【作者】 曾凡林；

【导师】 缪小春；

【作者基本信息】 华东师范大学 ， 发展与教育心理学， 2017， 博士

【摘要】 依恋障碍是指儿童社会参与障碍或建立人际关系失败,包括脱抑制性依恋障碍和反应性依恋障碍两种类型。依恋障碍儿童通常至少经历了一种极度不充足的照顾模式的创伤,包括社交忽视或剥夺、反复变换主要照料者、福利机构中成长。过去15年中,依恋障碍已经成为依恋临床应用研究的最活跃领域之一,越来越多的研究丰富了关于儿童障碍症状、病因和发展的认识,但是不充足照料导致依恋障碍的病理机制、依恋障碍的长期后果尚不清楚。本研究定位于儿童异常心理发展研究,结合定量和定性的研究方法。作者采取研究-实践-政策整合研究思路,尝试在儿童依恋障碍领域的研究,促进儿童发展科学、儿童照料实践和政策领域的科学知识生成、转化和应用。研究分成三个部分。第一部分:研究儿童依恋障碍的行为特点和发展特征,由三个研究组成。研究一调查了儿童福利机构中85名脱抑制性依恋障碍儿童的行为问题。结果发现:脱抑制性依恋障碍儿童的行为问题检出率高达74%,而且女童的行为问题检出率(78.5%)高于男童(60%)。依恋障碍儿童表现出多种内化问题和外化问题,并且可能存在多种共病。研究二采用结构化访谈法研究了福利机构内依恋障碍儿童的社会适应。结果发现:依恋障碍儿童的社会适应总体不良。儿童教育程度、积极的情绪状态、良好的同伴关系对依恋障碍儿童的社会适应都有正向预测作用。研究三分析了一例典型的脱抑制性依恋障碍儿童。结果发现:寄养儿童第一次寄养安置破裂的根本原因在于,寄养儿童与寄养家长没有建立起信任的替代亲子关系。寄养儿童的心理健康有三个保护性因素:寄养父母和寄养儿童之间的频繁互动、正常发挥的家庭功能、寄养家长的心理准备。第二部分:研究儿童依恋障碍的病理机制和发展模型,由两个研究组成。研究四探讨了互动缺失与依恋障碍的关系。结果发现:自我刺激行为与依恋障碍存在联系。在院儿童和寄养儿童的自我刺激行为与依恋障碍共患,其中,寄养儿童的发生率显著低于在院儿童。互动缺失或不足本质上是无回应式照料,源于照料者的忽视,是造成儿童自我刺激和依恋障碍的原因。"付出-回报式互动"可以用来解释依恋障碍的核心病理机制。家庭寄养改善了儿童-照料者互动,有效地降低了儿童自我刺激和依恋障碍的发生率。研究五反思依恋理论在解释依恋障碍时存在明显的局限性,应该在更广泛的、复杂的社会关系中考察和解释依恋障碍的病理机制和发展。结合实证研究和文献分析,作者提出解释儿童依恋障碍发展的"发展型互动关系生态模型",认为发展型互动关系缺失或不足可解释儿童依恋障碍的病理,互动、参与和融合是儿童人际关系发展的基础,关系是儿童发展的主体,互动关系的质量决定儿童的社会性发展。儿童的社会性发展甚至是心理健康发展都是建立在发展型互动关系的基础上,发展型互动关系生态模型也可以作为解释儿童发展的一般模型。基于生态系统的互动分析表明:微观系统中的照料者-儿童互动缺失或质量不高是依恋障碍的病理机制;中观系统中的儿童社会参与障碍或建立人际关系困难是依恋障碍的主要症状;宏观系统中的融合失败表示儿童遭到社会排斥,导致儿童社会适应的长期消极后果;福利机构儿童照料者的工作环境(如照料者与儿童比)是影响孤残儿童的外系统;时序维度则提示依恋障碍的发展过程是,从微观的互动缺失到中观的参与障碍,再到宏观系统中的融合失败或遭到社会排斥。第三部分:关注儿童依恋障碍发展研究应用于儿童照料实践与政策,由三个研究组成。研究六基于发展型互动关系生态模型和生态系统的互动分析,提出"儿童照料实践与政策的社会参与模型",可应用于儿童照料实践指导和政策制定。研究七将多重依恋作为儿童替代照料的理论基础,研究了家庭寄养的家庭功能。结果表明:家庭寄养的功能良好,可以成为一种有效的替代照料,建立照料者-儿童之间的亲密关系,有助于儿童依恋障碍的预防和改善。持续时间和教育可以强化寄养家庭的情感联系和适应能力。寄养家庭亲子关系的三角平衡模型可以用来评估寄养家庭功能和判断孤残儿童家庭寄养是否成功。研究八探讨如何将依恋障碍研究应用于儿童照料实践和政策。文献回顾发现,心理研究与公共政策制定的关系越来越密切,发展心理学的应用研究涵盖儿童照料、心理健康等多个领域的公共政策。依恋理论和依恋障碍的研究对儿童照料实践和政策产生了深远的影响。我们以家庭寄养为例,初步探讨了将研究发现应用于家庭寄养政策制定的策略。更多还原

