[Bipolar disorders and multiple etiologies : a link with attachment disorders ?] / Troubles bipolaires et étiologies multiples : un lien avec les troubles de l'attachement ?

Bipolar disorders (BD) bring together different forms of mood disorders, characterized by the occurrence of depressive, manic, hypomanic and/or mixed episodes. They are recognized as the seventh cause of disability per year of life among 15 to 44 year old people by the World Health Organization (WHO). It is therefore a frequently encountered pathology. On the etiological level, the avenues currently accepted concerning BD are multiple, yet they still remain at the hypothesis stage. Each of these avenues therefore has therapeutic potential. It therefore seems interesting to address the different major hypotheses existing to date on the etiological level. We will first describe BD from historical, nosological and epidemiological points of view. We will then develop the genetic etiological aspects and the neural aspects through brain imaging research. Finally, we will propose a reflection on the specific relational etiology and the avenues of research that result from it.

Les troubles bipolaires (TB) regroupent différentes formes de troubles de l'humeur, caractérisés par la survenue d'épisodes dépressifs, maniaques, hypomanes et/ou mixtes. Ils sont reconnus comme la septième cause de handicap par année de vie parmi les personnes âgées de 15 à 44 ans par l'Organisation Mondiale de la Santé (OMS). Il s'agit donc d'une pathologie fréquemment rencontrée. Sur le plan étiologique, les pistes actuellement retenues concernant les TB sont multiples et restent encore au stade d'hypothèses. Chacune de ces pistes contribue à élargir le champ des ressources thérapeutiques possibles. Il nous semble, dès lors, intéressant d'aborder e les différentes hypothèses majeures existant à ce jour sur le plan étiologique. Nous resituerons préalablement les TB sur les plans historiques, nosologiques puis épidémiologiques. Nous développerons ensuite les aspects étiologiques génétiques et les aspects neurobiologiques à travers les recherches en imagerie cérébrale. Enfin, nous proposerons une réflexion sur l'étiologie spécifiquement relationnelle et les pistes de recherche qui en découlent.

Neural correlates of face familiarity in institutionalised children and links to attachment disordered behaviour.

BACKGROUND: One of the most well-documented sequelae of early maltreatment and institutionalisation is attachment problems, including behaviours under the labels of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Despite growing evidence of the neurobiological effects of institutionalisation, the neural correlates of these behavioural patterns are largely unknown. METHODS: The current study examined effects of both institutionalisation in general and attachment disordered behaviour, in particular, on brain-based markers of face processing, in 100 Portuguese children (70 currently institutionalised, 30 continuously raised by their families). Children's neural processing of caregiver's and stranger's faces was assessed with Event-Related Potentials (ERPs). RESULTS: Compared to children from the community, institutionalised children showed smaller amplitudes in the N170, to both stranger and caregiver faces. Amongst the institutionalised group, living in a setting with a higher children-to-caregivers' ratio was associated with smaller P400 amplitudes. The display of DSED symptoms was associated with a smaller P1 to both faces, as well as a reduced differentiation between faces in P400 amplitudes and smaller P400 to the stranger's face. In contrast, RAD symptoms were not associated with any ERP measures. CONCLUSIONS: Results replicate previously reported hypoactivation in institutionalised children, in a less-globally deprived setting than past work, indicating that such a pattern is associated with lack of individualised care and increased symptoms of DSED.

Socioemotional profiles of autism spectrum disorders, attention deficit hyperactivity disorder, and disinhibited and reactive attachment disorders: a symptom comparison and network approach.

Children with autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD) and disinhibited and reactive attachment disorders (RAD/DAD) often experience socioemotional problems. Elucidating a clear picture of these profiles is essential. Strengths and Difficulties Questionnaires (SDQs) were analysed from cohort of children with ASD (n = 1430), ADHD (n = 1193), and RAD/DAD (n = 39). Kruskal-Wallis Tests and network analytic techniques were used to investigate symptom profiles. Children with ASD experienced more emotional problems, peer problems and fewer prosocial behaviours. Children with ADHD and RAD/DAD had higher levels of hyperactivity and conduct problems. Overall, ASD and ADHD networks were highly correlated (rs = 0.82), and we did not observe a statistically significant difference in terms of global Strength.

Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems.

Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.

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.

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.

Adverse caregiving in early life: The trauma and deprivation distinction in young children.

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move beyond broad indices of risk and toward more specific and individualized understanding of how risk exposures are linked to clinical outcomes in young children. Within infant and early childhood mental health, there is a need for greater specificity in linking adverse caregiving experiences in early life to psychopathology in children. We highlight a framework distinguishing experiences of trauma from experiences of deprivation and use the examples of posttraumatic stress disorder and reactive attachment disorder to demonstrate how greater specificity in our understanding of early adverse caregiving can lead to more accurate and targeted diagnosis and treatment for young children. Both researchers and clinicians benefit from an approach to gain a greater appreciation of the links between specific types of experiences and outcomes in the children that we serve.

