Lars O. White

Attachment dismissal predicts frontal slow-wave ERPs during rejection by unfamiliar peers.

Attachment representations are thought to provide a cognitive-affective template, guiding the way individuals interact with unfamiliar social partners. To examine the neural correlates of this process, we sampled event-related potentials (ERPs) during exclusion by unfamiliar peers to differentiate insecure-dismissing from securely attached youth, as indexed by the child attachment interview. Thirteen secure and 10 dismissing 11- to 15-year-olds were ostensibly connected with two peers via the Internet to play a computerized ball-toss game. Actually, peers were computer generated, first distributing the ball evenly, but eventually excluding participants. Afterward children rated their distress. As in previous studies, distress was related to a negative left frontal slow wave (500-900 ms) during rejection, a waveform implicated in negative appraisals and less approach motivation. Though attachment classifications were comparable in frontal ERPs and distress, an attachment-related dismissal dimension predicted a negative left frontal slow wave during rejection, suggesting that high dismissal potentially involves elevated anticipation of rejection. As expected, dismissal and self-reported distress were uncorrelated. Yet, a new approach to quantifying the dissociation between self-reports and rejection-related ERPs revealed that dismissal predicted underreporting of distress relative to ERPs. Our findings imply that evaluations and regulatory strategies linked to attachment generalize to distressing social contexts in early adolescence.

Depressive comorbidity in preschool anxiety disorder

Background The threshold for clinical relevance of preschool anxiety has recently come under increasing scrutiny in view of large variations in prevalence estimates. We studied the impact of presence/absence of additional depressive comorbidity (symptoms and/or diagnosis) on preschoolers with anxiety disorders in relation to clinical phenomenology, family, and peer problems compared to healthy controls. Method A population of 1738 preschoolers were screened and oversampled for internalizing symptoms from community sites, yielding a sample of 236 children. Results Using a multi-informant approach (mother, father, teacher, child), we found evidence that children with anxiety disorders and depressive comorbidity display a greater internalizing symptom-load, more peer problems and live in families with more psychosocial impairment (poor family functioning, family adversity, maternal mental health problems). The pure anxiety group was merely dissociable from controls with regard to internalizing symptoms and family adversity. Conclusion The presence of depressive comorbidity in anxiety disorders may mark the transition to a more detrimental and impairing disorder at preschool age.

Kin rejection: social signals, neural response and perceived distress during social exclusion.

Across species, kin bond together to promote survival. We sought to understand the dyadic effect of exclusion by kin (as opposed to non-kin strangers) on brain activity of the mother and her child and their subjective distress. To this end, we probed mother-child relationships with a computerized ball-toss game Cyberball. When excluded by one another, rather than by a stranger, both mothers and children exhibited a significantly pronounced frontal P2. Moreover, upon kin rejection versus stranger rejection, both mothers and children showed incremented left frontal positive slow waves for rejection events. Children reported more distress upon exclusion than their own mothers. Similar to past work, relatively augmented negative frontal slow wave activity predicted greater self-reported ostracism distress. This effect, generalized to the P2, was limited to mother- or child-rejection by kin, with comparable magnitude of effect across kin identity (mothers vs. children). For both mothers and children, the frontal P2 peak was significantly pronounced for kin rejection versus stranger rejection. Taken together, our results document the rapid categorization of social signals as kin relevant and the specificity of early and late neural markers for predicting felt ostracism.

Short-term psychoanalytic child therapy for anxious children: a pilot study.

Few studies report treatment outcome for early childhood internalizing disorders following psychotherapy, especially psychodynamic techniques. We aimed to investigate effectiveness of a novel, developmentally appropriate, short-term psychodynamic treatment program for 4- to 10-year-olds with anxiety disorders in an outpatient setting. We conducted a quasi-experimental wait-list controlled study. Thirty children (12 females) with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorders and their families received 20-25 sessions of manualized short-term Psychoanalytic Child Therapy (PaCT). We assessed outcome with standardized diagnostic interviews and parent reports of internalizing and total problems at all time points. Child puppet interviews and teacher reports were also available for pre-post treatment and follow-up analyses. While 18 families entered treatment immediately, 12 families were first wait-listed before receiving treatment. Analyses of symptom improvement were based on comparisons between groups (treatment vs. wait-list) as well as pre-post and 6-month follow-up data across all families (including wait-listed families). Among the 27 completers, 66.67% (n = 18) no longer met criteria for any anxiety disorder (59.88% in intent-to-treat analysis) while no children remitted across the wait-list interval. Parent-reported child internalizing and total problems significantly declined during treatment relative to wait-list. Child and teacher reports also revealed significant pre-post symptom reductions on internalizing and total problems. Diagnostic and symptom remission rates were maintained at 6-month follow-up except on child reports. This preliminary study adds to a growing database showing that psychodynamic treatments may offer an effective line of treatment for childhood internalizing symptoms and disorders in the eyes of clinicians, children, parents, and teachers.

