Visualizing the invisible tie: Linking parent-child neural synchrony to parents' and children's attachment representations.

It is a central tenet of attachment theory that individual differences in attachment representations organize behavior during social interactions. Secure attachment representations also facilitate behavioral synchrony, a key component of adaptive parent-child interactions. Yet, the dynamic neural processes underlying these interactions and the potential role of attachment representations remain largely unknown. A growing body of research indicates that interpersonal neural synchrony (INS) could be a potential neurobiological correlate of high interaction and relationship quality. In this study, we examined whether interpersonal neural and behavioral synchrony during parent-child interaction is associated with parent and child attachment representations. In total, 140 parents (74 mothers and 66 fathers) and their children (age 5-6 years; 60 girls and 80 boys) engaged in cooperative versus individual problem-solving. INS in frontal and temporal regions was assessed with functional near-infrared spectroscopy hyperscanning. Attachment representations were ascertained by means of the Adult Attachment Interview in parents and a story-completion task in children, alongside video-coded behavioral synchrony. Findings revealed increased INS during cooperative versus individual problem solving across all dyads (𝛸2(2) = 9.37, p = 0.009). Remarkably, individual differences in attachment representations were associated with INS but not behavioral synchrony (p > 0.159) during cooperation. More specifically, insecure maternal attachment representations were related to higher mother-child INS in frontal regions (𝛸2(3) = 9.18, p = 0.027). Conversely, secure daughter attachment representations were related to higher daughter-parent INS within temporal regions (𝛸2(3) = 12.58, p = 0.006). Our data thus provide further indication for INS as a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of early parent-child interactions. RESEARCH HIGHLIGHTS: We assessed attachment representations using narrative measures and interpersonal neural synchrony (INS) during parent-child problem-solving. Dyads including mothers with insecure attachment representations showed higher INS in left prefrontal regions. Dyads including daughters with secure attachment representations showed higher INS in right temporo-parietal regions. INS is a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of parent-child interactions, especially within the mutual prediction framework.

Precursors and Effects of Self-reported Parental Reflective Functioning: Links to Parental Attachment Representations and Behavioral Sensitivity.

Parental reflective functioning is thought to provide a missing link between caregivers' own attachment histories and their ensuing parenting behaviors. The current study sought to extend research on this association involving 115 parents, both mothers and fathers, of 5-to-6-year-old preschoolers using the German version of the Parental Reflective Functioning Questionnaire (PRFQ). Our study was the first to combine Adult Attachment Interview classifications of parental attachment, behavioral observations of parental sensitivity and PRFQ ratings while drawing on a sizable father subsample. We found theoretically consistent significant relations between all measures, while our results particularly highlighted the role of dismissing attachment for decreases in parenting quality on both cognitive and behavioral levels as the dismissing status differentially affected specific components of self-reported parental reflective functioning and observed sensitivity. Interestingly, these patterns were largely comparable in mothers and fathers. Exploratory mediation analyses further suggested that decreased parental reflective functioning may partially mediate the relationship between parents' dismissing attachment and decreased parental sensitivity. Thus, for prevention and intervention programs targeting parental sensitivity and thus children's long term healthy mental development, the interplay between parental reflective functioning and parents' own attachment history emerges as a key mechanism. Finally, our study served as a further validation of the PRFQ given the caveat that the pre-mentalizing subscale may need further revision in the German version.

Emotional maltreatment and neglect impact neural activation upon exclusion in early and mid-adolescence: An event-related fMRI study.

Child maltreatment gives rise to atypical patterns of social functioning with peers which might be particularly pronounced in early adolescence when peer influence typically peaks. Yet, few neuroimaging studies in adolescents use peer interaction paradigms to parse neural correlates of distinct maltreatment exposures. This fMRI study examines effects of abuse, neglect, and emotional maltreatment (EM) among 98 youth (n = 58 maltreated; n = 40 matched controls) using an event-related Cyberball paradigm affording assessment of both social exclusion and inclusion across early and mid-adolescence (≤13.5 years, n = 50; >13.5 years, n = 48). Younger adolescents showed increased activation to social exclusion versus inclusion in regions implicated in mentalizing (e.g., superior temporal gyrus). Individual exposure-specific analyses suggested that neglect and EM coincided with less reduction of activation to social exclusion relative to inclusion in the dorsal anterior cingulate cortex/pre-supplementary motor area (dACC/pre-SMA) among younger versus older adolescents. Integrative follow-up analyses showed that EM accounted for this dACC/pre-SMA activation pattern over and above other exposures. Moreover, age-independent results within respective exposure groups revealed that greater magnitude of neglect predicted blunted exclusion-related activity in the parahippocampal gyrus, while EM predicted increased activation to social exclusion in the precuneus/posterior cingulate cortex.

