CORRELATES OF CHANGE IN POSTINSTITUTIONALIZED INFANTS’ SUSTAINED SOCIAL WITHDRAWAL BEHAVIOR FOLLOWING ADOPTION

Maternal depression and infant social withdrawal as predictors of behaviour and development in vertically HIV-infected children at 3.5 years

BACKGROUND

In low- and middle-income countries, there is a high prevalence of post-partum depression and it is often associated with HIV status. Maternal depression negatively affects mothering and can lead to social withdrawal in infants. Maternal depression and infant social withdrawal can have deleterious long-term effects on children's behaviour and neurodevelopmental trajectories.

AIM

To investigate whether maternal depression and infant social withdrawal at 10-12 months post-partum were significant predictors of child behaviour and development at 42 months.

METHOD

Seventy-four mother-infant dyads living with HIV were followed in a prospective, longitudinal design. Mothers were assessed for depression using the Center for Epidemiologic Studies Depression scale (CES-D). Infant social withdrawal was assessed by the modified Alarm Distress Baby Scale (m-ADBB), and development and behaviour were evaluated by the Griffiths Mental Development Scales (GMDS) and the Child Behavior Checklist (CBCL), respectively.

RESULTS

Maternal depression  explained 4.8% of the variance in child behaviour (β = 0.98, t = 2.05, p < 0.05) and 10.3% of the variance in development   (β = -0.30, t = -2.66, p < 0.05). Infant social withdrawal   was not a significant predictor of behaviour   (β = 3.27, t = 1.36, p = 0.18), but it did uniquely explain 7% of the variance in development (β = -1.32, t = -2.48, p < 0.05).

CONCLUSION

In the context of HIV, screening for maternal depression and the quality of mother-infant interactions are important (especially in the 1st year post-partum), given the significant long-term impact they have on behaviour and neurodevelopment.

ABBREVIATIONS

ANOVA: analysis of variance; ART: antiretroviral therapy; CBCL: Child Behavioral Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; CHEI: children HIV-exposed and infected; CHER: Children with HIV Early Antiretroviral Treatment Trial; CHEU: children HIV-exposed and uninfected; CHUU: children HIV-unexposed and -uninfected; GMDS: Griffiths Mental Development Scales; HIV: human immunodeficiency virus; LMIC: low- and middle-income countries; m-ADBB: modified Alarm Distress Baby Scale; NRF: National Research Foundation; SAMRC: South African Medical Research Council; WHO: World Health Organization.

A meta-analytic review of parenting interventions in foster care and adoption

Foster and adoptive parents often face challenges while taking care of children who, due to their adverse early life experiences, are at risk of developing insecure attachment relationships, behavior problems, and stress dysregulation. Several intervention programs have been developed to help foster and adoptive parents to overcome these challenges. In the current study, a series of eight meta-analyses were performed to examine the effectiveness of these intervention programs on four parent outcomes (sensitive parenting, k = 11, N = 684; dysfunctional discipline, k = 4, N = 239; parenting knowledge and attitudes, k = 7, N = 535; parenting stress, k = 18, N = 1,306), three child outcomes (attachment security, k = 6, N = 395; behavior problems, k = 33, N = 2,661; diurnal cortisol levels, k = 3, N = 261), and placement disruption (k = 7, N = 1,100). Results show positive effects for the four parent outcomes and child behavior problems, but not for attachment security, child diurnal cortisol levels, or placement disruption. Indirect effects on child outcomes may be delayed, and therefore long-term follow-up studies are needed to examine the effects of parenting interventions on children.

Adult attachment representations and depressive symptoms: A meta-analysis

BACKGROUND

Attachment theory has long argued that insecure and disorganized attachment representations are associated with vulnerability to psychopathology in general, and depressive symptoms in particular. However, studies assessing the link between insecure and disorganized attachment and depressive symptoms report inconsistent results. The primary aim of this meta-analysis was to examine the extent to which adult attachment representations are associated with depressive symptoms.

METHODS

We conducted a literature search for published studies using PsycINFO, MEDLINE, and ProQuest in March 2017, identifying 55 samples (N = 4,386). Eligible studies assessed depression using a well-validated self-report or clinical diagnostic measure of depression and attachment using the Adult Attachment Interview.

RESULTS

Results demonstrated that insecure individuals had higher levels of depression than secure-autonomous individuals (d = 0.21, 95% CI [0.08-0.33]). Specifically, insecure-preoccupied individuals (d = 0.48, 95% CI [0.30-0.65]), but not insecure-dismissing individuals (d = 0.09, 95% CI [-0.03-0.22]), exhibited significantly more depressive symptoms than the secure-autonomous individuals. Additionally, unresolved adults had higher levels of depression than adults with organized attachment classifications (d = 0.29, 95% CI [0.13-0.44]).

LIMITATIONS

Due to the nature of the studies reviewed, causal inferences regarding the links found between adult attachment representations and depressive symptoms may not be drawn. Further, the aggregate effect sizes do not solely reflect the magnitude of the association between attachment representations and clinically-diagnosed major depressive disorder.

CONCLUSIONS

The results of this meta-analysis have important conceptual and practical implications for attachment-based prevention and intervention efforts, as they suggest that attachment representations, specifically insecure-preoccupied and unresolved, are associated with depressive symptoms in adulthood. Future research using longitudinal and intervention-based designs should examine the extent to which insecure-preoccupied and unresolved attachment lead to increased depressive symptoms, as well as the mechanisms by which these attachment patterns across the life span may increase vulnerability to depressive symptoms in adulthood.

IMPACT OF JOINT ATTENTION ON SOCIAL-COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long-term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months' postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow-up session 6 months' postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age-at-adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at-risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.