Maternal invalidation and child RSA reactivity to frustration interact to predict teacher-reported aggression among at-risk preschoolers.

BACKGROUND: Aggression is a transdiagnostic indicator of risk and represents one of the most common reasons children are referred for mental health treatment. Theory and research highlight the impact of maternal invalidation on child aggression and suggest that its influence may vary based on differences in child physiological reactivity. Moreover, the interaction between these risk factors may be particularly pronounced among children of mothers with emotion regulation (ER) difficulties. The current study examined the independent and interactive effects of maternal invalidation and child physiological reactivity to frustration on teacher-reported aggression in an at-risk sample of preschool children. METHOD: Participants included 77 mothers (Mage = 33.17 years, s.d. = 4.83; 35% racial/ethnic minority) and their children (Mage = 42.48 months; s.d. = 3.78; 56% female; 47% racial/ethnic minority). Groups of mothers with and without clinician-rated ER difficulties reported on maternal invalidation, and child respiratory sinus arrhythmia (RSA) was assessed continuously during a frustration task as an indicator of physiological reactivity. Teachers or daycare providers reported on child aggression. RESULTS: Results demonstrated positive associations between maternal ER difficulties and both maternal invalidation and child RSA reactivity to frustration. As expected, the interaction between maternal invalidation and child RSA reactivity was significant, such that higher maternal invalidation and greater child RSA reactivity to frustration predicted more aggression in a daycare or preschool setting. Importantly, this effect was demonstrated while controlling for demographic covariates and baseline RSA. CONCLUSIONS: Findings are in line with diathesis-stress and biosocial models of risk and point to multiple targets for prevention and early intervention.

The role of youths' cardiac autonomic balance and parental responses to youth emotion in vulnerability to borderline personality disorder development.

Developmental models of borderline personality disorder (BPD) emphasize the effects of youths' biological vulnerabilities and their experiences of parental responses to emotion, as well as the interaction between these two elements. The current study evaluated the independent and interactive effects of two indices of autonomic nervous system response and parental responses to youth negative emotions on severity and exacerbation of youths' BPD features during the transition to adolescence. The sample consisted of 162 psychiatric youth (10-14 years; 47.2% female) and their parents. At baseline, youth and their parents completed a lab-based conflict discussion during which parasympathetic and sympathetic nervous system response were measured and indices of sympathetic-parasympathetic balance and coactivation/coinhibition were calculated. Youth also reported on supportive and non-supportive parental responses. At baseline and after 9 months, youth self-reported on their BPD features. Results demonstrated that shifting toward sympathetic dominance independently predicted exacerbation of BPD across 9 months. Additionally, fewer experiences of supportive parental responses and more non-supportive parental responses were associated with greater severity of BPD features in youth. This study highlights the role of autonomic response to parent-child conflict as well as the significance of parental responses to youth emotion for the development of BPD during this developmental window.

Bullying Perpetration and Victimization as Social Mechanisms in the Development of Borderline Personality Traits during Adolescence: A Longitudinal Study.

INTRODUCTION: Borderline personality features are often associated with toxic social relationships and problematic peer functioning. Less is known, however, about the extent to which bullying experiences may shape the development and maintenance of borderline-related traits during crucial periods of rapid normative developments in impulse and emotion regulation skills. Given the core interpersonal character of borderline personality pathology (BPP), such research focus may be relevant to better understand possible causal social mechanisms in the development of personality difficulties within the borderline trait spectrum. METHOD: The current longitudinal study examined whether experiences of both bullying perpetration and victimization in pre-adolescence mediated the developmental course of BPP traits between childhood and adolescence. To examine these associations, a sample of children (N = 242; 57% girls; Mage = 10.87 years) was recruited and followed up 1 and 4 years later. RESULTS: Mediation analysis indicated that the prospective link between child and adolescent BPP trait vulnerability was shaped by pre-adolescent experiences of bullying victimization, but not by bullying perpetration. DISCUSSION: These results indicate that the continuity between child and adolescent borderline trait features are partly explained by exposure to bullying victimization, indicating that the impact of environmental invalidation on BPP development also extends to the peer context.

Are We Thinking about the Same Disorder? A Trifactor Model Approach to Understand Parents' and Their Adolescents' Reports of Borderline Personality Pathology.

