Blair Paley

Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress.

The authors tested a cognitive-interpersonal hypothesis of depression by examining the role of interpersonal cognitions in the prediction of depression associated with interpersonal stressors. A measure of adult attachment assessed interpersonal cognitions about ability to be close to others and to depend on others and anxiety about rejection and abandonment. Participants were women who had recently graduated from high school; they were followed for 1 year with extensive interview evaluation of life events, depression, and other symptomatology. Generally, cognitions, interpersonal events, and their interactions contributed to the prediction of interview-assessed depressive symptoms, but the effects were not specific to depression and predicted general symptomatology measured by diagnostic interviews as well, and results also varied by attachment subscale. Results were discussed in terms of a developmental psychopathology approach to disorders in young women.

A controlled social skills training for children with fetal alcohol spectrum disorders

Children with fetal alcohol spectrum disorders (FASD) have significant social skills deficits. The efficacy of a child friendship training (CFT) versus a delayed treatment control (DTC) was assessed for 100 children ages 6 to 12 years with FASD. Children in the CFT showed clear evidence of improvement in their knowledge of appropriate social behavior, and according to parent report, CFT resulted in improved social skills and fewer problem behaviors compared with DTC. Gains were maintained at 3-month follow-up. After receiving treatment, the DTC group exhibited similar improvement. Teachers did not report improvement as a function of social skills treatment. The findings suggest that children with FASD benefit from CFT but that these social skills gains may not be observed in the classroom.

Psychiatric conditions associated with prenatal alcohol exposure

Since the identification of fetal alcohol syndrome (FAS) over 35 years ago, mounting evidence about the impact of maternal alcohol consumption during pregnancy has prompted increased attention to the link between prenatal alcohol exposure (PAE) and a constellation of developmental disabilities that are characterized by physical, cognitive, and behavioral impairments. These disabilities include a continuum of developmental disorders known as fetal alcohol spectrum disorders (FASDs). Longitudinal studies suggest that individuals with FASDs are at a greatly increased risk for adverse long-term outcomes, including mental health problems and poor social adjustment. This review summarizes the existing literature on mental health outcomes for individuals with PAE across the lifespan, including findings in infancy and early childhood, middle childhood, and adolescence and early adulthood. Research on the psychiatric disabilities suffered by individuals with FASDs throughout development highlights the need for training of mental health professionals in the identification and the provision of specific treatments to address the unique features of this developmental disability since early identification and treatment have been demonstrated to be protective against more serious secondary disabilities. It is hoped that with greater awareness of the mental health problems experienced by individuals with FASDs, these individuals can receive appropriate and early treatment resulting in more adaptive and rewarding lives.

Executive functioning predicts social skills following prenatal alcohol exposure.

Adverse sequelae of prenatal alcohol exposure include executive function and social skills impairments, although these two domains have not been empirically linked in alcohol-exposed individuals. This study investigated this relationship using the BRIEF and the SSRS in 98 children aged 6 to 11 years. Executive functions explained a significant percentage of variance in parent and teacher rated social skills. No differences were found among children with diagnoses of FAS, partial FAS, or alcohol-related neurodevelopmental disorder. It may be helpful to consider executive functioning in designing social skills interventions for alcohol-exposed children whether or not they have full FAS.

The relationship between attachment cognitions and psychological adjustment in late adolescent women

This longitudinal study of 137 female high school seniors investigated the relationship of attachment cognitions, current psychological functioning, and psychological functioning 12 months later. Attachment cognitions, assessed with the Revised Adult Attachment Scale and the Inventory of Parent and Peer Attachment, were significantly associated with current symptomatology. The Revised Adult Attachment Scale, in interaction with initial symptomatology, predicted depression, substance abuse, eating disorders, and personality disorders 12 months later. The Inventory of Parent and Peer Attachment parent subscales predicted eating disorder and personality disorder symptomatology, whereas the peer subscales predicted substance abuse, eating disorder, and personality disorder symptomatology.

Predictors of Stress in Parents of Children with Fetal Alcohol Spectrum Disorders

ABSTRACT This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the childs executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.

Intervention for Individuals with Fetal Alcohol Spectrum Disorders: Treatment Approaches and Case Management.

Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs). An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidence-based interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure. This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs.

Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.

Pediatricians' Knowledge, Training, and Experience in the Care of Children With Fetal Alcohol Syndrome

OBJECTIVES. Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities. The purpose of this study was to identify current knowledge, diagnosis, prevention, and intervention practices related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics. METHODS. This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Questionnaires were mailed to a 3% random sample (n = 1600) of American Academy of Pediatrics members in the United States. General pediatricians, pediatric subspecialists, and pediatric residents were included. RESULTS. Participation rate was 55% (n = 879). Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders. However, they were less likely to report comfort with routine pediatric care of these children. Whereas 62% felt prepared to identify and 50% felt prepared to diagnose, only 34% felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders. Even fewer (n = 114 [13%]) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy. CONCLUSIONS. The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice. Furthermore, the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies. The development, dissemination, and implementation of best practice tools for prevention, diagnosis, and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended.

Prenatal Alcohol Exposure, Child Externalizing Behavior, and Maternal Stress

Objective. This study examined linkages between prenatal exposure to alcohol, current maternal alcohol use, child externalizing behavior, and maternal stress in a sample of 4- to 6-year-old children and their mothers. Design. Questionnaires, interviews, and behavioral observations were used to assess study variables in 42 mother - child dyads. Results. Current maternal alcohol use did not relate to childrens behavior problems. However, children with higher levels of prenatal exposure to alcohol exhibited more externalizing behavior. In turn, higher levels of child externalizing behavior were associated with increased maternal stress. An alternative model, in which maternal stress was assumed to relate to less supportive mother - child interactions and higher levels of current maternal alcohol consumption, which in turn were expected to relate to higher rates of child externalizing behavior, did not fit the data. Conclusions. The impact of prenatal alcohol exposure likely extends to caregivers. Interventions must focus not only on affected individuals but also on their families, who may experience significant stress in trying to care for such individuals.