Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum.

BACKGROUND: Sleep disturbance is common in gestational parents during pregnancy and postpartum periods. This study evaluated the feasibility and efficacy of a scalable cognitive behavioural therapy (CBT) sleep intervention tailored for these periods. METHODS: This is a two-arm, parallel-group, single-blind, superiority randomised controlled trial. Nulliparous females without severe medical/psychiatric conditions were randomised 1:1 to CBT or attention- and time-matched control. All participants received a 1 h telephone session and automated multimedia emails from the third trimester until 6 months postpartum. Outcomes were assessed with validated instruments at gestation weeks 30 (baseline) and 35 (pregnancy endpoint), and postpartum months 1.5, 3, 6 (postpartum endpoint), 12 and 24. RESULTS: In total, 163 eligible participants (age M ± s.d. = 33.35 ± 3.42) were randomised. The CBT intervention was well accepted, with no reported adverse effect. Intention-to-treat analyses showed that compared to control, receiving CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p values ⩽ 0.001), as well as at 24 months postpartum (p ranges 0.012-0.052). Group differences across the first postpartum year were non-significant. Participants with elevated insomnia symptoms at baseline benefitted substantially more from CBT (v. control), including having significantly lower insomnia symptoms throughout the first postpartum year. Group differences in symptoms of depression or anxiety were non-significant. CONCLUSIONS: A scalable CBT sleep intervention is efficacious in buffering against sleep disturbance during pregnancy and benefitted sleep at 2-year postpartum, especially for individuals with insomnia symptoms during pregnancy. The intervention holds promise for implementation into routine perinatal care.

Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features, maternal mental state, and observed interaction.

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother-infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother-infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self-as-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother-Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother-infant interaction. Implications for research and clinical practice are discussed.

A pesar de la larga asociación teorética en la literatura de la afectividad entre el historial de trauma materno y perturbaciones en la interacción madre-infante, pocos estudios han investigado mecanismos de transmisión de patrones de relación traumatogénicos en díadas madre-infante de alto riesgo. Este estudio investigó interrelaciones entre el historial de trauma materno, las distorsionadas representaciones maternas (DMR, v.g. pensamientos y sentimientos perturbados acerca del infante y de sí misma como madre), la mentalización materna (v.g. capacidad para concebir las intenciones propias y de otros en términos de estados mentales), y la calidad de interacción en un grupo muestra clínico de madres con características de Trastornos de Personalidad Limítrofe (BPD) y sus infantes (N = 61). Entre las medidas usadas están el Cuestionario de Trauma de Niñez, la Entrevista de Desarrollo de la Progenitora, la Escala de Relación Madre-Infante, la Lista de Verificación de Síntomas de Personalidad Limítrofe - 23, y las Escalas de Disponibilidad Emocional. Los resultados indicaron que las características BPD mediaron la relación entre el historial de trauma materno y las DMR prediciendo perturbaciones en la interacción. Es más, los análisis mostraron que la mentalización materna tenía un efecto amortiguador entre las DMR y la no hostilidad materna y aun así la severidad de las características BPD moderaron la relación entre la mentalización y las DMR. Los resultados sugieren que la patología limítrofe posterior al parto pudiera impactar adversamente la experiencia de ser madre para mujeres con historial de trauma, incluyendo déficits en la mentalización (v.g. la hipermentalización) y las perturbaciones en la interacción madre-infante. Se discuten las implicaciones para la investigación y la práctica clínica.

