Parents - child role reversal in trilogue play: case studies of trajectories from pregnancy to toddlerhood

Role reversal, whereby a child attempts to meet her parent's adult needs for parenting, intimacy, or companionship, has been identified as a risk factor for developmental disturbances. It has been defined from diverse perspectives as a child attachment strategy, a parent - toddler relational disturbance, and a boundary disturbance between parents and child. The recently discovered infant's triangular capacity, namely the sharing of her attention and affects with both parents, allows one to analyse the infant's contribution to early family dynamics. Role reversal was detected in 4 out of 45 father - mother - infant interactions observed in trilogue play from pregnancy to toddlerhood. The developmental trajectories towards role reversal are explored by means of case analyses. Results are compared with cases of problematic triangulation encountered in the same sample. In role reversal, family interactions are rigidly organized around a "two against one" coalition, whereby the normative hierarchy between parents and child is reversed. The child's triangular capacity is overactivated, controlling the tension between her parents by provocation - animation strategies

Prenatal Representations of Family in Parents and Coparental Interactions as Predictors of Triadic Interactions During Infancy

In this study, we explored the predictive role of family interactions and family representations in mothers and fathers during pregnancy for postnatal motherfatherinfant interactions during the first 2 years after birth. Families (N = 42) were seen at the fifth month of pregnancy and at 3 and 18 months after birth. During pregnancy, parents were asked to play with their baby at the first meeting by using a doll in accordance with the procedure of the prenatal Lausanne Trilogue Play (LTP; A. Corboz-Warnery & E. Fivaz-Depeursinge, 2001; E. Fivaz-Depeursinge, F. Frascarolo-Moutinot, & A. Corboz-Warnery, 2010). Family representations were assessed by administering the Family System Test (T. Gehring, 1998). Marital satisfaction and the history of the couple were assessed through self-reported questionnaires. At 3 and 18 months, family interactions were assessed in the postnatal LTP. Infant temperament was assessed through parent reports. Results show that (a) prenatal interactions and child temperament are the most important predictors of family interactions and (b) paternal representations are predictive of family interactions at 3 months. These results show that observational assessment of nascent family interactions is possible during pregnancy, which would allow early screening of family maladjustment. The findings also highlight the necessity of taking into account paternal representations as a significant variable in the development of family interactions.

Impact of a Cleft Lip and/or Palate on Maternal Stress and Attachment Representations.

Objective : The announcement, prenatally or at birth, of a cleft lip and/or palate represents a challenge for the parents. The purpose of this study is to identify parental working internal models of the child (parental representations of the child and relationship in the context of attachment theory) and posttraumatic stress disorder symptoms in mothers of infants born with a cleft. Method : The study compares mothers with a child born with a cleft (n  =  22) and mothers with a healthy infant (n  =  36). Results : The study shows that mothers of infants with a cleft more often experience insecure parental working internal models of the child and more posttraumatic stress symptoms than mothers of the control group. It is interesting that the severity or complexity of the cleft is not related to parental representations and posttraumatic stress disorder symptoms. The maternal emotional involvement, as expressed in maternal attachment representations, is higher in mothers of children with a cleft who had especially high posttraumatic stress disorder symptoms, as compared with mothers of children with a cleft having fewer posttraumatic stress disorder symptoms. Discussion : Mothers of children with a cleft may benefit from supportive therapy regarding parent-child attachment, even when they express low posttraumatic stress disorder symptoms.

Early mother-child interaction and later quality of attachment in infants with an orofacial cleft compared to infants without cleft.

Objective : The main objective of this study was to assess mother-child patterns of interaction in relation to later quality of attachment in a group of children with an orofacial cleft compared with children without cleft. Design : Families were contacted when the child was 2 months old for a direct assessment of mother-child interaction and then at 12 months for a direct assessment of the child's attachment. Data concerning socioeconomical information and posttraumatic stress symptoms in mothers were collected at the first appointment. Participants : Forty families of children with a cleft and 45 families of children without cleft were included in the study. Families were recruited at birth in the University Hospital of Lausanne. Results : Results showed that children with a cleft were more difficult and less cooperative during interaction at 2 months of age with their mother compared with children without a cleft. No significant differences were found in mothers or in dyadic interactive styles. Concerning the child's attachment at 12 months old, no differences were found in attachment security. However, secure children with a cleft were significantly more avoidant with their mother during the reunion episodes than secure children without cleft. Conclusion : Despite the facial disfigurement and the stress engendered by treatment during the first months of the infant's life, children with cleft and their mothers are doing as well as families without cleft with regard to the mothers' mental health, mother-child relationships, and later quality of attachment. A potential contribution for this absence of difference may be the pluridisciplinary support that families of children with cleft benefit from in Lausanne.

