Matthew Woolgar

Children’s Social Representations in Dolls’ House Play and Theory of Mind Tasks, and their Relation to Family Adversity and Child Disturbance

Five-year-old children of depressed and well mothers were assessed on theory of mind tasks, and enacted scenes from their family lives in dolls’ house play. Performance on theory of mind tasks was only weakly related to family circumstances and child distur-bance, but was significantly associated with measures of the child’s general and verbal intelligence. In contrast, children’s social representations elicited during dolls’ house play showed systematic relationships with family adversity (maternal depression and parental conflict) in interaction with the child’s gender: girls exposed to difficulties depicted particularly harmonious mother-child relationships, and their accounts showed a high degree of narrative structure; while boys so exposed depicted poor parenting, and their accounts were relatively incoherent. The children’s dolls’ house play was also associated with several aspects of their wider experience, including objective assessments of mother-child interactions, and behavioural and emotional adjustment in school. This technique may usefully elucidate the basis of child behavioural problems and psychopathology in the context of disturbed family relationships, and provide a route for therapeutic intervention.

Children's play narrative responses to hypothetical dilemmas and their awareness of moral emotions

Five-year-old childrens moral development was assessed using a projective doll-play technique (the MacArthur Story Stem Battery; MSSB), an emotion-understanding task, concurrent maternal reports of behaviour problems and child performance in a cheating task. Three narrative scales were derived from the childrens MSSB play themes: a non-physical punishment scale, a prosocial scale and an antisocial scale. Thechildrens use of non-physical discipliningthemes was related to their awareness of moral emotions. The antisocial and prosocial narrative scales were related to concurrent maternal ratings of externalizing and internalizing problems, respectively. Although the emotions children anticipated in the emotion-understanding task did not predict behaviour in the cheating task, their justifications for the different emotions tended to do so, as did the prosocial play narrative scale. The findings suggest a degree of coherence across the assessments of moral development, and are discussed with reference to childrens script-based understanding.

Evidence-based management of conduct disorders.

Purpose of review It is becoming increasingly apparent that antisocial children often grow up to inflict considerable damage on others at a high cost, and also lead very impoverished lives themselves. There is rising public and governmental concern to get on top of aggressive and criminal behaviour, which is especially prevalent in the socially and economically disadvantaged. Recent findings While parent training has been around for some 30 years, it has now been supplemented by efficacious child problem-solving and teacher-training programmes. For severe delinquency, community-based multisystemic interventions are reasonably effective when applied diligently. They cover social skills, and keep youths very closely supervised while giving them immediate rewards for compliance. Summary Despite popular impressions to the contrary, a lot is known about the causes of antisocial behaviour and conduct disorders, and now there are effective interventions to reduce it. However, many policymakers and commissioners are still unaware that effective programmes exist, or that when implemented, insufficient attention is paid to the need for fidelity to the model used and to the development of therapist skill. Effectiveness is then often disappointing in ‘real life’ conditions. However, when these factors are addressed, the evidence is clear that substantial gains can be made.

The negative consequences of over-diagnosing attachment disorders in adopted children: the importance of comprehensive formulations

In many child services across health, education and social care, ‘attachment disorder’ is a popular description and explanation for complex presentations of children who have been neglected or maltreated and is frequently used to describe fostered and adopted children. Very often the use of this term bears little resemblance to the established diagnostic systems, nor indeed to attachment theory as conceptualised by Bowlby. Its misuse can lead professionals to overlook commoner and more treatable conditions, to the detriment of the children. In fact both reactive and disinhibited attachment disorders are rare, but are becoming better characterised by high quality research. Poor understanding about the attachment disorder construct can pose particular problems for clinicians working with adopted children. The current paper briefly reviews the practical difficulties with the attachment disorder diagnosis as applied to adopted children and uses four case studies taken from a specialist Adoption and Fostering Service to highlight some of the problems for services working with adopted children. Finally, we propose some provisional recommendations for the assessment and treatment of adopted children and their families, which aim to be consistent with attachment theory as well as with the existing evidence base on wider child mental health problems.

Attempting to prevent postnatal depression by targeting the mother–infant relationship: a randomised controlled trial

AIM The purpose of the study was to investigate whether an intervention which focused on enhancing the quality of the mother-infant relationship would prevent the development of postnatal depression (PND) and the associated impairments in parenting and adverse effects on child development. BACKGROUND Recent meta-analyses indicate modest preventive effects of psychological treatments for women vulnerable to the development of PND. However, given the strong evidence for an impact of PND on the quality of the mother-infant relationship and child development, it is notable that there are limited data on the impact of preventive interventions on these outcomes. This is clearly a question that requires research attention. Accordingly, a randomised controlled trial (RCT) was conducted of such a preventive intervention. METHODS A large sample of pregnant women was screened to identify those at risk of PND. In an RCT 91 were randomly assigned to receive the index intervention from research health visitors, and 99 were assigned to a control group who received normal care. In an adjacent area 76 women at risk of PND received the index intervention from trained National Health Service (NHS) health visitors. The index intervention involved 11 home visits, two antenatally and nine postnatally. They were supportive in nature, with specific measures to enhance maternal sensitivity to infant communicative signals, including items from the Neonatal Behavioral Assessment Scale. Independent assessments were made at 8 weeks, 18 weeks, and 12 and 18 months postpartum. Assessments were made of maternal mood, maternal sensitivity in mother-infant engagement, and infant behaviour problems, attachment and cognition. FINDINGS The RCT revealed that the index intervention had no impact on maternal mood, the quality of the maternal parenting behaviours, or infant outcome, although there were suggestions, on some self-report measures, that those with a lower level of antenatal risk experienced benefit. This was also the case for the intervention delivered by trained NHS health visitors. The findings indicate that the approach investigated to preventing PND and its associated problems cannot be recommended.

