behaviours of their partners. Additionally, a comparison of partner effects indicated that overreactive discipline more strongly predicted child's negative effect than child's negative effect predicted overreactive discipline. In contrast, although a child's negative effect predicted lax discipline, lax discipline did not predict subsequent child's negative effect. Copyright © 2010 John Wiley & Sons, Ltd.     

母亲依恋风格与孤独症谱系障碍儿童母子依恋:母亲教养方式的中介作用

早期依恋对孤独症谱系障碍（Autism Spectrum Disorders,简称ASD）儿童的心理健康、人际关系以及未来的社会融合有重要影响。本研究采用问卷调查法,对从北京、青岛、郑州、武汉、无锡和赤峰市等地28所融合幼儿园中筛选出来的210名ASD儿童及其母亲进行施测,考察母亲的依恋风格对ASD儿童母子依恋的影响,以及母亲教养方式在其中的中介作用。研究发现：（1）总体而言,ASD儿童与母亲之间的依恋关系总体状况良好;轻度ASD儿童的母子依恋水平显著高于中度、重度ASD儿童;（2）母亲依恋回避、依恋焦虑与ASD儿童母子依恋均呈显著负相关;母亲关爱、鼓励自主与ASD儿童母子依恋均呈显著正相关,母亲控制与ASD儿童母子依恋呈显著负相关;母亲依恋回避、依恋焦虑与母亲关爱均呈显著负相关,与母亲控制均呈显著正相关;（3）母亲关爱在母亲依恋回避与ASD儿童母子依恋之间起部分中介作用,母亲关爱、母亲控制在母亲依恋焦虑与ASD儿童母子依恋之间起完全中介作用。