Predictors of the rate and course of reactive attachment disorder and disinhibited social engagement disorder symptoms in foster children during the first year of placement.

BACKGROUND: Due to adverse care experiences, foster children are at risk for developing symptoms of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). OBJECTIVE: This study investigated the factors influencing rate and course of RAD and DSED symptoms during the first year of placement in long-term foster care. PARTICIPANTS AND SETTING: The sample consisted of 55 foster children aged 1 to 6 years. Measurements were taken at placement as well as 6 and 12 months after placement. METHODS: RAD and DSED symptoms were assessed with the Disturbance of Attachment Interview (DAI). DSED symptoms were also assessed by observation with the Rating of Infant Stranger Engagement (RISE). Foster parents and caseworkers reported on children's preplacement experiences and placement characteristics. RESULTS: RAD symptoms were rare at Wave 1 (5.5 %) and remitted in most children within the first six months of placement, t(54) = 3.06, p = .003. A total of 30.9 % of the foster children presented DSED symptoms according to the DAI, but only 5.5 % of the children according to the RISE. Foster parents reported symptom reduction, t(54) = 3.71, p = .003, while observational data indicated symptom stability. Prior placement in emergency foster care was associated with lower levels of RAD at Wave 1, F(1.62, 80.88) = 7.80, p = .002, while later placed children presented more RAD and DSED symptoms (RRAD2 = 0.07, RDSED2 = 0.08, RRISE2 = 0.12). Psychopathology of the biological parents (RRAD2 = 0.07, RDSED2 = 0.08) and visitation with the biological parents (RRISE2 = 0.14) predicted symptom stability. CONCLUSION: A substantial number of foster children present persistent DSED symptoms indicating a need for evidenced based interventions.

Adult Outcomes of Children With Reactive Attachment Disorder in a Non-Institutionalized Sample.

Objective: Research on reactive attachment disorder (RAD) has focused on institutionalized samples, and long-term outcomes have not been described. This study examines the natural history of RAD into adulthood in a US community sample.Methods: The electronic medical record of a tertiary care center was reviewed for individuals who received an ICD-9 or ICD-10 diagnosis of RAD between 3-12 years old and were ≥ 18 years old at the start of the study; data were collected between February and June 2018. Children with RAD (n = 49) were identified and psychiatric, social, and medical outcomes were collected in childhood and adulthood. A subset of the RAD cohort with comorbid attention-deficit/hyperactivity disorder (ADHD) based on ICD codes (n = 34) was compared with age-matched controls with ADHD and without attachment disorders (n = 102).Results: Children with RAD had high rates of adult psychiatric diagnoses (73.5%), substance use (42.9%), suicide attempts (28.6%), and psychiatric hospitalizations (71.4%). They also demonstrated poor psychosocial outcomes, including low high school (34.7%) and college (2.0%) graduation, high unemployment (26.5%), state-funded health insurance (65.3%), and legal issues (34.7%). Compared to children with ADHD alone, children with RAD and ADHD had higher rates of comorbid adult psychiatric diagnoses (OR 3.0, P = .02), suicide attempts (OR 7.5, P < .01), and hospitalizations (OR 6.4, P < .01).Conclusions: This study describes the natural history of RAD into adulthood in a non-institutionalized sample. The findings suggest that children with RAD have a high burden of psychiatric comorbidities and reduced psychosocial functioning into adulthood that extend beyond the impairment associated with ADHD, a common comorbidity in RAD. These findings highlight the continuous impact of early attachment difficulties on the developmental trajectory of children.

Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) Symptomatology in a High-Risk Clinical Sample.

Attachment relationships are broadly considered foundational to child development as such attachment disorders, reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), pose a severe threat to children's safety and developmental trajectory. This study examined the prevalence of full diagnosis and symptoms of RAD and DSED in a high-risk sample of adopted children (n = 98; mean age: 46.26 months; range: 16.09 months-6.51 years). Consistent with existing literature, a full diagnosis of RAD and DSED was rare, 1% (n = 1) and 8.1% (n = 8), respectively. However, over half of the sample presented with at least one clinically concerning symptom of RAD or DSED. Given the nature of attachment disorders and the level of concern associated with symptoms, these findings emphasize the need for effective mental health screening, sensitivity beyond just a full diagnosis, and early interventions for adopted children.

