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There is an urgent imperative to scale up access to effective, family‐focused mental health services for trauma‐exposed infants, toddlers, and preschoolers, who represent the most vulnerable and most underserved sector of the clinical child population. This article describes the process of scaling child–parent psychotherapy, an evidence‐based treatment currently used in 39 U.S. states and six countries, as an example of the promise and challenge of large‐scale implementation of relationship‐based treatments [ABSTRACT FROM AUTHOR]

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Trauma exposure is strongly linked to maternal posttraumatic stress disorder (PTSD) and depressive symptoms during the perinatal period; however, childhood trauma exposure is often assessed without accounting for adult exposure. This study tested the unique impacts of childhood and adulthood trauma exposure on PTSD and depressive symptoms among pregnant women (N = 107, 82.9% Latina) enrolled in a nonrandomized intervention study. Regression analyses at baseline showed positive associations between trauma exposure and PTSD symptoms irrespective of trauma timing, childhood: B = 1.62, t(91) = 2.11, p =.038; adulthood: B = 2.92, t(91) = 3.04, p =.003. However only adulthood trauma exposure, B = 1.28, t(94) = 2.94, p =.004, was positively associated with depressive symptoms. Mixed‐effects analyses of variance revealed interaction effects of time and adulthood trauma exposure, indicating that women with high degrees of adulthood trauma exposure had higher baseline levels of PTSD, F(1, 76.4) = 6.45, p =.013, and depressive symptoms, F(1, 87.2) = 4.88, p =.030, but showed a more precipitous decrease posttreatment than women with lower levels of adulthood trauma exposure. These findings support the clinical relevance of assessing both childhood and adulthood trauma exposure during the perinatal period given their impacts on baseline symptoms and psychotherapy response. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is often considered an adult problem despite profound consequences for the children who are exposed toviolent relational patterns. About a third of children and adolescents report past exposure to parental IPV, and a majority were first exposed as infants. Exposure to IPV during pregnancy through the first 5 years of a child's life has consequences ranging from adverse birth outcomes to diagnosable emotional problems and lasting physiological dysregulation. This article reviews risks and consequences of IPV in pregnancy and early childhood and discusses a relational psychotherapeutic treatment approach (Child–Parent Psychotherapy) applied to both developmental stages to mitigate the adverse consequences of family violence on parents and their children. Research evidence for the effectiveness of Child–Parent Psychotherapy (CPP) among IPV‐exposed families is reviewed as are specific treatment components which seek to restore relational safety following familial violence. Additionally, clinical considerations unique to families with histories of or ongoing exposure to IPV are discussed. Finally, recommendations are presented to improve the integration between medical and early childhood behavioral health systems for families at highest risk for chronic IPV. Key points for the family court community: Infants and children exposed to IPV are at elevated risk for later socioemotional difficulties, physiological dysregulation and child welfare involvement.IPV threatens relational safety; dyadic, relationship‐based psychotherapies are well suited to repair ruptures in family relationships caused by violence restore psychological health.Child Parent Psychotherapy and its perinatal application are interventions that can improve to child and parental psychopathology, parenting beliefs and attachment security. [ABSTRACT FROM AUTHOR]

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Traumatic Stress is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Traumatic Stress is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Traumatic Stress is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Traumatic Stress is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the impact of exposure to domestic violence on infants, toddlers, and preschoolers; the manifestations of post-traumatic stress disorder in the first years of life; and the parameters of Child-Parent Psychotherapy as a relationship-based treatment that aims at enhancing the parent's effectiveness as a protector as a means of restoring the child's momentum towards healthy development. Obstacles to the child's mental health and to the success of treatment are discussed, with particular attention to the adverse effects of parental psychopathology and of environmental stressors such as poverty, cultural marginalization, and lack of access to resources. It is argued that the infant mental health clinician working with traumatized children and their families needs to adopt a therapeutic approach that actively incorporates collaboration with other service systems, including pediatric care, childcare, law enforcement, child protective services, and the courts, in order to provide ecologically sound and culturally competent treatment. [ABSTRACT FROM AUTHOR]

