KLOP – samenvatting boek deeltentamen 2
Chapter 5: Disorders of Early Childhood (p. 297-306) -
Temperament -> “temperament traits are early-emerging basic dispositions in the
domains of activity, affectivity, attention, and self-regulation, and these dispositions are
the product of complex interactions among genetic, biological, and environmental
factors across time.”
Reactivity involves the infant’s excitability and responsiveness. Regulation involves what
infants do to control their reactivity. There is a constant back-and-forth in reactivity and
regulation as children engage with others and the environment.
Temperament dimensions:
Surgency -> reflects infant and toddler sociability and positive emotionality
Negative affectivity -> reflects infant and toddler predispositions to experience
fear and frustration/anger
Effortful control -> reflects infant and toddler attempts to regulate stimulation
and response
Typological (or categorical) approaches to temperament groups children into types
based on combinations of traits. Temperament profiles:
a. Typical patterns -> balanced mix of emotion, activity, and regulation
b. High reactivity + high negative affect + regulation difficulties -> easily upset,
experiences strong negative emotions, and struggle to calm down – similar to
Thomas & Chess “difficult” temperament.
c. High reactivity + high fear + regulation difficulties -> reacts strongly with fear and
has trouble managing it – might be more prone to anxiety or fearfulness.
d. High reactivity + positive affect + range of regulation responses -> highly reactive
but in a positive way, and has flexible ways of managing emotions – this could be
more adaptive.
Temperament profiles are associated with current and later adaptation as well as
current and later difficulties.
Temperament provides a compelling example of “dynamic biology-environment play”
leading to “individual differences in neurobehavior that support emotion, cognition, and
behavior for years to follow”.
The most important dimensions of parenting, in terms of impact on temperament, are
warmth (connected to the child’s needs for affection, soothing, protection, belonging,
learning and efficacy) and positive and negative control (connected to the child’s needs
for autonomy and self-regulation).
Beginning in infancy and continuing through childhood and adolescence, emotion
regulation experiences – focused on the modulation of the occurrence, duration, and
intensity of feeling states and physiological processes – provide an important window
into adaptation and maladaptation. Positive parenting helps protect against emotional
overarousal.
,Goodness of fit between infants and their caregivers is not an all-or-nothing situation.
For any infant-caregiver pair, there are both matches and mismatches. Problematic are
infant-caregiver pairs with more numerous or more extreme mismatches and frequent
overcontrolling or intrusive behaviors.
The assumption is that infants and toddlers who are highly reactive and difficult to calm
are challenging for any kind of parent.
Differential susceptibility -> infants and toddlers with “risky temperaments” are both
more likely to be negatively affected by problematic parenting and other adverse
external contexts and to be positively impacted by responsive parenting and positive
external contexts.
Understanding temperament in young children is the first step toward understanding the
development of personality. Temperament traits are considerably displayed and
progressively more stable over development. The most extreme temperament profiles
exhibit the most stability.
By the end of the first year, infants have accomplished several key formative tasks:
Attachment relationships reflect the degree to which infants experience safety,
comfort, and affection.
Sense of self comprises the earliest set of cognitions and emotions focused on
the infant as a separate being (e.g “Who am I? Am I likeable? Am I good?”)
Understanding of others and the world includes early beliefs about unfamiliar
adults and children along with the new situations in which infants so often find
themselves.
Over time, infants understand, in a fundamental way, that they will be cared for, that
they are worthy of care, and that the world around them is a pleasant place with
interesting people, objects, and activities. This understanding – experienced and
expressed emotionally, cognitively, and behaviorally – is the basis of attachment. The
most critical advantage of attachment, from an evolutionary perspective, is to ensure
protection and the survival of the infant. Protection and survival are linked to several
defining features of caregivers:
1. Providing a safe haven, a person to whom the infant can turn to for comfort and
support
2. Allowing for proximity maintenance for an infant who seeks closeness and resists
separation
3. Establishing a secure base, a person whose presence serves as a source of
security from which children venture out to explore the world and to which they
can reliably return.
Caregiver (in)sensitivity, (un)availability, and responsiveness/unpredictability contribute
to infants’ and toddlers’ emotionally salient beliefs and expectations related to self (“I
am worthy/not worthy of care”), significant others (“I can/cannot trust that you will
respond to me in appropriate ways”), and the world (“The world is/is not safe”). These
patterns of attachment can be broadly characterized as secure or insecure.
