Negative and distorted attributions towards child, self, and primary attachment figure among posttraumatically stressed mothers: what changes with Clinician Assisted Videofeedback Exposure Sessions (CAVES).

This study found that within a non-referred community pediatrics clinic sample, the severity of mothers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluation-protocol that included a form of experimental intervention entitled the "Clinician Assisted Videofeedback Exposure Session(s)" (CAVES), for mothers with IPV-PTSD as compared to control-subjects.

Autonomic functioning in mothers with interpersonal violence-related posttraumatic stress disorder in response to separation-reunion.

This study characterizes autonomic nervous system activity reactive to separation-reunion among mothers with Interpersonal Violence-Related Posttraumatic Stress Disorder (IPV-PTSD). Heart-rate (HR) and high frequency heart-rate-variability (HF-HRV) were measured in 17 IPV-PTSD-mothers, 22 sub-threshold-mothers, and 15 non-PTSD mother-controls while interacting with their toddlers (12-48 months). Analyses showed IPV-PTSD-mothers having generally lower HR than other groups. All groups showed negative correlations between changes in HR and HF-HRV from sitting- to standing-baseline. During initial separation, controls no longer showed a negative relationship between HR and HF-HRV. But by the second reunion, the negative relationship reappeared. IPV-PTSD- and sub-threshold-mothers retained negative HR/HF-HRV correlations during the initial separation, but stopped showing them by the second reunion. Results support that mother-controls showed a pattern of autonomic regulation suggestive of hypervigilance during initial separation that resolved by the time of re-exposure. PTSD-mothers showed delayed onset of this pattern only upon re-exposure, and were perhaps exhibiting defensive avoidance or numbing during the initial separation/reunion.

An fMRI study of the brain responses of traumatized mothers to viewing their toddlers during separation and play.

This study tested whether mothers with interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) vs healthy controls (HC) would show greater limbic and less frontocortical activity when viewing young children during separation compared to quiet play. Mothers of 20 children (12-42 months) participated: 11 IPV-PTSD mothers and 9 HC with no PTSD. During fMRI, mothers watched epochs of play and separation from their own and unfamiliar children. The study focused on comparison of PTSD mothers vs HC viewing children in separation vs play, and viewing own vs unfamiliar children in separation. Both groups showed distinct patterns of brain activation in response to viewing children in separation vs play. PTSD mothers showed greater limbic and less frontocortical activity (BA10) than HC. PTSD mothers also reported feeling more stressed than HC when watching own and unfamiliar children during separation. Their self-reported stress was associated with greater limbic and less frontocortical activity. Both groups also showed distinct patterns of brain activation in response to viewing their own vs unfamiliar children during separation. PTSD mothers' may not have access to frontocortical regulation of limbic response upon seeing own and unfamiliar children in separation. This converges with previously reported associations of maternal IPV-PTSD and atypical caregiving behavior following separation.

The relationship of violent fathers, posttraumatically stressed mothers and symptomatic children in a preschool-age inner-city pediatrics clinic sample.

This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS), related to maternal report of interpersonal violence, mediates the effects of such violence on (a) child PTSS as well as on (b) child externalizing and internalizing symptoms. Study participants were mothers (N = 77) and children 18 to 48 months recruited from community pediatric clinics. Data were analyzed continuously via bivariate correlations and then multiple linear regression. Post hoc Sobel tests were performed to confirm mediation. Paternal violence accounted for 15% of the variance of child PTSS on the PCIP-OR (ß = .39, p ≤ .001). While the child's father being violent significantly predicts child PTSS related to domestic violence, as mentioned, when maternal PTSS is included in the multiple regression model, father's being violent becomes less significant, while maternal PTSS remains strongly predictive. Sobel tests confirmed that maternal PTSS severity mediated effects of paternal violence on clinician-assessed child PTSS as well as on maternal report of child externalizing and internalizing symptoms. When presented with a preschool-aged child who is brought to consultation for behavioral difficulties, dysregulated aggression, and/or unexplained fears, clinicians should evaluate maternal psychological functioning as well as assess and treat the effects of interpersonal violence, which otherwise may be avoided during the consultation.

Subjective and objective measures of parent-child relationship dysfunction, child separation distress, and joint attention.

The literature suggests an adverse impact of maternal stress related to interpersonal violence on parent-child interaction. The current study investigated associations between a mother's self-reported parent-child relationship dysfunction and what she does in response to her child's cues. It also examined whether maternal perception of parent-child dysfunctional interaction and child behavior when stressed by separation, along with maternal behavior in response to child distress, predicted impaired joint attention (JA) during play. Participant mothers (n = 74) and their children ages 12-48 months were recruited from community pediatrics clinics and completed two videotaped visits. After correlations, multiple linear regression was applied to find the best model fit that would predict outcomes of interest. We found that both maternal subjective report of self-reported parent-child relationship dysfunction and observed child separation distress together predicted atypical maternal behavior. Self-reported parent-child relationship dysfunction, observed atypical maternal behavior, and child separation distress combined significantly predicted less time spent in joint attention during play. Maternal posttraumatic stress predicted less maternal availability after separation stress. Clinicians should thus carefully assess and listen to parents' communication of disturbances in their relationship with their young child. Left untreated, parent-child relationship dysfunction may well lead to impairment in learning and social-emotional development.

