Attachment theory (Bowlby, 1969) and its limitations are first described. Next, emotional availability (EA; Biringen et al., 1998; Biringen, 2008) is introduced as an expansion upon the original conceptualization of the parent–child attachment relationship. As a construct and as a measure, EA considers the dyadic and emotional qualities of adult–child relationships. EA is predictive of a variety of child outcomes, such as attachment security, emotion regulation, and school readiness. Recently developed programs to enhance adult–child EA are described.

Parental Substance Use Disorder (SUD) constitutes a high-risk condition for parent-child interactions and child development. Empirical evidence indicates high rates of psychopathology and neuropsychological impairments in individuals with SUD. Despite research indicating that parenting skills are related to psychological well-being and cognitive/neuropsychological functioning, prior studies have not examined the associations between these areas of parental functioning and the quality of parent-child interactions in the context of SUD. Aim(s). The present study adopts an integrated perspective to investigate the way in which maternal neuropsychological functioning and psychopathology are associated with mother-child emotional availability (EA), in the context of parental Substance Use Disorder. Methods. Twenty-nine mothers with SUD were assessed in interaction with their children, as well as with respect to their neuropsychological functioning and psychopathology. Results. In this group, high rates of maternal neuropsychological impairments and psychopathology, as well as generally low levels of EA, were uncovered. Regression analyses showed that maternal neuropsychological functioning was significantly associated with mother-child EA, specifically sensitivity; the role of maternal psychopathology, however, was only marginally significant. Conclusion. In the context of SUD, maternal neuropsychological impairments are significantly associated with mother-child EA. Clinical implications of the findings are discussed.

Contagious yawning, in which yawning is triggered involuntarily when we observe another person yawn, is a common form of echophenomena-the automatic imitation of another's words (echolalia) or actions (echopraxia) [1]. The neural basis for echophenomena is unknown; however, it has been proposed that it is linked to disinhibition of the human mirror-neuron system [1-4] and hyper-excitability of cortical motor areas [1]. We investigated the neural basis for contagious yawning using transcranial magnetic stimulation (TMS). Thirty-six adults viewed video clips that showed another individual yawning and, in separate blocks, were instructed to either resist yawning or allow themselves to yawn. Participants were videoed throughout and their yawns or stifled yawns were counted. We used TMS to quantify motor cortical excitability and physiological inhibition for each participant, and these measures were then used to predict the propensity for contagious yawning across participants. We demonstrate that instructions to resist yawning increase the urge to yawn and alter how yawns are expressed (i.e., full versus stifled yawns) but do not alter the individual propensity for contagious yawning. By contrast, TMS measures of cortical excitability and physiological inhibition were significant predictors of contagious yawning and accounted for approximately 50% of the variability in contagious yawning. These data demonstrate that individual variability in the propensity for contagious yawning is determined by cortical excitability and physiological inhibition in the primary motor cortex.

Attachment theory posits that sensitive interactions between caregivers and children are the bedrock of a secure attachment (Ainsworth, Blehar, Waters, & Wall, 1978). The larger concept of “emotional availability” (Biringen, Robinson, & Emde, 1998) refers to the avenue by which secure attachments are formed, including qualities additional to parental sensitivity. That is, according to the emotional availability framework (Biringen et al., 1998), parental structuring, non-intrusiveness, and non-hostility and sensitivity contribute to the climate that nurtures secure attachment. Child qualities also contribute to secure attachment, in the form of child's responsiveness and child's involvement/engagement with the caregiver. This paper will explore the similarities and differences in these two (primarily) observational concepts as well as propose areas that require broadening, given recent research on family dynamics. Moreover, we describe implications for clinical practice involving intact and divorced families.

Background/Objectives Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity would have heightened cardiovascular risk compared to children of normal BMI women, and that the UPBEAT intervention would mitigate this risk. Subjects/Methods Children were recruited from one UPBEAT trial centre. Cardiovascular measures included blood pressure, echocardiographic assessment of cardiac function and dimensions, carotid intima-media thickness and heart rate variability (HRV) by electrocardiogram. Results Compared to offspring of normal BMI women (n = 51), children of women with obesity from the trial standard care arm (n = 39) had evidence of cardiac remodelling including increased interventricular septum (IVS; mean difference 0.04 cm; 95% CI: 0.018 to 0.067), posterior wall (PW; 0.03 cm; 0.006 to 0.062) and relative wall thicknesses (RWT; 0.03 cm; 0.01 to 0.05) following adjustment. Randomisation of women with obesity to the intervention arm (n = 31) prevented this cardiac remodelling (intervention effect; mean difference IVS −0.03 cm (−0.05 to −0.008); PW −0.03 cm (−0.05 to −0.01); RWT −0.02 cm (−0.04 to −0.005)). Children of women with obesity (standard care arm) compared to women of normal BMI also had elevated minimum heart rate (7 bpm; 1.41 to 13.34) evidence of early diastolic dysfunction (e prime) and increased sympathetic nerve activity index by HRV analysis. Conclusions Maternal obesity was associated with left ventricular concentric remodelling in 3-year-old offspring. Absence of remodelling following the maternal intervention infers in utero origins of cardiac remodelling. Clinical trial registry name and registration number The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.

The Equality Act 2010 provides that people with severe disfigurements are deemed to be disabled. Through the lens of the Convention on the Rights of Persons with Disabilities and models of disability, this article highlights a number of difficulties with the Act's approach, including the problematic 'severity' threshold, the issue of complex conditions which include both disfigurement and functional impairment, and a lack of provision for progressively disfiguring conditions. Analysis is then provided of opportunities to mitigate these difficulties, specifically the concept of perceptive discrimination, and the application of the duty to make reasonable adjustments to disfiguring conditions. It is argued that the law needs to be reformed and options for change are presented.

The Equality Act 2010 provides that someone with a severe disfigurement may fall within the protected characteristic of disability. However, the parameters of the severe disfigurement provision remain uncertain. These parameters are under particular tension from the related concepts of appearance and disability, which partially overlap with disfigurement. This article argues that ‘disfigurement’ should be read as encompassing a broader range of appearance-altering conditions than has yet been recognised. Legal protection should extend beyond conditions such as scarring to include other visible differences. The personal, relative nature of disfigurement should also be recognised; disfigurement should not be viewed as a universal standard irrespective of context, but as a measure of the extent to which a particular person’s appearance is affected by an impairment. Resolving the underlying tension between the concepts of disability and appearance is key not just to addressing disfigurement but also other visible, stigmatised conditions, including obesity.

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