Young children in brief separation. A fresh look

Behavioral problems, dissociative symptoms, and empathic behaviors in children adopted in infancy from institutional and foster care in the Czech Republic

This study examined if considerably different caregiving experiences in infancy influence socio-emotional development later in childhood. We included children aged 6-9 years who were, immediately after birth, placed in quality state-run institutions (N = 24) or quality state-run foster care with one family (N = 23). All children have lived in stable families since their adoption before 15 months of age. Children in the comparison group have always lived with their biological parents (N = 25). We found that the previously institutionalized group had significantly more behavioral problems, more dissociative symptoms, and lower empathic behavior scores than the comparison group. The previously fostered group also exhibited more behavioral problems and dissociative symptoms than the comparison group but, notably, significantly fewer behavioral problems than the previously institutionalized group. The findings underscore the beneficial role of foster care compared to institutional care and that quality and consistency of early caregiving play a crucial role in later socio-emotional development.

Parent-child border separation and the road to repair: addressing a global refugee phenomenon

As a result of the Department of Homeland Security's zero-tolerance policy (ZTP), over 5,000 children were separated from their parents at the U.S. southern border from 2017-2021, with over 1,000 still lacking confirmed reunifications. Separations also occur daily due to immigration raids, chaotic processing, and changing immigration policies. This article addresses the most fundamental question faced by families enduring such separations; how to mend attachment bonds that have been suddenly severed, especially within a population likely already traumatized. The paper begins by updating readers about separation in the United States and offers a concise summary of the consequences of child-parent separation. The paper then introduces Child-Parent Psychotherapy (CPP) as an intervention for affected families. This paper also uniquely applies CPP to older children and provides three case examples of its use in treating separated families. Finally, the paper offers general suggestions for supporting these families.

Molecular and cellular mechanisms of the first social relationship: A conserved role of 5-HT from mice to monkeys, upstream of oxytocin

Maternal affiliation by infants is the first social behavior of mammalian animals. We report here that elimination of the Tph2 gene essential for serotonin synthesis in the brain reduced affiliation in mice, rats, and monkeys. Calcium imaging and c-fos immunostaining showed maternal odors activation of serotonergic neurons in the raphe nuclei (RNs) and oxytocinergic neurons in the paraventricular nucleus (PVN). Genetic elimination of oxytocin (OXT) or its receptor reduced maternal preference. OXT rescued maternal preference in mouse and monkey infants lacking serotonin. Tph2 elimination from RN serotonergic neurons innervating PVN reduced maternal preference. Reduced maternal preference after inhibiting serotonergic neurons was rescued by oxytocinergic neuronal activation. Our genetic studies reveal a role for serotonin in affiliation conserved from mice and rats to monkeys, while electrophysiological, pharmacological, chemogenetic, and optogenetic studies uncover OXT downstream of serotonin. We suggest serotonin as the master regulator upstream of neuropeptides in mammalian social behaviors.

Young children’s representation of people who are elsewhere—Or dead

Given the legacy of John Bowlby, Attachment theory has often portrayed separation from a caregiver as likely to provoke protest, despair, and ultimately detachment in infants and young children. Indeed, the emotional challenge of separation is built into a key measurement tool of Attachment theory, the Strange Situation. However, James Robertson, one of Bowlby’s leading collaborators, voiced dissent. He argued that young children can cope with separations—even when they last for several days or weeks. They are able to keep the absent person in mind provided an alternative, familiar caregiver remains available. Observational and experimental findings lend support to Robertson’s claim. Recent analyses of natural language provide further support. Although young toddlers (ranging from 20 to 26 months) often make contact- or attachment-related comments about absent caregivers, such comments become less frequent with age whereas reflective references to absent caregivers—comments that do not express contact-related concerns about their absence—are often produced by young toddlers and remain frequent throughout early childhood. Children’s early-emerging ability to keep an absent attachment figure in mind raises intriguing questions about their responses to the permanent absence of an attachment figure—as in the case of death. Consistent with contemporary research showing that many grieving adults report continuing bonds to a deceased attachment figure—rather than a gradual process of emotional detachment—children also report such continuing bonds. By implication, children and adults are prone to construe the death of a loved one not just as a biological endpoint that terminates the possibility of any continuing relationship but instead as a departure that can be bridged by a continuation of the earlier bond in an altered form.

