Story-stem Task Research Articles

Creativity in early childhood: How do imagination and self-regulation predict creativity in a story-stem task?

Creativity in early childhood: How do imagination and self-regulation predict creativity in a story-stem task?

Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial

Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but knowledge on the differential effects of behavioral techniques for specific subgroups of children is very limited. Attachment representations of children with ADHD may affect how receptive children are to changes in parenting. In this study, we investigated whether specific behavioral techniques were more or less effective for children with ADHD in relation to their attachment representations. We included parents of 74 children with ADHD (4–11 years, M = 8.15) who took part in a larger randomized controlled microtrial in which they were randomized to a two session training in antecedent-based techniques (i.e., stimulus control techniques: rules, instructions; n = 26), a two session training in consequent-based techniques (i.e., contingency management techniques: praise, rewards, ignoring; n = 25) or a waitlist control condition (n = 23). We examined whether attachment representation moderated the effectiveness of a) training versus waitlist, and b) antecedent- versus consequent-based techniques. Attachment representations were measured with a story stem task, the intervention outcome was daily parent-rated problem behaviors of the children. Attachment representation did not moderate the effects of the training compared to the waitlist. However, compared to antecedent-based techniques, consequent-based techniques were less effective for more securely and less disorganized attached children, and particularly effective for more disorganized attached children. This was the first study examining attachment as a moderator of behavioral techniques for ADHD. If replicated, the findings of this study can be used for treatment development and tailoring.

Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD).

Attention-Deficit/Hyperactivity Disorder (ADHD) in children is associated with several adverse family characteristics, such as higher parenting stress, more conflicted parent–child relationships, lower parental competence, and higher levels of parental psychopathology. Hence, children with ADHD more often grow up under suboptimal circumstances, which may impact the development of their attachment representations. Here, we investigated whether children with ADHD have more insecure and disorganized attachment representations than their typically developing peers, and which factors could explain this association. We included 104 children between 4 and 11 years old, 74 with ADHD (without Conduct Disorder) and 30 typically developing control children. Children completed a state-of-the-art story stem task to assess their attachment representation, and we measured parents’ expressed emotion (as an index of parent–child relationship quality), parents’ perceived sense of competence, parental education levels, and parent-rated ODD symptoms of the child. We found that, after controlling for multiple comparisons, children with ADHD had less secure and more ambivalent and disorganized attachment representations relative to their typically developing peers. These group differences were independent of comorbid ODD and parental education levels. There were no group differences on avoidant attachment representations. Explorative analyses within the ADHD group showed that attachment representations were not related to parent–child relationship quality, perceived parenting competence, parental education levels, and comorbid ODD symptoms. We conclude that children with ADHD disproportionately often have attachment problems. Although this conclusion is important, treatment implications of this co-occurrence are yet unclear as research on ADHD and attachment is still in its infancy.

Parental reflective function and children's attachment-based mental state talk as predictors of outcome in psychodynamic child psychotherapy.

Mentalization, operationalized as reflective function, is defined as the capacity to understand behavior in terms of mental states. Mentalization can be self-focused (i.e., mentalizing that focuses on one's own thoughts and feelings) or other-focused (i.e., mentalizing that focuses on others' thoughts and feelings). Some studies in adult psychotherapy show the importance of patients' mentalization capacity for treatment outcome; however, this has not yet been investigated in psychodynamic child psychotherapy. This study aimed to investigate whether baseline parental reflective function (PRF) and children's mental state talk (MST) predicted changes in emotional and behavioral problems in psychodynamic child psychotherapy. The sample included 60 Turkish school-age children (Mage = 7.90, SD = 1.35, 43.3% girls) with internalizing (18.3%), externalizing (5%), and comorbid (56.7%) problems, and 20% of the children were in the nonclinical range. The mothers were interviewed using the Parent Development Interview, which was coded for PRF (self- and child-focused). Children were administered an attachment-based story stem task, coded for MST (self- and other-focused). The Brief Problem Monitor was administered every month over the course of treatment for a total of 366 sessions. Multilevel modeling analyses indicated that mothers' child-focused PRF and children's self-focused MST predicted changes in problem behaviors. Parents' mentalization about their children and children's mentalization about their own internal states could be predictors of treatment response in psychodynamic child psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Imbalances and Impairments in Mental State Talk of Children with Internalizing and Externalizing Problems

ABSTRACT The aims of this study were to investigate the associations between impairments and imbalances in children’s mental state talk, attachment security and abuse/neglect experiences, and to study how much of the variance in internalizing and externalizing problems was explained by mentalization problems. The sample included 100 Turkish children (M Age = 7.00 (SD = 2.01), 38% girls) referred to a outpatient psychotherapy clinic. Children were administered an attachment-based story stem task in order to code attachment security and different categories of mental state talk, including the extent of their direction (self vs other), balance, and appropriateness. Parents and teachers filled out socio-behavioral function scales. Findings indicated a significant positive association between externalizing problems and impaired mentalization. Internalizing problems were associated with mentalizing the other at the expense of one’s own mental states and underusing emotions. Attachment insecurity and adverse experiences were associated with mentalization impairments and imbalances. Finally, underuse of emotions and self-focused mental state talk predicted internalizing problems and impaired mental state talk predicted externalizing problems at trend level of significance. Qualitative analyses supported the results, which suggest that whereas children with externalizing problems suffer from severe mentalization deficits, children with internalizing problems undermentalize about themselves and emotions.

