Alicia F. Lieberman

Early Face-to-Face Interaction and Its Relation to Later Infant-Mother Attachment.

BLEHAR, MARY C.; LIEBERMAN, ALICIA F.; and AINSWORTH, MARY D. SALTER. Early Face-to-Face Interaction and Its Relation to Later Infant-Mother Attachment. CHILD DEVELOPMENT, 1977, 48, 182194. Face-to-face interaction between 26 infants and (a) their mothers and (b) a relatively unfamiliar figure was observed longitudinally between 6 and 15 weeks of age in the home environment. Highlights of normative findings are that infants became more responsive over this time period, whereas maternal behavior did not change. In the sample as a whole, infants were more responsive to the mother than to the unfamiliar figure on only 1 measure, bouncing. Individual differences in maternal behavior were stable throughout, but individual differences in infant behavior were not. Individual differences in interaction were analyzed and summarized by means of a factor analysis. Factor I opposed positive infant responsiveness to minimal response and maternal playfulness to impassiveness. Factor II contrasted maternal contingent pacing, infant delight, and prolonged interaction with routine maternal manner, abruptness, negative infant response, and brief interaction. Individual differences in interaction were found to be related to later differences in infant-mother attachment, as assessed by a strange-situation procedure at 51 weeks of age. Infants later identified as securely attached were more responsive in early en face encounters than infants judged to be anxiously attached, and their mothers were more contingently responsive and encouraging of interaction. Infants later identified as anxiously attached were more unresponsive and negative in early en face interaction than securely attached infants, and their mothers were more likely to be impassive or abrupt. Securely attached infants were more positively responsive to the mother than to an unfamiliar figure in early face-to-face episodes, while anxiously attached infants were not.

Infant-parent psychotherapy with toddlers

Infant-parent psychotherapy in the second year of life presents specific challenges related to the childs developmental characteristics. The concept of projective identification is discussed as a mechanism for understanding the toddlers specific contribution to attachment disorders with the parent. A versatile clinical format is recommended including joint parent-child sessions, individual work with the toddler and the parents, and the use of therapeutic modes of communication specifically geared to the toddlers needs (“toddlerese”). Clinical examples and research applications are given to illustrate these points.

Traumatic and Stressful Events in Early Childhood: Can Treatment Help Those at Highest Risk?

OBJECTIVE This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs). METHODS Participants comprised 75 preschool-aged children and their mothers referred to treatment following the childs exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs). RESULTS For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group. CONCLUSIONS The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well. PRACTICE IMPLICATIONS Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the childs treatment may be particularly effective in the treatment of young children exposed to multiple risks.

Trauma in early childhood: Empirical evidence and clinical implications

Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young childrens response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.

Clinical implications of traumatic stress from birth to age five

Children aged birth to five years are exposed to a disproportionately increased amount of potentially traumatic events compared to older children. This review examines the prevalence of traumatic exposure in the birth-to-five age range, the indicators and diagnostic criteria of early traumatic stress, and the contextual issues associated with the experience of early trauma. The article also selectively reviews the impact of trauma on the biological, emotional, social, and cognitive functioning of young childrens development along with some promising clinical treatment and service interventions that target the parent-child relationship as a vehicle of trauma recovery. Despite extensive documentation of the negative impact of trauma on the normal development of young children, research, clinical, and policy efforts to address the psychological repercussions of early victimization remain remarkably limited. Future directions in research and clinical practice as well as implications for policy are discussed.

The treatment of attachment disorder in infancy and early childhood: Reflections from clinical intervention with later-adopted foster care children

