Effects of an attachment-based intervention on daily cortisol moderated by dopamine receptor D4: A randomized control trial on 1- to 3-year-olds screened for externalizing behavior

Developmental cascades from early childhood attachment security to adolescent level of personality functioning among high-risk youth

This study examines associations between early childhood attachment security and adolescent personality functioning in a high-risk sample within a developmental psychopathology framework. Data from 2,268 children (1165 male; 1103 female) and caregivers participating in Future of Families and Child Well-Being Study (FFCWS) were used to examine (1) effects of genetic polymorphisms of the serotonin transporter (5-HTTLPR) and dopamine D4 receptor (DRD4) genes and adverse childhood experiences (ACEs) on attachment security and emotional and behavioral dysregulation in early childhood and (2) longitudinal associations and transactional relationships among attachment security, dysregulation, negative parenting attitudes and behaviors, social competence, and adolescent personality functioning. Results revealed that ACEs predicted attachment security over and above sex or the genetic risk, and gene × environment interactions did not increment prediction. Results of cascade models showed that greater early childhood attachment security predicted higher adolescent level of personality functioning via pathways through intermediary variables. Limitations and future research directions are discussed.

Conduct Problems and Hair Cortisol Concentrations Decrease in School-Aged Children after VIPP-SD: A Randomized Controlled Trial in Two Twin Cohorts

The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) is effective in increasing parental sensitivity and sensitive discipline, and aims to decrease child behavior problems. Changes in quality of parenting may be accompanied by effects on child stress levels. However, studies of VIPP-SD effects on child behavior problems have shown mixed results and there are no studies to date of the effect of the intervention on children's stress levels, as measured by hair cortisol concentration (HCC). Furthermore, differences in intervention effectiveness may be explained by differential susceptibility factors. We hypothesized that the effects of the VIPP-SD on child behavior problems might be moderated by currently available child polygenic scores of differential susceptibility (PGS-DS). In the current pre-registered trial, we randomly assigned 40% of n = 445 families with school-aged twin children to the intervention group. The VIPP-SD was successful in decreasing both children's conduct problems and HCC. Effects were not moderated by available child PGS-DS. We conclude that a brief, home-based video-feedback parenting intervention can decrease child behavior problems and affect the child's stress-related neuroendocrine system as assessed with hair cortisol. In future studies, more specific PGS-DS for externalizing behaviors should be used as well as parental PGS-DS.

Adolescents hospitalised for suicidality: biomarkers, social and affective predictors: a cohort study

OBJECTIVES

The present research examines genomics and in vivo dynamics of family context and experienced affect following discharge from psychiatric hospitalisation for suicidal thoughts and behaviours (STBs). The purpose of this paper is to provide an overview of a new model, description of model-guided integration of multiple methods, documentation of feasibility of recruitment and retention and a description of baseline sample characteristics.

DESIGN

The research involved a longitudinal, multimethod observational investigation.

SETTING

Participants were recruited from an inpatient child and adolescent psychiatric hospital. 194 participants ages 13-18 were recruited following hospitalisation for STB.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants underwent a battery of clinical interviews, self-report assessments and venipuncture. On discharge, participants were provided with a phone with (1) the electronically activated recorder (EAR), permitting acoustic capture later coded for social context, and (2) ecological momentary assessment, permitting assessment of in vivo experienced affect and STB. Participants agreed to follow-ups at 3 weeks and 6 months.

RESULTS

A total of 71.1% of approached patients consented to participation. Participants reported diversity in gender identity (11.6% reported transgender or other gender identity) and sexual orientation (47.6% reported heterosexual or straight sexual orientation). Clinical interviews supported a range of diagnoses with the largest proportion of participants meeting criteria for major depressive disorder (76.9%). History of trauma/maltreatment was prevalent. Enrolment rates and participant characteristics were similar to other observational studies.

CONCLUSIONS

The research protocol characterises in vivo, real-world experienced affect and observed family context as associated with STB in adolescents during the high-risk weeks post discharge, merging multiple fields of study.

Early attachment networks to multiple caregivers: History, assessment models, and future research recommendations

Early attachment has been commonly hypothesized to predict children's future developmental outcomes, and robust evidence relying on assessments of single caregiver-child attachment patterns has corroborated this hypothesis. Nevertheless, most often children are raised by multiple caregivers, and they tend to form attachment bonds with more than one of them. In this paper, we briefly describe the conceptual and empirical roots underlying the notion of attachment networks to multiple caregivers. We detail potential reasons for research focusing on a single caregiver (most often mothers, but recently also fathers) and the historical attempts to establish a more ecologically valid assessment of attachment to multiple caregivers. Finally, we describe a recently developed organizational framework that includes testable models on which future research may rely for assessing the predictive power of attachment networks to multiple caregivers on children's developmental outcomes.

The ATTACH™ program and immune cell gene expression profiles in mothers and children: A pilot randomized controlled trial

Background

Children exposed to adversity and toxic stress are at increased risk for poor health across the lifespan, possibly through alterations to immune pathways. Parenting interventions could buffer the effect of adversity on child immune activity. The purpose of this study was to test whether mothers and children who were randomly assigned to a parenting intervention (ATTACH™) had healthier post-intervention immune cell gene expression patterns, as indexed by the Conserved Transcriptional Response to Adversity (CTRA), compared with mothers and children in a wait-list control group.

Methods

A sample of 20 mother-child dyads were recruited from a domestic violence shelter in Calgary, AB, Canada. The ATTACH™ program is a 10-week psycho-educational intervention that fosters maternal reflective function, i.e. how to understand and respond to mental states. Dyads were randomly assigned to an intervention or wait-list group. Dried blood spots were collected from both groups post-intervention, subjected to RNA sequencing, and assessed for CTRA gene expression using mixed effect linear model analysis. Covariates were age, child sex, maternal race/ethnicity, and maternal medication use.

