Universality claim of attachment theory: Children's socioemotional development across cultures.

The first part of this paper reviews the basic tenets of attachment theory with respect to differences in cultural socialization strategies. In one strategy infants have the lead, and the social environment is responsive to the infant's wishes and preferences. In another strategy the caregivers-children or adults-are experts who know what is best for a baby without exploring his or her mental states. Accordingly, the definition of attachment is conceived as a negotiable emotional bond or a network of responsibilities. Attachment theory represents the Western middle-class perspective, ignoring the caregiving values and practices in the majority of the world. However, attachment theory claims universality in all its components. Since the claim of universality implies moral judgments about good and bad parenting, ethical questions need to be addressed. These issues are discussed in the second part of the paper. It is first demonstrated that sensitive responsiveness in attachment theory is built on a different concept of the person and self than concepts of good caregiving in many rural subsistence-based farming families. Evaluating one system with the standards of another ignores different realities and different value systems. The common practice of large-scale interventions in rural subsistence-based contexts promoting Western-style parenting strategies without knowing the local culture positions a false understanding of scientific evidence against cultural knowledge. This practice is unethical. Diversity needs to be recognized as the human condition, and the recognition of diversity is an obligation for better science as well as for improving people's lives.

Adapting social conditioned place preference for use in young children.

OBJECTIVE: Social-emotional processing is key to daily interactions and routines, yet a challenging construct to quantify. Measuring social and emotional processing in young children, children with language impairments, or non-verbal children, presents additional challenges. This study addresses a pressing need for tools to probe internal responses such as feelings, drives, and motivations that do not rely on intact language skills. METHODS: In this study, we extend our recent success of inducing conditioned place preference (CPP) in children to demonstrate the success of using a social unconditioned stimulus in the CPP paradigm in both typically developing children (n = 36) and in children with a diagnosis of autism spectrum disorder (n = 14). RESULTS: This is the first study to demonstrate successful social conditioned place preference in the human population. Both typically developing children and children with autism spectrum disorder demonstrate significant social conditioned place preference by spending significantly more time in the room paired with social interaction following training. CONCLUSIONS: Significant heterogeneity of CPP scores in both groups of children indicates that social motivation is expressed along a continuum, and that the CPP paradigm may provide a more comprehensive characterization of social motivation beyond a diagnosis of an autism spectrum disorder for each child.

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry.

BACKGROUND: Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives. FINDINGS: A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives. CONCLUSIONS: Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control.

BACKGROUND: International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE: To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. METHODS: Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. RESULTS: Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). CONCLUSIONS: In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.

First steps toward an understanding of procedural fairness.

In four experiments, we tested whether 20-month-old infants are sensitive to violations of procedural impartiality. Participants were shown videos in which help was provided in two different ways. A main character provided help to two other agents either impartially, by helping them at the same time, or in a biased way, by helping one agent almost immediately while the other after a longer delay. Infants looked reliably longer at the biased than at the unbiased help scenarios despite the fact that in both scenarios help was provided to each beneficiary. This suggests that human infants can attend to departures from impartiality and, in their second year, they already show an initial understanding of procedural fairness.

Infants possess an abstract expectation of ingroup support.

One pervasive facet of human interactions is the tendency to favor ingroups over outgroups. Remarkably, this tendency has been observed even when individuals are assigned to minimal groups based on arbitrary markers. Why is mere categorization into a minimal group sufficient to elicit some degree of ingroup favoritism? We consider several accounts that have been proposed in answer to this question and then test one particular account, which holds that ingroup favoritism reflects in part an abstract and early-emerging sociomoral expectation of ingroup support. In violation-of-expectation experiments with 17-mo-old infants, unfamiliar women were first identified (using novel labels) as belonging to the same group, to different groups, or to unspecified groups. Next, one woman needed instrumental assistance to achieve her goal, and another woman either provided the necessary assistance (help event) or chose not to do so (ignore event). When the two women belonged to the same group, infants looked significantly longer if shown the ignore as opposed to the help event; when the two women belonged to different groups or to unspecified groups, however, infants looked equally at the two events. Together, these results indicate that infants view helping as expected among individuals from the same group, but as optional otherwise. As such, the results demonstrate that from an early age, an abstract expectation of ingroup support contributes to ingroup favoritism in human interactions.

Can rapport building strategies, age, and question type influence preschoolers' disclosures of adult wrongdoing?