The importance of investing in early years health and social care

Emeritus Professor Alan Glasper, from the University of Southampton, discusses the focus of a new initiative to improve early years health and social care, launched by the Duchess of Cambridge.

The psychobiological consequences of child separation at the border: lessons from research on attachment and emotion regulation

In the spring of 2018, the Attorney General of the United States issued a memorandum declaring a "zero tolerance policy" under which all adults entering the United States illegally would be criminally prosecuted, and, if traveling with minor children, forcibly separated from their children. Although the government was ordered to reunite the children with their parents it is still unclear how many children have been or remain separated. Given the high risk of permanent harm to a vulnerable population, and the fact that this risk may continue into the near future, we present a review of what nearly eight decades of scholarly research has taught us about the damaging impact of deprivation and separation from parents. The article briefly reviews the origins of attachment theory as well as empirical studies that examine the psychobiological impact on children who experienced parental deprivation or separation. The paper concludes with recommendations, for future research.

I. INTRODUCTION: UNDERSTANDING THE TRANSITION TO SIBLINGHOOD FROM A DEVELOPMENTAL PSYCHOPATHOLOGY AND ECOLOGICAL SYSTEMS PERSPECTIVE

The birth of an infant sibling is a common occurrence in the lives of many toddler and preschool children. Early childhood is also a time for the emergence of disruptive behavior problems that may set the stage for later problem behaviors. The current study examined individual differences in young children’s behavioral and emotional adjustment after the birth of a sibling in an effort to uncover developmental trajectories reflecting sudden and persistent change (maladaptation), adjustment and adaptation (resilience), gradual linear increases, and no change (stability and continuity). Growth mixture modeling (GMM) was conducted with a sample of 241 families expecting their second child using a longitudinal research design across the first year after the sibling’s birth (prenatal, 1, 4 8 and 12 months) on seven syndrome scales of the Child Behavior Checklist (CBCL 1.5–5:(Achenbach & Rescorla, 2000 ): aggression, attention problems, anxiety/depression, emotional reactivity, withdrawal, somatic complaints, and sleep problems. For all scales, multiple classes describing different trajectory patterns emerged that reflected predominantly intercept differences; children high on problem behavior after the birth were those high before the birth. There was no evidence of a sudden, persistent maladaptive response indicating children underwent a developmental crisis for any of the problem behaviors examined. Most children were low on all problem behaviors examined and showed little change or actually declined in problem behaviors over time, although some children did experience more pronounced changes in the borderline clinical or clinical range. Only in the case of aggressive behavior was there evidence of an Adjustment and Adaptation Response showing a sudden change (prenatal to 1 month) that subsided by 4 months, suggesting that some young children react to stressful life events but adapt quickly to these changing circumstances. Further, children’s withdrawal revealed a curvilinear, quadratic path, suggesting children both increased and decreased in their withdrawal over time. Guided by a developmental ecological systems framework, we employed data mining procedures to uncover the child, parent, and family variables that best discriminated the different trajectory classes and found that children’s temperament, coparenting, parental self-efficacy, and parent-child attachment relationships were prominent in predicting children’s adjustment after the birth of an infant sibling. Finally, when trajectory classes were used to predict sibling relationship quality at 12 months, children high on aggression, attention problems, and emotional reactivity in the year after the birth engaged in more conflict and less positive involvement with the infant sibling at the end of the first year.