Results

In unadjusted models, differences by treatment group were detected, F(1,1794) ​= ​4.26, p ​= ​.039. Mothers and children who completed the ATTACH™ intervention had lower CTRA scores, indicating healthier immune cell gene expression profiles (Mn ​= ​−0.36, SE ​= ​0.17), compared with mothers and children in the wait-list control group (Mn ​= ​0.11, SE ​= ​0.15). Results persisted after controlling for covariates.

Discussion

ATTACH™ participation predicted healthier immune cell gene expression profiles post-intervention compared with wait-list controls. Parenting interventions could decrease the impact of toxic stress on maternal-child immune health.

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The ATTACH™ program is a reflective function parenting intervention.

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The ATTACH™ program predicted healthier immune cell gene expression in children.

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The ATTACH™ program predicted healthier immune cell gene expression in mothers.

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The ATTACH™ program could protect the health of families escaping domestic violence.

A bioecocultural approach to supporting adolescent mothers and their young children in conflict-affected contexts

An estimated 12 million girls aged 15-19 years, and 777,000 girls younger than 15 give birth globally each year. Contexts of war and displacement increase the likelihood of early marriage and childbearing. Given the developmentally sensitive periods of early childhood and adolescence, adolescent motherhood in conflict-affected contexts may put a family at risk intergenerationally. We propose that the specifics of normative neuroendocrine development during adolescence, including increased sensitivity to stress, pose additional risks to adolescent girls and their young children in the face of war and displacement, with potential lifelong consequences for health and development. This paper proposes a developmental, dual-generational framework for research and policies to better understand and address the needs of adolescent mothers and their small children. We draw from the literature on developmental stress physiology, adolescent parenthood in contexts of war and displacement internationally, and developmental cultural neurobiology. We also identify culturally meaningful sources of resilience and provide a review of the existing literature on interventions supporting adolescent mothers and their offspring. We aim to honor Edward Zigler's groundbreaking life and career by integrating basic developmental science with applied intervention and policy.

Three phases of Gene × Environment interaction research: Theoretical assumptions underlying gene selection

Some Gene × Environment interaction (G×E) research has focused upon single candidate genes, whereas other related work has targeted multiple genes (e.g., polygenic scores). Each approach has informed efforts to identify individuals who are either especially vulnerable to the negative effects of contextual adversity (diathesis stress) or especially susceptible to both positive and negative contextual conditions (differential susceptibility). A critical step in all such molecular G×E research is the selection of genetic variants thought to moderate environmental influences, a subject that has not received a great deal of attention in critiques of G×E research (beyond the observation of small effects of individual genes). Here we conceptually distinguish three phases of G×E work based on the selection of genes presumed to moderate environmental effects and the theoretical basis of such decisions: (a) single candidate genes, (b) composited (multiple) candidate genes, and (c) GWAS-derived polygenic scores. This illustrative, not exhaustive, review makes it clear that implicit or explicit theoretical assumptions inform gene selection in ways that have not been clearly articulated or fully appreciated.

Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis

BACKGROUND

Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results.

METHODS

In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day.

RESULTS

A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found.

CONCLUSION

Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.

Maternal care of heterozygous dopamine receptor D4 knockout mice: Differential susceptibility to early-life rearing conditions

The differential susceptibility hypothesis proposes that individuals who are more susceptible to the negative effects of adverse rearing conditions may also benefit more from enriched environments. Evidence derived from human experiments suggests the lower efficacy dopamine receptor D4 (DRD4) 7‐repeat as a main factor in exhibiting these for better and for worse characteristics. However, human studies lack the genetic and environmental control offered by animal experiments, complicating assessment of causal relations. To study differential susceptibility in an animal model, we exposed Drd4^+/− mice and control litter mates to a limited nesting/bedding (LN), standard nesting (SN) or communal nesting (CN) rearing environment from postnatal day (P) 2‐14. Puberty onset was examined from P24 to P36 and adult females were assessed on maternal care towards their own offspring. In both males and females, LN reared mice showed a delay in puberty onset that was partly mediated by a reduction in body weight at weaning, irrespective of Drd4 genotype. During adulthood, LN reared females exhibited characteristics of poor maternal care, whereas dams reared in CN environments showed lower rates of unpredictability towards their own offspring. Differential susceptibility was observed only for licking/grooming levels of female offspring towards their litter; LN reared Drd4^+/− mice exhibited the lowest and CN reared Drd4^+/− mice the highest levels of licking/grooming. These results indicate that both genetic and early‐environmental factors play an important role in shaping maternal care of the offspring for better and for worse.

Video feedback for parental sensitivity and attachment security in children under five years

BACKGROUND

Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals.

OBJECTIVES

To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes.

SEARCH METHODS

In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.

Mother–infant cortisol attunement: Associations with mother–infant attachment disorganization

This study explores the conceptualization of mother–infant cortisol attunement both theoretically and empirically, and its association with mother–infant attachment disorganization. In a community sample (N = 256), disorganization and cortisol were assessed during the Strange Situation Procedure (SSP) at infant age 17 months. Salivary cortisol was collected at baseline, and 20 and 40 min after the SSP. We utilized three statistical approaches: correlated growth modeling (probing a simultaneous conceptualization of attunement), cross-lagged modeling (probing a lagged, reciprocal conceptualization of attunement), and a multilevel model difference score analysis (to examine the pattern of discrepancies in mother–infant cortisol values). Correlated growth modeling revealed that disorganized, relative to organized, dyads had significant magnitude of change over time, such that, among disorganized dyads, as mothers had greater declines in cortisol, infants had greater increases. The difference score analysis revealed that disorganized, relative to organized, dyads had a greater divergence between maternal and infant cortisol values, such that maternal values were lower than infant values. Disorganized attachment status was not significantly associated with attunement when conceptualized as reciprocal and lagged in the cross-lagged model. Findings suggest that mother–infant dyads in disorganized attachment relationships, who are by definition behaviorally misattuned, are also misattuned in their adrenocortical responses.

