The significance of insecure and disorganized attachment for children's internalizing symptoms: a meta-analytic study

A systematic review and meta-analysis of the effectiveness of interventions targeting the parent-child relationship in families of children with an intellectual disability

BACKGROUND

The review aimed to investigate the effectiveness of parent-child relationship interventions for families of children with intellectual disability up to 12 years old.

METHODS

Quasi-experimental or randomised controlled trials (RCTs) of interventions targeting the parent-child relationship where ≥50% of children had an intellectual disability were included. Meta-analyses of parent-child relationship outcomes and child outcomes used standardised mean difference as the effect size.

RESULTS

Twenty-seven papers were included (N = 1325). Parent-child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication.

CONCLUSIONS

Findings suggest that interventions targeting parent-child relationship quality are associated with substantial improvements in parent-child relationship and may improve child outcomes related to socialisation and communication.

The power of the adult attachment interview in predicting subsequent psychopathology: a tribute to Mary Main

Mary Main's conceptualization and operationalization of attachment states of mind through the Adult Attachment Interview (AAI) represent seminal contributions to the attachment field. The AAI is a semi-structured clinical interview used to assess attachment states of mind that is widely used in research and clinical settings. Unresolved state of mind regarding loss or trauma has been linked to concurrent internalizing symptoms. The current study explored the associations between unresolved classification and later depression and anxiety, above and beyond trauma history and symptoms. Participants (n = 70) were parents (98.6% female, 67.1% Black/African-American) from a follow-up of a randomized clinical trial of a parenting program for families referred to child welfare services. Parents completed the AAI, Childhood Trauma Questionnaire, and the Psychiatric Diagnostic Screening Questionnaire at timepoint 1 (T1) and the Brief Symptom Inventory approximately 12 years later, at timepoint 2 (T2). Hierarchical regressions revealed that unresolved state of mind significantly predicted depression at T2, and marginally predicted anxiety at T2, above and beyond childhood trauma, post-traumatic stress symptoms, and early internalizing symptoms. These results suggest that unresolved states of mind are clinically significant and provide unique information about later internalizing symptoms in adults with a history of trauma or loss.

Frightening maternal behavior over the first 2 years of life: effects on children's behavior problems in middle childhood

Frightening maternal behavior is linked to infant disorganization, which predicts child behavioral problems. We examined continuity in frightening maternal behavior across the first 2 years by developing a new measure of anomalous/frightening (AN/FR) behavior that incorporates changes in parent-child interactions as children acquire symbolic representation. Maternal AN/FR behavior in toddlerhood also was examined in relation to later internalizing and externalizing symptoms. First-time mothers (N = 125) completed the Adult Attachment Interview (AAI) prenatally, and mother-child dyads were observed interacting at 8 months, in Strange Situations at 12-15 months, and playing at 24 months. Teachers rated children's behavior problems at 7 years. Mothers classified as Unresolved on the AAI displayed more Frightening (FR) behavior at 8 months. Mothers' FR behavior predicted both attachment disorganization at 12-15 months and maternal AN/FR behavior at 24 months, which then predicted children's internalizing symptoms at age 7. Infant disorganization was indirectly related to internalizing symptoms, mediated by maternal AN/FR behavior.

Toddler disorganized attachment in relation to cortical thickness and socioemotional problems in late childhood

Disorganized attachment is a risk for mental health problems, with increasing work focused on understanding biological mechanisms. Examining late childhood brain morphology may be informative - this stage coincides with the onset of many mental health problems. Past late childhood research reveals promising candidates, including frontal lobe cortical thickness and hippocampal volume. However, work has been limited to Western samples and has not investigated mediation or moderation by brain morphology. Furthermore, past cortical thickness research included only 33 participants. The current study utilized data from 166 children from the GUSTO Asian cohort, who participated in strange situations at 18 months and MRI brain imaging at 10.5 years, with 124 administered the Child Behaviour Checklist at 10.5 years. Results demonstrated disorganization liked to internalizing problems, but no mediation or moderation by brain morphology. The association to internalizing (but not externalizing) problems is discussed with reference to the comparatively higher prevalence of internalizing problems in Singapore.

