Attachment styles in maltreated children: a comparative study

Risk and protective factors for substance use and media addictive behaviors in adolescents during the COVID-19 pandemic

OBJECTIVE

This study examined the long-term effects of the COVID-19 pandemic on adolescents' substance use, digital media use, and symptoms of internet, gaming, and social media addiction.

METHOD

A nationally representative longitudinal cohort of 1665 Israeli teens and preteens, aged 9-16, completed questionnaires assessing substance use prevalence, daily screen time, symptoms of media addiction, and potential risk and protective factors. Data were collected before the pandemic (October 2019), after the second wave lockdown (November 2020), and after the fifth wave (April 2022) in Israel.

RESULTS

The analysis documented significant increases in substance use, daily screen time, and social media addiction indices over time. Gratitude, life satisfaction, positive emotions, future orientation, grit, and secure attachment emerged as significant protective factors. Sensation-seeking, negative emotions, and mental health symptoms were identified as risk factors.

CONCLUSIONS

These findings highlight the importance of educational and public mental health services in addressing the pandemic's long-term impact on the mental health and addictive behaviors of adolescents. They also emphasize the significance of enhancing protective factors and reducing risk factors to effectively mitigate substance and digital media abuse among adolescents.

Job Burnout Among the Helping Professions: The Roles of Childhood Maltreatment, Attachment Styles and Perceived Supervisor Support

Job burnout is a major predicament globally, especially among the helping professions. Based on the job demands-resources (JDR) theory and on attachment theory, this study explored the relations between a history of childhood maltreatment (CM), insecure attachment styles (avoidant and anxious), perceived supervisor support and job burnout. A sample of 320 helping professionals participated in the study, of which 35% reported experiencing CM. Findings confirmed the hypothesis that a history of CM was positively related to both avoidant and anxious attachment styles. Anxious attachment style partly mediated the relationship between CM and burnout. In addition, the relationship between CM and burnout was mediated by avoidant attachment style and perceived supervisor support, so that highly avoidant professionals perceived their supervisors as less supportive, reporting higher levels of burnout. Notably, there were no discernible variations in burnout levels when comparing professionals who had experienced maltreatment with those who had not. The study highlights the value of adopting an attachment perspective to better understand job burnout among the helping professions.

Chronic oxytocin administration stimulates the oxytocinergic system in children with autism

Clinical efficacy of intranasal administration of oxytocin is increasingly explored in autism spectrum disorder, but to date, the biological effects of chronic administration regimes on endogenous oxytocinergic function are largely unknown. Here exploratory biological assessments from a completed randomized, placebo-controlled trial showed that children with autism (n = 79, 16 females) receiving intranasal oxytocin for four weeks (12 IU, twice daily) displayed significantly higher salivary oxytocin levels 24 hours after the last oxytocin nasal spray administration, but no longer at a four-week follow up session. Regarding salivary oxytocin receptor gene (OXTR) epigenetics (DNA-methylation), oxytocin-induced reductions in OXTR DNA-methylation were observed, suggesting a facilitation of oxytocin receptor expression in the oxytocin compared to the placebo group. Notably, heightened oxytocin levels post-treatment were significantly associated with reduced OXTR DNA-methylation and improved feelings of secure attachment. These findings indicate that four weeks of chronic oxytocin administration stimulated the endogenous oxytocinergic system in children with autism.

Effects of multiple-dose intranasal oxytocin administration on social responsiveness in children with autism: a randomized, placebo-controlled trial

BACKGROUND

Intranasal administration of oxytocin is increasingly explored as a new approach to facilitate social development and reduce disability associated with a diagnosis of autism spectrum disorder (ASD). The efficacy of multiple-dose oxytocin administration in children with ASD is, however, not well established.