Early life predictors of callous-unemotional and psychopathic traits

Psychopathy is a disorder that occurs primarily in males. Offenders with psychopathic traits are responsible for a disproportionate amount of crime in society, particularly violent crime. Early childhood is a time when individual differences in empathy and guilt-key indicators of the construct of psychopathy-are first evident. A growing number of longitudinal studies have begun to investigate how factors in infancy and early childhood predict psychopathic-like traits in later childhood, adolescence, and adulthood. These studies have suggested that parenting styles during infancy (parental sensitivity, maternal harsh intrusion, commenting on the emotional state of the child) as well as attachment styles are predictive of later psychopathic-like traits. In addition, child characteristics such as temperament and the functioning of biological systems such as the autonomic nervous system and hypothalamic-pituitary-adrenal axis are predictive. Overall, studies have suggested that at least some of the origins of psychopathic traits are present in infancy and early childhood, which is consistent with the perspective of psychopathy as a neurodevelopmental disorder. A recent evolutionary-developmental model provides hypotheses regarding how psychopathy may develop and why it is more common in males than females. This model, and its implications for intervention, is discussed in the context of the longitudinal studies that have been conducted on psychopathy.

Genomics, Big Data, and Broad Consent: a New Ethics Frontier for Prevention Science

Emerging technologies for analyzing biospecimens have led to advances in understanding the interacting role of genetics and environment on development and individual responsivity to prevention and intervention programs. The scientific study of gene-environment influences has also benefited from the growth of Big Data tools that allow linking genomic data to health, educational, and other information stored in large integrated datasets. These advances have created a new frontier of ethical challenges for scientists as they collect, store, or engage in secondary use of potentially identifiable information and biospecimens. To address challenges arising from technological advances and the expanding contexts in which potentially identifiable information and biospecimens are collected and stored, the Office of Human Research Protections has revised federal regulations for the protection of human subjects. The revised regulations create a new format, content, and transparency requirements for informed consent, including a new mechanism known as broad consent. Broad consent offers participants a range of choices regarding consent for the storage and future use of their personally identifiable data. These regulations have important implications for how prevention scientists and oversight boards acquire participant consent for the collection, storage, and future use of their data by other investigators for scientific purposes significantly different from the original study. This article describes regulatory changes and challenges affecting traditional informed consent for prevention research, followed by a description of the rationale and requirements for obtaining broad consent, and concludes with a discussion of future challenges involving ongoing transparency and protections for participants and their communities.

Association between maternal childhood maltreatment and mother-infant attachment disorganization: Moderation by maternal oxytocin receptor gene and cortisol secretion

This study examined maternal oxytocin receptor (OXTR, rs53576) genotype and cortisol secretion as moderators of the relation between maternal childhood maltreatment history and disorganized mother-infant attachment in the Strange Situation Procedure (SSP). A community sample of 314 mother-infant dyads completed the SSP at infant age 17 months. Self-reported maltreatment history more strongly predicted mother-infant attachment disorganization score and disorganized classification for mothers with more plasticity alleles of OXTR (G), relative to mothers with fewer plasticity alleles. Maltreatment history also more strongly predicted mother-infant attachment disorganization score and classification for mothers with higher SSP cortisol secretion, relative to mothers with lower SSP cortisol secretion. Findings indicate that maltreatment history is related to disorganization in the next generation, but that this relation depends on maternal genetic characteristics and cortisol.

Methylation matters: FK506 binding protein 51 (FKBP5) methylation moderates the associations of FKBP5 genotype and resistant attachment with stress regulation

The parent-child attachment relationship plays an important role in the development of the infant's stress regulation system. However, genetic and epigenetic factors such as FK506 binding protein 51 (FKBP5) genotype and DNA methylation have also been associated with hypothalamus-pituitary-adrenal axis functioning. In the current study, we examined how parent-child dyadic regulation works in concert with genetic and epigenetic aspects of stress regulation. We study the associations of attachment, extreme maternal insensitivity, FKBP5 single nucleotide polymorphism 1360780, and FKBP5 methylation, with cortisol reactivity to the Strange Situation Procedure in 298 14-month-old infants. The results indicate that FKBP5 methylation moderates the associations of FKBP5 genotype and resistant attachment with cortisol reactivity. We conclude that the inclusion of epigenetics in the field of developmental psychopathology may lead to a more precise picture of the interplay between genetic makeup and parenting in shaping stress reactivity.

A process model of the implications of spillover from coparenting conflicts into the parent-child attachment relationship in adolescence

Drawing on a two-wave, multimethod, multi-informant design, this study provides the first test of a process model of spillover specifying why and how disruptions in the coparenting relationship influence the parent-adolescent attachment relationship. One hundred ninety-four families with an adolescent aged 12-14 (M age = 12.4) were followed for 1 year. Mothers and adolescents participated in two experimental tasks designed to elicit behavioral expressions of parent and adolescent functioning within the attachment relationship. Using a novel observational approach, maternal safe haven, secure base, and harshness (i.e., hostility and control) were compared as potential unique mediators of the association between conflict in the coparenting relationship and adolescent problems. Path models indicated that, although coparenting conflicts were broadly associated with maternal parenting difficulties, only secure base explained the link to adolescent adjustment. Adding further specificity to the process model, maternal secure base support was uniquely associated with adolescent adjustment through deficits in adolescents' secure exploration. Results support the hypothesis that coparenting disagreements undermine adolescent adjustment in multiple domains specifically by disrupting mothers' ability to provide a caregiving environment that supports adolescent exploration during a developmental period in which developing autonomy is a crucial stage-salient task.

