Validity and Reliability of the Attachment Insecurity Screening Inventory (AISI) 2-5 Years

In-person versus online delivery of a behavioral sleep intervention (Sleeping Sound©) for children with ADHD: protocol for a parallel-group, non-inferiority, randomized controlled trial

BACKGROUND

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children's daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD©, compared to a face-to-face delivery mode.

METHODS

This parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5-12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy.

DISCUSSION

To the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner.

TRIAL REGISTRATION

ANZCTR, ACTRN12621001681842 . Registered 9 December 2021-Retrospectively registered.

Insecure attachment and internalizing behavior problems in growth discordant identical twins

BACKGROUND

Psychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and future relationships.

AIMS

To investigate psychosocial development, attachment and school functioning in MC twins with sFGR and compare outcomes with the general population and between smaller and larger twins.

STUDY DESIGN

Observational cohort study.

SUBJECTS

MC twins with sFGR (defined as a birth weight discordance ≥20 %) born between 2002 and 2017 and aged 3-17 years.

OUTCOME MEASURES

Multiple parent report questionnaires: the Child Behavior Checklist (social-emotional development and behavior), the (Early) Childhood Behavior Questionnaire Very Short Form (temperament), the Attachment Insecurity Screening Inventory (attachment) and a school functioning questionnaire.

RESULTS

Median age for the 48 twin pairs was 11 (interquartile range (IQR) 8-13) years. Attachment insecurity for both twins was higher than in the general population for ambivalence/resistance (34 % (21/62) vs. 16 %, p = 0.024) and total attachment insecurity (35 % (22/62) vs. 16 %, p = 0.016). Smaller twins had more internalizing behavioral problems, i.e. negative emotions and behaviors turned inwards (22 % (10/46) vs. 11 % (5/46), p = 0.021) and a higher negative affect, i.e. more likely to experience negative emotions (3.2 (2.9-3.7) vs. 2.9 (2.2-3.2), p = 0.009) than larger twins, as well as a lower secondary school level (p = 0.031).

CONCLUSION

MC twins with sFGR have more ambivalent/resistant attachment insecurity following the complicated pregnancy course. Smaller twins have a tendency towards negative emotions and internalizing behaviors compared to larger twins, indicating an increased sensitivity for depression and anxiety.

Pandémie de COVID-19: attachement, anxiété, régulation émotionnelle et stratégies de coping chez les enfants d’âge scolaire

Introduction

Un impact de la pandémie de COVID-19 sur les émotions et comportements des enfants a été retrouvé dans plusieurs études. Cependant, cet impact n’a pas été retrouvé dans toutes les études. L’attachement pourrait être lié à des réactions et des niveaux d’anxiété différents.

Objectif

L’objectif principal de cette étude était d’analyser les liens entre l’attachement insécure des enfants et les variables liées à l’anxiété et à la gestion émotionnelle et comportementale des enfants pendant la pandémie.

Méthode

Les participants de l’étude (n = 83 parents et leur enfant âgé de 6 à 12 ans) ont complété de façon anonyme des questionnaires en ligne évaluant l’insécurité d’attachement, l’anxiété-état, les stratégies de coping et la régulation émotionnelle. Ils ont également répondu à des questions sociodémographiques et liées à leur contexte de vie et vécu de la pandémie.

Résultats

L’anxiété-état est liée de façon significative à la dysrégulation émotionnelle des enfants mais pas à la stratégie de coping tourné vers l’émotion. Des liens significatifs ont été observés entre l’insécurité d’attachement, d’une part, et l’anxiété-état des enfants, la stratégie de coping tourné vers l’émotion et la dysrégulation émotionnelle des enfants, d’autre part. La dysrégulation émotionnelle médiatiserait le lien entre attachement désorganisé et anxiété-état.

Conclusion

Les liens entre l’insécurité d’attachement et l’anxiété-état des enfants, d’une part, et la stratégie de coping tourné vers l’émotion, d’autre part, montrent l’importance de prendre en compte les facteurs individuels et interactionnels dans les manifestations socio-émotionnelles des enfants pendant la pandémie de COVID-19.

Caregivers' mind-mindedness and rural left-behind young children's insecure attachment: The moderated mediation model of theory of mind and family status

BACKGROUND

China's rapid development and urbanization since the early 1980s have compelled many rural residents to move from rural to urban areas for work, leaving thousands of children at home.

OBJECTIVE

This study tested the mediating effect of children's theory of mind on the relationship between caregivers' mind-mindedness and their children's insecure attachment differently depending on the different family status (the moderator) of left-behind and non-left-behind.

PARTICIPANTS

The participants were 3 to 6 years old 74 left-behind children (LBHC) and 89 non-left-behind children (NLBHC).

