The significance of early parent-child attachment for emerging regulation: A longitudinal investigation of processes and mechanisms from toddler age to preadolescence.

Eisenberg, Cumberland, and Spinrad (1998; Eisenberg, Spinrad, & Cumberland, 1998) included parent-child attachment as a key dimension of the early emotion socialization environment. We examined processes linking children's early attachment with social regulation and adjustment in preadolescence in 102 community mothers, fathers, and children. Security of attachment, assessed at 2 years, using observers' Attachment Q-Set (Waters, 1987), was posited as a significant, although indirect, predictor of children's adaptive social regulation at 10 and 12 years. We proposed that security initiated paths to future social regulation by promoting children's capacities for emotion regulation in response to frustration at 3, 4.5, and 5.5 years: having to suppress a desired behavior, observed in delay tasks, to regulate anger, observed in parent-child control contexts, and a traitlike tendency to regulate anger when frustrated, rated by parents. We conceptualized adaptive social regulation at 10 and 12 years as encompassing regulation of negative emotional tone, observed in diverse parent-child interactions, parent-rated regulation of negativity in broad social interactions, and child-reported internalization of adults' values and standards of conduct. Multiple-mediation analyses documented two paths parallel for mother- and father-child relationships: From security to emotion regulation in delay tasks to internalization of adults' values, and from security to parent-rated traitlike regulation of anger to parent-rated regulation of negativity in broad social interactions. Two additional paths were present for mothers and children only. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Children's theory of mind as a mechanism linking parents' mind-mindedness in infancy with children's conscience.

Growing research on parental mind-mindedness has revealed significant positive associations between parents' appropriate mind-minded (MM) comments to their infants and children's future theory of mind (ToM). In turn, ToM has been broadly linked with a range of social-moral competencies. However, few (if any) studies have examined long-term paths from mothers' and fathers' mind-mindedness in infancy to conscience at early school age, with ToM serving as a mediator of those links. We tested such a model in a prospective longitudinal study of 102 community infants, mothers, and fathers. Parents' MM comments to their infants were coded in naturalistic interactions in snack and play contexts at 7 months. Children's ToM was assessed in false-belief tasks at 4.5 and 5.5 years, and two aspects of their conscience were assessed at 6.5 years: discomfort following transgressions and prosocial judgments in hypothetical moral dilemmas. We tested our model in a comprehensive path analysis that accounted for developmental continuity of both aspects of conscience. Children's ToM was positively associated with both measures of future conscience. The long-term paths from parental mind-mindedness in infancy to conscience were found for mother-child relationships only. For mothers and children, we supported the paths from maternal appropriate MM comments during a snack context in infancy to both aspects of children's conscience mediated by children's ToM. The findings extend earlier evidence suggesting the potentially important role of the parent-child interactive context for long-term effects of early parental mind-mindedness and highlight differences in the roles MM comments may play in mother-child and father-child relationships.

Early relational experience: A foundation for the unfolding dynamics of parent-child socialization.

Psychologists have long tried to understand why trajectories of socialization in individual parent-child dyads can be distinct, leading to adaptive or maladaptive developmental outcomes. In this article, we elucidate origins of those differences by examining the subtle yet enduring implications of early parent-child relationships in longitudinal studies of low- and high-risk families, using correlational and experimental designs, and multiple measures. Those relationships are key for socialization because they can alter cascades from children's biologically based difficult temperament to parents' negative control to negative children's outcomes, as demonstrated by social-learning theories. We suggest that those cascades unfold only in parent-child dyads whose early relationships lack positive mutuality and security. Such relationships set the tone for adversarial cascades. In contrast, early mutually positive, secure relationships initiate cooperative, effective socialization and defuse risks of negative cascades. Parents' and children's internal representations of each other may explain how such divergent sequelae unfold.

Long-term sequelae of mothers' and fathers' mind-mindedness in infancy: A developmental path to children's attachment at age 10.

