Article

The Cycle of Abuse: Emotional Availability in Resilient and Non-Resilient Mothers with Early Life Maltreatment

Authors:
  • Heidelberg University Clinic
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Abstract

Background: Early life maltreatment (ELM) has a high risk of transmission across generations, known as "the cycle of abuse." ELM is also an important risk factor for developing mental disorders, and having a mental disorder increases the risk of child abuse. Both the abuse potential in mothers with ELM and in mothers with a history of mental disorders might be associated with a disturbed mother-child interaction. Objective: The current study examined differences in emotional availability between mothers with a history of ELM and previous or current mental disorders (non-resilient), mothers with ELM without mental disorders (resilient), and control mothers without ELM and without mental disorders. Methods: Thirty-three non-resilient mothers, 18 resilient mothers, and 37 control mothers and their 5- to 12-year-old children participated in a standardized mother-child interaction task. Videotaped interactions were rated by three independent, trained raters based on the Emotional Availability Scales (EA Scales) and compared between the groups. Results: The non-resilient mothers and their children showed reduced maternal sensitivity, structuring, non-intrusiveness, non-hostility, responsiveness, and involvement compared to the resilient mothers and their children and the control mothers and their children (p = 0.006, ηp2 = 0.12). No differences on any of the EA Scales were found between resilient mothers and control mothers. Conclusions: These deficits in mother-child interaction in non-resilient mothers might contribute to mechanisms that could explain the cycle of abuse. Interestingly, resilient mothers, who did not develop a mental disorder despite having experienced ELM, did not show these deficits. Thus, prevention programs promoting resilience might be a key to break the cycle of abuse.

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... People who were exposure to childhood adversities (specifically neglect and abuse) have more chance to develop resilience in adulthood when they engage in marital or affectionate relationships that provide stability and support (DuMont et al., 2007). Mothers with adversities at childhood who became resilient in adulthood demonstrated greater emotional availability in their relations with their children compared to mothers who faced adversities in childhood and did not develop satisfactory levels of resilience (Mielke et al., 2020). ...
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The present study aimed to examine the mothers` interactive behaviors with their children related to their history of adverse experiences at childhood and parental sense of competence. The sample was composed by 47 mothers and their children of 2-to-5-year-old. One observational session of mother–child interactions was recorded. In another session, the questionnaires (Adverse Childhood Experience [ACE] and Parental Sense of Competence Scale [PSOC]) were applied. Parenting Interactions with Children coded the maternal interactive behavior: Checklist of Observations Linked to Outcomes (PICCOLO). The sample was divided according to Medium–High- and Low-PICCOLO performance into two situations respectively (free- and structured-play). The results showed that maternal interactive behavior performance in both situations was similar in the medium–high and low groups, independently of the mothers` history of adversities at childhood and sense of parental competence. In conclusion, mothers showed overall positive interactive behavior patterns, also in all specific domains, and a high level of parental sense of competence, independently of recollected adverse maternal childhood experiences.
... Literature shows that mothers of adolescents with BPD are more likely to have BPD or other affective disorders themselves [93]. Also, resilience to trauma could be considered in this context: it has been previously discussed if maternal ELM alone or rather the combination with a mental disorder would negatively influence mother-child interactions [56,65]. Therefore, although in our study mothers of both groups reported similar levels of ELM, the combination of maternal ELM and ensuing psychopathology might be contributing to the development of child BPD traits. ...