Each year, exposure to violent trauma takes its toll on the development of millions of children. When their trauma goes unaddressed, children are at greater risk for school failure; anxiety and depression and other post-traumatic disorders; alcohol and drug abuse, and, later in life, engaging in violence similar to that to which they were originally exposed. In spite of the serious psychiatric/developmental sequelae of violence exposure, the majority of severely and chronically traumatized children and youth are not found in mental health clinics. Instead, they typically are seen as the ‘trouble-children’ in schools or emerge in the child protective, law enforcement, substance abuse treatment, and criminal justice systems, where the root of their problems in exposure to violence and abuse is typically not identified or addressed. Usually, providers in all of these diverse service systems have not been sufficiently trained to know and identify the traumatic origins of the children's presenting difficulties and are not sufficiently equipped to assist with their remediation. This multiplicity of traumatic manifestations outside the mental health setting leads to the inescapable conclusion that we are dealing with a supra-clinical problem that can only be resolved by going beyond the child's individual clinical needs to enlist a range of coordinated services for the child and the family. This paper will focus on domestic violence as a paradigmatic source of violent traumatization and will (a) describe the impact and consequences of exposure to violence on children's immediate and long-term development; (b) examine the opportunities for, as well as the barriers to, bridging the clinical phenomena of children's violent trauma and the existing systems of care that might best meet their needs; and (c) critique current national policies that militate against a more rational and coherent approach to addressing these needs. [ABSTRACT FROM AUTHOR]

Fraiberg and her colleagues (1975) introduced the metaphor “ghosts in the nursery” to describe the ways in which parents, by reenacting with their small children scenes from the parents' own unremembered early relational experiences of helplessness and fear, transmit child maltreatment from one generation to the next. In this article we propose that angels in the nursery—care-receiving experiences characterized by intense shared affect between parent and child in which the child feels nearly perfectly understood, accepted, and loved—provide the child with a core sense of security and self-worth that can be drawn upon when the child becomes a parent to interrupt the cycle of maltreatment. We argue that uncovering angels as growth-promoting forces in the lives of traumatized parents is as vital to the work of psychotherapy as is the interpretation and exorcizing of ghosts. Using clinical case material, we demonstrate the ways in which early benevolent experiences with caregivers can protect against even overwhelming trauma, and examine the reemergence of these benevolent figures in consciousness as an instrument of therapeutic change. Finally, we examine implications of the concept of “angels in the nursery” for research and clinical intervention. [ABSTRACT FROM AUTHOR]

This article describes the interface between the fields of attachment and child trauma, their respective contributions to an understanding of infant mental health disturbances, and the clinical applications of an integration between attachment theory and trauma-informed treatment and research. The organizing theme is that a dual attachment and trauma lens must be used in the assessment and treatment of infants and toddlers with mental health and relationship problems. The quality of attachment is an important factor in children's capacity to process and resolve traumatic experiences. At the same time, traumatic events often have a damaging effect on the quality of existing attachments by introducing unmanageable stress in the infant–parent relationship. It is argued that trauma in the first years of life needs to be assessed and treated in the context of the child's primary attachments. Reciprocally, the etiology of attachment disturbances should include an assessment of possible exposure to trauma in the child and in the parents. Current conceptualizations of attachment and trauma are reviewed from this perspective, and a clinical illustration is presented to highlight how a traumatic stressor can trigger behaviors reminiscent of disorganized attachment. [ABSTRACT FROM AUTHOR]

This article describes the mental health assessment in preparation for treatment conducted in two University-based clinical programs that offer dyadic child-parent psychotherapy as the treatment modality. The Infant-Parent Program is a mental health program serving children between birth and 3 years of age and their families when the parent-child relationship is jeopardized by risk factors in the parent, child, or family circumstances. The Child Trauma Research Project is an intervention outcome research program serving preschool- aged children and their mothers when the child witnessed domestic violence. The programs share a similar assessment approach emphasizing the importance of a working alliance, spontaneous parental reports, and observation of child-parent interaction in a variety of settings. However, their different functions in terms of clinical service and research dictate appropriate modifications in their respective assessment procedures. The two assessment protocols and their rationale will be described in the context of the clinical and research goals of the programs. © 1997 Michigan Association for Infant Mental Health [ABSTRACT FROM AUTHOR]