METHODS

A double-blind, randomized, placebo-controlled trial with parallel design explored the effects of a 4-week intranasal oxytocin administration (12 IU, twice daily) on parent-rated social responsiveness (Social Responsiveness Scale: SRS-2) in pre-pubertal school-aged children (aged 8-12 years, 61 boys, 16 girls). Secondary outcomes included a questionnaire-based assessment of repetitive behaviors, anxiety, and attachment. Effects of oxytocin were assessed immediately after the administration period and at a follow-up, 4 weeks after the last administration. The double-blind phase was followed by a 4-week single-blind phase during which all participants received intranasal oxytocin.

RESULTS

In the double-blind phase, both the oxytocin and placebo group displayed significant pre-to-post-improvements in social responsiveness and secondary questionnaires, but improvements were not specific to the intranasal oxytocin. Notably, in the single-blind phase, participants who were first allocated to intranasal placebo and later changed to intranasal oxytocin displayed a significant improvement in social responsiveness, over and above the placebo-induced improvements noted in the first phase. Participants receiving oxytocin in the first phase also showed a significant further improvement upon receiving a second course of oxytocin, but only at the 4-week follow-up. Further, exploratory moderator analyses indicated that children who received psychosocial trainings (3 or more sessions per month) along with oxytocin administration displayed a more pronounced improvement in social responsiveness.

LIMITATIONS

Future studies using larger cohorts and more explicitly controlled concurrent psychosocial trainings are warranted to further explore the preliminary moderator effects, also including understudied populations within the autism spectrum, such as children with co-occurring intellectual disabilities.

CONCLUSIONS

Four weeks of oxytocin administration did not induce treatment-specific improvements in social responsiveness in school-aged children with ASD. Future studies are warranted to further explore the clinical efficacy of oxytocin administration paired with targeted psychosocial trainings that stimulate socio-communicative behaviors. Trial registration The trial was registered with the European Clinical Trial Registry (EudraCT 2018-000769-35) on June 7th, 2018 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2018-000769-35/BE ).

Adaptación y validación argentina de la Cross Cultural Children Trust Beliefs Scale

El estudio de la confianza interpersonal es crucial para el desarrollo psicosocial humano. Se ha observado que, durantela niñez, favorece el comportamiento moral y prosocial, los vínculos de amistad, la competencia social, la experienciade emociones positivas y el rendimiento académico, entre otros aspectos. El presente trabajo tuvo por objetivo adaptar yvalidar la Cross Cultural Children Trust Beliefs Scale (ccctbs), a fin de poder evaluar este constructo en población argentina. La muestra incluyó 348 niños (51.2% mujeres; 48.8% varones), de entre 8 y 12 años de edad (m = 10.58; de = 1.31),quienes completaron la ccctbs y una escala de apego. Se consiguió una versión conceptual y semánticamente equivalentea la original, con buenas propiedades psicométricas. La escala argentina conserva el mismo número de ítems y replica elmodelo operacional de partida, constituido por tres bases principales de la confianza: fiabilidad (α = .76; ω = .80), confianzaemocional (α = .72; ω = .78) y honestidad (α = .78; ω = .83). Las puntuaciones de la ccctbs correlacionaron positiva ysignificativamente con la medida de apego seguro, lo que aporta evidencias de su validez nomológica.

Antisocial and borderline personality traits and childhood trauma in male prisoners: Mediating effects of difficulties in emotional regulation

OBJECTIVE

To investigate the prevalence of probable antisocial personality disorder (ASPD) and borderline personality disorder (BPD) among prisoners, and further examine the mediating effect of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and BPD.

METHODS

A total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and suicidal behaviors were measured by self-administered structured questionnaires. Logistic regressions were performed to investigate the associations of ASPD and BPD with suicidal behaviors. Path analysis was used to examine the mediating effects of difficulties in ER between childhood trauma and symptoms of ASPD and BPD.

RESULT

Approximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD, respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors. Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the dimensions of clarity, impulse, and strategies on BPD.

