Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk.

BACKGROUND: Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap. METHOD: Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis. RESULTS: Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability. CONCLUSIONS: Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.

Experiences of Interpersonal Trauma Among Parents With Intellectual Disabilities: A Systematic Review.

Research has suggested highly elevated levels of interpersonal trauma (IPT) among parents with intellectual disabilities (ID), and that such experiences may contribute to the caregiving and child developmental problems often seen in this population. Conflicting results have however been reported, and there is no systematic review on this matter. This study therefore systematically reviewed the empirical evidence concerning (a) prevalence of IPT among parents with ID, and links with (b) caregiving-relevant and (c) child developmental outcomes, in accordance with the PRISMA 2020 guidelines. Searches were conducted in MEDLINE, CINAHL, PsycINFO, and PTSDpubs. Peer-reviewed empirical articles reporting exposure to any form of systematically assessed IPT (unspecified IPT, physical, sexual, and emotional abuse, neglect, prolonged childhood separations from caregivers, witnessing abuse in the family) among parents with ID were included, yielding a final selection of 20 studies. Findings consistently indicated markedly elevated levels of IPT among parents with ID, with a majority (>50%) having experienced some form of IPT. Estimates for both unspecified and specific forms were typically higher than corresponding estimates in other groups at elevated risk, and than meta-analytical general population estimates in comparable countries. Findings regarding caregiving-relevant outcomes were mixed but indicated links with adverse outcomes, particularly regarding parental mental health. Reports pertaining to child developmental outcomes were scant and inconsistent. We highlight important limitations in the extant literature and provide directions for future research and clinical practice.

Parents with intellectual disability reporting on factors affecting their caregiving in the wake of the COVID-19 pandemic: A qualitative study.

BACKGROUND: Parents with intellectual disability are vulnerable to parenting stress and overwhelming life events. The COVID-19 pandemic constitutes a potentially overwhelming event, but there is little knowledge concerning the effects on parents' caregiving. The present study aimed to fill this gap. METHOD: Semi-structured interviews with 10 Swedish parents with intellectual disability were analysed using thematic analysis. RESULTS: One broad caregiving-related theme: increased caregiving demands and reduced resources for coping resulting in strained parent-child interactions and relationships. Four subthemes highlighted influential factors: pandemic information, professional support, social relationships and informal support, and children's school activities. Strained parent-child interactions were particularly common in the absence of adapted pandemic information, if professional and informal support were compromised, and if the parents had dealt with school-related changes. CONCLUSIONS: Findings support contextual models of caregiving and a stress-resources perspective, and emphasise the importance of adapted information and support to parents with intellectual disability during crises.

Concepts travel faster than thought: an empirical study of the use of attachment classifications in child protection investigations.

Scholarly discussion suggests prevalent, overconfident use of attachment classifications in child protection (CP) investigations but no systematic research has examined actual prevalence, the methods used to derive such classifications, or their interpretations. We aimed to cover this gap using survey data from a nationally representative sample of Swedish CP workers (N = 191). Three key findings emerged. First, the vast majority formed an opinion about young children's attachment quality in all or most investigations. Second, most did not employ systematic assessments, and none employed well-validated attachment methods. Third, there was overconfidence in the perceived implications of attachment classifications. For example, many believed that insecure attachment is a valid indicator of insufficient care. Our findings illustrate a wide researcher-practitioner gap. This gap is presumably due to inherent difficulties translating group-based research to the level of the individual, poor dissemination of attachment theory and research, and infrastructural pressures adversely influencing the quality of CP investigations.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

How Does Temperament in Toddlers at Elevated Likelihood for Autism Relate to Symptoms of Autism and ADHD at Three Years of Age?

The current study investigated longitudinal associations between parent-rated temperament, observed exuberance and accelerometer activity level at 18-months and symptoms of ASD and ADHD at 36-months in a sample of 54 children at elevated likelihood for ASD. For the specific parent-rated temperament scales, most observed significant associations appeared to be specific for either ASD or ADHD symptoms. Indeed, by controlling for overlapping symptoms a different pattern of associations emerged. These results illustrate how temperamental measures may signal risk for later ASD versus ADHD symptomatology in infants at elevated likelihood for ASD. In addition, they indicate the potential of adopting a broader view on neurodevelopmental disorders by investigating not only ASD traits, but also co-occurring disorders such as ADHD in samples of elevated likelihood for ASD.

