This paper integrates the work of Stern on affect regulation, Ainsworth on quality of attachment, Piaget on cognitive development, Tulving on memory systems, and Bowlby on internal representational models around the issue of promoting secure attachment. It is proposed that procedural models of the self and attachment figures develop in infancy, are maintained throughout the life span, and are accessed preconsciously to regulate everyday behavior. In the preoperational period, semantic models of generalizations regarding the self and others are constructed (often from parents' words), encoded, and accessed linguistically when the expectations implied by procedural models are discrepant with outcomes; that is, semantic models are used for problem solving. Episodic models, encoded by multiple means (e.g., verbally, auditorially, visually) develop last and consist of episodes of experience that can be accessed unconsciously and regulate behavior when individuals are emotionally aroused. Of interest is the relation among these emerging models, the patterns of information processing contained in them, and the means of guiding their development in children experiencing distorted relationships. Treatment approaches drawn from social learning theory, family systems theory, cognitive therapy, and psychodynamic theory are associated with the memory systems and integrated into an approach to treatment.

Four studies are reported in which an interview or questionnaire is used to measure the relation between behavioral inhibition, defined as consistent restraint in response to unfamiliar social or nonsocial stimuli, and adult mental health. In Study 1, undergraduates were tested using a retrospective self-report questionnaire. Those who reported more behaviors suggesting childhood inhibition also reported more mental health problems. Study 2 was an attempt to establish the postdictive validity of the measurement of childhood inhibition. College students and their parents completed the questionnaire independently and were in extremely strong agreement regarding the student's inhibited behaviors as a child. In Study 3, self-reported contemporary behaviors suggesting inhibition correlated with the retrospective self-report of inhibition. Both measures correlated with the State Anxiety Subscale of the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale, and both accounted for unique variance in anxiety, but only contemporary inhibition accounted for unique variance in depression. In Study 4, adults who had been treated for panic disorder or depression were interviewed and reported more behaviors indicative of inhibition during childhood than did control subjects. These four studies support the usefulness of retrospective self-report as a measure of childhood inhibition and are compatible with the hypothesis that a tendency toward inhibited behavior in childhood or adulthood may be a risk factor for mental health problems.

This study addresses the question of whether or not parents' working models of childhood attachments constitute a risk factor for difficulties in current parent-child relations. In a sample of 27 families and their preschool-aged children, mother-child and father-child dyads were observed in separate laboratory play sessions from which ratings of parents' and children's behavior were collected. Working models of attachment were assessed using the Adult Attachment Interview (George, Kaplan, & Main, 1984). Results showed that parents classified as insecure were less warm and provided less structure in interactions with their children than did parents classified as secure. Children of insecure parents were less warm toward their parents than were children of secure parents. Analyses of parents' joint attachment classification showed that insecure women married to insecure men were less warm and provided less structure with their children than did mothers in either the insecure-secure or secure-secure dyads. These findings suggest that, in two-parent families, an insecure working model may be a risk factor for less competent parenting but that the risk is more pronounced when both parents have insecure working models of attachment.

This study examined family-level and child-level influences on diversity in depression and aggression among children at risk. Data were from 144 children aged 7–14 years. A procedure introduced by Lavori, Keller, Beardslee, and Dorer (1988) was used to correct for the inclusion of more than one child from each family. Family-level influences examined were maltreatment and parental psychopathology. Maladjustment was highest in children of psychiatrically ill parents from maltreating homes and lowest in children of psychiatrically ill parents from nonmaltreating homes. Child-level influences examined were social cognition, intelligence, early developmental difficulties, sex, and age. Independent of family risk status, younger male children with high social-cognitive skills and no early developmental difficulties were least depressed. Child characteristics were less predictive of aggression. Overall, this study shows that efforts to explain diversity in high-risk children's development benefit from attending to all the offspring of high-risk parents and to multiple interacting family risk factors.

This study addressed the role of deficits in the organization of the self, or narcissistic pathology, among widows who evidenced depressive outcomes following the loss of their husbands. The significance of object representations and self-regulatory capacities (introjects) within the self-representation in predicting psychiatric status in a sample of 77 widows 1 year after spousal loss was examined. In addition, the link between functional deficits within the self and observable state markers of such deficits as they related to depression was investigated. A combination of projective and self-report measures were used to assess self and object representation. The General Health Questionnaire (Goldberg & Hillier, 1979) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.) (Spitzer & Williams, 1985) were employed as measures of psychiatric disorder. Analyses revealed that functional aspects of self representations, or introjects, differentiated clinically depressed widows from those experiencing “normal” mourning. However, object representations were relatively weak predictors of depression following bereavement and evidenced little association with self representation. Observable markers of self-pathology were strongly related to functional impairments in the self but did not operate causally to predict depressive outcome. Theoretical and clinical implications of the linkage between functional deficits in the self and depression are discussed.