CONCLUSION

ASPD and BPD are two of the common personality disorders in prisoners. Difficulties in ER are key to understanding the relationships between childhood trauma and personality disorders.

Attachment and the Development of Prosocial Behavior in Children and Adolescents: A Systematic Review

(1) Background: One key assumption of attachment theory is the relationship between security and the development of prosocial behavior. A secure child is more likely to feel and show concern for another individual, resulting in higher levels of prosocial behaviors (defined as voluntary behavior intended to benefit others—e.g., helping, sharing, comforting). (2) Method: Using a systematic review of the literature (PROSPERO: CRD42022290706), 703 articles were identified (EBSCO databases), from which 16 were considered eligible by the first two authors (inter-reviewer agreement: 85.714%). The criteria for an article’s exclusion were as follows: samples of children/teens not living in natural contexts; studies on psychopathologies; intervention programs; qualitative designs; studies on development or the validation of measures; studies that did not reliably measure the variables studied. (3) Results and Discussion: The eligible studies revealed incongruous results about the potential associations between attachment security to mothers and fathers and prosocial behavior. More consistent and significant relationships were found between the quality of attachment and empathy, while the associations between attachment and prosocial behavior were inconsistent (e.g., nine articles revealed significant associations; seven did not). In six studies, empathy was revealed to play an important role as the mediator between attachment security and prosocial behavior. The limitations and future recommendations were discussed.

Revisión y análisis psicométrico de la Escala de Confianza interpersonal para niños argentinos

En el año 2004, Sacchi publicó una escala para evaluar la confianza interpersonal en niños y niñas argentinos (ESCI-niños). Su trabajo constituyó la primera iniciativa realizada en el país para abordar el estudio sistemático de esta variable que resulta crucial para el desempeño social saludable. No obstante, los resultados psicométricos preliminares no fueron completamente adecuados y la autora sugirió retomar su análisis en futuras investigaciones. Así, el objetivo del presente trabajo fue revisar y analizar psicométricamente la ESCI-niños a fin de aportar nuevas evidencias de su confiabilidad y validez. Primeramente, se reemplazó la escala de respuesta Si-No por una de cinco puntos, y se eliminaron los ítems de relleno. En segundo lugar, se administró el instrumento a 343 niños y niñas (M= 10,93; DE= 1,24), estudiantes desde cuarto a séptimo grado de la escolaridad primaria en la provincia de Misiones, Argentina. El Análisis Factorial Exploratorio indicó una estructura binaria “Confianza-Desconfianza”. Cada factor incluye 8 ítems y presenta una consistencia interna admisible para población infantil (ω Confianza= .69; ω Desconfianza= .67). Para estudiar la validez nomológica, la ESCI-niños fue correlacionada con una medida de apego, observándose relaciones significativas entre Confianza y Apego Seguro (r = .27; p < .001), y entre Desconfianza y estilos de Apego Evitativo (r = .32; p < .001) y Ansioso/Ambivalente (r = .32; p < .001). Se concluye que la ESCI-niños muestra un funcionamiento aceptable en población infantil argentina, aunque sería recomendable continuar explorando otras propiedades psicométricas. Se discuten limitaciones y orientaciones para futuros estudios

Haben radikalisierte Personen Zugang zu psychotherapeutischer Unterstützung?

Hintergrund

Im Zusammenhang mit extremistischer Gewalt wird häufig die Rolle von Psychotherapeuten in der Prävention und Früherkennung von Radikalisierung diskutiert, insbesondere um ungünstige Entwicklungsverläufe bei jungen Menschen zu verhindern. Bislang fehlen Studien, die radikalisierte Personen nach ihren Kontakten mit Psychotherapeuten befragen. Fragestellung der Studie war daher, ob radikalisierte Personen Zugang zu psychotherapeutischer Unterstützung oder zu anderen Hilfesystemen haben, und ob es dafür in ihrem Leben Anknüpfungspunkte gegeben hat bzw. hätte.

