Disinhibited attachment behavior among infants of mothers with borderline personality disorder, depression, and no diagnosis.

Disinhibited attachment behavior is related to early institutional rearing and to later social maladaptation. It is also seen among infants reared at home whose mothers have histories of child maltreatment or psychiatric hospitalization. However, little is known about the maternal psychiatric diagnoses that might be associated with disinhibited behavior or the mechanisms through which maternal diagnosis might influence infant behavior. In the current study (N = 59), 2 maternal diagnoses, borderline personality disorder (BPD; n = 13) and depression (n = 15), were compared with a no diagnosis group (n = 31) on extent of infant disinhibited behavior. Disinhibited infant behavior was assessed at infant age of 12-18 months using the validated Rating of Infant-Stranger Engagement. Mother-infant interaction was coded using the Atypical Maternal Behavior Instrument for Assessment and Classification. Results indicated that infants of mothers with BPD were significantly more likely to be rated as disinhibited in their behavior toward the stranger compared with infants of mothers with depression and with no diagnosis. Disinhibited behavior was further related to the quality of mother-infant interaction, and maternal frightened/disoriented interaction partially mediated the effect of maternal BPD on infant disinhibited behavior. Disinhibited behavior among previously institutionally reared infants is relatively resistant to intervention after toddlerhood and is associated with maladaptation into adolescence. Therefore, high priority should be placed on understanding the developmental trajectories of home-reared infants with disinhibited behavior and on providing early assessment and early parenting support to mothers with BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Relation between Severity of Autism and Caregiver-Child Interaction: a Study in the Context of Relationship Development Intervention.

The aim of this study was to examine the relations between severity of children's autism and qualities of parent-child interaction. We studied these variables at two points of time in children receiving a treatment that has a focus on social engagement, Relationship Development Intervention (RDI; Gutstein 2009). Participants were 18 parent-child dyads where the child (16 boys, 2 girls) had a diagnosis of autism and was between the ages of 2 and 12 years. The severity of the children's autism was assessed at baseline and later in treatment using the autism severity metric of the Autism Diagnostic Observation Schedule (ADOS; Gotham et al. Journal of Autism and Developmental Disorders, 39, 693-705 2009). Although the ADOS was designed as a diagnostic measure, ADOS calibrated severity scores (CSS) are increasingly used as one index of change (e.g., Locke et al. Autism, 18, 370-375 2014). Videotapes of parent-child interaction at baseline and later in treatment were rated by independent coders, for a) overall qualities of interpersonal relatedness using the Dyadic Coding Scales (DCS; Humber and Moss The American Journal of Orthopsychiatry, 75, 128-141 2005), and b) second-by-second parent-child Co-Regulation and Intersubjective Engagement (processes targeted by the treatment approach of RDI). Severity of autism was correlated with lower quality of parent-child interaction. Ratings on each of these variables changed over the course of treatment, and there was evidence that improvement was specifically related to the quality of parent-child interaction at baseline.

Symbolizing as interpersonally grounded shifts in meaning: social play in children with and without autism.

The aim of this study was to examine the relation between symbolic play and communicative engagement among children with and without autism. Our predictions were firstly, that in moment-by-moment interactions during semi-structured interactive play with an adult, children with and without autism would tend to show shifts in meanings in symbolic play when engaged in coordinated states of joint engagement (events involving 'sharing-of-meaning'); secondly, that across atypically developing participants, sharing-of-meaning would (a) correlate with scores on a standardized test of pretend play, and (b) be inversely correlated with scores on the Autism Diagnostic Observation Schedule; and finally, that participants with autism would contrast with matched developmentally delayed participants in manifesting lower levels of joint engagement, lower levels of symbolic play, and fewer shifts in symbolic meaning. Each of these predictions was borne out. The intimate developmental relation between social engagement and symbolic play appears to be important for explaining the developmental psychopathology of autism.

The coherence of autism.

There is a growing body of opinion that we should view autism as fractionable into different, largely independent sets of clinical features. The alternative view is that autism is a coherent syndrome in which principal features of the disorder stand in intimate developmental relationship with each other. Studies of congenitally blind children offer support for the latter position and suggest that a source of coherence in autism is restriction in certain forms of perceptually dependent social experience.

