Attachment representations in sexually abused preschoolers: a comparative study

Identifying PTSD and Complex PTSD Profiles in Child Victims of Sexual Abuse

Post-traumatic stress disorder (PTSD) symptoms are frequent in child victims of sexual abuse. Authors argued that early trauma could lead to alterations in development that go far beyond the primary symptoms of PTSD and have proposed that Complex PTSD (C-PTSD) involving alterations in attachment, biology, affect regulation, consciousness, behavioral regulation, cognition, and self-concept, may better describe children experiencing chronic trauma at an early developmental stage. The aim of the study was to disentangle the diversity of profiles in child victims of sexual abuse based on the C-PTSD framework. Latent profile analysis was used to identify distinct subgroups in a sample of 861 sexually abused children aged 6 to 12. Children and their non-offending parents completed questionnaires evaluating PTSD symptoms and measures documenting alterations in development characteristics of C-PTSD. Latent profile analysis identified a best-fitting model consisting of three profiles: PTSD (40.7% of children), Resilient (32.8% of children), and C-PTSD (26.5% of children). Compared to others, children in the C-PTSD profile were more likely to have experienced more forms of interpersonal trauma and showed impairments in several domains. Findings underscore the importance of tailoring interventions to efficiently address the needs of young victims of sexual trauma.

Preliminary Danish Norms for the Odense Child Trauma Screening (OCTS)

The Odense Child Trauma Screening (OCTS) is Danish story stem screening tool applicable for assessment of preschoolers and young children in risk of being traumatized. Having shown initial evidence of validation, Danish norms are needed to strengthen the clinical assessment with the OCTS by serving as a baseline comparison for assessment of potentially traumatized children. We tested 169 children from the Danish general population aged 4-8 with the OCTS and investigated sex and age differences in play-based behavior and narrative representations. Caregivers reported electronically on child demographic information, psychosocial functioning, and history of trauma exposure using The Strengths and Difficulties Questionnaire (SDQ) and The Diagnostic Infant and Preschool Assessment (DIPA) trauma list. Across the 145 scores of the OCTS coding scheme, significant sex and age differences were only found in five and sixteen scores respectively. In the five codes where significant sex differences were observed, boys' normative scores were higher. No significant sex differences were found in the partial story scores or the OCTS total score. Three significant age differences in partial story and OCTS total scores emerged with 4-year-olds scoring higher than 6-8-year-olds. We further found 13 significant age differences in code scores with higher scores among the youngest of the two groups in question suggesting that scores tend to decrease along older age. Few significant sex and age differences were found in children's OCTS play-based behavior and narrative representations. Indicative of few sex and age biases of the OCTS coding scheme and stories, results suggest that the OCTS can be applied across the intended target group of children aged 4 to 8 years. As higher scores were found in the younger age groups, clinicians should be attentive to age in certain codes of the OCTS coding scheme in their assessment of children in clinical practice. The preliminary normative scores must be interpreted and clinically applied with caution due to our non-representative sample and lack of analyses on factors potentially influencing children's responses to the OCTS (e.g., developmental, contextual, cultural factors).

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-024-00616-7.

Latent classes in preschoolers' internal working models of attachment and emotional security: Roles of family risk

Children's relationships inform their internal working models (IWMs) of the world around them. Attachment and emotional security theory (EST) emphasize the importance of parent-child and interparental relationships, respectively, for IWM. The current study examined (a) data-driven classes in child attachment and emotional security IWM, (b) associations between IWM classes and demographic variables, maltreatment, intimate partner violence (IPV), and maternal depressive symptoms, and (c) consistency in attachment and emotional security IWM classes, including as a function of maltreatment, IPV, and maternal depressive symptoms. Participants were 234 preschool-aged children (n = 152 experienced maltreatment and n = 82 had not experienced maltreatment) and their mothers. Children participated in a narrative-based assessment of IWM. Mothers reported demographics, IPV, and maternal depressive symptoms. Latent class analyses revealed three attachment IWM classes and three emotional security IWM classes. Maltreatment was associated with lower likelihood of being in the secure attachment class and elevated likelihood of being in the insecure dysregulated attachment class. Inconsistencies in classification across attachment and emotional security IWM classes were related to maltreatment, IPV, and maternal depressive symptoms. The current study juxtaposes attachment and EST and provides insight into impacts of family adversity on children's IWM across different family relationships.

