J. Clasien de Schipper

Autonomic reactivity in relation to attachment and early adversity among foster children

This study examined whether the quality of relationships with foster caregivers was associated with autonomic nervous system reactivity of children during separation and reunion with their foster caregiver. Moreover, effects of early adversity were examined in relation to attachment and autonomic nervous system reactivity. The sample included 60 children between 26 and 88 months of age, who participated with their primary foster caregivers in the Strange Situation. Respiratory sinus arrhythmia and preejection period were measured as indicators of parasympathetic and sympathetic nervous system reactivity, respectively. Attachment quality (ordered/disordered and secure/insecure attachment), was coded on the basis of childrens behavior in the Strange Situation using the Cassidy and Marvin coding system. Children with a background of neglect and those with disordered (disorganized-controlling or insecure-other) attachment showed most sympathetic reactivity during the procedure. Moreover, children with disordered attachment showed less vagal regulation (respiratory sinus arrhythmia decreases on separation and increases on reunion) than children with ordered attachment. The findings show that the quality of relationships with current caregivers, and to a lesser extent specific experiences of neglect, may have an impact on childrens abilities to regulate emotions in the context of environmental stress and challenges.

The relation of flexible child care to quality of center day care and children's socio-emotional functioning: A survey and observational study

In two studies in daycare centers, we investigated a newly developed index for flexible child care describing parents’ use of evening care and flexible attendance scheduling for their child. We examined the relation between this index together with stability in care, mother’s stress and the child’s temperament on the one hand, and quality of caregivers’ behavior and a child’s socio-emotional functioning in day care on the other. In Study I, the mothers and caregivers of 186 children (aged 6–30 months) participated in a survey. In Study II, approximately 18 months later, 52 children from Study I were observed in their daycare setting. Children showed more well-being in day care when they had few parallel care arrangements, and when there was more daily stability in staffing and grouping patterns. Unexpectedly, caregivers in groups with more stability in staffing and grouping patterns, showed less positive caregiving behavior. When staff turnover rate was higher, positive caregiving behavior was lower. Finally, children in more flexible child care showed more non-compliance.

Children's physical health complaints after exposure to intimate partner violence

OBJECTIVES A clear association between exposure to intimate partner violence (IPV) and childrens physical health is still not well determined, because adverse effects might be explained by the confounding detrimental effects of other traumatic experiences. This study investigated whether children exposed to IPV have higher risks for physical health complaints compared to children in a general population sample. Second, health complaint differences were explored between IPV witnesses and those who in addition experienced other forms of abuse or neglect. DESIGN Risk estimates for 21 everyday physical health complaints were made for children exposed to IPV compared to a general population sample using odds ratios. METHODS Primary caregivers of 275 child witnesses of IPV (6-12 years of age) referred to several specialized mental health or child welfare institutes throughout the Netherlands (2004-2009) reported on childrens somatic complaints using 21 items of the Child Behaviour Checklist (CBCL; Achenbach & Rescorla, 2001) reflecting sleeping, eating, pain complaints, and self-harm. RESULTS Compared to a population sample (n= 903), child witnesses more often experienced health complaints, in particular, more eating, sleeping, and pain problems and more self-harm. Few differences in health complaints were found between child witnesses with and without additional adverse experiences of maltreatment. CONCLUSIONS The degree of physical health complaints in children exposed to IPV is considerable, whether or not they were also victims of other forms of abuse. Early attention to everyday health complaints in children exposed to IPV might prevent more serious health problems in adolescence and adulthood.

Screening symptoms of reactive attachment disorder: evidence for measurement invariance and convergent validity

The Relationship Problems Questionnaire (RPQ) was developed to screen symptoms of the inhibited and disinhibited subtype of reactive attachment disorder (RAD). This study further examines the psychometric properties of the RPQ in children with severe emotional and behavioural problems by testing its measurement invariance across informants and its convergent validity. Parents and teachers of 152 children [mean age (Mage) = 7.92] from 20 schools for special education filled out the RPQ and the Strengths and Difficulties Questionnaire (SDQ). During a home visit in a subsample of 77 children the Disturbances of Attachment Interview (DAI) was administered to the caregiver and the child was observed using an observational schedule for RAD. Exploratory and confirmatory factor analyses revealed the expected two‐factor structure for both parent and teacher RPQ. Configural and metric invariance, but no scalar invariance, were obtained across informants. Both RPQ‐subscales had acceptable to good internal consistencies and correlated as expected with similar DAI‐subscales. Furthermore, the disinhibited RPQ‐scale related with observations of the childs approach to a stranger. Finally, significant associations were found between the RPQ and the SDQ. Overall, the RPQ has good psychometric qualities as a multi‐informant instrument for RAD‐symptoms in children with severe emotional and behavioural problems. Copyright

