Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms.

PURPOSE: Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood and adolescence. Both neurocognitive and environmental factors have been related to ADHD. The current study contributes to the documentation of the predictive relation between early attachment deprivation and ADHD. METHOD: Data were collected from 641 adopted adolescents (53.2% girls) aged 11-16 years in five countries, using the DSM oriented scale for ADHD of the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families, Burlington, 2001). The influence of attachment deprivation on ADHD symptoms was initially tested taking into consideration several key variables that have been reported as influencing ADHD at the adoptee level (age, gender, length of time in the adoptive family, parents' educational level and marital status), and at the level of the country of origin and country of adoption (poverty, quality of health services and values). The analyses were computed using the multilevel modeling technique. RESULTS: The results showed that an increase in the level of ADHD symptoms was predicted by the duration of exposure to early attachment deprivation, estimated from the age of adoption, after controlling for the influence of adoptee and country variables. The effect of the age of adoption was also demonstrated to be specific to the level of ADHD symptoms in comparison to both the externalizing and internalizing behavior scales of the CBCL. CONCLUSION: Deprivation of stable and sensitive care in infancy may have long-lasting consequences for children's development.

Supporting insensitive mothers: the Vilnius randomized control trial of video-feedback intervention to promote maternal sensitivity and infant attachment security.

OBJECTIVE: This randomized control trial examined the effects of a short-term, interaction-focused and attachment-based video-feedback intervention (VIPP: video-feedback intervention to promote positive parenting). Design VIPP effect on mothers' sensitive responsiveness and infant-mother attachment security was evaluated in a sample (n = 54) of low sensitive, non-clinical, middle class Lithuanian mothers. METHODS: Maternal sensitivity was assessed in a free play session with the Ainsworth's sensitivity scale, and attachment security was observed using the Attachment Q sort for home observations. RESULTS: We found that the intervention mothers indeed significantly improved their sensitive responsiveness through participation in our VIPP. The effect size was large according to Cohen's criteria, d = 0.78. VIPP enhanced maternal sensitive responsiveness even when maternal age, educational level, depression, daily hassles, efficacy, infant gender, and infant negative and positive affect were controlled for. However, attachment security in the VIPP infants was not enhanced after the intervention, compared with the control infants, and the infants did not seem to be differentially susceptible to the increase in maternal sensitivity dependent on their temperamental reactivity. CONCLUSION: We suggest that a relatively brief and low-cost programme can provide effective support for mothers who lack sensitivity in the interactions with their infants.

The development and adjustment of 7-year-old children adopted in infancy.

The present study (N = 159) provides evidence of an increased risk for behavior problems of infant-placed 7-year-old internationally, transracially adopted children in the Netherlands. However, parents reported more behavior problems for adopted boys than for adopted girls. Notably, about 30% of the adopted children were classified as clinical on the CBCL scale for total problems, which is a much larger percentage than the 10% found in the normative population. It was suggested that these results could be explained by the operation of multiple risk factors before and after adoption placement, e.g. the child's genetic disposition, pre-natal and pre-adoption care, or the child's cognitive understanding of adoption in middle childhood. Also, results suggest that maternal sensitive responsiveness in adoptive families declines in the transition from early to middle childhood. In contrast to the home setting, the adopted children showed favorable behavioral and socioemotional adjustment at school, while their academic achievement and intelligence were in the normal range or above average. In particular Korean children had high IQs: 31% of these children obtained an intelligence score above 120. It was suggested that adoptive parents seem to offer their children sufficient or even more than average cognitive stimulation. Furthermore, adopted girls scored higher in optimal ego-control, social competence, and peer group popularity than nonadopted girls from the general population: 30% of the adopted girls were rated as popular by their classmates, which compares favorably to the 13% found in the general school population.

Early intervention in adoptive families: supporting maternal sensitive responsiveness, infant-mother attachment, and infant competence.

Results from adoption studies suggest that adoptive families may experience special impediments with respect to the developmental progress and outcome of their children. Based on attachment theory, two early intervention programs were designed to support families in the Netherlands with an internationally adopted child. The intervention aimed at promoting maternal sensitive responsiveness, secure infant-mother attachment relationships, and infant exploratory competence. Ninety families with an interracially adopted infant (71 from Sri Lanka and 19 from Korea) were assigned to either a control group or one of two intervention groups. All of the children, 44 boys and 46 girls, were placed for adoption under the age of 5 months (M = 8 weeks). The first intervention group (N = 30) received a personal book, which focused on sensitive parenting. The second intervention group (N = 30) was provided with the same book as well as with three video-feedback sessions at their home. The control group (N = 30) did not receive intervention. In the control group sensitive responsiveness and security of attachment were comparable to outcomes from normative samples. The least intensive program, the personal book, did not bring about change in mothers or infants. In contrast, intervention effects were established upon maternal sensitive responsiveness, infant competence, and infant-mother attachment in the group that received both the book and video feedback.

Intervention in transmission of insecure attachment: a case study.

Several attachment-based intervention studies have been performed, with varying success. An important question is whether short-term interventions can be successful in promoting parental sensitivity and security of infant-parent attachment as well as in changing parental representations of attachment. We investigated this issue in an exploratory way in a case study. A short-term home-based intervention with written material and video feedback, which was effective regarding parental sensitivity and infant security in a former study, was provided a parent who revealed an insecure attachment representation in the Adult Attachment Interview. The intervention sessions were expanded with discussions about past and present experiences of attachment. After four intervention sessions the mother's behavior towards her child was rated as more sensitive than before the intervention. Also, the infant-mother attachment, as observed in the Strange Situation, appeared to be more secure. Nevertheless, in a second Adult Attachment Interview administered after the intervention, the mother showed again an insecure representation of attachment. Possible implications of these results are discussed.

Breaking the intergenerational cycle of insecure attachment: a review of the effects of attachment-based interventions on maternal sensitivity and infant security.

In this paper the effectiveness of preventive or therapeutic interventions aiming at enhancing parental sensitivity and children's attachment security is addressed. Sixteen pertinent studies have been reviewed, and 12 studies have been included in a quantitative meta-analysis (N = 869). Results show that interventions are more effective in changing parental insensitivity (d = .58) than in changing children's attachment insecurity (d = .17). Longer, more intensive, and therapeutic interventions appear to be less effective than short-term preventive interventions. Interventions which are effective at the behavioral level may not necessarily lead to changes in insecure mental representations of the parents involved. The implications of changes at the behavioral level (sensitivity; attachment) without accompanying changes at the representational level will be discussed.

[Attachment and identity of adoptive children]. / Attachment und Identität von Adoptivkindern.

At first the development of the mother-child-attachment is discussed on the basis of the theories of Bowlby and Ainsworth. A study by one of the Dutch authors (Juffer) is described, in which the quality of the attachment was assessed in 90 foreign adoptions and in which a positive impact of interventions (booklet, discussion of videotapes) on the quality of the attachment was found. Then the relationship between adoptees and their biological parents is discussed. The consequences of the "double parenthood" for the identity development of adopted children is described.