SETTINGS

Participants were from rural counties of central China in Henan province that has experienced a large labor migration.

METHODS

A cross-sectional moderated mediation model linked mind-mindedness (independent variable) and insecure attachment (dependent variable) through the theory of mind (mediator) and family status (moderator: left-behind/non-left-behind), controlling for age, gender, and siblings.

RESULTS

First, LBHC scored higher on insecure-disorganized attachment than NLBHC. Second, the early childhood theory of mind mediated the relationship between the caregiver's mind-mindedness and young children's insecure attachment. Third, family status moderated the effects of the theory of mind on insecure attachment. The mediating role was established only for the left-behind family, and the lower theory of mind ability was associated with the greater insecure attachment of LBHC.

CONCLUSIONS

Our findings highlight the critical role of mind-mindedness, theory of mind, and family status in the attachment theory and clarify the association between different levels of young children's theory of mind and insecure attachment based on family status.

Development of the Dog Attachment Insecurity Screening Inventory (D-AISI): A Pilot Study on a Sample of Female Owners

Simple Summary

The Strange Situation Procedure is a laboratory test originally designed to assess the quality of a child’s attachment bond to their mother and is widely used in dogs to assess their attachment bond towards the owner. However, the SSP is time consuming and limits the amount and variety of obtainable data. In order to overcome these limitations, we adapted a three-dimensional parent-report scale, named the Attachment Insecurity Screening Inventory (AISI) 6–12, originally developed to assess 6- to 12-year-old children’s attachment insecurity, to dog–owner dyads, and we assessed scale consistency and validity. A first statistical analysis performed on the responses provided by 524 female owners to the online questionnaire revealed five scale dimensions named “physical contact”, “control”, separation anxiety”, “owner as emotional support”, and “owner as a source of positive emotion”. However, a further forced extraction of three components resulted in subscales that mirrored the ones reported for the original AISI in terms of item composition (i.e., ambivalent, avoidant, and disorganized). The three subscales also had satisfactory to good measures of internal reliability. The final scale was named the Dog Attachment Insecurity Screening Inventory (D-AISI). Although promising, it needs to be refined and tested for more validity measures.

Abstract

To date, the Strange Situation Procedure is the only tool available to investigate the quality of the dog’s attachment bond towards the owner. This study aimed to adapt a parent-report scale, named the Attachment Insecurity Screening Inventory (AISI) 6–12, originally designed to assess 6- to 12-year-old children’s attachment insecurity, to dog–owner dyads and assess measures of consistency and validity. The online questionnaire was completed by 524 female dog owners. Principal component analysis (PCA) revealed five components named, respectively, “physical contact”, “control”, “separation anxiety”, “owner as emotional support”, and “owner as a source of positive emotion”. Because of the three-factor structure of the original AISI, a PCA with a pre-fixed set of three factors was also performed. The resulting subscales mirrored the ones found for the original scale (i.e., ambivalent, avoidant, and disorganized), although four items did not fit the model. Internal reliability appeared to be satisfying for the ambivalent and the disorganized subscales, and good for the avoidant subscale. The theoretical background and the results of this study suggest that the three-dimensional model represents a better solution for the interpretation of the Dog Attachment Insecurity Screening Inventory (D-AISI). Although promising, this scale requires refinement and assessment of additional validity measures.

Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: Study Protocol for Single-Case Experimental Design with Multiple Baselines (Preprint)

Background

Disruptive behavior is a common reason for young children to be referred to mental health care services worldwide. Research indicates that treatments for child disruptive behavior where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, this study focuses on creating the opportunity for parents to practice positive parenting skills more outside of the clinical setting by adding virtual reality (VR) as an additional homework element. PCIT has shown to make impactful long-term improvements in parental warmth, responsiveness, and the parent-child relationship. Through VR, parents practice the taught parenting skills out loud in the comfort of their own homes in VR scenarios. We expect that VR addition will innovatively increase the effectiveness of PCIT.

Objective

This study aimed to evaluate the added value of VR to PCIT by using a multiple baseline single-case experimental design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR element, we secondarily expected that meeting the skill criteria will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will be better, whereas parental stress and child disruptive behavior will decrease.

Methods

A total of 15 children (aged 2-7 years) with disruptive behavior and their parents will be followed throughout the PCIT-VR treatment. Using a multiple baseline SCED with 3 phases, 15 families will fill out questionnaires weekly, in addition to having pre- and posttreatment and follow-up measurements to monitor their positive parenting skills, child disruptive behavior, parenting stress, and VR progress. Moreover, quantitative information and qualitative interviews will be analyzed visually and statistically and summarized to provide a complete picture of experiences.

Results

As of February 2021, 6 families have been enrolled in the study at the moment of submission. Data collection is projected to be completed in 2023. Quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences.

