The role of sociodemographic risk and maternal behavior in the prediction of infant attachment disorganization

Developing the mother-child interaction inventory and uncovering mother-child interaction profiles in Türkiye

BACKGROUND

In this study, we aimed to design a mother-report inventory to comprehensively assess mother-child interaction in the 0-3 age range, focusing on maternal and child interaction behavior and mutual attunement.

METHODS

Our research involved three stages, with 1061 mothers and their 0-3-year-old children: 45 in the pilot study, 498 in exploratory factor analysis and latent profile analysis, and 518 in confirmatory factor analysis.

FINDINGS

The Mother-Child Interaction Inventory emerged as a valid and reliable measurement tool, comprising three distinct scales: 1) Maternal Interaction Behavior Questionnaire with sensitive structuring, hostility, and intrusiveness subscales; 2) Child Interaction Behavior Questionnaire with emotional-behavioral involvement and child characteristics; and 3) Mutual Attunement Questionnaire with reciprocity and problem-solving subscales. Latent profile analysis revealed four mother-child interaction profiles, indicating different characteristics in maternal and child interaction behavior and mutual attunement, categorized as "Excellent interaction quality," "Average interaction quality 1", "Average interaction quality 2," and "Poor interaction quality."

DISCUSSION

The study underscores the significance of maternal and child interaction behavior and mutual attunement in determining the quality of mother-child interaction. The mother-report The Mother-Child Interaction Inventory is a functional measurement tool to evaluate interaction separately and holistically, unveiling mother-child interaction profiles in the Turkish context.

PRACTICE IMPLICATIONS

The practical implications of this research are significant for health professionals, educators, and stakeholders working with children and families. The Mother-Child Interaction Inventory provides a valuable tool for assessing interaction dynamics, offering insights that can be directly applied to improve mother-child interaction.

Mother-infant bonding: The role of postpartum depression, violence, and bonding established with one's own mother during childhood

Mother-infant bonding is influenced by several risk and protective factors, and the literature has investigated the relationships between these factors independently. This study aimed to verify the interrelationships of some of these factors and how they influence mother-infant bonding in Brazil. In this study, 361 mothers participated, and the outcome variable of mother-infant bonding was assessed using the Postpartum Bonding Questionnaire (PBQ). Multivariate regression analysis was performed using a hierarchical model with three blocks structured according to the influence exerted on mother-infant bonding. The PBQ's factor scores were estimated and used in the subsequent analyses to decrease measurement error. The variable "violence experienced by mothers" was statistically significant for explaining the second block model but not significant for the third block. Network analysis was performed after multiple regression, showing that the violence experienced by mothers does not directly influence mother-infant bonding but rather is mediated by postpartum depression. This explains why violence is not significant in the hierarchical multiple regression when maternal depression is added to the model. This study's strengths lie in its utilization of PBQ factor scores and network analysis, enabling the estimation of conditional relationships among variables. This approach provides deeper insights into factors affecting mother-infant bonding.

An exploration of the domain specificity of maternal sensitivity among a diverse sample in the infancy period: Unique paths to child outcomes

Maternal sensitivity during an observed mother-child clean-up task at 18 months and maternal sensitivity during an observed mother-child free-play task at 18 months were tested as independent predictors of child internalizing symptoms, externalizing symptoms, social competence, and language development at 24 months. Participants (n = 292 mothers) were recruited between 2015 and 2017, and were low-income (mean annual income = $19,136) and racially and ethnically diverse (43.8% Black; 44.2% Latinx). Maternal sensitivity during clean-up was a significant predictor of all social-emotional outcomes, and a unique predictor of child internalizing symptoms. Maternal sensitivity during free-play was a unique predictor of child language. Results suggest that context-specific subtypes of maternal sensitivity may differentially relate to early child outcomes.

Effect of Neonatal Abstinence Syndrome Treatment Status and Maternal Depressive Symptomatology on Maternal Reports of Infant Behaviors

OBJECTIVE

The objective of this study is to investigate the effects of maternal perinatal depression symptoms and infant treatment status for neonatal abstinence syndrome (NAS) on maternal perceptions of infant regulatory behavior at 6 weeks of age.

METHODS

Mothers and their infants (N = 106; 53 dyads) were recruited from a rural, White cohort in Northeast Maine. Mothers in medication-assisted treatment (methadone) and their infants (n = 35 dyads) were divided based on the infant's NAS pharmacological treatment (n = 20, NAS+ group; n = 15, NAS- group) and compared with a demographically similar, nonexposed comparison group (n = 18 dyads; COMP group). At 6 weeks postpartum, mothers reported their depression symptoms Beck Depression Inventory-2nd Edition) and infant regulatory behaviors [Mother and Baby Scales (MABS)]. Infant neurobehavior was assessed during the same visit using the Neonatal Network Neurobehavioral Scale (NNNS).

