Infant attachment and temperament as predictors of subsequent externalizing problems and cardiac physiology

BACKGROUND: The primary objective of this study was to examine the extent to which both individual child temperament and parent-child relationship quality independently and/or interactively predicted physiological, psychosocial, and behavioral 'outcomes'. Employing a longitudinal prospective design over three years, statistical associations were found among infant attachment, uninhibited temperament, and 4-year behavioral and physiological functioning that supported a bio-psychosocial model of development. METHOD: Three cohorts totaling 140 children and their mothers visited the laboratory for observational assessments of attachment classification at age 14 months (Strange Situation), behavioral inhibition at 24 months, and social behaviors with unfamiliar peers at age 4 years. Cardiac measures of heart rate and respiratory sinus arrhythmia (RSA) were collected at every time point. At age 4 years maternal ratings of child temperament and behaviors were also obtained. RESULTS: Analyses of variance (ANOVAs) with inhibition group (high, moderate, low) and attachment classification (A, B, C) revealed that the low inhibited group had significantly higher activity level scores and displayed significantly less reticence at 4 years compared to the moderately and highly inhibited groups. Infants who had an avoidant attachment with their mothers had more externalizing problems (aggressive behaviors) at age 4 than either securely or ambivalently attached infants. This predictive relation, however, was qualified by an interaction whereby avoidant attachment and uninhibited temperament together predicted a higher incidence of externalizing behavior problems. Moreover, infants' avoidant attachment was not concurrently but predictively associated with lower heart rate and high RSA at age 4 years. Therefore, an avoidant mother-child relationship in infancy could influence the development of an underaroused autonomic profile in early childhood. CONCLUSIONS: Consistent with bio-psychosocial models of development, these findings support the contention that both early child temperament and parent-child relationship quality contribute to subsequent psychological/behavioral and physiological functioning.     

Interplay of genes and early mother–child relationship in the development of self-regulation from toddler to preschool age

Background:  A broad capacity for deliberate self-regulation plays a key role in emotion regulation. This longitudinal investigation from infancy to preschool age examines genotype by environment (G × E) interaction in the development of self-regulation, using molecular measures of children's genotypes and observed measures of the quality of early mother–child relationship, as reflected in attachment organization in infancy.
Methods:  In 89 children, we assessed the polymorphism in the serotonin transporter gene (5-HTTLPR, ss/sl vs. ll allele status), security of attachment to mothers at 15 months in the Strange Situation, and children's ability for self-regulation at 25, 38, and 52 months, using behavioral batteries of tasks that called for deliberately suppressing a dominant response and performing instead a sub-dominant response.
Results:  There was a robust G × E interaction between genetic risk and the quality of early relationship. Among children who carried a short 5-HTTLPR allele ( ss/sl ), those who were insecurely attached developed poor regulatory capacities, but those who were securely attached developed as good regulatory capacities as children who were homozygotic for the long allele ( ll ). There was no effect of security for ll homozygotes.
Conclusions:  Those findings, consistent with diathesis-stress model, bridge research on self-regulation in typically developing children with research on non-human primates and research on psychopathology. They also indicate that a secure attachment relationship can serve as a protective factor in the presence of risk conferred by a genotype.     

Study of operated hydrocephalus patients three years after surgery

The development of hydrocephalic children who had been subjected to atrial shunt operation in infancy, has been studied at the age of 3 years. Psychological investigation was carried out in 24 of the 27 surviving cases. Mental development was normal in 14 children while 10 displayed mental retardation, of whom 8 are still suited for schooling. The grave aetiologic factors are considered primarily responsible for retardation. The functional development achievable by successful surgical treatment is discussed.     