Material und Methode

Zur Beantwortung der Frage wurden mit 7 jungen Erwachsenen, die von Fachkräften als „radikalisiert“ eingeschätzt wurden, leitfadengestützte Interviews durchgeführt. Diese wurden im Anschluss inhaltsanalytisch ausgewertet.

Ergebnisse

Es zeigt sich, dass die Befragten bislang kaum bis gar keinen Kontakt mit Psychotherapeuten hatten. Gleichzeitig fanden sich bei den Probanden hohe Belastungen durch ungünstige und größtenteils traumatische Kindheitserlebnisse, bei denen eine therapeutische Intervention wahrscheinlich hilfreich gewesen wäre. Aufseiten der Probanden wird der eigene Hilfebedarf erkannt. Es besteht allerdings große Skepsis gegenüber therapeutischen Hilfen.

Schlussfolgerung

Es wird diskutiert, wie radikalisierte Personen einen besseren Zugang zu psychotherapeutischen Hilfen erhalten könnten, beispielsweise durch eine bessere Vernetzung und Zuweisungspraxis der verschiedenen Hilfesysteme. Zudem wird diskutiert, wie Betroffene mehr Vertrauen in das Hilfesystem gewinnen können. Die Ergebnisse dieser Pilotstudie basieren auf einer kleinen Stichprobe, weshalb weitere Arbeiten zum Thema sich trotz des erheblich limitierten Zugangs zu entsprechenden Probanden anschließen sollten.

Attachment Style Classification Questionnaire for latency age: Psychometrics properties of Argentine Sample

The purpose of this article was to perform a psychometric study of the Attachment Style Classification Questionnaire (ASCQ) in Spanish language. This paper included three studies. The objectives of study 1 were to analyze the discriminative power of items, to carry out an EFA to determine the structure of the questionnaire, and to calculate the internal consistency of factors. The objectives of study 2 were to test the questionnaire structure through a CFA, and to determine if the model obtained was invariant between sex and age. The objective of Study 3 was to study the convergent validity. The three studies were carried out with three different samples of 180, 200, and 425 Argentinian children, aged 9 to 12 years, respectively. The results confirm the three factor structure of the adapted questionnaire, showing good psychometric properties (satisfactory internal consistency and adequate validity).

A qualitative exploration of the experiences of adoptive parents attending 'Nurturing Attachments', a dyadic developmental psychotherapy informed group

Children who are adopted have frequently experienced a range of aversive experience which impact on their ability to form secure attachments. Dyadic Developmental Psychotherapy (DDP) is an intervention designed to develop and promote secure attachments with children who have experienced developmental trauma. Eight adoptive parents participated in semi-structured interviews regarding their experiences of attending the 'Nurturing Attachment' group informed by DDP. The transcripts of their interviews were explored using Interpretative Phenomenological Analysis. The analysis revealed five inter-connected superordinate themes which were as follows: A supportive group, A shift in perspective, 'Turning trauma into secure attachment', 'Am I doing it right?' and Continuing the adoption journey. Themes are considered in relation to the theoretical underpinnings and practice of DDP. Some further implications for clinical and research practice are also discussed.

Efficacy or Chaos? Parent-Child Interaction Therapy in Maltreating Populations: A Review of Research

Child abuse remains a serious and expensive social problem in the United States. Few evidence-based treatments (EBTs) exist for at-risk families and/or maltreating families where neglect or abuse has occurred, limiting the ability of social service agencies to comply with legislative mandates to use EBTs with clients. One promising intervention, parent-child interaction therapy (PCIT), has been tested in 11 separate trials with this population. This review of research on PCIT with abusive adults found that overall PCIT is an appropriate, efficacious intervention method to prevent future maltreatment by targeting parenting skills and child externalizing behaviors. These findings must be taken with caution, since the key factor to determine efficacy is completion of treatment, and all the studies involved showed significant problems with sample attrition. While the current studies are promising, there is a need for research that focuses on measuring parental sensitivity and attachment levels, explores use in the foster and adoptive communities, and studies that use tertiary subjects to serve as unbiased reporters of perceived levels of behavioral changes.