En dépit de la longue association théorique dans les recherches sur l'attachement entre le passé de trauma de la mère et les perturbations dans l'interaction mère-bébé, il existe peu d'études portant sur les mécanismes de transmission de patterns relationnels traumagénétiques chez les dyades mère-bébé à haut risque. Cette étude s'est penchée sur les interrelations entre le passé de trauma de la mère, des représentations maternelles déformées (des DMR, c'est-à-dire des pensées déformées ainsi que des sentiments déformés sur le bébé et soi-même en tant que parent), la mentalisation maternelle (c'est-à-dire la capacité de concevoir ses propres intentions ainsi que celles des autres en termes d'états mentaux), et la qualité de l'interaction chez un échantillon clinique de mères ayant les caractéristiques du trouble de la personnalité limite et leurs bébé (N = 61). Les mesures utilisées ont inclus le Questionnaire de Trauma de l'Enfance, l'Entretien du Développement du Parent, l'Echelle de Relation Mère-Bébé, la Checklist de Symptômes de la Personnalité Limite-23, ainsi que les Echelles de Disponibilité Emotionnelle. Les résultats ont indiqué que les traits de TPL affectaient la relation entre l'histoire de trauma de la mère et les DMS = R prédisant une perturbation dans l'interaction. De plus les analyses ont montré que la mentalisation maternelle faisait effet de tampon entre les DMR et la non-hostilité maternelle et pourtant la sévérité des traits TPL modérait la relation entre la mentalisation et les DMR. Les résultats suggèrent qu'une pathologie limite postpartum pourrait avoir un impact adverse sur l'expérience de parentage pour les femmes ayant un passé de trauma, y compris des déficits dans la mentalisation (par exemple, une hyper-mentalisation) et des perturbations dans l'interaction mère-bébé. Les implications pour les recherches et la pratique clinique sont discutées.

Development and initial reliability and validity of a new measure of distorted maternal representations: The Mother-Infant Relationship Scale.

Distorted maternal representations (DMRs)-mother's ideas, understanding, and feelings about the infant-shape early interaction and the emerging relationship. Distorted interactions reportedly affect infant attachment and socioemotional development and may be associated with maternal early adversity and trauma. Limited measures are available that could be used as screening tools of DMRs. The aims of this study were to (a) describe the development of the Mother-Infant Relationship Scale (MIRS) and (b) to evaluate its psychometric properties. The development and validation of the MIRS closely followed standard guidelines for the development of psychometric tests. Psychometric properties were examined across two samples: 78 adult psychiatric patients with features of borderline personality and 86 individuals from a nonclinical sample (N = 164). The scale demonstrated excellent internal consistency (Cronbach's α = .91) for the clinical sample and adequate internal consistency (.78) for the nonclinical sample, excellent test-retest reliability (intraclass correlation coefficient = .81), and good concurrent validity with an observational (Pearson's correlation coefficients = -.35 to -.54) and a representational measure (.53). Factor analysis revealed three components: DMRs specific to (a) maternal hostility/rejection of the infant, (b) issues about parenting/attachment, and (c) anxiety/helplessness about infant care. Findings suggest that the MIRS is a reliable and valid screening tool of DMRs. Potential uses in clinical and research settings are discussed.

Las Representaciones Maternas Distorsionadas (DMR) - ideas, comprensión y sentimientos de la madre sobre el infante - le dan forma a la temprana interacción y la naciente relación. Las interacciones distorsionadas, según se dice, afectan la unión afectiva y el desarrollo socio-emocional del infante y pudieran estar asociadas con la temprana adversidad y trauma maternos. Limitadas medidas están disponibles para ser usadas como herramientas de detección de DMR. Las metas de este estudio fueron (1) describir el desarrollo de la Escala de la Relación Madre-Infante (MIRS) y (2) evaluar sus propiedades sicométricas. El desarrollo y validación de MIRS siguió muy de cerca los parámetros estándares para el desarrollo de pruebas sicométricas. Las propiedades sicométricas fueron examinadas en 2 grupos muestras: 78 pacientes siquiátricos adultos con características de personalidad limítrofe y 86 individuos de un grupo muestra no clínico (N=164). La escala demostró una consistencia interna excelente (alfa de Cronbach .91) para el grupo muestra clínico y adecuada (.78) para el no clínico, una excelente confiabilidad de prueba y re-prueba (ICC .81), y una buena validez simultánea con una medida de observación (coeficientes de correlación de Pearson entre -.35 y -.54) y una de representación (.53). Los análisis de factores revelaron 3 componentes: específicas DMR para (1) hostilidad materna/rechazo del infante, (2) asuntos sobre crianza/afectividad, (3) ansiedad/sentirse sin ayuda acerca del cuidado del infante. Los resultados sugieren que MIRS es una herramienta de detección de DMR confiable y válida. Se discuten los posibles usos en escenarios clínicos y la investigación.