Exclusion Expected? Cardiac Slowing Upon Peer Exclusion Links Preschool Parent Representations to School-Age Peer Relationships.

Attachment theory proposes that children's representations of interactions with caregivers guide information-processing about others, bridging interpersonal domains. In a longitudinal study (N = 165), preschoolers (Mage  = 5.19 years) completed the MacArthur Story Stem Battery to assess parent representations. At school-age (Mage  = 8.42 years), children played a virtual ballgame with peers who eventually excluded them to track event-related cardiac slowing, a physiological correlate of rejection, especially when unexpected. At both ages, parents and teachers reported on peer and emotional problems. During exclusion versus inclusion-related events, cardiac slowing was associated with greater positive parent representations and fewer emerging peer problems. Cardiac slowing served as a mediator between positive parent representations and peer problems, supporting a potential psychophysiological mechanism underlying the generalization of attachment-related representations to peer relationships.

[Assessment of Maltreatment in Childhood and Adolescence]. / Erfassung von Misshandlung im Kindes- und Jugendalter.

Assessment of Maltreatment in Childhood and Adolescence In view of mounting evidence for substantial prognostic relevance of child maltreatment for the future developmental course, assessment of maltreatment in children and adolescents is increasingly gaining attention. At the same time, maltreatment assessment is replete with difficulties, ranging from the definition of maltreatment and establishment of threshold values determining when events meet prognostically relevant criteria, to poor agreement between sources. The aim of this paper is to provide an overview of instruments for assessing maltreatment in children and adolescents. This overview serves as a point of departure to emphasize the importance of various sources for the purpose of assessing maltreatment and to consider the unique role of the child's or young person's perspective. We conclude with preliminary proposals regarding the role of maltreatment assessment in clinical practice.

[Evaluation of Short-term Psychoanalytic Child Therapy (PaCT) for Young Children with Depressive Disorders: Results from a Pilot Study]. / Evaluation der Psychoanalytischen Kurzzeittherapie (PaKT) für junge Kinder mit depressiven Störungen: Ergebnisse der Pilotstudie.

Depressive disorders in early childhood are associated with high psychosocial impairment and tend to remain stable over time without adequate treatment. Short-term psychoanalytic therapy is a common form of child psychotherapy, yet there is a lack of empirical evaluation of this approach for young children with depressive disorders. Therefore, this secondary evaluation of a study on the treatment of anxiety disorders used an uncontrolled pre-post design in a clinical setting to investigate whether children with depressive comorbidity would evidence significant diagnostic and symptomatic remission after treatment with manualized short-term Psychoanalytic Child Therapy (PaCT). Nineteen children who had an anxiety disorder and a (subclinical) depressive disorder (assessed with the Preschool Age Psychiatric Assessment using DSM-IV criteria) were treated with PaCT. After treatment, 15 of 19 children (78.94 %) were remitted and 15 of 17 children (88.24 %; 2 were lost to follow-up) were free of depressive disorders at the 6-month follow-up. Further analyses revealed significant effects for pre- to post and pre- to follow-up comparisons regarding internalizing symptoms and overall problems using parent- and (nursery-)teacher-ratings. These results suggest that short-term PaCT shows promise as a treatment for childhood depressive disorders.

Getting less than their fair share: Maltreated youth are hyper-cooperative yet vulnerable to exploitation in a public goods game.