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Background: Early detection and intervention of borderline personality disorder (BPD) in adolescence has become a public health priority. Theoretical models emphasize the role of social interactions and transgenerational mechanisms in the development of the disorder suggesting a closer look at caregiver-child relationships. Methods: The current study investigated mother-adolescent interactions and their association with adolescent BPD traits by using a case–control design. Thirty-eight adolescent patients with ≥ 3 BPD traits and their mothers (BPD-G) were investigated in contrast to 35 healthy control dyads (HC-G). Maternal, adolescent and dyadic behavior was coded using the Coding Interactive Behavior Manual (CIB) during two interactions: a fun day planning and a stress paradigm. Additional effects of maternal and/or adolescent early life maltreatment (ELM) on behavior were also explored. Results: BPD-G displayed a significantly lower quality of maternal, adolescent and dyadic behavior than the HC-G during both interactions. Maternal and adolescent behavior was predicted by BPD traits alone, whilst dyadic behavior was also influenced by general adolescent psychopathology. Exploratory analyses of CIB subscales showed that whilst HC-G increased their reciprocal behavior during stress compared to the fun day planning, BPD-G dyads decreased it. Maternal ELM did not differ between groups or have any effect on behavior. Adolescent ELM was correlated with behavioral outcome variables, but did not explain behavioral outcomes above and beyond the effect of clinical status. Discussion/Conclusion: Our data suggest a stronger focus on parent–child interactions in BPD-specific therapies to enhance long-term treatment outcomes in adolescent BPD patients. Further research employing study designs that allow the analyses of bidirectional transactions (e.g. longitudinal design, behavioral microcoding) is needed.
... The EAS have also been found to discriminate clinical (e.g., mentally ill, substance abusing) from nonclinical mothers in Australia (Aran et al., 2022;Newman et al., 2007;Trapolini et al., 2008), Belgium (Vliegen et al., 2009), Finland (Flykt et al., 2012), Germany (Kluczniok et al., 2016;Mielke et al., 2020), Italy (Frigerio et al., 2019), and the United States (Sadeh-Sharvit et al., 2016). The EAS also discriminate clinical (i.e., feeding disordered) and nonclinical children in Germany (Wiefel et al., 2005) and Israel (Atzaba-Poria et al., 2010;Gueron-Sela et al., 2011). ...
Chapter
Positive emotional relationships between mothers and children are critical to children’s healthy development. Here, we review the literature on cross-cultural similarities and differences in emotional availability between mother and child. Although the research base for Western cultures is expanding, there is limited information available about emotional availability in non-Western cultures. Particularly lacking are cross-cultural studies in general, as well as intra-cultural studies on Asian and African cultures. Despite this lack, the existing literature nonetheless suggests that emotional availability is a broadly applicable construct and that typically functioning mother–child dyads (or pairs) score in the adaptive range on the Emotional Availability Scales regardless of culture. At the same time, small systematic variations in the emotional availability of mother-child dyads across cultures have been documented, enriching our understanding of emotional availability’s central but nuanced role across the broad range of human experience.KeywordsEmotional availabilityCultureMother-child interaction
... Furthermore, our work group demonstrated in a previous study (UBICA-I) that mothers with a history of depression and severe early life maltreatment (ELM) show reduced maternal sensitivity, i.e., a less accurate and timed responsiveness to and perception of the child's signals [16], when interacting with their child [17]. As maternal sensitivity appears to be especially diminished when mothers had experienced ELM and additionally suffered from a mental disorder in contrast to mothers who had experienced ELM but did not develop a mental disorder, parental psychopathology seems to be of special relevance when it comes to negatively altered parenting behavior [18]. With respect to personality disorders, maternal BPD has been associated with increased hostility towards the child, which further mediated the relationship between maternal BPD and behavioral problems in the child [19]. ...
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... Ten years ago a guidance of the World Psychiatric Association (WPA) has been dedicated to the protection and promotion of mental health in children of persons with severe mental disorders indicating that not the diagnosis but severity and chronicity of psychopathology confer an increased risk for child maltreatment [2]. Furthermore, it has been shown that ELM alone does not significantly impact on parenting behavior but that mothers with a history of MI and severe ELM show a particularly high risk of low maternal sensitivity in interaction with their children [3,4]. About 3.8 million minors in Germany live in families with an MI parent [5]. ...
