The Long-Term Consequences ofMaltreatment in the Early Years:A Develop - PDF document

The Long-Term Consequences ofMaltreatment in the Early Years:A Developmental Pathway Modelto Antisocial BehaviorByron Egeland, Tuppett Yates,Karen Appleyard, and Manfred van DulmenUniversity of MinnesotaInstitute of Child DevelopmentThedevelopmentalpathwayslinkingmaltreatmentinearlychildhoodandantisocialbehaviorinadolescencewereexaminedusingdatafromalongitudinalstudyofhigh-riskchildrenandtheirfamilies.Twodevelopmentalprocessvariables,emo-tional/self-regulation(dysregulation)andestablishingacloseemotionalrelationshipbetweenthechildandprimarycaregiver(alienation),wereincludedinthemodelinanefforttobetterunderstandthepathwayfrommaltreatmenttoantisocialbehavior.Theresultsindicatedthatalienationand,toamuchlesserextent,dysregulationhelpedexplaintherelationbetweenearlymaltreatmentandlaterantisocialbehavior.Themodelincludingthedevelopmentalprocessvariableswasabetterrepresentationofthedatathanthemodelconsideringonlythedirecteffectbetweenearlymaltreatmentandlaterantisocialbehavior.Physicalabuseinearlychildhood,notemotionalneglect,ledtoalienationinpreschool,whichthenpredictedearlyonsetexternalizingproblemsintheelementaryschoolyears,ultimatelyresultinginantisocialbehaviorinadolescence.Oneoftheimplicationsofthesefindingsforpreventingadolescentantisocialbehavioristointerveneatanearlyagewitharelationship-basedprogram.Childabuseisamajorriskfactorforavarietyofbehaviorproblemsandpsychopathology(Bemporad&Romano,1992;Luntz&Widom,1994).Amongthediverseoutcomesthathavebeenassociatedwithmaltreatment,astronglinkhasbeenestablishedbetweenchildabuseandantisocialbehaviorinadolescenceCHILDREN’S SERVICES: SOCIAL POLICY, RESEARCH, AND PRACTICE,(4),249–260Copyright ©2002, Lawrence Erlbaum Associates, Inc. RequestsforreprintsshouldbesenttoByronEgeland,InstituteofChildDevelopment,51EastRiver Road, Minneapolis, MN55455. E-mail: egela001@umn.edu andadulthood(Widom,1989),particularlyforboys(Malinosky-Rummell&Hansen,1993).Althoughthelinearrelationbetweenchildabuseandantisocialbehaviorisstrong,littleisknownaboutthedevelopmentalprocessthatleadstoapathway of externalizing behavior problems.We,alongwithotherinvestigators,havebeenguidedinourstudyofthesequelaeofmaltreatmentbyanorganizationalperspectiveofdevelopmentthatfocusesonthequalitativereorganizationandintegrationthattakesplacewithinandamongbehavioralandbiologicalsystemsoftheindividual(Cicchetti,1993;Sroufe&Rutter,1984).Thesuccessfulnegotiationofstagesalientdevelopmentalissuesatoneage(e.g.,asecureattachmentininfancy)providesafoundationforsuccessfuldevelopmentaladaptationatalaterage(e.g.,peercompetenceinmiddlechildhood).Similarly,experiencessuchasmaltreatmentthatleadtomaladaptationataparticularage(e.g.,anxiousattachmentininfancy)increasetheprobabilityofdevelopmentalmaladaptationatlaterstagesofdevelopmentItiswellestablishedthatabuseoccurringintheearlyyearshasanegativeim-pactondevelopmentaladaptationasdefinedbythesalientdevelopmentalissuesofeachage(Cicchetti&Toth,2000).Ininfancy,maltreatmentisrelatedtoinsecureanddisorganized/disorientedattachmentstocaregivers(Cicchetti&Barnett,1991;Crittenden,1988;Egeland&Sroufe,1981).Inthetoddlerperiod,mal-treatedchildrenexhibitdisturbancesinthedevelopmentofself/othersystems.Forexample,maltreatedtoddlersappeartohavedifficultytalkingabouttheinternalstatesandfeelingsofselfandother(Beeghly&Cicchetti,1994).Inmiddlechild-hood,maltreatedchildrenhavedifficultywithrespecttothestagesalientissueofpeerrelationships.Forexample,Dodge,Pettit,andBates(1994)foundthatmal-treatedchildrenweremoredislikedbypeers,lesspopular,andmorewithdrawnintheearlyschoolyears