A long-term look at "early starters": Predicting adult psychosocial outcomes from childhood conduct problem trajectories.

Current evidence suggests that multiple pathways of "early-starting" conduct problems exist, including persisting and declining trajectories. Since relatively little is known about the early onset-declining pathway, this study examined the long-term outcomes of different childhood conduct problem trajectories in a disproportionately high-risk sample (N = 754). Parents reported on children's conduct problems at six time points (kindergarten to grade 7). At age 25, psychosocial outcomes were assessed across five domains (psychopathology, substance use, risky sexual behavior, antisocial behavior, and adaptive outcomes). Four childhood conduct problem trajectories were identified: extremely high increasing (EHI; 3.7%), high stable (HS; 22.0%), moderate decreasing (MD; 38.8%), and low decreasing (LD; 35.5%). The EHI and HS groups displayed the poorest psychosocial functioning at age 25, whereas the LD group exhibited the most positive adjustment. Although individuals in the MD group displayed relatively positive adjustment on some outcomes, they displayed more psychopathology and lower well-being in adulthood than the LD group. These findings suggest that there are diverse pathways of early-starting conduct problems, and that all early starters are at risk for later maladjustment. However, the degree and type of risk is related to the severity of conduct problems throughout childhood.

The role of the therapeutic alliance in eating disorder treatment outcomes: a systematic review.

The therapeutic alliance has proven to be an important construct in psychotherapy outcomes research for numerous psychiatric disorders. Given that dropout rates from treatment are especially high for individuals with eating disorders, it is critical to clarify the role that the therapeutic alliance plays in predicting treatment outcomes for this specific population. MEDLINE, CINAHL, and PsycINFO databases were systematically reviewed for studies that formally measured the therapeutic alliance construct and at least one other treatment variable in the context of eating disorder treatment. We identified 19 studies that indicate the therapeutic alliance may be an important factor in eating disorder treatment, yet reflect on the paucity of research on this topic in the context of treatment outcomes for both adult and adolescent populations. Current trends and limitations in the literature are highlighted to guide future research and ultimately improve clinical outcomes for patients with eating disorders.

The longitudinal link between parenting and child aggression: the moderating effect of attachment security.

This study examined whether infant attachment security moderates the association between parenting in preschool and later aggressive behavior among a sample of children at high risk for developing conduct problems. Participants were 82 adolescent mother-child dyads recruited from the community. Infant attachment status at age 1 year was measured using the Strange Situation. When children were aged 4.5 years, mothers reported on their self-efficacy in regards to parenting, and mothers' positive parenting and criticism were coded from direct observations of parent-child interactions. In grade 1, mothers reported on their children's aggressive behavior. Infant secure attachment significantly moderated the association between observed maternal criticism and child aggression. That is, among insecurely attached children, higher levels of maternal criticism were associated with more severe aggression. This longitudinal finding suggests that a secure attachment may buffer the deleterious effects of harsh parenting on child aggression.

Child abuse history in teen mothers and parent-child risk processes for offspring externalizing problems.

This study examined whether child abuse history in teen mothers impacts offspring externalizing problems indirectly, through its influence on attachment and maternal hostility. In a longitudinal sample of 112 teen mother-child dyads, mothers reported on their own abuse experiences, attachment and maternal hostility were assessed via direct observations, and externalizing problems were measured using maternal reports. Compared with mothers with no abuse history, mothers with a history of sexual and physical abuse were more likely to have an insecurely attached infant, which predicted higher externalizing problems in preschool, which in turn predicted subsequent increases in externalizing problems in Grade 3. Furthermore, relative to the no abuse history group, mothers with a history of sexual and physical abuse showed more hostility toward their child at preschool, which in turn predicted elevated externalizing problems in Grade 3. Mothers' history of either sexual or physical abuse alone did not have significant indirect effects on externalizing problems. Fostering secure attachment and reducing risk for maternal hostility might be important intervention goals for prevention programs involving at-risk mothers with abuse histories.