Sexuality and aggression emerge in the second year of life as important motivational systems that organize substantial aspects of the toddler's behavior, affecting the operation of the attachment system and transforming the parents' perceptions and behaviors toward the child. The interconnection between different motivational systems in the parent and child is discussed as an important dimension in broadening our understanding of attachment and caregiving behaviors and representations in toddlerhood. [ABSTRACT FROM AUTHOR]

Anxiously attached 12-month-olds and their mothers as assessed in the Strange Situation were randomly assigned to an intervention and a control group to test the hypothesis that infant-parent psychotherapy can improve quality of attachment and social-emotional functioning. Securely attached dyads comprised a second control group. Intervention lasted 1 year and ended when the child was 24 months. ANOVAs were used to compare the research groups at outcome. Intervention group toddlers were significantly lower than anxious controls in avoidance, resistance, and anger. They were significantly higher than anxious controls in partnership with mother. Intervention mothers had higher scores than anxious controls in empathy and interactiveness with their children. There were no differences on the outcome measures between the intervention and the secure control groups. The groups did not differ in maternal child-rearing attitudes. Within the intervention group, level of therapeutic process was positively correlated with adaptive scores in child and mother outcome measures. [ABSTRACT FROM PUBLISHER]

The social dominance behavior of dyads of unacquainted, same-sex 3½- year-olds was observed in a familiar laboratory playroom under two conditions: A free play situation and a situation where candy was introduced. In each of the two conditions, a principal components analysis was used to explore two issues: the usefulness of the multivariate approach in devising a definition of dominance, and the cross-situational stability of the construct. In the free play session, the first principal component that emerged was consistent with a theoretical definition of dominance. This picture was disrupted by the introduction of candy in the second condition. However, a high correlation was found between the dominance hierarchies established in each situation. It was concluded that the multivariate analysis is a useful method for the study of dominance. The generalizability of social dominance across settings was discussed as a possible explanation for the high cross-situational stability. [ABSTRACT FROM AUTHOR]

40 3-year-olds participated in a short-term longitudinal study assessing the relationship between peer competence and 2 antecedent variables, the security: of the attachment relationship with the mother and the amount of experience with peers. Security- of attachment was assessed through a home visit, the laboratory-based "strange situation," and a standardized maternal-attitude scale. The mother's report was used to estimate amount of experience with peers. Peer competence was assessed from the subjects' behavior in a familiar laboratory playroom with an unfamiliar same-age, same-sex playmate. Security of attachment as assessed at home was highly positively correlated with peer experience. Partial correlations showed that security of attachment was correlated only with nonverbal measures of peer competence, whereas peer experience was correlated only with verbal measures. It was concluded that security of attachment and peer experience were related to different aspects of peer competence. A separate analysis showed that maternal attitudes toward the child's expression of aggression and freedom to explore were significantly correlated with the measures of peer competence. [ABSTRACT FROM AUTHOR]

Face-to-face interaction between 26 infants and (a) their mothers and (b) a relatively unfamiliar figure was observed longitudinally between 6 and 15 weeks of age in the home environment. Highlights of normative findings are that infants became more responsive over this time period, whereas maternal behavior did not change. In the sample as a whole, infants were more responsive to the mother than to the unfamiliar figure on only I measure, bouncing. Individual differences in maternal behavior were stable throughout, but individual differences in infant behavior were not. Individual differences in interaction were analyzed and summarized by means of a factor analysis. Factor I opposed positive infant responsiveness to minimal response and maternal playfulness to impassiveness. Factor II contrasted maternal contingent pacing, infant delight, and prolonged interaction with routine maternal manner, abruptness, negative infant response, and brief interaction. Individual differences in interaction were found to be related to later differences in infant-mother attachment, as assessed by a strange-situation procedure at 51 weeks of age. Infants later identified as securely attached were more responsive in early en face encounters than infants judged to be anxiously attached, and their mothers were more contingently responsive and encouraging of interaction. Infants later identified as anxiously attached were more unresponsive and negative in early en face interaction than securely attached infants, and their mothers were more likely to be impassive or abrupt. Securely attached infants were more positively responsive to the mother than to an unfamiliar figure in early face-to-face episodes, while anxiously attached infants were not. [ABSTRACT FROM AUTHOR]