The relation between social engagement and pretend play in autism.

The focus of this study is the nature and concomitants of pretend play among young children with autism. Age- and language-matched children with autism (n= 27), autism spectrum disorder (n= 14), and developmental disorders without autism (n= 16) were administered the Test of Pretend Play (ToPP; Lewis & Boucher, 1997), with an additional rating of 'playful pretence'. As predicted, children with autism showed less playful pretend than participants with developmental disorders who did not have autism. Across the groups, playful pretence was correlated with individual differences in communication and social interaction, even when scores on the ToPP were taken into account. Limitations in creative, playful pretend among children with autism relate to their restricted interpersonal communication and engagement.

Autism severity and qualities of parent-child relations.

The aim of this study was to examine how severity of autism affects children's interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children's autism was assessed using the calibrated severity metric of the Autism Diagnostic Observation Schedule (Gotham et al. in J Autism Dev Disord 39:693-705, 2009). Parent-child dyads were videotaped in 10-min semi-structured play interactions, and qualities of interpersonal relatedness were rated with the Dyadic Coding Scales (Humber and Moss in Am J Orthopsychiatr 75(1):128-141, 2005). Quality of relationships between parents and children were evaluated with a parent self-report measure, the Parent Child Relationship Inventory (Gerard in Parent-Child Relationship Inventory (PCRI) manual. WPS, Los Angeles, 1994). Multivariate regression analysis revealed that severity of autism was inversely related to patterns of parent-child interaction but not to reported quality of parent-child relationship. We consider the implications for thinking about relatedness and relationships among children with autism, and opportunities for intervention.

Dialogic linkage and resonance in autism.

We evaluated how children with autism make linguistic adjustments when talking with someone else. We devised two novel measures to assess (a) overall conversational linkage and (b) utterance-by-utterance resonance within dialogue between an adult and matched participants with and without autism (n = 12 per group). Participants with autism were less able to establish 'cognitive linkage' with an interlocutor. As predicted, only among children with autism was there a positive correlation between the ability to link in with speaker's meanings and ratings of emotional connectedness with the conversational partner. Participants with autism were not less likely to show a basic form of dialogic resonance across successive utterances (the 'frame grab'), but more often elaborated their responses in an atypical manner.

Explaining autism: Ten reasons to focus on the developing self.

My aim in this paper is to present reasons for adopting a focus on the development of self/other-awareness when characterizing the developmental psychopathology of autism. The strengths of such a position include an emphasis on children's emotional relations with embodied persons as foundational for their growing understanding of minds. I give special attention to the process of identifying with the attitudes of others, and experience of other-person-centred emotions, for the development of communication and thinking. The study of limitations in these aspects of self-other relatedness among individuals with autism is pivotal for understanding the pathogenesis of the syndrome.

Reversible autism among congenitally blind children? A controlled follow-up study.

BACKGROUND: Atypical forms of autism may yield insights into the development and nature of the syndrome. METHODS: We conducted a follow-up study of nine congenitally blind and seven sighted children who, eight years earlier, had satisfied formal diagnostic criteria for autism and had been included in groups matched for chronological age and verbal ability. In keeping with the original study, we met with teachers to discuss a DSM-based checklist of clinical features of autism, and conducted direct observations of the children to complete assessments on the Childhood Autism Rating Scale (CARS; Schopler, Reichler, and Renner, 1986) and the Behavior Checklist for Disordered Preschoolers (BCDP; Sherman, Shapiro, & Glassman, 1983). RESULTS: As predicted, a substantially higher proportion of blind (eight out of nine) than sighted (none out of seven) children now failed to meet formal DSM criteria for autism, and in keeping with BCDP ratings, they had significantly lower CARS scores. CONCLUSIONS: Follow-up of nine congenitally blind children with autism revealed that, in adolescence, only one still satisfied diagnostic criteria for the syndrome. We consider the implications for theoretical perspectives on the development of autism.

