THE RELATIONSHIP BETWEEN MOTHERING IN INFANCY, CHILDHOOD EXPERIENCE AND ADULT MENTAL HEALTH

This longitudinal study has followed seventy-six individuals from birth to age 30 using films of the mother-child interaction, psychoanalytically informed interviews of parents and children, and psycho diagnostic testing to assess how the quality of mothering a child receives in the first year of life contributes to his/her subsequent emotional well-being. The thirty-year follow-up of the now adult participants found that those who had received more effective care in infancy in terms of maternal empathy, consistency, control, thoughtfulness, affection and management of aggression had higher-level psychological defence mechanisms as adults than children receiving less effective nurturing-suggesting a process in which the children internalised their mothers' own defence mechanisms. Other measures at 30 years (Global Functioning, Erikson psychosocial attainment, mental representation of security of attachment to parents and presence or absence of a psychiatric diagnosis) did not achieve statistical significance. On the other hand, trauma after infancy and before age 18 provided the strongest correlation with adult outcome: consistent with the theory of the effect of cumulative trauma on psychic functioning, children experiencing two or more adverse circumstances had significantly lower levels of global functioning as adults than those spared multiple traumas. With case examples, the findings illustrate how the effect of pre-verbal experience attenuates over time, and how later influences overlie early life in the course of psychological structuralisation.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Adult Outcomes of Child Conduct Problems: A Cohort Study

The present study assessed the mental health and criminal records of 6,449 males and 6,268 females who presented conduct problems as children by examining an unselected birth cohort followed up to age 30. Conduct problems were defined by teacher ratings of behavior problems and/or antisocial behavior in the community. There was little overlap in the children identified by teachers and by the community. These two groups of children were at differential risk for adult mental disorder. Seventy-six percent of the males and 30% of females with childhood conduct problems had either a criminal record, a mental disorder, or both by age 30. Risk ratios for adult criminality and/or mental disorders, however, were greater for females than for males with a history of childhood conduct problems. Almost all of the mental disorders were severe substance abuse. Mental disorders and crime were strongly associated among males with a history of childhood conduct problems.     

Relationships Among Emerging Adult Psychological Problems,Maltreatment, and Parental Psychopathology: Moderation by Parent–Child Relationship Quality

Current research supports clear relationships between parental psychopathology, parental maltreatment, and emerging adult child psychopathology. Less research has examined how the role of the parent–child relationship influences these existing associations. The current study tested two models that examined the moderating effect of parent–child relationship quality on parental psychopathology and emerging adult mental health as well as the effect on parental maltreatment and emerging adult mental health. It was expected that high parent–child relationship quality would buffer against the negative effects of parental psychopathology and maltreatment while enhancing the effects of functional parenting characteristics. Participants included 1,452 emerging adults, predominantly Caucasian (73.3%) college students who completed surveys on their mental health, recent experienced maltreatment, and their parents’ mental health problems. Results suggested lowest rates of mental health problems for emerging adults were associated with higher parent–child relationship quality and lower parental psychological problems, whereas negative outcomes were associated with higher parental psychopathology, regardless of parent–child relationship quality. Additionally, physical maltreatment was associated with lower rates of mental health concerns in the context of higher mother-daughter relationship quality. Results emphasize the continuing impact of the parent–child relationship, particularly the mother-daughter relationship, on emerging adults’ mental health. Moreover, the current study demonstrates the continuing influence of parents on their emerging adult children.     

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5–17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5–11 years) and adolescents (12–17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28–69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.     

Recognition of Facial Expressions of Emotion by Children with Emotional and Behavioral Disorders

Interpreting and responding appropriately to facial expressions of emotion are important aspects of social skills. Some children, adolescents, and adults with various psychological and psychiatric disorders recognize facial expressions less proficiently than their peers in the general population. We wished to determine if such deficits existed in a group of 133 children and adolescents with emotional and behavioral disorders (EBD). The subjects were receiving in-patient psychiatric services for at least one of substance-related disorders, adjustment disorders, anxiety disorders, mood disorders or disruptive behavior disorders. After being read stories describing various emotional reactions, all subjects were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's (1976) normed photographs. Overall, they performed well on this task at levels comparable to those occurring in the general population. Accuracy increased with age, irrespective of gender, ethnicity, or clinical diagnosis. After adjusting for age effects, the subjects diagnosed with either adjustment disorders, mood disorders, or disruptive behavior disorders were significantly more accurate at identifying anger than those without those diagnoses. In addition, subjects with mood disorders identified sadness significantly more accurately than those without this diagnosis, although the effect was greatest with younger children.     

