Karlen Lyons-Ruth

• Professor (Full) at Harvard Medical School

Maternal childhood maltreatment (MatCM) exerts deleterious influences on child psychosocial development. Yet, limited data exist on how MatCM influences infant neurodevelopment, particularly the roles of postnatal maternal interaction and cortisol as potential transmission mechanisms. Prior work has shown that maternal disorientation is linked to e...

Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceive...

Disinhibited attachment behavior (DAB) among infants is persistent and associated with behavioral and relational problems throughout childhood and adolescence. Little is known about risk factors for DAB among infants reared at home, although studies have linked DAB with maternal psychiatric hospitalization and maternal borderline personality disord...

Purpose Maternal cortisol levels in pregnancy may support the growth of or adversely affect fetal organs, including the brain. While moderate cortisol levels are essential for fetal development, excessive or prolonged elevations may have negative health consequences for both the mother and the offspring. Little is known about predictors of altered...

Despite a large animal literature documenting the role of low maternal nurturance and elevated glucocorticoid production on offspring limbic development, these pathways have not yet been assessed during human infancy. Informed by animal models, the present study examined whether 1) maternal disrupted interaction is related to infant cortisol levels...

Distinct neural effects of threat versus deprivation emerge by childhood, but little data are available in infancy. Withdrawn versus negative parenting may represent dimensionalized indices of early deprivation versus early threat, but no studies have assessed neural correlates of withdrawn versus negative parenting in infancy. The objective of thi...

Severity of maternal childhood maltreatment has been associated with lower infant grey matter volume and amygdala volume during the first two years of life. A developing literature argues that effects of threat (abuse) and of deprivation (neglect) should be assessed separately because these distinct aspects of adversity may have different impacts o...

Background: Hostile-Helpless (HH) state of mind is a form of disorganised attachment that is strongly associated with prior experiences of abuse. However, how abuse experiences contribute toward HH states of mind in late adolescence is unknown. Punitive control in adolescent-mother dyads has been implicated in the development of HH states of mind...

Background: The negative effects of childhood maltreatment can be intergenerational, and the prenatal period may play an important role in this intergenerational transmission. Maternal hypothalamic-pituitary-adrenal (HPA) axis dysfunction and maternal psychopathology represent two mechanisms through which the effects of childhood maltreatment are...

Edizioni Frenis Zero, Collana "Confini della Psicoanalisi", pagg. 276, ISBN 978-88-97479-38-3 Presentazione: Questa prima edizione italiana viene pubblicata dopo la morte di Arnold Modell, a cui questo libro è dedicato insieme a tre dei pionieri del dialogo tra psicoanalisi ed infant research: Daniel Stern, Berry Brazelton e Jeremy Nahum. Il libro...

Few studies have examined how mothering is organized in the first months of infancy, especially regarding risk‐related interactions. Person‐centred approaches, including latent profile analysis (LPA), add valuable insights about early parenting by identifying distinct profiles of interaction. First, this study aimed to identify profiles of disrupte...

In infancy and in the early years of life, emotion regulation and attachment relationships with parents are tightly intertwined. However, whether this link persists into adolescence has not yet been established and requires exploration. This pilot study utilizes an experimental design to assess the patterns of parent–adolescent interactions that ar...

Neglect is the most prevalent form of maltreatment, but it has been understudied relative to abuse. Additionally, developmental outcomes associated with early maternal withdrawal have been understudied relative to outcomes associated with harsh treatment. However, a large body of studies on rodents has documented the causal effect of low maternal c...

Objective Child maltreatment affects approximately 25% of the world’s population. Importantly, the children of mothers who have been maltreated are at increased risk of behavioral problems. Thus, one important priority is to identify child neurobiological processes associated with maternal childhood maltreatment (MCM) that might contribute to such...

We assessed how disorganized and controlling attachments (disorganized/disoriented, caregiving/role-confused, hostile/punitive) in later middle childhood relate to children's emotion regulation and emotion communication skills (N = 87). Disorganized and controlling behaviors were assessed with the Middle Childhood Attachment Strategies Coding Syste...

Maternal childhood maltreatment (MCM) is associated with parenting disruptions which may contribute to the intergenerational transmission of negative health and social outcomes. Most prior work has used variable-centered approaches to assess MCM. Complementary person-centered approaches can identify groups of participants characterized by similar p...

The relation between maternal and infant cortisol responses has been a subject of intense research over the past decade. Relatedly, it has been hypothesized that maternal history of childhood maltreatment (MCM) impacts stress regulation across generations. The current study employed four statistical approaches to determine how MCM influences the co...

The Atypical Maternal Behavior Instrument for Assessment and Classification—Brief (AMBIANCE‐Brief) was developed to provide a clinically useful and psychometrically sound assessment of disrupted parenting behavior for community practitioners. With prior evidence of this tool's reliability and validity in laboratory settings, this study aimed to det...