Attachment and body representations in adolescents with personality disorder

BACKGROUND

Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated.

METHOD

A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror.

RESULTS

The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR).

CONCLUSION

Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD.

Attachment security and disorganization in infants of mothers with severe psychiatric disorder: Exploring the role of comorbid personality disorder

The aim of this preliminary study was to explore infant-mother attachment quality in a Dutch clinical sample of mothers with severe psychiatric disorder, with or without comorbid personality disorder. Thirty-two mothers were recruited through specialized secondary and tertiary outpatient clinics and mental health institutions. Maternal psychiatric and personality diagnoses were verified with structured clinical interviews during pregnancy. Maternal concurrent level of psychiatric symptoms was assessed by self-report and infant-mother attachment quality by observation in the Strange Situation Procedure at 14 months postpartum. In the full sample, almost half of the infants were classified as disorganized. All infants of mothers with a comorbid personality disorder were classified as either insecure or disorganized. Infants of mothers with a comorbid personality disorder had a significantly higher disorganization score than infants of mothers with a psychiatric disorder only. Continuous attachment security scores did not differ significantly between groups. In the full sample, continuous infant attachment security and disorganization score were not significantly correlated with the level of maternal concurrent psychiatric symptoms. Our exploratory findings suggest a specific link between maternal psychiatric and comorbid personality disorder and attachment disorganization. Moreover, chronicity of symptoms appears more relevant for attachment behaviors than the severity of concurrent psychiatric symptoms. Maternal personality disorder may have a strong formative impact on infant attachment security and disorganization, which warrants further research to inform clinical practice, in order to reduce the risk of intergenerational transmission of maternal psychopathology.

The Cognitive Architecture of Infant Attachment

Meta-analytic evidence indicates that the quality of the attachment relationship that infants establish with their primary caregiver has enduring significance for socioemotional and cognitive outcomes. However, the mechanisms by which early attachment experiences contribute to subsequent development remain underspecified. According to attachment theory, early attachment experiences become embodied in the form of cognitive-affective representations, referred to as internal working models (IWMs), that guide future behavior. Little is known, however, about the cognitive architecture of IWMs in infancy. In this article, we discuss significant advances made in the field of infant cognitive development and propose that leveraging insights from this research has the potential to fundamentally shape our understanding of the cognitive architecture of attachment representations in infancy. We also propose that the integration of attachment research into cognitive research can shed light on the role of early experiences, individual differences, and stability and change in infant cognition, as well as open new routes of investigation in cognitive studies, which will further our understanding of human knowledge. We provide recommendations for future research throughout the article and conclude by using our collaborative research as an example.

Perinatal Predictors and Mediators of Attachment Patterns in Preschool Children: Exploration of Children's Contributions in Interactions with Mothers

Insecure and disorganized attachment patterns in children are linked to poor health outcomes over the lifespan. Attachment patterns may be predicted by variables that influence the quality of children's interactions with their primary caregivers/parents (usually mothers) such as prenatal and postnatal exposures and the children's own behaviours in interactions. The purposes of this exploratory study were to examine: (1) prenatal predictors of children's attachment patterns, and (2) postnatal mediators and moderators of associations between prenatal predictors and children's attachment patterns, with adjustment for relevant covariates. Mother-child dyads (n = 214) from the longitudinal Alberta Pregnancy Outcomes and Nutrition (APrON) cohort were studied using valid and reliable measures. Hayes' mediation analysis was employed to determine direct and indirect effects. Mothers' prenatal cortisol levels directly predicted disorganized (versus organized) child attachment in unadjusted models. Children's passivity (in adjusted models) and compulsivity (in unadjusted and adjusted models) in parent-child interactions mediated the pathway between mothers' prenatal cortisol levels and children's disorganized attachment patterns. Serial mediation analyses revealed that mothers' cortisol levels predicted their children's cortisol levels, which predicted children's compulsivity, and, ultimately, disorganized attachment in both unadjusted and adjusted models. No predictors were correlated with children's insecure (versus secure) attachment. This exploratory research suggests that prenatal exposure to mothers' cortisol levels and children's behavioural contributions to parent-child interaction quality should be considered in the genesis of children's attachment patterns, especially disorganization. Interventions focused on parent-child interactions could also focus on addressing children's behavioral contributions.