Les Représentations Maternelles Déformées (RMD en français) - les idées des mères, leur compréhension, leurs sentiments sur le nourrisson - donnent forme à l'interaction et à la relation qui émerge. Il semblerait que les interactions déformées affectent l'attachement du nourrisson et le développement socio-émotionnel et qu'elles pourraient être liées à l'adversité maternelle précoce et au trauma. Des mesures limitées sont disponibles qui pourraient être utilisées comme outils de dépistages des RMD. Dans ce contexte, les buts de cette étude étaient de (1) décrire le développement de l'Echelle de la Relation Mère-Nourrisson (MIRS en anglais) et (2) évaluer ses propriétés psychométriques. Le développement et la validation de la MIRS ont suivi attentivement les lignes directrices standard pour le développement de tests psychométriques. Les propriétés psychométriques ont été examinées au travers de 2 échantillons: 78 patients psychiatriques adultes avec des traits de la personnalité limite, et 86 individus d'un échantillon non-clinique (N=164). L'échelle a fait preuve d'une cohérence interne excellente (alpha de Cronbach ,91) pour l'échantillon clinique et adéquate (,78) pour l'échantillon non-clinique, ainsi que d'une fiabilité test-re-test excellente (ICC s81), tout comme d'une bonne validité simultanée avec une mesure d'observation (coefficients de corrélation de Pearson allant de -,35 à -,54) et une mesure de représentation (,53). L'analyse de facteurs a révélé 3 composantes spécifiques aux RMD (1) de l'hostilité/la rejection du nourrisson, (2) des problèmes de parentage/attachement, (3) de l'anxiété / du désarroi à propos du soin du nourrisson. Les résultats suggèrent que la MIRS est un outil fiable et valide de détection des RMD. Des utilisations possibles dans des milieux cliniques et des milieux de recherche sont discutés.

Attachment and child behaviour and emotional problems in autism spectrum disorder with intellectual disability.

BACKGROUND: Behaviour and emotional problems are highly prevalent in children with autism spectrum disorder (ASD). In typically developing children, attachment quality acts as a risk/protective factor for behavioural outcomes and adjustment, warranting investigation in children with ASD. METHOD: We investigated the relationship between attachment and child behaviour and emotional problems in children with ASD and comorbid intellectual disability. Data were collected from parent-child dyads where children were diagnosed with ASD and ID (n = 28) or other developmental disabilities (n = 20). RESULTS: Children with ASD had higher levels of behaviour and emotional problems and more attachment difficulties than children with other developmental disabilities. Poorer attachment quality contributed uniquely to the variance in child behaviour and emotional problems. CONCLUSIONS: Interventions targeting behaviour and emotional problems in children with ASD may benefit from an attachment model which addresses the child's difficulty in using caregivers as a coregulatory agent of emotions.

A scalable cognitive behavioural program to promote healthy sleep during pregnancy and postpartum periods: protocol of a randomised controlled trial (the SEED project).

BACKGROUND: Poor sleep, including symptoms of insomnia are common during pregnancy and postpartum periods. Poor sleep during the perinatal period is linked to impaired daytime functioning, mood disturbance, and risk for chronic insomnia. Cognitive behavioural therapy (CBT) is consistently shown to be efficacious in treating insomnia, but it is largely inaccessible to new mothers, and surprisingly, not part of current perinatal care. This study aims to evaluate the feasibility and efficacy of a scalable CBT-based intervention for better sleep quality. METHODS: In this single-blind randomised controlled trial, eligible nulliparous women are randomised in a 1:1 ratio to either the intervention (CBT) or active control (healthy diet) condition. The interventions are provided from the third trimester till 6 months postpartum. The primary outcome is maternal sleep quality and secondary outcomes are maternal sleep-related impairment, mood, health-related quality of life, relationship satisfaction, and mother-infant-relationship, all assessed using validated instruments at 30- (baseline) and 35 weeks gestation (pregnancy endpoint), and 1.5, 3, and 6 months (postpartum endpoint) after childbirth, with follow-up assessments conducted at 1-year and 2-year postpartum. DISCUSSION: This study has the potential to address the need for an evidence-based, non-pharmacological sleep intervention tailored for the pregnancy and postpartum periods. The intervention is designed to maximise reach and minimise cost, with the potential to scale up and incorporate in routine perinatal care. With outcomes measured at 8 time points, from the third trimester of pregnancy to 2-year postpartum, this study has the potential to examine both short- and long-term impact on maternal sleep and wellbeing. TRIAL REGISTRATION: ACTRN12616001462471 ; retrospectively registered on 19/10/2016.