Human cooperative behavior has long been thought to decline under adversity. However, studies have primarily examined perceived patterns of cooperation, with little eye to actual cooperative behavior embedded within social interaction. Game-theoretical paradigms can help close this gap by unpacking subtle differences in how cooperation unfolds during initial encounters. This study is the first to use a child-appropriate, virtual, public goods game to study actual cooperative behavior in 329 participants aged 9-16 years with histories of maltreatment (n = 99) and no maltreatment (n = 230) while controlling for psychiatric symptoms. Unlike work on perceived patterns of cooperation, we found that maltreated participants actually contribute more resources to a public good during peer interaction than their nonmaltreated counterparts. This effect was robust when controlling for psychiatric symptoms and peer problems as well as demographic variables. We conclude that maltreatment may engender a hyper-cooperative strategy to minimize the odds of hostility and preserve positive interaction during initial encounters. This, however, comes at the cost of potential exploitation by others.

Latent trajectories of internalizing symptoms from preschool to school age: A multi-informant study in a high-risk sample.

Recent proposals suggest early adversity sets in motion particularly chronic and neurobiologically distinct trajectories of internalizing symptoms. However, few prospective studies in high-risk samples delineate distinct trajectories of internalizing symptoms from preschool age onward. We examined trajectories in a high-risk cohort, oversampled for internalizing symptoms, several preschool risk/maintenance factors, and school-age outcomes. Parents of 325 children completed the Strengths and Difficulties Questionnaire on up to four waves of data collection from preschool (3-5 years) to school age (8-9 years) and Preschool Age Psychiatric Assessment interviews at both ages. Multi-informant data were collected on risk factors and symptoms. Growth mixture modelling identified four trajectory classes of internalizing symptoms with stable low, rising low-to-moderate, stable moderate, and stable high symptoms. Children in the stable high symptom trajectory manifested clinically relevant internalizing symptoms, mainly diagnosed with anxiety disorders/depression at preschool and school age. Trajectories differed regarding loss/separation experience, maltreatment, maternal psychopathology, temperament, and stress-hormone regulation with loss/separation, temperament, maternal psychopathology, and stress-hormone regulation (trend) significantly contributing to explained variance. At school age, trajectories continued to differ on symptoms, disorders, and impairment. Our study is among the first to show that severe early adversity may trigger a chronic and neurobiologically distinct internalizing trajectory from preschool age onward.

Like mother like daughter, like father like son? Intergenerational transmission of internalizing symptoms at early school age: a longitudinal study.

Despite the well-established link between parental depressive symptoms and children's internalizing symptoms, studies that divide transmission into gender-specific components remain scarce. Therefore, the present study focused on gender-specific associations between internalizing symptoms of parents and children over the course of early school age, a key stage where gender-specific roles are increasingly adopted. Participants were 272 children (49.6% girls) oversampled for internalizing symptoms. Parents completed questionnaires twice during early school age (mean age time 1 = 7.4 years; SD = 0.24; mean age time 2 = 8.5 years; SD = 0.28). Mothers and fathers separately reported on their own depressive symptoms and their child's internalizing symptoms. Latent multiple group analyses indicated gender-independent stability as well as gender-specific relations between parental and child outcomes. Maternal depressive symptoms were concurrently associated with symptoms of girls and boys, while paternal symptoms were concurrently associated only with symptoms of boys, but not of girls. Moreover, the associations between children and the parent of the same gender became more relevant over time, suggesting a growing identification with the same-gender model, particularly for fathers and boys. In regard to prospective effects, girls' internalizing symptoms at age 7 predicted paternal depressive symptoms 1 year later. In a rigorous longitudinal design, this study underscores the importance of gender specificity in the associations of internalizing symptoms between children and their mothers and fathers after controlling for symptom stability over time. The study also raises the interesting possibility that girls' internalizing symptoms elicit similar symptoms in their fathers.

Commentary: The dynamic panel model: a promising approach to clarify sources of influence in developmental psychopathology - a commentary on Wichstrøm et al. (2017).

In their study, Wichstrøm et al. (2017) have proposed a novel groundbreaking approach for developmental psychopathology that undoubtedly will inspire other research. Applying the dynamic panel model (DPM), the authors were able to show that within-disorder (homotypic) and between-disorder (heterotypic) continuities of psychiatric symptoms are mostly due to unmeasured time-invariant factors while only few effects of earlier symptoms on later symptoms remained significant after accounting for these factors. The DPM calls for future applications of this approach to samples across different countries, diverse developmental phases, and in various settings - community samples and clinical samples alike.