Inobhutnahme und Bindung

Inobhutnahmen sind zeitlich begrenzte Kriseninterventionen zum Schutz von Kindern meist in der Folge von vorhergehender Misshandlung und/oder Vernachlässigung. Die Dauer von Inobhutnahmen ist bei Säuglingen und Kleinkindern am längsten. Die mit einer längeren Trennung einhergehenden psychophysiologischen Belastungen der Kinder sowie das Vorgehen bei Inobhutnahmen werden vor dem Hintergrund der Bindungstheorie und bindungstheoretischer Forschung diskutiert. Es wird für die Entwicklung einer bindungstheoretisch begründeten Konzeption zu Verfahrensstandards und zur Gestaltung der Inobhutnahme bei Säuglingen und Kleinkindern plädiert.

Very extensive nonmaternal care predicts mother-infant attachment disorganization: Convergent evidence from two samples

We examined whether a maximum threshold of time spent in nonmaternal care exists, beyond which infants have an increased risk of forming a disorganized infant-mother attachment. The hours per week infants spent in nonmaternal care at 7-8 months were examined as a continuous measure and as a dichotomous threshold (over 40, 50 and 60 hr/week) to predict infant disorganization at 12-15 months. Two different samples (Austin and NICHD) were used to replicate findings and control for critical covariates: mothers' unresolved status and frightening behavior (assessed in the Austin sample, N = 125), quality of nonmaternal caregiving (assessed in the NICHD sample, N = 1,135), and family income and infant temperament (assessed in both samples). Only very extensive hours of nonmaternal care (over 60 hr/week) and mothers' frightening behavior independently predicted attachment disorganization. A polynomial logistic regression performed on the larger NICHD sample indicated that the risk of disorganized attachment exponentially increased after exceeding 60 hr/week. In addition, very extensive hours of nonmaternal care only predicted attachment disorganization after age 6 months (not prior). Findings suggest that during a sensitive period of attachment formation, infants who spend more than 60 hr/week in nonmaternal care may be at an increased risk of forming a disorganized attachment.

Infants and Toddlers in Foster Care

Young children involved in the child welfare system are susceptible to behavioral and physiological dysregulation. These children need nurturing care to develop organized attachments to caregivers; they need synchronous care to support their physiological and behavioral regulation; and they need stable caregivers who can commit to them, supporting their sense of self and behavioral regulation. Without intervention at the level of the parent and the system, most children involved with the child welfare system are unlikely to have these needs met. We present two models of intervention designed to enhance parents' synchrony and nurturance, and highlight aspects of the system that can enhance the stability and commitment of caregivers.

Infant bonding and attachment to the caregiver: insights from basic and clinical science

Early life infant-caregiver attachment is a dynamic, bidirectional process that involving both the infant and caregiver. Infant attachment appears to have a dual function. First, it ensures the infant remains close to the caregiver in order to receive necessary care for survival. Second, the quality of attachment and its associated sensory stimuli organize the brain to define the infant's cognitive and emotional development. Here we present attachment within an historical view and highlight the importance of integrating human and animal research in understanding infant care.

Attachment theory and its vicissitudes: Toward an updated theory

This paper attempts first steps toward reworking Bowlby’s attachment theory and formulating an updated version. The paper examines 11 tenets of attachment theory as it was originally proposed by Bowlby and colleagues. These tenets are discussed in terms both of historical and recent criticisms, and of relevant research. Reasons are given for why the discussion omits work involving animal models or focused on measurement issues. In conclusion, the tenets are assigned to four categories: ideas that have received little criticism; ideas that have been criticized but are generally accepted, although they need to take new research evidence into account; ideas that have been rejected or questioned more than they have been accepted; and ideas that have been rejected or extensively reinterpreted.

