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An unsettled question in attachment theory and research is the extent to which children's attachment patterns with mothers and fathers jointly predict developmental outcomes. In this study, we used individual participant data (IPD) meta-analysis to assess whether early attachment networks with mothers and fathers are associated with children's internalizing and externalizing behavioral problems. Following a pre-registered protocol, data from 9 studies and 1,097 children (mean age: 28.67 months) with attachment classifications to both mothers and fathers were included in analyses. We used a linear mixed effects analysis to assess differences in children's internalizing and externalizing behavioral problems as assessed via the average of both maternal and paternal reports based on whether children had two, one, or no insecure (or disorganized) attachments. Results indicated that children with an insecure attachment relationship with one or both parents were at higher risk for elevated internalizing behavioral problems compared with children who were securely attached to both parents. Children whose attachment relationships with both parents were classified as disorganized had more externalizing behavioral problems compared to children with either one or no disorganized attachment relationship with their parents. Across attachment classification networks and behavioral problems, findings suggest (a) an increased vulnerability to behavioral problems when children have insecure or disorganized attachment to both parents, and (b) that mother-child and father-child attachment relationships may not differ in the roles they play in children's development of internalizing and externalizing behavioral problems.

Background: The large-scale quantitative evidence base to understand and improve health and healthcare outcomes for people who are trans and/or non-binary is still developing, although what research there is suggests that risk of poor health is high, and experiences of healthcare services are often poor. In 2021 the GP Patient Survey, which is carried out annually to measure patient experience in primary care in England, added inclusive questions about gender identity and trans status for the first time. Methods: This protocol paper pre-registers the methods that we will use for this work for a secondary analysis of these data, including both the statistical analysis protocol and early patient and public involvement work, to answer the following three research questions: (1) What are the (a) demographic characteristics, (b) health conditions, and (c) healthcare experiences of trans and/or non-binary adults in England? (2) Was there any difference in whether people who are trans and/or non-binary had been asked to shield during the COVID-19 pandemic or not compared with all other survey responders? (3) Does the relationship between being trans and/or non-binary, and self-reported long-term mental health problems, autism and autistic spectrum disorder and learning disability vary by age, gender, ethnicity, deprivation, sexual orientation or region?

Unresolved states of mind regarding experiences of loss/abuse (U/d) are identified through lapses in the monitoring of reasoning, discourse, and behavior surrounding loss/abuse in response to the Adult Attachment Interview. Although the coding system for U/d has been widely used for decades, the individual indicators of unresolved loss/abuse have not been validated independently of the development sample. This study examined the psychometric validity of U/d, using individual participant data from 1,009 parent-child dyads across 13 studies. A latent class analysis showed that subsets of commonly occurring U/d indicators could differentiate interviewees with or without unresolved loss/abuse. Predictive models suggested a psychometric model of U/d consisting of a combination of these common indicators, with disbelief and psychologically confused statements regarding loss being especially important indicators of U/d. This model weakly predicted infant disorganized attachment. Multilevel regression analysis showed no significant association between ratings of unresolved other trauma and infant disorganized attachment, over and above ratings of unresolved loss/abuse. Altogether, these findings suggest that the coding system of U/d may have been overfitted to the initial development sample. Directions for further articulation and optimization of U/d are provided.

ObjectivePrevious work has raised questions about the role of general practitioners (GPs) in the identification of neurodevelopmental conditions such as autism spectrum disorders (autism) and attention deficit hyperactivity disorders (ADHD). This study aimed to explore how GPs identify these conditions in practice and their perspectives on recent changes to local referral pathways that mean referrals to the neurodevelopmental team come through educational professionals and health visitors, rather than GPs. This study also aimed to explore Child and Adolescent Mental Health Services (CAMHS) specialist’s perspectives on the role of GPs.SettingGP practices, local neurodevelopmental services and specialist CAMHS services in the UK.Participants: semistructured interviews were conducted with GPs (n=8), specialists in local CAMHS (n=7), and professionals at national CAMHS services around the country (n=10). Interviews were conducted between January and May 2019. A framework approach informed by thematic analysis was used to analyse the data.ResultsGPs drew on various forms of tacit and explicit information including behavioural markers, parental report, prior knowledge of the family, expert and lay resources. Opinions varied between GPs regarding changes to the referral pathway, with some accepting the changes and others describing it as a ‘disaster’. CAMHS specialists tended to feel that GPs required more neurodevelopmental training and time to conduct consultations.ConclusionThis study adds to the literature showing that GPs use an array of information sources when making referral decisions for autism and ADHD. Further work is urgently required to evaluate the impact of reconfiguring neurodevelopmental referral pathways such that GPs have a diminished role in identification.