Michelle DeKlyen

The role of attachment in the early development of disruptive behavior problems

This paper presents information pertaining to attachment processes as risk factors in the development of disruptive behavior in young children. In recognition of the fact that attachment is not the only or necessarily most important risk factor in the prediction of behavior problems, attachment is considered in the context of other domains of variables, including child biologic factors, family ecology, and parental management and socialization practices. Within the attachment domain, we describe three complementary processes that may lead to disruptive behavior: the information-processing aspects of affective-cognitive structures, the function of observable attachment patterns, and the motivational consequences of attachment security. The indirect effects of maternal representations of attachment on child disruptive behavior are also considered. Examples of protypical risk factor combinations involving attachment and other domains are provided. The implications of the attachment perspective for research and clinical work with young disruptive children are discussed.

Preschool Boys With Oppositional Defiant Disorder: Clinical Presentation and Diagnostic Change

OBJECTIVE Little is known about the clinical presentation and course of oppositional defiant disorder (ODD) when first diagnosed in the preschool years. Patterns of ODD symptomatology, comorbidity, persistence of disorder, and predictors of diagnostic outcome were examined in clinic-referred preschool boys. METHOD Boys (aged 4-5.5 years) with a DSM-III-R diagnosis of ODD were prospectively followed over a 2-year period. Multiple assessment procedures were used, including a modified version of the Diagnostic Interview Schedule for Children and parent and teacher ratings. RESULTS Ninety-two boys (mean age 56.9 months) with ODD were followed; 42 had comorbid attention-deficit hyperactivity disorder (ADHD). Among 79 boys assessed 2 years later, 76% had ODD, ADHD, or both. Of those, 25% had other diagnoses as well, primarily anxiety and/or mood disorders. Conduct disorder was rare. Subjects with comorbid ODD/ADHD at intake were significantly more likely to have a psychiatric disorder at follow-up, especially ADHD alone. CONCLUSIONS The findings suggest that ODD in the preschool period is a clear indicator of high risk, especially when co-occurring with ADHD. Further investigation of individual patterns of ODD symptom expression is recommended.

Attachment security in preschoolers with and without externalizing behavior problems: A replication

This study attempted to replicate previous findings that indicated that preschool-aged children with significant externalizing problems are more likely to have insecure attachment relations than nonproblem peers (Speltz, Greenberg, & DeKlyen, 1990). Fifty children (ages 3–6) and their mothers participated; 25 referred to a child psychiatry clinic for one of the DSM-IIIR Disruptive Behavior Disorders, and 25 matched comparisons without externalizing behavior problems. Attachment was measured at the time of referral using two separation and reunion sequences in a clinic context. We found that 80% of the clinic-referred children were classified as insecure, whereas only 28% of the comparisons were so classified ( p

Attachment in preschoolers with disruptive behavior: A comparison of clinic-referred and nonproblem children

This study tested the hypothesis that preschool-aged children with significant externalizing behavior problems are more likely to have insecure attachment relationships than nonproblem peers, as measured by separation/ reunion behavior at the time of clinic referral. Fifty children (ages 3–6) and their mothers participated: 25 referred to a child psychiatry clinic for one of the DSM-III-R Disruptive Behavior Disorders, and 25 matched comparison children without behavior problems. Using two new attachment coding systems for children of this age, we found that 84% of the children in the clinic group were classified as insecure, whereas only 28% of the comparison group were so classified ( p

Correlates of clinic referral for early conduct problems: variable- and person-oriented approaches.

The current study utilized both variable- and person-oriented analyses to examine correlates of early disruptive behavior problems. Participants included 80 preschool boys referred to a child psychiatry clinic and diagnosed with oppositional defiant disorder (with or without attention-deficit hyperactivity disorder) and 80 case-matched normal comparison boys. The study examined four domains of correlates: vulnerable child characteristics, poor parenting practices, insecure attachment, and adverse family ecology. Results indicated that the combination of these factors provided relatively high sensitivity (81%) and specificity (85%), clearly differentiating referred from comparison boys. A dramatic increase in clinic status occurred when three or more factors were present, and specific combinations of factors were differentially predictive of conduct problems. However, no correlates were found to be either necessary or sufficient for clinic status. By maintaining the integrity of individual cases, person-oriented analyses were able to answer different questions than more traditional variable-oriented analyses. Discussion focuses on the value of person-oriented analyses for understanding heterogeneous clinical groups.