El conocimiento y la comprensión acerca del impacto de experiencias adversas acumuladas sobre la salud y bienestar de los niños, adolescentes y adultos se ha expandido rápidamente durante los pasados 30 años. A pesar de la inestimable atención y apoyo que esta proliferación ha derivado con respecto a la importancia de las experiencias de la temprana niñez, creemos que es tiempo de pasar más allá de los amplios índices de riesgo hacia una comprensión más específica e individualizada de cómo el hecho de estar expuesto a riesgo se conecta con los resultados clínicos en niños pequeños. Dentro el camp de la salud mental infantil, hay una necesidad por mayor especificidad para conectar las adversas experiencias de prestación de cuidado en la temprana parte de la vida con la sicopatología en los niños. Enfatizamos un marco de trabajo que distingue las experiencias de trauma de las experiencias de privaciones y uso de ejemplos del trastorno de estrés postraumático y el trastorno reactivo de la vinculación para demostrar hasta qué punto la especificidad en nuestra comprensión del temprano cuidado adverso puede llevar a un diagnóstico y tratamiento más acertado y dirigido para los niños pequeños. Tanto los investigadores como el personal clínico se benefician de un acercamiento para obtener una mayor apreciación de os lazos entre tipos específicos y resultados en los niños a quienes les servimos.

Les connaissances et la compréhension sur l'impact d'une accumulation d'expériences adverses sur la santé et le bien-être des enfants, des adolescents et des adultes se sont rapidement étendues au fil des 30 dernières années. En dépit de l'attention précieuse et du soutien de cette prolifération qui ont montré l'importance des expériences de la petite enfance, nous pensons qu'il est temps de passer au-delà des indices généraux de risque pour désormais privilégier une compréhension plus spécifique et individualisée de la manière dont les expositions au risqué sont liées aux résultats cliniques chez les jeunes enfants. Au sein de la santé mentale du nourrisson, il est nécessaire d'avoir une plus grande spécificité dans le lien entre les expériences adverses de modes de soin au début de la vie à la psychopathologie chez les enfants. Nous mettons en lumière une structure qui distingue les expériences de trauma d'expériences de privation et utilisons les exemples du trouble de stress posttraumatique et du trouble de l'attachement réactif afin de démontrer la manière dont une plus grande spécificité dans notre compréhension peut mener à un diagnostic et à un traitement plus précis et plus ciblés pour les jeunes enfants. A la fois les chercheurs et les cliniciens bénéficient d'une approche qui nous fait gagner une plus grande appréciation des liens entre les types spécifiques d'expériences et les résultats chez les enfants que nous servons.

Reactive attachment disorder symptoms and prosocial behavior in middle childhood: the role of Secure Base Script knowledge.

BACKGROUND: Children with attachment disorder show prosocial behavior problems. Children with a reactive attachment disorder show inhibited and emotionally withdrawn behavior. Consequently, these children typically display prosocial behavior problems. However, the underlying mechanism between reactive attachment disorder and prosocial behavior problems is still unclear and findings in literature are mixed. METHODS: The current study investigated the role of children's attachment representations in this association. Attachment representations reflect knowledge about a cognitive script regarding the attachment figure as a source for support (Secure Base Script). We tested whether secure base script knowledge 1) mediates or 2) moderates the link between reactive attachment disorder and prosocial behavior problems in 83 children (6-11 years; 83.1% boys) recruited from special education schools for children with behavioral problems. Children completed a pictorial Secure Base Script Test. Their reactive attachment disorder symptoms were assessed during an interview with the primary caregivers. Primary caregivers and teachers filled out a prosocial behavior questionnaire about the child. RESULTS: Results did not support the mediation hypothesis, but evidence for the moderation hypothesis was found. Secure base script knowledge attenuated the negative association between attachment disorder symptoms and prosocial behavior. CONCLUSIONS: These findings contribute to the discussion about the link between attachment representations and attachment disorders.

Perinatal risk factors and reactive attachment disorder: A nationwide population-based study.

AIM: To examine the association between several perinatal and obstetric risk factors and reactive attachment disorder in children diagnosed in specialised services. METHODS: In this nested case-control study, 614 cases with reactive attachment disorder and 2423 controls matched with age and sex were identified from Finnish national registers. Conditional logistic regression was used to examine the association between a number of perinatal risk factors and reactive attachment disorder. RESULTS: In the adjusted analysis, a low birthweight of <2500 g was associated with an increased odds of reactive attachment disorder, with an odds ratio (OR) of 1.96 and 95% confidence interval (CI) of 1.17, 3.30 and a birthweight of 4000-4499 grams was associated with decreased odds OR 0.49 (95% CI 0.31, 0.75). The odds for being diagnosed with reactive attachment disorder increased with a gestational age of <32 weeks OR 3.72 (95% CI 1.52, 9.10), induced labour OR 1.34 (95% CI 1.03, 1.75) and monitoring in a neonatal intensive care unit (NICU) OR 1.67 (95% CI 1.09, 2.55). CONCLUSION: We found associations between low birthweight, preterm birth, NICU admission and reactive attachment disorder. The findings add to the current literature on the understanding of the development of reactive attachment disorder in children.