Rapidly growing research on parental mind-mindedness, a tendency to treat one's young child as a psychological agent and an individual with a mind, internal mental states, and emotions, has demonstrated significant links among parents' mind-mindedness, their parenting, and multiple aspects of children's development. This prospective longitudinal study of 102 community mothers, fathers, and infants, followed from 7 months to 10 years, contributes to research on mind-mindedness by addressing several existing gaps and limitations. We examine mechanisms that account for associations between parents' early mind-mindedness and children's future attachment security, using robust behavioral measures. Teams of trained observers coded parents' mind-minded comments to their infants at 7 months during naturalistic interactions, parents' responsiveness in naturalistic interactions and in elicited imitation tasks at 15 months, and children's security, using Attachment Q-Set at 2 years and Iowa Attachment Behavioral Coding at 10 years. Sequential mediation analyses supported a model of a developmental path from parents' appropriate mind-minded comments in infancy to children's security at age 10. For mothers and children, the path was mediated first through responsiveness at 15 months and then security at 2 years. For fathers and children, the path was mediated through attachment security at 2 years. Parents' nonattuned mind-minded comments had no effects on responsiveness or security. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Unique Path to Callous-Unemotional Traits for Children who are Temperamentally Fearless and Unconcerned about Transgressions: a Longitudinal Study of Typically Developing Children from age 2 to 12.

Despite the acknowledged significance of callous-unemotional (CU) traits in developmental psychopathology, few studies have examined their early antecedents in typically developing children, in long-term longitudinal designs, using observational measures. In 102 community mothers, fathers, and children (N = 51 girls), we examined main and interactive effects of children's fearless temperament and low concern about transgressions from toddler to early school age as predictors of CU traits in middle childhood and early preadolescence. In laboratory paradigms, we observed children's concern about breaking valuable objects (twice at each age of 2, 3, 4.5, 5.5, and 6.5 years) and about hurting the parent (twice at each age of 2, 3, and 4.5 years). We observed fearless temperament during scripted exposure to novel and mildly threatening objects and events (twice at each age of 2, 3, 4.5, and 5.5 years). Mothers and fathers rated children's CU traits and externalizing behavior problems at ages 8, 10, and 12. Children's low concern about both types of transgressions predicted CU traits, but those effects were qualified by the expected interactions with fearless temperament: Among relatively fearless children, those who were unconcerned about transgressions were at the highest risk for CU traits, even after controlling for the strong overlap between CU traits and externalizing problems. For fearful children, variation in concern about transgressions was unrelated to CU traits. Those interactions were not significant in the prediction of externalizing problems. The study highlights a potentially unique etiology of CU traits in early development.

A Secure Base from which to Cooperate: Security, Child and Parent Willing Stance, and Adaptive and Maladaptive Outcomes in two Longitudinal Studies.

Early secure attachment plays a key role in socialization by inaugurating a long-term mutual positive, collaborative interpersonal orientation within the parent-child dyad. We report findings from Family Study (community mothers, fathers, and children, from age 2 to 12, N = 102, 51 girls) and Play Study (exclusively low-income mothers and children, from age 3.5 to 7, N = 186, 90 girls). We examined links among observed secure attachment at toddler age, child and parent receptive, willing stance to each other, observed in parent-child contexts at early school age, and developmental outcomes. The developmental outcomes included parent-rated child antisocial behavior problems and observed positive mutuality with regard to conflict issues at age 12 in Family Study, and mother-rated child antisocial behavior problems and observed child regard for rules and moral self at age 7 in Play Study. In mother-child relationships, the child's willing stance mediated indirect effects of child security on positive mutuality in Family Study and on all outcomes in Play Study. In father-child relationships, both the child's and the parent's willing stance mediated indirect effects of child security on both outcomes. Early security initiates an adaptive developmental cascade by enlisting the child and the parent as active, willingly receptive and cooperative agents in the socialization process. Implications for children's parenting interventions are noted.

Commentary: An exciting evolutionary framework for new bridges between social-emotional and cognitive development - a reflection on Suor et al. (2017).

