Parenting behavior and the development of children with autism spectrum disorder.

Autism spectrum disorders (ASD) are neurodevelopmental disorders in which multiple genetic and environmental factors play roles. Symptoms of deficits in social communication and restrictive, repetitive behavioral patterns emerge early in a child's development. While parents do not cause these difficulties, impairments in social relatedness can strain parent child interactions and parental stress can have negative transactional effects that impede children development. Conversely, as with typically developing children, parental behavior can also enhance development in ASD and parents play a role in many interventions. In this review we examine parental contributions to the development of children with ASD, focusing on social communication and emotion regulation. We address parent and family characteristics that may impede development so they can be identified in families and interventions developed to target them.

Commentary: Sports participation at 4 years old? Thoughts on mental health-risk trajectories in the longitudinal study of Australian children - a commentary on Vella et al. (2018).

Vella and colleagues (this issue) report on children in the kindergarten cohort of the Longitudinal Study of Australian Children (LSAC) study, using predictors from age 4 years to identify six trajectories of mental health risk from ages 4-12. Somewhat surprisingly, they find that among some predictable candidates for risk, such as sex and family income, that sports participation at age four emerges as a novel predictor of low difficulty with respect to mental health trajectories across the next 8 years. Is this a case of mens sana in corpore sano? Or is sports participation, that is, swimming, dancing, gymnastics, and team sports, a proxy for other factors? What can the various predictors and the trajectories of mental health risk from this longitudinal study tell us about interventions to reduce risk?

IV. CO-CONSTRUCTION OF ATTACHMENT REPRESENTATIONS AND AFFECT-REGULATING COGNITIONS: THE ROLE OF MATERNAL ATTACHMENT SECURITY.

This study focused on the role of maternal co-construction skills in building attachment relevant representations in early childhood. Thirty-four mothers and their 4- to 5-year-old children were presented with two co-construction tasks, one an attachment storytelling task, the other an affect discussion task about emotion-laden situations. Maternal co-construction skills were assessed with several scales that scored the quality of the co-construction partnership, the mother's skill in prompting elaboration, and helping build an explanatory framework. Mothers completed the Attachment Script Assessment (ASA) and the Adult Attachment Interview (AAI) as well. Results indicated that mothers' secure base script knowledge (ASA) was significantly related to communication effectiveness, encouraging elaboration of storylines, and using open-ended and why questions. Maternal AAI coherence showed similar relations to co-construction support.

Cumulative adversity in early childhood is associated with increased BMI and behavioural problems.

Implications for practice and research: Mental health problems and obesity are significant outcomes for children experiencing adversity in early life. Behavioural outcomes and body mass index (BMI) are more consistently reported for children experiencing adversity in early life compared with blood pressure (BP). Incomplete data due to drop out over time and a reliance on parental reporting are challenges for large longitudinal studies; future research directions include balancing and testing such investigations with smaller in-depth studies.

Attachment and the metabolic syndrome in midlife: the role of interview-based discourse patterns.

OBJECTIVE: Adult attachment discourse patterns and current family relationship quality were examined as correlates of health behaviors and number of metabolic syndrome (MetS) criteria met, and as mediators of the link between childhood adversity and these health outcomes. METHODS: A sample of 215 white/European American and black/African American adults aged 35 to 55 years were examined using a cross-sectional study design. Discourse was assessed with the Adult Attachment Interview, using coherence (a marker of attachment security), unresolved trauma/loss (a marker of disorganized cognitions related to trauma or loss), and idealization (minimizing stressful experiences and their impact) scores. Relationship quality, adverse childhood experiences, and current depressive symptoms were assessed, as were health behaviors of diet, exercise, and smoking. MetS includes obesity, elevated blood pressure, elevated fasting glucose, high triglycerides, and low high-density lipoprotein cholesterol. RESULTS: Using path analysis and including childhood adversity severity and depressive symptoms in the model, both Adult Attachment Interview coherence and unresolved trauma/loss were directly linked to the number of MetS criteria (r = 0.186 and r = 0.170, respectively). Idealization was indirectly linked to MetS through poor diet (r = 0.183). The final model explained 21% of the variance in scores for the number of MetS criteria met. CONCLUSIONS: Insecure adult attachment is associated with increased risk of MetS.