Commentary: The importance of exploring dose-dependent, subtype-specific, and age-related effects of maltreatment on the HPA axis and the mediating link to psychopathology. A response to Fisher (2017).

We greatly appreciate Dr. Fisher's commentary that provides an excellent backdrop and well-considered perspective on our findings. We agree that our results mesh well with previous work documenting hypocortisolism among youth who experienced early adversity, especially neglect. Moreover, as also perceptively noted by Dr. Fisher, our cross-sectional data provide support for the notion that hypocortisolism is not simply a transient phenomenon, but, rather, a persistent pattern characterizing maltreated youth. Specifically, the consistency of the between group effect (from age 9.69 onwards) on a multimonth index of cumulative cortisol and the dose-dependent gradient of cortisol secretion within the maltreated group, which was related to the number of subtypes and the length of exposure to maltreatment, lend weight to this view.

Reduced hair cortisol after maltreatment mediates externalizing symptoms in middle childhood and adolescence.

BACKGROUND: The enduring impact of childhood maltreatment on biological systems and ensuing psychopathology remains incompletely understood. Long-term effects of stress may be reflected in cumulative cortisol secretion over several months, which is now quantifiable via hair cortisol concentrations (HCC). We conducted a first comprehensive investigation utilizing the potential of hair cortisol analysis in a large sample of maltreated and nonmaltreated children and adolescents. METHOD: Participants included 537 children and adolescents (3-16 years; 272 females) with maltreatment (n = 245) or without maltreatment histories (n = 292). Maltreated subjects were recruited from child protection services (CPS; n = 95), youth psychiatric services (n = 56), and the community (n = 94). Maltreatment was coded using the Maltreatment Classification System drawing on caregiver interviews and complemented with CPS records. Caregivers and teachers reported on child mental health. HCC were assessed in the first 3 cm hair segment. RESULTS: Analyses uniformly supported that maltreatment coincides with a gradual and dose-dependent reduction in HCC from 9 to 10 years onwards relative to nonmaltreated controls. This pattern emerged consistently from both group comparisons between maltreated and nonmaltreated subjects (27.6% HCC reduction in maltreated 9-16-year-olds) and dimensional analyses within maltreated subjects, with lower HCC related to greater maltreatment chronicity and number of subtypes. Moreover, both group comparisons and dimensional analyses within maltreated youth revealed that relative HCC reduction mediates the effect of maltreatment on externalizing symptoms. CONCLUSIONS: From middle childhood onwards, maltreatment coincides with a relative reduction in cortisol secretion, which, in turn, may predispose to externalizing symptoms.

The Pizzagame: A virtual public goods game to assess cooperative behavior in children and adolescents.

Social dilemmas are characterized by conflicts between immediate self-interest and long-term collective goals. Although such conflicts lie at the heart of various challenging social interactions, we know little about how cooperation in these situations develops. To extend work on social dilemmas to child and adolescent samples, we developed an age-appropriate computer task (the Pizzagame) with the structural features of a public goods game (PGG). We administered the Pizzagame to a sample of 191 children 9 to 16 years of age. Subjects were led to believe they were playing the game over the Internet with three sets of two same-aged, same-sex co-players. In fact, the co-players were computer-generated and programmed to expose children to three consecutive conditions: (1) a cooperative strategy, (2) a selfish strategy, and (3) divergent cooperative-selfish strategies. Supporting the validity of the Pizzagame, our results revealed that children and adolescents displayed conditional cooperation, such that their contributions rose with the increasing cooperativeness of their co-players. Age and gender did not influence children and adolescents' cooperative behavior within each condition. However, older children adapted their behavior more flexibly between conditions to parallel the strategies of their co-players. These results support the utility of the Pizzagame as a feasible, reliable, and valid instrument for assessing and quantifying child and adolescent cooperative behavior. Moreover, these findings extend previous work showing that age influences cooperative behavior in the PGG.

Social exclusion modulates event-related frontal theta and tracks ostracism distress in children.

