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.

Mother-Infant Interaction and Child Brain Morphology: A Multidimensional Approach to Maternal Sensitivity.

Emerging research suggests that normative variation in parenting quality relates to children's brain development. However, although the young brain is presumed to be especially sensitive to environmental influence, to our knowledge only two studies have examined parenting quality with infants as it relates to indicators of brain development, and both were cross-sectional. This longitudinal study investigated whether different components of maternal sensitivity in infancy predicted the volume of two brain structures presumed to be particularly sensitive to early experience, namely the amygdala and the hippocampus. Three dimensions of sensitivity (Cooperation/Attunement, Positivity, Accessibility/Availability) were observed in 33 mother-infant dyads at 1 year of age and children underwent structural magnetic resonance imaging at age 10. Higher maternal Accessibility/Availability during mother-infant interactions was found to be predictive of smaller right amygdala volume, while greater maternal positivity was predictive of smaller bilateral hippocampal volumes. These longitudinal findings extend those of previous cross-sectional studies and suggest that a multidimensional approach to maternal behavior could be a fruitful way to further advance research in this area, given that different facets of parenting might be differentially predictive of distinct aspects of neurodevelopment.

Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review.

OBJECTIVE: To review peer-reviewed literature relating to postoperative physiotherapy for degenerative cervical myelopathy (DCM), to determine efficacy in improving clinical outcome and recovery. DATA SOURCES: MEDLINE, EMBASE, CENTRAL, PEDro, ISRCTN registry, WHO ICTRP and Clinicaltrials.gov . References and citations of relevant articles were searched. METHODS: A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42016039511) from the origins of the databases till 15 February 2018. Included were all studies investigating physiotherapy as an intervention after surgical treatment of DCM to determine effect on clinical outcome and recovery. Study quality was determined using the Grades of Recommendation, Assessment, Development and Evaluation guidelines. RESULTS: In all, 300 records were identified through tailored systematic searches, after removing duplicates. After screening, only one investigated postoperative rehabilitation using physiotherapy for DCM; however, this was retrospective with no controls. This study suggested that rehabilitation including physiotherapy improved postoperative recovery. There are currently two registered trials investigating the use of postoperative physiotherapy for DCM. CONCLUSIONS: The literature provides insufficient evidence to make any evidence-based recommendations regarding postoperative physiotherapy use in DCM.

New insight on intergenerational attachment from a relationship-based analysis.

Research on attachment transmission has focused on variable-centered analyses, where hypotheses are tested by examining linear associations between variables. The purpose of this study was to apply a relationship-centered approach to data analysis, where adult states of mind, maternal sensitivity, and infant attachment were conceived as being three components of a single, intergenerational relationship. These variables were assessed in 90 adolescent and 99 adult mother-infant dyads when infants were 12 months old. Initial variable-centered analyses replicated the frequently observed associations between these three core attachment variables. Relationship-based, latent class analyses then revealed that the most common pattern among young mother dyads featured maternal unresolved trauma, insensitive interactive behavior, and disorganized infant attachment (61%), whereas the most prevalent adult mother dyad relationship pattern involved maternal autonomy, sensitive maternal behavior, and secure infant attachment (59%). Three less prevalent relationship patterns were also observed. Moderation analyses revealed that the adolescent-adult mother distinction differentiated between secure and disorganized intergenerational relationship patterns, whereas experience of traumatic events distinguished between disorganized and avoidant patterns. Finally, socioeconomic status distinguished between avoidant and secure patterns. Results emphasize the value of a relationship-based approach, adding an angle of understanding to the study of attachment transmission.

It takes two to talk: longitudinal associations among infant-mother attachment, maternal attachment representations, and mother-child emotion dialogues.

