Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5541_Библиотеки_им_академика_М_И_Перельмана.pdf
64 Chapter 4 Classification, Assessment and Diagnosis, and Intervention
of newborn infants and after-school programs connected
to the positive youth development framework that focus on
strengthening ethnic identity, social support, and prosocial
activities.
Secondary prevention has to do with interventions
that are implemented following early signs of distress and
dysfunction, before a disorder is clearly established in the
child. One example of this kind of prevention involves
identifying children who, with their caregivers, are exposed
to adverse childhood experiences (ACEs). As summarized
previously in Chapter 3, children who are exposed to
multiple risks are much more likely to struggle than
children who experience fewer risks. Health care providers
and mental health professionals are working to identify
high-risk children, sometimes using risk calculations,
in pediatricians’ offices, schools, and community settings so
referrals can be made and treatments can be offered before
children’s safety and well-being are further compromised
(MacNeill et al., 2021).
Another example of secondary prevention is the Mental
Health, Earlier project (Wakschlag et al., 2019). For this
project, researchers are focused on young children who display
atypical irritability (emotion dysregulation) coupled with
exposure to environmental adversity. The goal is to intervene
before problem behaviors increase and are more difficult to
treat. Like other prevention efforts, assessments are made
in primary care settings such as pediatric clinics to engage
caregivers in familiar settings and increase access to services.
Tert iar y prevention has to do with responding to
already present and clinically significant disorders. Both
secondary and tertiary prevention are focused on restoring
healthy functioning and minimizing future impairments.
Indeed, most of what mental health professionals do
involves secondary and tertiary prevention. As with primary
prevention, abundant research and clinical data suggest that
these are effective interventions.
Ethical guidelines for prevention science are
essential. These involve consultation with communities,
institutions, and public agencies about the selection of
specific interventions; forming collaborative relationships
with communities and institutions; implementation of
interventions for marginalized and disadvantaged groups
that respect sociocultural differences and value and empower
individuals and families; and maintaining transparency
and addressing data privacy and confidentiality concerns
(Leadbeater et al., 2018).
Working with Parents and Families
In addition to working directly with children and
adolescents, mental health professionals also work with
other individuals and in settings that impact youth distress
and dysfunction. Because parents are usually responsible for
recognizing the need for intervention and following through
on treatment plans, factors that influence recognition and
help-seeking are important. One example of an innovative
approach to increasing recognition of potential problems
and help-seeking involves attention to how important
information is shared with parents. When infographics are
used to provide facts about substance use in adolescence,
compared to written descriptions, parents with concerns
about their adolescents were much more likely to seek
additional information and treatment options (Becker et al.,
2020). Intentional communication that involves easily
understood information and clear suggestions for action are
straightforward ways to improve access to care.
Parent expectations, motivations, treatment choices,
and engagement in treatment are all important to consider.
Numerous actual and perceived barriers to treatment, such
as economic hardship, long waiting lists, and the belief that
therapy is unnecessary or ineffective are related to not seeking
treatment and/or dropping out of treatment. Self-doubt
about parenting and concerns about the therapist blaming
a parent for a child’s difficulties also influence treatment
decisions (Eaton et al., 2020). Meaningful collaborations
between parents and mental health professionals need to
include an awareness of what is already in place to support
positive outcomes for children and adolescents (Shonkoff
et al., 2021).
Parents and families require individualized helping
strategies. Some need information and education about
typical and atypical development. Others need emotional
support to care for struggling children. Still others need
assistance to deal with their own adversities, both personal,
such as trauma and mental illness, or environmental, such
as unemployment, housing instability, or the experience of
interpersonal violence.
Parents are often included in comprehensive treatment
plans. Many interventions for young children, for example,
focus on supporting attachment and sensitive caregiving.
Large-scale studies designed to prevent maltreatment provide
information about growth and development; emotion
socialization and communication; positive discipline; and
self-care for parents. Parent-focused prevention efforts
are frequently delivered at key developmental transitions
timed for the most positive impact: at birth, early or middle
childhood, and early adolescence (Morris et al., 2020). For
all caregivers and families, the overall goals are the same:
to create and sustain environments that are conducive to
children’s and adolescents’ growth and well-being.
Working with Schools
and Communities
Acknowledgment of widespread need and disparities in
children’s developmental outcomes has influenced the
expansion of mental health programs in schools and
communities. Because teachers frequently refer children
and adolescents for assessment and treatment and because
difficulties are often displayed in the school setting, it makes
sense that many interventions take place in schools with
the cooperation of school personnel and parents. For these
interventions to be successful, it is important for mental
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Intervention 65
health professionals to pay attention to the ecological context
of schools and the central role of teachers. Mental health
professionals and child advocates also must be well versed
in relevant legislation, including the many federal and state
laws, regulations, and requirements related to access to school
services for children with various kinds of disabilities. For
example, psychologists are often consulted by school personnel
during the design of an Individualized Education Program
(IEP), an education plan that is required for each child in
public school who is eligible for special education services.