The Natural History of IgE Sensitisation and Atopic Disease in Early Childhood

ABSTRACT. We have prospectively followed 57 children of atopic parents up to 5 years of age, documenting clinical atopic disease and allergen skin test reactions. The cumulative prevalences of the clinical features of atopic disease over the 5 years were: atopic dermatitis (58%), wheeze (49%), recurrent wheeze (33%), rhinitis (68%) and immediate food reactions (18%). Atopic dermatitis and immediate food reactions predominated in infancy (birth to 20 months) while wheezing was more prominent in later childhood (20 months to 5 years). Rhinitis was common in both infancy and childhood. IgE sensitisation to ingested allergens was prominent in early infancy and was usually transient. Inhaled allergen sensitisation occurred later in infancy and was generally permanent with wheal sizes tending to increase with age. There was a significant association between IgE sensitisation to ingested but not inhaled allergens and all atopic manifestations in infancy, with the exception of rhinitis. In contrast IgE sensitisation to inhaled allergens was associated with rhinitis and wheeze in later childhood. We found two clinical groups. One group, with only ingested allergen sensitisation had a high incidence of atopic dermatitis but low incidence of respiratory symptoms at 5 years of age. The other group, who developed evidence of IgE sensitisation to inhaled allergens, had a high incidence of rhinitis and wheeze but low incidence of atopic dermatitis at 5 years of age.     

A longitudinal study of otitis media with effusion among 2- to 5-year-old African-American children in child care

OBJECTIVE: To prospectively document the prevalence of otitis media with effusion (OME) in 86 African-American children between ages 2 and 5 years. STUDY DESIGN: Eighty-six children in center-based child care whose ear status had been followed from infancy continued to be observed. Middle ear status was assessed by pneumatic otoscopy and tympanometry biweekly. RESULTS: The prevalence of OME decreased as children became older. The mean proportion of examinations demonstrating bilateral OME (BOME) ranged from 12% between 24 to 30 months to 4% between 54 to 60 months of age. The mean proportion of exams revealing bilateral normal ears increased from 77% at 24 to 30 months to 88% at 54 to 60 months of age. Although 60 children had experienced BOME that lasted 4 months or longer in the 6- to 24-month age period, only 8 of these children experienced at least 4 months of continuous BOME between 24 to 60 months. CONCLUSIONS: The proportion of time with BOME decreased progressively with increasing age in this population. Only 8 of 60 children who had experienced more than 4 consecutive months of BOME before 2 years of age continued to manifest persistent effusion or experience recurrences of prolonged BOME after 2 years of age.     

Breaking the Intergenerational Cycle of Insecure Attachment: A Review of the Effects of Attachment-Based Interventions on Maternal Sensitivity and Infant Security

Abstract— In this paper the effectiveness of preventive or therapeutic interventions aiming at enhancing parental sensitivity and children's attachment security is addressed, Sixteen pertinent studies have been reviewed, and 12 studies have been included in a quantitative meta-analysis ( N = 869). Results show that interventions are more effective in changing parental insensitivity ( d =. 58) than in changing children's attachment insecurity ( d =. 17). Longer, more intensive, and therapeutic interventions appear to be less effective than short-term preventive interventions. Interventions which are effective at the behavioral level may not necessarily lead to changes in insecure mental representations of the parents involved. The implications of changes at the behavioral level (sensitivity; attachment) without accompanying changes at the representational level will be discussed.     

The natural history of IgE sensitisation and atopic disease in early childhood

We have prospectively followed 57 children of atopic parents up to 5 years of age, documenting clinical atopic disease and allergen skin test reactions. The cumulative prevalences of the clinical features of atopic disease over the 5 years were: atopic dermatitis (58%), wheeze (49%), recurrent wheeze (33%), rhinitis (68%) and immediate food reactions (18%). Atopic dermatitis and immediate food reactions predominated in infancy (birth to 20 months) while wheezing was more prominent in later childhood (20 months to 5 years). Rhinitis was common in both infancy and childhood. IgE sensitisation to ingested allergens was prominent in early infancy and was usually transient. Inhaled allergen sensitisation occurred later in infancy and was generally permanent with wheal sizes tending to increase with age. There was a significant association between IgE sensitisation to ingested but not inhaled allergens and all atopic manifestations in infancy, with the exception of rhinitis. In contrast IgE sensitisation to inhaled allergens was associated with rhinitis and wheeze in later childhood. We found two clinical groups. One group, with only ingested allergen sensitisation had a high incidence of atopic dermatitis but low incidence of respiratory symptoms at 5 years of age. The other group, who developed evidence of IgE sensitisation to inhaled allergens, had a high incidence of rhinitis and wheeze but low incidence of atopic dermatitis at 5 years of age.     