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.

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.

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.

Attachment disorders diagnosed by community practitioners: a replication and extension.

BACKGROUND: While considered a rare diagnosis, reactive attachment disorder (RAD) is simultaneously the subject of considerable debate. A recent report suggested that RAD is overdiagnosed in community settings and that conduct problems may be used to make a diagnosis of RAD (Woolgar & Baldock, Child and Adolescent Mental Health, 20, 2015, 34-40). This study seeks to replicate and extend these findings. METHOD: Clinical assessment data from 100 consecutive admissions of maltreated foster and adopted children (ages 3-17) to a specialty treatment clinic in the United States were reviewed. Measures included semi-structured interviews of RAD and disinhibited social engagement disorder (DSED) symptoms and caregiver-report questionnaires of emotional problems, conduct problems, and the quality of the parent-child relationship. RESULTS: Of the 100 cases reviewed, 39 presented with a diagnostic history of RAD, DSED, or 'attachment disorder'. Of these cases, three were diagnosed in-clinic with DSED; no cases met diagnostic criteria for RAD according to DSM-5 criteria. However, analyses found that those diagnosed with RAD by community-based clinicians were significantly more likely to display conduct problems and to be adopted (as opposed to in foster care). CONCLUSIONS: These findings confirm those of Woolgar and Baldock (Child and Adolescent Mental Health, 20, 2015, 34-40). It appears that the diagnostic criteria of RAD are commonly being inaccurately applied in general community-based practice. Clarification of diagnostic criteria for RAD in recent revisions of diagnostic taxonomies, the accumulation of empirical data on RAD, and improved instrumentation are either poorly disseminated or inadequately implemented in community-based practice settings.

Commentary: Increasing diagnostic precision in reactive attachment disorder - a commentary on Allen & Schuengel (2019).

A study by Allen and Schuengel in this issue of the journal replicates and extends previous findings by Woolgar and Baldock (2015) indicating that community practitioners are far more likely to diagnose reactive attachment disorder in symptomatic children than are specialists using well-validated measures. We consider historic variability in how this disorder is defined but note an emerging consensus in nosologies and among researchers. We consider how more systematic assessments might improve diagnostic efforts to specify the kinds of clinical phenomena that are associated with neglect and deprivation.

Mothers' Physiological and Affective Responding to Infant Distress: Unique Antecedents of Avoidant and Resistant Attachments.

In a sample of 127 mother-infant dyads, this study examined the predictive significance of mothers' physiological and observed emotional responding within distressing and nondistressing caregiving contexts at 6 months for infant attachment assessed with Fraley and Spieker's (2003) dimensional approach and the categorical approach at 12 months. Findings revealed that a lesser degree of maternal respiratory sinus arrhythmia withdrawal and higher levels of maternal neutral (vs. positive) affect within distressing (vs. nondistressing) caregiving contexts were distinctive antecedents of avoidance versus resistance assessed dimensionally (but not categorically), independent of maternal sensitivity. Discussion focuses on the usefulness of examining mothers' physiological and affective responding, considering the caregiving context, and employing the dimensional approach to attachment in identifying unique antecedents of patterns of attachment insecurity.

Attachment disorder and attachment theory - Two sides of one medal or two different coins?

INTRODUCTION: Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9. METHODS: A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development. RESULTS: The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills. CONCLUSIONS: Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

Refining the assessment of disrupted maternal communication: Using item response models to identify central indicators of disrupted behavior.

The Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Bronfman, Madigan, & Lyons-Ruth, 2009-2014; Bronfman, Parsons, & Lyons-Ruth, 1992-2004) is a widely used and well-validated measure for assessing disrupted forms of caregiver responsiveness within parent-child interactions. However, it requires evaluating approximately 150 behavioral items from videotape and extensive training to code, thus making its use impractical in most clinical contexts. Accordingly, the primary aim of the current study was to identify a reduced set of behavioral indicators most central to the AMBIANCE coding system using latent-trait item response theory (IRT) models. Observed mother-infant interaction data previously coded with the AMBIANCE was pooled from laboratories in both North America and Europe (N = 343). Using 2-parameter logistic IRT models, a reduced set of 45 AMBIANCE items was identified. Preliminary convergent and discriminant validity was evaluated in relation to classifications of maternal disrupted communication assigned using the full set of AMBIANCE indicators, to infant attachment disorganization, and to maternal sensitivity. The results supported the construct validity of the refined item set, opening the way for development of a brief screening measure for disrupted maternal communication. IRT models in clinical scale refinement and their potential for bridging clinical and research objectives in developmental psychopathology are discussed.

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.

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.