Attachment and Biobehavioral Catch-up: Addressing the Needs of Infants and Toddlers Exposed to Inadequate or Problematic Caregiving

Parental sensitivity is key to the development of brain architecture, self-regulatory capabilities, and secure, organized attachments for infants and young children. For a variety of reasons, many parents struggle providing sensitive, responsive care. Attachment and Biobehavioral Catch-up (ABC) is a 10-session home visiting program developed to enhance parental sensitivity. ABC has been shown effective in enhancing parental sensitivity, and enhancing children's attachment security and regulatory capabilities. A key feature of the intervention is providing parents practice and feedback in interacting sensitively with their children. Effectiveness in dissemination sites has been impressive, likely because treatment fidelity is defined well and monitored carefully.

Afternoon cortisol provides a link between self-regulated anger and peer-reported aggression in typically developing children in the school context

Aggression jeopardizes positive development in children and predicts social and academic maladjustment in school. The present study determined the relationships among anger dysregulation (a marker of emotion regulation), cortisol activity (a biomarker of stress), and peer-nominated aggression in typically developing children in their everyday classroom setting (N = 151, Mean age = 10.86, SD =.74). Salivary cortisol was collected at 09:15, 11:45, and 14:45 hr across 4 consecutive days. Children provided self-reports of anger regulation; peers reported proactive and reactive aggressive behaviors. Hierarchical linear regression analyses, followed by a bootstrapping analysis identified basal afternoon cortisol as a significant mediator between anger regulation and peer-reported aggression. More dysregulated anger significantly predicted lower afternoon cortisol, which in turn predicted increased peer-reported aggression. These results align with previous research on links among hypocortisolism, emotional regulation, and behavior, and suggest a possible meditational pathway between emotion and behavior regulation via decreased afternoon cortisol levels.

Effects of bonding with parents and home culture on intercultural adaptations and the moderating role of genes

In the current age of globalization, living abroad is becoming an increasingly common and highly sought after experience. Sojourners' ability to adjust to a new culture can be affected by their existing attachments, internalized as intrapsychic environment, as well as their biological sensitivity to environment. This sensitivity can be partly attributed to one's genomic endowments. As such, this prospective study sought to examine the differential effects of early experiences with parents and affection for home culture on young adults' ability to adapt to a foreign culture (n=305, students who studied overseas for a semester) - specifically, the difficulties they experience - moderated by genetic susceptibility. An additional 258 students who did not travel overseas were included as a comparison group to demonstrate the uniqueness of intercultural adaptation. Current findings suggest that the maternal, paternal and cultural bondings or affections affect different aspects of intercultural adjustment. Maternal bonding affected sojourners' relationships with host nationals, while paternal bonding affected sojourners' adjustment to a new physical environment. Moreover, individuals' genetic predispositions significantly moderate these main effects regarding how much difficulty the sojourners experienced overseas.

Poverty, early care, and stress reactivity in adolescence: Findings from a prospective, longitudinal study in South Africa

A considerable body of evidence suggests that early caregiving may affect the short-term functioning and longer term development of the hypothalamic-pituitary-adrenocortical axis. Despite this, most research to date has been cross-sectional in nature or restricted to relatively short-term longitudinal follow-ups. More important, there is a paucity of research on the role of caregiving in low- and middle-income countries, where the protective effects of high-quality care in buffering the child's developing stress regulation systems may be crucial. In this paper, we report findings from a longitudinal study (N = 232) conducted in an impoverished periurban settlement in Cape Town, South Africa. We measured caregiving sensitivity and security of attachment in infancy and followed children up at age 13 years, when we conducted assessments of hypothalamus-pituitary-adrenocortical axis reactivity, as indexed by salivary cortisol during the Trier Social Stress Test. The findings indicated that insecure attachment was predictive of reduced cortisol responses to social stress, particularly in boys, and that attachment status moderated the impact of contextual adversity on stress responses: secure children in highly adverse circumstances did not show the blunted cortisol response shown by their insecure counterparts. Some evidence was found that sensitivity of care in infancy was also associated with cortisol reactivity, but in this case, insensitivity was associated with heightened cortisol reactivity, and only for girls. The discussion focuses on the potentially important role of caregiving in the long-term calibration of the stress system and the need to better understand the social and biological mechanisms shaping the stress response across development in low- and middle-income countries.

Which neural mechanisms mediate the effects of a parenting intervention program on parenting behavior: design of a randomized controlled trial

BACKGROUND

The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) has proven effective in increasing parental sensitivity. However, the mechanisms involved are largely unknown. In a randomized controlled trial we examine parental neurocognitive factors that may mediate the intervention effects on parenting behavior. Our aims are to (1) examine whether the intervention influences parents' neural processing of children's emotional expressions and the neural precursors of response inhibition and to (2) test whether neural changes mediate intervention effects on parenting behavior.

METHODS

We will test 100 mothers of 4-6 year old same-sex twins. A random half of the mothers will receive the VIPP-SD Twins (i.e. VIPP-SD adapted for twin families), consisting of 5 home visits in a 3-months period; the other half will receive a dummy intervention. Neurocognitive measures are acquired approximately 2 weeks before and 2 weeks after the intervention. Mothers' electroencephalographic (EEG) activity is measured while performing a stop signal task and in response to children's facial expressions. To obtain a complementary behavioral measure, mothers also perform an emotion recognition task. Parenting behavior will be assessed during parent-child interactions at pre and post intervention lab visits.