,Child-caregiver attachment patterns are relationship-specific. This means that,
depending on their relationship history with a caregiver, children may display one
pattern with one parent or caregiver and another pattern with another parent or
caregiver.
Attachment:
Resistant attachment (or anxious/ambivalent attachment) -> related to
inconsistency or unpredictability. Mothers may respond to an infant’s signals for
affection and attention with delight on some days and ignore or dismiss those
signals on other days. These types of on-again, off-again caregiving environments
are confusing and frustrating. Depending on the kind and the degree of
inconsistent care, very young children with resistant attachments often appear
unsure and anxious about themselves, their caregivers, and their situations.
Avoidant attachment (or anxious/avoidant attachment) -> related to inadequate
care. Caregivers who are less competent, or resentful may repeatedly fail to
protect or nurture their children. With inadequate care, very young children
appear emotionally constricted and distant, with a sense of themselves as being
less worthy of care and concern. These children may explore their environments
more independently, with less concern about danger or venturing far from adults.
Disorganized attachment -> pattern of care in which the caregiver is perceived as
frightening, frightened, malicious, or a source of alarm. The attachment conflict
is centered on the caregiver, who is experienced as both a source of comfort and
a source of anxiety. Children display – especially in times of stress – behaviors
and emotions that are disorganized with regard to establishing or maintaining a
sense of safety or security.
Parental sensitivity – the ability to accurately interpret infant needs and to respond
promptly and appropriately – is usually viewed as the single most important factor that
influence the attachment patterns children develop.
More meaningful learning about relationships occurs in stressful situations. Successful
resolutions (soothing and comforting) in these stressful contexts contribute to secure
attachment outcomes.
Environments differ with respect to emotional input and cognitive input provided by
caregivers:
Emotional input -> affective information provided by facial expression, touch, and
tone of voice
Cognitive input -> mental stimulation, such as talk, visual stimulation, and
teaching
Both the quantity and the quality of emotional and cognitive input are enhanced when
they are sensitively provided.
Attachment is a critical challenge and meaningful achievement for several reasons:
1. Early attachment processes are bound up with early neurological and
physiological development, with evidence supporting brain and behavioral
synchrony.
, 2. The attachment relationship influences the emergence and organization of
emotion regulation and highlights the central role of emotion in early personality
development.
3. Attachment relationship provides a relationship prototype as well as a way to
model how to behave in relationships
4. Early attachment is linked to later positive socioemotional outcomes, including
empathy and compassion.
Risk -> one or more factors that make it more likely that a child will develop or
experience psychopathology. Difficult temperament is a risk factor for either
underregulation or overregulation as well as the specific combination of high negative
affectivity and low effortful control (or dysregulation).
High levels of fear (or behavioral inhibition) in both low-threat and high-threat situations
are associated with increased risk for internalizing difficulties. Children with inhibited
temperaments are at higher risk for the development of internalizing problems but are at
lower risk for externalizing problems.
High levels of overall negative affectivity, especially anger/frustration and dysregulation,
is associated with increased risk for both internalizing and externalizing problems.
Irritability is reflected in a child’s low threshold for experiencing agitation, frustration,
and anger in response to a blocked goal or blocked reward. Two components are
present with irritability:
1. Persistent cranky, grumpy, or angry mood.
2. Behavioral outbursts of intense anger (or dysregulation)
Chronic and severe irritability in early childhood is correlated with a number of child and
adolescent disorders.
Insecure attachments in themselves are not disorders. They are risk factors. Insecure
attachments do not inevitably lead to poor outcomes (just as secure attachments do
not assure trouble-free childhoods).
Younger children with disorganized attachments are at even greater risk than children
with avoidant or resistant attachments. Disorganized attachment is more likely to be
associated with later externalizing symptoms compared to internalizing symptoms.
Dissociation is an especially concerning symptom because it reflects disrupted
integration of the core functions of consciousness, including memory, identity, and
awareness of the environment.
Chapter 5: Disorders of Early Childhood (p. 310-316) -
DSM-5-TR describes two categories of attachment disorders, reactive attachment
disorder (RAD) and disinhibited social engagement disorder (DSED).