This article presents the results of a small pilot study examining links between Hostile/Helpless (HH) representations of caregiving in pregnancy and later child removal by child protective services. The sample was drawn from a replication study of the Minding the Baby® attachment-based home-visiting intervention conducted in the United Kingdom, se...

The guiding principle of this synthesis is to organize research on predictors of BPD features within a developmentally specific framework (e.g. infancy, preschool, middle childhood, adolescence). In addition, studies are prioritized that have longitudinal and observational components. Based on current literature, a Developmental Cascade Model of BP...

The self-damaging behaviors central to borderline personality disorder (BPD) become prominent in adolescence. Current developmental theories cite both early family processes and childhood dysregulation as contributors to BPD, but longitudinal data from infancy are rare. Using the National Institute of Child Health and Human Development (NICHD) Stud...

Abstract: Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent–child interaction that indicate risk...

Resulting from a community‐identified need for a well‐validated indicator of caregiving difficulties for use in practice settings, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination, this study aimed to assess the f...

Disrupted maternal interaction in early infancy is associated with maladaptive child outcomes. Thus, identifying early risk factors for disrupted interaction is an important challenge. Research suggests that maternal depressive symptoms and maternal cortisol dysregulation are associated with disrupted maternal interaction, but both factors have rar...

The hippocampus plays an important role in stress regulation and has been the focus of research regarding the effects of early life stress on brain development. Much of this research has focused on severe forms of early adversity, particularly maltreatment. However, a handful of studies are now examining the effects of more subtle variations in qua...

Theorists have suggested that attachment disorganization contributes to the development of borderline personality disorder (BPD). However, few stud- ies have directly observed attachment-related interactions with parents. This study used a newly developed attachment-based coding system to examine whether individuals with BPD were more likely to exh...

Existing literature points to the possibility that cortisol could be one link between maternal adversity and poorer parenting quality, but most studies have examined salivary cortisol concentrations rather than hair cortisol concentrations. The current study examined hair cortisol concentration (HCC) during the third trimester of pregnancy as a med...

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 beh...

This book has the hard task to cover an interdisciplinary area in which psychoanalysis has to deal with infant research. The development of infant research methodologies is illustrated in the present book by the contribution written by Beatrice Beebe, whose ‘journey’ leads us through the ‘creating’ of a discipline with its creators, her traveling c...

The purpose of this study was to assess behavioral manifestations of attachment in middle childhood, and to evaluate their relations with key theoretical correlates. The sample consisted of 87 children (aged 10–12 years) and their mothers. Dyads participated in an 8-min videotaped discussion of a conflict in their relationships, later scored with t...

The Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Bronfman, Madigan, & Lyons-Ruth, 2009–2014; Bronfman, Parsons, & Lyons-Ruth, 1992–2004) is a widely used and well-validated measure for assessing disrupted forms of caregiver responsiveness within parent–child interactions. However, it requires evaluating approxi...

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth –3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of diso...

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that...

A number of analytic writers have commented on the dilemma of the child “in the service of the parent.” More recently, developmental research studies have deepened our understanding of the developmental onset, trajectories, and correlates associated with role confusion in the parent-child relationship. In the current article, two clinical cases are...

Although randomized interventions trials have been shown to reduce the incidence of disorganized attachment, no studies to date have identified the mechanisms of change responsible for such reductions. Maternal sensitivity has been assessed in various studies and shown to change with intervention, but in the only study to formally assess mediation,...

We applied latent-trait, item response theory (IRT) techniques to evaluate the measurement distribution and precision of the behavioral indicators of the AMBIANCE system. A major advantage of IRT models, the analogue of factor analytic methods for binary data, is that they characterize the relation between a latent trait and an observable manifesta...

SRCD 2017 presentation

Mothers with borderline personality disorder (BPD) have been theorized to have decreased mentalization ability, which is the capacity to perceive and interpret mental states. This could increase the risk for troubled relationships with their infants and therefore have adverse consequences for child social and emotional development. Mind-mindedness...

The representational world of the mother has long been at the center of clinical discussions regarding the quality of parenting. However, assessing mother’s representation of role-confusion in her relation with her child has yet to be investigated, even if parent-child role-confusion can lead to maladaptive pathways. As part of a larger study we de...

The current paper expands on Ainsworth's seminal construct of maternal sensitivity by exploring the developmental pathways associated with one particular form of insensitivity: maternal withdrawal. Drawing on longitudinal data from infancy to age 20 in a high-risk cohort, we highlight how maternal withdrawal over the first eight years of life is as...

Objective: This study's aim was to evaluate whether infant disorganized attachment and infant proneness to distress exhibited differential relations to infant genetic factors as indexed by the serotonin transporter polymorphism. Background: The role of the short allele of the serotonin transporter polymorphism (5-HTTLPR) in enhancing sensitivity...