Delivering Diagnoses: Parents as Translators and Withholders of Children’s Mental Health Diagnoses

There is a lack of research on how mental health diagnoses are delivered and explained to children and the effectiveness of these strategies. This qualitative study examines how emerging adults recall the delivery of mental health diagnoses in childhood and how they suggest these diagnoses should be delivered to children. Semi-structured interviews were conducted with 42 emerging adults (aged 18–22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depressive disorders, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Findings reveal that parents, rather than mental health professionals, often inform children of their diagnoses. The data suggest that parents often act as translators of diagnostic information, acting as liaisons between mental health professionals and their children. The paper explores ways in which parents and mental health professionals withhold diagnoses from children, and how this affects children’s experiences. Drawing on their own experiences, participants offer suggestions regarding the best ways to deliver diagnoses to children. Findings suggest that adults should share mental health diagnoses openly with children. Implications for social workers and other allied health professionals who support families when children are diagnosed are discussed.     

Mental Disorders in Children and Parents in Family Law Proceedings: Cases on Child Protection Matters Versus Child Custody and Visitation Issues

Psychologists can contribute considerably to decision making in family law proceedings. The mental health of the parents and the children forms an important factor in psychological evaluation. It is the overall aim of this study to specifically examine the occurrence of mental disorders in evaluated family members in cases of termination of parental rights as opposed to cases of child custody and visitation rights. This data are based on 297 psychological evaluations completed between 2008 and 2012 at an evaluator association in Bremen, Germany. In this retrospective content analysis, evaluation reports were examined for indications of mental disorders in children, mothers and fathers. The data were assessed in bivariate analyses and logistic regression models. A total rate above 39 % indicates a comparatively high exposure to mental disorders of children and adolescents in this sample. A mental disorder of the mother and a mental disorder of the father occur significantly more often in cases of termination of parental rights than in cases of child custody/visitation rights. Children and adolescents who showed aggressive-dissocial behavior and aggressive-oppositional behavior were significantly more likely to be evaluated in legal issues of termination of parental rights as opposed to child custody/visitation rights. Restrictions in parental mental health and parenting capacity should be carefully weighed against restrictions in the mental health of the children and their developmental needs when conducting psychological evaluation.     

Discrimination,Internalized Homonegativity,and Attitudes Toward Children of Same‐Sex Parents: Can Secure Attachment Buffer Against Stigma Internalization?

With increasing numbers of same‐sex couples raising children in the United States, discriminatory attitudes toward children of same‐sex parents (ACSSP) are of increasing concern. As with other forms of stigma and discrimination, lesbian, gay, and bisexual (LGB) individuals are at risk for internalizing these societal attitudes, which can negatively affect parenting‐related decisions and behaviors and the mental and physical health of their children. Secure attachment is characterized by positive views of the self as loveable and worthy of care that are understood to develop in early relationships with caregivers. Secure attachment has been associated with positive mental and physical health, including among LGB individuals and couples. This study aimed to test the potential buffering role of secure attachment against stigma internalization by examining associations among secure attachment, discrimination, internalized homonegativity (IH), and ACSSP in an online survey study of 209 U.S. adults in same‐sex relationships. Bootstrap analyses supported our hypothesized moderated mediation model, with secure attachment being a buffer. Greater discrimination was indirectly associated with more negative ACSSP through greater IH for individuals with mean or lower levels, but not for individuals with higher than average levels of secure attachment, specifically because among those with higher levels of secure attachment, discrimination was not associated with IH. These findings build on and extend past research, with important implications for future research and clinical work with LGB individuals, same‐sex couples, and their families, including potential implementation of interventions targeting attachment security.     

Belastungen in der Kindheit und in der Jugend Essgestörter

Depending on definition and sample, a minority of varying size of women with eating disorders report to be victims of sexual and/or physical abuse. These stressful experiences are risk factors for mental disorders in general and not specifically for eating disorders. Parental high expectations and pre-morbid negative self-evaluation seem to be specific risk factors for anorexia nervosa and bulimia nervosa. Probably, patients with bulimia nervosa suffered more childhood adversity than those with restrictive anorexia nervosa. Patients with a history of sexual and/or physical abuse may be more severely ill and more difficult to treat than other patients with eating disorders. Careful questioning about childhood adversity seems advisable. In therapy, maintaining factors—like problems of self-esteem—are more important than predisposing or precipitating factors. For prevention, it is recommended to provide for the safety of children when treating their parents with mental illness—particularly substance use disorders—and to avoid parental high expectations.     