Multiple informant assessment is the norm when evaluating borderline personality pathology (BPP) in adolescence, especially by including reports from both parents and adolescents. However, these reports tend to be discrepant, and it is unclear how to integrate. The current study used a trifactor model to isolate sources of variance in parents' and adolescents' reports of BPP due to their shared and unique perspectives in a sample of 652 inpatient adolescents (63% female; Mage = 15.31, SD = 1.45) and their parents (81% mothers). Consensus/agreement was characterized by the externalizing features of BPP whereas idiosyncratic views of adolescent BPP covered the full latent BPP construct, suggesting that simple aggregation of parent and adolescent reports is inappropriate. Measurement invariance suggested that unique perspectives were characterized by slightly different operationalizations of BPP and response biases for specific features of BPP. Attachment security and parents' interpersonal problems predicted shared and unique perspectives differently for female and male adolescents. Lastly, we found that shared and unique perspectives differentially predicted interview based BPP, length of stay, and adolescent mentalizing. In sum, findings replicate previous evidence of parent-child informant discrepancy in youth psychopathology, broadly, and provide insights specific to BPP. Discussion includes practical recommendations for assessment and interpretation of BPP assessment.

The Assessment of Identity Development in Adolescence (AIDA) Questionnaire: First Psychometric Evaluation in Two North American Samples of Young People.

The Assessment of Identity Development in Adolescence (AIDA) is a recently developed measure of identity diffusion in young people. Originally validated in Switzerland, the English version has not yet been validated. Our aim was to evaluate the AIDA's internal factor structure, internal consistency, incremental validity, and relations to other variables in adolescents and young adults and derive clinical cutoffs for use in clinical settings. Study 1, involving 2,119 undergraduate students between the ages of 18-25 years, confirmed the expected bi-factor structure for the AIDA. Study 2 involved the recruitment of 122 adolescent inpatients (ages 12-17), of whom 36 met full DSM-based criteria for Borderline Personality Disorder, in addition to 164 adolescents of the same age, recruited from public schools (total 286 adolescents). Results of both studies demonstrated strong internal consistency and correlations of the expected magnitude and direction with other self-report measures of personality pathology. In addition, Study 2 demonstrated that the AIDA could successfully discriminate between adolescent inpatients with and without BPD, as well as healthy controls, and established preliminary clinical cutoffs that should be replicated in future studies. In all, these studies provide support for further validation and use of the AIDA in young people.

Momentary borderline personality disorder symptoms in youth as a function of parental invalidation and youth-perceived support.

BACKGROUND: Parental invalidation is central to etiological models of borderline personality disorder (BPD). Previous studies relied on retrospective accounts or laboratory observations to examine these associations. There is a dearth of research assessing these constructs in daily life, and limited studies have tested the effect of parental invalidation on BPD symptoms during early adolescence, when BPD onsets. The current study took a dynamic approach to assess parents' validating and invalidating behavior and its effect on youths' BPD symptom expression in daily life, while accounting for parent-perceived helpfulness of these behaviors and youth-perceived support. METHODS: A psychiatric sample of 162 early adolescents (age range = 10-14 years; 47% female) and their parent completed a four-day ecological momentary assessment study. Parents reported on the use of validating and invalidating (e.g. punishing and ignoring) behaviors during parent-child conflict, as well as perceived helpfulness of these behaviors. Youth reported on their BPD symptoms and perceived parental support. Multilevel models were used to test the between- and within-person effects of parents' validating and invalidating behaviors, parent-perceived helpfulness and youth-perceived support, and their interaction on youth's momentary expression of BPD symptoms. RESULTS: At the between-person level, invalidating behaviors, specifically punishing behaviors, were related to greater BPD symptoms in daily life, while ignoring behaviors were associated with fewer BPD symptoms. Youth-perceived support predicted fewer BPD symptoms. CONCLUSIONS: Results underscore the importance of parental invalidation for the expression of BPD symptoms in daily life and also highlight the importance of youth's subjective experience of parental support. Findings are discussed in terms of etiological and intervention models that emphasize a dyadic framework.

Adolescent Sleep Disturbance, Emotion Regulation and Borderline Features in an Inpatient Setting.