Early life maltreatment but not lifetime depression predicts insecure attachment in women

Early life maltreatment (ELM) poses a risk for the development of insecure attachment and depression over the life span, depending on the type of maltreatment (physical, sexual, emotional, neglect) and its severity. The aim of this study was to investigate the influence of ELM and lifetime depression on adult insecure attachment in a female sample (N = 188), consisting of n = 81 women with ELM and n = 107 without ELM. Women with ELM reported significantly higher scores on insecure attachment than women without ELM. A significant interaction effect for ELM × lifetime depression was found: Contradictory to the hypotheses, women with ELM but without lifetime depression scored highest on avoidant attachment, differing significantly from women with ELM and lifetime depression, even though the severity of ELM was higher among women with ELM and lifetime depression and they experienced significantly more severe neglect and sexual abuse, but not physical or emotional abuse. Regression analyses revealed that ELM was the only predictor of avoidant attachment, explaining 15.5% of the variance. Results underline the strong influence of ELM on adult attachment and are of special importance for prevention and intervention programs.

Predictors of Clinical Outcomes in Sexually Abused Adolescents

This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.

Biologic effects of stress and bonding in mother-infant pairs

OBJECTIVE

Maternal stress in humans influences behavior of children and can be assessed using biological markers. Mothers and their one-month-old infants were recruited from an existing study to examine baseline maternal serum oxytocin and hypothalamic-pituitary-adrenal axis response to infant blood heel stick stress as measured by salivary cortisol in the dyads. Objectives were to explore (1) relationships between mother and infant cortisol levels, (2) gender differences in infant biologic cortisol response, and (3) the association of cortisol levels in the dyads and maternal oxytocin levels

METHODS

Forty-two mother-infant dyads provided biologic samples and self-report data. Maternal oxytocin samples were obtained. Initial salivary cortisol was assessed in both the mother and infant, followed by a heel stick blood draw. Twenty minutes later, salivary cortisol was collected again from dyads.

RESULTS

Self-report measures were negative for depression and risk for childhood neglect. Although oxytocin and baseline cortisol in the infants was higher in mothers that did some breast-feeding, there was no statistically significant difference (p = 0.2 and p = 0.1, respectively). Analyses showed (a) higher baseline cortisol in mothers was related to higher baseline cortisol in infants (p ≤ 0.0001), (b) following the stressor, female infants had a larger positive change in cortisol, after adjusting for baseline cortisol (p = 0.045), and (c) there was no relationship between dyad cortisol levels and maternal oxytocin.

CONCLUSIONS

Maternal and infant biologic stress measures are related. Female infants have a larger hypothalamic-pituitary-adrenal response to a blood draw stressor as measured by salivary cortisol than male infants.

The role of attachment in the relationship between child maltreatment and later emotional and behavioral functioning

The experience of childhood maltreatment is an important predictor of unfavorable emotional and behavioral outcomes. Because little research examined explanatory variables in the relationship between childhood maltreatment experiences and later outcomes, this study examined the role that attachment serves in this relationship. Four hundred twenty-four participants completed questionnaires assessing the variables of interest for this study. Results indicated that both childhood maltreatment experiences (particularly emotional abuse) and attachment (particularly to mothers and peers) are significant predictors of later emotional and behavioral outcomes. Further, attachment contributed unique and significant variance to the relationship between childhood maltreatment experiences and later outcomes. Such findings suggested that secure attachment may serve as a protective factor against maladaptive emotional and behavioral outcomes as children reach emerging adulthood, even in the context of childhood maltreatment experiences. The importance of studying the relationships among these variables is discussed.