Child and adolescent psychiatry: past scientific achievements and challenges for the future

The worldwide history of scientific achievements in child and adolescent psychopathology is reviewed from the mid-twentieth century onwards. Attention is drawn, e.g., to diagnostic distinctions, measures of psychopathology, the several roles of epidemiological longitudinal studies, temperament and personality, developmental psychopathology, the use of 'natural experiments' to test causal inferences, environmental risks, the importance of gene-environment interplay, the relative coming together of initially diverse psychological therapies, the use of randomized-controlled trials to assess treatment efficacy, and the value and limitations of pharmacotherapy. The article ends with a look ahead to the most important opportunities and challenges for child and adolescent psychiatry, plus the hazards that need to be avoided.

Toward a general theory of infantile attachment: a comparative review of aspects of the social bond

This critical appraisal of contemporary interpretations in the area of infantile attachment begins with an outline of the principal features of the Bowlby-Ainsworth ethological theory, the instrumental/operant learning theory of Gewirtz, and Hoffman's classical conditioning model. Some attention is also given to Cairns's contiguity learning analysis and the Hoffman-Solomon opponentprocess model Discussion of these theories is followed by a review of representative data from infants at four phyletic levels (precocial birds, dogs, monkeys, and human beings), with an emphasis on three aspects of social bonding: (a) the formation and persistence of social ties in the infant under conditions of maltreatment, (b) the role of the attachment object in the adjustment of the infant to the broader environment (the so-called secure base effect), and (c) the infant's reaction to involuntary separation from the attachment object.

An attempt is made to judge how well each of the interpretations accounts for all or part of the data, with the conclusion that current theories do not accord completely with documented attachment phenomena. The following criticisms are highlighted: Ethological theory emphasizes that infants' behavior systems have been shaped by the ordinarily expectable environment and depend on that environment for their functioning, yet infants of many species form bonds to objects not typical in any species' environment, or even to sources of maltreatment. Learning theory is faulted for making predictions contradicted by the maltreatment data and for a lack of formal mechanisms to account for the secure base and separation effects. The contiguity analysis is criticized for its inability to account for the emergence of certain response patterns during separation, and the opponent-process model is called into question because of its failure to fit important affective dynamics of social separation (a central focus of this theory). Recommendations for future theories of attachment are offered.

Children with disrupted attachment histories: interventions and psychophysiological indices of effects

Diagnosis and treatment of children affected by disruptions of attachment (out of home placement, multiple changes of primary caregiver) is an area of considerable controversy. The possible contribution of psychobiological theories is discussed in three parts. The first part relates the attachment theoretical perspective to major psychobiological theories on the developmental associations of parent-child relationships and emotional response. The second part reviews studies of autonomic reactivity and HPA-axis activity with foster children, showing that foster children show more reactivity within physiological systems facilitating fight or flight behaviours rather than social engagement, especially foster children with atypical attachment behaviour. The third part is focused on treatment of children suffering from the consequences of disrupted attachment, based on a psychotherapy study with psychophysiological outcome measures. Implications are discussed for theory, diagnosis, and intervention.

Research in child psychoanalysis: twenty-five-year follow-up of a severely disturbed child

In an era of managed care, psychoanalytic treatment of children is under fire as critics question whether the evidence of success in child analysis is sufficiently robust to warrant the large commitment of time and money required for this treatment. This article chronicles the history and current state of research at the Anna Freud Centre, and describes the evolution of a database that has methodically recorded and systematically organized data from over 750 cases of children referred to the Centre over a forty-five-year period. Analysis of this database has determined what kinds of childhood disorders are best treated with intensive psychoanalysis, and what kinds do not respond to this form of treatment. A long-term follow-up of a small sample of these childreen suggests the kinds of long-term benefits that can be gained when an individual is treated with intensive psychoanalysis as a child. As an example, clinical material from the analysis of an eight-year-old is presented along with follow-up interview data twenty-five years later.

Separation and divergence: the untold story of James Robertson's and John Bowlby's theoretical dispute on mother-child separation

The work of Robertson and Bowlby is generally seen as complementary, Robertson being the practically oriented observer and Bowlby focusing on theoretical explanations for Robertson's observations. The authors add to this picture an "untold story" of the collaboration between Robertson and Bowlby: the dispute between the two men that arose in the 1960s about the corollaries of separation and the ensuing personal animosity. On the basis of unique archival materials, this until now little known aspect of the history of attachment theory is extensively documented. The deteriorating relationship between Robertson and Bowlby is described against the background of different currents in psychoanalysis in Britain in the interbellum.

Dissociation following traumatic medical treatment procedures in childhood: A longitudinal follow-up

Chronic illnesses often involve repeated hospitalization and invasive treatment procedures that can have a traumatic impact on child development. To explore possible consequences of treatment procedures, three groups of patients with congenital anomalies were examined longitudinally. At first admission, adolescents (ages 10-20, mean 15) with anorectal anomalies (n = 14), adolescents with Hirschsprung disease (n = 14), and hospitalized controls (n = 14) were assessed for treatment procedures, somatic function, mental health, and dissociative experiences. The assessment included the Adolescent Dissociative Experiences Scale (A-DES). At 10-year follow-up, the patients completed the Dissociative Experiences Scale (DES) and the Somatoform Dissociative Questionnaire (SDQ-20). Anal dilatation, an invasive medical treatment procedure performed daily by the parents the first 4 years, was correlated with the frequency and severity of persisting dissociative symptomatology. The procedure was the only significant predictor of A-DES and SDQ-20 scores, and one of two significant predictors of DES scores. This "experiment of nature" permitted a specific and unique opportunity to examine the impact of early traumatic exposure on child development in the absence of parental malevolence, and on later dissociative outcome in adolescence and adulthood. The findings might be valuable theoretically to our understanding of the development of psychopathology, and may lend itself for comparison with data on sexually abused children.

Transition to child care: associations with infant-mother attachment, infant negative emotion, and cortisol elevations

Seventy 15-month-old infants were studied at home before starting child care, during adaptation (mothers present) and separation (first 9 days without mothers) phases, and 5 months later. Security of infant-mother attachment was assessed before and 3 months after child care began. In the separation phase, salivary cortisol rose over the first 60 min following the mothers' departures to levels that were 75% to 100% higher than at home. Compared with insecure infants, secure infants had markedly lower cortisol levels during the adaptation phase and higher fuss and cry levels during the separation phase, and their fuss and cry levels were significantly correlated with their cortisol levels. Attachments remained secure or became secure if mothers spent more days adapting their children to child care.

Parents' and staff's perceptions of parental needs during a child's admission to hospital: an English perspective

The aim of this research was to compare perceptions of parental needs held by parents of hospitalized children and the staff caring for them, so that potential communication breakdown could be avoided. A well-trialled tool was used with a convenience sample in paediatric facilities in a National Health Service trust in north-east England. Some differences were found between parents and staff for scores for perceived importance of the 51 needs that were included in the questionnaire, and whether or not they were being satisfactorily met during the child's hospital admission, but there were no consistent patterns, so it is difficult to draw conclusions. Parents declared themselves more independent than the staff perceived them to be. Such findings facilitate improvements in communication between parents and staff and can be included in education programmes for both.

Parent-child connections: The essential component for positive youth development and mental health, safe communities, and academic achievement

A continuing parent-youth bond throughout adolescence and young adulthood is the foundation for genuine emotional health, academic achievement, and healthy developmental trajectories and the antidote to youth violence.

Developmental issues in relocation cases involving young children: when, whether, and how?

Many divorced parents seek the court's permission each year to move their children to a new location away from their other parents. Such moves stress and often disrupt psychologically important parent-child relationships, and this may in turn have adverse consequences for children. This article discusses the development of attachment relationships in infants and toddlers and the ways in which relocation is likely to affect young children of different ages; recent trends in judicial decisions regarding relocation; factors to consider when deciding whether or not to permit relocation; ways of promoting long-distance relationships between young children and their non-moving parents; and implications for legal policy and clinical practice.