Parent Emotion Regulation, Mindful Parenting, and Youth Attachment: Direct and Indirect Associations with Internalizing and Externalizing Problems

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health.

The relationship between attachment and posttraumatic stress in children and adolescents: A meta-analytic review

The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies (N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS (r = -.16) and a positive correlation between insecure attachment (r = .20), avoidant attachment (r = .20), anxious attachment (r = .32), and disorganized attachment (r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.

Parental prenatal representations of the child are related to 18-month-old children's social-emotional competence

Parental representations of the child are linked to positive developmental outcomes in children, but the impact of prenatal representations on early social-emotional development, particularly from fathers, is less understood. This study explores how fathers' and mothers' prenatal representations within two-parent families are associated with early social-emotional development. Prenatal representations of fathers (n = 88) and mothers (n = 92) were assessed between 28 and 32 weeks of gestation using the Working Model of the Child Interview, categorizing them as balanced or nonbalanced. The children's (n = 97; 49.5% girls) social-emotional and behavioral problems and competencies were measured at 18 months using the Brief Infant-Toddler Social and Emotional Assessment. Balanced prenatal representations of both parents were related to higher social-emotional competence in toddlers. However, prenatal representations were not related to social-emotional and behavioral problems. The results highlight the benefits of balanced prenatal representations in promoting early social-emotional competence in children.

Mother-Child Attachment Relationship in Pregnancy, Postpartum, and Early Childhood: Current Status and New Research Perspectives

The mother-child attachment relationship is a cornerstone of human development, with profound implications for the well-being of both the mother and child [...].

Helping Institutionalised Children through a Trusting Relationship-Findings from a One-Year Psychosocial Intervention Programme

Children growing up in institutions lack a stable relationship-essential for development. A significant proportion of them have disorganised attachment, which is associated with negative outcomes. Therefore, interventions aimed at improving attachment security are needed. We conducted a case series study (involving five participants aged 8-11 years) in a newly established psychosocial rehabilitation daycare centre to describe the changes in attachment security and mental health of institutionalised children after one year of attendance. The intervention consisted of individualised care focusing on staff building a trusting relationship with participants using the principles of Trust-Based Relational Intervention® (TBRI). Measures such as the Child Attachment Interview, SDQ, CBCL6/18, TRF6/18, and clinical interviews were used to follow change. The descriptive data of five participants are presented. All five children improved in mental health, and for two participants, organisation of attachment changed. Three children experienced relational ruptures. The findings suggest that psychosocial interventions that focus on building trusting relationships may be beneficial in institutionalised children. For these children, given their life history, it can be damaging to experience repeated breakdowns. Thus, the practical implication is that any new relationship for them with an adult should be established after an assessment of whether the relationship can be sustained.

Familial Abuse During Childhood and Later-Life Health: Exploring the Role of Victim-Perpetrator Relationships

OBJECTIVES

Childhood abuse has been extensively studied in relation to later-life health, yet relatively little attention has been given to understanding the nuanced dynamics across victim-perpetrator relationships. This study addresses this gap by identifying typologies of familial perpetrators of childhood abuse in a national sample and examining their associations with various health outcomes, including physical and mental health as well as substance abuse.

METHODS

We used 2 waves of data from the Midlife in the US Study (n = 6,295, mean age = 46.9 at baseline). The analysis was completed in 3 stages. Using Latent Class Analysis (LCA), we identified subpopulations of victims with distinct familial perpetrator histories. With assigned LCA memberships and propensity score weighting, we investigated the extent to which specific victim-perpetrator relationships are associated with health outcomes measured at baseline and a 10-year follow-up adjusting for other early-life risks. We evaluated whether the observed associations differ across the waves.