Suor et al. () present a compelling new evolutionary framework that offers an alternative interpretation of the well-established findings of cognitive deficits in children raised in harsh early environments. They argue that such findings do not convey a complete picture of those children's cognitive development, because children's cognition becomes specialized to solve problems in fitness-enhancing ways, and traditional abstract problem-solving tasks do not fully capture their abilities. The authors demonstrate that children exposed to early harshness, particularly children with Hawk temperaments, preferentially shift cognition to salient fitness-enhancing stimuli, and thus develop better skills for solving reward-oriented tasks. This intriguing and heuristically generative study inspires multiple new research avenues, of which we outline three: (a) Further examination of the concept of harsh environments, (b) addressing questions about the conceptualization and the role of child temperament, and (c) further advances in the measurement of children's distinct skills.

Lifetime eating disorder comorbidity associated with delayed depressive recovery in bipolar disorder.

BACKGROUND: Although eating disorders (EDs) are common in bipolar disorder (BD), little is known regarding their longitudinal consequences. We assessed prevalence, clinical correlates, and longitudinal depressive severity in BD patients with vs. without EDs. METHODS: Outpatients referred to Stanford University BD Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) affective disorders evaluation, and while receiving naturalistic treatment for up to 2 years, were monitored with the STEP-BD clinical monitoring form. Patients with vs. without lifetime EDs were compared with respect to prevalence, demographic and unfavorable illness characteristics/current mood symptoms and psychotropic use, and longitudinal depressive severity. RESULTS: Among 503 BD outpatients, 76 (15.1%) had lifetime EDs, which were associated with female gender, and higher rates of lifetime comorbid anxiety, alcohol/substance use, and personality disorders, childhood BD onset, episode accumulation (≥10 prior mood episodes), prior suicide attempt, current syndromal/subsyndromal depression, sadness, anxiety, and antidepressant use, and earlier BD onset age, and greater current overall BD severity. Among currently depressed patients, 29 with compared to 124 without lifetime EDs had significantly delayed depressive recovery. In contrast, among currently recovered (euthymic ≥8 weeks) patients, 10 with compared to 95 without lifetime EDs had only non-significantly hastened depressive recurrence. LIMITATIONS: Primarily Caucasian, insured, suburban, American specialty clinic-referred sample limits generalizability. Small number of recovered patients with EDs limited statistical power to detect relationships between EDs and depressive recurrence. CONCLUSIONS: Further studies are warranted to explore the degree to which EDs impact longitudinal depressive illness burden in BD.

Current irritability robustly related to current and prior anxiety in bipolar disorder.

BACKGROUND: Although current irritability and current/prior anxiety have been associated in unipolar depression, these relationships are less well understood in bipolar disorder (BD). We investigated relationships between current irritability and current/prior anxiety as well as other current emotions and BD illness characteristics. METHODS: Outpatients referred to the Stanford Bipolar Disorders Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Prevalence and clinical correlates of current irritability and current/prior anxiety and other illness characteristics were examined. RESULTS: Among 497 BD outpatients (239 Type I, 258 Type II; 58.1% female; mean ± SD age 35.6 ± 13.1 years), 301 (60.6%) had baseline current irritability. Patients with versus without current irritability had significantly higher rates of current anxiety (77.1% versus 42.9%, p < 0.0001) and history of anxiety disorder (73.1% versus 52.6%, p < 0.0001). Current irritability was more robustly related to current anxiety than to current anhedonia, sadness, or euphoria (all p < 0.001), and current irritability-current anxiety associations persisted across current predominant mood states. Current irritability was more robustly related to past anxiety than to all other assessed illness characteristics, including 1° family history of mood disorder, history of alcohol/substance use disorder, bipolar subtype, and current syndromal/subsyndromal depression (all p < 0.05). LIMITATIONS: Limited generalizability beyond our predominately white, female, educated, insured American BD specialty clinic sample. CONCLUSIONS: In BD, current irritability was robustly related to current/prior anxiety. Further studies are warranted to assess longitudinal clinical implications of relationships between irritability and anxiety in BD.

Gender by onset age interaction may characterize distinct phenotypic subgroups in bipolar patients.