DISCUSSION

Our results will shed light on the neurocognitive factors underlying changes in parenting behavior after a parenting support program, which may benefit the development of such programs.

TRIAL REGISTRATION

Dutch Trial Register: NTR5312 ; Date registered: January 3, 2017.

Social-learning parenting intervention research in the era of translational neuroscience

In the decades since social learning parenting interventions emerged, many evidence-based programs have been implemented at scale in community settings, and much research is now focusing on ways to maintain fidelity and impact during the implementation process. Notably, a considerable amount of theoretical confluence has occurred in parenting interventions from social learning, attachment, and other theoretical perspectives, with parent coaching as an example of this new generation of relational interventions. In addition, research examining the neurobiological effects of early adverse experiences is providing insight into key mediating and moderating mechanisms underlying the effectiveness of social learning parenting interventions, and new strategies for tailoring interventions to the needs of specific populations are being developed, making interventions more efficient, precise, and effective.

Vulnerability or Sensitivity to the Environment? Methodological Issues, Trends, and Recommendations in Gene-Environment Interactions Research in Human Behavior

Research on the potential role of gene-environment interactions (GxE) in explaining vulnerability to psychopathology in humans has witnessed a shift from a diathesis-stress perspective to differential susceptibility approaches. This paper critically reviews methodological issues and trends in this body of research. Databases were screened for studies of GxE in the prediction of personality traits, behavior, and mental health disorders in humans published between January 2002 and January 2015. In total, 315 papers were included. Results showed that 34 candidate genes have been included in GxE studies. Independent of the type of environment studied (early or recent life events, positive or negative environments), about 67-83% of studies have reported significant GxE interactions, which is consistent with a social susceptibility model. The percentage of positive results does not seem to differ depending on the gene studied, although publication bias might be involved. However, the number of positive findings differs depending on the population studied (i.e., young adults vs. older adults). Methodological considerations limit the ability to draw strong conclusions, particularly as almost 90% (n = 283/315) of published papers are based on samples from North America and Europe, and about 70% of published studies (219/315) are based on samples that were also used in other reports. At the same time, there are clear indications of methodological improvements over time, as is shown by a significant increase in longitudinal and experimental studies as well as in improved minimum genotyping. Recommendations for future research, such as minimum quality assessment of genes and environmental factors, specifying theoretical models guiding the study, and taking into account of cultural, ethnic, and lifetime perspectives, are formulated.

Serotonin transporter linked polymorphic region (5-HTTLPR) genotype moderates the longitudinal impact of early caregiving on externalizing behavior

We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly created high-quality foster care. At baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by the serotonin transporter linked polymorphic region genotype and intervention group, where the slope for short-short (S/S) individuals differed as a function of intervention group. The slope for individuals carrying the long allele did not significantly differ between groups. At 54 months of age, S/S children in the foster care group had the lowest levels of externalizing behavior, while children with the S/S genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the long allele. These findings, within a randomized controlled trial of foster care compared to continued care as usual, indicate that the serotonin transporter linked polymorphic region genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility.

Randomized Video-Feedback Intervention in Home-Based Childcare: Improvement of Children's Wellbeing Dependent on Time Spent with Trusted Caregiver

Background

The childcare environment offers a wide array of developmental opportunities for children. Providing children with a feeling of security to explore this environment is one of the most fundamental goals of childcare.

Objective

In the current study the effectiveness of Video-feedback Intervention to promote Positive Parenting-Child Care (VIPP-CC) was tested on children’s wellbeing in home-based childcare in a randomized controlled trial.

Methods

Forty-seven children and their caregivers were randomly assigned to the intervention group or control group. Children’s wellbeing, caregiver sensitivity, and global childcare quality were observed during a pretest and a posttest.

Results

We did not find an overall intervention effect on child wellbeing, but a significant interaction effect with months spent with a trusted caregiver was present. Children who were less familiar with the caregiver showed an increase in wellbeing scores in both the intervention and control group, but for the group of children who were more familiar with the caregiver, wellbeing increased only in the intervention group.

Conclusions

Although there was no overall effect of the VIPP-CC on children’s wellbeing, the VIPP-CC seems effective in children who have been cared for by the same trusted caregiver for a longer period of time.

Translating Genetic Research into Preventive Intervention: The Baseline Target Moderated Mediator Design

In this paper we present and discuss a novel research approach, the baseline target moderated mediation (BTMM) design, that holds substantial promise for advancing our understanding of how genetic research can inform prevention research. We first discuss how genetically informed research on developmental psychopathology can be used to identify potential intervention targets. We then describe the BTMM design, which employs moderated mediation within a longitudinal study to test whether baseline levels of intervention targets moderate the impact of the intervention on change in that target, and whether change in those targets mediates causal impact of preventive or treatment interventions on distal health outcomes. We next discuss how genetically informed BTMM designs can be applied to both microtrials and full-scale prevention trials. We use simulated data to illustrate a BTMM, and end with a discussion of some of the advantages and limitations of this approach.

Differential Susceptibility of the Developing Brain to Contextual Adversity and Stress

A swiftly growing volume of literature, comprising both human and animal studies and employing both observational and experimental designs, has documented striking individual differences in neurobiological sensitivities to environmental circumstances within subgroups of study samples. This differential susceptibility to social and physical environments operates bidirectionally, in both adverse and beneficial contexts, and results in a minority subpopulation with remarkably poor or unusually positive trajectories of health and development, contingent upon the character of environmental conditions. Differences in contextual susceptibility appear to emerge in early development, as the interactive and adaptive product of genetic and environmental attributes. This paper surveys what is currently known of the mechanisms or mediators of differential susceptibility, at the levels of temperament and behavior, physiological systems, brain circuitry and neuronal function, and genetic and epigenetic variation. It concludes with the assertion that differential susceptibility is inherently grounded within processes of biological moderation, the complexities of which are at present only partially understood.

