Background: Psychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and... Show moreBackground: Psychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and future relationships. Aims: To investigate psychosocial development, attachment and school functioning in MC twins with sFGR and compare outcomes with the general population and between smaller and larger twins. Study design: Observational cohort study. Subjects: MC twins with sFGR (defined as a birth weight discordance >= 20 %) born between 2002 and 2017 and aged 3-17 years. Outcome measures: Multiple parent report questionnaires: the Child Behavior Checklist (social-emotional devel-opment and behavior), the (Early) Childhood Behavior Questionnaire Very Short Form (temperament), the Attachment Insecurity Screening Inventory (attachment) and a school functioning questionnaire. Results: Median age for the 48 twin pairs was 11 (interquartile range (IQR) 8-13) years. Attachment insecurity for both twins was higher than in the general population for ambivalence/resistance (34 % (21/62) vs. 16 %, p = 0.024) and total attachment insecurity (35 % (22/62) vs. 16 %, p = 0.016). Smaller twins had more internalizing behavioral problems, i.e. negative emotions and behaviors turned inwards (22 % (10/46) vs. 11 % (5/46), p = 0.021) and a higher negative affect, i.e. more likely to experience negative emotions (3.2 (2.9-3.7) vs. 2.9 (2.2-3.2), p = 0.009) than larger twins, as well as a lower secondary school level (p = 0.031). Conclusion: MC twins with sFGR have more ambivalent/resistant attachment insecurity following the compli-cated pregnancy course. Smaller twins have a tendency towards negative emotions and internalizing behaviors compared to larger twins, indicating an increased sensitivity for depression and anxiety. Show less
This dissertation aimed to shed light on the study of attachment theory in areas other than western, educated, industrialized, rich, and democratic (WEIRD; Henrich et al., 2010) societies that... Show moreThis dissertation aimed to shed light on the study of attachment theory in areas other than western, educated, industrialized, rich, and democratic (WEIRD; Henrich et al., 2010) societies that dominate the literature. We aimed to describe the extent to which the attachment theory core hypotheses are supported by research in Latin America and specifically in a rural Peruvian Andean area. Show less
This dissertation aimed to contribute to the quality of foster care addressing three main objectives: The first objective was to investigate if existing parenting interventions are effective in... Show moreThis dissertation aimed to contribute to the quality of foster care addressing three main objectives: The first objective was to investigate if existing parenting interventions are effective in supporting/improving parenting and child outcomes in foster care using a meta-analytic approach. The second objective was to study the effectiveness of an adapted version of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) for foster care, i.e., VIPP-FC. The implementation of VIPP-SD in different types of families and in childcare settings was first reviewed, with special attention to VIPP-FC. Subsequently, the study protocol of the randomized controlled trial (RCT) investigating the effectiveness of VIPP-FC was described. In addition, the results of this RCT regarding the effectiveness of VIPP-FC on parenting behavior and attitudes were presented. The third objective was to examine correlates of indiscriminate friendliness (IF) displayed by foster children. To answer this question, the relations of attachment security, parental sensitivity, and child inhibitory control with IF were examined using data collected during the pretest of the VIPP-FC RCT. Results are described and discussed in different chapters, and implications for clinical practice and recommendations for future research are additionally provided. Show less
This dissertation focused on the role of attachment-based interventions in child protection cases involving young children. The results confirmed that placement decisions are impacted by subjective... Show moreThis dissertation focused on the role of attachment-based interventions in child protection cases involving young children. The results confirmed that placement decisions are impacted by subjective factors, including professionals’ own attitudes and mind-set. Because we argue that the influence of subjective factors can be reduced by inserting relevant evidence into the decision-making process, we tested the effectiveness of one procedure that might produce such information. Evidence for the notion that implementing an attachment-based intervention in parenting capacity assessments can enhance the quality of placement decisions was partially found in this dissertation: We found initial evidence for improved reliability, but not for improved validity, of placement decisions. Taking these findings together with international evidence, we do tentatively conclude that attachment-based interventions can contribute to an improved quality of placement decisions. However, more research is needed to determine what implementation would be most fruitful in the Dutch child protection context. Finally, our finding that maltreating parents with more severe levels of childhood trauma benefited less from an attachment-based intervention implicates that we need to consider families’ individual needs when conducting interventions in this setting. This way, not only more parents will benefit from these interventions, their responses to these interventions might also be a more valid source of information to support placement decisions. Show less