School-based mental health services may include
prevention-focused programs such as those designed to
promote learning and achievement; to decrease bullying,
racism, and discrimination; and to buffer the effects of
risk and adversities on health and well-being. In addition,
like interventions that support parents so they are able
to support their children, interventions that support
teachers also influence the well-being of youth. Teacher
wellness and an organizational culture that prizes teachers
contribute to protective effects that support resilience in
students experiencing distress and dysfunction (Luthar
et al., 2019).
Schools may also be places where other kinds of
interventions (e.g., family-based interventions) begin, such
as the “Family Check-Up” intervention, aimed at engaging
at-risk families in the middle school years to decrease rates
of antisocial behavior and substance use (Stormshak et al.,
2011). Schools as settings for mental health care are also
important for global health efforts as spaces for education and
empowerment and as safe centers for children and families
(Regan et al., 2020).
After-school and summer school programs, often
located in schools and recreational settings, are examples
of community intervention efforts, as are social safety
net programs that target early education, economic
support for families, food and housing security, and heath
care (Slopen & Williams, 2021). Whole community
approaches, such as the Carolina Abecedarian project,
are often systemwide interventions targeting families,
childcare settings, schools, and communities (https://abc
.fpg.unc.edu). The Carolina program has been adapted and
is now established in several countries. Another example
of a whole-community intervention involves community
networks focused on ACEs, trauma, and resilience (ATR
networks)—multidisciplinary, multi-level interventions
targeting individual, family, and community change (Rog
et al., 2021).
The final community contexts for child and adolescent
interventions are found in child welfare and juvenile justice
settings. Treatments that involve out-of-home or out-ofschool placements will be discussed in later chapters. Overall,
our consideration of clinical intervention efforts reflects our
consideration of developmental principles and practices.
The focus of intervention must be on developmentally
salient tasks and issues, and it must focus on multiple levels
of development—the child, the child as part of a family
system, and the child in the context of school, community,
and culture.
Key Terms
Assessment (55)
Diagnosis (56)
Classification (51)
Categorical classification (51)
Diagnostic and Statistical Manual (DSM) (51)
Reliability (52)
Interrater reliability (52)
Cross-time reliability (52)
Validity (52)
Internal validity (52)
External validity (52)
Externalizing dimension (52)
Internalizing dimension (52)
Heterogeneity (54)
Comorbidity (54)
Transdiagnostic symptoms (54)
Research Domain Criteria (RDoC) (55)
Hierarchical Taxonomy of Psychopathology (HiTOP) (55)
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Differential diagnosis (56)
Diagnostic efficiency (57)
Interviews (59)
Standardized tests (60)
Projective measures (60)
Observations (61)
Individuals with Disabilities Education Improvement
Act (IDEA) (61)
Outcome research (63)
Process research (63)
Primary prevention (63)
Universal preventive measures (63)
Selective preventive measures (63)
Indicated preventive measures (63)
Secondary prevention (64)
Tertiary prevention (64)
66 Chapter 4 Classification, Assessment and Diagnosis, and Intervention
Chapter Summary
●
Classification systems group individuals with similar
patterns of disorder. Effective classification systems help
organize symptom patterns into meaningful groups,
facilitate communication among professionals, and
inform research and treatment efforts.
●
The most used categorical (clinical) classification system
with adults and children is the Diagnostic and Statistical
Manual of the American Psychiatric Association (DSM5-TR). This type of classification identifies types of
disorders and then specifies the defining symptoms of
the disorders.
●
Dimensional classification systems are an especially
useful way to consider the development of
psychopathology. This approach is based on statistical
techniques that identify key dimensions of children’s
adaptation and maladaptation, with the assumption
that all children can be meaningfully described along
these dimensions.
●
Two useful and well-researched clinical dimensions
are the externalizing dimension, with undercontrolled
behaviors such as oppositional or aggressive behaviors;
and the internalizing dimension, with overcontrolled
behaviors such as anxiety or depression.
●
The integration of developmental perspectives with
classification systems is an ongoing concern in the field
of developmental psychopathology. Many research and
clinical efforts emphasize the integration of information
about typical development, age-salient challenges and
expectations, and developmentally informed assessment
and diagnosis.
●
Heterogeneity within classification categories involves
the ways in which children and adolescents with the same
diagnosis display somewhat different sets of symptoms or
difficulties.
