The nature of love: Harlow, Bowlby and Bettelheim on affectionless mothers

History of "Serve and Return" and a Synthesis of the Literature on its Impacts on Children's Health and Development

Parent/caregiver sensitivity and responsiveness are important for children's health and development. The "serve and return" metaphor was created to help providers and caregivers understand the importance of sensitive and responsive early caregiving. In this review, we explain the concept of "serve and return", outline historical and theoretical principles that culminated in this metaphor, highlight parent and child constructs associated with "serve and return" interactions, and synthesize literature on sensitive and responsive caregiving and children's health and developmental outcomes. Nurses and other healthcare professionals in public policy, clinical, community, education, and research roles need knowledge of "serve and return" interactions.

A machine learning-based diagnostic model for children with autism spectrum disorders complicated with intellectual disability

Background

Early detection of children with autism spectrum disorder (ASD) and comorbid intellectual disability (ID) can help in individualized intervention. Appropriate assessment and diagnostic tools are lacking in primary care. This study aims to explore the applicability of machine learning (ML) methods in diagnosing ASD comorbid ID compared with traditional regression models.

Method

From January 2017 to December 2021, 241 children with ASD, with an average age of 6.41 ± 1.96, diagnosed in the Developmental Behavior Department of the Children's Hospital Affiliated with the Medical College of Zhejiang University were included in the analysis. This study trained the traditional diagnostic models of Logistic regression (LR), Support Vector Machine (SVM), and two ensemble learning algorithms [Random Forest (RF) and XGBoost]. Socio-demographic and behavioral observation data were used to distinguish whether autistic children had combined ID. The hyperparameters adjustment uses grid search and 10-fold validation. The Boruta method is used to select variables. The model's performance was evaluated using discrimination, calibration, and decision curve analysis (DCA).

Result

Among 241 autistic children, 98 (40.66%) were ASD comorbid ID. The four diagnostic models can better distinguish whether autistic children are complicated with ID, and the accuracy of SVM is the highest (0.836); SVM and XGBoost have better accuracy (0.800, 0.838); LR has the best sensitivity (0.939), followed by SVM (0.952). Regarding specificity, SVM, RF, and XGBoost performed significantly higher than LR (0.355). The AUC of ML (SVM, 0.835 [95% CI: 0.747-0.944]; RF, 0.829 [95% CI: 0.738-0.920]; XGBoost, 0.845 [95% CI: 0.734-0.937]) is not different from traditional LR (0.858 [95% CI: 0.770-0.944]). Only SVM observed a good calibration degree. Regarding DCA, LR, and SVM have higher benefits in a wider threshold range.

Conclusion

Compared to the traditional regression model, ML model based on socio-demographic and behavioral observation data, especially SVM, has a better ability to distinguish whether autistic children are combined with ID.

Harry Harlow's pit of despair: Depression in monkeys and men

Major depressive disorder is the most common mood disorder in the United States today and the need for adequate treatment has been universally desired for over a century. Harry Harlow, famous for his research with rhesus monkeys, was heavily criticized when he undertook his controversial experiments trying to find a solution for depression in the 1960s-1970s. His research, however, did not just evolve gradually from his earlier research into learning and into love. Recently disclosed hand-written notes show, for the first time, the severity of Harlow's depressions as he wrote in detail about his feelings and thoughts during his stay in a mental hospital in 1968. In these notes, Harlow repeatedly vowed to put every effort into finding a cure for depression. This may, for a large part, explain why he did not stop his rigorous animal experiments where critics argue he should have, and he eventually managed to book positive results.

Parenting a Child with a Neurodevelopmental Disorder

Purpose of Review

Traditional thinking and focus in ‘childhood disability’ have been on the child with the impairment — with the imperative to make the right diagnosis and find the right treatments. The implicit if not direct expectation was that interventions should aim to ‘fix’ the problems. Professionals have led the processes of investigation and management planning, with parents expected to ‘comply’ with professionals’ recommendations. Much less attention has been paid to parents’ perspectives or their wellbeing.

Recent Findings

In the past two decades, we have seen a sea change in our conceptualizations of childhood disability. The WHO’s framework for health (the International Classification of Functioning, Disability and Health (aka ICF)) and CanChild’s ‘F-words for Child Development’ inform modern thinking and action. We now recognize the family as the unit of interest, with parents’ voices an essential element of all aspects of management. The goals of intervention are built around the F-words ideas of function, family, fun, friendships, fitness and future.

Summary

There has been world-wide uptake of the F-words concepts, with increasing evidence of the impact of these ideas on parents and professionals alike. There are important implications of these developments on the structure, processes and content of services for children with neurodevelopmental disorders, their families and the services designed to support them.

Early Rearing Conditions Affect Monoamine Metabolite Levels During Baseline and Periods of Social Separation Stress: A Non-human Primate Model (Macaca mulatta)

A variety of studies show that parental absence early in life leads to deleterious effects on the developing CNS. This is thought to be largely because evolutionary-dependent stimuli are necessary for the appropriate postnatal development of the young brain, an effect sometimes termed the "experience-expectant brain," with parents providing the necessary input for normative synaptic connections to develop and appropriate neuronal survival to occur. Principal among CNS systems affected by parental input are the monoamine systems. In the present study, N = 434 rhesus monkeys (233 males, 201 females) were reared in one of two conditions: as mother-reared controls (MR; n = 269) or without adults with 24-h access to same-aged peers (PR; n = 165). When subjects were six-months-old, they underwent a separation paradigm involving 4, sequential, four-day social separations from their mothers or peers, with each separation followed by three-day reunions with their mothers or their peers. Prior to the separation paradigm, baseline cisternal CSF samples were obtained, as well as at the end of each the four social separations, and after final separation, during a recovery period. CSF was assayed for concentrations of monoamine metabolites and a blood sample was genotyped for the serotonin transporter (5-HTT) genotype. Replicating earlier landmark findings, PR subjects with the s allele exhibited lower baseline concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), when compared to PR subjects homozygous for the L allele. MR subjects were undifferentiated by genotype. PR subjects exhibited lower CSF 5-HIAA concentrations during baseline, but higher CSF 5-HIAA during social separations, when compared to MR subjects. There were rearing effects for the dopamine metabolite homovanillic acid (HVA) and for the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG), with PR subjects showing higher HVA and lower MHPG when compared to MR subjects. These findings indicate that there are long-term deficits in the response of monoamines following early maternal absence. The results of this study confirm and extend earlier findings that early parental absence has deleterious consequences for the development of the monoamine systems, and that these consequences are modulated by the 5-HTT genotype.

A tale of four countries: How Bowlby used his trip through Europe to write the WHO report and spread his ideas

Attachment theory, developed by child psychiatrist John Bowlby, is considered a major theory in developmental psychology. Attachment theory can be seen as resulting from Bowlby's personal experiences, his psychoanalytic education, his subsequent study of ethology, and societal developments during the 1930s and 1940s. One of those developments was the outbreak of World War II and its effects on children's psychological wellbeing. In 1950, Bowlby was appointed WHO consultant to study the needs of children who were orphaned or separated from their families for other reasons and needed care in foster homes or institutions. The resulting report is generally considered a landmark publication in psychology, although it subsequently met with methodological criticism. In this paper, by reconstructing Bowlby's visit to several European countries, on the basis of notebooks and letters, the authors shed light on the background of this report and the way Bowlby used or neglected the findings he gathered.