The most difficult target group in mental health care for youth, is recognizable from social debates: An alarming example of a suicide or severe non-suicidal self-injury illustrates the... Show moreThe most difficult target group in mental health care for youth, is recognizable from social debates: An alarming example of a suicide or severe non-suicidal self-injury illustrates the vulnerability of these adolescents and underlines a powerless society. Notably, this target group is often excluded from scientific research. Hauber attributes this exclusion on the many psychiatric problems young people face and a rigid classification system. Theoretical models do not accommodate overlapping problems, despite the most serious conditions being characterized by such an overlap. Hauber described the need for a dimensional classification system to enable care providers to assess serious problems, such as an overlap of personality disorder, insecure attachment and non-suicidal self-injury. The influences of puberty, attachment insecurity and the adolescent’s social dynamics should be included in such a model. By having young people reflect in writing on their treatment, relevant information can be obtained to tailor personalized care, and drop-out can be minimized. New developments suggest improving resilience and connection with others, rather than just reducing symptoms. Hauber's research similarly showed the importance of connecting with others to grow emotionally in adolescence. This is a challenge in modern society, with loneliness being the highest mortality risk for humans. Show less
Abstract Background: A dimensional approach of psychopathology focuses on features and risk factors that are shared across diagnoses. In support for this dimensional approach, studies point to a... Show moreAbstract Background: A dimensional approach of psychopathology focuses on features and risk factors that are shared across diagnoses. In support for this dimensional approach, studies point to a general psychopathology factor (GPF) associated with risk for multiple psychiatric disorders. It is, however, unknown how GPF relates to white matter integrity (WMI). In the current diffusion tensor imaging (DTI) study, we examined how GPF relates to abnormalities in a skeleton representation of white matter tracts, taking into account a trans-diagnostic risk factor: unresolved-disorganized attachment (Ud) resulting from loss or trauma. Methods: Unique associations between GPF, Ud, and WMI were examined in a combined sample of adolescents (N = 63) with childhood sexual abuse-related posttraumatic stress disorder (N = 18), anxiety and depressive disorders (N = 26) and without psychiatric disorder (N = 19). WMI was measured using DTI. Ud was measured using the Adult Attachment Interview. We controlled for puberty stage, gender, age, and IQ. Results: Controlling for GPF, Ud was associated with reduced fractional anisotropy (FA) in the splenium and inferior fronto-occipital fasciculus (IFOF). Controlling for Ud, GPF was associated with reduced FA in the genu and body of the corpus callosum. Conclusions: Decreasing WMI in the genu and body with increasing psychopathology across diagnoses suggests demyelinization in these areas and may underlie comorbidity and presence of symptoms that transcend psychopathological diagnoses. In contrast, trauma-related WMI reductions in the splenium and IFOF may account for heterogeneity within diagnostic categories as a function of childhood trauma. These findings support the importance of a dimensional approach in addition to traditional diagnostic classifications in clinical research and practice. Keywords: Adversity, Child abuse, Psychopathology, Attachment, Brain imaging Show less
