Early caregiving predicts attachment representations in adolescence: findings from two longitudinal studies.

BACKGROUND: A growing research base demonstrates that adolescents' construction of secure attachment relationships may underlie successful social and personal relationships and healthy behavioral adjustment. Little is known about the early caregiving origins of adolescent attachment security; this study provides some of the first data on this topic. METHOD: The relative contribution of early and current caregiving quality to attachment security in adolescence was assessed in two longitudinal studies of a clinic-referred and an at-risk community sample using identical measures (n = 209). Quality of early parent-child relationships at age 3-7 years of age and parent-adolescent relationship quality at approximately 12 years were assessed using observational methods; psychosocial risk was derived from extensive interview and questionnaire assessments; adolescent attachment quality was assessed using a standard attachment interview. RESULTS: Analyses indicated moderate stability in observed parent-child interaction quality from early childhood to adolescence. Observational ratings of both early childhood and current caregiving quality were significantly associated with adolescent attachment security; however, early caregiver sensitivity was more strongly associated with adolescent attachment security and predicted later attachment security independently from current caregiving quality. Follow-up analyses indicated that this longitudinal prediction was significantly weaker in the clinic than in the at-risk community sample. CONCLUSIONS: Parental sensitive responding in childhood has enduring effects on attachment representation in adolescence, independent of current parenting relationship quality. These findings provide important new evidence supporting early parenting interventions for promoting youth well-being and adjustment.

Sensitivity to parenting in adolescents with callous/unemotional traits: Observational and experimental findings.

Children and adolescents with callous-unemotional (CU) traits have been distinguished as a subset of individuals with disruptive behavioral disorders who may be less sensitive to parenting influence; we test this hypothesis using multiple methods and assessment paradigms. Two hundred seventy-one adolescents (mean age = 12.6 years) from 3 samples at elevated risk for disruptive behavior disorders were studied. Symptoms of CU behavior were derived from standard questionnaire; assessments of behavioral adjustment were derived from clinical interview with parent, and parent-report, teacher-report, and self-report questionnaire. Parent-child relationship quality was based on observational assessments in which adolescent and parent behaviors were rated in 3 interaction tasks: (a) low conflict planning task; (b) problem-solving conflict task; (c) puzzle challenge task; parent interview and parent-report and child-report questionnaires of parenting were also assessed. Results indicated that the associations between parent-child relationship quality and behavioral adjustment were comparable in adolescents with and without CU traits. More notably, observational data indicated that adolescents with elevated CU traits showed comparatively greater within-individual variability in observed angry/irritable behavior across interaction tasks, suggesting greater sensitivity to and emotional dysregulation in challenging interpersonal contexts. The findings suggest that adolescents with CU are not less sensitive to parental influence and may in contrast show greater context-sensitive disturbances in emotional regulation. The results have implications for family-based assessment and treatment for adolescents with disruptive behavior disorders. (PsycINFO Database Record

The formation of secure new attachments by children who were maltreated: an observational study of adolescents in foster care.

Children who were maltreated and enter foster care are at risk for maladjustment and relationship disturbances with foster carers. A popular hypothesis is that prior attachment relationships with abusive birth parents are internalized and carried forward to impair the child's subsequent attachment relationships. However, the empirical base for this model is limited, especially in adolescence. We examined the attachment patterns of 62 adolescents with their birth parents and their foster parents; we compared them to a comparison sample of 50 adolescents in normal-risk families. Attachment was assessed using the Child Attachment Interview; adolescent-parent interaction quality was assessed from direct observation; disruptive behavior symptoms were assessed from multiple informants. Whereas nearly all of the adolescents in foster families exhibited insecure attachments to their birth mothers (90%) and birth fathers (100%), nearly one-half were classified as having a secure attachment with their foster mother (46%) and father (49%); rates of secure attachment toward foster parents did not differ significantly from the rate in comparison families. Within the foster care sample, attachment security to the foster mother was predicted from current observed relationship quality and the duration of current placement. In addition, attachment quality in foster adolescents was associated with fewer disruptive behavior symptoms, and this association was equally strong in foster and comparison families. Our findings demonstrate that there is substantial potential for maltreated children to change and develop subsequent secure attachments in adolescence.

Heartless and cunning? Intelligence in adolescents with antisocial behavior and psychopathic traits.

Clinical theory predicts that individuals high in psychopathic traits possess average or above average intelligence; however findings in adult and child samples have been mixed. The present study aimed to investigate (1) the relationship between verbal and nonverbal intelligence and the three dimensions of psychopathy (callous-unemotional (CU) traits, narcissism, impulsivity); and (2) whether these dimensions moderate the association between verbal and nonverbal intelligence and the severity of antisocial behavior. Participants were 361 adolescents aged 9-18 years (68% boys) and their parents, drawn from four samples with different levels of risk for antisocial behavior. Families were disadvantaged and 25% were from an ethnic minority. Verbal intelligence was unrelated to parent-reported CU traits, narcissism or impulsivity after controlling for gender, sociodemographic disadvantage, sample, antisocial behavior and hyperactivity. Narcissism, but not CU traits or impulsivity, was significantly related to lower nonverbal IQ. None of the three psychopathic trait dimensions moderated the relationship between verbal or nonverbal IQ and antisocial behavior. CU traits, narcissism, hyperactivity and inclusion in the very high or high risk samples were significantly related to more severe antisocial behavior. Results contradict the widely held view that psychopathic traits are associated with better than average verbal or nonverbal intelligence.