AAI coherence predicts caregiving and care seeking behavior: secure base script knowledge helps explain why.

Previous research has demonstrated significant links between the Adult Attachment Interview (AAI) and secure base use and support in marital interactions. The mechanisms underlying such findings have not been examined in detail. This paper examines the hypothesis that script-like attachment representations shape both attachment narratives and attachment-related caregiving behavior and thus helps explain the correlation between them. Crowell et al. ( 2002 ) reported that AAI transcript coherence is significantly related to adults' caregiving and care seeking in couple problem solving interactions. In a random selection of 60 cases from that study, we assessed the extent to which interviewees conceptualized their early attachment experiences in terms of a secure base script. A series of regression analyses demonstrated that approximately 80% of the correlation between AAI coherence and laboratory caregiving and care seeking reported by Crowell et al. ( 2002 ) is accounted for by secure base script knowledge. Scoring secure base script knowledge from AAI transcripts is a useful step toward understanding links between early experience, adult attachment representations, and adults' ability to provide and seek support in close relationships.

Editorial: Maternal Bonding: How and Why Does It Matter?

In 1970, Klaus and Kennell1 endorsed the idea of a sensitive period immediately after birth, associated with skin-to-skin contact, that was key to a human mother developing an affectional bond with her infant. Since that time, studies have investigated how the mother's affectional bond to her infant supports infant development as well as a variety of factors that impact the development of such a bond, including maternal engagement in fetal movements, experiences during the birth process, social support including that from the partner, and maternal mental health. This editorial aims to set the large, longitudinal study by Le Bas et al.2 in the context of past and current other work on the significance of parents' bonds to their infants.

Development of Emotion Regulation in Typically Developing Children.

Emotion regulation (ER) is a complex process that combines inherent as well as environmental and learned components of reactivity and regulation. Elements of ER are present from birth and are elaborated across development. An understanding of emotion dysregulation requires careful examination of all the elements that constitute typical ER so that relevant domains can be therapeutically targeted. This contribution reviews the development of ER in typically developing youth to set the stage for discussion of points of intervention.

Understanding, Assessing, and Intervening with Emotion Dysregulation in Autism Spectrum Disorder: A Developmental Perspective.

This article provides a comprehensive review of emotion dysregulation (ED) in individuals with autism spectrum disorder (ASD). The authors describe ED from a developmental perspective, and highlight how aberrations in social development and a restricted-repetitive repertoire of behaviors, render individuals with ASD more vulnerable to ED. The article also summarizes how ED in children and adolescents with ASD has been measured and conceptualized in research and clinic settings. Evidence-based pharmacologic and cognitive behavioral interventions targeting ED in ASD are summarized, with a focus on how such approaches are tailored to the developmental needs of individuals with ASD.

Stepped Treatment for Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior: A Randomized, Controlled Trial of Adjunctive Risperidone, Divalproex Sodium, or Placebo After Stimulant Medication Optimization.