Disorganized attachment has been proposed as a mediating mechanism in the relation between childhood abuse and dissociation. However, support for mediation has been mixed when using interview or self-report measures of attachment. In the current work, relations among severity of abuse, attachment disorganization, and dissociation were assessed in y...

Although the quality of the attachment relationship is often cited as an important determinant of development, the extent of impact of this environmental influence in shaping behavioral outcomes has been a matter of considerable debate. This may, in part, be because of the variability in methodologies used for assessing attachment across infancy, c...

Objective The present study assessed whether the often reported relation between childhood abuse and the extent of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) features would be mediated by Hostile–Helpless (HH) and/or Unresolved (U) states of mind on the Adult Attachment Interview (AAI). Method One hundred and...

Borderline symptoms are thought to emerge from the interaction of temperamental factors and environmental stressors. Both parental invalidation and attachment disorganization have been hypothesized to play an etiological role. However, to date the quality of parent-child interaction has not been observed directly. In this study, 120 young adults we...

Borderline symptoms are thought to emerge from the interaction of temperamental factors and environmental stressors. Both parental invalidation and attachment disorganization have been hypothesized to play an etiological role. However, to date the quality of parent-child interaction has not been observed directly. In this study, 120 young adults we...

Zeanah and Gleason have contributed a very informative and comprehensive review of the considerable recent advances in understanding reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Research in the past 15 years has grounded these diagnoses in a solid evidence base, due to the sophisticated work carried out by...

This paper proposes a method of examining the micro-events of the analytic process that borrows heavily, from developmental research. The increasing importance of illuminating the microprocess of interaction to understanding the process of change in analytic treatment is emphasised. A set of constructs and terminology is proposed for the study of t...

ABSTRACT The normative development of infant shared attention has been studied extensively, but few studies have examined the impact of disorganized attachment and disturbed maternal caregiving on mother-infant shared attention. The authors examined both maternal initiations of joint attention and infants' responses to those initiations during the...

The amygdala is vulnerable to stress-dependent disruptions in neural development. Animal models have shown that stress increases dendritic arborization leading to larger amygdala volumes. Human studies of early stress and amygdala volume, however, remain inconclusive. This study compared amygdala volume in adults with childhood maltreatment to heal...

The current paper expands on Ainsworth's seminal construct of maternal sensitivity by exploring the developmental pathways associated with one particular form of insensitivity: maternal withdrawal. Drawing on longitudinal data from infancy to age 20 in a high-risk cohort, we highlight how maternal withdrawal over the first eight years of life is as...

The primary objective was to assess whether prospectively observed quality of parent-child interaction in infancy and middle childhood contributed to the prediction of borderline symptoms and recurrent suicidality/self-injury in late adolescence. Adolescents (mean 19.9 years) from 56 families participating in a longitudinal study since infancy (ret...

Despite important progress in understanding the complex caregiving system, developmental research has only recently begun to focus on the mother’s internal affective state and its role in sensitive caregiving behavior. This review will summarize recent findings of functional neuroimaging research to elaborate on the neural components associated wit...

Enactments are investigated from the process-oriented focus of our therapeutic approach. By embedding their occurrence within the on-going flow of nonlinear dyadic process, we focus on the subtle back-and-forth between patient and analyst, as well as the importance of what we call now moments. An alternative to the dissociative self-state model is...

Disoriented, punitive, and caregiving/role-confused attachment behaviors are associated with psychopathology in childhood, but have not been assessed in adolescence. A total of 120 low-income late adolescents (aged 18-23 years) and parents were assessed in a conflict-resolution paradigm. Their interactions were coded with the Goal-Corrected Partner...

Self-reports of role confusion with the parent in childhood are associated with a variety of adverse outcomes. However, role-confusion has been studied primarily from the point of view of the child. The current study evaluated an instrument for assessing role confusion from maternal interviews rather than from child observations or self-reports in...

The study evaluated the association between maternal disrupted communication and the reactivity and regulation of the psychobiology of the stress response in infancy. Mothers and infants were recruited via the National Health Service from the 20% most economically impoverished data zones in a suburban region of Scotland. Mothers (N=63; M age=25.9)...

Disorganized attachment is an early predictor of the development of psychopathology in childhood and adolescence. Lyons-Ruth et al. (1999) developed the AMBIANCE coding scheme to assess disrupted communication between mother and infant, and reported the link between maternal behavior and disorganized attachment. The Hungarian group found an associa...

The relation between early mother-infant interaction and later socio-emotional development has been well established. The present study addresses the more recent interest in the impact of maternal caregiving on cognitive development and their role in decision-making in young adulthood. Using data from a prospective longitudinal study on attachment,...