In their insightful review of assessment strategies and treatment approaches to attachment disorders, O’Connor and Zeanah (this volume) systematically elucidate the uncertainties and controversies inherent in the DSM-IV and ICD-10 diagnoses of attachment disorder. They point out that, compounding the conceptual and methodological problems of formulating a coherent diagnostic category, there are no established treatment guidelines for institutionalized children with attachment disorder who continue to show attachment disorder behavior following adoption. The authors suggest that lack of consensus about the appropriate theoretical target (Stern, 1995) for treatment is a major reason for the dearth of studies investigating effective treatments for attachment disorder. Existing attachment-based interventions focus on improving the quality of the existing relationship between parent and child when maladaptive features of the relationship are hypothesized to cause the child’s disturbance. These attachment-influenced interventions are based on a concordance between theoretical assumptions and treatment strategies because the parent’s pathogenic internal models of attachment and patterns of caregiving are presumed to be major etiological factors in the relationship problems and in child’s disturbance. Accordingly, it is postulated that improving the parent’s perception of the child and the developmental appropriateness of parental care will ameliorate the child’s emotional health (Lieberman, Silverman & Pawl, 2000; McDonough, 2000). In the case of institutionalized children who are later adopted, on the other hand, the cause of the child’s disturbance is presumed to precede and lie outside the adoptive parent-child relationship. O’Connor and Zeanah underscore that the persistence of attachment disorder in institutionalized children adopted by ‘adequately sensitive’ parents poses a challenge for attachment-influenced treatment approaches because, in their words, ‘there is no intervention more radical than adoption’ (p. 225). The central argument of the present reply is that lack of trust in the reliable availability and protectiveness of the attachment figure(s) remains a core problem for institutionalized children who are later adopted, and that this persistent lack of trust has a major influence in shaping the adoptive parent’s perception of the child. The

The influence of domestic violence on preschooler behavior and functioning

Enhancing current explanations of domestic violence exposure effects on child cognitive and behavioral functioning was the purpose of this investigation. Participants were 31 domestic violence exposed and 31 non-exposed children ages 3 to 5 years and their single-parent household mothers. Child-mother pairs were matched for child’s age, gender, and ethnicity, mother’s age and education, and annual family income. Child cognitive and behavioral functioning was assessed via psychological assessment and parent report. The presence of mental health difficulties in mothers was assessed using self-report and clinician-administered instruments. Exposed children showed lower verbal functioning and higher internalizing behaviors than did their non-exposed peers. Exposed mothers displayed greater psychological difficulties than did their counterparts.

DSM-V Diagnostic Criteria for Bereavement-Related Disorders in Children and Adolescents: Developmental Considerations

Two bereavement-related disorders are proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V): Adjustment Disorder Related to Bereavement, to be located in the main body of the text as an official diagnostic entity; and Bereavement-Related Disorder, including a Traumatic Death Specifier, to be located in the Appendix as an invitation for further research. These diagnoses currently do not include developmentally informed criteria, despite the importance of developmental processes in the ways children and adolescents grieve. In this article, we draw upon a selective review of the empirical literature and expert clinical knowledge to recommend developmentally informed modifications and specifiers of the proposed criteria for both bereavement disorders and strategies to improve future research. This article is derived from an invited report submitted to the DSM-V Posttraumatic Stress Disorder, Trauma, and Dissociative Disorders Sub-Work Group, and suggested modifications have received preliminary approval to be incorporated into the DSM-V at the time of this writing. Adoption of these proposals will have far-reaching consequences, given that DSM-V criteria will influence both critical treatment choices for bereaved youth and the next generation of research studies.

A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children.

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological-transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families.

The Long-Term Consequences of Early Childhood Trauma: A Case Study and Discussion

Abstract There is a great need to better understand the impact of traumatic events very early in life on the course of childrens future development. This report focuses on the intriguing case of a girl who witnessed the murder of her mother by her father at the age of 19 months and seemed to have no recollection of this incident until the age of 11, when she began to exhibit severe symptoms of posttraumatic stress disorder (PTSD) in response to a traumatic reminder. The case presentation serves as the basis for a discussion regarding pertinent issues involved in early childhood trauma. This case and accompanying discussion were originally presented at the 19th Annual Meeting of the International Society for Traumatic Stress Studies and were transcribed and revised for use in this article. Specific topics include early childhood memory and trauma, learning and the appraisal of danger, and PTSD and traumatic grief in early childhood. Clinical and public health implications are also discussed. This case illustrates the dramatic impact that “preverbal” traumatic memories can have on childrens later functioning and speaks to the importance of assisting very young children in the immediate aftermath of traumatic events.