Social exclusion is a potent elicitor of distress. Previous studies have shown that medial frontal theta oscillations are modulated by the experience of social exclusion. Using the Cyberball paradigm, we examined event-related dynamics of theta power in the EEG at medial frontal sites while children aged 8-12 years were exposed to conditions of fair play and social exclusion. Using an event-related design, we found that medial frontal theta oscillations (4-8Hz) increase during both early (i.e., 200-400ms) and late (i.e., 400-800ms) processing of rejection events during social exclusion relative to perceptually identical "not my turn" events during inclusion. Importantly, we show that only for the later time window (400-800ms) slow-wave theta power tracks self-reported ostracism distress. Specifically, greater theta power at medial frontal sites to "rejection" events predicted higher levels of ostracism distress. Alpha and beta oscillations for rejection events were unrelated to ostracism distress at either 200-400ms or 400-800ms time windows. Our findings extend previous studies by showing that medial frontal theta oscillations for rejection events are a neural signature of social exclusion, linked to experienced distress in middle childhood.

Analyzing pathways from childhood maltreatment to internalizing symptoms and disorders in children and adolescents (AMIS): a study protocol.

BACKGROUND: Effective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathogenic mechanisms leading from maltreatment to mental disorders. Although some studies have already identified individual risk factors, there is a lack of large-scale multilevel research on how psychosocial, neurobiological, and genetic factors act in concert to modulate risk of internalizing psychopathology in childhood following maltreatment. To help close this gap, we aim to delineate gender-specific pathways from maltreatment to psychological disorder/resilience. To this end, we examine the interplay of specific maltreatment characteristics and psychological, endocrine, metabolomic, and (epi-)genomic stress response patterns as well as cognitive-emotional/social processes as determinants of developmental outcome. Specifically, we will explore endocrine, metabolomic, and epigenetic mechanisms leading from maltreatment to a higher risk of depression and anxiety disorders. METHODS/DESIGN: Four large samples amounting to a total of N = 920 children aged 4-16 years will be assessed: Two cohorts with prior internalizing psychopathology and controls will be checked for maltreatment and two cohorts with substantiated maltreatment will be checked for internalizing (and externalizing) psychopathology. We will apply a multi-source (interview, questionnaires, official records), multi-informant strategy (parents, children, teachers) to assess maltreatment characteristics (e.g., subtypes, developmental timing, chronicity) and psychopathological symptoms, supplemented with multiple measurements of risk and protective factors and cutting-edge laboratory analyses of endocrine, steroid metabolomic and epigenetic factors. As previous assessments in the two largest samples are already available, longitudinal data will be generated within the three year study period. DISCUSSION: Our results will lay the empirical foundation for (a) detection of early biopsychosocial markers, (b) development of screening measures, and

[Summary of the Pilot Study Short-term Psychoanalytic Child Therapy (PaCT) of Anxious Children]. / Evaluation der Psychoanalytischen Kurzzeittherapie für Kinder von 4-10 Jahren mit Angststörungen (PaKT): Zusammenfassung der Pilotstudie.

We provide a summary of a recently published study on Psychoanalytic Child Therapy (PaCT; Göttken, White, Klein, von Klitzing, 2014) for young children with emotional and affective symptoms. Consisting of approximately 20 psychotherapy sessions, therapists treat families in parent-child, child-alone, parent-alone settings, aiming to uncover and work through a relational theme underlying the symptoms. Thirty families were entered into a wait-list controlled study in an outpatient setting (n = 18 treatment group; n = 12 waitlist) with the aim of assessing the effectiveness of PaCT (Göttken u. von Klitzing, 2014) for 4- to 10-year-olds with anxiety disorders. After treatment, over half of the children of the treatment group no longer met criteria for anxiety disorder while no children of the control group remitted during the wait-list interval. In addition, parent, child and teacher reports showed significant symptom reduction. The pattern of results lend preliminary support to psychodynamic intervention as an effective tool for treating childhood anxiety and affective disorders and call for future randomized controlled trials to provide additional evidence for these promising effects.

Depressive comorbidity in preschool anxiety disorder.