Person-centred (deictic) expressions and autism.

We employed semi-structured tests to determine whether children with autism produce and comprehend deictic (person-centred) expressions such as 'this'/'that', 'here'/'there' and 'come'/'go', and whether they understand atypical non-verbal gestural deixis in the form of directed head-nods to indicate location. In Study 1, most participants spontaneously produced deictic terms, often in conjunction with pointing. Yet only among children with autism were there participants who referred to a location that was distal to themselves with the terms 'this' or 'here', or made atypical points with unusual precision, often lining-up with an eye. In Study 2, participants with autism were less accurate in responding to instructions involving contrastive deictic terms, and fewer responded accurately to indicative head nods.

Personal pronouns and communicative engagement in autism.

In three experimental conditions, we tested matched children with and without autism (n = 15 per group) for their comprehension and use of first person plural ('we') and third person singular ('he') pronouns, and examined whether such linguistic functioning related to their social interaction. The groups were indistinguishable in their comprehension and use of 'we' pronouns, although within each group, such usage was correlated with ratings of interpersonal connectedness with the collaborator. On the other hand, participants with autism were less likely to use third person pronouns or to show patterns of eye gaze reflecting engagement with an interlocutor's stance vis-à-vis a third person. In these settings, atypical third person pronoun usage seemed to reflect limited communicative engagement, but first person pronouns were relatively spared.

How mothers with borderline personality disorder relate to their year-old infants.

BACKGROUND: Women with borderline personality disorder have conflictual interpersonal relations that may extend to disrupted patterns of interaction with their infants. AIMS: To assess how women with borderline personality disorder engage with their 12 to 18-month-old infants in separation-reunion episodes. METHOD: We videotaped mother-infant interactions in separation-reunion episodes of the Strange Situation test. The mothers were women with borderline personality disorder, with depression, or without psychopathological disorder. Masked ratings of maternal behaviour were made with the Atypical Maternal Behavior Instrument for Assessment and Classification. RESULTS: As predicted, a higher proportion (85%) of women with borderline personality disorder than women in the comparison groups showed disrupted affective communication with their infants. They were also distinguished by the prevalence of frightened/disoriented behaviour. CONCLUSIONS: Maternal borderline personality disorder is associated with dysregulated mother-infant communication.

Anticipatory concern: a study in autism.

There has been substantial research on children's empathic responsiveness towards distressed people, and on the limited responsiveness of children with autism. To date, however, there have not been experimental studies to test how far children show concern towards someone who might be expected to feel badly, when that person has not (yet) expressed any negative feelings. We tested matched groups of children with autism and learning disability, and typically developing children of similar verbal mental age (approximately 6 years), with a novel procedure in which participants witnessed one person (E1) tearing the drawing of another (E2). In a comparison condition, a blank card was torn. In the torn-drawing condition, as predicted, fewer participants with autism orientated towards E2 with an immediate look, and as a group, they were rated as showing less concern for, and fewer concerned looks towards, E2. We discuss possible implications for theoretical perspectives on the early development of empathy in typically as well as atypically developing children.

Qualities of symbolic play among children with autism: a social-developmental perspective.

We hypothesized that the qualities of play shown by children with autism reflect their impoverished experience of identifying with other people's attitudes and moving among person-anchored perspectives. On this basis, we predicted their play should manifest a relative lack of the social-developmental hallmarks that typify creative symbolic functioning. We videotaped the spontaneous and modelled symbolic play of matched groups of children with and without autism. The two groups were similar in the mechanics of play, for example in making one thing stand for another and using materials flexibly. By contrast, and as predicted, children with autism were rated as showing less playful pretend involving self-conscious awareness of pretending, investment in the symbolic meanings given to play materials, creativity, and fun.

Dissociable aspects of imitation: a study in autism.

