Reactive Attachment Disorder following Early Maltreatment: Systematic Evidence beyond the Institution

Reactive Attachment Disorder (RAD) remains one of the least evidence-based areas of DSM and ICD nosology. Recent evidence from severely deprived institutional samples has informed review of RAD criteria for DSM-V; however, this data is not necessarily generalizable to expectable child environments in the developed world. We provide the first systematic study of this important syndrome in maltreated non-institutionalized adolescents from a high-income country. 153 high-risk adolescents in English out-of-home Looked After Care (LAC: mean age 174 months, SD 23, 52 % male) and 42 low-risk (LR) community controls (mean age 168 months, SD 18, 38 % male) were assessed for RAD behaviors. Data on maltreatment and care history were collected from social work reports and concurrent psychopathology from caregiver report. Triangulated data sources informed independent researcher ratings of adaptive functioning. LAC adolescents showed high prevalence of RAD behaviors. Factor analysis showed four symptom groups; Disinhibited Indiscriminate, Attention Seeking, Superficial Relationships and Unpredictability. RAD was associated with multiple maltreatment experience, earlier entry to care and increased rates of psychopathology. Superficial Relationships and Attention Seeking factors showed strong independent association with particularly pervasive functional impairment. Disinhibited RAD behaviors are identifiable with high prevalence in non-institutionalized high-risk adolescents. They are strongly associated with psychopathology and functional impairment. Retention of this subtype in DSM-V is supported. Findings on the inhibited subtype in adolescence are less persuasive. RAD behavior is a relevant marker of developmental impairment, has significant clinical implications and is deserving of further study within non-institutionalized risk populations.     

The body in clinical cognitive theory: from beck to mindfulness

Working with the body in Mindfulness-Based Cognitive Therapy (MBCT) is often seen as a ‘means to an end’; that is, a vehicle for diverting attention from negative thought patterns, thereby fostering a detached metacognitive awareness of problematic thinking. The MBCT literature, however, accords the body a more central role. The literature expresses both the idea that the body is integral to a basic level of meaning creation experienced as a ‘bodily felt sense of something’ and that direct sensory or bodily awareness can contribute to a critical change in the felt sense of emotional difficulties. Tracing the development of the concept of the body in clinical cognitive theory, the paper concludes that these ideas of the body are anticipated in earlier revisions to Beck's schema theory. The paper concludes that research into the psychological mechanisms behind bodily awareness would be a fruitful supplement to the current research focus on metacognitive awareness.     

Language, thought and color: recent developments

The classic issue of color naming and color cognition has been re-examined in a recent series of articles. Here, we review these developments, and suggest that they move the field beyond a familiar rhetoric of 'nature versus nurture', or 'universals versus relativity', to new concepts and new questions.     

Perceptions of Married Women and Married Men with Hyphenated Surnames

A predominately European American sample of 197 middle-class college students rated married women and men with hyphenated surnames on the Big Five personality factors (R. Lippa, 1991), the Personal Attributes Questionnaire (J. T. Spence & R. L. Helmreich, 1978), the adjectives masculine and feminine, and 12 adjective phrases reflecting different aspects of marriage. Both men and women perceived women and men with hyphenated last names as different from other married people. In comparison with the average married woman, the woman with a hyphenated name was perceived as more friendly, good-natured, industrious, and intellectually curious. She was also perceived as well educated and as more likely to have a career. Men with hyphenated surnames were also perceived as accommodating and good-natured, and viewed as being both nurturing and committed to their marriage. Women and men with hyphenated names were generally perceived as having higher levels of both instrumental and expressive traits than other married people. Women appear to have more positive perceptions than men, particularly of the man with a hyphenated name. The results suggest that college students have generally positive perceptions of married people with hyphenated names.     

Hand preference in simultaneous unimanual tasks: a preliminary examination

The aim of the current investigation was to determine the pattern of hand use during simultaneous unimanual tasks. Two studies were conducted. The first experiment examined the pattern of hand use in a catching task, while performing a secondary writing task. Results showed that individuals had a decreased tendency to catch with their preferred hand when their preferred hand was occupied, in comparison to when the preferred hand was unoccupied. The second experiment examined the pattern of hand use during a support and reach task, where the use of both hands was required. Here, results indicated that participants preferred to support themselves with their nonpreferred hand and reach with preferred hand toward right hemispace. With respect to left hemispace, participants showed the reverse pattern. This pattern of hand use indicates an important role for the nonpreferred hand, which has been relatively unexplored by researchers.     

