Reassessing the validity of the attachment Q-sort: An updated meta-analysis

Revisiting the childcare-attachment question: under what conditions is childcare participation associated with mother-child attachment security?

Decades have passed since the controversy regarding the putative risks of childcare for mother-child attachment broke out. Yet, some uncertainty remains, as relevant studies have produced inconsistent evidence. Some have proposed that those conflicting findings may be due to the fact that the effects of childcare are conditioned on parenting. Accordingly, this study examined whether relations between childcare participation and mother-child attachment vary according to maternal sensitivity and autonomy support. In this sample of 236 mother-child dyads, there was no indication of main effects of childcare participation on attachment. There were, however, some interactive effects, such that the children who showed the least secure attachment behaviors were those who did not attend childcare and had either less sensitive or less autonomy-supportive mothers. The findings suggest that the effects of childcare on mother-child attachment are best understood in light of the parenting children receive at home.

Insecure Attachment Orientation in Adults and Children and Negative Attribution Bias: A Meta-Analysis

This is the first meta-analysis to synthesize the literature on insecure attachment and negative attribution bias (NAB) from both developmental and social/personality attachment traditions. This meta-analysis is important because extant studies report inconsistent associations, making it difficult to draw conclusions about the nature of these associations. Based on 41 samples (N = 8,727) from 32 articles, we specify and compare the effect sizes of these associations across studies. Results confirmed positive associations between NAB and anxious and avoidant attachment dimensions and an insecure composite, with a medium effect size. Correlations were moderated by age group, type of attachment measurement, and cultural background. Our findings advance knowledge and build on attachment and attribution theories, reconcile mixed findings, and inform the development of NAB interventions. Important gaps in the literature are revealed that will inspire future research.

Changes in coercive parenting and child externalizing behavior across COVID-19 and the moderating role of parent-child attachment relationship quality

Research indicates increases in coercive parenting towards children and increases in child externalizing behavior during COVID-19 as compared to the pre-pandemic period. In this preregistered study, we extended previous knowledge by investigating to what extent, and under what conditions, changes in coercive parenting and child externalizing behavior are interrelated. Ninety-five mothers and fathers of children (of age 3 prior to the pandemic) reported on coercive parenting and child externalizing behavior before and during the pandemic, and trained assistants observed the quality of mother-child and father-child attachment relationship prior to the pandemic. We employed latent change score modeling to test the extent to which changes in maternal and paternal coercive parenting and changes in child externalizing behavior across the pre-pandemic period and the onset of the first COVID-19 lockdown are interrelated. Moreover, we tested whether these linkages are moderated by changes in the other parent's coercive parenting and the quality of parent-child attachment relationship. Specifically, we tested the moderation by mother-child (father-child) attachment relationship quality in the relation between changes in mothers' (fathers') coercive parenting and changes in child externalizing behavior. We found that changes in mothers', but not fathers' coercive parenting were positively associated with changes in child externalizing behavior. We found no moderation by changes in the other parent's parenting or by parent-child attachment relationship quality. Our findings provide support for the transactional processes underlying mothers' and children's behavior in the context of non-normative stressful conditions. We recommend incorporating evidence-based (parenting) support for mothers, fathers, and young children in prevention strategies and recovery tools employed during and after future lockdowns and non-normative stressful events.

The effect of relationship-based interventions for maltreated children and adolescents: a systematic review and meta-analysis

Child maltreatment is characterized by a harmful relational environment which can have negative cascading consequences for the child's development. Relationship-based interventions may improve maltreated children's functioning by addressing key aspects of the parent-child relationship at various stages of development. The objective of the current study was to perform a systematic review on relationship-based interventions for maltreated children and a meta-analysis on the impact of these interventions on observed parent-child relational behavior. Data collection consisted of a comprehensive literature search in six databases and contacting experts in the field and hand searching relevant publications. In total, 5,802 abstracts were screened, of which 81 relevant publications were identified, representing 4,526 participants. The meta-analysis found large improvements in observed parent interactive behavior (g = 0.888), smaller improvements in child attachment (g = 0.403) and child interactive behavior (g = 0.274). The effect on parent interactive behavior was larger in interventions addressing middle childhood. Risk of bias assessments showed that a large number of studies suffer from poor reporting, which limits the conclusions of the findings. Future research should examine parent-child relationship behavior across multiple developmental stages, as well as the impact of developmentally appropriate intervention elements on maltreated children.