Unresolved maternal attachment representations, disrupted maternal behavior and disorganized attachment in infancy: links to toddler behavior problems

BACKGROUND: Attachment theory's original formulation was substantially driven by Bowlby's (1969/1982) quest for a meaningful model of the development of psychopathology. Bowlby posited that aberrant experiences of parenting increase the child's risk of psychopathological outcomes, and that these risks are mediated by the quality of the attachment relationship. To empirically examine this hypothesis, the current study explores the associations between the development of toddler behavior problems and a) maternal unresolved attachment representations, b) maternal interactive behavior, and c) infant attachment relationships. Second, we test the mediating role of disorganized attachment in the association between disruptive behavior and toddler behavior problems, as well as unresolved attachment and behavior problems. METHOD: Sixty-four adolescent mother-infant dyads participated in this longitudinal study. The Adult Attachment Interview was administered at 6 months, the Strange Situation procedure was conducted at 12 months, disrupted behavior was assessed during play interactions at 12 months using the AMBIANCE measure, and the Child Behavior Checklist (CBCL) was used to assess behavior problems at 24 months of age. RESULTS: Maternal reports of externalizing problems were significantly associated with unresolved representations of attachment, disrupted maternal behavior, and disorganized attachment. Inclusion of these variables in a path analytic model suggested that disorganized attachment mediated the associations between disrupted maternal behavior and externalizing problems. Although the association between unresolved attachment representations and externalizing problems was no longer significant when mediation by disrupted behavior and disorganized attachment was taken into account, this indirect pathway was not significant. CONCLUSIONS: The results are consistent with Bowlby's (1969/1982) original conceptualization of the explanatory role of the attachment relationship in the development and manifestation of behavioral maladaptation. Effects of unresolved attachment on externalizing problems await further explanation.     

Variability in outcome for children with an ASD diagnosis at age 2

BACKGROUND: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms - or diagnoses - change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of 2-year-old children with ASD, and to identify child and environmental factors that contribute to variability in outcomes at age 4. METHODS: Forty-eight children diagnosed with autism or pervasive developmental disorder not otherwise specified (PDDNOS) at age 2 were followed to age 4. Diagnostic measures included the Autism Diagnostic Observation Schedule - Generic (ADOS-G) and clinical diagnosis at ages 2 and 4, and the ADI-R at age 4. RESULTS: Diagnostic stability for an ASD diagnosis (autism or PDDNOS) was 63%, and for an autism diagnosis was 68%. Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2. No differences between children with stable and unstable diagnoses were found for amount of intervention services received. Among the children with unstable diagnoses, all but one continued to have developmental disorders, most commonly in the area of language. CONCLUSIONS: The stability of ASD was lower in the present study than has been reported previously, a finding largely attributable to children who were diagnosed at 30 months or younger. Implications for clinical practice are discussed.     

Atopy in children with and without a family history of atopy. I. Clinical manifestations, with special reference to diet in infancy

The influence of a family history of atopy on atopic morbidity, and relationships between diet in infancy and allergic manifestations at the ages of one and five years were prospectively studied in 91 children. A control group consisted of 72 children with no family history of atopy. At the age of one year, atopic manifestations were found in 19% of 163 children, in 23% of those with a family history of atopy and in 14% of those with no such history. Skin problems were more common in children with a family history of atopy (43%) than in the control children (19%). Of the children with a family history of atopy, 23% had prolonged rhinorrhoea during infancy. The corresponding figure in children with no family history of atopy was 10%. Prolonged rhinorrhoea during infancy correlated with parental smoking only in children with a family history of atopy (47% vs. 18%). At the age of five years, atopic disease was found in 17% of 128 children, 24% of those with a family history of atopy and 9% of those with no such history. Atopic eczema was more common in children with a family history of atopy, irrespective of the diet consumed during infancy. Atopic signs were found in about half of all the children with a family history of atopy. If atopy had been present in the family, the child usually exhibited the same manifestation. Onset of atopic manifestations was not prevented or delayed.     