Research on the attachment-dialogue link has largely focused on infant-mother attachment. This study investigated longitudinal associations between infant-mother attachment and maternal attachment representations and subsequent mother-child emotion dialogues (N = 50). Maternal attachment representations were assessed using the Adult Attachment Interview when children were 3 months, infant-mother attachment was assessed using the Strange Situation Procedure at 13 months, and mother-child emotion dialogues were assessed using the Autobiographical Emotional Events Dialogue at 3.5 years. Consistent with past research, the three organized categories of infant-mother attachment relationships were associated with later mother-child emotion dialogues. Disorganized attachment relationships were associated with a lack of consistent and coherent strategy during emotion dialogues. Autonomous mothers co-constructed coherent narratives with their children; Dismissing and Preoccupied mothers created stories that were less narratively organized. Although the Unresolved category was unrelated to classifications of types of mother-child discourse, mothers' quality of contribution to the dialogues was marginally lower compared to the quality of their children's contributions to the emotion discussion. Secure children showed highest levels of child cooperation and exploration. Autonomous mothers displayed highest levels of maternal sensitive guidance during emotion dialogues. We provide preliminary evidence for role reversal in dialogues between Preoccupied and Unresolved mothers and their children.

Preschool ambivalent attachment associated with a lack of vagal withdrawal in response to stress.

The goal of the present study was to examine how quality of the child-caregiver attachment relationship related to children's cardiac vagal reactivity in response to a novel social stressor. Children's (N = 48; M age = 3 years 9 months) cardiac data were collected as they participated in an ambiguous and potentially threatening social situation together with their mothers. Their degree of behavioral inhibition also was observed. Attachment classifications were assessed separately. Children classified as Secure showed vagal withdrawal from baseline to the stressor, whereas children classified as Ambivalent did not show vagal withdrawal in response to the stressor. There was a marginally significant moderation of attachment-related differences in vagal withdrawal by level of behavioral inhibition. Among highly behaviorally inhibited children, those classified as Ambivalent demonstrated little or no vagal withdrawal compared to their Secure counterparts. In contrast, no attachment-related differences were found among those who appeared less behaviorally inhibited. Findings are discussed in relation to children's emerging self-regulation skills in the context of their attachment relationship.

Rumination and emotions in nonsuicidal self-injury and eating disorder behaviors: a preliminary test of the emotional cascade model.

OBJECTIVE: This study examined relations between repeated rumination trials and emotions in nonsuicidal self-injury (NSSI) and eating disorder behaviors (EDBs) within the context of the emotional cascade model (Selby, Anestis, & Joiner, 2008). METHOD: Rumination was repeatedly induced in 342 university students (79.2% female, Mage = 18.61, standard error = .08); negative and positive emotions were reported after each rumination trial. Repeated measures analyses of variance were used to examine the relations between NSSI and EDB history and changes in emotions. RESULTS: NSSI history associated with greater initial increases in negative emotions, whereas EDB history associated with greater initial decreases in positive emotions. Baseline negative emotional states and trait emotion regulation mediated the relation between NSSI/EDB history and emotional states after rumination. CONCLUSION: Although NSSI and EDBs share similarities in emotion dysregulation, differences also exist. Both emotion dysregulation and maladaptive cognitive processes should be targeted in treatment for NSSI and EDBs.

Understanding sensitivity: lessons learned from the legacy of Mary Ainsworth.

On the basis of extensive home observations, Ainsworth proposed that a mother's sensitivity to her infant's signals is the primary determinant of attachment security. Although subsequent research has found a relationship between sensitivity and attachment security, the effect sizes are much smaller than those reported by Ainsworth. In addition to the amount of observation time that might account for the effect size difference, we consider Ainsworth's focus on understanding the organizational structure of relationships. We coded 30 minute video records of interactions between 64 mother-infant dyads from semi-structured home observations conducted at 10 months of age. Coding consisted of writing a narrative summary of the interactions, annotating a completion of Ainsworth's rating scales of acceptance, accessibility, cooperation and sensitivity and then describing the mother's behavior using the Maternal Behaviour Q-set. Sensitivity scores derived from the Q-sort descriptions were robustly related (r = .65) to secure-insecure classifications in the Strange Situation conducted at 13 months. We reflect on the process of assessing Ainsworth's construct of sensitivity.

Time-course and risk factors of hypothyroidism following allogeneic hematopoietic stem cell transplantation (HSCT) in children conditioned with fractionated total body irradiation.

