Klaus Minde

Sleep Disorders in Early Childhood: Association with Insecure Maternal Attachment

Psychological, family, and social characteristics relating to attachment relationships were measured in mothers of 20 sleep-disordered toddlers, comparing them with 21 mothers of toddlers without sleep problems. The groups were matched on measures of socioeconomic status, child and maternal age, maternal education, marital status, and family size. Results showed that 100% of mothers of sleep-disordered children were classified as insecure with respect to attachment, as assessed by the Adult Attachment Interview, compared with 57% of control group mothers (p less than 0.002). There were no group differences on measures of maternal defensiveness, self-esteem, marital satisfaction, and social support. These results suggest that maternal current perspectives on their relationship history, rather than general psychosocial adjustment, are crucial contributors to the onset and perpetuation of sleep disorders in early childhood.

The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults’ perceptions of the health of their marriages and families were more negative than their spouses’ perceptions. The way in which spouses of ADHD adults compensated for their partners’ difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.

Sleep Problems in Toddlers: Effects of Treatment on Their Daytime Behavior

OBJECTIVE This study investigated the effects of a treatment program for severely sleep-disturbed children on their daytime interaction with their mothers. METHOD Twenty-eight children with serious sleep problems and 30 matched controls, aged 12 to 36 months, were compared on behavior rating scales, on sleep patterns, and during play and feeding interactions with their mothers before and after an intervention program. RESULTS After treatment the sleep-disturbed children improved in their behavior, in their sleep patterns, and during feeding interactions with their mothers. However, the behavior of the children but not that of their mothers improved. CONCLUSIONS The findings of this study indicate that a brief behavioral intervention program focused on helping families manage children with sleep disturbances can generalize to daytime mother-child interactions. This suggests that a compromised relationship in early life may be modified by rather simple interventions since changes of one behavioral system may modify the total relationship of young children with those caring for them.

The psychosocial functioning of children and spouses of adults with ADHD

BACKGROUND It is unclear what the impact of parental ADHD is on the day-to-day life of the rest of the family and how it contributes to the intergenerational transmission of this disorder. METHOD The psychosocial functioning of 23 spouses and 63 children of 33 families with an ADHD parent and 20 spouses and 40 children of 26 comparison families was examined. Both adults and their spouses were assessed for lifetime and current Axis I and Axis II diagnoses, present general psychiatric symptoms and their marital relationships. Children were screened for ADHD and other problems, using the C-DISC, CBLC, TRF and the Social Adjustment Inventory. RESULTS Children with an ADHD parent had higher rates of psychopathology than those from comparison families. Children with ADHD had more co-morbidities than non-ADHD children. Family and marital functions were impaired in ADHD families regardless of the gender of the affected parent. Children without ADHD from families with one psychiatrically healthy parent did well while the behaviour of children with ADHD was always poor and not associated with parental mental health. CONCLUSION The results underscore the strong genetic contribution to ADHD and the need to carefully assess the non-ADHD parent as they seem to influence the well-being of non-ADHD children in families with an ADHD parent.

Practice Parameters for the Psychiatric Assessment of Infants and Toddlers (0–36 Months)

These practice parameters describe the psychiatric assessment of infants and toddlers (0-36 months) and support the growth of infant and toddler psychiatry, a rapidly developing field. Infants and toddlers are brought to clinical attention because of concerns about emotional, behavioral, relational, or developmental difficulties. It is axiomatic that the infant or toddler must be understood, evaluated, and treated within the context of the family. A perspective that is developmental, relational, and multidimensional and that borrows from the knowledge of multiple disciplines is essential. Collaborative efforts support the urgent need and incomparable opportunity to understand and to intervene early and preventively with young children and their families.