The expected and the unexpected in recovery and development after abuse and neglect: The role of early foster carer commitment on young children's symptoms of attachment disorders and mental health problems over time.

BACKGROUND: Whilst we know that foster care is better than institutional care for abused and neglected children, we know less about the specific qualities of foster care that are important for their development and recovery from maltreatment effects. OBJECTIVE: This is the first study to investigate the effects of foster carer commitment on symptoms of Attachment Disorders (AD) and mental health problems in young children post-maltreatment. PARTICIPANTS & SETTING: 144 children, age 0-5, recently accommodated into foster care as part of an ongoing Randomised Controlled Trial. METHODS: Children were assessed using the Disturbances of Attachment Interview and the Strengths and Difficulties Questionnaire, then followed up 15 months and 2.5 years thereafter. Commitment of the foster carer was measured by 'This Is My Baby' interview. Multiple regression was used to analyse the data. RESULTS: Higher initial foster carer commitment, measured shortly after entry to care, was associated with a reduction in Reactive Attachment Disorder symptoms 15 months after placement, with a modest (non-significant) association persisting 2.5 years later. Initial commitment was not associated with symptoms of Disinhibited Social Engagement Disorder at any follow-up time point, nor with symptoms of mental health problems at 15 months. However, higher initial commitment was unexpectedly associated with higher mental health symptom scores at 2.5 years post-accommodation. CONCLUSIONS: This study highlights the complex and non-linear development of children in committed foster care, underscoring the need to examine multiple time-points and to consider symptoms of Attachment Disorders separately from those of other mental health problems.

Changes in Attachment Disorder symptoms in children internationally adopted and in residential care.

BACKGROUND: A high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and other forms of adversity. OBJECTIVE: The present study aims to explore symptoms of RAD and DSED in children in two protection alternatives (international adoption and residential care) after experiences of early adversity. PARTICIPANTS AND SETTING: The participants were 146 children: 40 children adopted into Spanish families from Russia, 49 children in residential care in Spanish institutions (40.8% in long-term foster centers) and 57 community comparison children. METHODS: The Relationship Problems Questionnaire was used to explore both RAD and DSED. All adoptive parents and institutional caregivers retrospectively reported the problems at time of placement (Wave 0), as well as the symptoms observed at the time of the study, with children aged 4-8 years old (Wave 1). At this stage, the assessment of the community comparison group was added. RESULTS: Adopted and children in residential care presented high levels of RAD and DSED symptoms at placement. For adoptees, previous experiences of abuse and neglect were marginally associated with the initial presence of RAD symptoms and a significant recovery was observed after an average of three years in their families, with a certain level of longitudinal continuity between initial and later assessments. In children currently placed in long-term residential centers in Spain, DSED symptoms worsened from W0 to W1. CONCLUSIONS: Adoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.

Development and Validation of a Measure of Attachment Disorders Based on DSM-5 Criteria: The Early TRAuma-Related Disorders Questionnaire (ETRADQ).

BACKGROUND: A review of the scientific literature showed few valid tools for assessing reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), two diagnostic entities traditionally grouped under "attachment disorders." The Early TRAuma-related Disorders Questionnaire (ETRADQ), a caregiver report, was developed to assess attachment disorders in school-age children based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition criteria. This study sought to validate this instrument. METHOD: Caregivers of school-age children from the community (n = 578) and caregivers of at-risk children adopted or in out-of-home care (n = 245) completed a sociodemographic questionnaire, the ETRADQ, the Relationship Problem Questionnaire, the RADA (RAD and DSED Assessment) interview, and the Barkley Functional Impairment Scale for Children and Adolescents. RESULTS: Confirmatory factor analysis of the ETRADQ items supported the expected organization of the measure, that is, two second-order factors and five subfactors: (1) RAD scale (three subscales: Low selective attachment, Low social and emotional responsiveness, Emotional unpredictability) and (2) DSED scale (two subscales: Interactions with unfamiliar adults, Social disinhibition). All scales showed excellent internal consistency, test-retest reliability, convergent validity, and known-group validity. CONCLUSIONS: Results support the reliability and validity of the ETRADQ.