Processing of faces and emotional expressions in infants at risk of social phobia

Individuals with social phobia display social information processing biases yet their aetiological significance is unclear. Infants of mothers with social phobia and control infants’ responses were assessed at 10 days, 10 and 16 weeks, and 10 months to faces versus non-faces, variations in intensity of emotional expressions, and gaze direction. Infant temperament and maternal behaviours were also assessed. Both groups showed a preference for faces over non-faces at 10 days and 10 weeks, and full faces over profiles at 16 weeks; they also looked more to high vs. low intensity angry faces at 10 weeks, and fearful faces at 10 months; however, index infants’ initial orientation and overall looking to high-intensity fear faces was relatively less than controls at 10 weeks. This was not explained by infant temperament or maternal behaviours. The findings suggest that offspring of mothers with social phobia show processing biases to emotional expressions in infancy.

The representation of fathers by children of depressed mothers: refining the meaning of parentification in high-risk samples

BACKGROUND Childrens representations of mothers in doll-play are associated with child adjustment. Despite the importance of fathers for childrens adjustment, especially in the context of maternal psychopathology, few studies have considered childrens representations of their fathers. METHOD We examined the portrayal of fathers by 5-year-old children of depressed (N = 55) and non-depressed (N = 39) mothers in a doll-play procedure concerning family experience. RESULTS Children gave equal prominence in their play to mothers and fathers. Representations of fathers were unrelated to maternal mood, but were associated with parental conflict. Representations of child care for the father that was unreciprocated predicted poor child adjustment in school, but only in children exposed to maternal postnatal depression. CONCLUSIONS It may be clinically useful to consider childrens distinctive representations of their mother and father; but the concept of parentification in relation to risk and resilience effects requires refinement.

The practical implications of the emerging findings in the neurobiology of maltreatment for looked after and adopted children: recognising the diversity of outcomes

The cutting-edge scientific research that is emerging regarding the neurobiological consequences of early maltreatment and neglect is highly relevant for thinking about the diverse needs of adopted and fostered children. Knowledge about the science has an important role to play in many areas, from child care proceedings to the mental health and educational needs of adopted children and young people. However, the science is complex and it is difficult to provide a succinct but valid summary of the rapidly expanding literature to guide practice. Indeed, there has been some concern from the scientists themselves that the research can be too easily misunderstood. The purpose of this article is to review some of the more recent research on the neurobiological consequences of maltreatment. A narrative is developed that pays due respect to the complexity of the findings, while drawing out practical implications for professionals working with adopted and fostered children. In particular, the notion of differential susceptibility and its consequences for individual differences in response to early negative environments is described. The science also stresses the inter-relatedness of the biological systems affected and, in turn, their dynamic relationships with environments over time. The article reviews the research relating to neuroscience, physiology and genetics in particular, before describing some animal research to integrate the various neurobiological consequences of maltreatment over the course of development, and which reveal implications for interventions.

Cognitive vulnerability to depression in young people in secure accommodation: The influence of ethnicity and current suicidal ideation

Young people in secure accommodation are at high risk of depression and self-harm. This study investigates the relationship between depressive symptoms, negative self-schemas and the cognitive vulnerability to depression in 38 young people in secure accommodation. The impact of a) current suicidal ideation and b) a previous history of self-harm behaviour on latent negative self-schemas was examined using a mood induction task. The low mood condition indicated these young people had a latent cognitive vulnerability to depression. However, this vulnerability was exacerbated in the context of current suicidal ideation but not by a history of self-harm behaviours. An unexpected finding was the negative self-schemas of young people from ethnic minority backgrounds were particularly susceptible to the mood induction. The findings are discussed both in terms of the cognitive vulnerabilities of adolescents detained in secure accommodation and the role of participant characteristics on the validity of mood induction studies in adolescence.

Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood.

BACKGROUND Maternal mental illness is associated with negative effects on the infant and child. Increased attention has been paid to the effects of specific perinatal disorders on parenting and interactions as an important mechanism of influence. OCD can be a debilitating disorder for the sufferer and those around them. Although OCD is a common perinatal illness, no previous studies have characterized parenting and mother infant interactions in detail for mothers with OCD. METHODS 37 mothers with postpartum OCD and a 6 month old infant were compared with 37 community control dyads on a variety of measures of psychological distress and parenting. Observed mother-infant interactions were assessed independently. RESULTS Obsessions and compulsions were reported in both groups, although they did not cause interference in the control group. Mothers with OCD were troubled by their symptoms for a mean of 9.6 hours/day. Mothers with OCD were less confident, reported more marital distress and less social support than healthy peers and were less likely to be breastfeeding. Infant temperament ratings did not differ. Mothers with OCD were rated as less sensitive in interactions than the comparison group, partly attributable to levels of concurrent depression. CONCLUSIONS Maternal postpartum OCD is a disorder that can affect experiences of parenting and mother-infant interactions although this may not be driven by OCD symptoms. Longitudinal studies are required to assess the trajectory and impact of maternal difficulties as the infant develops.