Longitudinal Outcomes of Child Parent Psychotherapy: Response to Commentaries.

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices.

Attachment and Affect between Mothers with Depression and their Children: Longitudinal Outcomes of Child Parent Psychotherapy.

The present investigation examined the longitudinal effects of Child-Parent Psychotherapy (CPP) for toddlers and their mothers with depression on: a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Mothers with depression (Mage = 31.7 years; 92.8% White, 3.5% Black, 2.1% Hispanic, 2.3% other) and their toddlers were randomized to receive CPP (DI; n = 66) or to a control group (DC; n = 64). Mothers without depression and their toddlers (NC; n = 68) were recruited as an additional comparison group. Dyads were assessed at baseline (T1; 20 months old), post-intervention (T2; 36 months old), and follow-up (T3; 9 years old). Data from a mother-child conflict task was coded as a measure of observed outcome variables. Change in post-intervention attachment security assessed via the Strange Situation was evaluated as a mediator between intervention condition and maternal and child affective expression and dyadic cohesion at T3. Change to secure attachment post-intervention significantly mediated the association between intervention condition and T3 maternal warmth and child anger/problem behavior. Toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 displayed higher levels of maternal warmth at T3 and lower levels of child anger and problem behavior at T3. Implications for the use of CPP as a preventive intervention and the importance of attachment as a mediator of long-term outcomes are discussed.

Attachment security mediates the longitudinal association between child-parent psychotherapy and peer relations for toddlers of depressed mothers.

Numerous investigations have demonstrated that child-parent psychotherapy (CPP) promotes secure attachment between mothers and offspring. However, the role of postintervention attachment security as it relates to long-term child outcomes has never been evaluated. The present study therefore examined postintervention attachment status as a mediator of the association between CPP for depressed mothers and their offspring and subsequent peer relations among offspring. Depressed mothers and their toddlers were randomized to receive CPP (n = 45) or to a control group (n = 55). A prior investigation with this sample indicated that offspring who received CPP attained significantly higher rates of secure attachment postintervention, whereas insecure attachment continued to predominate for offspring in the control group. The present study examined follow-up data of teachers' reports on participants' competence with classroom peers when they were approximately 9 years old. Findings indicated that children who received CPP were more likely to evidence secure attachments at postintervention, which in turn was associated with more positive peer relationships at age 9.

Neighborhood Disadvantage and Adolescent Substance Use Disorder: The Moderating Role of Maltreatment.

The ecological-transactional model proposes that nested contexts interact to influence development. From this perspective, child maltreatment represents an individual-level risk factor posited to interact with numerous other nested contextual levels, such as the neighborhood environment, to affect development. The aim of this study was to investigate whether adolescents with maltreatment histories represent a vulnerable group for whom disadvantaged neighborhoods confer risk for substance use disorders. Participants were 411 adolescents (age 15-18; mean age = 16.24) from an investigation of the developmental sequelae of childhood maltreatment. Multiple-group structural equation models, controlling for family-level socioeconomic status, indicated that neighborhood disadvantage was associated with more marijuana-dependence symptoms among maltreated but not among non-maltreated adolescents. Moreover, among maltreated adolescents, those who experienced multiple subtypes of maltreatment were at greatest risk for problematic marijuana use in the context of neighborhood disadvantage. Interestingly, the direct effect of neighborhood disadvantage, but not the interaction with maltreatment, was related to adolescent alcohol-dependence symptoms. Results highlight the importance of considering multiple levels of influence when examining risk associated with child maltreatment.

Relational interventions for child maltreatment: past, present, and future perspectives.

It is well established that child maltreatment has significant deleterious effects for the individual as well as for society. We briefly review research regarding the impact of child maltreatment on the attachment relationship, highlighting the need for relational interventions for maltreated children and their families to effectively thwart negative developmental cascades that are so often observed in the context of child maltreatment. Next, historical and contemporaneous perspectives on relational interventions for individuals with histories of child maltreatment are discussed, with attention to the empirical evidence for and the current evidence-based status of several relationally based interventions for child maltreatment. Differential sensitivity to the environment is then discussed as a theoretical framework with important implications for interventions for individuals who have been reared in maltreating environments. Current research on neurobiology and maltreatment is then reviewed, with an emphasis on the need for future investigations on genetic variants, epigenetics, and the efficacy of relational interventions for maltreated children. We conclude with a discussion of the tenets of developmental psychopathology, their implications for relational interventions for child maltreatment, and recommendations for advancing the development, provision, and evaluation of relational interventions for individuals with histories of child maltreatment.