●
Comorbidity is the occurrence of two or more disorders in
one individual. There are several reasons for comorbidity.
Some of these are the result of imperfect classification
systems. Others relate to the ways in which disorders
develop and play out over time.
●
Transdiagnostic symptoms are patterns of emotion,
thought, and behavior that cut across classification
categories or diagnostic boundaries.
●
Alternative approaches to classification include
the Research Diagnostic Criteria (RDoC), a set of
neurobiological and behavioral dimensions that underlie
typical and atypical development and outcomes, and the
Hierarchical Taxonomy of Psychopathology (HiTOP),
another dimensional classification model.
●
Psychological assessment involves the systematic
collection of relevant information. Assessments help
clinicians differentiate between everyday problems and
psychopathology and make accurate diagnoses.
●
Assessment methods, including interviews, standardized
tests, projective measures, and observation, all contribute
to a diagnosis. Differential diagnosis is making a decision
about which of several diagnoses best describes an
individual.
●
Research on psychotherapy generally focuses on either
outcome or process. Outcome research has to do with
whether, at the end of treatment, children and adolescents
have improved relative to their pretreatment status and
compared to others who have not received treatment.
Process research has to do with the specific mechanisms
and common factors that account for therapeutic change.
●
Interventions can vary in their focus (child, parent, or
school) and timing (primary, secondary, or tertiary),
depending in part on whether they are designed to
prevent or treat psychopathology.
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Disorders of Early Childhood
Chapter Outline
5
Developmental Tasks and Challenges Related to
Physiological Functioning, Temperament, and
Attachment 68
Physiological Functioning
Temperament
Attachment
Temperament, Attachment, and Psychopathology
Disorders of Early Development 76
Avoidant/Restrictive Food Intake Disorder 76
The Case of Jalen
The Case of Grace
Developmental Course
Etiology
Assessment and Diagnosis
Intervention
Sleep–Wake Disorders 78
The Case of Mia
Learning Objectives
1. Summarize the tasks and challenges related to physiological
functioning and sleep in early development.
2. Describe the constructs of reactivity and regulation in
temperament.
3. Compare and contrast the dimensional and typological
approaches to temperament pathways.
4. Summarize the tasks and challenges related to the
development of attachment.
5. Explain how the constructs of temperament and attachment
contribute to developmental pathways that reflect positive
versus negative outcomes.
6. Summarize the clinical presentation, developmental course,
etiology, and interventions for feeding disorders in early
development.
Developmental Course
Box 5.1 Emerging Science:
Reconsidering What “Evidence-Based” Means
Etiology
Assessment and Diagnosis
Intervention
Disorders of Attachment 80
The Case of Andreas
The Case of Lily
Developmental Course
Box 5.2 Risk and Resilience:
Orphanages: Risks, Interventions, and Outcomes
Etiology
Assessment and Diagnosis
Intervention
7. Summarize the clinical presentation, developmental course,
etiology, and interventions for sleep–wake disorders in early
development.
8. Summarize the clinical presentation, developmental course,
etiology, and interventions for reactive attachment disorder.
9. Summarize the clinical presentation, developmental
course, etiology, and interventions for disinhibited social
engagement disorder.
10. Appraise the ways in which research from the Bucharest
Early Intervention Program helps to understand pathways
and outcomes in typically-developing and atypicallydeveloping children.
Early Childhood Intervention:
Children in Romanian
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
67
68 Chapter 5 Disorders of Early Childhood
Contemporary perspectives on the mental health, wellbeing, and disorders of very young children are influenced
by the pioneering work of many clinicians and researchers.
Much of this work focused on better understanding of
temperament, attachment, and the centrality of the
caregiving relationship in early development. With respect to
temperament, current investigators build on the foundation
provided by psychologists Mary Rothbart and Jerome Kagan
and the longitudinal studies of Alexander Thomas and Stella
Chess (Thomas & Chess, 1977; Chess & Thomas, 1984).
For attachment, Rene Spitz’s studies of institutionalized
infants, John Bowlby’s (1953, 1961) reviews of maternal
deprivation and infant mourning, and Barbara Tizard’s
reports on children in residential nurseries (Tizard &
Hodges, 1978; Tizard & Rees, 1975) contributed compelling
data on disrupted or troubled parent–child relationships. In
this chapter, we examine the early patterns of adaptation
and maladaptation that reflect emerging disorders or an
increased risk for later disorders.
Developmental Tasks and Challenges Related to Physiological Functioning, Temperament, and Attachment
Physiological Functioning
From birth onward, infants interact with their personal and
material worlds in ways that promote physical, emotional,
intellectual, and social development. This growth is
marked by three biobehavioral shifts that signal important
intrapersonal and interpersonal changes (Emde, 1985).