Fathering and Early Onset Conduct Problems: Positive and Negative Parenting, Father–Son Attachment, and the Marital Context

Research literature linking negative and positive aspects of the father–child relationship with early onset conduct problems is reviewed. Evidence from the Preschool Families Project, a longitudinal study of clinic-referred preschool boys at risk for conduct disorder, is presented, including previously unpublished data on father–child attachment. Both negative (e.g., harsh, angry, and physically punitive) and positive (involvement, warmth, and secure attachment) dimensions of fathering, as well as aspects of the marital relationship, appear to be associated with the emergence of early onset conduct problems.

Activity Structure and Social Interactions with Peers in Developmentally Integrated Play Groups

Previous attempts to determine the impact of activity structure on the frequency of social interaction among preschoolers have been inconclusive. Yet the teachers structuring of play activities is a relatively low-cost manipulation that, if effective in increasing peer interactions, might be extremely useful to those concerned with mainstreaming preschool children with disabilities. In this study, 20 children with disabilities and 8 normally developing children were observed while they participated in activities from an experimental curriculum designed to foster social integration. We predicted that (1) more peer interaction would be observed in play activities that were more structured and (2) teacher interaction rates would not be related to activity structure ratings. Both hypotheses were supported. Rates of peer interaction for children with and without disabilities covaried with activity structure ratings. Among the children with disabilities, rate of peer interaction correlated positively with both mental age and social competence scores; no such relationship was found for the normally developing children. Teacher interaction rates correlated negatively with mental age and social competence scores for both groups.

Attachment in boys with early onset conduct problems

Few studies have examined the association between attachment and psychopathology in samples of clinically diagnosed children or the relation between attachment variables and the continuity of clinical symptoms. Clinic-referred preschool boys (n = 80) with early onset conduct problems (as indicated by diagnoses of Oppositional Defiant Disorder) were compared with a case-matched group of 80 nonproblem boys to determine whether observed attachment behaviors could: (a) differentiate the groups, (b) explain concurrent variation in problem severity within the clinic group, and (c) predict the outcomes of clinic boys 1 and 2 years later. Over half of the clinic boys with early onset conduct problems (54%) exhibited an insecure attachment strategy during reunion, as opposed to 18% of comparison group boys. All insecure patterns were overrepresented in the clinic group. Clinic boys were more likely than comparison boys to engage in provocative behavior when separated from their mothers. Contrary to our hypothesis, attachment variables showed little ability to explain concurrent or future variation in the problem severity or diagnostic status of clinic boys. We conclude that observable attachment behaviors exhibited during the preschool years are related to the initial identification of early onset conduct problems but may have little value by themselves in predicting the subsequent course and severity of problems in the 2 years following clinic referral.

Are Infants with Orofacial Clefts at Risk for Insecure Mother-Child Attachments?

OBJECTIVE Several risk factors in the early lives of children with clefts are believed to interfere with their development of secure attachments to parents; however, this possibility has rarely been studied empirically. This study compared 12- and 24-month attachment classifications of infants with cleft palate (CP), infants with cleft lip and palate (CLP), and a comparison group of unimpaired infants (COMP). METHOD Twenty-two CP infants, 24 CLP infants, and 61 matched COMP infants were assessed at 12 and 24 months of age in an urban childrens hospital. At both visits, mothers and infants participated in the Strange Situation, which was videotaped and subsequently coded for patterns of attachment behavior. RESULTS CP infants displayed a lower rate of 12-month attachment security than infants in the CLP or COMP groups. By 24 months, no diagnostic group differences in attachment classification were found. Stable 12- to 24-month attachment classifications were less likely in the CP group (36.3%) than in the COMP (62.3%) group. CP infants who were insecure at 12 months were more likely to become secure by 24 months than were CLP or COMP group infants. CONCLUSIONS In contrast to previous theory and clinical speculation, the facial appearance of infants with CLP does not appear to affect the early mother-infant relationship adversely. The infancy period is marked by attachment instability for infants with CP, who demonstrated lower-than-expected rates of security at 12 months. However, these problems resolved in nearly all cases by 24 months of age. Most infants with clefts emerged from the first 2 years of life with secure maternal attachments.

Integrating Handicapped and Nonhandicapped Preschoolers: Developmental Impact on Nonhandicapped Children

To examine the effects of placing young nonhandicapped children in classes primarily containing handicapped children, 16 nonhandicapped children were randomly assigned to four integrated special education preschool classes. A control group consisting of 16 children, matched for age and sex, who were enrolled in three preschool classes containing only nonhandicapped children, was employed as a comparison. A battery of assessments were administered to both groups at the beginning and end of the academic year. No significant differences in performance on these measures were found. Placement of nonhandicapped children in integrated special education classes, where the majority of peers were handicapped, did not appear to interfere with normal development.