OBJECTIVE: Stimulant medications are the most prevalent first-line pharmacotherapy for attention-deficit/hyperactivity disorder, but children with aggressive behavior often receive multiagent treatment. There is sparse evidence for the benefits of adjunctive medications when stimulant monotherapy provides inadequate benefit for aggressive behavior, yet the adverse effects of common adjuncts are well established. This study compared the efficacy in reducing aggressive behavior of risperidone (RISP), divalproex sodium (DVPX), and placebo (PBO) added to stimulant medication among childrenwhose symptoms persisted after individually optimized stimulant treatment. METHOD: This trial enrolled 6- to 12-year-old with attention-deficit/hyperactivity disorder, a disruptive disorder, significant aggressive behavior, and prior stimulant treatment. Open, systematically titrated stimulant treatment identified patients with inadequate reductions in aggressive behavior, who were then randomly assigned to receive adjunctive RISP, DVPX, or PBO under double-blinded conditions for 8 weeks. Family-based behavioral treatment was offered throughout the trial. The primary outcome was the parent-completed Retrospective Modified Overt Aggression Scale. RESULTS: Participants included 175 children (mean [SD] age 9.48 [2.04] years, 19% female). Of participants, 151 completed the stimulant optimization phase, with aggression remitting among 96 (63%), and 45 were randomly assigned to adjunctive treatment groups. The adjunctive RISP group showed greater reductions in aggression ratings than the PBO group (least squares means difference [ΔLSM], -2.33; 95% CI, -3.83 to -0.82; effect size [ES], -1.32), as did the DVPX group (ΔLSM, -1.60; 95% CI, -3.18 to -0.03; ES, -0.91). Mean standardized body mass index scores increased more among RISP-treated participants than participants receiving PBO (ΔLSM, 1.54; 95% CI, 0.68 to 2.40; ES, 0.58). CONCLUSION: High response rate during the trial's open stimulant optimization phase suggests that rigorous titration of stimulant medication and concurrent behavioral therapy may avert the need for additional medications. Among nonremitters, RISP and DVPX were efficacious adjunctive treatments, although RISP was associated with weight gain. CLINICAL TRIAL REGISTRATION INFORMATION: Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); https://www.clinicaltrials.gov; NCT00794625.

Parental divorce and adult children's attachment representations and marital status.

The purpose of this study was to explore adult attachment as a means of understanding the intergenerational transmission of divorce, that is, the propensity for the children of divorce to end their own marriages. Participants included 157 couples assessed 3 months prior to their weddings and 6 years later. Participants completed the Adult Attachment Interview and questionnaires about their relationships, and were videotaped with their partners in a couple interaction task. Results indicated that, in this sample, adult children of divorce were not more likely to divorce within the first 6 years of marriage. However, parental divorce increased the likelihood of having an insecure adult attachment status. For women, age at the time of their parents' divorce was related to adult attachment status, and the influence on attachment representations may be more enduring. Among adult children of divorce, those who were classified as secure in their attachment representations were less likely to divorce in the early years of marriage than insecure participants.

Prospective associations from family-of-origin interactions to adult marital interactions and relationship adjustment.

To test the social learning-based hypothesis that marital conflict resolution patterns are learned in the family of origin, longitudinal, observational data were used to assess prospective associations between family conflict interaction patterns during adolescence and offspring's later marital conflict interaction patterns. At age 14 years, 47 participants completed an observed family conflict resolution task with their parents. In a subsequent assessment 17 years later, the participants completed measures of marital adjustment and an observed marital conflict interaction task with their spouse. As predicted, levels of hostility and positive engagement expressed by parents and adolescents during family interactions were prospectively linked with levels of hostility and positive engagement expressed by offspring and their spouses during marital interactions. Family-of-origin hostility was a particularly robust predictor of marital interaction behaviors; it predicted later marital hostility and negatively predicted positive engagement, controlling for psychopathology and family-of-origin positive engagement. For men, family-of-origin hostility also predicted poorer marital adjustment, an effect that was mediated through hostility in marital interactions. These findings suggest a long-lasting influence of family communication patterns, particularly hostility, on offspring's intimate communication and relationship functioning.

Attachment and externalizing disorders: a developmental psychopathology perspective.