.Similarly,adolescentswithahistoryofearlyabusehavebeenfoundtointeractwiththeirfriendsinalessintimatefashioncomparedtononabusedadolescents(Parker&Herrera,1996).Usingstagesalientdevelopmentaltasksasindexesofchildfunctioning,theseresultsdemonstratethatamajorconsequenceofmaltreatmentisanimpairedabilitytoachieveexpecteddevelopmentaloutcomesacrosssubsequentageperiods(i.e.,maladaptation).Maladaptationrepresentsadeflectioninnormaldevelopmentthatmayinitiateadeviantpathwaytowardavarietyofproblems.Thustheeffectsofmaltreatmentonstagesalientdevelopmentalissuesandthenotionofdevelopmentalpathwaysmayhelp to explain the link between early maltreatment and psychopathology.Inthisarticleweexpandonthepathwaymodeltoprovideamoredetailedexplanationofthedevelopmentalprocessunderlyingtherelationbetweenmaltreatmentandantisocialbehavior.Specifically,wetestthehypothesisthatdevelopmentalmaladaptationintheareasofemotionalandbehavioralself-regulation,aswellasinthedevelopmentofacloseemotionalrelationshipbetweenthechildandprimarycaregiver,contributetotherelationbetweenearlymaltreatmentandEGELAND, YATES, APPLEYARD,VAN externalizingbehaviorinlaterchildhood.Moreover,weexploredifferencesindevelopmentalpathwaysasafunctionofthetypeofmaltreatment(physicalabusevs.emotional neglect) experienced in early childhood.Overthepast2decades,theconstructofself-regulationinyoungchildrenhasbecomecentraltomanytheoriesofdevelopmentalpsychopathology(Egeland&Bosquet,2002;Sroufe,1996).Emotionalandbehavioralself-regulationisamajorstagesalientissuefortheinfancy,toddler,andpreschoolperiods.Cicchetti,Ganiban,andBarnett(1991)definedemotionregulationasthefactorswithinanindividualandtheenvironmentthatredirect,control,modulate,andmodifyemotionalarousaltoenableanindividualtofunctionadaptivelyinemotionallychallengingsituations.Itisimportanttonotethatregulationisdefinedineachdevelopmentalperiod.Thechildmovesfromdyadicregulationininfancytocaregiver-guidedself-regulationinthetoddlerperiodandtowardindependentself-regulationinthepreschoolperiod.Bythepreschoolperiod,thechildisexpectedtoregulatehisorherownemotionalarousallevel(andbehavioralresponsetoarousal)withoutthehelpofacaregiver(Kochanska,1993).Inthisinvestigation,weareinterestedinthecon-structofdysregulationinthepreschoolperiod.Inthepreschoolperiod,dysregulationimpliesthatthechildhasnotdevelopedastablepatternofself-regu-lationinresponsetooverarousalsuchthatthechildwillhavedifficultyregulatingbehavior and emotions in response to frustration.Alienationistheseconddevelopmentalconstructhypothesizedtounderlieorexplaintherelationbetweenmaltreatmentandantisocialbehavior.Muchhasbeenwrittenabouttheimportanceofthequalityofthedevelopingrelationshipbetweentheyoungchildandprimarycaregiverforlaterdevelopment(Maccoby&Martin,1983).Alienationreferstothechild’savoidanceoftheprimarycaregiverandlackoftrustinthecaregiver’savailability,support,andguidance,particularlyinstressfulsituationsinwhichthechildneedssupportandassistancefromthecaregivertocopeeffectively.Wepredictthatmaltreatmentinearlychildhoodmayrelatetodysregulationandalienationinpreschool,whichwillthenpredictexternalizingbehavior in later childhood.Inadditiontotheconstructsofdysregulationandalienation,ourmodelcontainsanexternalizingbehaviorlatentconstructfromthemiddlechildhoodperiod.Therationaleforthisconstructisbasedontheconsistentfindingthatantisocialbehaviorisoneofthemoststablebehavioralcharacteristics(Patterson,DeBaryshe,&Ramsey,1989).Formostadolescentsandadultswhopersistindelinquentandantisocialpatterns,disruptivebehaviorbeginsearly(Robins,1986)andbecomesincreasinglystablethroughthemiddlechildhoodyears(Achenbach,Howell,Stephanie,McConaughy,&Stranger,1995)andadolescence(Egeland,Pianta,&Ogawa,1996;Loeber,1982).Thusitisimportanttocapturetherelationbetweenthemediatingconstructsandearly-onsetexternalizingbehaviorsinmiddlechildhood.LONG-TERM