The Narrative Story Stem Technique (NSST) a.k.a. Attachment Story Completion Task; MacArthur Story-Stem Battery Interviewing young children to assess their perceptions of social experience Presented by Timothy Page, Ph.D.

Problems in Interviewing Young Children Addressed by the NSST Limited capacities for self-reflection Limited abilities for verbal self-expression Traumatic memories may be incompletely processed, stored in affective and/or sensory memory systems, and not accessible to verbal recall Limited empirical support for traditional projective methods

Theoretical Foundation and Rationale for the NSST Attachment Theory Behavioral systems: Attachment, Exploratory, Caregiving Internal working models in preschool-aged children reflect caregiving experiences Normally, preschool-aged children rely increasingly on internal working models to achieve emotional security Children reveal essential features of their internal working models, i.e., models of social expectations, through creative activity, including projective methods

Structure of the NSST Story-stems, focused on familiar stressful situations “Show me and tell me what happens now.” Enactments with figures/props: Mother, Father, Grandmother 2 children Friend of children, dog Props (e.g., table, stove, bed, rock)

Examples of Story Stems Spilled Juice: The family is sitting at the table drinking juice. Bob/Jane reaches for the juice and he/she spills the juice! Monster in the Bedroom: The mother says to Bob/Jane, “It’s time for bed.” Bob/Jane goes to his/her room and says, “Oh no! There’s a monster in my room!”

Examples of Story Stems (contd.) Departure: The parents are going on a trip and the grandmother will stay with them. Reunion: The parents return from their trip.

Examples of Story Stems (contd.) Uncle Fred: The mother is sitting on the couch, crying. The child enters and the mother says, “I’m so sad because Uncle Fred has died.”

Protocol Issues Generally, for children 4-10 Protocol usually consists of 5-10 stories Standard prompts are used in research Additional stories may be created to address specific issues E.g., child in hallway hearing voices

Codes Child focused codes 1. Child autonomous behavior 2. (Unresolved) child vulnerability 3. Child empathy, mutuality, or caregiving behavior toward other child 4. Child to child hostility/aggression 5. Attachment behavior 6. Child empathic behavior/deference toward parent 7. Child-parent role reversal

Parent-Focused Codes 8. Parent nurture/caregiving/protection to child 9. Parent authoritative discipline or structure 9a. Parent as powerful/very competent/high status 10. Parent hostility/harsh discipline/ aggression/abuse to child 11. Good/bad shifts in parent representations 12. Unresolved parent vulnerability

Family-Focused Codes 13. Pleasant family interaction/activity 13a. Defensive positioning/closeness/ huddling 14. Pleasant interaction/activity/caring between mother and father 15. Conflict between mother and father

Data Reduction Major codes to reflect attachment “behavioral systems” Attachment system Exploratory system Caregiving system (nurture and authority) Sociability system

Other Codes 16. Distortions of narrative/odd/bizarre elements/intrusive & frightening imagery 17. Overall story coherence (3-point scale) 18. Dismissal/avoidance of story elements (3-point scale) 19. Responsiveness toward the examiner (hostility or ignoring) 20. Security score (7 pt.) Attachment classification

Empirical Support Several dozen studies, beginning 1988 At least 4 of which are longitudinal Associations of narratives with: Child attachment Maltreatment status Social behavior with peers Self-esteem Mothers’ psychological distress Mothers’ response to parenting intervention

Characteristics of Narratives Associated with Attachment Security & Social Competence Coherent, compact, generally positive in resolution Parents consistently authoritative (nurturing and limit-setting) Clear attachment behavior Empathic responding Competence Case example

Claire’s Story Severe maltreatment (neglect, physical, sexual abuse) as infants Five different foster placements and 12 moves between the ages 6 and 27 months State custody at 18 months Assessments at 18 months, 36 months, 8 years Adopted by aunt/uncle at 30 months

Claire’s 18 Month Assessment Reactive Attachment Disorder Flat affect Socially withdrawn No verbalization/intentional communication No preferred attachment Disorganized attachment behaviors during separation & reunion with both parents Developmentally delayed (tested 13 month level) Normal EEG and neurological exam “Freezing” episodes at times of mild-moderate stress

Claire’s 36 Month Assessment Used adoptive mother as primary attachment figure Claire strived to control the interaction with her caregiver in either a punitive or caregiving manner (A shift from disorganized attachment behaviors in infancy to controlling attachment behaviors in the preschool period is documented in the research literature.)

Claire’s 8-Year Assessment Data In average range on cognitive screens CBCL: Borderline range on the externalizing scale and in the clinical range on the delinquent subscale Adoptive parents undergoing contentious separation

Claire’s Departure Story E: The mom and dad are going on a trip. The mom says, “Girls, your dad and I are going on a trip. See you tomorrow, Grandma will stay with you.” S moves parents to car, “They get in the car, dad drives.” (E eventually removes car/parents from the table) E: Show me and tell me what happens now. S: Grandma goes to the park with them (moves Grandma and children to the grass). They both…have bloody noses ‘cause they fell down. Now they go home. (moves Grandmother and children off the grass, closer to her) And Jane told her sister a secret, “Let’s run away.” (smiles) S: And then they’re packing up their stuff when Grandma’s at the door, um, at the kitchen (moves Grandmother to other end of the table), and they sneak out the door (moves children away to far edge of table). And they sneak right here, to the store and they’re stealing candy. S: Then Grandma goes where they were inside the store. They had candy all over their face. Now they’re sick. Now they go to the hospital ‘cause each got a nail stuck in their throat. They all ate a candy nail (smiles). E: There was a nail in the candy? They got it stuck in their throat? (S. nods) Wow. S: They’re at the hospital (moves children and Grandmother to side of table). The end.

Reunion Story E: Well, let me show what happens next. You know what? It’s the next day and the Grandma says, “Girls, your mom and dad are home from their trip.” Show me and tell me what happens now. S: They get out the car (moves M and F toward Grandma and children). “Grandma (unintell.), did anything happen? (Grandmother reports to parents). S: (Grandmother replies) “Yes, the children went to the hospital ‘cause they got a nail stuck in their throat. They were punished ‘cause they sneaked out the house and ran away to the store. And then they busted their nose at the park and they had to go home and take a nap. The end. E: Um hmm, so that’s what she said. She told them everything that happened, right? S: (nods) Now the kids are punished. S: (moves LS and BS to the side) They lay there. And now Grandma’s, and now the parents are dropping Grandma off at home (moves all to the car). E: Um hmm, dropping her off. And did anybody else do anything after the mom and dad came home? S: (distracted with putting figures into the car) I don’t know (unintell.). S: (moves the car with all inside) Grandma’s at home (removes the Grandmother) (moves car back) They’re home. Somebody went in their house (removes all from car). S: And it was a robber, and almost killed Jane (moves LS apart from others). E: Almost killed Jane. S: Now they called the cops. The cops came but they weren’t there when they came. (sets all back into car) S: They left (moves car slightly) and they’re back home. S: And the cops were there (removes family from the car) and they arrested him…But he got away. They almost arrested him. And then they catched him. E: Oh, and then they caught him, eh? S: Yeah. E: Ok, that was a good story. Ok.

Some Noteworthy Characteristics Rambling structure with abrupt plot shifts associated with frightening events Deception/anti-social behavior Vulnerability of children Ultimate authoritative role of caregiver