Objective: The current study aimed to examine the relation between sleep disturbance, emotion dysregulation and borderline personality features in adolescent inpatients.Method: N = 217 adolescents (67.1% female; ages 12-17) with the following racial/ethnic breakdown: 67.4% White, 3.7% Hispanic, 2.8% Asian, 1.8% African American, and 6.4% multiracial) completed self-report measures of sleep disturbance, emotion dysregulation and borderline personality symptoms at admission to, discharge from, and at 6-months-post discharge from an inpatient psychiatric hospital. Group comparison and path analyses were conducted to examine differences in sleep disturbance between those with and without borderline personality disorder and the mediating role of emotion dysregulation in the relation between sleep disturbance and borderline personality features.Results: Borderline personality features and emotion dysregulation were significantly related to indices of sleep disturbance. Path models revealed that some sleep disturbance indices at admission directly predicted levels of borderline features at discharge and at 6-months-post-discharge. However, none of the indirect pathways between sleep disturbance at admission, emotion dysregulation at discharge, and borderline features at discharge or 6-months post-discharge were significant.Conclusions: Findings are consistent with prior literature which suggest that a unique relation exists between sleep disturbance and BPD, beyond comorbid depression symptoms. However, contrary to our hypotheses, the current study did not provide empirical support for the mediating role of emotion regulation in this relation. These findings have implications for existing personality disorder and sleep interventions and suggest further research into the mechanisms underlying the relation between sleep disturbance and borderline personality pathology is necessary.

Mediational Intervention for Sensitizing Caregivers to Improve Mental Health Outcomes in Orphaned and Vulnerable Children.

OBJECTIVE: There is an urgent need to equip community-based careworkers with the skills to address the mental health needs of orphans and vulnerable children (OVC) as an essential response to shortages in human resources for mental health in Sub-Saharan Africa. We conducted a quasi-experimental feasibility trial in South Africa to adapt and evaluate an established year-long semi-structured, manualized video-feedback caregiver intervention (the Mediational Intervention for Sensitizing Caregivers; MISC) for community-based organizations (CBOs). METHODS: Following a year-long iterative cross-cultural adaptation of MISC, we recruited 88 OVC (ages 7-11; 45.5% girls) and their CBO careworkers (N = 18; 94.4% female). Two CBOs (45 children; 9 CBO careworkers) received 12 months of MISC, and two CBOs (43 children; 9 CBO careworkers) received treatment as usual. Child mental health and quality of caregiving were assessed at 6 months into the intervention and at completion through multi-informant questionnaires and video-recordings of careworker-child interactions. Qualitative interviews were conducted to evaluate feasibility and acceptability. RESULTS: MISC-CBO was acceptable and feasible in terms of attendance and post-intervention interviews. MISC improved child mental health, as well as the quality of careworker caregiving in terms of interactive effects for affective and cognitive (Expanding) components of MISC, and main effects for the cognitive components of Rewarding and Provision of meaning. MISC components did not mediate the effects of the intervention. CONCLUSIONS: The current study shows that laypersons with no tertiary education and virtually no prior training who undergo MISC training can improve caregiving quality and the mental health of OVCs.

The Development of Criterion A Personality Pathology: The Relevance of Childhood Social Functioning for Young Adult Daily Self-Functioning.

The DSM-5 alternative model for the diagnosis of personality disorders (AMPD) states that self- and interpersonal (Criterion A) dysfunction is necessary to diagnose a personality disorder, qualified by maladaptive personality trait profiles (Criterion B). This study tested whether childhood maladaptive personality traits predict interpersonal dysfunction during adolescence, which further predicts lower self-functioning in young adulthood. A mixed clinical-community sample of 157 10-year-olds participated for ten years. Social problems and personality traits were rated by parents at age 10 and 12. At age 20, young adults completed 14 daily ratings of self-functioning. Traits of emotional instability and disagreeableness predicted social problems and self-problems. Social problems predicted worse self-functioning in adulthood. An indirect effect of childhood narcissistic traits on higher levels of self-functioning via lower levels of social problems was found. Results are discussed in terms of their contribution to our understanding of the AMPD from a developmental perspective.

Psychometric Properties of the Parent and Youth Versions of the Inadequate Boundaries Questionnaire in Community and Clinical Samples of Adolescents.