Gambling and Attachment: The Mediating Role of Alexithymia in Adolescents and Young Adults.

Attachment and alexithymia play a central role in the appearance and persistence of pathological gambling and related comorbid addictive behaviours among adolescents and young adults. The aim of the present study was to explore the differences between problem gamblers and non-problem gamblers in gambling severity, spending, video gaming, alcohol and drugs use, attachment, and alexithymia, as well as the interaction among these variables. The study sample included 560 participants non-problem gamblers (mean age = 15.49 years) and 54 problem gamblers (mean age = 16.43 years). Gambling disorder (SOGS-RA), drugs, alcohol, video games and spending (MULTICAGE CAD-4), attachment (IPPA), and alexithymia (TAS-20) were measured. Student's t, Pearson's r, and multiple mediation analyses were conducted. Problem gamblers scored significantly higher in all substance and non-substance addictive behaviours and alexithymia; as well as significantly lower scores in mother and father attachment scales. Moreover, gambling was negatively associated to father and mother attachment, and positively associated to alexithymia. Finally, alexithymia was found to mediate between parental attachment and gambling, spending, videogame, drug and alcohol abuse, especially in the case of mother attachment. This study demonstrated that adolescent and young adult problem gamblers show higher comorbid addictions than non-problem gamblers, in the same way as higher levels of alexithymia and poorer father attachment. Given that higher comorbidity in early ages is associated with worse prognosis and higher psychopathology in adult life, early detection and treatment purposes becomes essential.

White matter changes in children and adolescents with reactive attachment disorder: A diffusion tensor imaging study.

Childhood maltreatment is associated with altered brain structure and function and is a major risk factor for psychopathology, including reactive attachment disorder (RAD). However, whether changes to white matter microstructural integrity are associated with RAD is unclear. We used diffusion tensor imaging (DTI) to assess group differences in fractional anisotropy (FA) in patients with RAD (n = 25; mean age = 13.2) to typically developing (TD) controls (n = 33; mean age = 13.0). To further interpret differences in FA, additional parameters such as mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were assessed. We found that FA values in the body of corpus callosum (CC) and in the projection and thalamic pathways, including the posterior limb of the internal capsule and corona radiata (anterior, posterior, and superior), were significantly higher in the RAD than in the TD group. Additionally, RAD group showed significantly lower RD values in the body of the CC and abovementioned pathways than TD group. Our findings indicate that RAD is associated with altered structure of the CC and projection and thalamic pathways, which may play a role in emotion regulation. The aberrant development of these tracts in RAD may reflect stress-related psychophysiological responses.

Links Between Reactive Attachment Disorder, Caregiving and Temperament: A Differential Susceptibility Perspective.

The links between Reactive Attachment Disorder (RAD) and temperament received relatively little research attention, in spite of their clinical and social relevance. Children with RAD sustain disproportionate burdens of early adversity related to their caregiving environment. However, there seem to be important individual differences in susceptibility to adversity, since only a small number of children show signs of RAD. Based on the work of Zeanah and Fox, this review aims to bring new insights to this relevant clinical issue in light of recent research. A differential susceptibility hypothesis will be considered as a promising and innovative approach toward a further understanding of the links between temperament and RAD.

The revised Psychosis Attachment Measure: Measuring disorganized attachment.

OBJECTIVES: The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample. METHODS: Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self-reported diagnosis of, or treatment for, a psychosis-related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment. RESULTS: An exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test-retest reliability and the disorganized factor displayed good construct validity with related measures and constructs. CONCLUSIONS: These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed. PRACTITIONER POINTS: We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity. These results provide preliminary evidence that disorganized attachment can be measured using a simple self-report measure with individuals with psychosis. Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis. Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma-related conditions and borderline personality disorder.

The relationship between attachment insecurity and experiences on the paranoia continuum: A meta-analysis.