OBJECTIVE: Although bipolar disorder (BD) is a common recurrent condition with highly heterogeneous illness course, data are limited regarding clinical implications of interactions between gender and onset age. We assessed relationships between onset age and demographic/illness characteristics among BD patients stratified by gender. METHODS: Demographic and unfavorable illness characteristics, descriptive traits, and clinical correlates were compared in 502 patients from Stanford University BD Clinic patients enrolled in the Systematic Treatment Enhancement Program for BD between 2000 and 2011, stratified by gender, across pre-, peri-, and post-pubertal (<12, 13-16, and >17 years, respectively) onset-age subgroups. RESULTS: Among 502 BD patients, 58.2% were female, of whom 21.9% had pre-pubertal, 30.7% peri-pubertal, and 47.4% post-pubertal onset. Between genders, although demographics, descriptive characteristics, and most clinical correlates were statistically similar, there were distinctive onset-age related patterns of unfavorable illness characteristics. Among females, rates of 6/8 primary unfavorable illness characteristics were significantly higher in pre-pubertal and peri-pubertal compared to post-pubertal onset patients. However, among males, rates of only 3/8 unfavorable illness characteristics were significantly higher in only pre-pubertal versus post-pubertal onset patients, and none between peri-pubertal versus post-pubertal onset patients. LIMITATIONS: Caucasian, insured, suburban, American specialty clinic-referred sample limits generalizability, onset age based on retrospective recall. DISCUSSION: We describe different phenotypic presentations across age at illness onset groups according to gender. Among females and males, peri-pubertal and post-pubertal onset age groups were more different and more similar, respectively. Further investigation is warranted to assess implications of gender-by-onset-age interactions to more accurately delineate distinctive BD phenotypes.

Different characteristics associated with suicide attempts among bipolar I versus bipolar II disorder patients.

BACKGROUND: Suicide attempts are common in patients with bipolar disorder (BD), and consistently associated with female gender and certain unfavorable BD illness characteristics. Findings vary, however, regarding effects of BD illness subtype and yet other illness characteristics upon prior suicide attempt rates. We explored the effects of demographics and BD illness characteristics upon prior suicide attempt rates in patients stratified by BD illness subtype (i.e., with bipolar I disorder (BDI) versus bipolar II disorder (BDII)). METHODS: Outpatients referred to the Stanford BD Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD Affective Disorders Evaluation. Rates of prior suicide attempt were compared in patients with and without diverse demographic and BD illness characteristics stratified by BD subtype. RESULTS: Among 494 BD outpatients (mean ± SD age 35.6 ± 13.1 years; 58.3% female; 48.6% BDI, 51.4% BDII), overall prior suicide attempt rates in were similar in BDI versus BDII patients, but approximately twice as high in BDI (but not BDII) patients with compared to without lifetime eating disorder, and in BDII (but not BDI) patients with compared to without childhood BD onset. In contrast, current threshold-level suicidal ideation and lifetime alcohol use disorder robustly but less asymmetrically increased prior suicide attempt risk across BD subtypes. LIMITATIONS: American tertiary bipolar disorder clinic referral sample, cross-sectional design. CONCLUSIONS: Further studies are needed to assess the extent to which varying clinical characteristics of samples of patients with BDI and BDII could yield varying prior suicide attempt rates in patients with BDI versus BDII.

Differential prevalence and demographic and clinical correlates of second-generation antipsychotic use in bipolar I versus bipolar II disorder.

AIMS: To assess second-generation antipsychotic (SGA) use, demographics, and clinical correlates in patients with bipolar I disorder (BDI) versus bipolar II disorder (BDII). METHODS: Stanford Bipolar Disorder (BD) Clinic outpatients enrolled during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Current SGA use, demographics, and clinical correlates were assessed for BDI versus BDII. RESULTS: Among 503 BD outpatients, in BDI versus BDII, SGA use was more than twice as common (44.0% versus 21.2%), and doses were approximately twice as high. BDI patients taking (N = 107) versus not taking (N = 136) SGAs less often had current full time employment and college degree; and more often had lifetime psychiatric hospitalization, current depression, and current complex pharmacotherapy, and had a higher mean current Clinical Global Impression for Bipolar Version Overall Severity score, and these persisted significantly after covarying for employment and education. Prior psychiatric hospitalization was the most robust correlate of SGA use in BDI patients. In contrast, these demographic and clinical correlates of SGA use were not statistically significant among patients with BDII, although BDII (but not BDI) patients taking (N = 55) versus not taking (N = 205) SGAs were more likely to have current mood stabilizer use (67.3% versus 51.7%). LIMITATIONS: American tertiary bipolar disorder clinic referral sample, cross-sectional design. CONCLUSIONS: Current SGA use was robustly associated with prior psychiatric hospitalization in BDI and to a more limited extent with current mood stabilizer use in BDII. SGA use associations with other unfavorable illness characteristics in BDI were less robust.