Effectiveness of specific factors in community-based intervention for child-witnesses of interparental violence: A randomized trial

A community-based intervention with specific factors for children and parents exposed to interparental violence (IPV) was compared with a control intervention based on non-specific factors. We hypothesized that participation in an intervention with specific factors, focused on IPV, parenting and coping, would be associated with better recovery. IPV exposed children and parents were group randomized over a specific factors- and control intervention. Baseline, posttest and follow-up measurements of 155 parents and children (aged 6-12 years, 55.5% boys) were fitted in a multilevel model. Outcomes were parent and teacher reported childrens internalizing and externalizing problems (CBCL, TRF), child self-reported depressive symptoms (CDI) and parent and child reported childrens post-traumatic stress symptoms (TSCYC, TSCC). Based on intention-to-treat and completer analyses, children in the specific factors intervention did not show better recovery than children in the control intervention. Children in both interventions decreased significantly in parent-reported childrens internalizing and externalizing problems and post-traumatic stress symptoms. Children reported a decrease in their mean level of depressive and post-traumatic stress symptoms. Teachers reported a decrease in internalizing problems, but not in externalizing problems. No association between time since exposure and level and course of symptoms was found. Treatment differentiation was assessed and both programs were significantly different on hypothesized effective factors. Higher treatment adherence in both programs did not result in a larger difference in recovery. IPV exposed children improve over the course and after participating in a community-based child- and parent program, but specific factors in intervention may not carry additional benefits when implemented in community settings.

Mediators and Treatment Factors in Intervention for Children Exposed to Interparental Violence.

Changes in childrens emotion differentiation, coping skills, parenting stress, parental psychopathology, and parent–child interaction were explored as mediators of treatment factors in two selective preventive group interventions for children exposed to interparental violence (IPV) and their parents. One hundred thirty-four IPV-exposed children (ages 6–12 years, 52% boys) and their parents were randomized to an IPV-focused or common factors community-based group intervention and completed baseline, posttest, and follow-up assessments for posttraumatic stress (PTS). A multilevel model tested mediators that included childrens ability to differentiate emotions and coping skills, parenting stress, parental psychopathology, and parent–child interactions. In both conditions, exposure to nonspecific factors, specific factors unrelated to IPV and trauma-specific intervention factors was coded from videotaped child and parent sessions. Improved parental mental health mediated the link between greater exposure to nonspecific treatment factors and decreases in PTS symptoms. In addition, an increase in emotion differentiation and a decrease in parenting stress were associated with a decrease in PTS symptoms. Greater exposure to trauma-specific factors in child sessions was associated with a small decrease in emotion differentiation, an increase in coping skills, and a decrease in PTS symptoms over time. Greater exposure to nonspecific treatment factors in child and parent sessions was associated with more positive parent–child interaction. Parental mental health appears to be an important mechanism of change that can be promoted through exposure to nonspecific factors in parent intervention. For children, the effect of greater exposure to trauma-specific factors in intervention is less clear and may not have clear benefits.

Risk factors as moderators of recovery during and after interventions for children exposed to interparental violence

High family risk was tested as an impediment to recovery in children exposed to interparental violence (IPV) participating in community-based intervention. Characteristics of IPV were also explored as moderators for the effect of an IPV-focused intervention over a common factors intervention. Baseline, posttest and follow-up measurements of 155 parents and children (aged 6 to 12 years; 55.5% boys) were fitted in a multilevel model. Outcomes were clinical classifications of internalizing and externalizing problems, and posttraumatic stress symptoms. Tested moderators were child maltreatment, symptoms of disordered attachment, parental psychopathology, parenting stress, poverty, and IPV characteristics. Children without symptoms of disinhibited social engagement disorder, children of parents with high levels of psychopathology, and children of parents with high levels of parenting stress showed strongest recovery. Participation in an IPV-focused intervention was not more effective than in a common factors intervention, irrespective of the nature of the IPV. Based on rate of recovery, participation in community-based group interventions does not need to be contraindicated for children facing high family risk after being exposed to IPV, except for children with symptoms of disinhibited social engagement disorder.