OBJECTIVE: Attachment theory offers an intriguing formulation of protection and risk that ties together key aspects of behavior, emotion, and cognition. The authors present links among attachment status, other developmental domains, and the development and maintenance of externalizing disorders to illustrate an approach to integrating attachment theory and relationship research with the study of externalizing symptoms. METHOD: The authors review the literature on the attachment system's theoretical and empirical associations with domains of emotion regulation, social attributions, socialization and moral development, and intergenerational transmission of behavior, as well as with externalizing behaviors. RESULTS: There are a number of risk and protective connections between attachment security and other developmental processes that are associated with externalizing disorders. CONCLUSIONS: Knowledge of relational processes, in this case, attachment relationships, can contribute to an understanding of etiology, maintenance, and treatment of externalizing disorders.

Metabolic pathways link childhood adversity to elevated blood pressure in midlife adults.

Childhood adversity is a risk factor for adult health outcomes, including obesity and hypertension. This study examines whether childhood adversity predicted mean arterial pressure through mechanisms of central obesity and leptin, adiponectin, and/or insulin resistance, and including dietary quality. 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Path analyses were used to specify a chain of predictive variables in which childhood adversity predicted waist-hip ratio and dietary quality, circulating levels of hormones, and in turn, mean arterial pressure, adjusting for race, gender, and antihypertensive medications. Direct paths were found between childhood adversity, waist-hip ratio, and leptin levels and between leptin and dietary quality to mean arterial pressure. Systolic and diastolic blood pressures were similarly predicted. Early adversity appears to developmentally overload and dysregulate endocrine systems through increased risk for obesity, and through a direct impact on leptin that in turn, impacts blood pressure.

Prevalence and Treatment Outcomes of Persistent Negative Mood Among Children with Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior.

OBJECTIVE: Diagnostic criteria for disruptive mood dysregulation disorder (DMDD) require 1) periodic rageful outbursts and 2) disturbed mood (anger or irritability) that persists most of the time in between outbursts. Stimulant monotherapy, methodically titrated, often culminates in remission of severe aggressive behavior, but it is unclear whether those with persistent mood symptoms benefit less.This study examined the association between the presence of persistent mood disturbances and treatment outcomes among children with attention-deficit/hyperactivity disorder (ADHD) and periodic aggressive, rageful outbursts. METHODS: Within a cohort of children with ADHD and aggressive behavior (n = 156), the prevalence of persistent mood symptoms was evaluated at baseline and after completion of a treatment protocol that provided stimulant monotherapy and family-based behavioral treatment (duration mean [SD] = 70.04 [37.83] days). The relationship of persistent mood symptoms on posttreatment aggressive behavior was assessed, as well as changes in mood symptoms. RESULTS: Aggressive behavior and periodic rageful outbursts remitted among 51% of the participants. Persistent mood symptoms at baseline did not affect the odds that aggressive behavior would remit during treatment. Reductions in symptoms of sustained mood disturbance accompanied reductions in periodic outbursts. Children who at baseline had high irritability but low depression ratings showed elevated aggression scores at baseline and after treatment; however, they still displayed large reductions in aggression. CONCLUSIONS: Among aggressive children with ADHD, aggressive behaviors are just as likely to decrease following stimulant monotherapy and behavioral treatment among those with sustained mood symptoms and those without. Improvements in mood problems are evident as well. Therefore, the abnormalities in persistent mood described by DMDD's criteria do not contraindicate stimulant therapy as initial treatment among those with comorbid ADHD. Rather, substantial improvements may be anticipated, and remission of both behavioral and mood symptoms seems achievable for a proportion of patients. TRIAL REGISTRATION: ClinicalTrials.gov (U.S.); IDs: NCT00228046 and NCT00794625; www.clinicaltrials.gov.

Diet quality and diet patterns in relation to circulating cardiometabolic biomarkers.