DRD2 and SLC6A3 moderate impact of maternal depressive symptoms on infant cortisol

Both maternal depressive symptoms and infants' dopamine-related genetic characteristics have been linked to infants' hypothalamic-pituitary-adrenal (HPA) functioning. This study investigated the interactive influence of maternal depressive symptoms and infant DRD2 and SLC6A3 genotypes on infant cortisol reactivity; whether this interaction reflects diathesis-stress or differential susceptibility; and whether this interaction influences the flexibility of the infant cortisol response across challenges known to exert differential effects on infant cortisol reactivity. A community sample of 314 mother-infant dyads participated in toy frustration (age 16 months) and maternal separation (age 17 months) challenges, and salivary cortisol was collected at baseline, +20, and +40min. Maternal depressive symptoms were assessed with the Beck Depression Inventory-II at infant age 16 months. Infant buccal cells were collected at both time points for genotyping. DRD2 and SLC6A3 genotypes moderated the relation between maternal depressive symptomatology and infant cortisol reactivity in a diathesis-stress manner in the context of toy frustration, and in a differential susceptibility manner in the context of maternal separation. Higher levels of maternal depressive symptoms predicted reduced cortisol flexibility across challenges for infants with at least one A1 allele of DRD2 and infants with the 10/10 genotype of SLC6A3. Results suggest that maternal depressive symptomatology is related to infants' cortisol reactivity and to the flexibility of that reactivity across psychosocial challenges, but this relation is dependent on the infant's genetic characteristics.

Sibling genes as environment: Sibling dopamine genotypes and adolescent health support frequency dependent selection

While research consistently suggests siblings matter for individual outcomes, it remains unclear why. At the same time, studies of genetic effects on health typically correlate variants of a gene with the average level of behavioral or health measures, ignoring more complicated genetic dynamics. Using National Longitudinal Study of Adolescent Health data, we investigate whether sibling genes moderate individual genetic expression. We compare twin variation in health-related absences and self-rated health by genetic differences at three locations related to dopamine regulation and transport to test sibship-level cross-person gene-gene interactions. Results suggest effects of variation at these genetic locations are moderated by sibling genes. Although the mechanism remains unclear, this evidence is consistent with frequency dependent selection and suggests much genetic research may violate the stable unit treatment value assumption.

Differential susceptibility to environmental influences: Interactions between child temperament and parenting in adolescent alcohol use

Temperament and parental practices (PP) are important predictors of adolescent alcohol use (AU); however, less is known about how they combine to increase or decrease risk of AU. This study examined whether age 6 temperament (i.e., impulsivity and inhibitory control) interacted with age 6 coercive PP and/or age 14 parental monitoring to predict AU at 15 years among 209 adolescents. Results showed that low parental monitoring was associated with more frequent AU and that coercive PP interacted with impulsivity to predict AU. This interaction was examined as a function of two models that were not studied before in the prediction of AU: the diathesis-stress model (i.e., impulsive children are more "vulnerable" to adverse PP than those with an easy temperament); and the differential susceptibility model (i.e., impulsive children are also more likely to benefit from good PP). Results supported the differential susceptibility model by showing that impulsive children were not only at higher risk for AU when combined with high coercive PP but also benefit from the absence of coercive PP. This supports the suggestion that the conception of certain temperament characteristics, or in this case impulsivity, as a "vulnerability" for adolescent AU, may need revision because it misrepresents the malleability it may imply.

Interparental Relationship Sensitivity Leads to Adolescent Internalizing Problems: Different Genotypes, Different Pathways

Several studies have established that child interparental conflict evaluations link parent relationship functioning and adolescent adjustment. Using differential susceptibility theory and its vantage sensitivity complement as their framework, the authors examined differences between adolescents who vary in the DRD4 7 repeat genotype (i.e. 7+ vs. 7-) in how both interparental conflict and positivity affect adolescents' evaluations of interparental conflict (i.e., threat appraisals) and how these evaluations affect internalizing problems. Results from longitudinal multiple-group path models using PROSPER data (N = 452) supported the hypothesis that threat appraisals for 7+ adolescents would be more affected by perceptions of interparental positivity compared to 7- adolescents; however, threat appraisals for 7+ adolescents were also less affected by interparental conflict. Among 7- adolescents, interparental conflict perceptions were associated with higher threat appraisals, and no association was found for perceptions of positivity. For adolescents of both genotypes, higher threat was associated with greater internalizing problems.

Topical Review: The Emerging Field of Epigenetics: Informing Models of Pediatric Trauma and Physical Health

OBJECTIVE

Trauma experienced during childhood and adolescence has been linked to a number of chronic medical concerns. We highlight major findings from the pediatric trauma literature to provide a model for understanding this association.

METHODS

Studies examining the effects of trauma were systematically reviewed and synthesized into a model proposing a central role for epigenetics in the ways that childhood experiences can affect health.

RESULTS

Early hypothalamic pituitary adrenal (HPA) axis response may impact initial trauma experience, with downstream effects on posttrauma adjustment reflected in posttrauma neurobiology, psychological health, and physical health.

CONCLUSIONS

Prospective research with children and adolescents exposed to trauma is needed to better characterize the genetic and epigenetic influences on the course of HPA and immune processes as related to posttrauma psychological and physical health outcomes.