Hyaline membrane disease, birth weight, and gestational age. Effects on development in the first two years

Mean mental and motor developmental test scores (Bayley scales) at 4, 12, and 24 months of age were determined for 161 graduates of a neonatal intensive care unit during the period 1977 through 1979. Analysis of variance for our data showed significant effects of hyaline membrane disease (HMD) on mental and motor development at 4 months, but disappearance of these effects at 12 and 24 months of age. Conversely, birth weight was not significantly related to developmental performance at 4 months, but was strongly related to both mental and motor performance at 12 and 24 months of age. Gestational age was significantly related to mental performance at 24 months of age. No relationship was found between HMD and major CNS handicapping conditions; both birth weight and gestational age were highly related to the occurrence of neurologic handicaps. Of the three variables assessed, birth weight was the best predictor of neurodevelopmental outcome.     

The development of adopted children after institutional care: a follow-up study

BACKGROUND: Research suggests that institutional care has long-lasting effects on children. However, no study has longitudinally studied infants in an institution and their subsequent development at age four. METHODS: Sixty-one adopted children aged four years who had spent their first two years of life in an institution were compared to 39 children reared in their own two-parent families. Cognitive development, security of attachment, shyness, children's emotional understanding and behavioural problems were examined in both groups. Parental health and stress were also assessed. RESULTS: At four years adopted children still had lower scores on cognitive development, were less secure, and less able to understand emotions than family-reared children. Children with a secure attachment type in infancy were found to be less secure at age four, compared with those who were classified in infancy as having an insecure attachment type. Their physical development had recovered, they were less shy, had no behavioural problems and no problems in the relationship with their teacher. CONCLUSIONS: Early residential group care has long-lasting effects on important socio-emotional and cognitive aspects of preschool children's development.     

Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment

BACKGROUND: Family-based behavioral weight control treatment involves the parent in the modification of child and parent eating and activity change. OBJECTIVE: To assess if parent standardized body mass index (z-BMI) change predicts child z-BMI change. DESIGN: Secondary data analysis based on parent and child z-BMI changes from 3 family-based, randomized, controlled weight control studies. Hierarchical regression models tested whether parent z-BMI change increased prediction of child z-BMI change through treatment and 24-month follow-up beyond other factors that influence child weight change, such as child age, sex, socioeconomic status, and baseline child and parent z-BMI. Differences in child z-BMI change as a function of quartiles of parental z-BMI change were tested using an analysis of covariance. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Obese 8- to 12-year-old children and their parents from 142 families who participated in family-based weight control programs. MAIN OUTCOME MEASURES: Child and parent z-BMI changes over time. RESULTS: Parent z-BMI change significantly predicted child z-BMI change for the 0- to 6-month (P<.001) and 0- to 24-month (P <.009) time points. In hierarchical regression models, parent z-BMI change was a significant incremental predictor of child z-BMI change at 6 and 24 months, with the additional r(2) ranging from 11.6% at 6 months (P <.001) to 3.8% at 24 months (P =.02). Parents in the highest quartile of z-BMI change had children with significantly greater z-BMI change than that of children with parents in the other quartiles (P =.01). CONCLUSION: Parent z-BMI change is an independent predictor of obese child z-BMI change in family-based behavioral treatment, and youth benefit the most from parents who lose the most weight in family-based behavioral treatments.     

From the father's point of view: How father's representations of the infant impact on father–infant interaction and infant development

Despite the knowledge that fathers uniquely contribute to the development of their infants, relatively few studies have focused on the father–infant relationship during early infancy. In the present longitudinal study we included 189 fathers and examined whether their early attachment representations of the infant predicted future quality of father–infant interaction. We also investigated whether these representations were related to the infant's development. Paternal attachment representations were assessed by the Working Model of Child Interview (WMCI) at 6 months post-partum and classified fathers' representations as ‘balanced’ or ‘unbalanced’ (disengaged or distorted). At 24 months, father–infant interaction was videotaped and analyzed by the NICHD coding scales. Further, the Peabody Picture Vocabulary Test (PPVT-III) was administered to evaluate the infant's verbal development. Results revealed that fathers' early attachment representations of the infant predict the quality of future father–infant interaction, with balanced representations more strongly associated with more favorable behaviors in fathers and infants. In addition, paternal interactive behavior appears an important mechanism through which paternal representations influence the development of the infant. These results underline the importance of early identification of fathers with unbalanced attachment representations, and we therefore recommend that more attention should be directed to the quality of the early father–infant relationship in clinical settings.     