Even though John Bowlby (1907-1990) is generally regarded as the founder of attachment theory, Mary Ainsworth’s (1913-1999) contribution is considerable and goes beyond the design of the Strange... Show moreEven though John Bowlby (1907-1990) is generally regarded as the founder of attachment theory, Mary Ainsworth’s (1913-1999) contribution is considerable and goes beyond the design of the Strange Situation Procedure and the introduction of maternal sensitivity as decisive for a secure attachment relationship. Ainsworth worked in Toronto with William Blatz (1895-1964) for almost two decades before she moved to London and worked with Bowlby in 1950. Ainsworth was heavily influenced by Blatz and his security theory and infused Bowlby’s attachment theory in the making with elements of Blatz’s security theory. These elements, like for instance the secure base phenomenon, are clearly recognizable even now. The Strange Situation Procedure, an instrument Ainsworth designed to measure the quality of attachment in young children, can also be traced back to her time with Blatz: in the 1930s she designed instruments to measure the concept of security. The Strange Situation Procedure, however, was not the first of its kind: since the 1930s researchers had been experimenting with children, alone or in the company of their parents in unfamiliar surroundings, sometimes in the presence of a stranger. Taken together, we conclude that Ainsworth’s contribution to attachment theory is more significant than hitherto believed. Show less
The current thesis focuses on the longitudinal development of early-adopted children in the 1887/29874 Leiden Longitudinal Adoption Study (LLAS). In the LLAS, adopted children were followed from... Show moreThe current thesis focuses on the longitudinal development of early-adopted children in the 1887/29874 Leiden Longitudinal Adoption Study (LLAS). In the LLAS, adopted children were followed from infancy until young adulthood. In Chapter 1 we discuss the role of sensitive parenting and the precursors and developmental outcomes of attachment security. In the empirical study in Chapter 2 we report on the concurrent as well as longitudinal relations between maternal sensitivity, child temperament, and externalizing behavior problems. In the second empirical study in Chapter 3, we follow this line of enquiry and investigate concurrent and longitudinal relations between maternal sensitivity, child temperament and internalizing behavior problems. Chapter 4 reports on the final empirical study of the thesis, and focuses on the associations between maternal sensitivity and attachment in infancy and the diurnal cortisol curve in young adulthood. Our empirical studies show that maternal sensitivity in infancy and middle childhood indirectly predicts fewer internalizing behavior problems in adopted adolescents, and that maternal sensitivity in adolescence predicts less concurrent delinquent behavior. Attachment experiences in early life do not predict the adoptees' diurnal cortisol curve in later life. In Chapter 5 we discuss these results and some methodological issues more thoroughly. Show less
1887/26887 The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to... Show more1887/26887 The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in center child care and to answer the question whether narrow-focused caregiver interventions are effective in improving child care quality. The reported meta-analysis shows that narrow-focus intervention programs that target caregiver-child interaction and child social-emotional development through caregiver training are effective in improving child care quality. Moreover, we evaluated an attachment-based intervention program in a randomized controlled trial including 64 caregivers in Dutch child care centers. It is demonstrated that this program, the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline for Child Care (VIPP-CC), is effective in improving caregiver sensitivity and caregiver attitudes towards sensitive caregiving and discipline. Finally, we stress the importance of including novel indicators derived from environmental chaos theory in the assessment and improvement of child care quality and child wellbeing. Our results show that average noise levels and noise variability are important predictors of child emotional wellbeing in center care Show less
1887/26094 Chile has embarked on a road that must lead to the reduction of inequality gaps for the population. A public policy called Chile Growths With You has focused on an increase in the... Show more1887/26094 Chile has embarked on a road that must lead to the reduction of inequality gaps for the population. A public policy called Chile Growths With You has focused on an increase in the breadth of coverage of non-maternal care through childcare centers to provide equal opportunities in early childhood and onwards. This dissertation focuses on the quality of the early childcare environment in Chile and the role of ethnicity and socio-economic inequality. Ninety-five mother-child dyads were followed in their first year of life to examine changes in the attachment relationship and quality of the home environment, dependent on type of care (maternal care versus center daycare) and ethnicity (Mapuche versus non-Mapuche). Our results show that differences in quality of the home environment between the two ethnic groups are very small and that Mapuche families are distinguished from the majority group by lower income and lower maternal education. Fulltime daycare has no negative consequences for the attachment relationship and the quality of the home environment. Moreover, a positive change in attachment security was found but only for Mapuche children who attended daycare. Show less