Article
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Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398 . Registered on 5 July 2019
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Early life maltreatment can have severe and long-lasting consequences for the directly affected individual as well as for the next generation. Data from our research including mother-child dyads from Heidelberg and Berlin showed that early life maltreatment is associated with behavioral, hormonal and neural changes including personality traits and attachment style of the affected mothers that negatively affect their relationship with their child. The children of these mothers with previous experience of violence have an elevated risk to be maltreated, to show delayed development and to develop mental disorders. They also show a heightened cortisol concentration and reduced control of inhibition. It seems to be of importance whether the mother has experienced early life maltreatment but is resilient, i.e., she has not developed a mental disorder (up to the time of examination), or whether in addition to the early life maltreatment she has developed a mental disorder later in life. Children of mothers with early life experience of maltreatment and a mental disorder seem to be especially exposed to stress in parenthood and show the greatest impairments and risks. Based on the existing data from research, the practical and clinical implications are discussed and one possible intervention in terms of training of mentalization competency for parents is presented.
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When a family member becomes mentally or physically ill, the whole family is affected in a broader sense. So far the focus has been on the care of the sick index patient, although it has been proven that the inclusion of the social context, whether siblings, partners or parents, is not only beneficial for better compliance and better recovery rates but can also contribute to a significant reduction of accompanying stress factors of the other family members. To provide a better and more tailored care for families, the Center for Psychosocial Medicine at Heidelberg University Hospital has established an interdisciplinary working group composed of members from all departments to serve as a point of contact for families with core or concomitant mental health problems. This article presents how this working group implements the psychosocial care concept to enable the social integration of each patient and to enable efficient treatment and recovery, with respect to the four focal points “children and adolescents”, “parenthood”, “families” and “couples”.
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Background: Both, maternal borderline personality disorder (BPD) and maternal major depressive disorder (MDD) are often associated with adverse consequences for children, including increased risk for child behavior problems. Reduced maternal emotional availability might play a critical role in transmitting maternal psychopathology on the child. Our aim was to investigate the association between emotional availability and maternal BPD and MDD in remission (rMDD), and if this interrelatedness mediates the association between maternal mental disorders and child behavior problems. Methods: The interaction of 178 mother-child dyads was assessed during a play situation using the Emotional Availability Scales. Children were between 5 and 12 years old. Regression analyses were used to investigate the impact of maternal BPD and maternal rMDD on emotional availability. Ordinary least squares regression analyses using bootstrapping were conducted to investigate the mediating effect of emotional availability on the association between maternal mental disorders and child behavior problems. Results: Mothers with BPD showed increased hostility during mother-child interaction, whereas history of MDD was associated with reduced sensitivity. Maternal hostility was a mediator between maternal BPD and number of child psychiatric disorders, as well as externalizing and internalizing behavior. Maternal sensitivity mediated the association between maternal rMDD and number of child psychiatric disorders, as well as internalizing child behavior. Conclusions: Our data suggest that mothers with BPD show a qualitatively different pattern of emotional availability compared to mothers with rMDD. These patterns might reflect two separate pathways of transgenerational transmission of aspects of maternal mental disorders, where intervention and training programs could start: maternal rMDD impacts on child behavior problems via reduced sensitivity, and maternal BPD via increased hostility, which could both be addressed with specific therapeutic interventions.
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Background: Early childhood self-control and parenting are suggested to play key roles in the development of child problem behavior. The current study aims to 1) replicate earlier work by examining the unique and combined effects of child self-control and parenting on child problem behavior and 2) extend earlier work by including both mother and father reports. Methods: Data were used from 107 Dutch families: mothers, fathers, and their two-year old child. Child self-control was measured using both father's and mother's reports of effortful control and with an observed behavioral task (i.e., gift-in-bag task). Similarly, parenting (i.e., emotional availability and discipline) and child problem behavior (i.e., externalizing and internalizing problems) were measured by using both father's and mother's reports. Results: Child self-control reported by fathers and mothers, but not observed self-control, was related to fewer externalizing and (mother-reported) internalizing problems. Paternal emotional availability showed a modest association with fewer child externalizing problems, maternal emotional availability was related to fewer internalizing problems. Finally, there was an interaction between father- (but not mother) reported self-control and paternal emotional availability in the prediction of child internalizing problems. No main or interaction effect was revealed for discipline. Conclusion: Findings confirm prior work on self-control, parenting, and child problem behavior. Most importantly however, the current study adds to the literature by highlighting the need for additional research including maternal as well as paternal data. Specifically, insight in the unique role of fathers may shed light on aspects of child adjustment not covered by mother reports alone.