In the present experiment, we examined preschoolers' disclosures of a secret as a function of rapport building strategies used in Scandinavian field settings (verbal rapport building vs. prop rapport building), age in months (33-75 months) and question type (open-ended free recall invitation vs. suggestive questions). Fifty-three preschoolers (M = 60.5 months old, SD = 11.4) witnessed a researcher break a toy and were asked to keep the toy breakage a secret. The children were thereafter interviewed about the incident. Overall, 18.9% of the children disclosed the secret after an open-ended free recall invitation. The disclosure rate rose to 83% after the final phase of the interviews when questions containing suggestive details were asked of the children. Notably, we did not observe any significant effects as a function of manipulating rapport building strategy. A linear regression model showed that child age (in months) significantly predicted the amount of reported details, with younger preschoolers reporting fewer details compared to older preschoolers. Age also predicted the amount of correct details, but not the amount of incorrect details. No age differences were found with regard to children's disclosure tendencies or proportion of central details about the secret. Methodological limitations and practical implications will be addressed.

Factor structure of the Friends and Family interview.

The aim of this study was to specify the latent construct structure of the Friends and Family Interview (FFI: Steele & Steele, 2005) based on its dimensional scale coding protocol. The FFI is a semi-structured interview measuring attachment in middle childhood. We analyzed data from 341 FFI interviews with children aged 7-12 years, recruited in the Scandinavian Öresund Region. Exploratory Factor Analysis revealed a three-component model as best fitting the data. The first component, denoting attachment security, gathered all dimensional scales for evidence of secure base/safe haven regarding mother/father and coherence in the child's narrative style, along with scales regarding reflective functioning, self-perception, and social functioning. The second component comprised preoccupying feelings of anger, but also derogation. The third component gathered all scales coding idealization. Inter-relations among the components were consistent with attachment theory, and respondents' scores for all three components differed significantly across the four categorical attachment classifications. Affect regulation of negative emotion through anger and through derogation co-occurred, and was distinct from regulation through maintaining a belief that things are better than they appear (idealization). These two affect regulation strategies appeared commonly when reflective functioning, and an organized self-perception, and positive peer relations were less in evidence. The multi-dimensional FFI coding system appears to measure successfully these diverse features of the child's narrative provided in response to the interview. Overall, our findings support the construct validity of the FFI and provide further evidence of its usefulness for assessing attachment in middle childhood and early adolescence.

Assessing strengths of children with type 1 diabetes: Validation of the Diabetes Strengths and Resilience (DSTAR) measure for ages 9 to 13.

BACKGROUND: Adaptive diabetes-specific attitudes and behaviors, known as diabetes strengths, relate to positive self-management and quality of life outcomes in type 1 diabetes (T1D), but have not been studied in preadolescence. To facilitate strengths-based care and research on this topic, we developed and evaluated the psychometric properties of a measure of diabetes strengths for children age 9 to 13. METHODS: Participants were 187 children receiving care for T1D at a tertiary care children's hospital. They completed the 12-item self-report Diabetes Strengths and Resilience scale for children (DSTAR-Child), which we adapted from a measure validated for adolescents. Youth completed the DSTAR-Child twice, and measures of relevant constructs at baseline: general and diabetes-related quality of life, depressive symptoms, and diabetes distress. Parents rated children's engagement in self-management behaviors and general resilience. We extracted HbA1c from the medical record. RESULTS: The DSTAR-Child total score demonstrated reliability, including internal consistency and stability across two time points. The total score was significantly associated in expected directions with psychosocial measures and glycemic control but not self-management behaviors. In confirmatory factor analyses, the best-fitting structure contained two latent factors tapping intrapersonal and interpersonal strengths. Resulting subscale scores also appeared reliable and valid. CONCLUSIONS: This brief, practical measure of diabetes strengths demonstrated sound psychometric properties. Diabetes strengths appeared unrelated to self-management behaviors, perhaps because of the primary role of adult caregivers in T1D management for preadolescents. As a research and clinical tool, the DSTAR-Child can facilitate greater understanding of diabetes strengths and inform strengths-based strategies to foster resilient T1D outcomes.

A Primer on Mixed Methods for Pediatric Researchers.