BACKGROUND: Hypothyroidism is a complication of hematopoietic stem cell transplantation (HSCT)1 that has been studied primarily in children after matched sibling bone marrow transplantation. Unrelated donors and umbilical cord blood (CB) are now used in transplantation, and hypothyroidism in these populations is undocumented. Children who underwent fractionated total body irradiation (fTBI) and received bone marrow or umbilical cord blood transplantation from siblings or unrelated donors were examined for hypothyroidism over time. PROCEDURE: All children who received fTBI prior to allogeneic HSCT at The Children's Hospital (TCH), Denver between 1994 and 2002, and survived >1 year were included (N = 41 eligible; N = 33 met inclusion criteria). Probability of hypothyroidism was estimated by the Kaplan-Meier method and groups were compared using Cox's proportional hazards regression model. RESULTS: Hypothyroidism developed in 52% of the children at a median time of 1.9 years (range 0.7-8.3 years). Primary compensated hypothyroidism was diagnosed in 94% of those affected. Children who received unrelated donor HSCT were 8.4 times more likely to develop hypothyroidism than those receiving matched sibling HSCT. Recipients of CB were 4.6 times more likely to have hypothyroidism than recipients of bone marrow. CONCLUSIONS: There is a significant risk of developing hypothyroidism following fTBI, and allogeneic HSCT, that appears greater in recipients of unrelated donor HSCT and CB transplantation. Most of our patients who received BMT had sibling donors and the majority of CB transplants were from unrelated donors. It is difficult to determine which association is related to hypothyroidism, but the combination is significant.

Childhood emotional maltreatment, anxiety, attachment, and mindfulness: Associations with facial emotion recognition.

The current study investigated factors thought to contribute to facial emotion processing. Female university students (N = 126) completed self-report measures of childhood emotional maltreatment, anxiety symptoms, attachment anxiety and avoidance, and trait mindfulness before completing a facial emotion recognition task, where they viewed sequences of faces that incorporated progressively more emotional content until they were able to correctly identify the emotion. They completed the task under low and high cognitive load conditions to distinguish between relatively effortful versus automatic processing abilities. Regression analyses revealed that under low cognitive load, attachment avoidance and mindfulness predicted quicker identification of fear (i.e., with less perceptual information), whereas anxiety predicted slower identification of fear (i.e., with more perceptual information). In the high cognitive load condition, emotional maltreatment and mindfulness predicted quicker identification of fear, and anxiety and mindfulness predicted faster identification of emotions overall. Although current findings are correlational, most of these effects were specific to fearful faces, suggesting that experiences of childhood emotional maltreatment and associated socio-emotional sequelae are related to heightened processing of threat-related information.

Reconsidering the links between sibship size, maternal sensitivity, and child attachment: A multidimensional interactive approach.

Despite being a well-documented predictor of children's cognitive and social development, sibship has received remarkably little attention in the attachment and maternal sensitivity literature. The only study that has examined both sensitivity and attachment in relation to sibship found greater maternal sensitivity but no more secure attachment among first-born infants. In the current study, we sought to examine the same links while testing two related hypotheses: that sibship size relates only to some specific aspects of sensitivity, and that sibship size relates to sensitivity only among certain mothers, namely those who are at risk for suboptimal parenting because of an insecure attachment state of mind. We assessed three dimensions of maternal sensitivity at 12 months and child attachment at 15 and 25 months among 258 mother-infant dyads living in intact biparental families. Compared with mothers who had fewer children, those with more children were observed to be less accessible/available, less positive, but not less cooperative/attuned, when interacting with their infant. These links were moderated by maternal attachment state of mind, such that significant relations were observed only among mothers presenting a more insecure state of mind. Finally, sibship size was unrelated to attachment. These findings suggest that failure to consider different dimensions of sensitivity or important parental moderators may result in the erroneous conclusion that birth order and sibship size are inconsequential for parent-child relationships. (PsycINFO Database Record

Conducting an Integrative Health Interview.

Complementary medicine incorporates the use of non-evidence-based complementary modalities into conventional (Western) medicine. Alternative medicines are approaches that are used in place of conventional medicine. Integrative medicine is the synthesis of conventional medical treatments with "evidence-based" complementary medical practices. When complementary approaches are incorporated into mainstream health care, it is called integrative health (IH). Among children and adults, IH is common despite not all therapies being safe and/or effective. Clinicians have suboptimal knowledge of their patients' IH use because, in part, they do not know what questions to ask and/or do not have a standard intake form to collect an IH history, as recently demonstrated by an American Academy of Allergy, Asthma, and Immunology membership survey. To address this unmet need, a group of Complementary and Alternative Practice in Allergy Committee members and interprofessional collaborators reviewed the existing literature to locate IH history forms that could assist in identifying patients' IH use. When none was located, the group created 3 templates for the systematic collection and documentation of IH practices: 2 general screening surveys that could be given to patients to complete before an appointment and a third template that provides the clinician with open-ended questions to help uncover IH practices in culturally diverse patient populations. Specialists, already acknowledged as skillful interviewers, can expand their patient-centered expertise by developing their own IH competencies.