OBJECTIVES: Attachment has long been theorized to play a key role in the development of paranoia. Associations between both constructs have been reported over the last decade, but have ranged widely in magnitude to date. The present study is the first publication to synthesize existing literature and provide a meta-analytic estimate of the attachment-paranoia relationship. METHODS: A systematic search of studies available up to January 2019 was conducted using Embase, MEDLINE, CINAHL, PsycINFO, OpenGrey, and ProQuest Dissertations & Theses Global. This yielded 26 studies which met inclusion criteria (N = 10,539; mean age range 16-47; 45% male). Data were analysed using random effects models with restricted maximum likelihood variance estimator. Age and sex were examined as moderators in meta-regressions. RESULTS: Paranoia was significantly associated with attachment anxiety (r = .38; 95% CI: 0.32, 0.44; p < .0001; I2  = 88%; k = 26) and attachment avoidance (r = .24; 95% CI: 0.18, 0.29; p < .0001; I2  = 79%; k = 26). The strength of these associations did not differ between clinical and non-clinical participant samples. Neither age nor sex moderated identified relationships. CONCLUSIONS: There is a moderate association between both constructs of interest. These findings suggest that attachment insecurity may be an active agent in the aetiology and/or maintenance of experiences on the paranoia continuum. Implications for psychological treatment, for example, consideration of attachment status in formulations, are briefly discussed. PRACTITIONER POINTS: Paranoia is associated with both attachment anxiety and attachment avoidance. These associations are of similar strength for people with and without psychosis. Attachment may contribute to the development and/or maintenance of paranoia. It may be beneficial to target attachment in psychological therapies for psychosis.

Thalamic Volume Is Related to Increased Anterior Thalamic Radiations in Children with Reactive Attachment Disorder.

Reactive attachment disorder (RAD) is associated with childhood maltreatment and affects approximately 1% of the general population. Recent data suggest that childhood maltreatment is associated with brain alterations in white and gray matter. However, the neural mechanisms of RAD-related brain alterations remain unknown. Herein, we evaluated the white matter pathways and gray matter volumes in 31 and 41 age-matched children with RAD and typical development (TD), respectively, by analyzing T1- and diffusion-weighted images. An increased fractional anisotropy (FA) and axial diffusivity in the anterior thalamic radiations (ATR) and an increased volume in the bilateral pallidum and right thalamus were observed in children with RAD compared with those with TD. Moreover, the volume of the thalamus was associated with increased ATR FA in children with RAD. Our study confirmed the existence of atypical neurodevelopment processes in the thalamus, pallidum, and ATR in children with RAD and highlighted an interdependent relationship between the alterations in the thalamus and ATR. These findings may help to improve our understanding of the comprehensive neural mechanisms of RAD.

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence.

Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.

Attachment and social support mediate associations between Polyvictimization and psychological distress in early adolescence.

The current study assesses associations between multiple experience of traumatic events (polyvictimization), PTSD symptoms (PTSS) and psychiatric symptoms in early adolescence, and explores the mediating roles of attachment orientations and perceived social support in the associations between polyvictimization, PTSS and psychiatric symptoms. In 2001, a representative national sample of 390 Danish eighth-graders (M = 13.95, SD = .37) completed validated self-report questionnaires. Polyvictimization was related to higher PTSS and psychiatric symptoms. Importantly, polyvictimization was significantly linked to high attachment anxiety, which was linked with low perceived social support, which in turn was linked with high PTSS levels and psychiatric symptoms. Polyvictimization might have dire consequences in early adolescence. An individual's high attachment anxiety might be connected with lack of perceived social support, which should be seen as a possible psychological distress mechanism subsequent to exposure to a number of potentially traumatic events.

Obscure Dichotomy of Early Childhood Trauma in PTSD Versus Attachment Disorders.