Few studies have evaluated the separate contributions of maltreatment and ongoing quality of parent-child interaction to the etiology of antisocial personality features using a prospective longitudinal design. 120 low-income young adults (aged 18-23) were assessed for extent of ASPD features on the Structured Clinical Interview for Diagnosis-Axis I...

Self-reports of role confusion with the parent in childhood are associated with a variety of adverse outcomes. However, role-confusion has been studied primarily from the point of view of the child. The current study evaluated an instrument for assessing role confusion from maternal interviews rather than from child observations or self-reports in...

Socially disinhibited or indiscriminate behavior (IB) has traditionally been investigated using caregiver reports. More recently, an observational measure based on the Strange Situation Procedure (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978), the Rating of Infant and Stranger Engagement (RISE; C. Riley, A. Atlas-Corbett, & K. Lyons-Ruth, 20...

In this investigation we examined the developmental correlates and predictors of maternal emotional availability in interactions with their 7-year-old children among a sample of families at psychosocial risk. We found developmental coherence in maternal interactive behavior, and in the relations between maternal emotional availability and children'...

Comments on an article Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention by Stepp, Whalen, Pilkonis, Hipwell, and Levine (see record 2011-05873-001). The authors have offered us an extremely timely paper, given the surge of interest in borderline psychopathology in genera...

Disorganized/controlling attachment in preschool has been found to be associated with maternal and child maladjustment, making it of keen interest in the study of psychopathology. Additional work is needed, however, to better understand disorganized/controlling attachment occurring as early as age three. The primary aims of this study were to evalu...

When considering childhood trauma, it is common to think of physical or sexual abuse, or of other traumatic events involving a threat to the subject’s physical integrity, as described in the Diagnostic and Statistical Manual of Mental Disorders; 4th edn. (DSM-IV-TR) [1]. However, the experience of threat is very different during infancy, as infants...

In the development of borderline personality disorder (BPD) both genetic and environmental factors have important roles. The characteristic affective disturbance and impulsive aggression are linked to imbalances in the central serotonin system, and most of the genetic association studies focused on serotonergic candidate genes. However, the efficac...

Genotype and allele frequencies of dopaminergic polymorphisms in the US and Hungarian groups. Genotype frequencies are shown in the upper part, allele frequencies are shown in the lower part of each dopaminergic polymorphism, namely the COMT Val158Met, the DAT1 40 bp VNTR, the DRD2 TaqIB, TaqID, TaqIA SNPs, and the DRD4 120 bp duplication, -616 C/G...

: The Personal Attitude Scale (PAS; Hooley, 2000) is a method that is under development for identifying individuals high in Expressed Emotion based on personality traits of inflexibility, intolerance, and norm-forming. In the current study, the goal was to measure the association between this maternal attitudinal inflexibility, early hostile or dis...

Women with borderline personality disorder have conflictual interpersonal relations that may extend to disrupted patterns of interaction with their infants. To assess how women with borderline personality disorder engage with their 12 to 18-month-old infants in separation-reunion episodes. We videotaped mother-infant interactions in separation-reun...

Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of 56 low-income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Sc...

Main, Kaplan, and Cassidy's (1985) conceptualizations of disorganization in infancy and controlling behavior in preschool forged new directions in attachment research. However, there currently is no valid coding system for behavioral manifestations of attachment after 7 years of age. The present study presents the validity of an instrument for codi...

Childhood adversity increases the risk of psychopathology, but the neurobiological mechanisms underlying this vulnerability are not well-understood. In animal models, early adversity is associated with dysfunction in basal ganglia regions involved in reward processing, but this relationship has not been established in humans. Functional magnetic re...

Socially indiscriminate attachment behavior has been repeatedly observed among institutionally reared children. Socially indiscriminate behavior has also been associated with aggression and hyperactivity. However, available data rely heavily on caregiver report of indiscriminate behavior. In addition, few studies have been conducted with samples of...

This prospective 20-year study assessed associations between maternal depressive symptoms in infancy, childhood, and adolescence, and child and adolescent depressive symptoms in a sample of families at high psychosocial risk. Maternal symptomatology was assessed with the Center for Epidemiological Studies Depression Scale (CES-D) when children were...

Recent high-risk longitudinal studies have documented a unique contribution of the quality of the early mother-child relationship to diverse forms of psychopathology in young adulthood, even with family economic status, later traumatic experiences, and some genetic factors controlled. In addition, measures of attachment-related deviations in caregi...

Hypothalamic-pituitary-adrenal axis dysregulation after stress was found to be associated with borderline personality disorder (BPD). Nine female BPD young adults and 12 control subjects were investigated for stress reactivity and recovery after an interpersonal conflict discussion with their mothers. BPD subjects showed a delayed cortisol response...

This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant...