儿童早期情绪理解能力的发展

儿童随着年龄的增长,其情绪理解能力亦向更高层次发展,这为他们社会认知和适应能力的发展奠定了基础.近年来,有关婴幼儿早期情绪发展能力的研究较多使用"心理理论"方法,认为儿童情绪理解与"心理理论"之间关系密切,两者协同促进儿童的社会化发展.影响情绪理解能力发展的因素很多,其中亲子依恋关系较受关注,现已证明依恋关系质量明显影响儿童的情绪理解能力及其发展进程.该文就儿童情绪理解能力的发展、与心理理论间的关系以及亲子依恋的影响三个方面的研究进展作一介绍.     

儿童期虐待、亲子依恋与青少年抑郁的关系

目的 探讨儿童期虐待、亲子依恋与青少年抑郁情绪之间的关系.方法 选取河南省新乡市、济源市城区2所中学的736名第7、8、9级初中生为研究对象进行评估.采用儿童期虐待问卷(CTQ)、青少年依恋问卷(IPPA)和儿童抑郁障碍自评量表(DSRSC)分别评估初中生的儿童期受虐经历、亲子依恋关系和抑郁情绪.采用分层回归进行中介作用分析.结果 男性青少年儿童期受虐总分高于女性(分别为33.29±7.89和31.05±6.01,t=4.343,P=0.000),两性母亲依恋(男:59.89±15.86,女:61.45±16.48,t=-1.303,P=0.193)、父亲依恋(男:59.32±17.17,女:60.28±16.95,t=-0.764,P=0.445)、抑郁总分(男:7.68±5.27,女:7.31±4.21,t=1.057,P=0.291)比较差异均无统计学意义.儿童期虐待与青少年抑郁呈正相关(r=0.408,P=0.000),与母亲依恋(r=-0.544,P=0.000)和父亲依恋(r=-0.417,P=0.000)均呈负相关;母亲依恋与父亲依恋呈正相关(r=0.604,P=0.000),均与抑郁情绪呈负相关(r=-0.426,-0.426,Pa=0.000).男性和女性青少年中,亲子依恋均在儿童期虐待经历和抑郁间起部分中介作用.结论 青少年男性受虐高于女性,两性的亲子依恋和抑郁无显著差异;亲子依恋在儿童期虐待经历和抑郁间起部分中介作用,提示提高亲子依恋质量可部分减少虐待对青少年情绪的影响.     

孤独症病因分析

目的 分析孤独症儿童父母家庭和围生期高危因素、血铅水平与孤独症的关系.方法 收集符合<精神障碍诊断和统计手册>(第4版)(DSM-Ⅳ)孤独症诊断标准的儿童及与其年龄、性别相匹配的健康儿童各35名.采用孤独症危险因素调查表调查其父母家庭因素、围生期高危因素等资料,应用石墨炉原子吸收分光光度法测定二组血铅水平.结果 母亲孕期患病服药史、出生窒息史、新生儿期黄疸史等因素与儿童孤独症发生呈显著正相关(P＜0.05);孤独症儿童的血铅水平明显高于健康儿童(t=2.427 P＜0.05);母亲孕期患病服药史和血铅水平与孤独症发生呈正相关,是孤独症发生的独立危险因素.结论 孤独症儿童发病与围生期高危因素有关;血铅水平增高与孤独症的发病或加重孤独症异常行为可能有一定的关系.     

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当今时代,由于家庭的社会和经济状况发生了明显的变化,使得从出生至青少年的发育较过去也发生了相应的变化,主要表现在以下5个方面。1照养者-儿童的依恋关系婴儿和父母的依恋关系,始于出生,逐渐发展,止于3~4岁。尽管如此,依恋行为仍贯穿于整个人生[1]。在儿童中期阶段,儿童接触环境不断扩大,面临着许多危险,这时,儿童继续使用他们依恋人的形象作为安全的基石,在社会环境中探索和获得保护。依恋有4种类型,即安全型、不安全躲避型、不安全冲突型和不安全紊乱型。根据研究,不安全紊乱型依恋与家庭不良因素有关联,诸如照顾儿童不周、父母有重症…     