The first of these biobehavioral shifts occurs between two
and three months of age, after infants and caregivers have
negotiated the transition from intrauterine to extrauterine
experience via rhythmic routines of feeding, dressing, and
comforting. Later in the first year, between seven and nine
months, another shift takes place. By this time, most babies
communicate their feelings and intentions through gestures
and vocalizations, play with toys, and have a number of daily
and nightly schedules. The third shift occurs between 18 and
20 months. By then, toddlers are walking and talking
and are increasingly independent explorers of their many
environments. These accomplishments—involving new,
challenging, and sometimes stressful events—are no less
astounding because they are common outcomes. Indeed,
these achievements reflect the remarkable capacities of the
typical newborn.
One physiological system that undergoes dramatic
change over the early months and years of life is the
sleep–wake system. The sleep–wake system is tied to
brain maturation, organization, and function, and the
child’s consolidation of sleep into the nighttime hours is a
much-anticipated event by parents and caregivers. Highquality sleep (i.e., enough sleep and restorative sleep) is
associated with cognitive development and behavior and
emotion regulation as well as well-being across the lifespan
(El-Sheikh & Sadeh, 2015; El-Sheikh et al., 2019). Parents,
of course, play the key role in structuring and supporting
infant and child sleep. Positive relationships, bedtime
routines, sleep environments, and consistency are associated
with better sleep (El-Sheikh & Riley, 2017; Hoyniak et al.,
2020). Sociocultural factors such as beliefs about sleep and
preferences for children sleeping together or apart from
parents also influence the development of sleeping patterns.
We note here that mothers and fathers are not necessarily
the only caregivers for infants and toddlers. Day care
providers, grandparents, older siblings, and other relatives
and adults may all participate in the everyday lives of young
children and contribute to pathways of adaptation and
maladaptation.
Sleep quality, the amount of sleep, and the timing of sleep
changes over the course of childhood and adolescence. Many
children and adolescents have clear preferences for when they
go to sleep and when they wake up (Shimizu et al., 2020).
Racial and ethnic sleep disparities are observed. White
youth, for example, have more sufficient sleep compared
to Black and Hispanic youth. Many factors contribute to
these disparities, including adverse environmental situations
(Guglielmo et al., 2018).
Caregiver-reported sleep problems in typically-developing
children, including difficulties falling asleep and difficulties
staying asleep, vary from infancy to later childhood
(Williamson et al., 2019; refer to Figure 5.1). Sleep and
mental health are linked throughout the lifespan. Although
this chapter is focused on disorders in early development, we
will return repeatedly to the ways in which sleep impacts the
course of specific disorders across childhood and adolescence
in upcoming chapters.
Temperament
Many researchers and clinicians have spent decades working
to meaningfully describe the variations in newborns’ styles
of attention, activity, and distress that underlie the construct
of temperament. The definition of temperament that will
be used throughout the text is provided by Shiner (2015,
p. 86): “Temperament traits are early-emerging basic
dispositions in the domains of activity, affectivity, attention,
and self-regulation, and these dispositions are the product
of complex interactions among genetic, biological, and
environmental factors across time.”
Much of the research to date on temperament has
focused on two broad dimensions. Reactivity involves the
infant’s excitability and responsiveness. For instance, some
infants may become quite agitated while being passed from
relative to relative during a family reunion. Other infants
may accept strangers’ kisses, hugs, and peekaboo games in
stride. Regulation involves what infants do to control their
reactivity. Some distressed infants seek and receive comfort
from a parent and quickly settle down; others may wail and
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Developmental Tasks and Challenges 69
45
Child age
Prevalance at each age (%)
Sleep problems
Not happy to sleep alone
Figure 5.1 Prevalence of caregiver-reported sleep problems and sleep behaviors from birth
through middle childhood
40
35
30
25
20
15
10
5
0
0–1 years 2–3 years 4–5 years 6–7 years 8–9 years 10–11 years
Source: Williamson, A. A., Mindell, J. A., Hiscock, H., & Quach, J. (2019). Child sleep behaviors and sleep problems from infancy to school-age.
thrash about and take much longer to recover. Reactivity
and regulation are complex constructs, with genetic,
physiological, and relationship factors that influence
processes and outcomes (Rothbart, 2007). Reactivity and
regulation are not experienced in isolation from one another;
there is a constant back-and-forth as children engage with
2020). These profiles include groups of infants and toddlers
who display (a) typical patterns of emotion, activity, and
regulation; (b) high reactivity + high negative affect +
regulation difficulties; (c) high reactivity + high fear +
regulation difficulties; and (d) high reactivity + positive
affect + a range of regulation responses. Patterns of negative
Trouble getting to sleep
Waking overnight
others and the environment (White et al., 2012; refer to
Figure 5.2).