Conclusions

The SCED—with its phased design, randomization, and the opportunity to replicate and assess both individual and group treatment effects—and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects, or technological failure will be mitigated with the right statistical support. This study aims to magnify the scope of the treatment through additional skill training, ultimately in support of routinely implementing VR within PCIT.

International Registered Report Identifier (IRRID)

DERR1-10.2196/34120

Development and validation of the Attachment Relationship Inventory-Caregiver Perception 2-5 years (ARI-CP 2-5): Psychometric structure, external validity, and norms

There is a lack of instruments assessing child–caregiver attachment relationships in early childhood to be used in attachment‐based practice, in particular from a caregiver's perception, which is an important factor of clinical importance to take into account in parenting interventions targeting young children. Therefore, the 48‐item Attachment Relationship Inventory—Caregiver Perception 2–5 years (ARI‐CP 2–5) was developed. Survey data of 446 caregivers of 2‐ to 5‐year‐old children were collected, and a subsample of 83 caregivers participated in an observation study. Confirmatory factor analysis confirmed a four‐factor structure of secure, avoidant, ambivalent, and disorganized attachment relationship. Indications of configural, metric, and scalar invariance were found for caregivers’ and children's sex, children's age, and population (clinical vs. general population). The four scales showed sufficient internal consistency and significant associations with children's psychopathology, caregivers’ general attachment representations, caregivers’ mind‐mindedness, and population type. Moreover, preliminary evidence for convergent validity with observational attachment measures was found. It is concluded that the ARI‐CP 2–5 is a valid instrument that can be used as part of the screening and assessment of insecure attachment relationships.

Five-year-olds' facial mimicry following social ostracism is modulated by attachment security

Social ostracism triggers an increase in affiliative behaviours. One such behaviour is the rapid copying of others' facial expressions, called facial mimicry. Insofar, it remains unknown how individual differences in intrinsic affiliation motivation regulate responses to social ostracism during early development. We examined children's facial mimicry following ostracism as modulated by individual differences in the affiliation motivation, expressed in their attachment tendencies. Resistant and avoidant tendencies are characterized by high and low affiliation motivation, and were hypothesized to lead to facial mimicry enhancement or suppression towards an ostracizing partner, respectively. Following an ostracism manipulation in which children played a virtual game (Cyberball) with an includer and an excluder peer, mimicry of the two peers' happy and sad facial expressions was recorded with electromyography (EMG). Attachment was assessed via parent-report questionnaire. We found that 5-year-olds smiled to sad facial expressions of the excluder peer, while they showed no facial reactions for the includer peer. Neither resistant nor avoidant tendencies predicted facial mimicry to the excluder peer. Yet, securely attached children smiled towards the excluder peer, when sad facial expressions were displayed. In conclusion, these findings suggest a modulation of facial reactions following ostracism by early attachment.

The modulation of facial mimicry by attachment tendencies and their underlying affiliation motives in 3-year-olds: An EMG study

From early in life, facial mimicry represents an important example of implicit non-verbal communication. Facial mimicry is conceived of as the automatic tendency to mimic another person's facial expressions and is thought to serve as a social glue among interaction partners. Although in adults mimicry has been shown to be moderated by the social context and one's needs to affiliate with others, evidence from behavioural mimicry studies suggest that 3-year-olds do not yet show sensitivity to social dynamics. Here, we examined whether attachment tendencies, as a proxy for interindividual differences in affiliation motivation, modulates facial mimicry in 3-year-olds. Resistant and avoidant insecure attachment tendencies are characterized by high and low affiliation motivation, respectively, and these were hypothesized to lead to either enhancement or suppression of mimicry. Additionally, we hypothesized that these effects will be moderated by inhibitory control skills. Facial mimicry of happy and sad expressions was recorded with electromyography (EMG), attachment tendencies were assessed with a parent-report questionnaire and inhibitory control with the gift delay task. The final sample consisted of 42 children, with overall scores suggesting secure attachment. Our findings revealed that 3-year-olds mimicked happy and sad facial expressions. Moreover, resistant tendencies predicted enhanced sad but not happy facial mimicry, whereas avoidant tendencies were not significantly related to mimicry. These effects were not moderated by inhibitory control skills. In conclusion, these findings provide the first evidence for the modulation of mimicry by attachment tendencies and their underlying motivation for affiliation in young children, specifically for negatively-valenced emotional expressions.

Internal structure and reliability of the Attachment Insecurity Screening Inventory (AISI) for children age 6 to 12

BACKGROUND

The aim of the present study was to examine the internal structure and reliability of the Attachment Insecurity Screening Inventory (AISI) 6-12. The AISI 6-12 years is a parent-report questionnaire for assessing the parents' perspective on the quality of the attachment relationship with their child aged between 6 and 12 years.