Admissibility of attachment theory, research and assessments in child custody decision-making? Yes and No!

Attachment theory, research, and assessments have become increasingly applied to settle child custody cases. We discuss such applications in relation to admissibility criteria for scientific evidence and testimony proposed by Faigman et al. (2014). We argue that attachment theory and research can provide valid "framework evidence"; group-based attachment research has yielded general principles suitable as a frame of reference for pertinent court decisions. In particular, child custody decision-making should generally be guided by research indicating that children benefit from attachment networks. In contrast, assessments of attachment quality fall short of providing valid "diagnostic evidence"; information that a specific individual/dyad is a "true" instance of a general group-level principle. In particular, such assessments do not yield valid information about whether a particular caregiver has better caregiving skills than another caregiver and will better support child development. We conclude that attachment theory and research should be admissible for framework but not for diagnostic testimony.

Mothers With Mild Levels of Intellectual Disability: Emotion-Interpretation, Traumatization, and Child Attachment Representations.

Prior research indicates links between parents' experiences of interpersonal trauma and emotion-interpretation difficulties, and between such difficulties and child attachment insecurity and disorganization. Although mothers with mild levels of intellectual disability (ID) are at heightened risk for trauma and emotion-interpretation difficulties, and their children for attachment insecurity, corresponding links in this population have not been examined. We therefore investigated emotional interpretations among mothers with mild levels of ID (n = 23) and matched comparison mothers without ID (n = 25), in relation to mothers' experiences of trauma and their children's attachment representations. Mothers with mild levels of ID were not less accurate than comparison mothers with regard to general positive and negative emotion-interpretation accuracy, but they were significantly more likely to misinterpret shame and anger. Among mothers with mild levels of ID, misinterpretations of shame were positively related to maternal experiences of trauma, and to child attachment insecurity and disorganization.

Disorganized attachment representations, externalizing behavior problems, and socioemotional competences in early school-age.

Multifactorial research must examine if disorganized attachment is specifically associated with either ODD- or ADHD-symptoms,and the mechanisms through which disorganization may become associated with externalizing problems. The present short-term longitudinal study therefore examined attachment representations, and several competences important for socio-emotional functioning, in relation to ODD- and ADHD-symptoms at T1 (N = 105, M age = 80 months) and T2 (N = 80, M age = 104 months). There was a main effect of disorganized attachment on ODD-symptoms at both time points but not on ADHD-symptoms. Disorganized children also showed lowered attention to facial expressions, a diminished ability to discriminate facial expressions, and elevated emotional reactivity. Emotional reactivity mediated the link between disorganization and ODD-symptoms at T1, but not at T2. The findings support disorganized attachment as a risk-factor for ODD-symptoms rather than ADHD-symptoms, and suggest that disorganization may become associated with ODD-symptoms through broad effects on multiple competences.

Attachment difficulties and disorders.

Children and young people who are adopted from care, in care, or at risk of going into care are at higher risk of attachment difficulties and disorders. This may increase the likelihood of mental health conditions and poor emotional regulation. GPs play a role in managing this risk in the community in conjunction with a multi-disciplinary team and supporting referrals to secondary care. However, many GPs are unfamiliar with the terminology of attachment difficulties, attachment disorders, secure attachment and insecure attachment. This article aims to explain these terms and provide an update for GPs on the implications of the National Institute for Health and Clinical Excellence guidelines on child attachment, which focuses on looked after children.

Does child verbal ability mediate the relationship between maternal sensitivity and later self-regulation? A longitudinal study from infancy to 4 years.

There is a need to further examine the mechanisms by which maternal sensitivity influences the development of child self-regulation. This study investigated the role of maternal sensitivity when infants were 10 months old and child verbal ability at 18 months, in relation to various aspects of self-regulation at 48 months, in a sample of 95 typically developing children (46.3% girls). In particular, the study examined, from a Vygotskian perspective, whether child verbal ability, as measured by receptive and expressive language, mediated the relationship between maternal sensitivity and hot and cool aspects of self-regulation in the child. As hypothesized, maternal sensitivity predicted child verbal ability, as well as working memory, set shifting, and delay of gratification. Child receptive language predicted set shifting, inhibition, and delay of gratification. In addition, receptive language mediated the relationship between maternal sensitivity and inhibition only. Additive effects of maternal sensitivity and child receptive language in relation to set shifting were found, and a main effect of maternal sensitivity on child delay of gratification. The results add to the body of research suggesting that responsive parenting and child verbal ability are important for the development of self-regulation, and suggest that different mechanisms may be at work for different aspects of self-regulation.