Attachment among Adoptive Families: Two Emipirical Studies in an International Context

The present dissertation analyzed the construct of attachment at different time points, specifically focusing on two phases of adoptive family life that have so far received little attention from investigators. Study 1 focused on the first months of adoption, and analyzed the development of the attachment relationship to new caregivers. The sample was composed of a small but homogeneous group (n=6) of Korean-born children, adopted by Italian parents. The Parent Attachment Diary (Dozier & Stovall, 1997) was utilized to assess the child's attachment behavior. We assessed these behavior for the first 3 months after placement into adoption. Results showed a double variability of attachment behavior: within subjects during the 3-months, and between subjects, with just half of the children developing a stable pattern of attachment. In order to test the growth trajectories of attachment behavior, Hierarchical Linear Models (Bryk & Raudenbush, 1992) were also applied, but no significant population trend was identified. Study 2 analyzed attachment among adoptees during the sensitive period of adolescence. Data was derived from an international collection (n= 104, from Belgium Italy, and Romania) of semi-structured clinical interviews (with adolescents and with their adoptive parents), as well as from questionnaires. The purpose of this study was to detect the role played by risk and protective factors on the adoptee's behavioral and socio-emotional outcomes. In addition, we tested the possible interactions between the different attachment representations within the adoptive family. Results showed that pre-adoptive risk predicted the adolescent's adjustment; however, parental representations constituted an important moderator of this relationship. Moreover, the adolescent's security of attachment partially mediated the relationship between age at placement and later behavioral problems. In conclusion, the two present attachment studies highlighted the notable rate of change of attachment behavior over time, which showed its underlying plasticity, and thus the possible reparatory value of the adoption practice. Since parents have been proven to play an important role, especially in adolescence, the post-adoption support acquires even more importance in order to help parents promoting a positive and stable relational environment over time. - L'objectif de cette thèse est de décrire la formation des relations d'attachement chez les enfants et les adolescents adoptés, lors de deux phases particulières de la vie de la famille adoptive, qui ont été relativement peu étudiées. L'Étude 1 analyse les premiers mois après l'adoption, avec le but de comprendre si, et comment, une relation d'attachement aux nouveaux parents se développe. L'échantillon est composé d'un petit groupe (n = 6) d'enfants provenant de Corée du Sud, adoptés par des parents Italiens. A l'aide du Parent Attachment Diary (Dozier & Stovall, 1997), des observations des comportements d'attachement de l'enfant ont été recueillies chaque jour au cours des 3 premiers mois après l'arrivée. Les résultats montrent une double variabilité des comportements d'attachement: au niveau inter- et intra-individuel ; au premier de ces niveaux, seuleme la moitié des enfants parvient à développer un pattern stable d'attachement ; au niveau intra-individuel, les trajectoires de développement des comportements d'attachement ont été testées à l'aide de Modèles Linéaires Hiérarchiques (Bryk et Raudenbush, 1992), mais aucune tendance significative n'a pu être révélée. L'Étude 2 vise à analyser l'attachement chez des enfants adoptés dans l'enfance, lors de la période particulièrement sensible de l'adolescence. Les données sont issues d'un base de données internationale (n = 104, Belgique, Italie et Roumanie), composée d' entretiens cliniques semi-structurées (auprès de l'adolescents et des ses parents adoptifs), ainsi que de questionnaires. Les analyses statistiques visent à détecter la présence de facteurs de risque et de protection relativement à l'attachement et aux problèmes de comportement de l'enfant adopté. En outre, la présence d'interactions entre les représentations d'attachement des membres de la famille adoptive est évaluée. Les résultats montrent que les risques associés à la période pré-adoptive prédisent la qualité du bien-être de l'adolescent, mais les représentations parentales constituent un modérateur important de cette relation. En outre, la sécurité de l'attachement du jeune adopté médiatise partiellement la relation entre l'âge au moment du placement et les problèmes de comportement lors de l'adolescence. En conclusion, à l'aide de multiples données relatives à l'attachement, ces deux études soulignent son évolution notable au fil du temps, ce qui sous-tend la présence d'une certaine plasticité, et donc la possible valeur réparatrice de la pratique de l'adoption. Comme les parents semblent jouer un rôle important de ce point de vue, surtout à l'adolescence, cela renforce la notion d'un soutien post-adoption, en vue d'aider les parents à la promotion d'un environnement relationnel favorable et stable. - Il presente lavoro è volto ad analizzare l'attaccamento durante le due fasi della vita della famiglia adottiva che meno sono state indagate dalla letteratura. Lo Studio 1 aveva l'obiettivo di analizzare i primi mesi che seguono il collocamento del bambino, al fine di capire se e come una relazione di attaccamento verso i nuovi genitori si sviluppa. Il campione è composto da un piccolo gruppo (n = 6) di bambini provenienti dalla Corea del Sud e adottati da genitori italiani. Attraverso il Parent Attachment Diary (Stovall e Dozier, 1997) sono stati osservati quotidianamente, e per i primi tre mesi, i comportamenti di attaccamento del bambino. I risultati hanno mostrato una duplice variabilità: a livello intraindividuale (nell'arco dei 3 mesi), ed interindividuale, poiché solo la metà dei bambini ha sviluppato un pattern stabile di attaccamento. Per verificare le traiettorie di sviluppo di tali comportamenti, sono stati applicati i Modelli Lineari Gerarchici (Bryk & Raudenbush, 1992), che però non hanno stimato una tendenza significativa all'interno della popolazione. Obiettivo dello Studio 2 è stato quello di esaminare l'attaccamento nelle famiglie i cui figli adottivi si trovavano nella delicata fase adolescenziale. I dati, provenienti da una raccolta internazionale (n = 104, Belgio, Italia e Romania), erano costituiti da interviste cliniche semi-strutturate (con gli adolescenti e i propri genitori adottivi) e da questionari. Le analisi hanno indagato il ruolo dei fattori di rischio sullo sviluppo socio-emotivo e sugli eventuali problemi comportamentali dei ragazzi. Inoltre, sono state esaminate le possibili interazioni tra le diverse rappresentazioni di attaccamento dei membri della famiglia adottiva. I risultati hanno mostrato che il rischio pre-adottivo predice l'adattamento dell'adolescente, sebbene le rappresentazioni genitoriali costituiscano un importante moderatore di questa relazione. Inoltre, la sicurezza dell'attaccamento dell'adolescente media parzialmente la relazione tra età al momento dell'adozione e problemi comportamentali in adolescenza. In conclusione, attraverso i molteplici dati relativi all'attaccamento, i due studi ne hanno evidenziato il cambiamento nel tempo, a riprova della sua plasticità, e pertanto sottolineano il possibile valore riparativo dell'adozione. Dal momento che i genitori svolgono un ruolo importante, soprattutto in adolescenza, il supporto nel post- adozione diventa centrale per aiutarli a promuovere un ambiente relazionale favorevole e stabile nel tempo.