BACKGROUND & AIMS: We examined the effects of diet quality and dietary patterns in relation to biomarkers of risk including leptin, soluble intracellular adhesion molecule 1 (sICAM-1), C-reactive protein (CRP), and irisin. METHODS: We analyzed data from 196 adults cross-sectionally. Dietary patterns were identified by factor analysis and diet quality scores were generated using a validated food-frequency questionnaire. RESULTS: Both the alternate healthy eating index-2010 (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) scores were negatively related to CRP, even after controlling for body mass index and total energy intake. Similarly, the prudent diet pattern was negatively related to leptin, sICAM-1, and CRP, whereas the Western diet pattern showed positive associations with these markers; however, after adjusting for all confounders, the associations only remained significant for leptin and sICAM-1. Irisin was positively associated with DASH and the prudent diet after controlling for all confounders (standardized ß = 0.23, P = 0.030; standardized ß = 0.25, P = 0.021, respectively). Irisin showed positive associations with increasing fruit consumption, whereas the levels of irisin decreased as meat consumption increased. CONCLUSIONS: Irisin was directly associated with healthy diet types and patterns. Further studies regarding these mechanisms are warranted. This trial is registered at http://www.clinicaltrials.gov. Identifier: NCT01853332.

Security of attachment to spouses in late life: Concurrent and prospective links with cognitive and emotional wellbeing.

Social ties are powerful predictors of late-life health and wellbeing. Although many adults maintain intimate partnerships into late life, little is known about mental models of attachment to spouses and how they influence aging. Eighty-one elderly heterosexual couples (162 individuals) were interviewed to examine the structure of attachment security to their partners and completed measures of cognition and wellbeing concurrently and 2.5 years later. Factor analysis revealed a single factor for security of attachment. Higher security was linked concurrently with greater marital satisfaction, fewer depressive symptoms, better mood, and less frequent marital conflicts. Greater security predicted lower levels of negative affect, less depression, and greater life satisfaction 2.5 years later. For women, greater security predicted better memory 2.5 years later and attenuated the link between frequency of marital conflict and memory deficits. Late in life, mental models of attachment to partners are linked to wellbeing concurrently and over time.

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study.

BACKGROUND: Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking. METHODS: A cross-sectional sample of 151 males and females (age: 45.6±3.5 years, BMI: 30.0±7.1 kg/m(2)) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA-PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics. RESULTS: Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants. CONCLUSION: Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index.

When "new" meets "old": configurations of adult attachment representations and their implications for marital functioning.

Two studies addressed the implications of concordance versus discrepancy of attachment representations in individuals at 2 stages in their marital relationships. Engaged (n = 157) and dating (n = 101) couples participated in a multimethod 6-year longitudinal study of adult attachment. Individuals completed the Adult Attachment Interview (AAI), the Current Relationship Interview (CRI), and various questionnaires and were observed in interactions with partners. On the basis of AAI and CRI classifications, participants were placed in one of four groups: Secure-sub(AAI)/Secure-sub(CRI), Secure-sub(AAI)/Insecure-sub(CRI), Insecure-sub(AAI)/Secure-sub(CRI), or Insecure-sub(AAI)/Insecure-sub(CRI). Each of the configurations showed a particular pattern of behavior, feelings about relationships and the self, and likelihood of relationship breakup. The findings of the studies address important points about the protective effects of attachment security and have interesting implications for the extension of attachment theory into adulthood.

Stability of attachment representations: the transition to marriage.

This study examined the stability of adult attachment representations across the transition to marriage. One hundred fifty-seven couples were assessed using the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), the Current Relationship Interview (J. A. Crowell & G. Owens, 1996), and measures describing relationship functioning and life events 3 months prior to their weddings and 18 months into their marriages. The authors tested the hypotheses that attachment classifications are stable and that change is related to experiences in the relationship and/or life events; 78% of the sample received the same primary AAI classification (secure, preoccupied, and dismissing) at both times. Change was toward increased security and was associated with feelings and cognitions about the relationship. Only 46% of participants initially classified as unresolved retained the classification. Stability of the unresolved classification was associated with stressful life events and relationship aggression.