An attachment-based intervention for parents of adolescents at risk: mechanisms of change

Mechanisms that account for treatment effects are poorly understood. The current study examined processes that may underlie treatment outcomes of an attachment-based intervention (Connect) for parents of pre-teens and teens with serious behavior problems. Parents (N = 540) in a non-randomized trial reported on their teen's functioning prior to and following treatment. Results confirmed significant decreases in parents' reports of teens' externalizing and internalizing symptoms, replicating prior evaluations of this program. Reductions in parents' reports of teen attachment avoidance were associated with decreases in externalizing symptoms, while reductions in parents' reports of teen attachment anxiety were associated with decreases in internalizing symptoms. Parents' reports of improved teen affect regulation were also associated with decreases in both internalizing and externalizing symptoms. Results were comparable across gender and for parents of teens with pre-treatment externalizing symptoms in the clinical versus sub-clinical range. A model of therapeutic change in attachment-based parenting programs is discussed.

Developmental differences in early adolescent aggression: a gene × environment × intervention analysis

Aggression-related problems such as assault and homicide among adolescents and young adults exact considerable social and economic costs. Although progress has been made, additional research is needed to help combat this persistent problem. Several lines of research indicate that parental hostility is an especially potent predictor of adolescent aggression, although most longitudinal research has focused on clarifying the direction of effects. In this study, we used longitudinal data from the PROSPER project (N = 580; 54.8% female), a primarily rural Caucasian preventative intervention sample, to examine developmental change in early- to mid-adolescent aggressive behavior problems (age 11-16 years). In addition, we examined maternal hostility as a predictor of developmental change in aggression and the PROSPER preventative intervention, designed to reduce substance use and aggression, as a potential influence on this association. Lastly, several studies indicate that variation in the DRD4 7-repeat gene moderates both parenting and intervention influences on externalizing behavior. Accordingly, we examined the potential moderating role of DRD4. As hypothesized, there was a significant maternal hostility by intervention interaction indicating that the intervention reduced the negative impact of maternal hostility on adolescent change in aggressive behavior problems. DRD4 7-repeat status (7+ vs. 7-) further conditioned this association whereby control group 7+ adolescents with hostile mothers showed increasing aggressive behavior problems. In contrast, aggression decreased for 7+ adolescents with similarly hostile mothers in the intervention. Implications for prevention are discussed as well as current perspectives in candidate gene-by-environment interaction research.

Neurobiological changes after intervention in individuals with anti-social behaviour: a literature review

BACKGROUND

A neurobiological perspective has become accepted as a valuable approach for understanding anti-social behaviour. There is literature to suggest that, in non-offending populations, psychological treatments affect both neurobiological measures and clinical presentation. A theoretical position to this effect has been adopted with respect to offender treatment, but there has been no systematic review of empirical literature on this point.

AIMS

This study aimed to ascertain from published literature firstly whether there is evidence of change in neuropsychological or physiological measures after behavioural treatments/programmes for people with anti-social behaviour and secondly whether these neurobiological changes are associated with behavioural change.

METHOD

A systematic search strategy was formulated to include studies considering 'neurobiological factors', 'anti-social population', 'treatment' and 'treatment outcome'. The Maryland Scientific Methods Scale was used to select relevant studies of sufficient methodological quality.

RESULTS

Eleven studies were found, only one with adults. Overall, the values of specific neurobiological risk factors, particularly of basal cortisol, become less abnormal following intervention. There was some evidence for a link between change in neurobiological functioning and behavioural improvement.

CONCLUSIONS

Findings, although provisional, may provide new insights into the underlying mechanisms of interventions for anti-social behaviour. Future studies that include pre-treatment neurobiological assessment could help reveal physical vulnerabilities that interventions should target to improve treatment efficacy, and provide for objective, independent corroboration of change.

Parent-infant psychotherapy for improving parental and infant mental health

BACKGROUND

Parent-infant psychotherapy (PIP) is a dyadic intervention that works with parent and infant together, with the aim of improving the parent-infant relationship and promoting infant attachment and optimal infant development. PIP aims to achieve this by targeting the mother's view of her infant, which may be affected by her own experiences, and linking them to her current relationship to her child, in order to improve the parent-infant relationship directly.

OBJECTIVES

1. To assess the effectiveness of PIP in improving parental and infant mental health and the parent-infant relationship.2. To identify the programme components that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g. programme duration, programme focus).

SEARCH METHODS

We searched the following electronic databases on 13 January 2014: Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 1), Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS Citation Index, Science Citation Index, ERIC, and Sociological Abstracts. We also searched the metaRegister of Controlled Trials, checked reference lists, and contacted study authors and other experts.

SELECTION CRITERIA

Two review authors assessed study eligibility independently. We included randomised controlled trials (RCT) and quasi-randomised controlled trials (quasi-RCT) that compared a PIP programme directed at parents with infants aged 24 months or less at study entry, with a control condition (i.e. waiting-list, no treatment or treatment-as-usual), and used at least one standardised measure of parental or infant functioning. We also included studies that only used a second treatment group.

DATA COLLECTION AND ANALYSIS

We adhered to the standard methodological procedures of The Cochrane Collaboration. We standardised the treatment effect for each outcome in each study by dividing the mean difference (MD) in post-intervention scores between the intervention and control groups by the pooled standard deviation. We presented standardised mean differences (SMDs) and 95% confidence intervals (CI) for continuous data, and risk ratios (RR) for dichotomous data. We undertook meta-analysis using a random-effects model.