Adult attachment representations predict cortisol and oxytocin responses to stress.

There are many factors contributing to individual variations in the response to stressful experiences. The present study evaluated the patterns of stress responses according to attachment representations in 28 adults from a community sample, plus 46 subjects expected to be particularly sensitive to stress, having been exposed during childhood and/or adolescence to traumatizing events such as abuse or potentially lethal illnesses. Subjects were given the Adult Attachment Interview, which provides attachment classifications, and the Trier Social Stress Test (TSST), involving an experimental psychosocial challenge. Subjective responses to the TSST, as well as saliva samples (assayed for cortisol) and blood plasma samples (assayed for ACTH and oxytocin) were collected before, during and after the stress procedure. The stress responses presented specific patterns according to attachment classifications. Subjects with an autonomous attachment classification reported relatively low subjective stress, they presented a moderate response of the hypothalamic-pituitary-adrenal (HPA) axis (ACTH and cortisol), and a high level of oxytocin. Subjects with a dismissing classification reported a moderate subjective stress, they presented an elevated response of the HPA axis, and moderate levels of oxytocin. Subjects with a preoccupied classification presented moderate levels of subjective stress, and of HPA response, and a relatively low level of oxytocin. Finally, subjects with an unresolved classification reported elevated subjective stress; they presented a suppressed HPA response, and moderate levels of oxytocin. These data support the notion that attachment representations may affect stress responses, and suggest a specific role of oxytocin in both the attachment system and the stress system.