In addition to the broad constructs of reactivity and
regulation, numerous researchers have also examined
dimensions of temperament that re f lect t he combined influence
of genetics, physiology, and the maturation and increasing
coordination of physiological and psychological systems.
The temperament dimension of surgency reflects infant
and toddler sociability and positive emotionality. The
temperament dimension of negative affectivity reflects
Figure 5.2 Factors that contribute to reactivity
and regulation in young children
Environment
Development and
biological maturation
infant and toddler predispositions to experience fear and
frustration/anger. The temperament dimension of effortful
control reflects infant and toddler attempts to regulate
stimulation and response.
Typological (or categorical) approaches offer a different
perspective than dimensional approaches. Typological
approaches to temperament explore categories or groups
of children where a collection of traits—a temperament
profile—provides meaningful information above and
Temperamental
Reactivity
Neurobiology
Limbic regions
Amygdala
Striatum
Neurochemistry
Dopaminergic system
Serotonergic system
Temperamental
Regulation
Neurobiology
Prefrontal cortex
Lateral PFC
ACC
Neurochemistry
Dopaminergic system
Serotonergic system
beyond the traits or dimensions themselves. This approach
is exemplified by the easy temperament, slow-to-warm-up
temperament, and difficult temperament groups described
Expression of
Te mperament
decades ago by Thomas and Chess.
Depending on the statistical analyses used, between
four and six temperament profiles are identified (Beekman
et al., 2015; Gartstein et al., 2017; Planalp & Goldsmith,
Source: White, Lamm, Helfinstein, & Fox (2012). Neurobiology and
neurochemistry of temperament in children.
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
70 Chapter 5 Disorders of Early Childhood
Temperamental characteristics, such as negative affectivity,
are significant factors in later child and adult personality.
affect may include more frequent and more intense anger/
frustration experiences or combinations of fear, sadness, and
frustration/anger.
Temperament profiles are associated with current and
later adaptation as well as current and later difficulties.
For example, infants and toddlers who display high
reactivity and high fear are more likely to display behavioral
inhibition or withdrawal and to be more difficult to soothe.
Infants and toddlers who display high reactivity and high
negative affect are more likely to become upset when they
are prevented from reaching a goal and are more difficult to
calm (Beekman et al., 2015; Gartstein et al., 2017; Planalp
& Goldsmith, 2020).
Across both dimensional and typological models,
temperament provides a compelling example of “dynamic
biology-environment interplay” leading to “individual
differences in neurobehavior that support emotion,
cognition, and behavior for years to follow” (Ostlund et al.,
2021, p. 1585). There is abundant evidence that genetics
and physiological processes related to both reactivity
and regulation influence the development and stability
of both dimensions and profiles of temperament (Buss
& Qu, 2018).
In addition to individual differences related to genetics,
physiological processes underlying temperament are
influenced by a range of biobehavioral factors. Some of
these are prenatal risks. The development and functioning
of infants’ and toddlers’ physiological reactivity and stress
response systems, including the behavior activation system,
the HPA-axis response, and attentional and effortful control
processes are each influenced by prenatal poor nutrition,
maternal stress, and exposure to alcohol, other substances,
and environmental toxins (Gartstein & Skinner, 2018).
In a review of quantitative and molecular genetic studies,
researchers highlighted the gene-by-environment-by-time
processes that contribute to the emergence of temperament
traits, with genes switching on and off in the presence of
particular environments (Saudino & Wang, 2012). Shared
environmental factors did not appear to have much impact:
“Growing up in the same family does not make family
members resemble each other in temperaments” (p. 319).
Instead, there were substantial nonshared family effects,
underscoring the need for researchers to look for child
differences within (rather than across) families.
Parents, of course, contribute to child temperament in
multiple ways. Parent characteristics such as personality
and parenting practices, for example, help explain early
individual differences in infant and toddler reactivity and
regulation as well as more stable temperament traits (Bates
et al., 2019). The most important dimensions of parenting,
in terms of impact on temperament, are warmth (connected
to the child’s needs for affection, soothing, protection,
iStock.com/Fertnig
belonging, learning, and efficacy) and positive and negative
control (connected to the child’s needs for autonomy and
self-regulation) (Bates et al., 2014).