Autism Spectrum Disorders at 20 and 42 Months of Age: Stability of Clinical and ADI-R Diagnosis

The association between, and stability of, clinical diagnosis and diagnosis derived from the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, & Le Couteur, 1994) was examined in a sample of prospectively identified children with childhood autism and other pervasive developmental disorders assessed at the age of 20 months and 42 months. Clinical diagnosis of autism was stable, with all children diagnosed with childhood autism at age 20 months receiving a diagnosis of childhood autism or a related pervasive developmental disorder (PDD) at age 42 months. Clinical diagnosis of childhood autism was also reasonably sensitive, with all children who went on to receive a clinical diagnosis of childhood autism at 42 months being identified as having autism or PDD at 20 months. However, clinical diagnosis for PDD and Asperger's syndrome lacked sensitivity at 20 months, with several children who subsequently received these diagnoses at 42 months receiving diagnoses of language disorder or general developmental delay, as well as in two cases being considered clinically normal, at the earlier timepoint. The ADI-R was found to have good specificity but poor sensitivity at detecting childhood autism at 20 months; however, the stability of diagnosis from 20 to 42 months was good. In addition, the ADI-R at age 20 months was not sensitive to the detection of related PDDs or Asperger's syndrome. The continuity and discontinuity between behavioural abnormalities identified at both timepoints in the three domains of impairment in autism was examined, both in children who met final clinical criteria for an autistic spectrum disorder, and for children with language disorder who did not, as well as for a small sample of typically developing children.     

Genetic and environmental influence on attachment disorganization

Background: Empirical studies demonstrate that maternal sensitivity is associated with attachment security in infancy, while maternal frightening/frightened behavior is related to attachment disorganization. However, attachment disorganization is also predicted by individual dispositions in infancy. Indeed, recent studies indicate a link between attachment disorganization and DRD4 gene polymorphisms, thus suggesting a genetic vulnerability for attachment disorganization. The aims of our study were twofold, to test a) a possible direct link between molecular genetic variations and attachment disorganization, and b) a possible gene–environment interaction with a moderating effect of early maternal caregiving. Methods: Attachment security and disorganization, as well as quality of maternal behavior were assessed in the infants of the Regensburg Longitudinal Study IV (N = 106) at the age of 12 months. DNA samples were collected in order to assess the exon III repeat polymorphism in the coding region and the ?521 C/T single nucleotide polymorphism (SNP) in the regulatory region of the DRD4 gene and a repeat polymorphism (5‐HTTLPR) in the promoter region of the serotonin transporter gene. Results: Significant associations were found between attachment disorganization and the short polymorphism of the serotonin transporter gene. Also, a gene–environment interaction indicated that this genetic association was only valid for infants of mothers exhibiting low responsiveness. No other significant genetic associations with attachment disorganization were apparent. Conclusions: The study suggests a gene–environment interaction whereby biological determinants of attachment disorganization are moderated by social experiences. Different pathways of the development of attachment disorganization are discussed based on a bio‐behavioral model of development.     