There are two competing schools of thoughts involving children who have experienced early childhood trauma. One posture's nosology focuses on the post-traumatic stress responses; the other focuses on the deviant behaviors that ensue from pathogenic care in early childhood. This author sought to review the literature from a holistic perspective, embracing both diagnostic positions. Seventy-three articles addressing childhood trauma and the ensuing emotional or behavioral disturbances were evaluated, mostly empirical-including 16 that specified posttraumatic stress disorder (PTSD), 21 that specified attachment disorders, and 37 that included potential overlaps between both trauma derivatives. An additional 138 studies were reviewed but not included herein because those focused on broader issues. Statistical data, financial and emotional impacts, and the effects of disrupted attachments were addressed-including both children with secure attachments and those with compromised attachments. The critical effect of both positive and negative parental responses was evaluated, as well as correlations or overlaps in the diagnostic criteria and symptom manifestations of the children and any apparent gaps in the current research. The literature details that the prognosis and course of treatment vary significantly between the two etiologies-apparently at least in part due to possible clinician bias in conceptualizations of the two populations. There are clear overlaps in the diagnostic criteria that strongly suggest comorbidity between the disorders, however, which is especially critical to analyze in the future, since there are solid, empirical, evidence-based treatment protocols for PTSD, but not for attachment disorders resulting from pathogenic caregiver maltreatment.

Unraveling middle childhood attachment-related behavior sequences using a micro-coding approach.

Attachment theory states that children learn to trust in their parent's availability and support if they repeatedly experience that their parents respond sensitively to their needs during distress. Attachment is thus developed and shaped by day-to-day interactions, while at the same time, each interaction is a momentary expression of the attachment relation. How attachment-related behaviors of mother and child follow upon each other during interactions in middle childhood, and how these sequences differ in function of attachment quality, has hardly been studied up to now. To fill this gap, we analyzed the micro-coded interaction of 55 mother-child dyads (27 girls, 28 boys, mean age: 10.3) after a standardized stress-induction. Results reveal that all mother-child dyads show a loop between positive mother and child behaviors. This pattern is complemented with a loop of negative mother and child behaviors in low-trust and more avoidantly attached children: these children tend to handle negative mother behavior less well as they show more negative behavior and less positive behavior in response to negative maternal behavior. More anxiously attached children also show less positive behavior, but react positively on collaborative interactions. The micro-coded interactions thus reveal important insights that inform practitioners and advance attachment theory.

Investigating the Association Between Parental Absence and Developmental Trauma Disorder Symptoms.

The importance of parent-child relationships in social and emotional development is well established. The current study examined the vulnerability to developmental trauma disorder (DTD) symptoms for children who were left behind by their parents due to migration. Using samples from China, we investigated the change pattern of DTD symptoms with respect to scales for affect-physical dysregulation, self-dysregulation, and behavioral dysregulation among left-behind children in comparison to their peers. The results of a hierarchical linear model analysis indicated that there were no statistically significant differences in affect-physical dysregulation, self-dysregulation, or behavioral dysregulation between left-behind children and their counterparts at age 13, ηp 2 = .00-.013. However, DTD symptoms worsened over time for left-behind children, with a larger mean score difference in DTD symptoms at 18 years of age, ηp 2 = .24-.43. The results suggest a possible link between impaired caregiving systems and DTD symptoms. Early prevention efforts would benefit these children before they develop more serious psychosocial problems in the future.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Investigando la Asociación entre la Ausencia Parental y los Síntomas del Trastorno Traumático del Desarrollo AUSENCIA PARENTAL Y TRASTORNO TRAUMATICO DEL DESARROLLO La importancia de las relaciones padres-hijos en el desarrollo emocional y social se encuentra bien establecida. El presente estudio examinó la vulnerabilidad a los síntomas del trastorno traumático del desarrollo (DTD en sus siglas en inglés) en los niños que fueron abandonados por sus padres debido a migración. Usando muestras de China, se investigó el cambio de patrón de los síntomas del DTD con respecto a las escalas de desregulación física-afectiva, autorregulación, y la desregulación conductual entre los niños abandonados en comparación a sus pares. Los resultados de un análisis de modelos lineales jerárquicos indicaron que no existen diferencias significativas en la desregulación física-afectiva, autorregulación, o la desregulación conductual entre los niños abandonados y sus pares a la edad de 13 años, ηp 2 = .00-.013. Sin embargo, los síntomas del DTD empeoraron a lo largo del tiempo para los niños abandonados, con una diferencia mayor en el puntaje promedio en los síntomas del DTD a la edad de 18 años, ηp 2 = .24-.43. Los resultados sugieren un posible vínculo entre los sistemas de cuidado deteriorados y los síntomas del DTD. Los esfuerzos de prevención temprana beneficiarían a estos niños antes de que ellos desarrollen problemas psicosociales más serios en el futuro.