早产伴反应性依恋障碍儿童的社会生活能力和行为问题的追踪研究

目的 探求早期反应性依恋障碍对早产儿婴幼儿期社会生活能力和行为的影响.方法 选取307例早产儿,将其中确诊为反应性依恋障碍的66例作为研究对象进行随访；选择无依恋障碍且无其他各类疾病的早产儿66例作为对照组.2组儿童均追踪随访至2岁.采用问卷调查收集研究对象人口统计学特征及家庭环境状况.儿童的社会能力评定采用婴儿-初中生社会生活能力量表,并选用2～3岁儿童行为量表(CBCL)评定其情绪及行为问题.结果 在行为方面,除了攻击行为因子,其他各因子分在2组间差异均有统计学意义(Pa＜0.01,0.05),行为问题的检出率早产伴反应性依恋障碍组明显高于对照组(P＜0.01).早产伴反应性依恋障碍组儿童的社会生活能力得分低于对照组,差异有统计学意义(P＜0.05).结论 早产伴反应性依恋障碍儿童较无依恋障碍早产儿童有更多的行为和心理问题,提示建立和谐的亲子关系和良好的家庭养育环境,对更好地促进早产儿全面、健康的发展有重要意义.     

机构结构化教育联合家庭康复训练治疗儿童孤独症的疗效观察

目的探讨机构结构化教育联合家庭康复训练模式治疗儿童孤独症的疗效。方法选取100例孤独症儿童,随机分为联合治疗组(n=50)和对照组(n=50)。对照组给予机构结构化教育,联合治疗组给予机构结构化教育联合家庭康复训练。比较两组孤独症儿童行为检查量表(ABC)评分、孤独症治疗评估量表(ATEC)评分、中文版儿童孤独症及相关发育障碍心理教育评定量表(C-PEP)评分。结果训练12个月后,联合治疗组患儿ABC各维度评分及总分均显著低于对照组(PPP结论机构结构化教育联合家庭康复训练是儿童孤独症的有效治疗模式,值得临床推广应用。     

早产儿亲子依恋的研究进展

早产儿容易出现神经精神发育问题,评估早期依恋行为可以预测这些异常.父母心理表现、早产儿自身特点和社会环境因素等通过不同的组合方式影响依恋质量:早产容易导致父母尤其是母亲的养育焦虑,进而影响其感知和态度,导致不安全依恋;早产儿自身的神经发育会影响父母对他们的情感反应,进而影响依恋质量;家庭和社会环境与早产儿自身反应及父母养育行为和谐一致时,易形成安全依恋关系.有必要对早产儿进行早期依恋测试,及早发现问题,及时进行干预,减少神经行为发育问题的出现.提高早产儿的生存质量.     

早产儿亲子依恋的研究进展

早产儿容易出现神经精神发育问题,评估早期依恋行为可以预测这些异常.父母心理表现、早产儿自身特点和社会环境因素等通过不同的组合方式影响依恋质量:早产容易导致父母尤其是母亲的养育焦虑,进而影响其感知和态度,导致不安全依恋;早产儿自身的神经发育会影响父母对他们的情感反应,进而影响依恋质量;家庭和社会环境与早产儿自身反应及父母养育行为和谐一致时,易形成安全依恋关系.有必要对早产儿进行早期依恋测试,及早发现问题,及时进行干预,减少神经行为发育问题的出现.提高早产儿的生存质量.     

早产儿亲子依恋的研究进展

早产儿容易出现神经精神发育问题,评估早期依恋行为可以预测这些异常.父母心理表现、早产儿自身特点和社会环境因素等通过不同的组合方式影响依恋质量:早产容易导致父母尤其是母亲的养育焦虑,进而影响其感知和态度,导致不安全依恋;早产儿自身的神经发育会影响父母对他们的情感反应,进而影响依恋质量;家庭和社会环境与早产儿自身反应及父母养育行为和谐一致时,易形成安全依恋关系.有必要对早产儿进行早期依恋测试,及早发现问题,及时进行干预,减少神经行为发育问题的出现.提高早产儿的生存质量.     