We examined the development of international adoptees from infancy to young adulthood, and factors influencing developmental outcomes in middle childhood, adolescence and young adulthood. The... Show moreWe examined the development of international adoptees from infancy to young adulthood, and factors influencing developmental outcomes in middle childhood, adolescence and young adulthood. The results for cognitive development (Chapter 2) showed that early malnutrition influenced cognitive and health-related outcomes, but its consequences did not extend to socioeconomic success later in life. The human brain seems capable of adapting to changing environmental influences, but earlier placement in a positive family environment should be preferred (see also Chapter 1). The adoptees in the Leiden Longitudinal Adoption Study were exposed to few adversities due to their early adoptive placement, and the combination with the nurturing environment of a permanent adoptive family resulted in positive cognitive and socio-emotional outcomes (Chapters 2 and 3). Our results for longitudinal (sensitivity) and concurrent relations (reactivity to infant crying) with attachment representations in young adulthood (Chapters 3 and 4) clearly point to this role of the family environment in predicting social-emotional outcomes. High parenting quality is important, also in families where children do not share a common genetic basis with their parents. In sum, adoption can be seen as a positive intervention and the (adoptive) family environment matters for children growing up from infants to young adults. Show less
The development of self-regulation is one of the major challenges of a child’s healthy development. In the current thesis, the contribution and interplay of parental and biological factors in... Show moreThe development of self-regulation is one of the major challenges of a child’s healthy development. In the current thesis, the contribution and interplay of parental and biological factors in the development of self-regulation in preschoolers are studied in a large population-based cohort, the Generation R Study. We found that attachment insecurity in infancy was related to higher levels of toddler active resistance during Clean-Up. Maternal negative discipline was related to lower levels of committed compliance in toddlers, and the association between maternal positive discipline and child committed compliance was moderated by the child’s COMT rs4680 genotype, indicating that the association was stronger in children with the Met/Met variant than for children with other COMT genotypes. Maternal family-related stress during pregnancy predicted lower levels of toddler committed compliance through lower levels of maternal positive discipline. Maternal sensitivity was associated with lower levels of executive function problems and lower levels of internalizing problems in preschool age. In children with a relatively short corpus callosum in infancy, higher levels of maternal positive discipline predicted lower levels of inhibition problems. Our studies demonstrate the role of various aspects of positive parenting and mother-child relationship quality in preschool children’s regulation of emotions and behavior. Show less
Wat bepaalt de kwaliteit van gehechtheid? In een grootschalig onderzoek, Generation R, zijn de stresshuishouding en enkele kandidaatgenen van de kinderen onderzocht, en het gedrag van de ouder. De... Show moreWat bepaalt de kwaliteit van gehechtheid? In een grootschalig onderzoek, Generation R, zijn de stresshuishouding en enkele kandidaatgenen van de kinderen onderzocht, en het gedrag van de ouder. De gehechtheidsrelatie is de relatie tussen een kind en een ouder (of andere stabiele verzorger) die in het eerste levensjaar wordt opgebouwd. Veilig gehechte kinderen gebruiken hun ouder als veilige haven van waar ze de omgeving verkennen. Onveilig gehechte kinderen hebben hier moeite mee; zij kunnen niet de juiste balans vinden tussen contact met de ouder en het verkennen van de omgeving. Dit onderzoek laat zien dat onveilig gehechte kinderen heftiger op stress reageren dan veilig gehechte kinderen. Wanneer er sprake was van depressie in het leven van de moeder, leidt dit tot een verdere toename van stress bij de onveilig gehechte kinderen. Hetzelfde gold voor onveilig gehechte kinderen met een risico-gen dat verantwoordelijk is voor een minder goede stressregulatie. Verder vonden we dat sensitief opvoedgedrag van moeder leidde tot meer veilige gehechtheid, maar alleen wanneer het kind een bepaalde variant van een gen droeg dat van belang is bij het omgaan met stress. De resultaten laten de kwetsbaarheid en stressgevoeligheid van onveilig gehechte kinderen zien. Daarnaast kunnen we op basis van de huidige resultaten zeggen dat insensitief opvoedgedrag, depressie van moeder en genetische risico’s een rol spelen bij onveilige gehechtheid. De ontwikkeling van gehechtheid is complex, en het resultaat van het samenspel tussen biologische aspecten en de opvoedingsomgeving. Daarop moet toekomstig onderzoek dan ook gericht zijn. Show less