Maltreatment can impact the earliest stages of development during which time patterns of emotion regulation and attachment begin to be established (Carlson, Cicchetti, Barnett, & Braunwald, 1989b; Cicchetti, Ganiban, & Barnett, 1991). These disruptive patterns are problematic for early moral development and are likely to play a role in the development of conduct disorders (Aber & Cicchetti, 1984). Thus, maltreated children are clearly in a high-risk situation. To examine emotion regulation, internal representations of relationships, and early moral development, the use of a play narrative story stem technique (Bretherton, Ridgeway, & Cassidy, 1990; Buchsbaum & Emde, 1990) with maltreated children and a nonmaltreated disadvantaged comparison group of children is described. Representative case examples from each group are used to illustrate the effectiveness of this technique for eliciting themes about family relationships, conflicts, and their resolution or lack thereof as well as defenses and coping styles. The potential usefulness of this paradigm for clinical assessment and intervention are discussed.

Two population enquiries in Walthamstow and Islington, London, have shown that loss of the mother before the age of 17 years, either by death or separation for a year or more, doubles the risk of depressive and anxiety disorders among adult women. Furthermore, there was a particularly high rate of adult depression among those whose mothers died before they were 6 years old, and this was associated with a measure of childhood helplessness. There was no such link of either adult disorder or childhood helplessness with age at loss under 6 years for those losing a mother by separation. Two possible explanations were explored for these contrasting results. That concerning the adequacy of mourning of the mother's death received no support. However, evidence indicated that experience with the mother before the loss (usually affected by ongoing illness) explained the link of adult depression or anxiety with her early death. The failure of age at loss to relate in the separation group was probably due to the fact that among them age of separation was not a good indication of the quality of maternal care before age 6. Indirect evidence emerged which suggested that quality of early attachment (before age 6) to the natural mother before any loss relates to childhood helplessness. This in turn relates to a higher risk of disorder in adult life.

This investigation explored differences in depressive symptomatology among low-socioeconomic status children aged 7–12 years from abusive (N = 46), neglectful (N = 35), and nonmaltreating (N = 72) homes. Measures of aggression and self-esteem also were included. Children from abusive homes evidenced significantly more depressive symptomatology than children from either neglectful or nonmaltreating families. Additionally, children from physically abusive homes exhibited lower self-esteem than did nonmaltreated children. While significant differences among groups on aggression did not emerge, all groups evidenced higher levels of acting out behaviors than would be expected in a nonclinic group of children. Results were discussed in terms of the effects of physical abuse on depression and the importance of intervening to prevent the deleterious effects of abuse. Additionally, the impact of neglect and poverty status on the presence of aggression was discussed.

Werner's orthogenetic principle states that human behavior proceeds from a state of global diffuseness to one of articulated complexity, and that as individuals develop, their responses to the environment become more specific and more differentiated. The present study evaluated this hypothesis, in relation to psychopathology in general and depression in particular. Child Behavior Checklist responses for 1, 345 outpatient and inpatient children and adolescents were compared along two developmental dimensions: age and clinical severity. Results failed to support the hypothesis that the psychopathology in general is more differentiated among older and more severely disturbed children. The findings did indicate, however, that depression was more distinct among the older, more severely disturbed subjects. Finally, little evidence of a categorical depression was found in any of the four age by severity groups.

Findings of the few psychotherapy outcome studies with depressed children and adolescents raise questions about whether or not treatments are sufficiently sensitive to developmental factors. Here we review the outcome data, then survey potentially relevant research on the cognitions, competencies, and coping behavior of depressed youngsters. Much of the work in each domain is both procedurally and theoretically adevelopmental, and the psychotherapy research does not appear to be well informed by research in the other domains. To help remedy this situation, for each domain we suggest key developmental questions that need to be answered, and we discuss implications for psychotherapy. We also propose a three-way partnership involving basic developmental research linked with research on relations between depression and various cognitive and behavioral processes, with both lines of inquiry informing the development and refinement of interventions.

While depressive symptoms in adolescent mothers may affect both their own and their babies' development, little research has focused on the mothers. Self-reported symptoms on the Beck Depression Inventory were collected at 1, 6, 12, and 28–36 months postpartum. Concurrent and reciprocal longitudinal relations among symptom levels, stressful life events, and social supports were investigated. Symptom levels declined over the four assessments, with changes in somatic, rather than cognitive affective, symptoms accounting for the decrease. Stressful life events and all sources of social supports predicted concurrent levels of depressive symptoms, but only social supports predicted declines in symptoms in the first year postpartum. Reciprocally, depressive symptoms tended (p = .06) to predict increases in stressful life events over time. Mothers were also categorized as reporting few (50%), intermittent (27.5%), or chronic (22.5%) symptoms in the first 12 months postpartum. Intermittently and chronically depressed mothers perceived their own mothers as less accepting than nondepressed mothers. Compared to nondepressed and intermittently depressed mothers, chronically depressed mothers also reported more stressful life events, were more likely to live alone, and experienced more moves by 28–36 months postpartum. The reciprocal causal relations among depressive symptoms, stress, and attachments to grandmothers and peers are discussed.