Eltern-Kleinkind-Intervention am Institut für Erziehungshilfe

Early experience concerning relationships and interactions form the psychological structure which provides a child with optimal flexibility for age-appropriate developmental tasks. Each new developmental step builds on previous experience. Structural deficits may lead to adjustment, self-regulation, and self-organization disorders. The parent–preschool child intervention is a way to therapeutically help very young children and their parents. The high potential benefits lies in the knowledge that early emotional experience affects both mental and physical health. The experience of a positive and sustainable relationship with at least one person is an important protective factor in the development of the child. Studies have confirmed a positive relationship between secure attachment and later school performance. No other early intellectual support can replace a stable emotional bond to an attachment figure. Therefore, parent–toddler interventions are an important preventive measure with lifelong effects.     

Changes in Late Adolescents and Young Adults’ Attachment,Separation, and Mental Health During Wilderness Therapy

The study explored changes in young adults’ mental health, attachment, and separation from parents during a seven-week wilderness therapy program. Utilizing a longitudinal one-group design, the study examined outcomes of 157 young adults in one wilderness therapy program. From pre to post treatment, participants reported significant improvement in mental health symptoms and interpersonal relationships, as well as increases in the belief that others can be depended upon. Participants reported less resentment and anger towards mothers from pre to post treatment, but an increase in their needs for approval from fathers. The study details a link between young adults’ attachment, independence from parents, and improvement in mental health, suggesting that treatment which targets these links may provide more effective intervention.     

蒙汉族大学生父母教养方式、成人依恋与心理困扰的关系研究

通过整群抽样方法抽取了576名大学生,对其施测父母养育方式量表、亲密关系体验量表和心理困扰量表,运用结构方程模型技术,分别考察了父母养育方式的蒙汉族差异以及成人依恋模式在父母养育方式和心理困扰间的中介作用。结果表明:(1) 蒙古族父母对孩子的关爱程度和给孩子的自主性要显著高于汉族;(2) 汉族的成人依恋模式在父母过度保护与抑郁-焦虑-压力之间起着部分中介作用,而蒙古族成人依恋的中介作用不明显,但母亲的冷漠拒绝和过度保护会导致个体依恋回避和依恋焦虑,父亲的冷漠拒绝和过度保护会影响个体的抑郁和焦虑,母亲的过度保护和父亲的冷漠拒绝会影响个体的压力。     

关于听觉障碍儿童人格的一项研究

用缺陷儿童人格诊断量表和内田-克雷佩林心理测验对213名听觉障碍儿童进行测查,揭示了听觉障碍儿童人格发展的一些基本状况,以及影响他们人格发展的一些因素,研究表明,听力损失程度、父母是否听觉障碍、以及家庭（城乡）环境等因素对听觉障碍儿童的人格发展有显著的影响。     

Psychiatric disorders and the use of mental health services among children involved in bullying

This study had two aims: to evaluate the relationship between bullying and psychiatric disorders and to study the probability of using mental health services among children involved in bully/victim problems. The data consisted of interviews with 423 parents and 420 children. Diagnostic measures were based on the Isle of Wight Interview. Children involved in bullying as bullies, bully‐victims, and victims were compared with other children. Children involved in bully/victim problems were more prone to have psychiatric disorders than noninvolved children. The probability of being disturbed was highest among male bullies, followed by male bully‐victims and female victims (9.5‐fold, 7.9‐fold, and 4.3‐fold, respectively) compared with noninvolved same‐sex children. The most common diagnoses among children involved in bully/victim problems were attention deficit disorder, oppositional/conduct disorder, and depression. Furthermore, children involved in bully/victim problems were more likely to have used mental health services at some time during their lives and also during the previous 3 months. Special attention should be paid to children’s mental health when dealing with bullying problems at school. Referral pathways to mental health services and factors affecting the referral processes among children should be further studied. Aggr. Behav. 27:102–110, 2001. © 2001 Wiley‐Liss, Inc.     