RESULTS

Mothers in the NAS+ group showed significantly higher depression scores than the COMP group (p < .05) while the NAS- group did not. Across the sample, mothers with higher depression scores reported higher infant "unsettled-irregularity" MABS scores, regardless of group status. Agreement between maternal reports of infant regulatory behaviors and observer-assessed NNNS summary scares was poor in both the NAS+ and COMP groups.

CONCLUSIONS

Postpartum women in opioid recovery with infants requiring pharmacological intervention for NAS are more at risk for depression which may adversely influence their perceptions of their infants' regulatory profiles. Unique, targeted attachment interventions may be needed for this population.

A Systematic Review on Attachment and Sleep at Preschool Age

Sleep is a biological process that impacts nearly every domain of a child's life. Sleep-wake regulation influences and it is highly influenced by developmental variables related to parent-child relationships, such as attachment. The main goal of the present systematic review is to analyze and integrate the findings of empirical studies investigating the relations between attachment and sleep in preschool age, a period marked by important developmental changes that challenge both attachment system and sleep-wake regulation. A database search was performed using a combination of relevant keywords, leading to the identification of 524 articles, with 19 manuscripts assessed for eligibility; finally, seven studies (2344 children) were included. Overall, the findings were not consistent, with some studies reporting significant associations between attachment security and sleep quality, as well as between attachment insecurity and sleep problems, whereas others did not find significant associations. The results are discussed in light of the available theoretical models and integrated in the context of measurement approaches to attachment and sleep heterogeneity, aiming to guide future research on the topic.

Developmental pathways from maternal history of childhood maltreatment and maternal depression to toddler attachment and early childhood behavioral outcomes

The current study examined the development of toddler attachment and early childhood behavior among children of mothers with a history of childhood maltreatment and current major depressive disorder. Maternal depression, maternal sensitivity, and toddler attachment were assessed as mediators of the association between maternal history of childhood maltreatment and child internalizing and externalizing behavior. Participants were from a low-income, largely racial minority urban sample and included 123 mothers with (n = 69) and without (n = 54) major depressive disorder at baseline and their children assessed at 12, 26, and 36 months old. Findings suggest maternal depression and maternal sensitivity mediated the association between maternal history of childhood maltreatment and disorganized attachment. Maternal depression, but not disorganized attachment, mediated the association between maternal history of childhood maltreatment and child symptomatology. Results suggest that supporting mothers through depression and processing their adverse childhood experiences are critical in fostering positive child development.

Maternal Personality Predicts Insensitive Parenting: Effects through Causal Attributions about Infant Distress

The association between parent personality and parenting has been established in the literature; however, the mechanisms explaining this relationship remain poorly understood. In the current study, we examined associations between maternal personality and maternal insensitive behaviors through causal attributions about infant distress. Primiparous mothers (N = 259) reported maternal personality during the third trimester of pregnancy. Mothers and 6-month-old infants were videotaped during distress eliciting tasks and mothers' causal attributions were assessed using a video recall method. Maternal unresponsiveness and negativity were coded. Maternal neuroticism was indirectly associated with more overtly negative maternal behaviors through negative attributions, whereas agreeableness was directly associated with fewer unresponsive maternal behaviors. Additionally, mothers who made more situational attributions engaged in fewer unresponsive behaviors. Results suggest maternal personality and causal attributions play an important role in maternal behavior in distressing contexts. Directions for intervention, parent education, and future research are discussed.

An initial investigation of neonatal neuroanatomy, caregiving, and levels of disorganized behavior

Attachment disorganization is a risk factor for difficulties in attention, social relationships, and mental health. Conceptually, attachment disorganization may indicate a breakdown in fear regulation resulting from repeated exposure to frightening maternal care. In addition, past research has examined the influence of stress-inducing contextual factors and/or child factors upon the development of disorganization. However, no past work has assessed whether infant neuroanatomy, important to stress regulation, moderates the association between maternal care and levels of disorganized behavior. Here, utilizing data from a subsample of 82 dyads taking part in the "Growing Up in Singapore towards Healthy Outcomes" (GUSTO) cohort, we assessed the prediction from maternal sensitive caregiving at 6 mo and levels of attachment disorganization at 1.5 y, as moderated by hippocampal and amygdala volume determined within the first 2 weeks of life. Results indicate a significant interaction between neonatal left hippocampal volume and maternal sensitivity upon levels of disorganized behavior. Although these results require substantiation in further research, if replicated, they may enable new strategies for the identification of processes important to child mental health and points for intervention. This is because neonatal neuroanatomy, as opposed to genetic variation and sociodemographic risk, may be more directly linked to stress responses within individuals.