Caregiver influence is especially noteworthy on the
development of infant and toddler regulation. This is
because caregivers both respond to infant and toddler
emotionality and support infants’ and toddlers’ own
attempts at self-regulation. Caregivers regulate their
infants by responding to their signals of discomfort, such
as intervening during rambunctious sibling play or rocking
tired babies to sleep. Caregivers help babies by providing
shoulders to cry on, blankets to cuddle in, and stories and
lullabies at bedtime. In each of these instances, infants,
caregivers, and their relationships benefit from successful
regulation.
Beginning in infancy and continuing through childhood
and adolescence, emotion regulation experiences—focused
on the modulation of the occurrence, duration, and
intensity of feeling states and physiological processes—
provide an important window into adaptation and
maladaptation. Several mechanisms that contribute to
early emotion regulation capacity and skills are the child’s
observation of the parent’s regulation of emotion; emotionrelated parenting practices (e.g., labelling emotions,
emotion coaching and problem-solving, comforting), and
the emotional climate of the family (Morris et al., 2017).
Setting aside for the moment extreme adverse experiences
(such as maltreatment), typical variations in emotionrelated parenting practices influence a range of brainbehavior processes (e.g., structural connectivity, attentional
processes) and socioemotional outcomes. The key finding
from many investigations is that positive parenting helps
protect against emotional overarousal (Tan et al., 2020).
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Goodness of fit refers to the complementary relationship
between infant temperament and parenting.
Thomas and Chess (1977) and Chess and Thomas
(1984) describe goodness of fit as the interplay between infant
temperament and parenting. Some of the more frequently
mentioned combinations include well-matched pairs (e.g.,
easygoing babies with easygoing parents and exuberant
babies with exuberant parents) and less well-matched
pairs (e.g., easygoing babies with exuberant parents and
exuberant babies with easygoing parents). It is important
to understand that the goodness of fit between infants
and their caregivers is not an all-or-nothing situation.
For any infant–caregiver pair, there are both matches and
mismatches, with some mismatches associated with growth
and the broadening of the infant’s set of experiences (Stern,
1985). For example, parents might offer an encouraging
smile to wary toddlers as they struggle to approach a lamb
at the petting zoo. Indeed, children who display atypical
fear responses are likely to benefit from moderate challenges
and extra support as they navigate the wider world. More
problematic are infant–caregiver pairs with more numerous
or more extreme mismatches and frequent overcontrolling
or intrusive behaviors (Barnett & Scaramella, 2017).
When exploring goodness of fit, “difficult” temperaments
are often highlighted, with descriptions of babies who are
quickly aroused, emotionally intense, and hard to soothe.
The assumption is that infants and toddlers who are highly
reactive and difficult to calm are challenging for any kind
of parent, and that is almost certainly so. Keep in mind,
however, as noted in Chapter 2, differential susceptibility
suggests that infants and toddlers with “risky temperaments”
are both more likely to be negatively affected by problematic
parenting and other adverse external contexts and to be
positively impacted by responsive parenting and positive
external contexts (Zhang et al., 2021).
Research on gender and temperament is plentiful. Data
suggest that boys are more likely to score higher on scales
measuring surgency while girls score higher on measures
of effortful control; there are fewer differences related to
negative affectivity (e.g., Gagne et al., 2013). Research on
culture and temperament provides evidence for complex
Developmental Tasks and Challenges 71
models of the ways in which parents from many societies
differentially shape child temperament and temperament
pathways (Gartstein & Putnam, 2019).
Understanding temperament in young children is the first
step toward understanding the development of personality.
Thinking about how surgency, negative affectivity, and
effortful control map onto later personality characteristics
may provide important information about children’s risk
and resilience over time (Bates et al., 2010; Shiner, 2015;
refer to Table 5.1).
Given connections bet ween temperament and personality,
we expect to see evidence of temperamental consistency
across a variety of situations and stability across time. And
YAKOBCHUK VIACHESLAV/Shutterstock.com
that is what we find: Temperament traits are consistently
displayed and progressively more stable over development,
with moderate stability by preschool and increasing stability
over childhood. The most extreme temperament profiles
exhibit the most stability (Beekman et al. 2015; Gartstein
et al., 2017; Planalp & Goldsmith, 2020).
Attachment
Babies arrive with their own temperaments, their own minds,
and their own challenges. For all of these babies, there are
also many kinds of caregivers and many kinds of caregiving
relationships. By the end of the first year, most infants—
together with their caregivers—have accomplished several
key formative tasks. These include the development of an
attachment relationship, a rudimentary sense of self, and
a basic understanding of others and the world. Attachment
relationships reflect the degree to which infants experience
safety, comfort, and affection. Sense of self comprises the
earliest set of cognitions and emotions focused on the infant
as a separate being (e.g., Who am I? Am I likeable? Am I
good?). Understanding of others and the world includes early
beliefs about unfamiliar adults and children along with the
new situations in which infants so often find themselves.