OBJECTIVE: To provide a primer on conducting and analyzing mixed methods research studies, and to provide guidance on the write-up of mixed methods research. METHODS: A question and answer format is used to provide an overview of mixed methods research study designs, tasks and considerations related to conducting and analyzing mixed methods studies, and recommendations for the write-up of results for mixed methods studies. RESULTS: Individuals who conduct mixed methods research are encouraged to delineate the quantitative, qualitative, and mixed methods features of the research and how these features fit with the overall study questions. Research teams will benefit from including individuals with expertise in qualitative, quantitative, and mixed methods research. Data integration should be a central component to the analysis and write-up of mixed methods research. CONCLUSIONS: Increasing the use of mixed methods research in the field of pediatric psychology will contribute to advances in observational studies with children and families, intervention development and evaluation, and creation of new tools and assessments that aim to optimize child and family health outcomes.

Two-and-a-half-year-olds succeed at a traditional false-belief task with reduced processing demands.

When tested with traditional false-belief tasks, which require answering a standard question about the likely behavior of an agent with a false belief, children perform below chance until age 4 y or later. When tested without such questions, however, children give evidence of false-belief understanding much earlier. Are traditional tasks difficult because they tap a more advanced form of false-belief understanding (fundamental-change view) or because they impose greater processing demands (processing-demands view)? Evidence that young children succeed at traditional false-belief tasks when processing demands are reduced would support the latter view. In prior research, reductions in inhibitory-control demands led to improvements in young children's performance, but often only to chance (instead of below-chance) levels. Here we examined whether further reductions in processing demands might lead to success. We speculated that: (i) young children could respond randomly in a traditional low-inhibition task because their limited information-processing resources are overwhelmed by the total concurrent processing demands in the task; and (ii) these demands include those from the response-generation process activated by the standard question. This analysis suggested that 2.5-y-old toddlers might succeed at a traditional low-inhibition task if response-generation demands were also reduced via practice trials. As predicted, toddlers performed above chance following two response-generation practice trials; toddlers failed when these trials either were rendered less effective or were used in a high-inhibition task. These results support the processing-demands view: Even toddlers succeed at a traditional false-belief task when overall processing demands are reduced.

The Role of Pediatric Psychologists in the Transition of Youth to Adult Health Care: A Descriptive Qualitative Study of Their Practice and Recommendations.

Transition from pediatric to adult health care setting is a challenge for young patients because of the psychosocial issues they may present that could hinder their commitment to treatment and medical care. Psychologists play a key role in supporting these patients. They intervene with the most vulnerable ones for whom the current transitional practice does not necessarily meet their specific needs and help them to develop an appropriate level of autonomy despite medical condition. To date, few studies have described their clinical practice in this field. This study aimed to gather in-depth information about the elements that characterize their different roles in transition care. Following a semi-structured interviews with ten pediatric psychologists, we conducted a thematic content analysis to identify common themes among participants. The results indicate that the psychologists' practice focuses on four main aspects: assessment, intervention, education, and liaison. Their recommendations point towards a better organization of health care services and a reflection on the best practices in psychology. These results highlight the specific roles that pediatric psychologists play in the transition process within the health care environment.

[Relevance and experience of surveillance and brief contact intervention systems in preventing reattempts of suicide among children and adolescents]. / Pertinence et expérience des dispositifs de veille et de recontact dans la prévention suicidaire auprès des enfants et des adolescents.

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.

[Selection, Use, and Interpretation of German Intelligence Tests for Children and Adolescents Based on CHC-theory: Update, Extension, and Critical Discussion]. / Auswahl, Anwendung und Interpretation deutschsprachiger Intelligenztests für Kinder und Jugendliche auf Grundlage der CHC-Theorie: Update, Erweiterung und kritische Bewertung.

Selection, Use, and Interpretation of German Intelligence Tests for Children and Adolescents Based on CHC-theory: Update, Extension, and Critical Discussion In order to facilitate planning and interpretation of cognitive assessments for children and adolescents a CHC broad and narrow ability classification of nine widespread German tests of intelligence is presented. The Cattel-Horn-Carroll-theory of intelligence is an influential model in the field of intelligence testing. Its structure and basic premises are presented. On this basis, intelligence testing can be planned and interpreted systematically in a common theoretical framework. Practical implications and suggestions for diagnosticians (e. g. cross-battery-assessment) are pointed out. Finally, possibilities and limitations of CHC-theory in the field of intelligence testing are discussed.