Can reactivity and regulation in infancy predict inattentive and hyperactive/impulsive behavior in 3-year-olds?

A need to identify early infant markers of later occurring inattentive and hyperactive/impulsive behaviors has come to the fore in the current attention-deficit/hyperactivity disorder literature. The purpose of such studies is to identify driving mechanisms that could enable early detection of attention-deficit/hyperactivity disorder liability and thus facilitate early intervention. Here we study independent and interactive effects of cognitive regulation (inhibition and sustained attention), temperament (reactive and regulatory aspects), and maternal sensitivity (as external regulation) in a sample of 112 typically developing 10-month-old infants (59 boys, 52.7%), in relation to inattentive and hyperactive/impulsive behavior at 3 years. The results showed that infant temperamental regulation and maternal sensitivity made independent contributions to both inattention and hyperactivity/impulsivity, in that higher levels of temperamental regulation and maternal sensitivity were related to less inattentive and hyperactive/impulsive behavior. In addition, the temperamental factor positive affectivity/surgency made a significant contribution to later hyperactivity/impulsivity, in that higher levels of positive affectivity/surgency were related to more hyperactive/impulsive behavior. No interaction effects were found. Our findings suggest temperament and parental regulation as potential and independent markers of later inattentive and hyperactive/impulsive behavior.

Do Individual Differences in Early Affective and Cognitive Self-Regulation Predict Developmental Change in ADHD Symptoms From Preschool to Adolescence?

OBJECTIVE: The role of heterogeneous self-regulation deficits in ADHD has long been emphasized. Yet, longitudinal studies examining distinct self-regulation processes as prospective predictors of developmental change in ADHD symptoms spanning wide developmental periods are scarce. The aim of the current study was to examine affective and cognitive self-regulation as predictors of developmental change in ADHD symptoms from preschool to adolescence in a sample with one third of the children being at risk for developing an ADHD and/or ODD diagnosis. METHOD: At 5 years laboratory measures for hot and cool executive function (EF) and parental and teacher ratings were used for regulation of positive and negative emotionality. Symptoms of ADHD and ODD were measured at 5 and 13 years using parental and teacher ratings based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV). RESULTS: Converging developmental paths in hyperactivity/impulsivity across time were found for those high versus low in early cognitive self-regulation, whereas the development of inattention symptoms diverged across time for those high versus low in early affective self-regulation. CONCLUSION: These results support the idea that different aspects of self-regulation are important for developmental change in the two separate ADHD symptom domains from preschool to adolescence.

The role of sustained attention, maternal sensitivity, and infant temperament in the development of early self-regulation.

This study investigated infant predictors of early cognitive and emotional self-regulation from an intrinsic and caregiving environmental perspective. Sustained attention, reactive aspects of infant temperament, and maternal sensitivity were assessed at 10 months (n = 124) and early self-regulation (including executive functions, EF, and emotion regulation) was assessed at 18 months. The results indicated that sustained attention predicted early EF, which provide empirical support for the hierarchical framework of EF development, advocating early attention as a foundation for the development of cognitive self-regulation. Maternal sensitivity and surgency predicted emotion regulation, in that infants of sensitive mothers showed more regulatory behaviours and a longer latency to distress, whereas high levels of surgency predicted low emotion regulation, suggesting both the caregiving environment and temperament as important in the development of self-regulation. Interaction effects suggested high sustained attention to be a protective factor for children of insensitive mothers, in relation to emotion regulation. In addition, high levels of maternal sensitivity seemed to foster development of emotion regulation among children with low to medium levels of sustained attention and/or surgency. In all, our findings point to the importance of both intrinsic and extrinsic factors in infant development of self-regulation.

Diminished ability to identify facial emotional expressions in children with disorganized attachment representations.