Romantic love conceptualized as an attachment process

This article explores the possibility that romantic love is an attachment process--a biosocial process by which affectional bonds are formed between adult lovers, just as affectional bonds are formed earlier in life between human infants and their parents. Key components of attachment theory, developed by Bowlby, Ainsworth, and others to explain the development of affectional bonds in infancy, were translated into terms appropriate to adult romantic love. The translation centered on the three major styles of attachment in infancy--secure, avoidant, and anxious/ambivalent--and on the notion that continuity of relationship style is due in part to mental models (Bowlby's "inner working models") of self and social life. These models, and hence a person's attachment style, are seen as determined in part by childhood relationships with parents. Two questionnaire studies indicated that relative prevalence of the three attachment styles is roughly the same in adulthood as in infancy, the three kinds of adults differ predictably in the way they experience romantic love, and attachment style is related in theoretically meaningful ways to mental models of self and social relationships and to relationship experiences with parents. Implications for theories of romantic love are discussed, as are measurement problems and other issues related to future tests of the attachment perspective.     

Attachment and preschool children's understanding of maternal versus non‐maternal psychological states

There is growing evidence that insecurely attached children are less advanced in their social understanding than their secure counterparts. However, attachment may also predict how individual children use their social understanding across different relationships. For instance, the insecure child's social‐cognitive difficulties may be more pronounced when the psychological states of an attachment figure are being considered. In the current study, forty‐eight 4‐ to 5‐year‐old children were asked about their mothers' emotions and false beliefs, as well as those of non‐attachment figures. The Separation Anxiety Test (SAT) was administered to assess children's attachment representations. Children's SAT scores predicted their overall performance on the false belief and causes of emotion tasks, even after controlling for age and verbal ability. More interestingly, however, children with high scores on the Avoidance dimension of the SAT experienced greater difficulty understanding maternal false beliefs relative to those of an unfamiliar adult female. Thus, although attachment insecurity may hinder social‐cognitive development in general, the findings suggest that there are more specific effects as well. Attachment representations that are characterized by high levels of avoidance appear to interfere with children's ability to fully engage their social‐cognitive skills when reasoning about maternal mental states.     

Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV)

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.     

创伤暴露程度对青少年物质滥用的影响：创伤后应激障碍与依恋的中介作用

为了考察汶川地震后青少年的创伤暴露程度、创伤后应激障碍（PTSD）、父母依恋和同伴依恋与物质滥用之间的关系,采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、父母与同伴依恋问卷和物质滥用问卷对汶川县和茂县的1435名中学生进行调查,选取有物质滥用的青少年354名作为本研究的对象。结果发现：创伤暴露程度可以直接正向预测作用物质滥用。不过,在创伤暴露与物质滥用直接关系之间加入PTSD、父母和同伴依恋之后,创伤暴露程度对物质滥用的直接预测作用不再显著,并且创伤暴露程度不能通过同伴依恋预测物质滥用,也不能通过PTSD经同伴依恋对物质滥用发挥多重中介作用;但创伤暴露程度能通过PTSD正向预测物质滥用,可以通过父母依恋负向预测物质滥用,并且创伤暴露程度还可以通过PTSD经过父母依恋对物质滥用发挥正向的多重中介作用。     

Development and Preliminary Evaluation of Family Minds: A Mentalization-based Psychoeducation Program for Foster Parents

Mentalization-based interventions show promise in improving mental health outcomes for children and parents through increasing a family's reflective functioning, or ability to mentalize. Mentalizing involves the ability to understand behavior in relation to mental states, such as thoughts and feelings, and typically develops within the context of secure attachment relationships. One area not given much consideration when training foster parents is their capacity to mentalize. This study evaluated Family Minds, a newly developed psychoeducational intervention for foster parents, designed to increase their ability to mentalize. The current paper reports on the development and preliminary empirical evaluation of Family Minds in a quasi-experimental study where 102 foster parents received either Family Minds or a typical foster parenting class, which served as a control group. Results indicate that parents who received Family Minds significantly increased their levels of reflective functioning as assessed with the Parental Reflective Functioning Questionnaire and a new Five-Minute Speech Sample procedure coded using the Reflective Functioning Scale, and revealed a tendency to show decreased levels of parenting stress on the Parenting Stress Index, while the control group showed no such improvements. These findings support the hypothesis that a short-term psychoeducational intervention may improve foster parents' ability to mentalize themselves and their children. These skills are very beneficial for foster parents, as they frequently deal with children who come into their home with challenging behaviors, attachment issues, and negative internal working models of relationships. This type of intervention has the potential to lower placement breakdowns and improve the mental health of foster children.