Resting-state functional connectivity in adults with childhood emotional maltreatment

BACKGROUND

Childhood emotional maltreatment (CEM) has been associated with disturbances in emotional and behavioral functioning, and with changes in regional brain morphology. However, whether CEM has any effect on the intrinsic organization of the brain is not known. In this study, we investigated the effects of CEM on resting-state functional connectivity (RSFC) using seeds in the limbic network, the default-mode network (DMN) and the salience network, and the left dorsomedial prefrontal cortex (dmPFC). Method Using 3-T magnetic resonance imaging (MRI), resting-state functional MRI (RS-fMRI) scans were obtained. We defined seeds in the bilateral amygdala, the dorsal anterior cingulate cortex (dACC), the posterior cingulate cortex (PCC) and the left dmPFC, and used these to examine whether individuals reporting CEM (n=44) differed from individuals reporting no CEM (n=44) in RSFC with other brain regions. The two groups were matched for age, gender, handedness and the presence of psychopathology.

RESULTS

CEM was associated with decreased RSFC between the right amygdala and the bilateral precuneus and a cluster extending from the left insula to the hippocampus and putamen. In addition, CEM was associated with decreased RSFC between the dACC and the precuneus and also frontal regions of the brain.

CONCLUSIONS

We found that CEM has a profound effect on RSFC in the limbic network and the salience network. Regions that show aberrant connectivity are related to episodic memory encoding, retrieval and self-processing operations.

A prospective study on personality and the cortisol awakening response to predict posttraumatic stress symptoms in response to military deployment

Few prospective studies on pre-trauma predictors for subsequent development of posttraumatic stress disorder (PTSD) have been conducted. In this study we prospectively investigated whether pre-deployment personality and the cortisol awakening response (CAR) predicted development of PTSD symptoms in response to military deployment. Furthermore, we hypothesized that potential effects of age, childhood trauma and previous deployment on development of PTSD symptoms were mediated via pre-deployment personality, CAR and PTSD symptoms. Path analysis was performed on data from 470 male soldiers collected before and six months after a 4-month deployment to Afghanistan. Before deployment, personality was assessed with the short-form Temperament-Character Inventory and the Cook-Medley Hostility scale. In addition, pre-deployment saliva sampling for assessment of the CAR was performed immediately after awakening and 15, 30 and 60min thereafter. Pre-deployment high hostility and low self-directedness represented intrinsic vulnerabilities for development of PTSD symptoms after deployment. The CAR assessed before deployment did not predict PTSD symptoms after deployment. Pre-deployment low-to-moderate PTSD symptoms were associated with PTSD symptoms after deployment. As hypothesized, the effects of age and childhood trauma on PTSD symptoms after deployment were mediated via personality and pre-deployment PTSD symptoms. However, the number of previous deployments was not related to development of PTSD symptoms. The total model explained 24% of variance in PTSD symptoms after military deployment.

Recognizing and managing long-term sequelae of childhood maltreatment

Childhood maltreatment is a serious public health problem and represents a significant challenge to pediatricians. Maltreated children present with a variety of emotional and behavioral problems. Pediatricians should screen for risk factors associated with maltreatment and psychiatric sequelae associated with maltreatment. Because of the complexity of psychiatric sequelae in childhood maltreatment, children who have been maltreated will likely require multidisciplinary treatment in mental health care settings. Therefore, pediatricians need to be knowledgeable about mental health services in their communities and actively assist the family in obtaining services. Although we are gaining a more sophisticated understanding of the impact that maltreatment has on the mental health of children and adolescents, much remains to be done. It is critical for pediatricians to work within their professional organizations and their individual communities to address the systemic issues that create barriers to care for patients who have suffered maltreatment. It is also critical for pediatricians to encourage their professional organizations to establish good working relationships with other organizations in areas where they share interest, need, and commitment. Such collaborative relationships at local, state, and national levels can facilitate governmental policy changes that are needed to protect and care for children and adolescents. Only through such efforts can we bring about lasting changes that will support the health and well-being of children and adolescents.