Social skill in self-assertive strategies of toddlers with depressed and nondepressed mothers

The authors examined the effects of maternal depression on the skillfulness of toddlers' self-assertive strategies in interactions with their mother and with a female examiner. The participants were 110 mothers and their 26-month-old toddlers. Of these mothers, 57 had experienced an episode of clinical depression sometime since their child's birth, and 53 had had no history of depression. Toddlers exposed to maternal depression demonstrated significantly less social skill in their self-assertive strategies and more defiance when interacting with their mothers than did toddlers who were never exposed to maternal depression. The chronicity and severity of toddlers' exposure to maternal depression did not account for more pronounced differences in toddlers' skill in self-assertion toward mothers; however, toddlers exposed to more chronic courses of depression demonstrated less skill in their self-assertion toward the examiner. Toddlers who were exposed to maternal depression with a comorbid anxiety disorder did not exhibit less skill in their self-assertion toward mothers than did toddlers in either the depression-only or nondepressed groups. These findings suggest that exposure to maternal depression may interfere with toddlers' development of socially competent self-assertion strategies and may pose risks for future problems in the mother-toddler relationship.     

Who needs control? A cultural perspective on the process of compensatory control

Compensatory control theory (CCT) provides a framework for understanding the mechanisms at play when one's personal control is challenged. The model suggests that believing the world is a structured and predictable place is fundamental, insofar as it provides the foundation upon which people can believe they are able to exert control over their environment and act agentically towards goals. Because of this, CCT suggests, when personal control is threatened people try to reaffirm the more foundational belief in structure/predictability in the world, so that they then have a strong foundation to reestablish feelings of personal control and pursue their goals. This review seeks to understand how the basic assumptions of these compensatory control processes unfold in different cultural contexts. Drawing on research and theorizing from cultural psychology, we propose that cultural models of self and agency, culturally prevalent modes of control, and culture-specific motivations all have implications for compensatory control processes. Culture determines, in part, whether or not personal control deprivation is experienced as a threat to perceiving an orderly world, how/whether individuals respond to low personal control, and the function that responses to restore a sense of order in the world serve. A theoretical model of compensatory control processes across cultures is proposed that has implications for how people cope with a wide range of personal and societal events that potentially threaten their personal control.     

STIMULUS FADING AND TRANSFER IN THE TREATMENT OF SELF-RESTRAINT AND SELF-INJURIOUS BEHAVIOR

We conducted several manipulations of mechanical restraint properties during the course of treatment for two profoundly retarded adolescents who exhibited both self-restraint and self-injurious behavior. In study 1, a combination of prompting, differential reinforcement, and stimulus fading reduced one subject's self-restraint, which consisted of holding rigid tubes on his arms. Subsequently, stimulus control of both self-restraint and self-injurious behavior was transferred to tennis wrist bands. In study 2, a second subject's self-restraint—placing his hands in his pants—was immediately eliminated by the use of air splints. Additionally, differential reinforcement and air-pressure fading resulted in the complete mobility of his arms and a substantial increase in appropriate behaviors. Results of this investigation suggest that stimulus fading and transfer may be valuable components in the elimination of self-restraint.     

Internal consistency of a diagnostic interview for children: The Child Assessment Schedule

The purpose of this study was to evaluate the internal consistency of the content scales of the Child Assessment Schedule (CAS). A total of 116 psychiatric patients with a mean age of 10 years were administered the interview, and 92 parents were administered the parent version. Coefficient alpha was calculated for each of the 11 content scales. High internal consistency was demonstrated for school, friends, worries, mood, physical complaints, and expression of anger. More moderate but acceptable alphas were observed for the family, fears, and self-image scales. The same general pattern of results was observed for both the child and parent interviews. Additional analyses revealed that the number of items in the CAS could be reduced up to 30% without sacrificing internal consistency. These results indicate that 9 of the scales yield reliable scores.     

THE FUNCTIONS OF SELF-INJURIOUS BEHAVIOR: AN EXPERIMENTAL-EPIDEMIOLOGICAL ANALYSIS

Data are summarized from 152 single-subject analyses of the reinforcing functions of self-injurious behavior (SIB). Individuals with developmental disabilities referred for assessment and/or treatment over an 11-year period were exposed to a series of conditions in which the effects of antecedent and consequent events on SIB were examined systematically by way of multielement, reversal, or combined designs. Data were collected during approximately 4,000 experimental sessions (1,000 hr), with the length of assessment for individuals ranging from 8 to 66 sessions (M = 26.2) conducted over 2 to 16.5 hr (M = 6.5). Differential or uniformly high responding was observed in 145 (95.4%) of the cases. Social-negative reinforcement (escape from task demands or other sources of aversive stimulation) accounted for 58 cases, which was the largest proportion of the sample (38.1%). Social-positive reinforcement (either attention or access to food or materials) accounted for 40 (26.3%) of the cases, automatic (sensory) reinforcement accounted for 39 (25.7%), and multiple controlling variables accounted for 8 (5.3%). Seven sets of data (4.6%) showed either cyclical or inconsistent patterns of responding that were uninterpretable. Overall results indicated that functional analysis methodologies are extremely effective in identifying the environmental determinants of SIB on an individual basis and, subsequently, in guiding the process of treatment selection. Furthermore, an accumulation of assessment data from such analyses across a large number of individuals provides perhaps the most rigorous approach to an epidemiological study of behavioral function.