DSM-5-TR criteria for Reactive Attachment Disorder (RAD)
A) Consistent pattern of inhibited, emotionally withdrawn behavior toward
caregivers
a. Rarely or minimally seeks comfort when distressed
Chapter 5: Disorders of Early Childhood (p. 297-306) -
Temperament -> “temperament traits are early-emerging basic dispositions in the
domains of activity, affectivity, attention, and self-regulation, and these dispositions are
the product of complex interactions among genetic, biological, and environmental
factors across time.”
Reactivity involves the infant’s excitability and responsiveness. Regulation involves what
infants do to control their reactivity. There is a constant back-and-forth in reactivity and
regulation as children engage with others and the environment.
Temperament dimensions:
Surgency -> reflects infant and toddler sociability and positive emotionality
Negative affectivity -> reflects infant and toddler predispositions to experience
fear and frustration/anger
Effortful control -> reflects infant and toddler attempts to regulate stimulation
and response
Typological (or categorical) approaches to temperament groups children into types
based on combinations of traits. Temperament profiles:
a. Typical patterns -> balanced mix of emotion, activity, and regulation
b. High reactivity + high negative affect + regulation difficulties -> easily upset,
experiences strong negative emotions, and struggle to calm down – similar to
Thomas & Chess “difficult” temperament.
c. High reactivity + high fear + regulation difficulties -> reacts strongly with fear and
has trouble managing it – might be more prone to anxiety or fearfulness.
d. High reactivity + positive affect + range of regulation responses -> highly reactive
but in a positive way, and has flexible ways of managing emotions – this could be
more adaptive.
Temperament profiles are associated with current and later adaptation as well as
current and later difficulties.
Temperament provides a compelling example of “dynamic biology-environment play”
leading to “individual differences in neurobehavior that support emotion, cognition, and
behavior for years to follow”.
The most important dimensions of parenting, in terms of impact on temperament, are
warmth (connected to the child’s needs for affection, soothing, protection, belonging,
learning and efficacy) and positive and negative control (connected to the child’s needs
for autonomy and self-regulation).
Beginning in infancy and continuing through childhood and adolescence, emotion
regulation experiences – focused on the modulation of the occurrence, duration, and
intensity of feeling states and physiological processes – provide an important window
into adaptation and maladaptation. Positive parenting helps protect against emotional
overarousal.
,Goodness of fit between infants and their caregivers is not an all-or-nothing situation.
For any infant-caregiver pair, there are both matches and mismatches. Problematic are
infant-caregiver pairs with more numerous or more extreme mismatches and frequent
overcontrolling or intrusive behaviors.
The assumption is that infants and toddlers who are highly reactive and difficult to calm
are challenging for any kind of parent.
Differential susceptibility -> infants and toddlers with “risky temperaments” are both
more likely to be negatively affected by problematic parenting and other adverse
external contexts and to be positively impacted by responsive parenting and positive
external contexts.
Understanding temperament in young children is the first step toward understanding the
development of personality. Temperament traits are considerably displayed and
progressively more stable over development. The most extreme temperament profiles
exhibit the most stability.
By the end of the first year, infants have accomplished several key formative tasks:
Attachment relationships reflect the degree to which infants experience safety,
comfort, and affection.
Sense of self comprises the earliest set of cognitions and emotions focused on
the infant as a separate being (e.g “Who am I? Am I likeable? Am I good?”)
Understanding of others and the world includes early beliefs about unfamiliar
adults and children along with the new situations in which infants so often find
themselves.
Over time, infants understand, in a fundamental way, that they will be cared for, that
they are worthy of care, and that the world around them is a pleasant place with
interesting people, objects, and activities. This understanding – experienced and
expressed emotionally, cognitively, and behaviorally – is the basis of attachment. The
most critical advantage of attachment, from an evolutionary perspective, is to ensure
protection and the survival of the infant. Protection and survival are linked to several
defining features of caregivers:
1. Providing a safe haven, a person to whom the infant can turn to for comfort and
support
2. Allowing for proximity maintenance for an infant who seeks closeness and resists
separation
3. Establishing a secure base, a person whose presence serves as a source of
security from which children venture out to explore the world and to which they
can reliably return.
Caregiver (in)sensitivity, (un)availability, and responsiveness/unpredictability contribute
to infants’ and toddlers’ emotionally salient beliefs and expectations related to self (“I
am worthy/not worthy of care”), significant others (“I can/cannot trust that you will
respond to me in appropriate ways”), and the world (“The world is/is not safe”). These
patterns of attachment can be broadly characterized as secure or insecure.