Maternal sensitivity to distress and attachment outcomes: Interactions with sensitivity to nondistress and infant temperament

The extent to which maternal sensitivity to infant distress predicts specific attachment outcomes independent of and in conjunction with maternal sensitivity to infant nondistress and in conjunction with infant-negative emotionality was examined in a sample of 259 mother-infant dyads. Maternal sensitivity to infant distress and nondistress was observed in a series of distress-eliciting tasks when infants were 6 months and 1-year-old. Mothers rated infant-negative emotionality at 6 months. Infant-mother attachment was observed during the "strange situation" (Ainsworth, Blehar, Waters, & Wall, 1978) at 1 year. Four attachment outcomes were considered: the dichotomous security/insecurity classification, avoidant and resistant behaviors across both reunion episodes, and a single rating for disorganized behavior. Maternal sensitivity to distress and nondistress at 1 year were treated as covariates. Sensitivity to distress and nondistress at 6 months and 1 year did not predict more adaptive attachment outcomes as main effects. However, sensitivity to distress and nondistress at 6 months interacted significantly in relation to avoidance, such that sensitivity to nondistress was significantly associated with higher avoidance when sensitivity to distress was low, but not when sensitivity to distress was high. Furthermore, sensitivity to distress at 6 months interacted with infant-negative emotionality in relation to security and both resistant and disorganized behaviors, such that sensitivity to distress was positively associated with security and negatively associated with resistant and disorganized behaviors only among infants who were high on mother-reported negative emotionality. Implications for future research and intervention are discussed. (PsycINFO Database Record

DISORGANIZATION, FEAR AND ATTACHMENT: WORKING TOWARDS CLARIFICATION

In 1990, M. Main and J. Solomon introduced the procedures for coding a new "disorganized" infant attachment classification for the Ainsworth Strange Situation procedure (M.D.S. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978). This classification has received a high degree of interest, both from researchers and from child welfare and clinical practitioners. Disorganized attachment has primarily been understood through the lens of E. Hesse and M. Main's concept of "fright without solution," taken to mean that an infant experiences a conflict between a desire to approach and flee from a frightening parent when confronted by the Strange Situation. Yet, looking back, it can be observed that the way Hesse and Main's texts were formulated and read has generated confusion; there have been repeated calls in recent years for renewed theory and clarification about the relationship between disorganization and fear. Responding to these calls, this article revisits the texts that introduced the idea of fright without solution, clarifying their claims through articulating more precisely the different meanings of the term fear. This clarified account will then be applied to consideration of pathways to infant disorganized behaviors.

Further evidence of the limited role of candidate genes in relation to infant-mother attachment outcomes

In this paper, we examine the associations between specific candidate genes (DRD2, DRD4, COMT, biallelic and tri-allelic 5HTTLPR, and OXTR) and infant attachment outcomes as main effects and in conjunction with maternal sensitivity. The sample included 200 infants (97 European American, 94 African-American, and 9 biracial) and their mothers. Maternal sensitivity and overtly negative maternal behavior were observed when infants were 6 months and 1 year old in distress-eliciting contexts, attachment was assessed via the Strange Situation at age 1, and DNA samples were collected when children were 2 years old. Consistent with recent research in large samples, there was little evidence that these genes are associated with attachment security, disorganization, or distress as main effects (in additive, dominant, and homozygous models) or in conjunction with maternal sensitivity or overtly negative behavior (primarily dominance models). Furthermore, there was little evidence that associations vary as a function of race.

Infant attachment disorganization and moderation pathways to level and change in externalizing behavior during preschool ages

This research examined the child, parent, and family conditions under which attachment disorganization was related to both level and change in externalizing behavior during preschool among a community sample. Using the ordinary least squares regression, we found that attachment disorganization at 12 months significantly predicted children's externalizing behavior at 36 months and this prediction was not contingent on any other factors tested. For predicting changes in externalizing behavior from 36 to 60 months, we found a significant main effect of family cumulative risk and an interaction effect between attachment disorganization at 12 months and maternal sensitivity at 24 months. Specifically, high disorganization was related to a significant decrease in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high. Our main-effect findings replicated the significant effect of attachment disorganization and cumulative risk on externalizing behavior with preschool-aged children. Our interaction finding provided support for understanding the parenting conditions under which infant attachment disorganization may be related to change in externalizing behavior during preschool ages. Implications of the findings were discussed.