Determinants of individual differences in the sensitivity of parenting attitudes were investigated in mothers with schizophrenic or major mood disorders. Constructs from the major domains of the mother's childhood relational experiences, personality, social context, and child characteristics were evaluated in a developmental model to predict differences in parenting attitudes. Two pathways were identified. An index of the severity and chronicity of the mother's disorder was shown to predict less-adaptive parenting attitudes. A second pathway revealed that emotional support from network members influenced self-esteem, which predicted more adaptive parenting attitudes. However, perceptions of childhood relational experiences, particularly maternal uninvolvement, predicted parenting attitudes as well as accounted for relationships among emotional support, self-esteem, and parenting. The results were discussed from an attachment theory perspective. The implications of individual differences in maternal functioning for both the mother and the child's adaptation were discussed, and treatment issues were addressed.

The current study examines outcomes at Grade 8 for boys who, at Grade 6, displayed elevated, though not necessarily clinical, levels of conduct problems and depressive symptoms. An at-risk community sample of 203 early adolescent boys in the Oregon Youth Study, a multimethod/multiagent study, was divided into the following groups at Grade 6: (a) co-occurring conduct problems and depressed mood, (b) conduct problems only, (c) depressed mood only, and (d) neither problem. The four groups were compared at Grade 8 on family management and boy's adjustment, using multivariate analyses of variance. The groups were compared also on relationships with parents, delinquency, and suicidal ideation. As hypothesized, conduct problems showed higher stability than depressive symptoms from Grade 6 to Grade 8. The conduct-problem-only boys and boys with co-occurring conduct problems and depressive symptoms continued to show considerable adjustment deficits at Grade 8, whereas boys with only depressive symptoms showed some improvement. The co-occurring group showed elevated levels of suicidal ideation. As hypothesized, conduct problems at Grade 6 were predictive of increases in depressed mood by Grade 8, but depressed mood was not predictive of an increase in the conduct problems measure. Results are consistent with a failure model whereby lack of skill and noxious behavior lead to pervasive failures and vulnerability to depressed mood.

For more than a decade it has been reported that a significant proportion of youth referred for treatment come with aggressive problems that are difficult to treat and resistant to change. Concepts and research findings from the domains of body image, cognitive unconscious, and the new relational perspective in psychoanalysis are integrated to address this issue and construct a treatment model. It is proposed that body image schemas, representing early, interpersonal experiences and prescribing persistent aggressive behaviors, are cast in nonverbal, nonsymbolic forms. On the other hand, meanings of environmental rules are cast in symbolic/verbal forms. Therefore, little or no communication and conflict exist between these meanings. For the same reason, because verbal interpretation and discussions of beliefs and attitudes, emphasized by both cognitive-behavioral and psychodynamic therapies, are cast in symbolic-conceptual forms, they might not effectively influence embodied meanings that prescribe aggression. Accordingly, the goal of the proposed approach is to facilitate the translation of embodied meanings that underly aggression into symbolic form in order to promote communication between these meanings and those of expectations and interpretations. This translation is accomplished as the youth and therapist (paralleling infant-caretaker transactions) interact and negotiate an evolving series of ritualized activities within which the youth projects various unrepaired, developmental interferences (interpersonal dilemmas), and their associated embodied meanings, onto the therapist who enacts the roles of the projected dilemmas, using action symbols as solutions whenever possible. As the youth identifies with and internalizes the therapist's efforts and solutions, the embodied meanings become translated into symbols that communicate with those of rules at higher cognitive levels, resulting in mental conflict available to awareness and discussions. To illustrate the heuristic value of the model, a treatment case is described and new research directions discussed.

Concurrent and predictive relations among aggression, peer rejection, and self-reported depressive symptoms were examined in 521 third-, fourth-, and fifth-grade children at three time points over 1 year. Increases in aggression were significantly associated with increases in depression, and this relation was mediated, in part, through increases in peer rejection. The relation between peer-reported rejection and depression was mediated by perceived rejection. Finally, we found support for the cognitive diathesis-stress model of depression in children. Controlling for initial levels of depression and peer rejection, the interaction between stress (increases in peer rejection) and a depressogenic attributional style contributed significantly to the prediction of self-reported depressive symptoms 1 year later.

This paper introduces a new, clinical-developmental approach to research, theory and intervention. A line of research is described exploring the relationship between developmental organizations of meaning and symptom expression in adolescence. These cross-sectional and longitudinal studies demonstrate needed distinctions between self-complexity and self-maturity/integration—concepts that are described in the context of an overarching framework. In the final section of the paper, clinical methods are introduced for different adolescent developmental worlds and are exemplified with two cases.

A brief treatment protocol for pediatric psychogenic pain conditions is presented, based on attachment and family systems theories and on the following principles of developmental psychopathology: commonality of developmental principles, developmental pathways, continuity and change in disorders of development, and disorders of development as reflecting competence-based strategies. Some principles of intervention based on this integrated model are presented, followed by an outline of the treatment protocol. Of 19 families who participated in the 4-day program, 17 had children who remained symptom-free on 6-month follow-up. Alternative family developmental pathways for pediatric psychogenic pain conditions are proposed as well as some directions for future research.