Psychoanalytic reconstructions and empirical data: reciprocal contributions.

Freud (1905, 1917, 1937) throughout his lifetime sought empirical scientific confirmation of the validity of his discoveries. In pursuit of this goal, he persistently emphasized the importance of establishing agreement between analytic reconstructions and the results of naturalistic child observation. The same objective lead Lichtenberg (1983), Emde (1981, 1985), and Stern (1985) to produce detailed evaluations of the impact of infant research findings on analytic developmental propositions. The present paper examines the relation among clinical reconstructions from an analysis developed through transference interpretations, empirical observations originating in the analytic patient's daughter's psychotherapy, and the results of empirical infant research that was being concurrently conducted by two of the authors. The findings from the clinical analysis of the mother, the psychotherapy of the daughter, and empirical infant research all converged on the same larger causative factor for the daughter's psychopathology--a type of maternal deprivation. Such a confluence of different sources of evidence, each identified by a different method of investigation, provides one kind of validation for psychoanalytic reconstructions, making it possible to provide that "satisfactory degree of certainty" which Freud (1937) called for in the attempt to integrate the patient's "psychic truth" with "actual" or historical truth.

Therapeutic abortion during adolescence: psychiatric observations.

PIP: The authors investigate the psychological reactions of 78 adolescent girls undergoing abortion during the first trimester of pregnancy. Adolescent emotion responses differ from those of adult patients in 2 ways: 1) the abortion decision is more "outer-other" directed by parents, peer group or sexual partner and is therefore more difficult and 2) developmental immaturity contributes to ambivalence about the decision, to distorted perception of procedure, and to a variety of pathological reactions. Patient symptoms suggest a mourning process in response to failure to realize an expectation rather than an object loss. Preabortion dreams are a potential adjuvant to psychiatric diagnosis and prognosis for adolescent patients.^ieng

Effects of maternal absence due to employment on the quality of infant-mother attachment in a low-risk sample.

Recent reports have suggested that day-care experience initiated prior to 12 months of age is associated with increased proportions of infants whose attachment to mother is classified as "insecure-avoidant." However, reviewers have questioned the generality of these findings, noting that samples in which associations between early day-care experience and avoidant attachment patterns have been reported come from high-risk populations, and/or that the infants' day-care settings may not have been of high quality. In the present study, effects of maternal absences on infant-mother attachment quality were assessed in a low-risk, middle-class sample (N = 110). In all instances, substitute care had been initiated at least 4 months prior to the infant's first birthday and was provided in the infant's home by a person unrelated to the baby. Infants were assessed using the Ainsworth Strange Situation when they were 12-13 months of age. Analyses indicated that a significantly greater proportion of infants whose mothers worked outside the home (N = 54) were assigned to the category "insecure-avoidant" as compared to infants whose mothers remained in the home (N = 56) throughout the first year of life. Analyses of demographic and psychological data available for the sample indicated that this relation is dependent upon maternal parity (primi- vs. multiparous mother). The association between attachment quality and work status was significant only for firstborn children of full-time working mothers. The results are interpreted as evidence that the repeated daily separations experienced by infants whose mothers are working full-time constitute a "risk" factor for the development of "insecure-avoidant" infant-mother attachments.

Psychosocial childbearing stress and metabolic control in pregnant diabetics.

The authors tested the relationship between psychosocial childbearing stress factors and metabolic control in a research sample of 39 pregnant insulin-dependent diabetic women. Subjects were selected using rigorous exclusion criteria from a population of more than 200 pregnant diabetic patients assessed in a University National Institutes of Health Center. Metabolic control was determined by plasma levels of preprandial day, night, and early morning fasting glucose, urinary ketones, and glycosylation of hemoglobin. Differences in plasma glucose concentrations and urinary ketone levels at several times during the day and night were associated with psychosocial stress factors. A similar relationship between stress and levels of diabetic control could not be demonstrated by hemoglobin A1 assay, a result contradicting most prior studies of adolescent populations. These findings are compatible with a biopsychosocial model of diabetes mellitus and emphasize the importance of using several different measures of diabetic control to determine stress-control relationships.