MAIN RESULTS

We included eight studies comprising 846 randomised participants, of which four studies involved comparisons of PIP with control groups only. Four studies involved comparisons with another treatment group (i.e. another PIP, video-interaction guidance, psychoeducation, counselling or cognitive behavioural therapy (CBT)), two of these studies included a control group in addition to an alternative treatment group. Samples included women with postpartum depression, anxious or insecure attachment, maltreated, and prison populations. We assessed potential bias (random sequence generation, allocation concealment, incomplete outcome data, selective reporting, blinding of participants and personnel, blinding of outcome assessment, and other bias). Four studies were at low risk of bias in four or more domains. Four studies were at high risk of bias for allocation concealment, and no study blinded participants or personnel to the intervention. Five studies did not provide adequate information for assessment of risk of bias in at least one domain (rated as unclear).Six studies contributed data to the PIP versus control comparisons producing 19 meta-analyses of outcomes measured at post-intervention or follow-up, or both, for the primary outcomes of parental depression (both dichotomous and continuous data); measures of parent-child interaction (i.e. maternal sensitivity, child involvement and parent engagement; infant attachment category (secure, avoidant, disorganised, resistant); attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and secondary outcomes (e.g. infant cognitive development). The results favoured neither PIP nor control for incidence of parental depression (RR 0.74, 95% CI 0.52 to 1.04, 3 studies, 278 participants, low quality evidence) or parent-reported levels of depression (SMD -0.22, 95% CI -0.46 to 0.02, 4 studies, 356 participants, low quality evidence). There were improvements favouring PIP in the proportion of infants securely attached at post-intervention (RR 8.93, 95% CI 1.25 to 63.70, 2 studies, 168 participants, very low quality evidence); a reduction in the number of infants with an avoidant attachment style at post-intervention (RR 0.48, 95% CI 0.24 to 0.95, 2 studies, 168 participants, low quality evidence); fewer infants with disorganised attachment at post-intervention (RR 0.32, 95% CI 0.17 to 0.58, 2 studies, 168 participants, low quality evidence); and an increase in the proportion of infants moving from insecure to secure attachment at post-intervention (RR 11.45, 95% CI 3.11 to 42.08, 2 studies, 168 participants, low quality evidence). There were no differences between PIP and control in any of the meta-analyses for the remaining primary outcomes (i.e. adverse effects), or secondary outcomes.Four studies contributed data at post-intervention or follow-up to the PIP versus alternative treatment analyses producing 15 meta-analyses measuring parent mental health (depression); parent-infant interaction (maternal sensitivity); infant attachment category (secure, avoidant, resistant, disorganised) and attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and infant cognitive development. None of the remaining meta-analyses of PIP versus alternative treatment for primary outcomes (i.e. adverse effects), or secondary outcomes showed differences in outcome or any adverse changes.We used the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to rate the overall quality of the evidence. For all comparisons, we rated the evidence as low or very low quality for parental depression and secure or disorganised infant attachment. Where we downgraded the evidence, it was because there was risk of bias in the study design or execution of the trial. The included studies also involved relatively few participants and wide CI values (imprecision), and, in some cases, we detected clinical and statistical heterogeneity (inconsistency). Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes.

AUTHORS' CONCLUSIONS

Although the findings of the current review suggest that PIP is a promising model in terms of improving infant attachment security in high-risk families, there were no significant differences compared with no treatment or treatment-as-usual for other parent-based or relationship-based outcomes, and no evidence that PIP is more effective than other methods of working with parents and infants. Further rigorous research is needed to establish the impact of PIP on potentially important mediating factors such as parental mental health, reflective functioning, and parent-infant interaction.

Neurobiological factors as predictors of cognitive-behavioral therapy outcome in individuals with antisocial behavior: a review of the literature

This review focuses on the predictive value of neurobiological factors in relation to cognitive-behavioral therapy outcome among individuals with antisocial behavior. Ten relevant studies were found. Although the literature on this topic is scarce and diverse, it appears that specific neurobiological characteristics, such as physiological arousal levels, can predict treatment outcome. The predictive value of neurobiological factors is important as it could give more insight into the causes of variability in treatment outcome among individuals with antisocial behavior. Furthermore, results can contribute to improvement in current treatment selection procedures and to the development of alternative treatment options.

Parenting quality in drug-addicted mothers in a therapeutic mother-child community: the contribution of attachment and personality assessment

Growing evidence shows that attachment is a key risk factor for the diagnosis and treatment of clinical diseases in Axis I, such as drug addiction. Recent literature regarding attachment, psychiatric pathology, and drug addiction demonstrates that there is a clear prevalence of insecure attachment patterns in clinical and drug addicted subjects. Specifically, some authors emphasize that the anxious-insecure attachment pattern is prevalent among drug-addicted women with double diagnosis (Fonagy et al., 1996). The construct of attachment as a risk factor in clinical samples of drug-addicted mothers needs to be studied more in depth though. The present explorative study focused on the evaluation of parenting quality in a therapeutic mother-child community using attachment and personality assessment tools able to outline drug-addicted mothers' profiles. This study involved 30 drug addicted mothers, inpatients of a therapeutic community (TC). Attachment representations were assessed via the Adult Attachment Interview; personality diagnosis and symptomatic profiles were performed using the Structured Clinical Interview of the DSM-IV (SCID-II) and the Symptom Check List-90-R (SCL-90-R), respectively. Both instruments were administered during the first six months of residence in a TC. Results confirmed the prevalence of insecure attachment representations (90%), with a high presence of U patterns, prevalently scored for dangerous and/or not protective experiences in infanthood. Very high values (>5) were found for some experience scales (i.e., neglect and rejection scales). Data also showed very low values (1-3) in metacognitive monitoring, coherence of transcript and coherence of mind scales. Patients' different profiles (U vs. E vs. Ds) were linked to SCID-II diagnosis, providing insightful indications both for treatment planning and intervention on parenting functions and for deciding if to start foster care or adoption proceedings for children.