孤独症儿童脆性位点精神发育迟滞1基因检测

目的对孤独症儿童进行脆性位点精神发育迟滞1(FMR-1)基因检测,探讨儿童孤独症与FMR-1基因的关系。方法孤独症患儿75例。用一般情况调查表进行调查,以儿童孤独症评定量表、孤独症行为检查量表筛查可疑患儿,按照中国精神障碍分类与诊断标准第3版(CCMD-3)的儿童孤独症诊断标准进行诊断和FMR-1基因检测。结果孤独症患儿FMR-1基因异常率极低,仅1.3%。结论儿童孤独症遗传学发病机制可能与FMR-1基因无关。     

Maternal expressed emotion related to attachment disorganization in early childhood: a preliminary report

Using a longitudinal sample of children, this study examined the relation between maternal Expressed Emotion (EE) and mother-child attachment disorganization at age 6 years. A nonclinical sample of 33 children (at ages 12 months and 18 months) from Berlin, Germany participated with their mothers in Ainsworth's Strange Situation. Thirty-two children were again observed with their mothers at age 6 years in a standard laboratory attachment observation. At the time of the 6-year assessment, maternal EE was assessed based on a Five-Minute Speech Sample. Mothers also completed the Life Events Questionnaire, a measure of family stress, and the Present State Examination, a measure of maternal depression. Maternal Expressed Emotion was significantly linked to mother-child attachment security at age 6 years. Further analyses revealed that High EE was most closely linked to the disorganized attachment pattern at age 6 years, an at-risk attachment pattern that has been associated with intrusive and hostile maternal behavior. The relationship was upheld when other relevant variables, including infant attachment disorganization and a measure of perceived family stress, were simultaneously considered. The study provides independent validation of Expressed Emotion as a measure of relationship quality in early childhood. It also provides a basis for the further investigation of the nature of the relation between maternal Expressed Emotion and attachment disorganization.     

Emanuel Miller Lecture: Attachment insecurity,disinhibited attachment,and attachment disorders: where do research findings leave the concepts?

Background:  Despite the evidence on anomalous attachment patterns, there has been a tendency to interpret most of these as reflecting differences in security/insecurity.
Methods:  Empirical research findings are reviewed in relation to attachment/insecurity as evident in both infancy and later childhood, disorganised attachment, inhibited attachment disorder, and disinhibited attachment disorder.
Findings:  Substantial differences are found in the correlates and meaning of these different features, as well as in the patterns associated with conditions such as autism, psychopathy, and Williams syndrome.
Conclusions:  It is seriously misleading to view all of these patterns through the lens of security/insecurity. This heterogeneity in social relationship features necessarily has implications for the assessment measures for social relationships that need to be used.     

Autism and attachment: a meta-analytic review

METHOD: Sixteen studies on attachment in children with autism were reviewed, and ten studies with data on observed attachment security (N = 287) were included in a quantitative meta-analysis. RESULTS: Despite the impairments of children with autism in reciprocal social interaction, the majority of the studies found evidence for attachment behaviours in these children. In four samples using the Strange Situation procedure the average percentage of secure attachments amounted to 53% (n = 72). Meta-analytic results showed that children with autism were significantly less securely attached to their parents than comparison children, and the combined effect size for this difference was moderate (r =.24). Children with autism displayed less attachment security than comparisons without autism, but this difference disappeared in samples with children with higher mental development, and in samples in which autism was mixed with less severe symptoms of autistic spectrum disorders. CONCLUSIONS: It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachment insecurity.     

An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children

Objective:  To explore attachment narratives in children diagnosed with reactive attachment disorder (RAD).
Method:  We compared attachment narratives, as measured by the Manchester Child Attachment Story Task, in a group of 33 children with a diagnosis of RAD and 37 comparison children.
Results:  The relative risk (RR) for children with RAD having an insecure attachment pattern was 2.4 (1.4–4.2) but 30% were rated as securely attached. Within the RAD group, children with a clear history of maltreatment were more likely to be Insecure-Disorganised than children without a clear history of maltreatment.
Conclusions:  Reactive attachment disorder is not the same as attachment insecurity, and questions remain about how attachment research informs clinical research on attachment disorders.     