The interaction of social risk factors and HPA axis dysregulation in predicting emotional symptoms of five- and six-year-old children

OBJECTIVE We examined the links of social relational (family environment and peer victimization) and neuroendocrinological (HPA axis dysregulation) risk factors to childrens emotional symptoms. We placed special emphasis on the joint effects of these risk factors with respect to the emergence and course of the emotional symptoms. METHODS One hundred and sixty-six children were interviewed (Berkeley Puppet Interview) at age 5 and 6. Teachers and parents completed the Strengths and Difficulties Questionnaire. Parents completed the Family Environment Scales. Peer victimization was assessed by teacher and child reports. Childrens saliva cortisol was measured before and after a highly structured story completion task which targeted their cognitive emotional representations of family conflicts. RESULTS In the cross-sectional analyses, negative family environment, peer victimization, and cortisol increase during the story completion task independently contributed to the variance of emotional symptoms. There was a significant interaction effect between family environment and cortisol increase: those six-year-olds who had experienced an unfavorable family environment only showed high levels of emotional symptoms if they exhibited a cortisol increase during the story completion task. In the longitudinal analysis, peer victimization at age 5 predicted an increase of emotional symptoms at age 6, but only for those children who exhibited a blunted cortisol response a year earlier. CONCLUSIONS Negative family environment and peer victimization proved to be independently associated with emotional symptoms. HPA axis reactivity differentially moderated these associations. Therapeutic strategies should take the interaction between negative relational experiences and biological susceptibility to stress into account.

Analyzing pathways from childhood maltreatment to internalizing symptoms and disorders in children and adolescents (AMIS): a study protocol

BackgroundEffective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathogenic mechanisms leading from maltreatment to mental disorders. Although some studies have already identified individual risk factors, there is a lack of large-scale multilevel research on how psychosocial, neurobiological, and genetic factors act in concert to modulate risk of internalizing psychopathology in childhood following maltreatment. To help close this gap, we aim to delineate gender-specific pathways from maltreatment to psychological disorder/resilience. To this end, we examine the interplay of specific maltreatment characteristics and psychological, endocrine, metabolomic, and (epi-)genomic stress response patterns as well as cognitive-emotional/social processes as determinants of developmental outcome. Specifically, we will explore endocrine, metabolomic, and epigenetic mechanisms leading from maltreatment to a higher risk of depression and anxiety disorders.Methods/designFour large samples amounting to a total of N = 920 children aged 4–16 years will be assessed: Two cohorts with prior internalizing psychopathology and controls will be checked for maltreatment and two cohorts with substantiated maltreatment will be checked for internalizing (and externalizing) psychopathology. We will apply a multi-source (interview, questionnaires, official records), multi-informant strategy (parents, children, teachers) to assess maltreatment characteristics (e.g., subtypes, developmental timing, chronicity) and psychopathological symptoms, supplemented with multiple measurements of risk and protective factors and cutting-edge laboratory analyses of endocrine, steroid metabolomic and epigenetic factors. As previous assessments in the two largest samples are already available, longitudinal data will be generated within the three year study period.DiscussionOur results will lay the empirical foundation for (a) detection of early biopsychosocial markers, (b) development of screening measures, and (c) multisystem-oriented interventions in the wake of maltreatment.

Latent trajectories of internalizing symptoms from preschool to school age : A multi-informant study in a high-risk sample