托特罗定叠加槐杞黄颗粒和心理行为干预治疗晨尿渗透浓度正常的原发性遗尿症患儿的随机平行对照研究

目的 对去氨加压素(DDAVP)治疗无效的、晨尿渗透浓度正常的原发性遗尿（PNE）患儿,以托特罗定为基础叠加槐杞黄颗粒和心理行为干预,寻求最佳治疗方案。方法 对DDAVP治疗无效的PNE门诊患儿经过 1个月的药物洗脱期,以区组随机方法分为3组：西药组（托特罗定）、中西药组（托特罗定+槐杞黄颗粒）和联合组（托特罗定+槐杞黄颗粒+心理行为干预）行平行随机对照试验,入组时依据患儿及其家长回忆的月遗尿次数视为基线遗尿次数,在治疗结束时（近期）和治疗结束后3个月（远期）评估疗效并行意向性分析。结果 符合纳入排除标准的234例PNE患儿进入本文分析,3组各78例,3组间年龄、性别和基线遗尿次数差异均无统计学意义（P均>0.05）;近期和远期总有效率,联合组和中西药组均好于西药组,差异有统计学意义（P分别为0.017和<0.001）;近期总有效率,联合组与中西药组差异无统计学意义（P>0.05）,远期总有效率,联合组与中西药组差异有统计学意义（P＝0.005）,联合组近期和远期得到1例有益结果需要治疗PNE人数（NNT）分别为6.5（95％CI：3.7～25.3）和2.4（95％CI：1.8～3.6）,中西药组远期NNT为和4.6(95％CI:2.7～15.2)。结论 托特罗定+槐杞黄颗粒+心理行为干预2.4例DDAVP治疗无效的晨尿渗透浓度正常的PNE患儿在远期疗效上有1例有效,而且置信区间很窄,对这一结果信心很大。     

Consistency and change in the development of premature infants weighing less than 1,501 grams at birth

Ninety-four infants with birth weights less than 1,501 g were evaluated on neurologic functioning and mental abilities at 1 year and, again, at 3 to 4 years of age. Results of the examination showed high correspondence in neurologic status and in mental ability between infancy and the preschool period, particularly for children who were diagnosed as clearly normal or abnormal at 1 year. In addition, poorer performance in a test of infant mental ability (which relies primarily on sensorimotor skills), in motor skills, and in neurologic functioning, respectively, were linked to lower IQ, difficulties in expressive language, and articulation deficits at the preschool age. Socioeconomic status predicted 3-year IQ scores and changes in mental ability scores but was not a factor in determining either preschool age neurologic status or changes in neurologic status in the children studied. Socioeconomic status of the children was less predictive of preschool outcome than results of the 1-year examinations.     

A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000

OBJECTIVE: To determine the prognostic factors and optimal approaches to the diagnosis and management of biliary atresia, the leading indication for liver transplantation in children. STUDY DESIGN: A retrospective study was performed of all children who underwent hepatoportoenterostomy (HPE) for biliary atresia between 1997 and 2000 at 9 centers in the United States. Outcome at age 24 months was correlated with demographic and clinical parameters. RESULTS: A total of 104 children underwent HPE; 25% had congenital anomalies, and outcome was worse in those with biliary atresia splenic malformation syndrome. Diagnostic and clinical approaches varied, although specific approaches did not appear to correlate with outcome. The average age at referral was 53 days, and the average age at HPE was 61 days. At age 24 months, 58 children were alive with their native liver, 42 had undergone liver transplantation (37 alive, 5 dead), and 4 had died without undergoing transplantation. Kaplan-Meier analysis of survival without liver transplantation revealed markedly improved survival in children with total bilirubin level<2 mg/dL at 3 months after HPE (84% vs 16%; P<.0001). CONCLUSIONS: Outcome in the study centers was equivalent to that reported in other countries. Total bilirubin in early follow-up after HPE was highly predictive of outcome. Efforts to improve bile flow after HPE may lead to improved outcome in children with biliary atresia.     

Atopy in Children with and without a Family History of Atopy

ABSTRACT. The influence of a family history of atopy on atopic morbidity, and relationships between diet in infancy and allergic manifestations at the ages of one and five years were prospectively studied in 91 children. A control group consisted of 72 children with no family history of atopy. At the age of one year, atopic manifestations were found in 19 % of 163 children, in 23 % of those with a family history of atopy and in 14 % of those with no such history. Skin problems were more common in children with a family history of atopy (43 %) than in the control children (19 %). Of the children with a family history of atopy, 23 % had prolonged rhinorrhoea during infancy. The corresponding figure in children with no family history of atopy was 10 %. Prolonged rhinorrhoea during infancy correlated with parental smoking only in children with a family history of atopy (47 % vs. 18 %). At the age of five years, atopic disease was found in 17 % of 128 children, 24 % of those with a family history of atopy and 9 % of those with no such history. Atopic eczema was more common in children with a family history of atopy, irrespective of the diet consumed during infancy. Atopic signs were found in about half of all the children with a family history of atopy. If atopy had been present in the family, the child usually exhibited the same manifestation. Onset of atopic manifestations was not prevented or delayed.