Article
Background: There is a well-established link between maternal depression and child mental health. Similar effects have been found for maternal history of early life maltreatment (ELM). However, studies investigating the relationship of children's quality of life and maternal depression are scarce and none have been conducted for the association with maternal ELM. The aim of the present study was to investigate the effects of maternal history of ELM and depression on children's health-related quality of life and to identify mediating factors accounting for these effects. Methods: Our study involved 194 mothers with and without history of depression and/or ELM and their children between five and 12 years. Children's health-related quality of life was assessed by maternal proxy- and child self-ratings using the KIDSCREEN. We considered maternal sensitivity and maternal parenting stress as potential mediators. Results: We found an effect of maternal history of depression but not of maternal history of ELM on health-related quality of life. Maternal stress and sensitivity mediated the effects of maternal depression on child global health-related quality of life, as well as on the dimensions Autonomy & Parent Relation, School Environment (maternal and child rating), and Physical Wellbeing (child rating). Limitation: Due to the cross-sectional design of the study, causal interpretations must be made with caution. Some scales yielded low internal consistency. Conclusions: Maternal impairments in areas of parenting which possibly developed during acute depression persist even after remission of acute affective symptoms. Interventions should target parenting stress and sensitivity in parents with prior depression. Fulltext: https://authors.elsevier.com/a/1VolO_3m9tfYs1
Article
Background: The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother-infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. Methods: Mothers (n=164; oversampled for history of childhood maltreatment given parent study's focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. Results: Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. Limitations: Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. Conclusions: Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis.
Article
Background/aims: High maternal emotional availability (EA) positively affects various domains of child development. However, the question of which factors promote or hinder maternal EA has not been investigated systematically. The present study investigated several maternal characteristics, namely maternal psychopathology, maternal attachment style insecurity, and theory of mind (ToM) as possible factors that influence maternal EA. Methods: The sample was comprised of 56 mothers and their preschool-aged children. Half of the mothers were diagnosed with postpartum depression and or anxiety disorders according to DSM-IV, and the other half were healthy controls. Results: The results showed that both low maternal attachment style insecurity and high ToM skills significantly predicted maternal EA sensitivity, independently from maternal postpartum and concurrent psychopathology and education. Moreover, maternal attachment style insecurity fully mediated the link between maternal postpartum psychopathology and sensitivity. Conclusion: The findings suggest that maternal attachment style security can buffer negative effects of maternal psychopathology on maternal sensitivity in the mother-child interaction.
Article
Background: The association between maternal depression and adverse outcomes in children is well established. Similar links have been found for maternal childhood abuse. One proposed pathway of risk transmission is reduced maternal emotional availability. Our aim was to investigate whether sensitive parenting is impaired in mothers with depression in remission, and whether among these mothers childhood abuse has an additional impact. Methods: The mother-child interaction of 188 dyads was assessed during a play situation using the Emotional Availability Scales, which measure the overall affective quality of the interaction: maternal sensitivity, structuring, nonhostility, and nonintrusiveness. Mothers with depression in remission were compared to healthy mothers. Children were between 5 and 12 years old. Group differences and impact of additional childhood abuse were analyzed by one-factorial analyses of covariance and planned contrasts. Results: Mothers with depression in remission showed less emotional availability during mother-child interaction compared to healthy control mothers. Specifically, they were less sensitive and, at trend-level, less structuring and more hostile. Among these mothers, we found an additional effect of severe maternal childhood abuse on maternal sensitivity: Mothers with depression in remission and a history of severe childhood abuse were less sensitive than remitted mothers without childhood abuse. Conclusions: Our data suggest that depression impacts on maternal emotional availability during remission, which might represent a trait characteristic of depression. Mothers with depression in remission and additional severe childhood abuse were particularly affected. These findings may contribute to the understanding of children's vulnerability to develop a depressive disorder themselves.