What does it mean for a child to imitate someone else? We tested matched groups of children with and without autism (n=16 for each group, with a mean chronological age of 11 years and a mean verbal mental age of 6 years) to investigate two potentially dissociable aspects of imitation: copying goal-directed actions, on the one hand, and imitating the "style" with which a person demonstrates those actions, on the other. Our hypothesis was that the latter, but not necessarily the former, kind of imitation reflects a special quality of interpersonal engagement in which one person identifies with another, and that the propensity to identify with others is specifically weak in autism. As predicted, participants with and without autism were similar in their ability to copy six relatively complex goal-directed actions but were significantly different in imitating the style with which six simpler goal-directed actions were executed, especially when style was incidental to accomplishing a goal. We interpret the findings in terms of a link among children's capacities for intersubjective engagement, imitation, and learning new ways to relate to objects.

Narrative role-taking in autism.

Are children with autism able to adopt, and shift among, the psychological perspectives of different people? Fifteen children with autism and 15 without autism, matched for chronological age and verbal ability, were given Feffer's (1970) role-taking task in which they were asked to tell and then re-tell stories from different protagonists' perspectives. The children with autism understood the task, adjusted narratives according to alternative viewpoints, and were similar to control participants in their use of mental state terms. Despite this, the children with autism achieved significantly lower scores for adopting different figures' perspectives, and for shifting among complementary viewpoints. The results illustrate aspects of social-cognitive impairment that extend beyond the children's limitations in 'theory of mind' understanding.

Identification: the missing link between joint attention and imitation?

In this paper we outline our hypothesis that human intersubjective engagement entails identifying with other people. We tested a prediction derived from this hypothesis that concerned the relation between a component of joint attention and a specific form of imitation. The empirical investigation involved "blind" ratings of videotapes from a recent study in which we tested matched children with and without autism for their propensity to imitate the self-/other-orientated aspects of another person's actions. The results were in keeping with three a priori predictions, as follows: (a) children with autism contrasted with control participants in spending more time looking at the objects acted upon and less time looking at the tester; (b) participants with autism showed fewer "sharing" looks toward the tester, and although they also showed fewer "checking" and "orientating" looks, they were specifically less likely to show any sharing looks; and, critically, (c) within each group, individual differences in sharing looks (only) were associated with imitation of self-other orientation. We suggest that the propensity to adopt the bodily anchored psychological stance of another person is essential to certain forms of joint attention and imitation, and that a weak tendency to identify with others is pivotal for the developmental psychopathology of autism.

A controlled study of Hostile-Helpless states of mind among borderline and dysthymic women.

The aim of this study was to determine whether women with borderline personality disorder (BPD) are more likely than those with dysthymia to manifest contradictory Hostile-Helpless (HH) states of mind. A reliable rater blind to diagnosis evaluated features of such mental representations in transcripts of Adult Attachment Interviews from 12 women with BPD and 11 women with dysthymia of similar socioeconomic status (SES), all awaiting psychotherapy. In keeping with three hierarchical (non-independent) a priori predictions regarding the mental representations of women with BPD, the results were that (a) all those with BPD, compared with half the group with dysthymia, displayed HH states of mind; (b) those with BPD manifested a significantly higher frequency of globally devaluing representations; and (c) they exhibited a strong trend toward identifying with the devalued hostile caregiver (58% BPD vs. 18% dysthymic). In addition, significantly more BPD than dysthymic patients made reference to controlling behavior towards attachment figures in childhood. These findings offer fresh insights into the nature of BPD and extend previous evidence concerning affected individuals' patterns of thinking and feeling about childhood attachment figures.

Communicative depth: soundings from developmental psychopathology.

My aim in this paper is to consider what it means to engage and communicate with another person. I do so by adopting the approach of developmental psychopathology, and compare and contrast the structure of communication that is manifest by typically developing infants on the one hand, and by children and adolescents with autism on the other. I highlight the pivotal significance of human beings' propensity to share or otherwise co-ordinate experiences with others, and analyze the conditions that make sharing and other forms of intersubjective relatedness possible. Often, discussions that oppose cognitive, affective, and motivational accounts of autism are pursued in an inappropriate frame of reference: at root, we need to understand the nature and developmental implications of affected children's difficulties in achieving communicative depth. In the pursuit of such understanding, we may gain insights into typically developing infants' capacities for intersubjective engagement.