Insights into child abuse and neglect: Findings from the Minnesota Longitudinal Study of Risk and Adaptation.

The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the early history of the MLSRA and its contributions to the study of child maltreatment and to review and summarize results from the recently updated childhood abuse and neglect coding of the cohort, with particular emphasis on findings related to adult adjustment. While doing so, we highlight key themes and contributions from Dr Dante Cicchetti's body of research and developmental psychopathology perspective to the MLSRA, a project launched during his tenure as a graduate student at the University of Minnesota.

Topical Review: Assessment of Binocular Sensory Processes in Low Vision.

SIGNIFICANCE: This article summarizes the evidence for a higher prevalence of binocular vision dysfunctions in individuals with vision impairment. Assessment for and identification of binocular vision dysfunctions can detect individuals experiencing difficulties in activities including reading, object placement tasks, and mobility.Comprehensive vision assessment in low vision populations is necessary to identify the extent of remaining vision and to enable directed rehabilitation efforts. In patients with vision impairment, little attention is typically paid to assessments of binocular vision, including ocular vergence, stereopsis, and binocular summation characteristics. In addition, binocular measurements of threshold automated visual fields are not routinely performed in clinical practice, leading to an incomplete understanding of individuals' binocular visual field and may affect rehabilitation outcomes.First, this review summarizes the prevalence of dysfunctions in ocular vergence, stereopsis, and binocular summation characteristics across a variety of ocular pathologies causing vision impairment. Second, this review examines the links between clinical measurements of binocular visual functions and outcome measures including quality of life and performance in functional tasks. There is an increased prevalence of dysfunctions in ocular alignment, stereopsis, and binocular summation across low vision cohorts compared with those with normal vision. The identification of binocular vision dysfunctions during routine low vision assessments is especially important in patients experiencing difficulties in activities of daily living, including but not limited to reading, object placement tasks, and mobility. However, further research is required to determine whether addressing the identified deficits in binocular vision in low vision rehabilitative efforts directly impacts patient outcomes.

Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics.

More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; Mage = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; Mage = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.

Convergent validity and stability of secure base script knowledge from young adulthood to midlife.

Attachment theory posits that early experiences with caregivers are made portable across development in the form of mental representations of attachment experiences. These representations, the secure base script included, are thought to be stable across time. Here, we present data from two studies. Study 1 (N = 141) examined the degree of empirical convergence between the two major measures of secure base script knowledge in Study 2, we examined stability of secure base script knowledge from late adolescence to midlife combining data from both a high- and normative-risk cohort (N = 113). Study 1 revealed evidence for convergent validity (r = .50) and Study 2 revealed moderate rank-order stability (r = .43), which was not moderated by cohort risk status. Results support the validity of secure base script knowledge assessments and prediction that attachment representations show moderate stability across early adulthood and into midlife.

Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial.

OBJECTIVE: Older adults with vision impairment currently have no access to tailored fall prevention programmes. Therefore, the purpose of this study, nested within an ongoing randomised controlled trial (RCT), is to document the adaptation of an existing fall prevention programme and investigate the perspectives of instructors involved in delivery and the older adults with vision impairment receiving the programme (recipients). DESIGN: We documented programme adaptations and training requirements, and conducted semistructured, individual interviews with both the instructors and the recipients of the programme from 2017 to 2019. The content of each interview was analysed using behaviour change theory through deductive qualitative analysis. SETTING: New South Wales and Australian Capital Territory, Australia. PARTICIPANTS: The 11 trained instructors interviewed were employees of a vision rehabilitation organisation and had delivered at least one programme session as part of the RCT. The 154 recipients interviewed were community-dwelling adults aged ≥50 years with vision impairment and no diagnosis of dementia, and had completed their participation in the programme as part of the intervention group of the RCT. RESULTS: Six key themes were identified relating to recipient (delivery aptitude, social norms, habit formation) and instructor (individualised adaptation, complimentary to scope of practice, challenges to delivery) perspectives. With initial training, instructors required minimal ongoing support to deliver the programme and made dynamic adaptations to suit the individual circumstances of each recipient, but cited challenges delivering the number of programme activities required. Recipient perspectives varied; however, most appreciated the delivery of the programme by instructors who understood the impact of vision impairment. CONCLUSIONS AND IMPLICATIONS: This novel qualitative study demonstrates that the adapted programme, delivered by instructors, who already have expertise delivering individualised programmes to older people with vision impairment, may fill the gap for a fall prevention programme in this population. TRIAL REGISTRATION NUMBER: ACTRN12616001186448.