BACKGROUND: The threshold for clinical relevance of preschool anxiety has recently come under increasing scrutiny in view of large variations in prevalence estimates. We studied the impact of presence/absence of additional depressive comorbidity (symptoms and/or diagnosis) on preschoolers with anxiety disorders in relation to clinical phenomenology, family, and peer problems compared to healthy controls. METHOD: A population of 1738 preschoolers were screened and oversampled for internalizing symptoms from community sites, yielding a sample of 236 children. RESULTS: Using a multi-informant approach (mother, father, teacher, child), we found evidence that children with anxiety disorders and depressive comorbidity display a greater internalizing symptom-load, more peer problems and live in families with more psychosocial impairment (poor family functioning, family adversity, maternal mental health problems). The pure anxiety group was merely dissociable from controls with regard to internalizing symptoms and family adversity. CONCLUSION: The presence of depressive comorbidity in anxiety disorders may mark the transition to a more detrimental and impairing disorder at preschool age.

Kin rejection: social signals, neural response and perceived distress during social exclusion.

Across species, kin bond together to promote survival. We sought to understand the dyadic effect of exclusion by kin (as opposed to non-kin strangers) on brain activity of the mother and her child and their subjective distress. To this end, we probed mother-child relationships with a computerized ball-toss game Cyberball. When excluded by one another, rather than by a stranger, both mothers and children exhibited a significantly pronounced frontal P2. Moreover, upon kin rejection versus stranger rejection, both mothers and children showed incremented left frontal positive slow waves for rejection events. Children reported more distress upon exclusion than their own mothers. Similar to past work, relatively augmented negative frontal slow wave activity predicted greater self-reported ostracism distress. This effect, generalized to the P2, was limited to mother- or child-rejection by kin, with comparable magnitude of effect across kin identity (mothers vs. children). For both mothers and children, the frontal P2 peak was significantly pronounced for kin rejection versus stranger rejection. Taken together, our results document the rapid categorization of social signals as kin relevant and the specificity of early and late neural markers for predicting felt ostracism.

[Maternal reflective functioning as a predictor of therapeutic success of psychoanalytic short-term therapy for children aged 4 to 10 years]. / Reflexive Kompetenz der Mütter als Prädiktor des Therapieerfolgs mit Psychoanalytischer Kurzzeittherapie im Alter von 4 bis 10 Jahren.

Recent work implicates the capacity to mentalize as a predictor of therapeutic success of psychodynamically oriented psychotherapy for adults. However, little, if any, research focuses on similar associations in childhood. In the current study, we investigated the role of maternal reflective functioning (RF) in the treatment of 25 children with clinically diagnosed anxiety disorders and a high level of externalizing comorbidity in an outpatient setting. Before and after treatment of their children with short-term Psychoanalytic Child Therapy (PaCT), we assessed maternal RF using the Parent Development Interview and requested parents to report on symptoms of their 4-10-year-old children using the Child Behavior Checklist (CBCL). RF proved highly stable and showed no significant change from pre- to post-treatment over an average treatment interval of 41 weeks. While remission in internalizing symptoms was unrelated to pretreatment maternal RF, children with high-RF mothers showed significant remission of externalizing comorbidity in comparison to children with low-RF mothers both immediately after treatment as well as at six-month follow-up. These preliminary results support parental RF as a valuable prognostic criterion for successful treatment of externalizing symptoms with PaCT. These findings call for replication in large-scale follow-up studies with children diagnosed with externalizing disorders.

From Maltreatment to Psychiatric Disorders in Childhood and Adolescence: The Relevance of Emotional Maltreatment.

Different forms of maltreatment are thought to incur a cumulative and non-specific toll on mental health. However, few large-scale studies draw on psychiatric diagnoses manifesting in early childhood and adolescence to identify sequelae of differential maltreatment exposures, and emotional maltreatment, in particular. Fine-grained multi-source dimensional maltreatment assessments and validated age-appropriate clinical interviews were conducted in a sample of N = 778 3 to 16-year-olds. We aimed to (a) substantiate known patterns of clinical outcomes following maltreatment and (b) analyse relative effects of emotional maltreatment, abuse (physical and sexual), and neglect (physical, supervisory, and moral-legal/educational) using structural equation modeling. Besides confirming known relationships between maltreatment exposures and psychiatric disorders, emotional maltreatment exerted particularly strong effects on internalizing disorders in older youth and externalizing disorders in younger children, accounting for variance over and above abuse and neglect exposures. Our data highlight the toxicity of pathogenic relational experiences from early childhood onwards, urging researchers and practitioners alike to prioritize future work on emotional maltreatment.