Recent proposals suggest early adversity sets in motion particularly chronic and neurobiologically distinct trajectories of internalizing symptoms. However, few prospective studies in high-risk samples delineate distinct trajectories of internalizing symptoms from preschool age onward. We examined trajectories in a high-risk cohort, oversampled for internalizing symptoms, several preschool risk/maintenance factors, and school-age outcomes. Parents of 325 children completed the Strengths and Difficulties Questionnaire on up to four waves of data collection from preschool (3-5 years) to school age (8-9 years) and Preschool Age Psychiatric Assessment interviews at both ages. Multi-informant data were collected on risk factors and symptoms. Growth mixture modelling identified four trajectory classes of internalizing symptoms with stable low, rising low-to-moderate, stable moderate, and stable high symptoms. Children in the stable high symptom trajectory manifested clinically relevant internalizing symptoms, mainly diagnosed with anxiety disorders/depression at preschool and school age. Trajectories differed regarding loss/separation experience, maltreatment, maternal psychopathology, temperament, and stress-hormone regulation with loss/separation, temperament, maternal psychopathology, and stress-hormone regulation (trend) significantly contributing to explained variance. At school age, trajectories continued to differ on symptoms, disorders, and impairment. Our study is among the first to show that severe early adversity may trigger a chronic and neurobiologically distinct internalizing trajectory from preschool age onward.

Commentary: The importance of exploring dose-dependent, subtype-specific, and age-related effects of maltreatment on the HPA axis and the mediating link to psychopathology. A response to Fisher (2017)

We greatly appreciate Dr. Fishers commentary that provides an excellent backdrop and well-considered perspective on our findings. We agree that our results mesh well with previous work documenting hypocortisolism among youth who experienced early adversity, especially neglect. Moreover, as also perceptively noted by Dr. Fisher, our cross-sectional data provide support for the notion that hypocortisolism is not simply a transient phenomenon, but, rather, a persistent pattern characterizing maltreated youth. Specifically, the consistency of the between group effect (from age 9.69 onwards) on a multimonth index of cumulative cortisol and the dose-dependent gradient of cortisol secretion within the maltreated group, which was related to the number of subtypes and the length of exposure to maltreatment, lend weight to this view.

A Multisource Approach to Assessing Child Maltreatment From Records, Caregivers, and Children

Practitioners and researchers alike face the challenge that different sources report inconsistent information regarding child maltreatment. The present study capitalizes on concordance and discordance between different sources and probes applicability of a multisource approach to data from three perspectives on maltreatment—Child Protection Services (CPS) records, caregivers, and children. The sample comprised 686 participants in early childhood (3- to 8-year-olds; n = 275) or late childhood/adolescence (9- to 16-year-olds; n = 411), 161 from two CPS sites and 525 from the community oversampled for psychosocial risk. We established three components within a factor-analytic approach: the shared variance between sources on presence of maltreatment (convergence), nonshared variance resulting from the child’s own perspective, and the caregiver versus CPS perspective. The shared variance between sources was the strongest predictor of caregiver- and self-reported child symptoms. Child perspective and caregiver versus CPS perspective mainly added predictive strength of symptoms in late childhood/adolescence over and above convergence in the case of emotional maltreatment, lack of supervision, and physical abuse. By contrast, convergence almost fully accounted for child symptoms for failure to provide. Our results suggest consistent information from different sources reporting on maltreatment is, on average, the best indicator of child risk.

Putting Ostracism into Perspective: Young Children Tell More Mentalistic Stories after Exclusion, But Not When Anxious

Much is known about when children acquire an understanding of mental states, but few, if any, experiments identify social contexts in which children tend to use this capacity and dispositions that influence its usage. Social exclusion is a common situation that compels us to reconnect with new parties, which may crucially involve attending to those parties’ mental states. Across two studies, this line of inquiry was extended to typically developing preschoolers (Study 1) and young children with and without anxiety disorder (AD) (Study 2). Children played the virtual game of toss “Cyberball” ostensibly over the Internet with two peers who first played fair (inclusion), but eventually threw very few balls to the child (exclusion). Before and after Cyberball, children in both studies completed stories about peer-scenarios. For Study 1, 36 typically developing 5-year-olds were randomly assigned to regular exclusion (for no apparent reason) or accidental exclusion (due to an alleged computer malfunction). Compared to accidental exclusion, regular exclusion led children to portray story-characters more strongly as intentional agents (intentionality), with use of more mental state language (MSL), and more between-character affiliation in post-Cyberball stories. For Study 2, 20 clinically referred 4 to 8-year-olds with AD and 15 age- and gender-matched non-anxious controls completed stories before and after regular exclusion. While we replicated the post regular-exclusion increase of intentional and MSL portrayals of story-characters among non-anxious controls, anxious children exhibited a decline on both dimensions after regular exclusion. We conclude that exclusion typically induces young children to mentalize, enabling more effective reconnection with others. However, excessive anxiety may impair controlled mentalizing, which may, in turn, hamper effective reconnection with others after exclusion.