VI. INTERGENERATIONAL TRANSMISSION OF SECURE BASE SCRIPT KNOWLEDGE: THE ROLE OF MATERNAL CO-CONSTRUCTION SKILLS.

This study examined the link between mothers' and children's script-like representations of attachment and the role of maternal co-construction skills in facilitating script knowledge in their children. Fifty-nine children recruited from preschools in Bucharest, Romania (age range 4 to 5 years) completed a shortened version of the Attachment Story Completion Task (ASCT) to assess their secure base script knowledge whereas their mother's script knowledge was assessed with the Attachment Script Assessment (ASA). In addition, the mother-child pairs completed the Affect Discussion Task (see Chapter II) to assess mothers' co-construction skills. Mother and child secure base script knowledge was significantly related, as were maternal co-construction skills and child script knowledge. Regression analyses indicated that maternal co-construction skills impacted children's script knowledge above and beyond the effects of maternal script scores.

IV. CO-CONSTRUCTION OF ATTACHMENT REPRESENTATIONS AND AFFECT-REGULATING COGNITIONS: THE ROLE OF MATERNAL ATTACHMENT SECURITY.

This study focused on the role of maternal co-construction skills in building attachment relevant representations in early childhood. Thirty-four mothers and their 4- to 5-year-old children were presented with two co-construction tasks, one an attachment storytelling task, the other an affect discussion task about emotion-laden situations. Maternal co-construction skills were assessed with several scales that scored the quality of the co-construction partnership, the mother's skill in prompting elaboration, and helping build an explanatory framework. Mothers completed the Attachment Script Assessment (ASA) and the Adult Attachment Interview (AAI) as well. Results indicated that mothers' secure base script knowledge (ASA) was significantly related to communication effectiveness, encouraging elaboration of storylines, and using open-ended and why questions. Maternal AAI coherence showed similar relations to co-construction support.

Cognitive bias modification of interpretation in children with social anxiety disorder.

Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups.

The effect of targeting tolerance of children's negative emotions among anxious parents of children with anxiety disorders: A pilot randomised controlled trial.

Following cognitive behavioural therapy for child anxiety a significant minority of children fail to lose their diagnosis status. One potential barrier is high parental anxiety. We designed a pilot RCT to test claims that parental intolerance of the child's negative emotions may impact treatment outcomes. Parents of 60 children with an anxiety disorder, who were themselves highly anxious, received either brief parent-delivered treatment for child anxiety or the same treatment with strategies specifically targeting parental tolerance of their child's negative emotions. Consistent with predictions, parental tolerance of the child's negative emotions significantly improved from pre- to post-treatment. However, there was no evidence to inform the direction of this association as improvements were substantial in both groups. Moreover, while there were significant improvements in child anxiety in both conditions, there was little evidence that this was associated with the improvement in parental tolerance. Nevertheless, findings provide important clinical insight, including that parent-led treatments are appropriate even when the parent is highly anxious and that it may not be necessary to adjust interventions for many families.

Parental responsibility beliefs: associations with parental anxiety and behaviours in the context of childhood anxiety disorders.

BACKGROUND: High levels of parental anxiety are associated with poor treatment outcomes for children with anxiety disorders. Associated parental cognitions and behaviours have been implicated as impediments to successful treatment. We examined the association between parental responsibility beliefs, maternal anxiety and parenting behaviours in the context of childhood anxiety disorders. METHODS: Anxious and non-anxious mothers of 7-12 year old children with a current anxiety disorder reported their parental responsibility beliefs using a questionnaire measure. Parental behaviours towards their child during a stressor task were measured. RESULTS: Parents with a current anxiety disorder reported a greater sense of responsibility for their child's actions and wellbeing than parents who scored within the normal range for anxiety. Furthermore, higher parental responsibility was associated with more intrusive and less warm behaviours in parent-child interactions and there was an indirect effect between maternal anxiety and maternal intrusive behaviours via parental responsibility beliefs. LIMITATIONS: The sample was limited to a treatment-seeking, relatively high socio-economic population and only mothers were included so replication with more diverse groups is needed. The use of a range of stressor tasks may have allowed for a more comprehensive assessment of parental behaviours. CONCLUSIONS: The findings suggest that parental anxiety disorder is associated with an elevated sense of parental responsibility and may promote parental behaviours likely to inhibit optimum child treatment outcomes. Parental responsibility beliefs may therefore be important to target in child anxiety treatments in the context of parental anxiety disorders.

Measuring scripted attachment-related knowledge in middle childhood: the Secure Base Script Test.

Secure base scripts (SBS) are thought of as the earliest, rudimentary mental representations of attachment, comprising temporally and causally related events occurring in interactions between children and their attachment figures. SBS have been studied in preschool children, adolescents and adults, but there is little research relating SBS to other attachment measures in middle childhood. Here, the Secure Base Script Test (SBST), a narrative-based measure of attachment scripts in middle childhood, was developed and evaluated. In two studies with 7-12-year-olds (total N = 261), high internal consistency, inter-rater reliability and discriminant validity was established. SBS knowledge was consistent across different contexts and relationships and converged strongly with security and coherence in representations assessed by the Friends and Family Interview and moderately with self-reported attachment security. Furthermore, SBS knowledge predicted children's capacity to respond to distress in an adaptive way. Our findings may be taken to provide some first evidence for generalized scripted attachment knowledge already in middle childhood.

Cognitive, affective, and behavioral characteristics of mothers with anxiety disorders in the context of child anxiety disorder.

Parental emotional distress, particularly high maternal anxiety, is one of the most consistent predictors of child anxiety treatment outcome. In order to identify the cognitive, affective, and behavioral parenting characteristics of mothers of children with anxiety disorders who themselves have an anxiety disorder, we assessed the expectations, appraisals, and behaviors of 88 mothers of anxious children (44 mothers who were not anxious [NONANX] and 44 mothers with a current anxiety disorder [ANX]) when interacting with their 7-12-year-old children. There were no observed differences in anxiety and avoidance among children of ANX and NONANX mothers, but, compared with NONANX mothers, ANX mothers held more negative expectations, and they differed on observations of intrusiveness, expressed anxiety, warmth, and the quality of the relationship. Associations were moderated by the degree to which children expressed anxiety during the tasks. Maternal-reported negative emotions during the task significantly mediated the association between maternal anxiety status and the observed quality of the relationship. These findings suggest that maternal anxiety disorder is associated with reduced tolerance of children's negative emotions. This may interfere with the maintenance of a positive, supportive mother-child interaction under conditions of stress and, as such, this may impede optimum treatment outcomes. The findings identify potential cognitive, affective, and behavioral targets to improve treatment outcomes for children with anxiety disorders in the context of a current maternal anxiety disorder.

Script-like attachment representations in dreams containing current romantic partners.

Recent research has demonstrated parallels between romantic attachment styles and general dream content. The current study examined partner-specific attachment representations alongside dreams that contained significant others. The general prediction was that dreams would follow the "secure base script," and a general correspondence would emerge between secure attachment cognitions in waking life and in dreams. Sixty-one undergraduate student participants in committed dating relationships of six months duration or longer completed the Secure Base Script Narrative Assessment at Time 1, and then completed a dream diary for 14 consecutive days. Blind coders scored dreams that contained significant others using the same criteria for secure base content in laboratory narratives. Results revealed a significant association between relationship-specific attachment security and the degree to which dreams about romantic partners followed the secure base script. The findings illuminate our understanding of mental representations with regards to specific attachment figures. Implications for attachment theory and clinical applications are discussed.