CONSEQUENCES OF MALTREATMENT Usinglongitudinaldatafrominfancythroughlateadolescence,weexaminedthedevelopmentalprocessbywhichchildrenwhoweremaltreatedatanearlyageenterapathwayofexternalizingbehaviorthatultimatelyleadstodelinquencyandantisocialbehaviorinadolescence.Usingstructuralequationmodeling,weinvestigatedthelinkbetweenmaltreatmentintheearlyyearsandexternalizingbehaviorinmiddlechildhood,asexplainedbyemotionalandbehavioraldysregulationandalienation from the primary caregiver in the preschool period.Thesampleconsistedof140high-riskchildrenandtheirfamilieswhohadbeenfollowedfrombeforebirththroughage17½andforwhomtherewasnomissingdata.Fromthissample,whowerepartoftheMinnesotaLongitudinalStudyofHigh-RiskParentsandChildren,childrenwereidentifiedasphysicallyabusedoremotionallyneglectedduringearlychildhood(0–54months).Childrenclassifiedasphysicallyabused(=14)weresubstantiatedchildprotectioncases.Childrenwhowereemotionallyneglectedduetopsychologicallyunavailablecaregiving(=13)wereidentifiedbyprojectstaffusingmultiplemeasuresfromhomeandlabo-ratoryassessments.Aspartoftheassessmentconductedinthehomeat3,6(twice),and9months,weobservedthemotherandbabyinfeedingandplaysitua-tions.At12,18,24,and42months,wevideotapedinteractionsbetweenmotherandchildinstructuredandsemistructuredlaboratorytasks.Fromtheseobserva-tionsweidentifiedagroupofmotherswhowereemotionallydistantandunre-sponsivetothechild’sbidsforcomfortandhelp.Thesemothersappearedtobede-tachedanduninvolvedwiththeirchildren,interactingwiththemonlywhenThepreschooldysregulationlatentconstructwascreatedtorepresentthechild’sself-regulatorypatternandinternalizedcaregiverstandards.ThevariablesusedtoformthislatentconstructwereratingsofthechildintheBarrierBox,alaboratorytaskgivenat42monthsdesignedtochallengeandfrustratethechildinasituationinwhichthemotherwasnotpresent(Harrington,Block,&Block,1978).Inthepresenceoftheexperimenter,childrenwereallowedtoplaywithasetofattractivetoysthatsubsequentlywereremovedandplacedinasealedPlexiglasbox.Childrenwerefacedwiththeoptionoftryingtoopentheboxtoobtaintheattractivetoysorplayingwithasetoflessattractivetoys.Ratingscalesofego-control(i.e.,thechild’sabilitytocopewithfrustration,specificallythedegreetowhichthechildexercisescontroloverwishes,impulses,andfeelings),intensityofhelp-seeking(i.e.,thedegreetowhichthechildseekshelpfromtheexperimenter),andnegative effect were used to construct the dysregulation latent construct.Variablesforthealienationconstructwerederivedfromchildobservationinateachingtasksituationthatconsistedoffourchallengingchildtasksthatrequiredparentalassistanceandteachingstrategies.Thetask,whichwasalsogivenat42months,requiredchildrentobuildblocksfrommodels,nameobjectswithwheels,EGELAND, YATES, APPLEYARD,VAN sortobjects,andcompleteamaze.Three7-pointchildratingswereselectedtorepresentthechild’sexperienceofalienation:avoidanceofthemother(i.e.,thedegreetowhichthechildavoidedinteractingwiththemother),compliancewiththemother,andnegativitytowardthemother.InterraterreliabilityforboththeBarrierAlatentvariablerepresentingexternalizingbehaviorinmiddlechildhoodwasconstructedfromteacherratingsontheChildBehaviorChecklist(CBCL;Achenbach&Edelbrock,1986)administeredattheendofGrades1,2,and3.Thelatentconstructreflectingadolescentantisocialbehaviorproblemsincludedtwoindicators:acompositeofparent,teacher,andchildreportontheCBCL/YouthSelf-ReportForm(YSRF;Achenbach,1991a,1991b;Achenbach&Edelbrock,1986)onthesubscalesdelinquentandaggressivebehavioratage16;adiagnosisofconductdisorderobtainedfromtheScheduleofAffectiveDisordersandSchizophreniaforSchool-AgedChildren(K-SADS;Puig-Antich&Chambers,1978)diagnostic