Perceived Invalidation in Adolescent Borderline Personality Disorder: An Investigation of Parallel Reports of Caregiver Responses to Negative Emotions.

Childhood experiences of emotional invalidation are commonly reported by adults with borderline personality disorder (BPD). This study aimed to compare perceptions of emotional invalidation between adolescents with and adolescents without BPD, and their primary caregivers. Participants were 51 adolescents subdivided into a clinical group of 26 adolescents with BPD and a community-control group of 25 adolescents, each with their primary caregivers. To examine perceptions of invalidation, adolescents and caregivers completed parallel reports assessing caregiver responses to adolescents' negative emotions. Adolescents with BPD reported more punitive and less supportive responses to their negative emotions than their caregivers. In the control group, by contrast, differences between caregiver and adolescent reports were due to caregivers rating themselves more harshly than did adolescents. Findings demonstrated that adolescents with BPD perceived their caregivers to be relatively less supportive and more invalidating than did adolescents without BPD. Results highlight the importance of adolescents' subjective experiences of caregiving to enduring borderline psychopathology.

Mentalization in Adolescents With Borderline Personality Disorder: A Comparison With Healthy Controls.

Mentalization is proposed to underlie the disturbed interpersonal relatedness that is a hallmark of borderline personality disorder (BPD). Despite growing evidence of BPD in adolescents, studies examining mentalization in relation to adolescent BPD have remained limited. Given contradictory findings of this relationship, particularly with adults, further research of mentalization in adolescents with BPD is warranted. The current study further clarifies the nature of mentalizing impairments, related to BPD, by examining different aspects of mentalization between adolescents with BPD (n = 26) and a group of healthy controls (n = 25). Findings support studies that suggest that mentalization may be an important treatment target, influencing BPD symptoms and interpersonal functioning in adolescents with BPD. They also support the importance of examining mentalizing abilities in relation to varying levels of complexity, interpersonal contexts, and levels of arousal. Limitations and further research are discussed.

An investigation of the mentalization-based model of borderline pathology in adolescents.

OBJECTIVE: According to mentalization-based theory, transgenerational transmission of mentalization from caregiver to offspring is implicated in the pathogenesis of borderline personality disorder (BPD). Recent research has demonstrated an association between hypermentalizing (excessive, inaccurate mental state reasoning) and BPD, indicating the particular relevance of this form of mentalizing dysfunction to the transgenerational mentalization-based model. As yet, no study has empirically assessed a transgenerational mentalization-based model of BPD. The current study sought firstly to test the mentalization-based model, and additionally, to determine the form of mentalizing dysfunction in caregivers (e.g., hypo- or hypermentalizing) most relevant to a hypermentalizing model of BPD. METHOD: Participants were a mixed sample of adolescents with BPD and a sample of non-clinical adolescents, and their respective primary caregivers (n = 102; 51 dyads). Using an ecologically valid measure of mentalization, mediational analyses were conducted to examine the relationships between caregiver mentalizing, adolescent mentalizing, and adolescent borderline features. RESULTS: Findings demonstrated that adolescent mentalization mediated the effect of caregiver mentalization on adolescent borderline personality pathology. Furthermore, results indicated that hypomentalizing in caregivers was related to adolescent borderline personality pathology via an effect on adolescent hypermentalizing. CONCLUSIONS: Results provide empirical support for the mentalization-based model of BPD, and suggest the indirect influence of caregiver mentalization on adolescent borderline psychopathology. Results further indicate the relevance of caregiver hypomentalizing to a hypermentalizing model of BPD.

Caregiver Mental Health, Parenting Practices, and Perceptions of Child Attachment in Children with Autism Spectrum Disorder.

This paper investigates the role of caregiver mental health and parenting practices as predictors of attachment in children with intellectual disability/developmental delay, comparing between children with ASD (n = 29) and children with other developmental disabilities (n = 20). Parents reported that children with ASD had high levels of anxiety and stress, and attachment insecurity in children (less closeness and more conflict in attachment relationships, and more inhibited attachment behaviours) compared with children with other developmental disabilities. Children's attachment quality was associated with parenting practices and the presence of an ASD diagnosis. These results highlight the bidirectional nature of the quality of caregiving environments and attachment in children with ASD, and also provide a strong rationale for targeting children's attachment quality in early interventions.

Reflective function mediates the relationship between emotional maltreatment and borderline pathology in adolescents: A preliminary investigation.