Article
Background: Previous research shows that maternal mental illness is an important risk factor for child maltreatment. This study aims to quantify the relationship between maternal mental health and risk of child maltreatment according to the different types of mental health diagnoses. Methods: The study used a retrospective cohort of children born in Western Australia between 1990 and 2005, with deidentified linked data from routine health and child protection collections. Results: Nearly 1 in 10 children (9.2%) of mothers with a prior mental health contact had a maltreatment allegation. Alternatively, almost half the children with a maltreatment allegation had a mother with a mental health contact. After adjusting for other risk factors, a history of mental health contacts was associated with a more than doubled risk of allegations (HR=2.64, 95% CI 2.50 to 2.80). Overall, all mental health diagnostic groups were associated with an increased risk of allegations. The greatest risk was found for maternal intellectual disability, followed by disorders of childhood and psychological development, personality disorders, substance-related disorders, and organic disorders. Maltreatment allegations were substantiated at a slightly higher rate than for the general population. Conclusions: Our study shows that maternal mental health is an important factor in child protection involvement. The level of risk varies across diagnostic groups. It is important that mothers with mental health issues are offered appropriate support and services. Adult mental health services should also be aware and discuss the impact of maternal mental health on the family and children's safety and well-being.
Article
This systematic review explores two questions: what parenting difficulties are experienced by mothers with borderline personality disorder (BPD); and what impact do these have on her children? Studies had to include mothers with a diagnosis of BPD, who was the primary caregiver to a child/children under 19 years. PsycINFO and MEDLINE were screened (update: July 2014), yielding 17 relevant studies. Mothers with BPD are often parenting in the context of significant additional risk factors, such as depression, substance use and low support. Interactions between mothers with BPD and their infants are at risk of low sensitivity and high intrusiveness, and mothers have difficulty in correctly identifying their emotional state. Levels of parenting stress are high, and self-reported competence and satisfaction are low. The family environment is often hostile and low in cohesion, and mothers with BPD show low levels of mind-mindedness but high levels of overprotection of older children. Outcomes for children are poor compared with both children of healthy mothers, and mothers with other disorders. Infants of mothers with BPD have poorer interactions with their mother (eg, less positive affect and vocalising, more dazed looks and looks away). Older children exhibit a range of cognitive-behavioural risk factors (eg, harm avoidance, dysfunctional attitudes and attributions), and have poorer relationships with their mothers. Unsurprisingly, given these findings, children of mothers with BPD have poorer mental health in a range of domains. This review highlights the elevated need for support in these mother-child dyads. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Article
The aim of this study was to examine the impact of a maternal history of abuse on mother-infant interaction (emotional availability; EA) in infancy and early toddlerhood. Over an 18-month period, women giving birth to a child in the local obstetric units were screened using the Childhood Trauma Questionnaire. Women who reported moderate or severe sexual and/or physical abuse were included in the maltreatment group (n=58; MG) and compared with a non-maltreated comparison group (n=61; CG). EA was investigated under experimental conditions when the children were 5 and 12 months of age using the Emotional Availability Scales. While mother-child dyads in the MG showed only very discrete interactional alterations at an infant age of 5 months, their EA differed significantly from the CG at 12 months due to the lack of an increase in EA observed in the MG. Exploratory analyses showed an additional effect of emotional abuse on EA at 12 months. These data indicate that the period when child locomotion develops might represent a critical time window for mothers with a history of abuse. Our results constitute an advance in research on child abuse as they identify a possible time window of non-normative alteration in mother-child interaction. This period could be targeted by strategies to prevent intergenerational transmission of abusive experiences. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Despite widespread belief that violence begets violence, methodological problems substantially restrict knowledge of the long-term consequences of childhood victimization. Empirical evidence for this cycle of violence has been examined. Findings from a cohort study show that being abused or neglected as a child increases one's risk for delinquency, adult criminal behavior, and violent criminal behavior. However, the majority of abused and neglected children do not become delinquent, criminal, or violent. Caveats in interpreting these findings and their implications are discussed in this article.
