Maternal childhood maltreatment trauma resolution: Development of a novel narrative coding measure and implications for intergenerational parenting processes

Child maltreatment constitutes a significant environmental risk for children, with carryover effects into future generations. There is a need to characterize protective factors that may buffer against the intergenerational transmission of maltreatment. The current study addresses this gap through two primary aims: 1) the development and validation of a novel measure assessing resolution of maternal childhood maltreatment trauma using narrative coding methods and 2) the evaluation of maternal maltreatment trauma resolution as a buffering factor that may moderate associations between maternal neglect histories and sensitive parenting of offspring. Results of reliability analyses from this sample of 210 diverse, low-income mothers suggest the novel childhood maltreatment trauma resolution measure is highly reliable. Furthermore, results highlight the generalizability, criterion validity, and concurrent and predictive validity of the measure. Results from cross-sectional analyses show that trauma resolution moderates associations between maternal physical neglect histories and sensitive parenting, such that under high maternal trauma resolution, there is no longer a negative association between neglect histories and sensitive parenting. Results from longitudinal analyses also show a protective effect of maternal trauma resolution, such that trauma resolution has a protective-enhancing effect on maternal sensitivity. Implications for research and clinical practice with families are discussed.

Exploring Attachment and Internal Representations in Looked-After Children

BACKGROUND

This article explores the Story Stem Assessment Profile (SSAP), a narrative-based measure, for the assessment of internal representations in children between the ages of 4 and 11 years old.

METHODS

The findings draw upon two samples of children comprising of a sample of looked-after children at Five Rivers Child Care (FR) (n = 42) and a community-based population (n = 42). The FR group identified were suggested to have a higher level of need, as defined by scores obtained from the Strengths and Difficulties Questionnaire (SDQ) and Relationship Problems Questionnaire (RPQ).

RESULTS

Using the SSAP, the findings indicate the instrument's discriminant validity with strong differences being displayed between the two populations. Consistently children in the FR sample displayed more disorganized, avoidant and negative representations, whilst at the same time having significantly fewer representations characteristic of 'secure' attachment.

CONCLUSION

The SSAP is successful in differentiating between 'low' and 'high' cohorts of children aged 4-11 years. The study provides strong support for the measure as a way of capturing internal and attachment representations, with further research to explore possible changes in these representations at follow-up being promising and intriguing. Continued research efforts at FR will allow for improved clinical formulations, increased understanding and therefore positive outcomes relating to the children in their care.

A study of associations among attachment patterns, maltreatment, and behavior problem in institutionalized children in Japan

The present study investigates the relationships among children's history of maltreatment, attachment patterns, and behavior problems in Japanese institutionalized children. Twenty-nine children (12 boys and 17 girls) from three different institutions in the Kinki area (Western part of Japan) participated in this study. Their average age was 6. 41-years (ranging from 4 to 10). Thirteen of the children (44.8%) had history of maltreatment before they were institutionalized. Children's attachment was assessed by the Attachment Doll Play Assessment (George & Solomon, 1990, 1996, 2000). The child's main caregiver answered the Child Behavior Checklist (CBCL; Archenbach, 1991) to identify children's behavior problems. Results indicated a significant relationship between maltreatment history and attachment pattern. The relationship between attachment pattern and behavior problem was also confirmed. Implications and limitations of this study were discussed.

The Attachment Doll Play Assessment: Predictive Validity with Concurrent Mother-Child Interaction and Maternal Caregiving Representations

Attachment is central to the development of children’s regulatory processes. It has been associated with developmental and psychiatric health across the life span, especially emotional and behavioral regulation of negative affect when stressed (Schore, 2001; Schore and Schore, 2008). Assessment of attachment patterns provides a critical frame for understanding emerging developmental competencies and formulating treatment and intervention. Play-based attachment assessments provide access to representational models of attachment, which are regarded in attachment theory as the central organizing mechanisms associated with stability or change (Bowlby, 1969/1982; Bretherton and Munholland, 2008). The Attachment Doll Play Assessment (ADPA, George and Solomon, 1990–2016; Solomon et al., 1995) is a prominent established representational attachment measure for children aged early latency through childhood. This study examines the predictive validity of the ADPA to caregiving accessibility and responsiveness assessed from mother-child interaction and maternal representation. Sixty nine mothers and their 5–7-year-old children participated in this study. Mother-child interaction was observed during a pre-separation dyadic interaction task. Caregiving representations were rated from the Caregiving Interview (George and Solomon, 1988/1993/2005/2007). Child security with mother was associated with positive dyadic interaction and flexibly integrated maternal caregiving representations. Child controlling/disorganized attachments were significantly associated with problematic dyadic interaction and dysregulated-helpless maternal caregiving representations. The clinical implications and the use of the ADPA in clinical and educational settings are discussed.

Foundations of posttraumatic stress disorder: Does early life trauma lead to adult posttraumatic stress disorder?

The effects of childhood abuse are diverse, and although pathology is not the only outcome, psychiatric illness, including posttraumatic stress disorder (PTSD), can develop. However, adult PTSD is less common among those who experienced single-event traumas as children than it is among those who experienced childhood abuse. In addition, PTSD is more common among adults than children who experienced childhood abuse. Such evidence raises doubt about the direct, causal link between childhood trauma and adult PTSD. The experience of childhood trauma, and in particular abuse, has been identified as a risk factor for subsequent development of PTSD following exposure to adult trauma, and a substantial literature identifies revictimization as a factor that plays a pivotal role in this trajectory. The literature on the developmental effects of childhood abuse and pathways to revictimization, when considered in tandem with the biological effects of early stress in animal models, may provide some explanations for this. Specifically, it seems possible that permanent sensitization of the hypothalamic–pituitary–adrenal axis and behavioral outcomes are a consequence of childhood abuse, and these combine with the impact of retraumatization to sustain, perpetuate, and amplify symptomatology of those exposed to maltreatment in childhood.

Distinguishing neglect from abuse and accident: analysis of the case files of a hospital child protection team in Israel

The study compares the characteristics of children assessed as neglected, physically abused, or accident victims by a hospital child protection team (CPT) and identifies the information on which the CPT based its assessments. The comparison is based on content analysis of records of 414 children examined by the CPT in a major hospital in Israel between 1991 and 2006, of whom 130 (31.4%) were neglected, 54 (13.0%) were physically abused, and 230 (55.6%) were accident victims. Findings of three hierarchical logistic regressions show that the children classified as neglected had the most early development problems, but were the least likely to have received psychological treatment, and that that their families were the most likely to be receiving state financial support and to have had prior contact with the social services. They also show that the CPT had received the least information indicative of maltreatment about these children from the community and that their medical and physical examinations aroused the least suspicion. Finally, they show that the impressions the hospital staff and CPT had of the parents during the hospital visit had greater power to distinguish between the groups than the children's characteristics or the parents' socio-demographic background. The findings attest to the ability of the CPT to differentiate between neglect victims and physical abuse or accident victims. With this, they also point to ambiguities in the classification process that should be addressed by further research and training and to the need for detailed and thorough documentation of the information and observations on which the CPT's assessments are based.

Negative and atypical story content themes depicted by children with behaviour problems

BACKGROUND

Specific thematic content arising from children’s doll play is often considered to give clinically meaningful information regarding their mental state, but has received little systematic enquiry. This exploratory study examined the negative and atypical content themes in the attachment story narratives of children with behaviour problems, and their associations with child symptomatology and parental depressed mood.

METHOD

Videotaped mother-child attachment doll play completions of 77 children from a clinical sample were blind coded for negative content themes. Mothers completed questionnaires for maternal depression and child behaviour.

RESULTS

Children rating positive for behaviour disorder were more likely to represent maternal injury, role reversal and marked maternal sadness. Severe behavioural symptoms were associated with more pervasive negative themes. Half of the overall sample depicted child accidents and maternal unresponsiveness, whereas child aggression, child anger and maternal absence were rare. Girls with depressed mothers showed an absence of particular negative representations (e.g., child sadness) compared to boys.

CONCLUSIONS

Specific atypical themes are associated with the extent of child psychopathology and may be modified by exposure to maternal depressed mood. The methodological limitations in this exploratory study are also discussed.