The Inadequate Boundaries Questionnaire (IBQ) was created as a multi-dimensional measure of boundary violations in parent-child relationships. Use of the IBQ has been increasing; however, its psychometric properties, including its proposed five-factor structure, have yet to be comprehensively evaluated. The current study examined the factor structure, reliability, mother-adolescent agreement, and convergent and discriminant validity of the IBQ-Parent and -Youth English versions among community and clinical adolescents and their mothers. Confirmatory factor analysis most strongly supported four factors: Guilt Induction-Psychological Control, Parentification, No Boundaries (Enmeshment), and Triangulation. The scales showed acceptable to excellent reliability. Mother-adolescent agreement was moderate in the healthy community sample and weaker in the clinical sample. Convergent and discriminant associations supported the validity of the Guilt Induction-Psychological Control scale, with a more complex picture emerging for other scales. Implications of these findings and directions for future research with the IBQ are discussed.

Internalizing and Externalizing Problems Among At-Risk Preschoolers: The Mediating Role of Maternal Invalidation.

Children of parents with emotion regulation (ER) difficulties may be at heightened risk for internalizing and externalizing problems, and maternal invalidation may explain this association. The current study used a cross-informant design to test the indirect effect of clinician-rated maternal ER difficulties on teacher-reported internalizing and externalizing problems through maternal invalidation. This risk pathway was tested in two groups of preschoolers: children of mothers with ER difficulties and children of mothers without ER difficulties (healthy controls; HC). Participants were 85 mothers (Mage =33.30 years; 36% racial/ethnic minoritized status) and their children (Mage =4234 months; 47% racial/ethnic minoritized status). Maternal ER difficulties had a significant indirect effect on child internalizing problems and externalizing problems, specifically aggressive behavior, through maternal invalidation. Specifically, mothers with ER difficulties reported more maternal invalidation, and their children exhibited more internalizing problems and aggressive behavior in a preschool/daycare setting, pointing to multiple avenues for prevention and intervention.

Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences.

BACKGROUND: Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation. METHODS: N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected. RESULTS: Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts. CONCLUSIONS: The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.

Narrative Coherence in Adolescence: Relations With Attachment, Mentalization, and Psychopathology.

Narrative coherence refers to the overall completeness of the narrative that helps the individual to draw meaning from past events. Research has predominantly focused on developmental trajectories of narrative coherence among typically developing individuals and less research sheds light on narrative coherence in adolescents facing serious psychological difficulties. This study is the first to apply Baerger and McAdams's well-validated coding scheme of narrative coherence to adolescents and to rate narrative coherence based on the content derived from the Child Attachment Interview in the context of attachment security, mentalization, and internalizing and externalizing pathology in 70 inpatient adolescents. Findings emphasized that the coding scheme is applicable for adolescents and attachment narratives. Narrative coherence was negatively correlated with age and no gender differences were found. Higher attachment security and better mentalization both contributed to more coherent narratives. More coherent narratives predicted less externalizing problems, but when controlling for mentalization and attachment security, mentalization was the strongest predictor. The relation between narrative coherence and other social-cognitive constructs is discussed, as well as how poor narrative coherence should be taken into account with respect to psychopathology in adolescence. Finally, the value of this coding scheme to evaluating narrative coherence in adolescence is discussed.

Convergence in Reports of Adolescents' Psychopathology: A Focus on Disorganized Attachment and Reflective Functioning.

Although convergence in parent-youth reports of adolescent psychopathology is critical for treatment planning, research documents a pervasive lack of agreement in ratings of adolescents' symptoms. Attachment insecurity (particularly disorganized attachment) and impoverished reflective functioning (RF) are 2 theoretically implicated predictors of low convergence that have not been examined in the literature. In a cross-sectional investigation of adolescents receiving inpatient psychiatric treatment, we examined whether disorganized attachment and low (adolescent and parent) RF were associated with patterns of convergence in adolescent internalizing and externalizing symptoms. Compared with organized adolescents, disorganized adolescents had lower parent-youth convergence in reports of their internalizing symptoms and higher convergence in reports of their externalizing symptoms; low adolescent self-focused RF was associated with low convergence in parent-adolescent reports of internalizing symptoms, whereas low adolescent global RF was associated with high convergence in parent-adolescent reports of externalizing symptoms. Among adolescents receiving inpatient psychiatric treatment, disorganized attachment and lower RF were associated with weaker internalizing symptom convergence and greater externalizing symptom convergence, which if replicated, could inform assessment strategies and treatment planning in this setting.

Paradoxical Effects of Intranasal Oxytocin on Trust in Inpatient and Community Adolescents.