Use of the chicken lysozyme 5' matrix attachment region to generate high producer CHO cell lines.

Scaffold or matrix attachment region (S/MAR) genetic elements have previously been proposed to insulate transgenes from repressive effects linked to their site of integration within the host cell genome. We have evaluated their use in various stable transfection settings to increase the production of recombinant proteins such as monoclonal antibodies from Chinese hamster ovary (CHO) cell lines. Using the green fluorescent protein coding sequence, we show that S/MAR elements mediate a dual effect on the population of transfected cells. First, S/MAR elements almost fully abolish the occurrence of cell clones that express little transgene that may result from transgene integration in an unfavorable chromosomal environment. Second, they increase the overall expression of the transgene over the whole range of expression levels, allowing the detection of cells with significantly higher levels of transgene expression. An optimal setting was identified as the addition of a S/MAR element both in cis (on the transgene expression vector) and in trans (co-transfected on a separate plasmid). When used to express immunoglobulins, the S/MAR element enabled cell clones with high and stable levels of expression to be isolated following the analysis of a few cell lines generated without transgene amplification procedures.

In vitro attachment of glycosyl-inositolphospholipid anchor structures to mouse Thy-1 antigen and human decay-accelerating factor.

Glycosyl-inositolphospholipid (GPL) anchoring structures are incorporated into GPL-anchored proteins immediately posttranslationally in the rough endoplasmic reticulum, but the biochemical and cellular constituents involved in this "glypiation" process are unknown. To establish whether glypiation could be achieved in vitro, mRNAs generated by transcription of cDNAs encoding two GPL-anchored proteins, murine Thy-1 antigen and human decay-accelerating factor (DAF), and a conventionally anchored control protein, polymeric-immunoglobulin receptor (IgR), were translated in a rabbit reticulocyte lysate. Upon addition of dog pancreatic rough microsomes, nascent polypeptides generated from the three mRNAs translocated into vesicles. Dispersal of the vesicles with Triton X-114 detergent and incubation of the hydrophobic phase with phosphatidylinositol-specific phospholipases C and D, enzymes specific for GPL-anchor structures, released Thy-1 and DAF but not IgR protein into the aqueous phase. The selective incorporation of phospholipase-sensitive anchoring moieties into Thy-1 and DAF but not IgR translation products during in vitro translocation indicates that rough microsomes are able to support and regulate glypiation.

The influence of attachment on perceived stress and cortisol response to acute stress in women sexually abused in childhood or adolescence.

The long-term implications of sexual abuse in childhood or adolescence (CSA) have been relatively well documented regarding attachment (disorganized attachment in childhood, unresolved trauma in adulthood), stress reactions (altered patterns of stress reactivity under experimental conditions), and psychopathology. Attachment has been shown to mediate the implications of CSA, namely on psychopathology. The implication of attachment on stress responses of abused persons has not been documented. Twenty-seven 20-46 years old women who had experienced episodes of CSA, and 17 controls have been interviewed using the Adult Attachment Interview. Sixty-three percent of abused women presented an unresolved trauma (12% for the controls). Thirty-six women (14 controls and 22 abused) came again to the laboratory for a session involving an experimental stress challenge (TSST). Subjects provided repeated appreciations of perceived stress on visual analogue scales and saliva samples were collected to assay cortisol levels. Whereas abused women with unresolved trauma showed the highest levels of perceived stress, they simultaneously presented the most suppressed cortisol reactions (there were significant post hoc differences between "unresolved abused" and controls on the increase of perceived stress and on cortisol recovery after the acute stress). It is suggested that important stressful experiences (such as CSA), especially when they have not been psychologically assimilated, may cause a disconnection, during subsequent mildly stressful circumstances, between the perception of stress and natural defensive body reactions.

Versión reducida del cuestionario CaMir (CaMir-R) para la evaluación del apego [Short version of CaMir questionnaire (CaMir-R) to assess attachment].