,Child-caregiver attachment patterns are relationship-specific. This means that,
depending on their relationship history with a caregiver, children may display one
pattern with one parent or caregiver and another pattern with another parent or
caregiver.
Attachment:
Resistant attachment (or anxious/ambivalent attachment) -> related to
inconsistency or unpredictability. Mothers may respond to an infant’s signals for
affection and attention with delight on some days and ignore or dismiss those
signals on other days. These types of on-again, off-again caregiving environments
are confusing and frustrating. Depending on the kind and the degree of
inconsistent care, very young children with resistant attachments often appear
unsure and anxious about themselves, their caregivers, and their situations.
Avoidant attachment (or anxious/avoidant attachment) -> related to inadequate
care. Caregivers who are less competent, or resentful may repeatedly fail to
protect or nurture their children. With inadequate care, very young children
appear emotionally constricted and distant, with a sense of themselves as being
less worthy of care and concern. These children may explore their environments
more independently, with less concern about danger or venturing far from adults.
Disorganized attachment -> pattern of care in which the caregiver is perceived as
frightening, frightened, malicious, or a source of alarm. The attachment conflict
is centered on the caregiver, who is experienced as both a source of comfort and
a source of anxiety. Children display – especially in times of stress – behaviors
and emotions that are disorganized with regard to establishing or maintaining a
sense of safety or security.
Parental sensitivity – the ability to accurately interpret infant needs and to respond
promptly and appropriately – is usually viewed as the single most important factor that
influence the attachment patterns children develop.
More meaningful learning about relationships occurs in stressful situations. Successful
resolutions (soothing and comforting) in these stressful contexts contribute to secure
attachment outcomes.
Environments differ with respect to emotional input and cognitive input provided by
caregivers:
Emotional input -> affective information provided by facial expression, touch, and
tone of voice
Cognitive input -> mental stimulation, such as talk, visual stimulation, and
teaching
Both the quantity and the quality of emotional and cognitive input are enhanced when
they are sensitively provided.
Attachment is a critical challenge and meaningful achievement for several reasons:
1. Early attachment processes are bound up with early neurological and
physiological development, with evidence supporting brain and behavioral
synchrony.
, 2. The attachment relationship influences the emergence and organization of
emotion regulation and highlights the central role of emotion in early personality
development.
3. Attachment relationship provides a relationship prototype as well as a way to
model how to behave in relationships
4. Early attachment is linked to later positive socioemotional outcomes, including
empathy and compassion.
Risk -> one or more factors that make it more likely that a child will develop or
experience psychopathology. Difficult temperament is a risk factor for either
underregulation or overregulation as well as the specific combination of high negative
affectivity and low effortful control (or dysregulation).
High levels of fear (or behavioral inhibition) in both low-threat and high-threat situations
are associated with increased risk for internalizing difficulties. Children with inhibited
temperaments are at higher risk for the development of internalizing problems but are at
lower risk for externalizing problems.
High levels of overall negative affectivity, especially anger/frustration and dysregulation,
is associated with increased risk for both internalizing and externalizing problems.
Irritability is reflected in a child’s low threshold for experiencing agitation, frustration,
and anger in response to a blocked goal or blocked reward. Two components are
present with irritability:
1. Persistent cranky, grumpy, or angry mood.
2. Behavioral outbursts of intense anger (or dysregulation)
Chronic and severe irritability in early childhood is correlated with a number of child and
adolescent disorders.
Insecure attachments in themselves are not disorders. They are risk factors. Insecure
attachments do not inevitably lead to poor outcomes (just as secure attachments do
not assure trouble-free childhoods).
Younger children with disorganized attachments are at even greater risk than children
with avoidant or resistant attachments. Disorganized attachment is more likely to be
associated with later externalizing symptoms compared to internalizing symptoms.
Dissociation is an especially concerning symptom because it reflects disrupted
integration of the core functions of consciousness, including memory, identity, and
awareness of the environment.
Chapter 5: Disorders of Early Childhood (p. 310-316) -
DSM-5-TR describes two categories of attachment disorders, reactive attachment
disorder (RAD) and disinhibited social engagement disorder (DSED).
DSM-5-TR criteria for Reactive Attachment Disorder (RAD)
A) Consistent pattern of inhibited, emotionally withdrawn behavior toward
caregivers
a. Rarely or minimally seeks comfort when distressed