Parent Cardiac Response in the Context of Their Child's Completion of the Cold Pressor Task: A Pilot Study.

Parents' ability to regulate their emotions is essential to providing supportive caregiving behaviours when their child is in pain. Extant research focuses on parent self-reported experience or observable behavioural responses. Physiological responding, such as heart rate (HR) and heart rate variability (HRV), is critical to the experience and regulation of emotions and provides a complementary perspective on parent experience; yet, it is scarcely assessed. This pilot study examined parent (n = 25) cardiac response (HR, HRV) at rest (neutral film clip), immediately before the cold pressor task (pre-CPT), and following the CPT (post-CPT). Further, variables that may influence changes in HR and HRV in the context of pediatric pain were investigated, including (1) initial HRV, and (2) parent perception of their child's typical response to needle procedures. Time-domain (root mean square of successive differences; RMSSD) and frequency-domain (high-frequency heart rate variability; HF-HRV) parameters of HRV were computed. HR and HF-HRV varied as a function of time block. Typical negative responses to needle pain related to higher parental HR and lower HRV at rest. Parents with higher HRV at baseline experienced the greatest decreases in HRV after the CPT. Consequently, considering previous experience with pain and resting HRV levels are relevant to understanding parent physiological responses before and after child pain.

The secure base script: associated with early maladaptive schemas related to attachment.

OBJECTIVES: To examine the relations between traditionally assessed early maladaptive schemas and the attachment-specific secure base script (a script-like representation of what individuals expect to happen when they face distress), to inform our understanding of beliefs about the self in relation to others. The present study took an ecologically driven approach, assessing knowledge of the secure base script from descriptions of current relationships. DESIGN: A cross-sectional design was used. METHODS: One hundred forty-six undergraduate students, recruited as part of a larger study on adversity and self-concept, provided narrative descriptions of their current relationships. Narratives were coded for attachment-related 'secure base' content using a secure base script scale for relationship narratives. Early maladaptive schemas were assessed with the Young Schema Questionnaire, and attachment was additionally evaluated using the Experiences in Close Relationships questionnaire. RESULTS: Self-reported attachment avoidance and anxiety were related to secure base script content in theory-consistent ways. The extent to which participants described secure base script content was inversely associated with four out of five maladaptive schemas characterized most centrally by disconnection from others. Furthermore, these associations remained significant when controlling for self-reported attachment style. Self-reported attachment avoidance and anxiety also were related to maladaptive schemas in a predictable pattern. CONCLUSIONS: Results bridge cognitive and attachment theories, supporting the interrelatedness of secure base script knowledge assessed in current relationships, and schema-related content regarding connectedness with others. Better integration of theories regarding internal representations may serve to enrich psychotherapeutic formulation from a variety of clinical perspectives. PRACTITIONER POINTS: Schema Therapy's (Young, Klosko, & Weishaar, 2003 , Schema therapy: A practitioner's guide. New York: Guilford Press) early maladaptive schemas, with themes of disconnection from others/in relationships, are related to the attachment construct of knowledge of a secure base script. Applying secure base script coding procedure to a relationship speech task provides a potentially valuable performance-based tool for evaluating important attachment related constructs in a brief, non-obtrusive format. Better understanding of how self-schema and attachment constructs are associated may be of benefit to case formulation for psychotherapeutic intervention.

Attachment anxiety and attentional control predict immediate and delayed emotional Stroop interference.