Research suggests that oxytocin, a neuropeptide implicated in attachment, is a promising clinical tool because it increases affiliation and attachment behaviors, which are reduced in a range of psychiatric disorders. Oxytocin has been recommended as a psychiatric treatment for adolescents, but this remains largely unstudied. Skepticism is warranted, based on mixed findings in adults and absence of data across development. The objective of this study was to examine the effect of intranasal oxytocin on attachment-related and non-attachment-related trust in an interactive game, determining how this effect differs among inpatient adolescents and healthy controls and whether this effect is moderated by attachment security. There were 122 adolescents (ages 12-17; n = 75 inpatient, 70% female, 37% Black, 24% Hispanic, 20% White, and 20% multiracial; n = 46 control, 55% female, 75% Caucasian) randomized to receive self-administered intranasal oxytocin or a placebo and play a trust game with their mother and a stranger over the Internet. Oxytocin only affected the trust game behavior of adolescents when attachment security was moderate or low. At these levels, oxytocin increased the trust of patients, such that their behavior was equivalent to that of healthy controls. Paradoxically, oxytocin reduced the investments of healthy control subjects. This study takes a first step toward determining whether, and for whom, oxytocin may have a trust-enhancing effect and challenges simplistic notions of oxytocin as the attachment-chemical of the brain-pointing instead to differential oxytocin effects based upon clinical status (patient vs. control) and attachment security.

Evaluation of the PAI-A Anxiety and Depression Scales: Evidence of Construct Validity.

Against the background of a dearth of studies examining the properties of the scale scores of the Personality Assessment Inventory-Adolescent (PAI-A; Morey, 2007), this study was conducted to evaluate evidence of construct validity for the Anxiety (ANX) and Depression (DEP) scales of the PAI-A. Convergent and discriminant validity of the ANX and DEP scale scores were investigated using a sample of adolescents admitted to the adolescent program of a private tertiary care inpatient treatment facility. Multiple methods assessing anxious and depressive symptomology and diagnoses were included. Construct validity of the ANX and DEP scales was mostly supported. Advantages of using the PAI-A for the assessment of anxiety and depression were discussed.

Exploring the clinical utility of the DSM-5 conduct disorder specifier of 'with limited prosocial emotions' in an adolescent inpatient sample.

BACKGROUND: With the recent addition of a callous-unemotional (CU) specifier to the diagnosis of conduct disorder (CD) in the DSM-5, studies are needed to evaluate the clinical utility of this specifier and the best ways to identify youth meeting criteria for this specifier in clinical samples. METHODS: To this end, the current study examined cross-sectional correlates and treatment response across four groups of inpatient adolescents (N=382, ages 12-17): those with CD without the specifier, with CD and the CU specifier, CU alone, and a group of psychiatric controls. We used two different measures to identify adolescents with high levels of CU traits: the Antisocial Process Screening Device (APSD) [1] and the Inventory of Callous-Unemotional Traits (ICU) [2]. Questionnaires and structured interviews were used to evaluate a range of outcomes including presence of baseline levels and treatment outcomes of both externalizing and internalizing problems. FINDINGS: Results indicated that the ICU, but not the APSD differentiated between conduct disordered youth with and without the specifier on externalizing behaviors in both cross-sectional relations and treatment response. CONCLUSIONS: The results of the current study caution the use of the most frequently used measure to identify the CU specifier, and make suggestions about alternatives.

First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents.

OBJECTIVE: Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. METHODS: The sample included 259 consecutive admissions to an adolescent inpatient unit (Mage=15.42, SD=1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. RESULTS: Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects. CONCLUSIONS: The study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.

Experiential avoidance mediates the link between maternal attachment style and theory of mind.

Theoretical and empirical models suggest a relation between attachment style and theory of mind (ToM) in childhood and adulthood; however, this link has not been evaluated to the same extent in adolescence. Additionally, these models typically fail to consider mechanisms by which attachment style affects ToM abilities. The present study sought to test a mediational model in which experiential avoidance mediates the relation between maternal attachment style and ToM. A sample of 282 adolescents (Mage=15.42years, SD=1.44, 62.8% female) was recruited from an inpatient psychiatric hospital. Findings revealed that maternal attachment style in females was related to ToM, through experiential avoidance. Specifically, those with a disorganized maternal attachment were most likely to engage in experiential avoidant cognitive and emotional strategies, which in turn related to lower levels of ToM ability. Implications and areas for future research are discussed.