Invalidating Caregiving Environments, Specific Emotion Regulation Deficits, and Non-suicidal Self-injury.

This study examined the indirect effects of distinct aspects of invalidating caregiving environments (i.e., paternal maltreatment, maternal maltreatment, and perceived alienation) on non-suicidal self-injury (NSSI) via six specific emotion regulation difficulties. We hypothesized that specific emotion regulation deficits would mediate associations between invalidating environments and NSSI. Participants included 114 young adults (57 self-injurers; 57 age- and sex-matched comparison participants) aged 17-25 years. Three parallel mediation models tested hypotheses. Results showed that maternal maltreatment, paternal maltreatment, and perceived alienation indirectly predicted NSSI through poor emotional clarity. Maternal maltreatment uniquely predicted NSSI through limited access to regulation strategies. Lastly, maternal maltreatment and perceived alienation were both linked to greater difficulties engaging in goal-directed behavior during emotional upsets; however, contrary to hypotheses, this particular deficit was associated with decreased odds of engaging in NSSI. Findings illustrate how different aspects of invalidating environments and specific emotion regulation deficits may be implicated in NSSI engagement.

Romantic functioning mediates prospective associations between childhood abuse and neglect and parenting outcomes in adulthood.

Research suggests intergenerational links between childhood abuse and neglect and subsequent parenting quality, but little is known about the potential mechanisms underlying intergenerational continuities in parenting. Adult romantic functioning may be one plausible mechanism, given its documented associations with both adverse caregiving in childhood and parenting quality in adulthood. The present study used data from the Minnesota Longitudinal Study of Risk and Adaptation to (a) investigate prospective associations between childhood experiences of abuse and neglect and multiple parenting outcomes in adulthood, and (b) evaluate the degree to which adult romantic functioning mediates those associations. Information regarding childhood abuse and neglect was gathered prospectively from birth through age 17.5 years. Multimethod assessments of romantic functioning were collected repeatedly through early adulthood (ages 20 to 32 years), and parenting quality was assessed as participants assumed a parenting role (ages 21 to 38 years). As expected, childhood abuse and neglect experiences predicted less supportive parenting (observed and interview rated) and higher likelihood of self-reported Child Protective Services involvement. The association with interview-rated supportive parenting was partially mediated by lower romantic competence, whereas the association with Child Protective Services involvement was partially mediated by more relational violence in adult romantic relationships. Implications of these novel prospective findings for research and clinical intervention are discussed.

The Legacy of Early Abuse and Neglect for Social and Academic Competence From Childhood to Adulthood.

This study used data from the Minnesota Longitudinal Study of Risk and Adaptation (N = 267) to investigate whether abuse and neglect experiences during the first 5 years of life have fading or enduring consequences for social and academic competence over the next 3 decades of life. Experiencing early abuse and neglect was consistently associated with more interpersonal problems and lower academic achievement from childhood through adulthood (32-34 years). The predictive significance of early abuse and neglect was not attributable to the stability of developmental competence over time, nor to abuse and neglect occurring later in childhood. Early abuse and neglect had enduring associations with social (but not academic) competence after controlling for potential demographic confounds and early sensitive caregiving.

Adult attachment representations and the quality of romantic and parent-child relationships: An examination of the contributions of coherence of discourse and secure base script knowledge.

