The Efficacy of Toddler-Parent Psychotherapy for Fostering Cognitive Development in Offspring of Depressed Mothers

The efficacy of Toddler-Parent Psychotherapy (TPP) as a preventive intervention for fostering cognitive development in the offspring of depressed mothers was evaluated. Mothers with major depressive disorder and their toddlers were randomly assigned to TPP (n = 43) or to a nonintervention group (n = 54) and compared to a control group (n = 61) of women with no current or past mental disorder. At baseline (age 20 months), the groups did not differ on the Bayley Mental Development Index. At post-intervention follow-up (age 3 years), a relative decline in IQ was found in the depressed nonintervention group, whereas the depressed intervention and the normal control groups continued to be equivalent, with higher WPPSI-R Full Scale and Verbal IQs. The worst outcome was found among nonintervention children whose mothers had subsequent depressive episodes. The results confirm the developmental risks faced by offspring of depressed mothers and support the efficacy of the preventive intervention in safeguarding successful cognitive development in at-risk youngsters.     

Predictors of resilience in maltreated and nonmaltreated Latino children

To date, few studies have sought to investigate the effects of child maltreatment and processes influencing maladaptation and resilience in Latino children. In the current investigation, multiple aspects of functioning, personal resources, and relationship features were examined in school-age maltreated and nonmaltreated Latino children. Maltreated Latino children were found to have fewer areas of resilient functioning. Ego-resiliency and ego-control, as personal resources, and the ability to form a positive relationship with an adult figure outside of the immediate family predicted resilience. However, certain aspects of interpersonal functioning were differentially related to resilience for maltreated and nonmaltreated Latino children. These findings have implications for understanding how resilience can be promoted in maltreated and nonmaltreated Latino children.     

Attachment and Affect between Mothers with Depression and their Children: Longitudinal Outcomes of Child Parent Psychotherapy

The present investigation examined the longitudinal effects of Child-Parent Psychotherapy (CPP) for toddlers and their mothers with depression on: a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Mothers with depression (M_age?=?31.7 years; 92.8% White, 3.5% Black, 2.1% Hispanic, 2.3% other) and their toddlers were randomized to receive CPP (DI; n?=?66) or to a control group (DC; n?=?64). Mothers without depression and their toddlers (NC; n?=?68) were recruited as an additional comparison group. Dyads were assessed at baseline (T1; 20 months old), post-intervention (T2; 36 months old), and follow-up (T3; 9 years old). Data from a mother-child conflict task was coded as a measure of observed outcome variables. Change in post-intervention attachment security assessed via the Strange Situation was evaluated as a mediator between intervention condition and maternal and child affective expression and dyadic cohesion at T3. Change to secure attachment post-intervention significantly mediated the association between intervention condition and T3 maternal warmth and child anger/problem behavior. Toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 displayed higher levels of maternal warmth at T3 and lower levels of child anger and problem behavior at T3. Implications for the use of CPP as a preventive intervention and the importance of attachment as a mediator of long-term outcomes are discussed.

     

Longitudinal associations among child maltreatment, social functioning, and cortisol regulation

Child maltreatment increases the risk for impaired social functioning and cortisol regulation. However, the longitudinal interplay among these factors is still unclear. This study aimed to shed light on the effect of maltreatment on social functioning and cortisol regulation over time. The sample consisted of 236 children (mean age 7.64 years, SD = 1.36; 125 maltreated children and 111 nonmaltreated children, 128 boys and 108 girls) who attended a week-long summer camp for 2 consecutive years. Saliva was collected during 5 days at 9:00 a.m. and 4:00 p.m. Means of morning and afternoon cortisol levels and cortisol change (difference between morning and afternoon levels, controlled for morning levels) were used to group the children into low-, medium-, and high-cortisol groups. Prosocial, disruptive/aggressive, and withdrawn behaviors were assessed using information from peers and counselors. Maltreated children showed less prosocial and more disruptive/aggressive and withdrawn behavior. Results of structural equation modeling analyses indicated that there were indirect effects of maltreatment on Year 2 morning cortisol via prosocial and disruptive/aggressive behavior: Lower levels of prosocial behavior and higher levels of disruptive/aggressive behavior were related to lower morning cortisol levels 1 year later. Withdrawn behavior was related to higher afternoon cortisol values 1 year later. Results of this study suggest that maltreated children are more likely to experience difficulties in social functioning, which in turn is related to cortisol regulation 1 year later. This altered hypothalamic-pituitary-adrenocortical (HPA) axis functioning may put children at risk for later psychopathology.     

Differential expression of social dominance as a function of age and maltreatment experience

Recent perspectives on social dominance in normative populations have suggested a developmental progression from using primarily coercive strategies to incorporation of more socially competent strategies to attain material and social resources. Parental influences on the resource control strategies children use have been proposed but not investigated empirically. The present study examined age- and gender-related differences in dominance strategies in 470 children from high-risk neighborhoods who were between 6 and 13 years of age, approximately half of whom had experienced maltreatment. A Q-sort measure of social dominance was developed and received preliminary support. Consistent with predictions from resource control theory, age-related differences in dominance-related behavior were demonstrated in both nonmaltreated and maltreated children. Maltreated children were more likely than nonmaltreated children to be identified as dominant bullies at any age. Dominance and bullying were not more likely to be associated for children who had experienced physical and sexual abuse relative to those who were neglected or emotionally maltreated. Results are discussed in terms of the influence of maltreatment on the social development of children, and intervention approaches for limiting these deleterious effects are recommended.     

Maternal Intergenerational Transmission of Childhood Multitype Maltreatment

Previous research suggests that child maltreatment is transmitted across familial generations. However, extant studies focused exclusively on single maltreatment subtypes, instead of the more common experience of multitype maltreatment. This limitation is addressed in the first known study to examine the maternal intergenerational transmission of childhood multitype maltreatment among 104 mothers and their children. Findings demonstrated that mothers' childhood multitype maltreatment directly predicted their children's multitype maltreatment, instead of having indirect effects through maternal romantic attachment dimension, intimate partner violence, and psychological distress. Mothers' childhood multitype maltreatment was also related to intimate partner violence and anxious romantic attachment but unrelated to psychological distress. Our findings highlight the need for clinical attention to the long-term generational effects of diverse childhood traumas.     

关于完善我国医学教育体系的思考

当前我国社会经济的迅猛发展,已经对现行的医学教育体系提出了强有力的挑战。从医学教育自身特点出发,探讨我国现行医学教育体系的一些重要缺陷及其对策。建议全面引入医学教育国际标准,调整培养要求,积极稳妥地推行长学制医学教育,建立严格而规范的毕业后基本职业技能培训及职业准入制度,理顺高等教育体系内的医学教育统一管理体制,以完善我国医学教育体系。