Most infants thrive in homes that provide for their needs
and desires in ways that are mostly sensitive, reasonably
consistent, and usually warm. Over time, most infants come
to understand, in a fundamental way, that they will be cared
for, that they are worthy of care, and that the world around
them is a pleasant place with interesting people, objects,
and activities. This understanding—experienced and expressed
emotionally, cognitively, and behaviorally—is the basis of
attachment. According to attachment theorists (Ainsworth,
1969, 1979; Bowlby, 1982; Main et al., 1985; Sroufe & Waters,
1977), the development of an attachment relationship is the
significant psychological achievement of late infancy.
The most critical advantage of attachment, from an
evolutionary perspective, is to ensure the protection and
the survival of the infant (Bowlby, 1982). Protection and
survival are linked to several defining features of caregivers:
(1) providing a safe haven, a person to whom the in fant can turn to
for comfort and support; (2) allowing for proximity maintenance
for an infant who seeks closeness and resists separation; and
(3) establishing a secure base, a person whose presence serves as
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
72 Chapter 5 Disorders of Early Childhood
Table 5.1 Temperament and Personality Characteristics over Time
Big Five Dimension Childhood Adolescence Adulthood
Extraversion Increases over the first year
Negative
emotionality and
neuroticism
Agreeableness — Stable over adolescence. Increases across
Effortful
control and
conscientiousness
Openness to
experience
Source: Bates et al. (2010). Temperament and personality through the lifespan.
and then decreases from
early to middle childhood.
Negative emotionality
decreases.
Effortful control increases. Mixed findings for
— Mixed findings. Increases in early
a source of security from which children venture out to explore
the world and to which they can reliably return.
In their daily interactions with caregivers, infants and
toddlers share a variety of positive and negative experiences
and exchange relevant emotions, actions, and appraisals (e.g.,
moving closer to a parent for comfort during a thunderstorm).
Infants and toddlers also balance their wishes to explore
with their ongoing concerns for maintaining interpersonal
connections. For example, very young children may play
with other children and toys in an unfamiliar home so
long as a parent is nearby. When a parent moves farther
away or leaves the room, keeping the parent within view or
reestablishing closeness may become more important than
exploration. In more challenging or stressful circumstances,
such as the birth of a sibling, a difficult illness, or family
stress after a parent loses a job, attachments provide a deeply
rooted sense of safety and security.
Whi le the typical proce sses of attachment can b e described
as they unfold over months of caregiving (Ainsworth et al.,
1978; Bowlby, 1982), there are also distinctive patterns
in children’s attachments. Individual differences emerge
from particular caregiving and relationship histories that
become internalized early in development; similar patterns
are observed in all countries and cultures (Posada et al.,
2013; Stern et al., 2021). Caregiver sensitivity, availability,
and responsiveness—or insensitivity, unavailability, or
unpredictability—contribute to infants’ and toddlers’
emotionally salient beliefs and expectations related to self
(“I am worthy/not worthy of care,” “I am/am not lovable”),
significant others (“I can/cannot trust that you will respond
to me in appropriate ways”), and the world (“The world is/is
Social dominance
increases and shyness
decreases; other aspects of
extraversion show stability.
Mixed findings. Neuroticism decreases
conscientiousness.
Mixed findings, but in
general, extraversion
decreases over the course
of adulthood.
beginning in late
adolescence/early
adulthood.
adulthood.
Conscientiousness
increases across
adulthood.
adulthood and decreases
in later adulthood.
not safe and pleasant”). These patterns of attachment can be
broadly characterized as secure or insecure.
Patterns of secure att achment, in general, ref lect care giving
histories in which the caregiver responds sensitively,
consistently, and appropriately to an infant’s physical,
emotional, and social needs. In contrast, patterns of insecure
attachment develop over time as a result of inconsistent,
inadequate, or unavailable care, with such caregiver
characteristics sometimes interacting with particular infant
traits and/or environmental stressors. Patterns of insecurity
are usually described in terms of resistant, avoidant, and
disorganized attachments. It is important to emphasize that
child-caregiver attachment patterns are relationship-specific.
This means that, depending on their relationship history
with a caregiver, children may display one pattern with one
parent or caregiver and another pattern with another parent
or caregiver.
Resistant attachment (or anxious/ambivalent attachment)
is generally related to inconsistency or unpredictability.
Mothers may respond to an infant’s signals for affection and
attention with delight on some days and ignore or dismiss
those signals on other days. Fathers may comfort a fearful
toddler in one circumstance and make fun of that toddler’s
distress in another instance. These types of on-again, offagain caregiving environments are confusing and frustrating.