METHODS

The sample consisted of 681 mothers and fathers reporting on 372 children (72.3% adoption parents, 14.9% non-biological primary care takers including foster parents, and 12.8% biological parents). The internal structure was assessed with multilevel confirmatory factor analyses (CFA) and the reliability of the scores with Cronbach's and ordinal alphas.

RESULTS

Multilevel CFA confirmed a three-factor model of avoidant, ambivalent/resistant and disorganized attachment. Multi-group CFA indicated full configural and metric measurement invariance, and partial scalar and strict measurement invariance across mothers and fathers. Reliability coefficients were found to be sufficient.

CONCLUSIONS

This study showed the potential of using parental reports in the initial screening of attachment related problems, especially considering the practical approach of parental reports. However, further development of the AISI 6-12 years seems important to increase the validity of the AISI 6-12 years. In addition, future studies are necessary to replicate the current findings, and to strengthen the evidence that the AISI 6-12 years is appropriate for the use in middle childhood and validly assesses the parents' perspective on attachment insecurities in their child.

Sexual abuse in very young children: a psychological assessment in the Amsterdam Sexual Abuse Case study

Background: Child sexual abuse (CSA) is a worldwide problem affecting children of all ages and socioeconomic backgrounds. A knowledge gap exists regarding the psychological outcomes for children, boys in particular, who are abused during their early lives. Objective: To provide a descriptive psychological profile of children who experienced sexual abuse as infants or toddlers from a male daycare worker and babysitter, and to assess the psychopathological impact on their parents. Method: Parents of children involved in the Amsterdam Sexual Abuse Case (41 parents; 44 children, age range 3-11 years, 30 boys, 14 girls) completed measures on post-traumatic stress disorder (PTSD), dissociation, sexual and non-sexual behaviour problems, and attachment insecurity in their children, as well as on parental psychological well-being, 3 years after disclosure. Sexual abuse characteristics were obtained from police records. Results: We found that 3% of confirmed child victims had PTSD, 30% sexual behaviour problems, 24% internalizing problems, 27% attachment insecurity, and 18% any psychiatric disorder (including PTSD); 39% were asymptomatic. In parents, we found feelings of guilt, shame, and anger about the abuse of their child; 19% showed PTSD symptoms and 3% showed avoidant and 8% anxious attachment problems in their intimate relationship. Parental symptomatology was related to child symptomatology, except for child sexual behaviour problems. One-quarter of confirmed child victims and 45% of parents had received psychological treatment. Conclusions: Three years after disclosure, extrafamilial CSA in very young children was associated with sexual and non-sexual behaviour problems and attachment insecurity, but rarely with PTSD or dissociation. For parents it was associated with PTSD symptoms and emotional reactions. Assessments and interventions should focus on the wide spectrum of problems that follow CSA, as well as on parental psychopathology and the parent-child relationship. Future follow-up assessments in our longitudinal study should provide insights into longer-term outcomes.

Problemas de externalização e internalização em pré-adolescentes e vinculação aos pais || Externalizing and internalizing problems in pre-adolescents and attachment to parents

Os comportamentos de externalização e internalização na infância e na adolescência refletem um mal-estar do sujeito, que muitas vezes o próprio não sabe explicar, mas que se traduz noutras áreas da vida. A publicação recorrente das elevadas percentagens destes problemas, nestas idades, suscita a necessidade de estudos periódicos em amostras de comunidade, para que se possa sinalizar e intervir precocemente. A vinculação insegura aos pais é um dos fatores associado à emergência destes problemas. Apresentamos um estudo exploratório, com o Questionário de Capacidades e Dificuldades (SDQ) e o Inventário de Vinculação a Pais e Pares (IPPA), das relações entre problemas de externalização, problemas de internalização e vinculação aos pais, reportados por pré-adolescentes portugueses, numa amostra de 258 sujeitos, 124 rapazes (48.1 %), e 134 raparigas (51.9 %), entre os 9 e 12 anos (M = 10.34; DP = 0.88). Estudou-se a relação entre a presença de problemas de comportamento reportados pelos pré-adolescentes e os mesmos problemas reportados pelos seus pais, tendo-se obtido correlações positivas e significativas entre ambas as avaliações. Maior segurança na vinculação aos pais (i.e., maiores valores nas dimensões “Aceitação mútua-compreensão”, “Comunicação-proximidade afetiva” e menores no “Afastamento-rejeição”) correlaciona negativamente com os problemas de comportamento reportados pelos próprios, reforçando a importância da segurança das relações de vinculação aos pais na manutenção de comportamentos mais adaptados nos adolescentes