Elevated rates of ADHD in mothers of children with comorbid ADHD and epilepsy.

OBJECTIVES: To describe the prevalence of ADHD in mothers of children with comorbid ADHD and epilepsy (ADHD+E) and to compare ADHD symptoms in mothers with (Fam(+)) and without (Fam(-)) additional relative(s) with epilepsy. PATIENTS & METHODS: Mothers (n = 16) of children with ADHD+E were assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children ADHD module and the ADHD Rating Scale IV. Information was collected on the presence (Fam(+)) or absence (Fam(-)) of first- or second-degree relatives with epilepsy in the sample. RESULTS: A total of 50% of mothers met the DSM-IV criteria for ADHD. ADHD was more prevalent in Fam(+) mothers (80%) compared with Fam(-) mothers (36%; p = 0.14). Fam(+) mothers had more current hyperactivity symptoms than Fam(-) mothers (p = 0.002), higher current ADHD severity (p = 0.02) and higher ADHD Rating Scale IV hyperactivity scores (p = 0.008). CONCLUSION: The prevalence of ADHD in mothers of children with ADHD+E is elevated in this pilot study, suggesting that ADHD symptoms in children with epilepsy and their mothers reflects shared familial genetic or environmental risks, potentially resulting in a higher prevalence of both disorders among family members. This is a pilot study and larger controlled studies are warranted.

The Use of Antiepileptic Drugs (AEDs) for the Treatment of Pediatric Aggression and Mood Disorders.

Aggressive symptomatology presents across multiple psychiatric, developmental, neurological and behavioral disorders, complicating the diagnosis and treatment of the underlying pathology. Anti-Epileptic Drugs (AEDs) have become an appealing alternative in the treatment of aggression, mood lability and impulsivity in adult and pediatric populations, although few controlled trials have explored their efficacy in treating pediatric populations. This review of the literature synthesizes the available data on ten AEDs - valproate, carbamazepine, oxcarbazepine, phenytoin, lamotrigine, topiramate, levetiracetam, zonisamide, gabapentin and tiagabine - in an attempt to assess evidence for the efficacy of AEDs in the treatment of aggression in pediatric populations. Our review revealed modest evidence that some of the AEDs produced improvement in pediatric aggression, but controlled trials in pediatric bipolar disorder have not been promising. Valproate is the best supported AED for aggression and should be considered as a first line of treatment. When monotherapy is insufficient, combining an AED with either lithium or an atypical anti-psychotic can result in better efficacy. Additionally, our review indicates that medications with predominately GABA-ergic mechanisms of action are not effective in treating aggression, and medications which decrease glutaminergic transmission tended to have more cognitive adverse effects. Agents with multiple mechanisms of action may be more effective.

Association between attention-deficit/hyperactivity disorder and epilepsy in pediatric populations.

There is a bidirectional relationship between attention-deficit/hyperactivity disorder (ADHD) and epilepsy. ADHD increases seizure risk, while patients with epilepsy have an increased prevalence of ADHD. The reasons explaining this association are not fully understood. Proposed mechanisms include effects of antiepileptic medications, underlying neurodevelopmental vulnerability, the effects of chronic seizures and subclinical epileptiform activity on cognitive functions and adrenergic dysfunction. There may also be a common genetic defect underlying both disorders in some families. Antiepileptics associated with ADHD-like side effects include phenobarbital, gabapentin, vigabatrin and topiramate. Methylphenidate has been studied in a double-blind setting against placebo for treatment of ADHD comorbid with epilepsy, and has a good risk-benefit ratio. Amphetamine, atomoxetine, clonidine and guanfacine only have case series to support their use and bupropion should be avoided.