Article
There is no one style of parenting which characterizes young mothers as a group. In addition, life circumstances play an important role in shaping maternal behaviour. The aim of this study was to identify patterns of maternal play behaviour and contextual (social and personal) factors associated with these different patterns. In this study, 107 young mothers were observed at home during play with their toddlers; maternal behaviour was coded for joint attention (shared focus of mother and toddler attention) and emotional availability (e.g. sensitivity, intrusiveness, hostility). Mothers reported on aspects of their childhood history and current personal functioning and social support. A person-centred analytic approach, using cluster analysis, revealed three distinct groups of maternal play behaviour: (1) ‘sensitive-engaged’ (2) ‘inconsistent-directive,’ and (3) ‘intrusive-prohibitive’. Multivariate analyses revealed that contextual factors in mothers' lives (e.g. childhood abuse, depressive symptomatology, partner violence, social support, and parenting self-confidence) were differentially associated with parenting clusters. Copyright © 2007 John Wiley & Sons, Ltd.
Article
Parent–child attunement therapy (PCAT) is a promising intervention for toddlers (aged 12–30 months) who have experienced maltreatment. PCAT has two overall purposes: (1) to strengthen caregivers' relationship with their children; and (2) to facilitate caregivers' learning of appropriate child management techniques. PCAT represents an adaptation of parent–child interaction therapy (PCIT), which has been empirically documented in preschool and early elementary schoolchildren to improve behavioural adjustment and engender a stronger bond between caregiver and child. There is, however, a noted paucity of intervention research for toddlers, specifically maltreated toddlers. As toddlerhood represents a critical period for enhancing the relationship between caregivers and children and is a stage when youngsters are at increased risk for maltreatment, the objectives of PCAT become even more salient during the toddler years. The purpose of this study, therefore, is to introduce PCAT and then examine its effectiveness through a single case study of a 23-month-old maltreated toddler and his biological mother. Pre- and post-assessment measures included the Parenting Stress Index, the Dyadic Parent–Child Interaction Coding System (DPICS), the Achenbach Child Behavior Checklist (CBCL), the Emotional Availability (EA) Scales and the Eyberg Child Behavior Inventory (ECBI). The results of this study demonstrate the effectiveness of PCAT in increasing the number of positive caregiver–toddler interactions and enhancing the overall quality of the caregiver–toddler relationship. Practitioners will be able to use the techniques described in this manuscript to improve the parent–toddler relationship and ameliorate many commonly experienced behavioural difficulties found among maltreatment-prone parent–toddler dyads. Therapeutic progress is easily charted so that effectiveness may be documented and termination of therapy may be easily discerned. Copyright © 2005 John Wiley & Sons, Ltd.
Article
Prior research reports stronger associations between childhood maltreatment and adult psychopathology when maltreatment is assessed retrospectively compared with prospectively, casting doubt on the mental health risk conferred by maltreatment and on the validity of retrospective reports. To investigate associations of psychopathology with prospective v. retrospective maltreatment ascertainment. A nationally representative sample of respondents aged 16-27 years (n = 1413) in New Zealand completed a retrospective assessment of maltreatment and DSM-IV mental disorders. Survey data were linked with a national child protection database to identify respondents with maltreatment records (prospective ascertainment). Childhood maltreatment was associated with elevated odds of mood, anxiety and drug disorders (odds ratios = 2.1-4.1), with no difference in association strength between prospective and retrospective groups. Prospectively ascertained maltreatment predicted unfavourable depression course involving early onset, chronicity and impairment. Prospectively and retrospectively assessed maltreatment elevated the risk of psychopathology to a similar degree. Prospectively ascertained maltreatment predicted a more unfavourable depression course.