Attachment theory suggests that early experiences with caregivers are carried forward across development in the form of mental representations of attachment experiences. Researchers have investigated at least two representation-based constructs when studying attachment and successful adaptation in adulthood: (a) coherence of autobiographical discourse/memories and (b) knowledge of the secure base script. Here, we present data examining the unique contributions of coherent discourse regarding childhood caregiving experience and secure base script knowledge in a prospective high-risk longitudinal study, the Minnesota Longitudinal Study of Risk and Adaptation. The current study included three indicators of the quality of romantic relationships: (a) observed quality of interaction with romantic partners, (b) self-reported relationship satisfaction, and (c) interview-rated effectiveness of romantic engagement. Parent-child relationship quality was also assessed across three key outcomes: (a) infant attachment security, (b) observations of supportive parenting, and (c) interview-rated supportive parenting. When examining both attachment representations simultaneously, each representation-based construct was uniquely associated with different relationship quality indices. Specifically, secure base script knowledge was uniquely associated with infant attachment security in the next generation, and coherence of discourse was uniquely associated with observations of romantic relationships quality and interview-rated supportive parenting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Associations between mother-preschooler attachment and maternal depression symptoms: A systematic review and meta-analysis.

The current study aimed to systematically review and meta-analyze concurrent and longitudinal associations between maternal depression symptoms and mother-child attachment during the preschool period (aged 2 to 7 years) as assessed using the coding systems by Cassidy and Marvin (1992) and Main and Cassidy (1988). The review was pre-registered with PROSPERO (International Prospective Register of Systematic Reviews; Registration number CRD42017073417) and was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 7,969 records were screened and 18 articles were deemed as eligible for inclusion in the review. Studies were reviewed using qualitative synthesis techniques and, where appropriate, meta-analysis. Qualitative synthesis indicated that mothers of disorganized/controlling children most consistently reported the highest levels of depressive symptoms, both concurrently and longitudinally. The association between disorganized/controlling child attachment and concurrent maternal depressive symptoms was significant (n = 1,787; g = 0.27, 95% CI [0.13,0.40]), and was not moderated by sample type, child gender, or risk of bias. Findings of a relationship between child attachment insecurity and maternal depressive symptoms must be qualified due to significant within-study heterogeneity and publication bias. Results suggest that maternal depressive symptoms may confer risk for disorganized/controlling attachment during the preschool period.

Maternal sensitivity during the first 3½ years of life predicts electrophysiological responding to and cognitive appraisals of infant crying at midlife.

This study examined the predictive significance of maternal sensitivity in early childhood for electrophysiological responding to and cognitive appraisals of infant crying at midlife in a sample of 73 adults (age = 39 years; 43 females; 58 parents) from the Minnesota Longitudinal Study of Risk and Adaptation. When listening to an infant crying, both parents and nonparents who had experienced higher levels of maternal sensitivity in early childhood (between 3 and 42 months of age) exhibited larger changes from rest toward greater relative left (vs. right) frontal EEG activation, reflecting an approach-oriented response to distress. Parents who had experienced greater maternal sensitivity in early childhood also made fewer negative causal attributions about the infant's crying; the association between sensitivity and attributions for infant crying was nonsignificant for nonparents. The current findings demonstrate that experiencing maternal sensitivity during the first 3½ years of life has long-term predictive significance for adults' processing of infant distress signals more than three decades later. (PsycINFO Database Record

The functions and addictive features of non-suicidal self-injury: A confirmatory factor analysis of the Ottawa self-injury inventory in a university sample.

The Ottawa Self-Injury Inventory (OSI) is a comprehensive self-report measure of non-suicidal self-injury (NSSI). In an effort to build on past research and further validate the OSI, this study presents a confirmatory factor analysis of the OSI's subscales measuring the functions and addictive features of NSSI using a university sample. Participants were 316 university students aged 17-25 years (84.8% female) who had engaged in NSSI at least once in their lifetime. Consistent with past research, results confirmed the four-factor structure of the Functions items (Internal Emotion Regulation, Social Influence, External Emotion Regulation, Sensation Seeking), as well as the single-factor structure of Addictive Features items. Correlations calculated between the obtained factors and indicators of NSSI severity revealed that higher endorsement of NSSI's Internal Emotion Regulation functions, External Emotion Regulation functions, and Addictive Features were associated with more frequent lifetime NSSI, recent (past 6 months) NSSI, and greater distress regarding NSSI urges; greater endorsement of NSSI's Sensation Seeking functions was also linked with more frequent lifetime NSSI. Results provide further support for the OSI's psychometric properties in a university sample, and offer additional evidence for links between specific NSSI functions and addictive features and more severe manifestations of the behavior.

PrevenTing Falls in a high-risk, vision-impaired population through specialist ORientation and Mobility services: protocol for the PlaTFORM randomised trial.

BACKGROUND: Older people with vision impairment have significant ongoing morbidity, including risk of falls, but are neglected in fall prevention programmes. PlaTFORM is a pragmatic evaluation of the Lifestyle-integrated Functional Exercise fall prevention programme for older people with vision impairment or blindness (v-LiFE). Implementation and scalability issues will also be investigated. METHODS: PlaTFORM is a single-blinded, randomised trial designed to evaluate the v-LiFE programme compared with usual care. Primary outcomes are fall rate over 12 months, measured using prospective monthly fall calendars, and function and participation assessed by the Late-Life Function and Disability Instrument (Late-Life FDI) Function component. The secondary outcome is rate of falls requiring medical care. Activity-normalised fall rate will be estimated using accelerometer-measured physical activity data. EuroQol 5-dimension 5-level questionnaire will measure quality of life and impact of falls. Health record linkage will estimate resource use associated with falls. v-LiFE cost-effectiveness will be determined compared with usual care. 500 participants (250 per group) can provide 90% power to detect a significant between-group difference in fall rates; 588 will be recruited to allow for drop-out. Falls per person-year and Late-Life FDI will be compared between groups. DISCUSSION: PlaTFORM will determine if falls can be prevented among older people with vision loss through a home-based exercise programme. v-LiFE embeds balance and strength training within everyday activities with the aim of preventing falls. The study will also determine whether the programme can be effectively delivered by personnel who provide Orientation and Mobility training for people with vision impairment. TRIAL REGISTRATION NUMBER: ACTRN12616001186448p.

Multiple Dimensions of Childhood Abuse and Neglect Prospectively Predict Poorer Adult Romantic Functioning.

The present study used data from the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) to investigate how multiple dimensions of childhood abuse and neglect predict romantic relationship functioning in adulthood. Several dimensions of abuse and neglect (any experience, type, chronicity, co-occurrence, and perpetrator) were rated prospectively from birth through age 17.5 years. Multimethod assessments of relational competence and violence in romantic relationships were conducted repeatedly from ages 20 to 32 years. As expected, experiencing childhood abuse and neglect was associated with lower romantic competence and more relational violence in adulthood. Follow-up analyses indicated that lower romantic competence was specifically associated with physical abuse, maternal perpetration, chronicity, and co-occurrence, whereas more relational violence was uniquely associated with nonparental perpetration. We discuss these novel prospective findings in the context of theory and research on antecedents of romantic relationship functioning.

Childhood abuse and neglect, attachment states of mind, and non-suicidal self-injury.

This investigation examined preoccupied attachment states of mind as both a risk factor for non-suicidal self-injury (NSSI) and as a mechanism by which prospectively assessed childhood experiences of abuse and neglect predicted the frequency/severity of NSSI behavior up to age 26 years in 164 individuals (83 females) who were followed from birth in the Minnesota Longitudinal Study of Risk and Adaptation. Preoccupied (but not dismissing) states of mind regarding both childhood caregivers and adult romantic partners were correlated with more frequent/severe NSSI. Furthermore, preoccupied states of mind regarding caregivers partially accounted for the association between childhood abuse/neglect and NSSI. This work represents a rare prospective test of a developmental psychopathology framework for understanding NSSI behavior, in which atypical caregiving experiences are carried forward through attachment representations of caregivers that reflect behavioral risk.

Preoccupied but not dismissing attachment states of mind are associated with nonsuicidal self-injury.

In this investigation the factor structure of the Adult Attachment Interview was studied in a partially at-risk sample of 120 young adults. More specifically, 60 participants had engaged in nonsuicidal self-injury (NSSI; 53 females, M age = 20.38 years), and 60 were non-self-injuring controls matched by age and sex. Theoretically anticipated differential associations between preoccupied (but not dismissing) states of mind and NSSI were then examined. Exploratory factor analyses identified evidence for two weakly correlated state of mind dimensions (i.e., dismissing and preoccupied) consistently identified in factor analyses of normative-risk samples. As hypothesized, results further showed that preoccupied (but not dismissing) states of mind were associated with NSSI behavior. Findings support existing arguments suggesting that the regulatory strategy adults adopt when discussing attachment-related experiences with primary caregivers, particularly passive, angry, or unresolved discourse patterns, is uniquely correlated with NSSI.

Childhood abuse and neglect and insecure attachment states of mind in adulthood: Prospective, longitudinal evidence from a high-risk sample.

The present report used data from the Minnesota Longitudinal Study of Risk and Adaptation to investigate the factor structure and childhood abuse and/or neglect related antecedents of adults' attachment states of mind in a high-risk sample. Adult Attachment Interviews (AAIs) were collected when participants were age 26 years (N = 164) and Current Relationship Interviews (CRIs) were collected from participants (N = 116) and their romantic partners when target participants were between ages 20 and 28 years (M = 25.3 years). For both the AAI and the CRI, exploratory factor analyses revealed that (a) attachment state of mind scales loaded on two weakly correlated dimensions reflecting dismissing and preoccupied states of mind and (b) ratings of unresolved discourse loaded on the same factor as indicators of preoccupied states of mind. Experiencing any subtype of abuse and/or neglect, especially during multiple developmental periods, and experiencing multiple subtypes of abuse and/or neglect during childhood were associated with risk for preoccupied (but not dismissing) AAI states of mind regarding childhood relationships with caregivers. Analyses focused on the particular subtypes, and perpetrators indicated that the predictive significance of childhood abuse/neglect for adult's AAI preoccupied states of mind was specific to experiences of abuse (but not neglect) perpetrated by primary caregivers. In addition, experiencing chronic or multiple subtypes of childhood abuse and/or neglect increased risk for dismissing (but not preoccupied) CRI states of mind regarding adult romantic partners.

Correlates of child-father and child-mother attachment in the preschool years.

The increase in fathers' involvement in childrearing, particularly beyond infancy, warrants research exploring factors influencing the quality of child-father attachment relationships, and the impact of these relationships on children's social development. The current investigation explored various correlates of preschoolers' child-father attachment security to both parents, including contextual factors (i.e., socioeconomic status, child temperament, parenting stress), parental play sensitivity, and child social adaptation. Participants included 107 preschool-aged children (59 girls; M = 46.67 months, SD = 8.57) and their fathers and mothers. Results revealed that both mothers' and fathers' play sensitivity were associated with child attachment security after controlling for different contextual factors. Furthermore, the magnitude of the association between child conduct problems and child-father attachment insecurity was stronger than the corresponding association with child-mother attachment insecurity. Findings provide important information on caregiving factors associated with child-father attachment security in the preschool years and the importance of this bond to children's social adaptation.

Effect of gastroretentive gabapentin (Gralise) on postmastectomy pain syndrome: a proof-of-principle open-label study.

INTRODUCTION: Chronic pain is a common and debilitating complication following breast surgery. One of the most challenging for treatment is the neuropathic pain condition, postmastectomy pain syndrome (PMPS). Gabapentin is a pharmacotherapy for neuropathic pain disorders; however, its once-daily, gastroretentive formulation, Gralise, has not been evaluated in PMPS. OBJECTIVE: To evaluate the safety and effectiveness of Gralise in patients with moderate-to-severe PMPS. METHODS: The primary effectiveness endpoint was a change in the worst pain intensity score from baseline to completion of 8 weeks of Gralise therapy. The secondary endpoints included the change in mood, coping behavior, sleep, and function. Sensitivity to experimental stimuli was tested before and after treatment via quantitative sensory testing. The incidence and type of adverse event were used to evaluate the safety and tolerability of Gralise. RESULTS: Twenty-one patients with confirmed moderate-to-severe PMPS were enrolled. Nineteen of 21 (90.5%) patients completed the 8-week treatment with Gralise. A significant positive change was found in pain intensity, pain impact, and sleep. There was no change in sensory testing scores. Of total, 63.16% of patients reported reduction in present pain, 78.95% in average pain, 89.47% in worst pain, and 84.21% in overall pain severity at posttreatment visit. No significant adverse effects were noted in the study. LIMITATIONS: Variation in type of breast surgery, small sample size, lack of placebo control. CONCLUSION: There was a significant improvement in pain and sleep, and Gralise was well tolerated in patients with PMPS. Further investigation is warranted.