Changes in children's attachment security to mother and father after the birth of a sibling: Risk and resilience in the family

Changes in children's attachment security to mother and father were examined for 230 firstborn children (M = 31.17 months), their mothers and fathers participating in a longitudinal investigation starting in the last trimester of the mothers' pregnancy and 1, 4, 8, and 12 months after the birth of an infant sibling. Both parents completed the Attachment Q-set at prenatal, 4, and 12 months. Growth mixture models revealed four latent classes in which children's attachments were (a) both secure with a modest decline to both parents (68.3%); (b) more secure with father than mother with a steep decline for both (12.6%); (c) both insecure with no change (10%); and (d) more secure with mother than father with a modest increase for both (9.1%). Multi-group latent growth curve analyses revealed that parenting and coparenting differed across families. Children had lower externalizing behavior problems in families with two secure attachments than in families with one secure attachment, either to mother or to father, who, in turn, had fewer problems than children with two insecure attachments. Findings underscore the strengths of a family systems framework to understand attachment relationships with multiple caregivers and the family risks and protective factors that covary with children's behavioral adjustment after the birth of a sibling.

Self-report measure of parental reflective functioning: A study of reliability and validity across three samples of varying clinical risk

The Parental Reflective Functioning Questionnaire (PRFQ) provides an efficient way to measure a parent's capacity to recognize their child's mental states and to understand the relationship between underlying mental states and behavior. To date, limited work evaluates its psychometric properties beyond initial validation studies. Here we examined the reliability and validity of the PRFQ in three samples of varying clinical risk (e.g., community sample, previous mental health diagnosis, substance use disorder diagnosis). Across samples, the majority (e.g., 75%-78%) of mothers identified as White; all mothers were from the USA. We compared the PRFQ to task-based measures of mentalization, the Parent Development Interview (PDI), and measures of the parent-child relationship. The PRFQ was a reliable measure across samples, and it was associated in theoretically consistent ways with task-based measures of mentalization. Parental RF across the PDI and PRFQ were not highly correlated in a sample of mothers with substance use disorders. Existing RF measures may be tapping into a different component of the broader construct of parental reflective functioning (PRF). The PRFQ was further validated by demonstrating relationships with parent-report measures of the parent-child relationship. Taken together, these findings provide additional support for the reliability and validity of the PRFQ.

Longitudinal associations between mother-child attachment security in toddlerhood and white matter microstructure in late childhood: a preliminary investigation

Early childhood experiences are considered to influence the strength and effectiveness of neural connections and thus the development of brain connectivity. As one of the most pervasive and potent early relational experiences, parent-child attachment is a prime candidate to account for experience-driven differences in brain development. Yet, knowledge of the effects of parent-child attachment on brain structure in typically developing children is scarce and largely limited to grey matter, whereas caregiving influences on white matter (i.e. neural connections) have seldom been explored. This study examined whether normative variation in mother-child attachment security predicts white matter microstructure in late childhood and explored associations with cognitive-inhibition. Mother-child attachment security was assessed using home observations when children (N = 32, 20 girls) were 15 and 26 months old. White matter microstructure was assessed using diffusion magnetic resonance imaging when children were 10 years old. Child cognitive-inhibition was tested when children were 11 years old. Results revealed a negative association between mother-toddler attachment security and child white matter microstructure organization, which in turn related to better child cognitive-inhibition. While preliminary given the sample size, these findings add to the growing literature that suggests that rich and positive experiences are likely to decelerate brain development.

Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews

BACKGROUND

Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful.

OBJECTIVES

This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice.

DESIGN AND METHODS

We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey.

RESULTS

The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used.

CONCLUSIONS

There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment.

LIMITATIONS

Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this.

FUTURE WORK

There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42019137362.

FUNDING

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.

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