[Working with Involuntary Clients - When Control Becomes an Element of Counselling]. / Die Arbeit mit unfreiwilligen Klientinnen und Klienten Wenn Kontrolle zum Bestandteil von Beratung wird.

Working with Involuntary Clients - When Control Becomes an Element of Counselling Counselling involuntary clients is an ambitious as well as contested job, which sometimes causes professionals to distance themselves from this work or even to reject it. This might be one of the reasons why the task to exercise control within a counselling context is assigned to the child protection agency (Jugendamt) while Psychological and Social Help Centers are tasked to provide "only" support services to involuntary clients. Hence, the two jobs of exercising control and providing help are split between the institutions. The arrangement allows professionals to get rid of an unattractive job. In child protection work such a division of responsibility is neither wise nor possible, even if this does not mean that there is no need to distinguish between the tasks and duties of the involved professionals. This article will first of all illustrate why it is necessary to discuss "involuntary clients" within child protection work and why this kind of counselling always implicates some kind of control. In the second part of the article, some results from serious case reviews will be presented. They demonstrate the kind of challenges and difficulties which the work with parents and children in child protection can create.

[Voluntariness in Outpatient Psychotherapy with Children and Adolescents]. / Über die Freiwilligkeit in der ambulanten Kinder- und Jugendlichenpsychotherapie.

Voluntariness in Outpatient Psychotherapy with Children and Adolescents Voluntariness is no selective construct in psychotherapy with children and adolescents. Generally psychotherapy is utilized under external pressure, at least partially. At any rate it is crucial to painstakingly analyze the motivation for change and possible obstacles to motivation. On that basis different strategies to foster motivation for change can be applied. Problems regarding the efficiency of voluntary or involuntary utilization of outpatient psychotherapy for children and adolescents should be subjects to further research.

Pediatric Psychologists' Collaboration in a National Pediatric Obesity Initiative: A Case Study in Interprofessional Collaboration.

Health Care reform calls for collaborative team-based care; psychologists must therefore strengthen their competencies for work in interprofessional clinical care settings. Toward that end, a group of psychologists participated with physicians, dieticians, physical activity specialists, nurses, and others in a national interprofessional workgroup focused on pediatric obesity. The interprofessional group was designed to identify areas in need of national advocacy, key assessment and treatment concerns, and gaps in internal policies and procedures in children's hospitals. This article provides a case report of psychologists' roles and experience in this workgroup, and focuses on factors that underlie successful collaboration among diverse health professionals, as well as potential barriers to success. The participating psychologists developed a working model for collaboration with other disciplines. Additionally, they formed a Psychology Subcommittee to identify and address discipline-specific issues regarding collaborative practice in pediatric psychology. Lessons learned in this interprofessional collaborative undertaking have relevance for future collaborative endeavors.

Advocating for the Child: The Role of Pediatric Psychology for Children With Cleft Lip and/or Palate.

Children with cleft lip and/or palate (CL ± P) undergo several surgical procedures from birth to adulthood to achieve functional, aesthetic, and psychosocial normalcy. Although children with CL ± P have normal physical development apart from their CL ± P, they face increased risk for emotional, social, behavioral, and academic concerns. In this article, we discuss how the psychology team helps support children with CL ± P and their families. We also explore how the child's overall functioning is evaluated through interview and assessment tools. Throughout, we validate the need for specialized considerations related to having a CL ± P such as increased risk for peer victimization as well as readiness for medical and surgical procedures. By examining the psychology team's role across a child's lifespan, we hope to show that our goal is to advocate for the child and to encompass the child's voice throughout the treatment process.

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology.

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.

Rethinking natural altruism: simple reciprocal interactions trigger children's benevolence.

A very simple reciprocal activity elicited high degrees of altruism in 1- and 2-y-old children, whereas friendly but nonreciprocal activity yielded little subsequent altruism. In a second study, reciprocity with one adult led 1- and 2-y-olds to provide help to a new person. These results question the current dominant claim that social experiences cannot account for early occurring altruistic behavior. A third study, with preschool-age children, showed that subtle reciprocal cues remain potent elicitors of altruism, whereas a fourth study with preschoolers showed that even a brief reciprocal experience fostered children's expectation of altruism from others. Collectively, the studies suggest that simple reciprocal interactions are a potent trigger of altruism for young children, and that these interactions lead children to believe that their relationships are characterized by mutual care and commitment.