Attachment in adolescence: overlap with parenting and unique prediction of behavioural adjustment.

BACKGROUND: Attachment theory was conceptualized by Bowlby as relevant across the life span, from 'cradle to grave'. The research literature on attachment in infants and preschool-aged children is extensive, but it is limited in adolescence. In particular, it is unclear whether or not attachment security is distinguishable from other qualities of the parent-adolescent relationship and predicts adjustment independently of alternate measures of it. METHODS: Data from three parallel studies of adolescents, representing normal- to high-risk status, were combined, n = 248. Attachment was assessed using the Child Attachment Interview, a recently constructed measure designed for older children and adolescents. Parent-adolescent relationship quality was assessed in detail through questionnaires, interviews and observation of a standard problem-solving interaction. Adolescent adjustment was assessed through parental psychiatric interview, teacher questionnaire and adolescent self-report. RESULTS: Bivariate analyses showed that secure attachment representations were modestly associated with diverse measures of the current parent-adolescent relationship such as monitoring, negative expressed emotion, and directly observed parental warmth and anger. In addition, attachment representations were reliably associated with key indicators of psychological adjustment in adolescence, including parent-rated oppositional-defiant disorder symptoms and teacher-reported emotional and behavioural difficulties. Regression analyses revealed that secure attachment representations explained unique variance in these indicators of adjustment, independent of alternative measures of the parent-adolescent relationship. CONCLUSION: Adolescents' representational models of attachment are related to but distinct from current parenting quality and provide unique insight into the understanding of behavioural adjustment. The findings support a distinct conceptual role of attachment representations in adolescence. Clinical assessment and treatment models should include attachment patterns in this age group.

Predictive value of callous-unemotional traits in a large community sample.

OBJECTIVE: Callous-unemotional (CU) traits in children and adolescents are increasingly recognized as a distinctive dimension of prognostic importance in clinical samples. Nevertheless, comparatively little is known about the longitudinal effects of these personality traits on the mental health of young people from the general population. Using a large representative sample of children and adolescents living in Great Britain, we set out to examine the effects of CU traits on a range of mental health outcomes measured 3 years after the initial assessment. METHOD: Parents were interviewed to determine the presence of CU traits in a representative sample of 7,636 children and adolescents. The parents also completed the Strengths and Difficulties Questionnaire, a broad measure of childhood psychopathology. Three years later, parents repeated the Strengths and Difficulties Questionnaire. RESULTS: At 3-year follow-up, CU traits were associated with conduct, hyperactivity, emotional, and total symptom scores. After adjusting for the effects of all covariates, including baseline symptom score, CU traits remained robustly associated with the overall levels of conduct problems and emotional problems and with total psychiatric difficulties at 3-year follow-up. CONCLUSIONS: Callous-unemotional traits are independently associated with future psychiatric difficulties in children and adolescents. An assessment of CU traits adds small but significant improvements to the prediction of future psychopathology.

The effect of inpatient care on measured Health Needs in children and adolescents.

BACKGROUND: The concept of 'health need' relates patient problems in symptom and psychosocial domains to available appropriate treatments. We studied the effectiveness of inpatient treatment in modifying measured 'Health Needs' in children and adolescents admitted to UK inpatient units. METHODS: A prospective cohort study of 150 children and adolescents admitted to eight UK inpatient units, using formal pre-admission, pre-discharge and 1-year follow-up measurement of Health Needs. RESULTS: Total patient 'Cardinal Problems' reduced highly significantly (p < .001) from 8.5 at admission to 5.7 at discharge (effect size .81) and to 4.1 one year after discharge (effect size 1.35). Functional domains free of 'Health Needs' increased from 14.9 to 19.4 (effect size 1.08) from the point of admission to the end of follow-up. These changes were clinically meaningful, present in all domains and reduced morbidity to a level typical of outpatient cases. CONCLUSIONS: Admission (mean length 116 days, SD 88) leads to clinically important improvement in measured Health Needs over multiple domains for children with serious, complex mental health difficulties. These improvements in multiple symptom and functional domains persist over the next year.

Normative childhood repetitive routines and obsessive compulsive symptomatology in 6-year-old twins.

BACKGROUND: To investigate the association between normative repetitive routines of childhood and paediatric obsessive compulsive symptom syndrome (OCSS) and the extent to which it is genetically mediated. METHODS: In a two-phase design a community sample of 4,662 6-year-old twin-pairs were sampled and 854 pairs were assessed in the second phase for normative repetitive routines using the Childhood Routines Inventory (CRI) and for OCSS by maternal-informant diagnostic interview. The OCSS phenotype was defined using standard diagnostic criteria for obsessive compulsive disorder, though regardless of impairment. RESULTS: In the bivariate model, correlation between the CRI defined phenotype and the OCSS phenotype was estimated to be .40 (95% CI .27-.50), and this correlation was attributable wholly to additive genetic effects. The bivariate model also provided estimates of heritability of the two phenotypes separately: 55% (95% CI 80-89%) for the OCSS phenotype, with the remaining variance attributable mainly to non-shared environment, and 50% (95% CI 39-62%) for CRI assessed normative repetitive routines of childhood, with 36% of the remaining variance attributable to shared environment and 14% to non-shared. CONCLUSIONS: The moderate correlation between normative childhood repetitive routines and obsessive compulsive symptomatology, attributable to genetic factors, is consistent with the hypothesis that high levels of this trait in young children constitute a risk factor for the development of obsessive compulsive symptoms.