【Abstract】 Attachment disorder describes the failure of establishing relationship or social engagement disorder in childhood,which is classified into two subtypes:Reactive Attachment Disorder and Disinhibited Attachment Disorder.Children with attachment disorder usually experienced at least one pattern of extremely insufficient caregiving,such associal neglect or deprivation,frequent changes of primary caregivers,orbeing raised in institutional settings.In the past 15 years,attachment disorder has become one of the most active fields in clinical practice research of attachment.Much knowledge about the symptoms,causes and development of attachment disorder has been learned from more increasingly studies.But it is still unclear about pathological mechanism which insufficient caregiving leads attachment disorder,and also about the long-term sequelae of this disorder.This study was about abnormal child psychological development,and quantitative and qualitative methods were used to collect and analyze data.The author utilized a framework which integrated research,practice and policy,and promote to generate,translate,and apply scientific knowledge in the research field of development science,child care practice and public policy related to attachment disorder.The whole study consists of three parts.Part 1 was to study behavioral characters and developmental features of childhood attachment disorder,which consists of three studies.The first study investigated behavioral problems of children with disinhibited attachment disorder who rearing in institutional settings.The results showed that the detection rate of behavior problems reached up to 74%among children with attachment disorder,and the rate of girls(78.5%)was higher than that of boys(60%).Attachment disorder’s symptoms were associated with more internalizing and externalizing problems,and mixed with various co-morbidities.In the second study,structured interview was adopted to study social adaptation of children with attachment disorder in social welfare institutions.The results showed that most children with attachment disorder preformed social maladaptation.Three factors including education,positive emotion state and good peer relationship could positively predict social adaptation of children with attachment disorder.The third study selected a foster child with typical Disinhibited Attachment Disorder as a case study.The results suggested that the essential cause of the first foster care breakdown probably was failure to establish alternative trust parent-child relationship between foster parent and foster child.The study found that three protective factors were related to mental health of foster child which included frequent interaction between caregiver and child,family function in working order,and psychological preparation.Part 2 was to explore pathology and development model of childhood attachment which consists of two studies.The fourth study was to explore the relationship between lack of interaction and attachment disorder.The results suggested that self-stimulatory behaviors were associated with attachment disorder both among foster children and institutional children.The incidence rate of self-stimulatory behavior among foster children is significantly less than that of institutional children.The lack or insufficiency of interaction is essentially unresponsive care originated from the neglect of caregivers,which caused self-stimulatory behaviors and attachment disorder."Serve-return interaction" between caregiver and child can explain the core pathological mechanism of attachment disorder.Foster care enhanced caregiver-child interaction which reduced the incidence rate of self-stimulatory behaviors and attachment disorder.In the fifth study,the author reflected the limitation of attachment theory in explaining attachment disorder,and suggested to inspect and explain the pathological mechanism and development of attachment disorder in more complex and broader social settings.Base on integrating empirical evidences and literature,the author proposed the Ecological Model of Developmental Interactive Relationship(EMDIR)to explain the development of childhood attachment disorder.The model supposes that the insufficiency or lack of developmental interactive relationship perhaps leads to attachment disorder.Interaction,engagement and inclusion are the basis of relationship development,and relationship is in the core body of child development,and the quality of relationship determines childhood social development.Childhood social development and even mental health development are based on developmental interactive relationship,and the EMDIR also can be used as a general development model.The lack or low quality of caregiver-child interaction in microsystem is the pathological mechanism of attachment disorder;social engagement disorder or difficulty in establishing relationship in mesosystem is the essential symptom of the disorder;failure of social inclusion in macrosystem means that the child with attachment disorder is being social excluded,which leads to long-term negative consequence of social adaption;work environment of caregivers in institutions(e.g.caregiver-child ratio)influences the exosystem of disabled orphans;the development course of attachment in choronosystem presents from the lack or low quality of interaction in microsystem to engagement disorder in mesosystem then to failure of relationship in macrosystem.Part 3 focused on the application of research findings in practice and policy of child care,which consisted of three studies.In the sixth study,the author proposed Social Engagement Model of Practice and Policy in Child Care based on the Ecological Model of Developmental Interactive Relationship and interaction analysis according to ecological system.The model may be applied to practice guidance and public policy making.In the seventh study,multiple attachment relationships was taken as the theoretic basis of alternative caregiving,and the function of foster families for disabled orphans was assessed.The results indicated that foster care had brought positive family function,and foster care should be an effective alternative caregiving which can help establish intimate relationship between foster parents and foster children.Time of duration and education can reinforce the affect bonding and adaptive capacity.The Balanced Triangle Model of Parent-Child Relationship in foster family which supposed by the author will be applied to assess the function of foster families and judge whether foster care placement of disabled orphan is successful.The eighth study was to explore how we could apply the research findings of attachment disorder into practice and policy-making of child care.The literature review showed that psychological researches were becoming increasingly connected with public policy making,and the application researchesof child development covered a lot of fields related to child care and mental health.Attachment theory and the research about attachment disorder have a profound effect on child care practice and policy.The author took foster care of disabled orphan as an instance,initially explore the strategies to apply research findings to policy-making in foster care.更多还原