interview given at age 17½.RESULTSThesimplecorrelationsandthemeansandstandarddeviationsarepresentedinTa-ble1.Psychologicalunavailabilitywassignificantlyrelatedtothevariablesmak-ingupthealienationconstructandtoexternalizingscoresinGrades1and3.Physi-calabusewasalsorelatedtothevariablesthatcomprisedthealienationconstruct.Inaddition,physicalabusewasassociatedwithscoresontheego-controlvariableinthedysregulationconstructandhigherscoresonexternalizinginGrades1,2,and3.PhysicalabusewasalsosignificantlyrelatedtoadiagnosisofconductdisorAdditionaldescriptivestatisticsareprovidedinTable2.Thepercentageofmaltreatedchildrenreceivingascoreof63orgreater(90thpercentile)ontheCBCL/YSRFfromatleastoneinformantatage16was77%forthepsychologicallyunavailablegroup,79%forthephysicallyabusedgroup,and44%forthenonmaltreatedhigh-riskgroup.Similarly,39%ofthepsychologicallyunavailable,50%ofthephysicallyabused,and21%ofthenonmaltreatedchildrenreceivedadiagnosisofconductdisorderontheK-SADSdiagnosticinterviewgivenatage17½.TheseresultsindicatethatbothpsychologicallyunavailablecaregivingandphysicalabuseintheearlyyearsareriskfactorsforlaterexternalizingbehaviorUsingLISREL8.3,wetestedtwostructuralequationmodels:Model1,inwhichtherelationbetweenphysicalabuse/psychologicalunavailabilityandexternalizingproblemsinmiddlechildhoodwaspartiallyexplainedbyalienationanddysregulation,andModel2,inwhichthesesamerelationswerenottakenintoaccount.Acomparisonofthechi-square/dfratiobetweenthetwomodelsindiLONG-TERM CONSEQUENCES OF MALTREATMENT 254 TABLE1DescriptiveStatisticsandZero-OrderCorrelationsforIndicatorVariablesIndicatorvariable12345678910111213unavailability1.PsychologicalunavailabilityPhysicalabuse2.Physicalabuse.22—Alienation3.Compliance.16.30—4.Avoidance.23.20.71—5.Negativitytowardmother.18.21.80.78—Dysregulation6.Negativeaffect.05.10.26.16.18—7.Intensityofhelp.07.07.08.05.08.43—8.Ego-control.03.19.29.27.27.73.58—Externalizing1239.TRFGrade1.20.21.09.10.12.07.12.10—10.TRFGrade2.10.31.22.22.15.23.26.32.58—11.TRFGrade3.22.32.30.38.29.24.20.31.52.58—12.AGDELage16.14.05.08–.01.03–.14.06–.09.16.11.10—13.CDage17.11.20.18.11.13–.01.05.05.27.33.25.29—.09.109.343.763.992.323.673.3655.9455.6155.18333.96.29.303.202.653.011.381.551.4110.9310.449.6155.24.43 Note.N=140.Correlationsgreaterthan.16aresignificantat.05.TRF=Teacher’sReportFormexternalizingbehavior;AGDEL=aggression/delinquency;CD=conductdisorder.Meanrawscorefordelinquencyandaggressionscalesfromthecombinedchild,parent,andteacherformoftheChildBehaviorChecklist(Achenbach,191991b;Achenbach&Edelbrock,1986). catedthatModel1fitthedatabetterthanModel2(/dfchange=26.32(6),p.005).Model1,inwhichtherelationbetweenphysicalabuse/psychologicalun-availabilityandexternalizingproblemswasexplainedbyalienationanddysregulation,wasabetterrepresentationofthedatathanModel2,whichdidnotOverall,Model1fitthedatawell(RootMeanSquaredErrorofApproximation,RMSEA=.03;GoodnessofFitIndex,GFI=.93;seeFigure1).Physicalabuseispositivelyrelatedtoalienation(.19,=2.24),dysregulation(.22,=2.07),andexternalizingproblemsatGrades1,2,and3(.28,=3.05).However,psychologi-calunavailabilitywasnotsignificantlyrelatedtoeitherofthedevelopmentalpro-cesslatentconstructsorexternalizinginGrades1,2,and3.Alienationwasasig-nificantpredictorofexternalizingproblemsinGrades1,2,and3(.24,=2.54),butdysregulationdidnotsignificantlypredictexternalizingproblemsinGrades1,2,and3.TherewasastrongassociationbetweenexternalizingproblemsatGrades1,2,and3andantisocialbehaviorinadolescence(.44,=4.12).Model1accountedfor26%ofthevarianceinpredictingexternalizingproblemsinGrades1,2,and3,and19%ofthevarianceinpredictingantisocialbehavioratage16–17½.Incomparison,Model2(withnomediatingrelationships)accountedforonly19%ofthevarianceinpredictingexternalizingproblemsatGrades1,2,and3and21%ofthevariance