This study attempted to replicate previous findings that indicated that preschool-aged children with significant externalizing problems are more likely to have insecure attachment relations than nonproblem peers (Speltz, Greenberg, & DeKlyen, 1990). Fifty children (ages 3–6) and their mothers participated; 25 referred to a child psychiatry clinic for one of the DSM-IIIR Disruptive Behavior Disorders, and 25 matched comparisons without externalizing behavior problems. Attachment was measured at the time of referral using two separation and reunion sequences in a clinic context. We found that 80% of the clinic-referred children were classified as insecure, whereas only 28% of the comparisons were so classified (p <.001). Further, a high percentage of clinic insecure children showed a controlling pattern of attachment. Thus, the present study, with improved methodological rigor, provided an almost exact replication to previous results. The discussion focuses on what contribution attachment research can provide to a developmental psychopathology perspective on early externalizing disorders.
This article is an extensive review of the psychological literature on cleft lip and palate and other craniofacial anomalies. Issues of parental acceptance, social competence, self-concept, emotional adjustment, and cognitive functioning are examined. Cumulative research suggests that many children with craniofacial conditions develop in a typical manner and do not experience psychological problems. However, a significant number of children (30% to 40% in most studies) experience difficulties with internalizing and/or externalizing problems, learning disorders, and social competence. A multifactorial model for examining the domains that are related to both psychological risk and protection is recommended. The need for multicenter studies that are prospective and clinically relevant is emphasized.
Infants with clefts show relative deficits in cognitive and psychomotor development. Cognitive deficits are apparent in nonverbal as well as verbal areas of performance.
Previous studies have found that children with cleft lip and palate (CLP) and isolated cleft palate (CP) have elevated risk for a variety of psychosocial problems, but the origins of such problems are unclear. We expected that early medical and other stressors during infancy--including feeding problems and facial disfigurement--would have adverse effects on the infant, his or her caregivers, and the family environment, leading to a higher than expected rate of insecure attachments among infants with clefts. Twelve-month attachment classifications of CLP, CP, and comparison group infants were examined. No significant group differences in attachment status were found. When 3-month infant, maternal, and social/family characteristics were examined as potential predictors of insecure attachment, predictors interacted with diagnostic status. For the cleft group, infant and maternal characteristics, but not family characteristics, significantly predicted insecure attachment. For the comparison group, maternal and family characteristics, but not factors associated with the infant, were predictive. Infants with clefts, despite their special needs and caregiving requirements, seem not to have elevated risk for insecure attachments at the end of their first year. Contrary to social-psychological formulations, the facial appearance of infants with CLP had no adverse effect on the quality of their maternal attachment.
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