The effects of parental components in a trauma-focused cognitive behavioral based therapy for children exposed to interparental violence: study protocol for a randomized controlled trial

BackgroundInterparental violence is both common and harmful and impacts children’s lives directly and indirectly. Direct effects refer to affective, behavioral, and cognitive responses to interparental violence and psychosocial adjustment. Indirect effects refer to deteriorated parental availability and parent-child interaction. Standard Trauma Focused Cognitive Behavioral Therapy may be insufficient for children traumatized by exposure to interparental violence, given the pervasive impact of interparental violence on the family system. HORIZON is a trauma focused cognitive behavioral therapy based group program with the added component of a preparatory parenting program aimed at improving parental availability; and the added component of parent-child sessions to improve parent-child interaction.Methods/designThis is a multicenter, multi-informant and multi-method randomized clinical trial study with a 2 by 2 factorial experimental design. Participants (N = 100) are children (4–12 years), and their parents, who have been exposed to interparental violence. The main aim of the study is to test the effects of two parental components as an addition to a trauma focused cognitive behavioral based group therapy for reducing children’s symptoms. Primary outcome measures are posttraumatic stress symptoms, and internalizing and externalizing problems in children. The secondary aim of the study is to test the effect of the two added components on adjustment problems in children and to test whether enhanced effects can be explained by changes in children’s responses towards experienced violence, in parental availability, and in quality of parent-child interaction. To address this secondary aim, the main parameters are observational and questionnaire measures of parental availability, parent-child relationship variables, children’s adjustment problems and children’s responses to interparental violence. Data are collected three times: before and after the program and six months later. Both intention-to-treat and completer analyses will be done.DiscussionThe current study will enhance our understanding of the efficacy interparental violence-related parental components added to trauma focused cognitive behavioral group program for children who have been exposed to IPV. It will illuminate mechanisms underlying change by considering multiple dimensions of child responses, parenting variables and identify selection criteria for participation in treatment.Trial registrationNetherlands Trial Register NTR4015. Registered 4th of June, 2013.

The Mediating Role of Secrecy in The Development of Psychopathology in Sexually Abused Children.

Although child sexual abuse (CSA) is associated with psychopathology, limited research examined mechanisms through which CSA leads to psychopathology in children. It is generally assumed that CSA is associated with secrecy among children, to our knowledge this assumption has not yet been empirically tested. This gap in our understanding of the aftermath of CSA is surprising in light of abundant evidence linking secrecy to psychopathology among children. The current study examined whether, as compared to children who have not experienced CSA, CSA victims have a greater tendency for secrecy as reported by mothers and children, and whether psychopathology in CSA victims may be explained by their tendency to keep secrets. Sixty-three non-offending mothers and their sexually abused children (68.3% female; M age=10.89) and 48 mothers and their non-abused children (62.5% female; M age=11.17) completed questionnaires on secrecy and psychopathology (i.e., internalizing and externalizing behavior problems). Mothers of abused children perceived higher levels of secrecy and psychopathology in their children as compared to mothers of non-abused children. There were no differences in child-reported secrecy between abused and non-abused children. Mediation analyses revealed that mother-reported secrecy mediated the association between CSA and psychopathology. These findings suggest that secrecy is a potential mechanism underlying psychopathology associated with CSA, which has important implications for treatment of abused children.

I’ll Never Forgive You: High Conflict Divorce, Social Network, and Co-Parenting Conflicts

The relation between divorce, co-parenting conflicts, and children’s adjustment problems has been well established. An unresolved question for research and clinical interventions, however, is how conflicts between parents are maintained and/or escalate. This cross-sectional research tested the hypothesis that co-parenting conflicts in divorced couples are associated with perceived social network disapproval and that this relation is mediated by parents’ tendency to forgive each other. In Study 1, a convenience sample of 136 divorced parents recruited via online forums, we showed that perceived social network disapproval was indeed positively related to co-parenting conflicts and that parents’ tendency to forgive the other parent—albeit partly—explained this relationship. Strength of our research is that in Study 2, 110 parents referred to children’s mental health care because the wellbeing of the children was severely compromised by the severity of the conflicts between parents, we replicated these results. In both studies perceived social network disapproval and co-parenting conflicts were positively related and this link was mediated by forgiveness: perceived social network disapproval was negatively related to forgiveness, which in turn was negatively related to more parental conflicts.