The CaMir is a questionnaire aimed at measuring attachment cognitions. It is based on subjects' evaluations of past and present attachment experiences and family functioning. It is a widely used tool both in research and in clinical settings. The aim of this study was to develop a short version of CaMir in Spanish (CaMir-R) and to obtain evidence about its validity and reliability in a sample of 676 adolescents (364 female and 312 male) belonging to different groups (clinical, maltreated, and community samples) with an age range between 13 and 19 years (M = 15.62, SD = 1.49). We examined its internal structure, convergent, and decision validity, the relationship between its dimensions and psychopathological symptoms, as well as its internal consistency and temporal stability. The CaMir-R included 7 factors whose internal consistency indexes ranged between 0.60 and 0.85. With the exception of the «Parental Permissiveness» dimension, which did not show good reliability, the results suggest that the CaMir-R provides a valid and reliable assessment of attachment representations and of the conception of family functioning.

From controlling to letting go : what are the psychosocial needs of parents of adolescents with a chronic illness?

While one of the main objectives of adolescence is to achieve autonomy, for the specific population of adolescents with a chronic illness (CI), the struggle for autonomy is accentuated by the limits implied by their illness. However, little is known concerning the way their parents manage and cope with their children's autonomy acquisition. Our aim was to identify the needs and preoccupations of parents of adolescents with CI in coping with their children's autonomy acquisition and to determine whether mothers and fathers coped differently. Using a qualitative approach, 30 parents of adolescents with CI participated in five focus groups. Recruitment took place in five specialized pediatric clinics from our university hospital. Thematic analysis was conducted. Transcript analyses suggested four major categories of preoccupations, those regarding autonomy acquisition, giving or taking on autonomy, shared management of treatment and child's future. Some aspects implied differences between mothers' and fathers' viewpoints and ways of experiencing this period of life. Letting go can be hard for the father, mother, adolescent or all three. Helping one or the other can in turn improve family functioning as a whole. Reported findings may help health professionals better assist parents in managing their child's acquisition of autonomy.

Transition from pediatric to adult health care: expectations of adolescents with chronic disorders and their parents.

The aim of this study was to assess the expectations of adolescents with chronic disorders with regard to transition from pediatric to adult health care and to compare them with the expectations of their parents. A cross-sectional study was carried out including 283 adolescents with chronic disorders, aged 14-25 years (median age, 16.0 years), and not yet transferred to adult health care, and their 318 parents from two university children's hospitals. The majority of adolescents and parents (64%/70%) perceived the ages of 18-19 years and older as the best time to transfer to adult health care. Chronological age and feeling too old to see a pediatrician were reported as the most important decision factors for the transfer while the severity of the disease was not considered important. The most relevant barriers were feeling at ease with the pediatrician (45%/38%), anxiety (20%/24%), and lack of information about the adult specialist and health care (18%/27%). Of the 51% of adolescents with whom the pediatric specialist had spoken about the transfer, 53% of adolescents and 69% of parents preferred a joint transfer meeting with the pediatric and adult specialist, and 24% of these adolescents declared that their health professional had offered this option. In summary, the age preference for adolescents with chronic disorders and their parents to transfer to adult health care was higher than the upper age limits for admission to pediatric health care in many European countries. Anxiety and a lack of information of both adolescents and their parents were among the most important barriers for a smooth and timely transfer according to adolescents and parents.

Mother's attachment representations of their premature infant at 6 and 18 months after birth.

The effects of premature birth on attachment have generally been examined from the infant's perspective. There is a lack of data concerning parental attachment representations toward a premature child. Because of the psychological stress engendered in parents confronted with a premature birth, we hypothesized that their attachment representations would be altered during the first months after the hospital discharge. Fifty families with a premature infant (25-33 gestation weeks) and a control group of 30 families with a full-term infant participated to the study. Perinatal risks were evaluated during hospitalization. To assess mothers' representations of their infant, the Working Model of the Child Interview (WMCI, Zeanah & Benoit, 1995 & Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997) were administered when their children were 6 and 18 months old. The severity of the perinatal risks was found to have an impact on the mothers' attachment representations. At six months, only 20% of the mothers of a prematurely born infant (30% at 18 months) had secure attachment representations, vs. 53% for the control group (57% at 18 months). Furthermore, mothers of low-risk premature infants more often had disengaged representations, whereas distorted representations were more frequent in the high-risk group of premature children. These findings suggest that the parental response to a premature birth is linked to the severity of postnatal risks. The fact that secure attachment representations are affected in mothers of low-risk infants just as much as they are in mothers of high-risk infants points to the need to conduct further studies aimed at evaluating whether preventive intervention for both low-risk and high-risk premature will be helpful.