The Efficacy of 2 Different Dosages of Methylphenidate in Treating Adults With Attention-Deficit Hyperactivity Disorder

Objective: To evaluate the efficacy of methylphenidate in treating adults with attention-deficit hyperactivity disorder (ADHD), using subjective (self-report) and objective (computerized test) measures. Method: This double-blind crossover trial of placebo vs methylphenidate included subjects with childhood and current ADHD symptoms, IQs above 80, no other psychiatric condition explaining their difficulties or requiring other treatment, and no substance abuse in the previous 6 months. We administered 10 mg 3 times daily of medication (that is, placebo or methylphenidate) for 2 weeks. On the final day, subjects completed self-report measures and were tested on computerized tests. We then increased dosage to 15 mg 3 times daily for 2 weeks and administered a complete reassessment on the final day. Following a 1-week washout, we repeated this process on the second medication (that is, placebo or methylphenidate). Results: Thirty adults with ADHD participated. Self-report measures and computerized tests showed significant improvements in ADHD symptoms on methylphenidate, compared with placebo. Other psychiatric symptoms (notably, anxiety and depression) were alleviated with methylphenidate. There was no significant difference between the 2 dosages of methylphenidate. Conclusion: Methylphenidate is effective in improving ADHD symptoms in adults with ADHD, is well tolerated, and has minimal side effects.

Maternal Preference between Premature Twins up to Age Four

This paper describes methods of measuring a preference a mother develops for one twin over the other and describes the effect such preference has on the intellectual functioning and behavior of 24 twin pairs over 4 years. Results indicate that the majority of mothers develops a preference for one premature twin within 2 weeks after birth and maintains this preference for at least 4 years. The preferred twin has fewer behavior problems and a higher IQ at age 4. However, temperament is not correlated with preferential status.

Culturally sensitive assessment of attachment in children aged 18–40 months in a South African township

The objective of our work is to study the possible relevance nonwestern cultural traditions have on the concordance of attachment patterns assessed in mothers and their young children. The attachment of 46 toddlers and their mothers, living in a black township in Johannesburg, South Africa, was assessed using scores derived from mother-child observations in the home (Attachment Q-Sort) and an interview (Working Model of the Child Interview). Mothers also had a semistructured psychiatric interview. Agreement between home observations and interview ratings was 29% for secure and 71% for insecure attachment when U.S.-developed scoring criteria for the interview were used. Agreement increased to 81% for secure and 67% for insecure attachment when the same protocols were rescored, using a culturally modified scoring system, developed by local cultural experts. This study suggests that verbal representations of attachment patterns are more influenced by cultural traditions than are actual parent-child interactions.

Aggression in Preschoolers: Its Relation to Socialization

The present article discusses developmental changes of aggression seen in preschool children and reports on an 18-month short-term prospective study of three preschool populations: a group referred for aggressive behavior problems, a normal control group, and a group of youngsters who had lived in violent homes, but showed no aggressive behaviors. Results indicate that the aggressive children, in comparison with the other two groups at age 4, showed a significant delay in their interpersonal awareness and perspective taking ability. However, although the aggressive children caught up with their peers in the course of the study period, there was no accompanying decrease in their aggressive behavior. The theoretical and clinical implications of these findings are discussed.

Maternal behavior and attachment in low birthweight twins and singletons

GOLDBERG, SUSAN; PERROTTA, MARIE; MINDE, KLAUS; and CORTER, CARL. Maternal Behavior and Attachment in Low-Birthweight Twins and Singletons. CHILD DEVELOPMENT, 1986, 57, 34-46. Early mother-infant interaction and later security of attachment were assessed for 17 pairs of twins, 5 singleton survivors of twin pairs, and 20 singletons, all low-birth-weight preterm infants. Mother and infant behavior during home observations at 6 weeks and 3, 6, and 9 months was rated on scales developed by Ainsworth and Egeland and Brunquell. A, B, and C patterns of behavior in the Strange Situation conformed to the frequencies predicted from prior full-term samples and were not affected by twinship. However, the proportion of B, and B4 dyads in the B group significantly exceeded that predicted from normative data. Mothers in B2 and B3 dyads were rated more sensitive and responsive than all others at all 4 observations. Contrary to our expectations that mothers in A and C dyads would receive the lowest ratings, this occurred only at 6 weeks. At later observations mothers in B1 and B4 dyads consistently received the lowest ratings. The discussion focuses on possible reasons for this unexpected finding.