Prematurity and infant stimulation: a review of research.

Morbidity risks continue to constitute a major problem for the premature infant, despite striking progress in neonatal care and technology. This article reviews the early stimulation literature over the past 15 years, and discusses the findings of improved weight gain, respiratory status and psychomotor development when infants are stimulated early in life. Although some authors have criticized this area of research because of methodological problems, the overwhelming evidence points to the beneficial consequences of tactile and vestibular stimulation programs in high-risk nurseries. Further research is, however, clearly indicated in order to more fully elucidate the major variables and mechanisms responsible for the experimental effects, and to elaborate a more standardized program of psychological care of premature infants.

Development of a self-report measure of adherence for children and adolescents with insulin-dependent diabetes.

Two samples of insulin-dependent diabetic youths were studies in successive attempts to refine a brief patient self-report measure of general long-term adherence to a diabetic regimen. Validity and reliability were assessed for both samples by measuring a number of related variables: locus of control, stressful life events, knowledge of diabetes, parent report, and glycosylated hemoglobin. Initial evidence of validity was demonstrated in a variety of criterion areas. Both reliability and validity were replicated on the second sample. Adherence is discussed as a complex multidimensional variable, the measurement of which requires several different methods, including the selfreport measure described here. Warnings about social desirability as a confounding factor were discussed, as were suggestions for other adherence measures.

Developmental follow-up of 6-7 year old children of mothers employed during their infancies.

This study followed up 92 children at ages 6-7 first studied as one-year-olds in order to determine differences in the developmental outcome of the offspring of employed as compared to "stay at home" mothers. The developmental domain evaluated in the 6-7 year old children was peer competence, rated by laboratory play and child psychological test instruments. Mothers' reports of children's behavioral pathology at age 6-7 correlated with a higher number of maternal work hours during the infant's first year, but the children did better during overall play situations. Age 1 attachment ratings better predicted free play social competence for the entire sample than did maternal hours of work absence, but girls accounted for statistical significance. Maternal sensitivity from infancy was associated with maternal reports of (low) problem behaviors; however, regression analyses did not support the hypothesis that relations between either work status or attachment and current problem behaviors were mediated by early maternal sensitivity.

Stress and metabolic control in diabetes: psychosomatic evidence and evaluation of methods.

Psychosomatic research findings correlating psychologic stress with diabetic control fail as yet to provide valid conclusions. Investigators have presented many contradictory findings. The two major pathways by which stress could affect control, a) changes in compliance behavior, and b) a neurohumoral axis, have not been clearly distinguished from each other. The study of adolescent cohorts is associated with the problem of heterogeneity, limiting the application of results to other diabetic populations. Methods of determining diabetic control have been incomplete and the definition and measurement of stress have major inadequacies for the analysis of such a complex psychosomatic problem. Existing evidence is comprehensively reviewed and evaluated. The authors use a modified definition of stress to construct a stress scale specific to pregnant diabetics.

Correlations between antepartum maternal metabolism and newborn behavior.

We suggested that antepartum maternal metabolism may affect later cognitive and behavioral function of progeny by impacting on developing brain cells in utero. This study reports on the observed relationships between serial characterizations of maternal fuels during pregnancy and Brazelton neonatal behavioral assessment scale ratings of offspring from 73 well-controlled pregestational diabetic patients, 112 gestational diabetic patients, and 24 nondiabetic patients. After controlling for the effects of premature birth on the Brazelton neonatal behavioral assessment scale, significant correlations were found between second- and third-trimester glycemic regulation (hemoglobin A1c and fasting plasma glucose levels) and three of four newborn behavioral dimensions of the Brazelton neonatal behavioral assessment scale. In each case, as maternal glucose increased, the newborns' Brazelton neonatal behavioral assessment scale responses were poor. Results were not substantially different when gestational and pregestational diabetic patients were analyzed separately, nor can they be attributed to various perinatal events (neonatal asphyxia, hypoglycemia) or differences in socioeconomic status or ethnicity. The presence of fuel-related neurobehavioral deficits in neonates of diabetic mothers suggests that such infants start their interactions with care givers from a modified base.