Adopted children who kill their adoptive parents.

The killing of parents, frequently referred to as parricide, is a disturbing phenomenon that often generates widespread media coverage. Most of the scholarly literature on this topic has focused on biological offspring who kill mothers and fathers. Some analyses have examined juveniles and adults who kill their stepparents. To date, virtually no research exists on children who kill their adoptive parents because this type of victim-offender relationship has been absent from available homicide databases, thereby preventing such analyses. The present study is a content analysis of news reports of 46 cases of adopted children who killed their adoptive parents in several different countries. Data pertaining to offender and victim demographics, incident characteristics, and the processing of offenders from the initial charge through conviction and sentencing are examined. To the extent possible, media accounts are used to classify cases according to motives or circumstances leading to the killings. The article concludes with a comparison of profiles of children who kill adoptive parents in relation to those who kill biological parents, important observations that emerged from these news accounts, and discussion of possible explanations of parricide by adopted children, including adopted children syndrome, reactive attachment disorder, and biological risk factors. Limitations of this study and directions for future research are addressed.

Attachment Disorders.

The ability to form attachments with other human beings is an essential skill that typically begins early in life. The parent/caregiver-child relationship is the first crucial relationship that an infant forms, and the health of this relationship has a profound effect on the child's social and emotional development. Children who form secure relationships with their parent or other primary caregiver have fewer internalizing and externalizing behaviors, are more socially competent, and have better-quality friendships. Conversely, children with attachment disorders exhibit a varying capacity to form and sustain relationships and demonstrate emotional depth, they and experience a higher level of peer conflict. Children with insecure attachments have a greater likelihood for physical health morbidities and impaired social, psychological, and neurobiological functioning extending into adulthood. It is crucial that pediatric nurse practitioners implement practice behaviors to better identify children at risk for attachment disorders and link them with appropriate interventions. This continuing education article will explore attachment; and attachment theory; and attachment disorders in terms of types, risk factors, consequences, and treatment and will also provide implications for practice.

A Role of Oxytocin Receptor Gene Brain Tissue Expression Quantitative Trait Locus rs237895 in the Intergenerational Transmission of the Effects of Maternal Childhood Maltreatment.

OBJECTIVE: Women exposed to childhood maltreatment (CM) are more likely to exhibit insensitive parenting, which may have consequences for their offspring's development. Variation in the oxytocin-receptor gene (OXTR) moderates risk of CM-associated long-term sequelae associated with mother-child attachment, although functionality of previously investigated single nucleotide polymorphisms (SNPs) remained elusive. Here, we investigated the role of OXTR rs237895, a brain tissue expression quantitative trait locus (eQTL), as a moderator of the relationship between CM and maternal behavior (MB) and the association between MB and offspring attachment security. METHOD: Of 110 women with information on rs237895 genotype (T-allele = 64, CC = 46), 107 had information on CM (CTQ) and 99 on standardized observer-based ratings of MB at 6 months postpartum (responsivity and detachment), which were used in principal component analysis to obtain a latent factor representing MB. Offspring (n = 86) attachment was evaluated at 12 months of age. Analyses predicting MB were adjusted for socioeconomic status, age, postpartum depression, and genotype-based ethnicity. Analyses predicting child attachment were adjusted for infant sex, socioeconomic status, and postpartum depression. RESULTS: rs237895 significantly moderated the relationship between CM and MB (F1;66 = 7.99, p < .01), indicating that CM was associated with maternal insensitivity only in high-OXTR-expressing T-allele carriers but not in low-OXTR-expressing CC homozygotes. Moreover, maternal insensitivity predicted offspring insecure attachment (B = -0.551; p < .05). CONCLUSION: Women with a high OXTR expressing genotype are more susceptible to CM-related impairments in MB that, in turn, predict attachment security in their children, supporting the role of the OT system in the intergenerational transmission of risk associated with maternal CM.