孤独症患儿婴儿时期的行为特征研究

目的：探讨孤独症患儿的早期特征性行为,为早期诊断提供依据。方法：采用回顾性调查方法对30例孤独症患儿及26例其他发育迟缓患儿在婴儿期的异常行为进行调查分析。结果：孤独症在婴儿时期以没有社交微笑、没有目光对视,对环境反应淡漠,很难用声音、动作或玩具吸引患儿的注意,叫其名字没有反应等症状明显区别于发育迟缓患儿(P<0.01);模仿、依恋行为差异有显著性(P<0.01或P<0.05);刻板动作及兴趣怪异仅见于孤独症患儿,但发生率较低。结论：孤独症在婴儿期即表现出许多特异性症状,表明孤独症多起病于生后早期,这些症状不同于其他智力发育迟缓患儿,对于孤独症的早期识别具有重要意义。     

Early adolescent outcomes for institutionally-deprived and non-deprived adoptees. I: disinhibited attachment

BACKGROUND: Disinhibited attachment is an important sequel of an institutional rearing, but questions remain regarding its measurement, its persistence, the specificity of the association with institutional rearing and on whether or not it constitutes a meaningful disorder. METHOD: Children initially reared in profoundly depriving institutions in Romania and subsequently adopted into UK families were compared with respect to findings at 11 years with children who had not experienced institutional deprivation and who had been adopted within the UK before the age of 6 months. Measures included parental reports, a Strange Situation procedure modified for use in the home and systematic standardised investigator ratings of the children's behaviour. RESULTS: Disinhibited attachment, as reported by parents, showed a high degree of persistence from 6 to 11, but also a reduction over time in its frequency. Investigator ratings validated the parental reports but suggested that much of the fall in rate of disinhibited attachment was a function of the parental measure being less developmentally appropriate at 11 than it had been at 6. Disinhibited attachment was strongly associated with institutional rearing but there was not a significant increase in relation to duration of institutional deprivation beyond the age of 6 months. Mild, but not marked, disinhibited attachment was quite frequent in non-institutionalised adopted children but both the course and correlates indicated that its meaning was probably quite different. In the institution-reared children, disinhibited attachment was associated with a marked increase in service usage and associations with other forms of psychopathology. CONCLUSIONS: Disinhibited attachment constitutes a valid, and handicapping, clinical pattern that is strongly associated with an institutional rearing.     

Chronic Family Adversity and Infant Attachment Security

Abstract— A beginning step in the prevention of psychopathology in children is the identification of conditions and events associated with a disproportionately high incidence of behavior problems. Rutter, Cox, Tupling, Berger and Yule (1975a, British Journal of Psychiatry , 126 , 493–509) have reported a dramatic increase in the probability of children's adjustment difficulties as a function of multiple, family stressors. However, this association has never been tested with infants. Among instruments of infant behavior, attachment classification has been found to be a significant predictor of later adjustment problems, particularly among low-income samples. The present investigation examines the relation between six significant familial stressors and infant attachment security in a sample of 100 low-income parent-infant dyads. Family stressors included parental criminality, maternal depressive symptomatology, maternal personality risk, overcrowding in the home, and the quality of the relationship with a significant other. Cumulative family adversity was found to differentiate secure from insecure infants, but only among families with three of four stressors present. There also was moderate support one hypothesis derived from attachment theory, namely that stressors more closely associated with maternal functioning are more common among families with insecurely attached infants. Conceptual links between stressors and attachment are discussed, including pathways by which chronic stressors may interfere with the formation and maintenance of secure mother-infant attachment relations.     