Article
Childhood maltreatment is associated with subsequent parenting difficulties; however, most research has relied on self-reported parenting outcomes, and observational measures have revealed mixed findings. Furthermore, research has focused predominantly on histories of sexual and/or physical abuse. This study explored associations between a wide range of childhood maltreatment experiences and both observed and self-reported parenting outcomes. Mothers of 4- to 6-year-old children at moderate social risk completed the History of Maltreatment and Trauma Form (HMTF), which assesses a range of maltreatment experiences and delineates specific characteristics such as chronicity and severity. Participants completed questionnaires assessing parenting stress and competence, and their emotional availability (sensitivity, intrusiveness, hostility) toward their children was coded from videorecorded interactions. Construct (factorial, convergent and discriminant) validity of the HMTF was demonstrated through factor analysis and a multi-trait, multi-method matrix comparing it to the Childhood Trauma Questionnaire. HMTF-assessed childhood maltreatment, specifically witnessing family violence, neglect and emotional maltreatment, were significantly associated with mothers' observed hostility toward their children, even after controlling for potentially traumatic adult experiences. In contrast, childhood sexual abuse history was associated with self-reported concerns regarding parenting competence, and this association held even after controlling for other forms of childhood maltreatment and potentially traumatic adult experiences. Self-reported parenting outcomes were unrelated to observed parenting behavior. Findings highlight the complexity of associations between child maltreatment and subsequent parenting outcomes. Although much previous research has focused on sexual and physical abuse, other more contextual forms of maltreatment may be similarly or more strongly associated with certain parenting outcomes. Furthermore, different forms of maltreatment may be associated with perceived versus observed parenting outcomes.
Article
Despite widespread belief that violence begets violence, methodological problems substantially restrict knowledge of the long-term consequences of childhood victimization. Empirical evidence for this cycle of violence has been examined. Findings from a cohort study show that being abused or neglected as a child increases one's risk for delinquency, adult criminal behavior, and violent criminal behavior. However, the majority of abused and neglected children do not become delinquent, criminal, or violent. Caveats in interpreting these findings and their implications are discussed in this article.
Article
The development of a retrospective, investigator-based interview measure of Childhood Experience of Care and Abuse (CECA) used with two community samples of adults in London is described. The component ratings are shown to have satisfactory inter-rater reliability and also validity as determined by agreement between sisters' independent accounts. The association between the different childhood scales is explored as well as the relationship of childhood experiences to adult depression. Methodological issues concerning investigator-based versus respondent-based measures of childhood are discussed and a case made for use of the former. Advantages of using the CECA, a retrospective, time-based measure of childhood, are outlined.
Article
Studies of psychiatric and social risk factors for child maltreatment have been limited by retrospective methodologies and reliance on officially reported or identified samples. Using data from both Waves I and II of the National Institute for Mental Health's Epidemiologic Catchment Area survey, 7,103 parents from a probabilistic community sample who did not self-report physical abuse or neglect of their children at Wave I were followed to determine the risk factors associated with the onset of self-reported physical abuse or neglect identified at Wave II. Social factors considered included age, socioeconomic status, social support, education, household size, and gender. In addition, several psychiatric disorders, including substance abuse disorders and depression were examined. Risk models were developed using hierarchical logistic regression. Physical abuse and neglect were found to have distinct sets of risk factors, with minimal overlap between the groups. Social and demographic variables were found to be limited predictors of maltreatment, while substance abuse disorders were strongly associated with the onset of both abuse and neglect (relative risks = 2.90 and 3.24 respectively). Depression was found to be a strong risk factor for physical abuse (relative risk = 3.45). Implications of the findings are discussed in terms of major causal models of maltreatment.