This thesis examined the development of adopted children to shed more light on the effects of deprivation on child development and the potential for catch-up and recovery after placement in the... Show moreThis thesis examined the development of adopted children to shed more light on the effects of deprivation on child development and the potential for catch-up and recovery after placement in the more advantageous environment of an adoptive family. In the first part of the thesis a meta-analysis is presented in which we compared adopted children’s attachment relationships with the normative attachment distribution of nonadopted children raised by their biological parents, and - as a comparison - we also compared the attachment distribution of foster children with the normative distribution. The second and third parts of the thesis focus on the development of former foster and post-institutionalized children, 11 to 16 months old at arrival, two and six months after their adoption from China. Several salient developmental domains were studied: attachment, cognitive and motor development, physical growth, stress regulation, and social-emotional behavior. Show less
In dit proefschrift staat ouderschap in de vroege kindertijd centraal, onder andere de reacties van volwassenen op het huilen van baby’s. Voor baby’s is huilen één van de belangrijkste manieren om... Show moreIn dit proefschrift staat ouderschap in de vroege kindertijd centraal, onder andere de reacties van volwassenen op het huilen van baby’s. Voor baby’s is huilen één van de belangrijkste manieren om te communiceren. Zo laten ze weten dat ze ergens behoefte aan hebben of zich niet lekker voelen. Maar niet alle ouders reageren op een sensitieve, liefdevolle manier: voor sommige ouders is het huilen van hun kind zo stressvol dat ze eerder op een hardhandige wijze reageren. In deze studie is onderzocht hoe volwassenen reageren op het huilen van een baby. Daarbij werd een standaard huilfragment van een pasgeboren kind gemanipuleerd en op verschillende hoogten afgespeeld. De toonhoogte van het huilgeluid en de manier waarop volwassenen het huilen interpreteren, bleken belangrijk te zijn. Hoge huilgeluiden vormen een risicofactor voor het stevig willen aanpakken van het kind. Zieke en premature kinderen hebben vaker zulke hoge huiltonen. Ook is onderzocht of verschillen in reactie op huilen erfelijk zijn. Dat is inderdaad het geval, maar niet voor alle aspecten van reageren op huilen. Verschillen in sensitieve reacties waren erfelijk bepaald, maar de neiging om het kind op een hardhandige manier aan te pakken niet. Show less
Although institutional care jeopardizes children’s development, some studies suggest that well-functioning child-care institutions may offer children a better environment than their own... Show moreAlthough institutional care jeopardizes children’s development, some studies suggest that well-functioning child-care institutions may offer children a better environment than their own dysfunctional families. For the growing number of HIV-infected children who often live in underprivileged families or institutions, comparative studies on their care arrangements are crucial. In her dissertation Natasha Dobrova-Krol examined the impact of institutional care and HIV-infection on several developmental domains of more than 60 Ukrainian preschoolers. Physical growth, stress regulation, cognitive and social development, as well as organization of attachment and children’s indiscriminately friendly behavior were addressed in this study. Developmental outcomes of HIV-infected children reared in disadvantaged families were compared with the outcomes of children reared in institutions providing adequate medical and physical care. In search for possible risk and protective factors in the development of the children individual characteristics and various aspects of the rearing environment were explored. The findings of this study demonstrated that institutional rearing impeded the development of children in all domains. Both for children with and without HIV family care, even of compromised quality, was better than institutional care, even of good quality. HIV-infection was found to be associated with less favorable outcomes in physical growth and cognitive development. The negative impact of institutional care, however, was larger than the presence of HIV. In three out of six developmental domains that were examined, HIV-infected children reared in disadvantaged families showed significantly better results than both HIV-infected and uninfected children reared in institutions, and no difference was found in the other domains. The quality of the child-caregiver relationship had a larger impact on children’s physical growth and cognitive performance than either HIV-infection or the quality of the physical environment and thus represents an important intervention target. The study has important implications for intervention efforts in child-care institutions. Show less