Effects of intellectual disability and attachment on hostile intent attribution bias

Understanding hostile intent attribution (HIA) seems important for prevention of problems in social adaptation. This study aimed to explore whether HIA in childhood is determined by both a cognitive factor (i.e. intellectual disability) and an affective factor (i.e. attachment representations). One hundred and eight 8- to 12-year-old children (54 with intellectual disability and 54 with typical development) passed the Attachment Story Completion Task and the Intention Attribution Test for Children. Results indicated that in ambiguous situations, attachment disorganization was associated with HIA, whereas intellectual disability was not. In nonintentional situations, both attachment hyperactivation and intellectual disability were linked with HIA. These results highlight the importance of helping children develop organized attachment representations and optimal activation of their attachment system to prevent social maladaptation.

Attachment representations among school-age children with intellectual disability

BACKGROUND

Research data documenting a high risk of insecure and disorganized attachment among children with intellectual disability (ID) in infancy and early childhood raises the question of mutual influences between ID and attachment in later childhood.

AIMS

The objectives of the present study were to examine attachment among school-age children with ID and whether attachment varies according to level of intellectual functioning, adaptative functioning, and presence of a genetic syndrome (i.e. Down syndrome).

METHODS

Attachment among 54 children with ID aged 8-12 years (30 with Down Syndrome, 24 with non-specific ID) was assessed using the Attachment Story Completion Task, and compared with that of 108 typically developing children, 54 of the same chronological age and 54 of the same mental age.

OUTCOMES

Results show (1) less security among children with ID than among same-age controls (2) more disorganization among children with ID compared to the two control groups, (3) a link between attachment disorganization and level of adaptive functioning among children with ID and (4) no difference in attachment between children with DS and children with non-specific ID.

CONCLUSIONS

Children with ID remain vulnerable to disorganization during late childhood. More research is needed to understand the factors underlying disorganized attachment representations.

Disorganized attachment and emotion dysregulation as mediators of the association between sexual abuse and dissociation in preschoolers

BACKGROUND

Child sexual abuse (CSA) is a prevalent social problem associated with a plethora of difficulties in preschool children. Young victims are likely to show dissociation symptoms that may significantly impede their adaptation. Yet, mechanisms linking CSA with later dissociative symptoms remain unclear. The aim of the present study was to explore whether disorganized attachment and emotion dysregulation could act as mediators of the association between CSA and dissociation.

METHODS

A sample of 424 preschool children (274 CSA victims, 150 comparison group children; 3.5-6 years old) and their parents were recruited. Parents reported on children's emotion dysregulation at initial assessment while attachment representations were assessed through children's narratives using the Attachment Story Completion Task (Bretherton et al., 1990) coded with the Q-Sort (Miljkovitch et al., 2004). Parents reported on children's dissociative symptoms one year later.

RESULTS

Mediation analysis showed that disorganized attachment and emotion dysregulation mediated the association between CSA and dissociation. CSA was linked to greater disorganization scores that were associated with higher scores of emotion dysregulation. Emotion dysregulation was in turn associated with increased severity of dissociation symptoms in preschool children one year later.

LIMITATIONS

Given that attachment and emotion dysregulation were both assessed at T1, the temporal sequencing of mediators remains to be validated in a longitudinal design.

CONCLUSIONS

Findings highlight the relevance of fostering healthy parent-child relationships, as well as the development of optimal emotion regulation skills in young CSA victims to prevent the emergence of dissociation symptoms in this vulnerable population.