The development of children's ability to identify facial emotional expressions has long been suggested to be experience dependent, with parental caregiving as an important influencing factor. This study attempts to further this knowledge by examining disorganization of the attachment system as a potential psychological mechanism behind aberrant caregiving experiences and deviations in the ability to identify facial emotional expressions. Typically developing children (N = 105, 49.5% boys) aged 6-7 years (M = 6 years 8 months, SD = 1.8 months) completed an attachment representation task and an emotion identification task, and parents rated children's negative emotionality. The results showed a generally diminished ability in disorganized children to identify facial emotional expressions, but no response biases. Disorganized attachment was also related to higher levels of negative emotionality, but discrimination of emotional expressions did not moderate or mediate this relation. Our novel findings relate disorganized attachment to deviations in emotion identification, and therefore suggest that disorganization of the attachment system may constitute a psychological mechanism linking aberrant caregiving experiences to deviations in children's ability to identify facial emotional expressions. Our findings further suggest that deviations in emotion identification in disorganized children, in the absence of maltreatment, may manifest in a generally diminished ability to identify emotional expressions, rather than in specific response biases.

Maternal Sensitivity in Mothers with Mild Intellectual Disabilities is Related to Experiences of Maltreatment and Predictive of Child Attachment: A Matched-Comparison Study.

BACKGROUND: Scientific knowledge on the quality of caregiving/maternal sensitivity among mothers with mild intellectual disabilities (ID) is limited and subject to many methodological shortcomings, but seems to suggest that these mothers are less sensitive than mothers without intellectual disabilities. METHODS: In this matched-comparison study (N = 48), the present authors observed maternal sensitivity for 20 min in four different laboratory play situations. The study also included semi-structured interviews to assess maternal experiences of maltreatment and child attachment. RESULTS: The present authors found significantly lower sensitivity among mothers with intellectual disabilities than among a comparison group of mothers without intellectual disabilities. Among mothers with intellectual disabilities, low sensitivity was related to maternal experiences of maltreatment and predictive of disorganized child attachment. In the comparison group, high maternal sensitivity was related to partner presence and social support, and predictive of child intelligence. CONCLUSIONS: The present authors highlight the importance of attending to intellectual disabilities mothers' history of receiving care to understand their capacity for giving adequate care.

The heterogeneity of attention-deficit/hyperactivity disorder symptoms and conduct problems: Cognitive inhibition, emotion regulation, emotionality, and disorganized attachment.

This study examined the contributions of several important domains of functioning to attention-deficit/hyperactivity disorder (ADHD) symptoms and conduct problems. Specifically, we investigated whether cognitive inhibition, emotion regulation, emotionality, and disorganized attachment made independent and specific contributions to these externalizing behaviour problems from a multiple pathways perspective. The study included laboratory measures of cognitive inhibition and disorganized attachment in 184 typically developing children (M age = 6 years, 10 months, SD = 1.7). Parental ratings provided measures of emotion regulation, emotionality, and externalizing behaviour problems. Results revealed that cognitive inhibition, regulation of positive emotion, and positive emotionality were independently and specifically related to ADHD symptoms. Disorganized attachment and negative emotionality formed independent and specific relations to conduct problems. Our findings support the multiple pathways perspective on ADHD, with poor regulation of positive emotion and high positive emotionality making distinct contributions to ADHD symptoms. More specifically, our results support the proposal of a temperamentally based pathway to ADHD symptoms. The findings also indicate that disorganized attachment and negative emotionality constitute pathways specific to conduct problems rather than to ADHD symptoms.

Mothers with intellectual disability, their experiences of maltreatment, and their children's attachment representations: a small-group matched comparison study.

Maternal intellectual disability (ID) is regarded a risk factor in child development, but there is no scientific evidence on maternal ID in relation to children's attachment. Using a matched comparison design, a small group (n = 23) of mothers diagnosed with ID was studied to help fill this gap. Besides maternal ID, we examined the role of abuse/trauma/maltreatment (ATM) in the mothers' biographies, along with potential confounds. Comparison group mothers (n = 25) had normal variations in intelligence and matched mothers with ID on residential area, income, child age, and sex. History of maternal ATM was assessed using a semi-structured interview and was found to be significantly more likely in the ID group mothers' experience than the comparison group mothers. Children's (M age = 77 months) attachment representations were assessed with the Separation Anxiety Test. Among children of mothers with ID, a substantial minority (35%) had a secure and the vast majority (>80%) an organized attachment representation. Mothers with ID who had suffered elevated ATM were significantly more likely to have children who were scored high on disorganization and insecurity. We discuss possible implications of our findings for societal considerations regarding parenting and child attachment in the context of parental ID status.