Development of the Child Dissociation Assessment System using a narrative story stem task: A preliminary study

IntroductionChronic maltreatment and disorganized attachment in children predict the development of dissociation, which can negatively impact functioning. Few measures of child dissociation currently exist and amongst these, limitations exist when they are applied to populations of maltreated children. ObjectiveThis paper details the development of the Child Dissociation Assessment System (CDAS), consisting of the Child Dissociation Code (CDC) and Child Dissociation Tool (CDT). The CDC allows clinicians to screen for dissociative symptoms while the CDT examines how these symptoms impact different domains of functioning. MethodBoth measures score verbal and non-verbal material, which emerges during the MacArthur Story Stem Battery (MSSB), a child-friendly narrative story stem task whose non-threatening nature is suited for use with maltreated children. Using the CDAS, the MSSB protocols of 20 children between 6 and 12 years old (10 from a clinical sample and 10 from a non-clinical sample) were scored. ResultsThe CDAS possesses adequate to excellent inter-rater reliability, and the CDC discriminates between maltreated and non-maltreated children. ConclusionThe CDAS may be of interest for researchers and clinicians working with populations of maltreated children. Preliminary findings are promising and a larger-scale validation would be indicated.

Attachment and emotion regulation in middle childhood: changes in affect and vagal tone during a social stress task

ABSTRACTIn middle childhood, more securely attached children show better emotion regulation when assessed as general tendencies (e.g. coping style), but studies looking at emotion in response to specific stressors have revealed mixed results. This study examined how attachment security, avoidance, and ambivalence – assessed with a story stem task (99 children, 9–11 years old) – relate to dynamic indices of affective and autonomic responses (baseline, reactivity, recovery). Reports of positive and negative affect, and high-frequency heart rate variability (HF-HRV), were assessed during a social stressor task. Securely attached children did not show reactivity effects, although they did show greater recovery of positive affect after the task ended. Avoidant children showed both less reactivity and recovery of negative affect, suggesting a dampened emotional response. Ambivalent children showed more reactivity and more recovery of negative affect. Autonomic response changes were only evident for ambivalent children, who showed less suppression of HF-HRV variability under stress.

Investigating Direct and Indirect Effects of Attachment on Internalizing and Externalizing Problems through Emotion Regulation in a Cross-Sectional Study

The purpose of this study was to investigate the relationship between attachment, emotion regulation (ER), and risk for internalizing/externalizing problems in typically developing children. To this end, a mediation model was proposed in which attachment security was hypothesized to exert an indirect effect on internalizing/externalizing problems through ER. A sample of 212 preschoolers aged between 3 and 5 years old was included in the study. Children’s attachment representations were assessed using the Attachment Story Completion Task (ASCT); a story-stem task was also employed to evaluate children’s ability to generate ER strategies in response to anger, sadness, and fear eliciting vignettes. Parents and teachers evaluated risk for emotional and behavioral problems using the Child Behavior Checklist (CBCL), and the Caregiver-Teacher Report Form (C-TRF), respectively. The results showed that effective ER strategies mediated the relationship between attachment security and internalizing problems, but not externalizing problems. Furthermore, when effective ER strategies were differentiated, attachment security had a significant indirect effect on internalizing problems through problem-solving, but not on externalizing problems. Comforting was associated with increased attachment security, but not with ratings of internalizing/externalizing problems. Distraction was not associated with attachment security, and hence, exhibited only direct effects on reducing levels of internalizing and externalizing problems These findings suggested that in typically developing children distraction and problem-solving strategies might act as protective factors against mental health problems, but only problem-solving seems to be associated with children’s perception about attachment when measured on a continuum from insecure to secure attachment.

Children’s attachment-related narratives following US Gulf Coast hurricanes: Linkages with understanding and teacher stress

The central focus of this study was the perceptions of emotional security among 64 elementary school-aged children exposed to the hurricanes that affected the US Gulf Coast in 2005. Specifically, we examined the representational qualities of attachment, exploration, and caregiving as assessed with a narrative story-stem task in relation to parental reports of children’s exposure to the hurricanes, their knowledge of hurricanes, and their teacher’s exposure to the hurricanes. Knowledge of hurricanes was assessed with a new narrative method representing hurricane conditions wherein children were asked to tell stories about what hurricanes are and what damage they could do. Children’s narrative representations of attachment, exploration, and caregiving were unrelated to parental reports of their children’s exposure to the hurricanes but were significantly related to their knowledge of hurricanes, specifically the effects of hurricanes on people, and to teachers’ reported loss of property related to the hurricanes. The findings suggest that a core component of children’s representational models is the capacity for empathy for the experience of others.