Attachment anxiety has been associated with a hyperactivating response to threat. A modified emotional Stroop task was used to investigate temporal characteristics of the threat response by assessing response latencies to interpersonally threatening words (immediate interference) and two directly subsequent neutral filler words (delayed interference). Greater immediate and delayed interference to threatening words was observed (n = 125), with higher levels of attachment anxiety associated with immediate interference to threatening cues, and lower levels with delayed interference. Thus, attachment anxiety was related to the speed at which moderate perceived threat disrupted ongoing processes under top-down attentional control. Furthermore, top-down attentional control moderated the extent to which immediate or delayed interference was observed. Among participants who demonstrated relatively stronger top-down attentional control, immediate and delayed interference to threatening cues was minimal, suggesting that results involving emotional Stroop interference were primarily attributable to participants with relatively weaker top-down attentional control. The implications of these findings are considered within the broader context of performance-based and neuroimaging research, with suggestions for future applied research.

The impact of childhood maltreatment history on parenting: a comparison of maltreatment types and assessment methods.

OBJECTIVE: Childhood maltreatment is associated with subsequent parenting difficulties; however, most research has relied on self-reported parenting outcomes, and observational measures have revealed mixed findings. Furthermore, research has focused predominantly on histories of sexual and/or physical abuse. This study explored associations between a wide range of childhood maltreatment experiences and both observed and self-reported parenting outcomes. METHODS: Mothers of 4- to 6-year-old children at moderate social risk completed the History of Maltreatment and Trauma Form (HMTF), which assesses a range of maltreatment experiences and delineates specific characteristics such as chronicity and severity. Participants completed questionnaires assessing parenting stress and competence, and their emotional availability (sensitivity, intrusiveness, hostility) toward their children was coded from videorecorded interactions. RESULTS: Construct (factorial, convergent and discriminant) validity of the HMTF was demonstrated through factor analysis and a multi-trait, multi-method matrix comparing it to the Childhood Trauma Questionnaire. HMTF-assessed childhood maltreatment, specifically witnessing family violence, neglect and emotional maltreatment, were significantly associated with mothers' observed hostility toward their children, even after controlling for potentially traumatic adult experiences. In contrast, childhood sexual abuse history was associated with self-reported concerns regarding parenting competence, and this association held even after controlling for other forms of childhood maltreatment and potentially traumatic adult experiences. Self-reported parenting outcomes were unrelated to observed parenting behavior. CONCLUSIONS: Findings highlight the complexity of associations between child maltreatment and subsequent parenting outcomes. Although much previous research has focused on sexual and physical abuse, other more contextual forms of maltreatment may be similarly or more strongly associated with certain parenting outcomes. Furthermore, different forms of maltreatment may be associated with perceived versus observed parenting outcomes.

Understanding the transmission of attachment using variable- and relationship-centered approaches.

The interrelations of maternal attachment representations, mother-infant interaction in the home, and attachment relationships were studied in 99 adolescent mothers and their 12-month-old infants. A q-factor analysis was used to identify emergent profiles of mother and infant interaction. Traditional multivariate statistical analyses were complemented by a relationship-based approach utilizing latent class analysis. The results confirmed many theoretical predictions linking interaction with autonomous maternal representations and secure attachment, but failed to support a mediating role for maternal sensitivity. Strong associations were found between mothers displaying nonsensitive and disengaged interaction profiles, infants who did not interact harmoniously with the mother and preferred interaction with the visitor, unresolved maternal representations, and disorganized attachment relationships. Moreover, maternal nonsensitive and disengaged interaction in the home mediated the association between unresolved representations and disorganization. The results of the latent class analysis were consistent with these findings and revealed additional, empirically derived associations between attachment classifications and patterns of interactive behavior, some of which prompt a reconsideration of our current understanding of attachment transmission in at-risk populations.

Childhood maltreatment, complex trauma symptoms, and unresolved attachment in an at-risk sample of adolescent mothers.

Associations between unresolved attachment, abuse history, and a wide range of trauma-related symptomatology were examined in an at-risk sample (N = 62). Fifty percent reported severe childhood physical and/or sexual abuse. An independent trauma interview elicited more reports of childhood sexual abuse than the Adult Attachment Interview (AAI); conversely, the AAI elicited more reports of physical abuse. Childhood physical abuse, sexual abuse, and general maltreatment were associated with unresolved status. Furthermore, sexual abuse history and general maltreatment predicted unresolved loss, suggesting that they adversely affected the integration of other emotional and/or traumatic experiences. Women classified as Unresolved reported higher levels of dissociation, confusion regarding self-identity, and relationship problems. Findings complement and extend empirical support for the theorized association between dissociative processes and unresolved attachment.