Article
While the potential negative effects on children of maternal depression has been documented, the influence of a maternal history of childhood abuse on child development is unclear. This study, the first stage of a 3-year follow-up study, looks at childhood abuse in women with depression in the postpartum period. Fifty-six women admitted with postpartum depressive disorders were assessed with respect to their wellbeing, relationships and infant interaction. Twenty-eight women had a history of sexual abuse before the age of 16, nine physical/emotional abuse and 19 had no history of abuse. The mother-infant relationship was seen to be impaired in the sexually abused group (p = 0.007). The significance increased when all abused women were compared to controls (p = 0.001). In addition, abuse was associated with more severe depression on the Beck Depression Inventory (p = 0.046), and a trend to higher anxiety and longer lengths of stay (p = 0.05 for physical abuse). Partners rated themselves as being more skilled and confident parents. The effect of childhood abuse was indistinguishable between emotional and physical abuse in postpartum depressed women. The most significant effect was a deleterious one on the mother-infant relationship in those women with a history of abuse.
Article
This investigation examined the longitudinal prediction of emotional availability in mother-child interaction during middle childhood from two indicators of socioemotional functioning in infancy: security of infant-mother attachment; and maternal depressive symptoms. Forty-five children and their mothers were seen during infancy: security of attachment was assessed in the laboratory Strange Situation; and mothers completed a self-report of depressive symptoms. At age 7, children were observed with their mothers in a lab playroom. The dyad's emotional availability was assessed during reunion following an hour-long separation. Results demonstrated significant associations between infancy and middle childhood socioemotional organization, both for mothers and for children. Security of attachment in infancy was related to maternal sensitivity and structuring, and to child responsiveness and involvement at age 7. Maternal depressive symptoms in infancy were associated with maternal sensitivity and structuring at age 7. Greatest differentiation was found between infants with secure attachments and those with insecure-disorganized attachments.
Article
This longitudinal study aimed to determine whether maternal depression was related to caregiving behavior and further whether this relationship was mediated and/or moderated by maternal caregiving representations. Ninety-two mothers were assessed for symptoms of depression when their children were 4, 12, and 15 months, and later at 4 years of age. At 4 years of age, mothers' caregiving representations of their child and their relationship were examined using the Parent Development Interview (PDI), and aspects of maternal behaviors were rated during mother-child play interactions using the Emotional Availability Scales (EA). The experience of chronic maternal depression was related to lower levels of maternal sensitivity, and this association was mediated by mothers' impaired capacity to take their child's perspective. The link between depression and lower maternal sensitivity was also moderated by perspective taking, indicating that poor perspective taking had a negative impact on sensitivity only for chronically depressed mothers. In conclusion, the current study demonstrated that mothers' representational models are affected by cognitive distortions associated with depression, and these distortions interfere with a mother's capacity to interact sensitively with her child.
International Neuropsychiatric Interview
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International Personality Disorder Examination (IPDE). Odessa, FL: Psychological Assessment Resources
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Loranger AW. International Personality Disorder Examination (IPDE). Odessa, FL: Psychological Assessment Resources; 1999.
Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B) [Multiple-choice vocabulary intelligence test], German version. Balingen: Spitta Verlag
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Lehrl S. Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B) [Multiple-choice vocabulary intelligence test], German version. Balingen: Spitta Verlag; 2005.
CFT 1, Grundintelligenztest Skala 1
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Weiss RH, Osterland J. CFT 1, Grundintelligenztest Skala 1 [Culture Fair Intelligence Test, Scale 1] (RB Cattell, 1966), German version. Göttingen: Hogrefe; 1997.
Grundintelligenztest Skala 2 -Revision (CFT 20-R)
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Weiss RH. Grundintelligenztest Skala 2 -Revision (CFT 20-R) [Culture Fair Intelligence Test, Scale 2 -Revision], German version. Göttingen: Hogrefe; 2006.
Fort Collins: Department of Human Development and Family Studies
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Biringen Z, Robinson J, Emde RN. The Emotional Availability scale (3rd ed.). Fort Collins: Department of Human Development and Family Studies, Colorado State University.
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