Quality of child–parent attachment moderates the impact of antenatal stress on child fearfulness

Background: Animal studies have shown that prenatal stress has persisting effects on several aspects of offspring development; more recent studies show that this effect may be eliminated by positive postnatal rearing. Human studies of prenatal anxiety/stress are now also beginning to document links between antenatal stress/anxiety and behavioural and cognitive development of the child; however, there is no human evidence as to whether the early caregiving environment moderates the effect of antenatal anxiety/stress on child outcomes. Methods: Antenatal and postnatal measures of stress were collected on 123 women who were recruited from an antenatal clinic. Laboratory‐based assessment of the children’s cognitive development and fearfulness were assessed when the children were aged 17 months. In addition, child–parent attachment quality was assessed using the Strange Situation. Results: Attachment classification moderated the link between antenatal stress and observed fearfulness. The effect of antenatal stress on fearfulness was most accentuated in children with an Insecure/Resistant attachment classification; the significant antenatal stress × attachment classification interaction held after controlling for postnatal stress and obstetric, social and demographic factors. Attachment did not moderate the effects of antenatal anxiety on cognitive development. Discussion: These findings provide the first human evidence that postnatal parenting may moderate the adverse effects of antenatal stress. These results raise developmental questions about the timing and effect of interventions to reduce the adverse effects of antenatal stress exposure.     

Attachment security as a mechanism linking foster care placement to improved mental health outcomes in previously institutionalized children

Background: Children reared in institutions experience elevated rates of psychiatric disorders. Inability to form a secure attachment relationship to a primary caregiver is posited to be a central mechanism in this association. We determined whether the ameliorative effect of a foster care (FC) intervention on internalizing disorders in previously institutionalized children was explained by the development of secure attachment among children placed in FC. Second we evaluated the role of lack of attachment in an institutionalized sample on the etiology of internalizing disorders within the context of a randomized trial. Methods: A sample of 136 children (aged 6–30 months) residing in institutions was recruited in Bucharest, Romania. Children were randomized to FC (n = 68) or to care as usual (CAU; n = 68). Foster parents were recruited, trained, and overseen by the investigative team. Attachment security at 42 months was assessed using the Strange Situation Procedure, and internalizing disorders at 54 months were assessed using the Preschool Age Psychiatric Assessment. Results: Girls in FC had fewer internalizing disorders than girls in CAU (OR = 0.17, p = .006). The intervention had no effect on internalizing disorders in boys (OR = 0.47, p = .150). At 42 months, girls in FC were more likely to have secure attachment than girls in CAU (OR = 12.5, p < .001), but no difference was observed in boys (OR = 2.0, p = .205). Greater attachment security predicted lower rates of internalizing disorders in both sexes. Development of attachment security fully mediated intervention effects on internalizing disorders in girls. Conclusion: Placement into FC facilitated the development of secure attachment and prevented the onset of internalizing disorders in institutionalized girls. The differential effects of FC on attachment security in boys and girls explained gender differences in the intervention effects on psychopathology. Findings provide evidence for the critical role of disrupted attachment in the etiology of internalizing disorders in children exposed to institutionalization.     

The importance of parenting in the development of disorganized attachment: evidence from a preventive intervention study in adoptive families

Background:  As infant disorganized attachment is a serious risk factor for later child psychopathology, it is important to examine whether attachment disorganization can be prevented or reduced.
Method:  In a randomized intervention study involving 130 families with 6-month-old adopted infants, two attachment-based intervention programs were tested. In the first program, mothers were provided a personal book, and in the second program mothers received the same personal book and three home-based sessions of video feedback. The third group did not receive intervention (control group).
Results:  The intervention with video feedback and the personal book resulted in enhanced maternal sensitive responsiveness ( d  = .65). Children of mothers who received this intervention were less likely to be classified as disorganized attached at the age of 12 months ( d  = .46), and received lower scores on the rating scale for disorganization than children in the control group ( d  = .62). In the book-only intervention group children showed lower disorganization ratings compared to the control group, but no effect on the number of infants with disorganized attachment classifications was found.
Conclusion:  Our short-term preventive intervention program with video feedback and a book lowered the rate of disorganized attachment. The effectiveness of our intervention documents the importance of parenting in the development of infant attachment disorganization.