Sleep, residual mood symptoms, and time to relapse in recovered patients with bipolar disorder.

BACKGROUND: Sleep disturbance in bipolar disorder (BD) is common during and between mood episodes. In recovered (euthymic at least two months) BD patients, we assessed sleep compared to controls and its relationships with residual mood symptoms and mood episode recurrence. METHOD: Recovered Stanford University BD Clinic patients diagnosed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation and monitored with the STEP-BD Clinical Monitoring Form (CMF) for >1 year and healthy controls completed the Pittsburgh Sleep Quality Index (PSQI). PSQI parameters were compared in BD patients versus controls, and the most robustly differentiating PSQI parameter was assessed in relationship to residual mood symptoms, and time to mood episode recurrence in BD patients. RESULTS: Eighty nine recovered BD patients compared to 56 healthy controls had significantly worse PSQI global score, more sleep medication use, longer sleep latency, and worse daytime dysfunction. PSQI global score had the greatest BD patient versus control effect size, and among BD patients, correlated significantly with residual mood symptoms and predicted earlier mood episode recurrence, even after covarying for residual mood symptoms. LIMITATIONS: Use of subjective (PSQI) rather objective (polysomnography) sleep metric. Statistical power limited by small sample size. Potential psychotropic medication confound. Northern California tertiary BD clinic referral sample. CONCLUSION: Further research is needed to confirm that in recovered BD patients, poor sleep quality correlates with residual mood symptoms, and independently predicts mood episode recurrence. If confirmed, these observations suggest potential mood benefit for focusing on sleep quality in interventions for recovered BD patients.

American tertiary clinic-referred bipolar II disorder compared to bipolar I disorder: More severe in multiple ways, but less severe in a few other ways.

BACKGROUND: Prevalence and relative severity of bipolar II disorder (BDII) vs. bipolar I disorder (BDI) are controversial. METHODS: Prevalence, demographics, and illness characteristics were compared among 260 BDII and 243 BDI outpatients referred to the Stanford University BD Clinic and assessed with the Systematic Treatment Enhancement Program for Bipolar Disorder Affective Disorders Evaluation. RESULTS: BDII vs. BDI outpatients had statistically similar prevalence (51.7% vs. 48.3%), and in multiple ways had more severe illness, having significantly more often: lifetime comorbid anxiety (70.8% vs. 58.4%) and personality (15.4% vs. 7.4%) disorders, first-degree relative with mood disorder (62.3% vs. 52.3%), at least 10 prior mood episodes (80.0% vs. 50.9%), current syndromal/subsyndromal depression (52.3% vs. 38.4%), current antidepressant use (47.3% vs. 31.3%), prior year rapid cycling (33.6% vs. 13.4%), childhood onset (26.2% vs. 16.0%), as well as earlier onset age (17.0±8.6 vs. 18.9±8.1 years), longer illness duration (19.0±13.0 vs. 16.1±13.0), and higher current Clinical Global Impression for Bipolar Disorder-Overall Severity (4.1±1.4 vs. 3.7±1.5). However, BDII vs. BDI patients significantly less often had prior psychosis (14.2% vs. 64.2%), psychiatric hospitalization (10.0% vs. 67.9%), and current prescription psychotropic use, (81.5% vs. 93.0%), and had a statistically similar rate of prior suicide attempt (29.5% vs. 32.1%). LIMITATIONS: American tertiary bipolar disorder clinic referral sample, cross-sectional design. CONCLUSIONS: Further studies are warranted to determine the extent to which BDII, compared to BDI, can be more severe in multiple ways but less severe in a few other ways, and contributors to occurrence of more severe forms of BDII.