Shared Cognition in Childhood Anxiety: Interpretation Bias in Preschool Children and Their Parents

Although interpretation bias has been associated with the development and/or maintenance of childhood anxiety, its origins remain unclear. The present study is the first to examine intergenerational transmission of this bias from parents to their preschool-aged children via the verbal information pathway. A community sample of fifty parent–child pairs was recruited. Parents completed measures of their own trait anxiety and interpretation bias, their child’s anxiety symptoms, and a written story-stem measure, to capture the way parents tell their children stories. Interpretation bias was assessed in preschool-aged children (aged between 2 years 7 months and 5 years 8 months) using an extended story-stem paradigm. Young children’s interpretation bias was not significantly associated with their own anxiety symptoms. Neither was there evidence for a significant association between parent and child interpretation bias. However, parents who reported they would tell their child one or more threatening story endings in the written story-stem task had significantly higher anxiety than those who did not include any threatening story endings. In turn, children whose parents did not include any threatening endings in their written stories had significantly lower threat interpretations on the child story-stem paradigm, compared to those with parents who included at least one threatening story ending. The results suggest that parental verbal information could play a role in the development of interpretation bias in young children.

Internal working models and adjustment of physically abused children: the mediating role of self‐regulatory abilities

Abused children's internal working models (IWM) of relationships are known to relate to their socioemotional adjustment, but mechanisms through which negative representations increase vulnerability to maladjustment have not been explored. We sought to expand the understanding of individual differences in IWM of abused children and investigate the mediating role of self-regulation in links between IWM and adjustment. Cluster analysis was used to subgroup 74 physically abused children based on their IWM. Internal working models were identified by children's representations, as measured by a narrative story stem task. Self-regulation was assessed by teacher report and a behavioral task, and adjustment was measured by teacher report. Cluster analyses indicated two subgroups of abused children with distinct patterns of IWMs. Cluster membership predicted internalizing and externalizing problems. Associations between cluster membership and adjustment were mediated by children's regulation, as measured by teacher reports of many aspects of regulation. There was no support for mediation when regulation was measured by a behavioral task that tapped more narrow facets of regulation. Abused children exhibit clinically relevant individual differences in their IWMs; these models are linked to adjustment in the school setting, possibly through children's self-regulation.

Parental Separation and Children's Behavioral/Emotional Problems: The Impact of Parental Representations and Family Conflict

In this longitudinal study, we examine whether the effect of parental separation on kindergarten children's behavioral/emotional problems varies according to the level of family conflict, and children's parental representations. One hundred and eighty seven children were assessed at ages 5 and 6. Family conflict was assessed using parents' ratings. Children's parental representations were assessed using a story-stem task. A multiinformant approach (parent, teacher, child) was employed to assess children's behavioral/emotional problems. Bivariate results showed that separation, family conflict, and negative parental representations were associated with children's behavioral/emotional problems. However, in multivariate analyses, when controlling for gender and symptoms at age 5, we found that children of separated parents who showed negative parental representations had a significantly greater increase in conduct problems between 5 and 6 than all other children. In terms of emotional symptoms and hyperactivity, symptoms at 5 and (for hyperactivity only) gender were the only predictors for symptoms 1 year later. Our results suggest that kindergarten children's representations of parent-child relationships moderate the impact of parental separation on the development of conduct problems, and underline play and narration as a possible route to access the thoughts and feelings of young children faced with parental separation.

Associations between family relationships and symptoms/strengths at kindergarten age: what is the role of children's parental representations?

The quality of the family relationships plays an important role in the development of children's psychopathology and in their socio-emotional development. This longitudinal study aims to investigate whether family relationships are related to children's symptoms/strengths at kindergarten, and whether family relationships are predictors of changes in children's symptoms/strengths between 5 and 6. Our main interest is to examine the role of children's parental representations. One hundred and fifty-three kindergarten children (67 girls, 86 boys) participated in this study. Children's parental representations were assessed using a story stem task (age 5). The family environment was assessed using parents' ratings (age 5). A multi-informant approach (parent, teacher, child) was employed to assess children's symptoms/strengths at 5 and 6. Children were interviewed using a standardised puppet interview. Parents and teachers completed questionnaires. Children's parental representations as well as the family environment were associated with children's symptoms/strengths at 5 and 6. When controlled for gender, children's representations were the only predictor of changes in symptoms/strengths between 5 and 6. A large number of negative parental representations at 5 predicted an increase in conduct problems. A large number of positive parental representations at 5 predicted an increase in pro-social behaviour. In terms of emotional symptoms and hyperactivity/inattention, symptoms at 5 were the only predictor for symptoms one year later. Our results suggest that kindergarten children's narrative representations may elaborate the processes underlying the expression of child disturbance and strengths, and underline the relevance of the play and narration of young children for diagnostics and therapy.