Deficits in mentalizing, particularly within the context of attachment relationships i.e., reflective function (RF), are posited to result from childhood maltreatment and to influence the development of borderline personality disorder (BPD). Whilst a mentalization-based model of BPD provides a theoretical explanation, direct empirical support for this model, in linking childhood maltreatment to borderline pathology remains limited. This study examined the interrrelationships between childhood maltreatment, RF, and borderline pathology in a mixed adolescent sample, consisting of adolescents with BPD (n=26) and a group of non-clinical adolescents (n=25). With the aim of directly testing the mentalization-based model of BPD, we additionally investigated the influence of each form of childhood maltreatment within this developmental pathway. Self-report data supported the hypothesized indirect effect of childhood maltreatment on elevated borderline pathology through lowered RF in adolescents. Both emotional abuse and emotional neglect were found to indirectly influence borderline pathology through adolescent RF, however, only emotional abuse indirectly influenced borderline pathology through RF, after all other maltreatment types were controlled for. Findings support the promotion of mentalization, within attachment-related contexts, as an intervention target for adolescents with borderline pathology and as a potential target of prevention for at-risk children and adolescents with histories of childhood maltreatment, especially emotional abuse. Future research should delineate other underlying mechanisms, independent of RF, which may also link the influence of childhood maltreatment, and in particular, emotional abuse, to BPD.

Coparenting Competence in Parents of Children with ASD: A Marker of Coparenting Quality.

The coparenting relationship has been linked to parenting stress, parenting self-efficacy and many other concerns associated with the development of children with ASD. Parents of children with ASD (N = 22) were interviewed to explore three domains of their coparenting relationship; (1) adaptation to the emergence of their child's autism, (2) parenting their child with ASD, (3) expectations for their child's developmental outcomes. The concept of coparenting competence, developed during analysis, describes collective perceptions of parenting efficacy. Parents linked perceptions of coparenting competence to their, ability to cope with diagnosis and parenting, motivation to do what they could for their child, and hopes for their child's development. The concept of coparenting competence could play an important role in future research and intervention.

Psychodynamic formulation in the era of the brain - towards integration.

OBJECTIVE: The objectives of this study were to describe advances in neurosciences and their relationship to psychodynamic models of psychopathology and to present an integrative approach to psychodynamic formulation which incorporates the neurobiological underpinnings of self-functioning and a model of relational trauma. CONCLUSION: Developmental psychopathology is now better able to describe the significance of early developmental periods and the interpersonal context of self-development. These findings contribute to an integrated biopsychosocial psychodynamic formulation based on core principles of early development.

A qualitative study of attachment relationships in ASD during middle childhood.

Although research has indicated that children with Autism Spectrum Disorder (ASD) display normative attachment behaviours, to date there has been limited qualitative research exploring these relationships. This study aimed to describe qualitative features of the child-caregiver attachment relationship in children with ASD. Primary caregivers to 26 children with ASD (aged 7-14 years) and 23 typically developing children (aged 7-13 years) were administered the Disturbances of Attachment Interview (Smyke & Zeanah, 1999) to elicit descriptions of children's attachment behaviours. Thematic analysis of interview transcripts indicated that while children with ASD demonstrated a range of normative attachment behaviours, they displayed impairments in the use of the caregiver as a secure base and co-regulating agent. ASD-associated impairments in emotion processing, sharing/reciprocity, and emotion co-regulation, as well as the caregiver's experience, were important in understanding attachment relationships in ASD. Findings highlight the need to consider the bidirectional nature of the attachment relationship in ASD.

Parents of Children with ASD Experience More Psychological Distress, Parenting Stress, and Attachment-Related Anxiety.

There has been limited study of the relationship between child attachment and caregiver wellbeing amongst children with autism spectrum disorder (ASD). This study examined self-reported child attachment quality alongside caregivers' report of their own psychological distress, parenting stress and attachment style, amongst 24 children with high-functioning autism or Asperger's disorder (ASD; aged 7-14 years) and 24 typically developing children (aged 7-12 years), and their primary caregiver. Children with ASD were no less secure, but their caregivers were more stressed and reported more attachment-related anxiety, compared to typically developing dyads. Child attachment security was related to caregiver psychological distress and attachment style, but only amongst typically developing children. Impacts of emotion processing impairments on caregiver-child relationships in ASD are discussed.