Is maternal PTSD associated with greater exposure of very young children to violent media?

This study examined media viewing by mothers with violence-related posttraumatic stress disorder (PTSD) and related media exposure of their preschool-age children. Mothers (N = 67) recruited from community pediatric clinics participated in a protocol involving a media-preference survey. Severity of maternal PTSD and dissociation were significantly associated with child exposure to violent media. Family poverty and maternal viewing behavior were also associated. Maternal viewing behavior mediated the effects specifically of maternal PTSD severity on child exposure. Clinicians should assess maternal and child media viewing practices in families with histories of violent trauma exposure and related psychopathology.

Distorted maternal mental representations and atypical behavior in a clinical sample of violence-exposed mothers and their toddlers.

OBJECTIVE: To determine whether maternal violence-related posttraumatic stress disorder (PTSD), reflective functioning (RF), and/or quality of mental representations of her child predict maternal behavior within a referred sample of interpersonal violence-exposed mothers and their children (ages 8-50 months). METHOD: Forty-one dyads completed two videotaped visits including measures of maternal mental representations and behavior. RESULTS: Negative and distorted maternal mental representations predicted atypical behavior (Cohen's d>1.0). While maternal PTSD and RF impacted mental representations, no significant relationships were found between PTSD, RF, and overall atypical caregiving behavior. Severity of maternal PTSD was however positively correlated with the avoidant caregiving behavior subscale. CONCLUSIONS: Maternal mental representations of her child are useful risk-indicators that mark dysregulation of trauma-associated emotions in the caregiver.

Caregiver traumatization adversely impacts young children's mental representations on the MacArthur Story Stem Battery.

The aim of our study was to investigate the impact of maternal exposure to family violence, maltreatment, and related posttraumatic stress disorder (PTSD) on young children's mental representations of self and caregivers. Participant mothers (n=24) and children (n=25) were recruited from a referred sample when they were 4-7 years old. Maternal report and child story stem narratives were used. Mother's experience of domestic violence and severity of violence-related PTSD symptoms robustly predicted more dysregulated aggression, attentional bias to danger and distress, as well as more avoidance of and withdrawal from conflicts presented in the children's story stems. Less narrative coherence was also noted. Traumatized mothers experience and symptoms prior to their child's turning 4 years old adversely affected their child's mental representations from 4-7 years.

Child mental representations of attachment when mothers are traumatized: The relationship of family-drawings to story-stem completion.

This study examines the relationship between child play-narratives and family drawings by children of violence-exposed mothers with posttraumatic stress disorder (PTSD). The Family Attachment Drawing Task (FAD-T) and MacArthur Story Stem Battery (MSSB) were administered. Of the 23 children (ages 4-7 years), 16 (70%) created drawings that were coded as being representative of insecure attachment. Attachment insecurity and disorganization of child-caregiver attachment on the FAD-T were significantly associated with trauma-related dimensions of the MSSB, but not to other factors. This study suggests that the FAD-T provides access to child mental representations, which may affect intergenerational transmission of violent trauma.

Traumatized mothers can change their minds about their toddlers: Understanding how a novel use of videofeedback supports positive change of maternal attributions.

This study explored the use of a brief experimental intervention that integrates principles of infant-parent psychotherapy, videofeedback, controlled exposure to child distress in the context of parental posttraumatic stress disorder (PTSD), and stimulation of parental reflective functioning (RF). The Clinician Assisted Videofeedback Exposure Session (CAVES) was applied to 32 interpersonal violence-exposed mothers of very young children (8-50 months) with respect to change of maternal perception of her child. While we found no significant reduction over two videotaped assessment visits with a mental health professional, we did find a significant reduction in the degree of negativity of maternal attributions towards her child following the videotaped visit focused on the CAVES (p<.01). Maternal RF, a mother's capacity to think about mental states in herself and her child, accounted for 11% of the variance in reduction of maternal negativity after accounting for baseline levels of negativity. Clinician-assisted videofeedback appears to support emotional self-regulation of mothers with violence-related PTSD. Focusing with a therapist on videofeedback of child separation distress exposes mothers to avoided mental states of helplessness and perceived loss of protection. Negative maternal attributions may mark violent trauma-associated emotion dysregulation and projected self-representations of the maltreated mother.