Depending on the kind and the degree of inconsistent care,
very young children with resistant attachments often appear
unsure and anxious about themselves, their caregivers, and
their situations. These children may be very vigilant about a
parent’s location or availability, or may not feel comfortable
enough to explore a new playground. These children may or
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Although specific child-rearing practices may vary across
cultures, the importance of a secure attachment relationship to
healthy psychological development is universal.
may not settle down with a familiar babysitter when mom
runs a few errands. And these children may or may not
happily reconnect with parents when they return.
Avoidant attachment (or anxious/avoidant attachment)
is generally related to inadequate care. Caregivers who are less
competent, overwhelmed, or resentful may repeatedly fail to
protect or nurture thei r children. In addition, intru sive, excessively
controlling care may influence the development of an avoidant
attachment. With inadequate care, very young children appear
emotionally constricted and distant, with a sense of themselves
as being less worthy of care and concern. Individuals in the
child’s immediate and wider social settings may be perceived
as unfriendly and not especially responsive. These children
may explore their environments more independently, with
less concern about danger or venturing far from adults. With
intrusive care, children may avoid overstimulating interactions,
blunt their emotional displays, attempt to care for themselves,
and look to persons other than their caregivers for comfort.
Disorganized attachment signals a pattern of care in
which the caregiver is perceived as frightening, frightened,
malicious, or a source of alarm. This pattern may also be
observed in young children who have experienced long or
repeated separations from a caregiver (Granqvist et al., 2017).
With disorganized attachment, the attachment conflict is
centered on the caregiver, who is experienced as both a source
of comfort and a source of anxiety. Children display—
especially in times of stress—behaviors and emotions that
are disorganized with regard to establishing or maintaining a
sense of safety or security. The absence or breakdown of a set
of attention, emotion, and behavioral strategies is reflected
in undirected or misdirected behaviors, behavioral freezing
or stereotyped movements, and/or expressions of fear and
apprehension. Although many children may display one or
more behaviors associated with disorganized attachment
at one time or another, the consistency and intensity of
the pattern—the conflicted behaviors, disorientation, and
fear—leads to the disorganized classification (Hesse &
Main, 2006; Granqvist et al., 2017).
Developmental Tasks and Challenges 73
Numerous factors have been identified that influence
the kind of care that infants receive and the attachment
patterns that children develop. Parental sensitivity—the
ability to accurately interpret infant needs and to respond
promptly and appropriately—is usually viewed as the single
most important factor. Other parental factors receiving
theoretical and empirical attention include emotional
availability, the attachment histories of the parents, loss and
trauma experiences, and the parents’ psychological wellbeing and/or psychopathology.
Although undoubtedly important, sensitive caregiving
accounts for a limited amount of the variance in attachment
outcomes, especially in families experiencing economic
Yann Layma/The Image Bank/Getty Images
disadvantage. The parent’s provision of a secure base,
in which the caregiver responds to both sides of the
attachment-exploration continuum, may be more predictive
of attachment status (Woodhouse et al., 2020). Research on
secure base provision is focused on caregiver responses when
the infant cries (distress situations), with less emphasis on
responses to fussiness or bids for connection (nondistress
situations). Lack of parental response when the child seeks
interaction but is mostly calm and regulated is less critical
compared to appropriate parental responses when the child
is distressed. From this perspective, more meaningful
learning about relationships occurs in stressful situations.
Successful resolutions (soothing and comforting) in these
stressful contexts contribute to secure attachment outcomes.
Both sensitivity and secure base provision are
embedded in a network of caregiver social activities (King
et al., 2021; Stern et al., 2021). Caregivers are individuals
with multiple social roles (parent, romantic partner,
friend, employee, parent to other children) involved in
multiple social processes. These processes contribute to
children’s experiences of affiliation and attachment, social
communication, the perception and understanding of self,
and the perception and understanding of others (refer to
Figure 5.3).
Caregiving environments are multidimensional. In
addition to variation related to sensitivity and secure
base provision, we can examine variation related to
the neglect-enrichment continuum (King et al., 2019).
Within this framework, environments differ with
respect to emotional input and cognitive input provided
by caregivers. Emotional input includes affective
information provided by facial expression, touch, and
tone of voice. Cognitive input includes talk, visual
stimulation, and teaching. Both the quantity and the
quality of emotional and cognitive input are enhanced
when they are sensitively provided.
Similar to findings related to temperament and nonshared
family effects, it is important to note that child-caregiver
attachment patterns may be dissimilar within families.
Caregivers have specific relationships with individual
children. Those relationships may be differentially
influenced by parent characteristics, child characteristics,
changes in family circumstances, and many other factors.
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.