An exploration of the adaptation and development after persecution and trauma (ADAPT) model with resettled refugee adolescents in Australia: A qualitative study.

Refugee adolescents endure high rates of traumatic exposure, as well as subsequent resettlement and adaptational stressors. Research on the effects of trauma in refugee populations has focussed on psychopathological outcomes, in particular posttraumatic stress disorder. However this approach does not address the psychosocial and adaptive dimensions of refugee experience. The ADAPT model proposes an alternate conceptualization of the refugee experience, theorizing that refugee trauma challenges five core psychosocial adaptive systems, and that the impact on these systems leads to psychological difficulties. This study investigated the application of the ADAPT model to adolescents' accounts of their refugee and resettlement experiences. Deductive thematic analysis was used to analyse responses of 43 adolescent refugees to a semistructured interview. The ADAPT model was found to be a useful paradigm to conceptualize the impact of adolescents' refugee and resettlement journeys in terms of individual variation in the salience of particular adaptive systems to individuals' experiences. Findings are discussed in light of current understandings of the psychological impact of the refugee experience on adolescents.

Differential accounts of refugee and resettlement experiences in youth with high and low levels of posttraumatic stress disorder (PTSD) symptomatology: A mixed-methods investigation.

In recent years there has been increased debate and critique of the focus on psychopathology in general, and posttraumatic stress disorder (PTSD) in particular, as a predominant consequence of the refugee experience. This study was conducted to broaden the conceptualization and examination of the outcomes of the refugee experience by jointly examining how adaptive processes, psychosocial factors, and psychopathology are implicated. A mixed-methods approach was used to specifically examine whether adolescents' (N = 10) accounts of their refugee and resettlement experiences differed according to their level, "high" or "low," of PTSD symptomatology. The superordinate themes of cultural belongingness and identification, psychological functioning, family unit functioning and relationships, and friendships and interpersonal processes, were identified as having particular relevance for the study's participants and in distinguishing between participants with high and low levels of PTSD symptomatology. Findings were characterized by marked differences between adolescents' accounts according to their symptomatology levels, and may thereby inform important avenues for future research as well as clinical prevention and intervention programs with refugee youth.

Familial separations, coping styles, and PTSD symptomatology in resettled refugee youth.

Youth from refugee backgrounds have been found to experience high rates of posttraumatic stress disorder (PTSD), even after years of resettlement. The present study sought to investigate how familial separations and coping styles act as correlates of PTSD symptoms in resettled refugee youth (N = 50). Participants (Mage = 16.63; range: 12-21) completed self-report questionnaires assessing PTSD symptoms and their use of coping styles, and engaged in a semi-structured interview designed by the authors to investigate their resettlement and adaptational experiences in Australia. Youth who were separated from immediate family members demonstrated significantly more PTSD symptoms than their counterparts, and there was a relationship between avoidant coping and PTSD, although this diminished once the confound between scales was controlled for. This study found evidence for the integrity of the family unit as a correlate of PTSD in refugee youth, but no evidence of a relationship between coping style and family separations.

The role of parental self-efficacy in adolescent school-refusal.

Parental characteristics such as psychopathology and parenting practices are understood to be implicated in school-refusal presentations. Expanding upon these largely affective and behavioral factors, the present study sought to examine the role of a parenting cognitive construct--parenting self-efficacy--in understanding school-refusal. School-refusing adolescents (n = 60, 53% male) and school-attending adolescents (n = 46, 39% male) aged 12-17 years (M = 13.93, SD = 1.33), along with a parent, participated in the study. Participants completed study measures of demographics, psychopathology, overall family functioning, and parenting self-efficacy. As expected, parents of school-refusing adolescents were found to have lower levels of parental self-efficacy than parents of school-attending adolescents. Parenting self-efficacy was inversely associated with parent- and adolescent- psychopathology as well as family dysfunction. Logistic regression analyses determined parenting self-efficacy to be a predictor of school-refusal. However, upon controlling for related constructs including family dysfunction, adolescent depression, and parent depression, the predictive capacity of parenting self-efficacy was eliminated. Taken together, the results highlight the likely complex relationships between parental self-efficacy, familial psychopathology, and dysfunctional family processes within this population. Research is required to further delineate these dynamic relationships among families of school-refusing adolescents.