at age 16–17½ (see Figure 2).Whenexaminedinisolation,physicalabuseandpsychologicalunavailabilityatanearlyagewerefoundtoberiskfactorsforantisocialbehaviorinadolescence.ThissimplerelationwasdemonstratedbythehigherpercentageofmaltreatedchildrencomparedtononmaltreatedchildrenwhowerediagnosedasconductLONG-TERM CONSEQUENCES OF MALTREATMENT Type of Maltreatment% Above Clinical CutoffYSRF at Age 16% Diagnosed as ConductDisordered on thePhysical abuse6450Psychological unavailability7739No maltreatment3821 Externalizingatage16determinedbyatleastoneinformantwith-scoreabove63(90thpercentile).CBCL=ChildBehaviorChecklist;TRF=Teacher’sReportForm;YSRF=YouthSelf-ReportForm(Achenbach,1991a,1991b;Achenbach&Edelbrock,1986);K-SADS=Scheduleof 256 FIGURE2OverviewofStructuralEquationModel(MaximumLikelihoodEstimation)onExternalizingProblemBehaviorswithoutmediatingrelationships,delinquency/aggression(=140;parametersarecompletelystandardized).RMSEA=RootMeanSquaredErrorofApproximation; GFI = Goodness of Fit Index; CFI = Comparative Fit Index; CN = Critical FIGURE1OverviewofStructuralEquationModel(MaximumLikelihoodEstimation)onExternalizingProblemBehaviors,delinquency/aggression(=140;parametersarecompletelystandardized).RMSEA=RootMeanSquaredErrorofApproximation;GFI=GoodnessofFitIndex; CFI = Comparative Fit Index; CN = Critical disorderedatage17½andwhoreceivedascoreabovethe90thpercentileontheCBCL/YSRFfromatleastoneinformantatage16.However,theserelationschangedwhenstructuralequationmodelingprocedureswereappliedtoourlongitudinaldata.Wetestedtwodifferentmodelstobetterunderstandthesimplerelationbetweenearlymaltreatmentandantisocialbehaviorinadolescence.TherelationbetweenmaltreatmentandexternalizingbehaviorproblemsinGrades1,2,and3isbetterexplainedbyincludingalienationand,toalesserdegree,dysregulationinthemodel.TheinclusionofthesedevelopmentalprocessconstructsinModel1resultedinasignificantlybetterfitofthedatathanModel2,whichdidnotincludetheprocessconstructs.Physicalabusehadasignificantinfluenceonalienation,andalienationhadasignificanteffectonexternalizingbehaviorintheearlyelementaryschoolyears.Comparingtheimpactofthetwotypesofmaltreatment,psychologicalunavailabilityandphysicalabuse,itisclearthattheformerhadverylittleeffectonthedevelopmentalprocessvariablesexaminedhere or on early externalizing behavior that led to adolescent antisocial behavior.Thefindingthatpsychologicallyunavailablecaregivingdoesnotdirectlyaffectearlyonsetexternalizingbehaviororthedevelopmentalprocessvariablesofalien-ationanddysregulationissomewhatsurprising.Thesimplerelationbetweenpsy-chologicalunavailabilityandadolescentoutcomes(e.g.,atage16,77%ofthechil-dreninthisgroupwereabovetheclinicalcutoffontheCBCL)wasstriking;however,byincludingphysicalabuseandthedevelopmentalprocessvariablesinthestructuralequationmodel,psychologicalunavailabilitydidnotmakeauniquecontributioninpredictingantisocialbehavior.Furtherresearchshouldinvestigateotherpossibleoutcomesofpsychologicalunavailability,suchasinternalizingAsnotedearlier,earlierresearchshowedthatabusehasanegativeeffectonanumberofdifferentstagesalientdevelopmentalissues.Inthisinvestigationweexaminedtheinfluenceofmaltreatmentontwostagesalientissuesfromthepreschoolperiod:qualityoftheparent–childrelationshipandemotionalandbehavioralself-regulation.Wewerealsointerestedinthequalityofadaptationononeorbothofthesestagesalientissuesasputativemediatorsofthedevelopmentofearly-onsetexternalizingbehaviorproblems.Apoorqualityparent–childrelationship,intheformofalienation,wasfoundtobeanimportantmediatingvariableintherelationbetweenphysicalabuseandexternalizingbehaviorproblems.Insumalienationisaprobableconsequenceofmaltreatmentthatappearstobepartoftheprocessleadingtoanearly-onsetexternalizingtrajectory.Thesefindingsofferempiricalsupportforpathwayspositedbyattachmenttheoryfromphysicalabusetoalienationtoantisocialbehavioranddelinquency.Infantswhoexperienceharshcaregivingarelikelytodevelopanattachmentrelationshipthatischaracterizedbyminimalaffectivesharingandcomfortseekingandalackoftrustintheirprimarycaregiver(Lyons-Ruth&Jacobvitz,1999).AsLONG-TERM CONSEQUENCES OF MALTREATMENT toddlersandpreschoolers,thesechildrenhavedifficultyusingtheirprimarycaregiverasasecurebasetoexploretheirenvironmentandasasourceofcomfortwhendistressed(Egeland,Sroufe,&Erickson,1983).Ifthispatternpersistsintopreschool,thesechildrenarelikelytoincreasinglydistancethemselvesfromthecaregiver.Overtimealienationbecomesastablecharacteristicofthesechildren,whichmayleadtoantisocialbehavior.ThefailuretofindasignificantpathwayfromdysregulationtoexternalizingbehaviorinGrades1,2,and3issomewhatsurprising.ItmaybethatthevariablesfromtheBarrierBoxobservationusedtoconstructthedysregulationlatentconstructwerenotavalidmeasureofemotionalandbehavioralself-regulation.Forexample,itispossiblethatnotallchildrenwerefrustratedbythetask;therefore,thetaskdidnottapthechild’sresourcestocopewithhighlevelsofarousal.Alternatively,becausethemotherwasnotpresentfortheBarrierBoxtask,itispossiblethatthechild’scopingstrategywasnotthesameasitwouldhavebeeninthepresenceofthemother.Perhapsabettertestofregulationforchildrenwhoare42monthsoldwouldbeataskinwhichthemotherispresent.Itshouldalsobenotedthattheassociationbetweendysregulationandexternalizingisinflu-encedbycontrollingfortherelationamongtheearliervariables(i.e.,typesofmaltreatment).Changingcontrolvariables(e.g.,eliminatingphysicalabuse)inthestructuralequationmodelwouldlikelychangetheassociationbetweendysregulationandexternalizing.Thecurrentdatayieldimportantimplicationsforpreventionandinterventionefforts.First,becausephysicalabuseandpsychologicalunavailabilityappeartohaveuniquedevelopmentalpathwaysandpossiblyoutcomes,treatmentforfami-lieswithdifferentmaltreatmenthistorieswillvary.Thuseffortstopreventdelin-quencyshouldbetailoredtothespecificdevelopmentalandrelationshiphistoryofthechild.Alienationappearstobeanimportantdevelopmentalprocessvariablethatexplainstherelationbetweenphysicalabuseandlaterantisocialbehavior.Thusthesedatasuggestthatinterventioneffortsaimedatpreventinglaterantisocialanddelinquentbehavioramongmaltreatedyouthmaybemostprofitablydirectedtowardinterventionsthatfosterasenseofconnectednessandreciprocitybetweenthechildandcaregiver.Preventionprogramsdesignedtopromoteasecureparent–infantattachmentrelationshiphavebeenfoundtobereasonablysuccessful(Egeland,Weinfield,Bosquet,&Cheng,2000).However,similarprogramsforpreschoolandolderchildrenandtheirprimarycaregiversstillneedtobedeveloped.Interventionprogramsdesignedtoenhancethequalityoftheparent–childrelationshipwouldlikelyreducealienationbetweenchildandcaregiverandultimatelypreventfuturebehaviorproblems.Inadditiontotheneedtodeveloprelationship-basedinterventions,policymakersneedtobeawarethatotherfactorsmayinfluencethequalityofthedevelopingrelationshipbetweentheparentandyoungchild,suchasadequatefamilyhousing,medicalcare,medicalleave,andavailabilityofdaycare.EGELAND, 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