RESULTS

Parental and sibling abuse commonly co-occur, surpassing the occurrence of single perpetrators. Although minimal health disparities are evident between sibling-only abuse and no/little abuse groups at baseline, parent-only abuse is associated with compromised health outcomes. Severe abuse from both siblings and parents is linked to the most adverse health outcomes. At the follow-up survey, the associations between familiar abuse and health outcomes weakened, particularly for substance abuse.

DISCUSSION

This study, delving into family relationships, family violence, and health disparities, provides new evidence to augment our comprehension of the enduring link between childhood abuse and health within the family context.

Individual longitudinal changes in DNA-methylome identify signatures of early-life adversity and correlate with later outcome

Adverse early-life experiences (ELA) affect a majority of the world's children. Whereas the enduring impact of ELA on cognitive and emotional health is established, there are no tools to predict vulnerability to ELA consequences in an individual child. Epigenetic markers including peripheral-cell DNA-methylation profiles may encode ELA and provide predictive outcome markers, yet the interindividual variance of the human genome and rapid changes in DNA methylation in childhood pose significant challenges. Hoping to mitigate these challenges we examined the relation of several ELA dimensions to DNA methylation changes and outcome using a within-subject longitudinal design and a high methylation-change threshold. DNA methylation was analyzed in buccal swab/saliva samples collected twice (neonatally and at 12 months) in 110 infants. We identified CpGs differentially methylated across time for each child and determined whether they associated with ELA indicators and executive function at age 5. We assessed sex differences and derived a sex-dependent 'impact score' based on sites that most contributed to methylation changes. Changes in methylation between two samples of an individual child reflected age-related trends and correlated with executive function years later. Among tested ELA dimensions and life factors including income to needs ratios, maternal sensitivity, body mass index and infant sex, unpredictability of parental and household signals was the strongest predictor of executive function. In girls, high early-life unpredictability interacted with methylation changes to presage executive function. Thus, longitudinal, within-subject changes in methylation profiles may provide a signature of ELA and a potential predictive marker of individual outcome.

Development of the Arabic Inventory of Parent and Domestic Worker Attachment (A-IPDWA): A tool to assess adolescents' attachment to secondary figures

INTRODUCTION

Adolescents' attachment security toward parental figures has been assessed in multiple cultures and languages. In some cultural contexts, the presence of a secondary parental figure is ubiquitous, though its effect on children's and adolescents' well-being has been understudied. The present study aimed to validate a culture-specific Arabic instrument of attachment security, in an adolescent sample of Qatar. Since foreign domestic workers (Khadama) play a key role as secondary caring figures in Middle Eastern countries, the new instrument included parents (i.e., mother and father) and domestic workers as providers of attachment security.

METHODS

A sample of 387 adolescents (ages 12-17 years; 48.3% females) participated in the study in the 2020-2021 school term. While 286 students completed the version in modern Arabic, 101 counterparts attending international schools filled in the English version for comparison purposes.

RESULTS

Confirmatory Factor Analysis for all three forms (i.e., mother, father, and domestic worker) showed the one-dimension of the Arabic tool. Optimal Tucker's Phi coefficient indicated a comparable one-factor structure of attachment security across linguistic versions. Moderate correlations (positive and negative, respectively) of attachment security towards father and mother (but not towards domestic workers) with family cohesion and family conflict dimensions of the Family Environment Scale provided evidence for the concurrent validity.

DISCUSSION

Gender differences in the links between adolescents' attachment security and family conflict were observed; culturally relevant relationship family patterns are stressed. The practical implications of the Arabic Inventory of Parent and Domestic Worker Attachment (A-IPDWA) validation are discussed.

Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy

Dyadic Developmental Psychotherapy (DDP) is a family-based therapy for adopted children aiming to achieve secure attachment between the child and parent. Due to restrictions under the COVID-19 pandemic, delivery of DDP transitioned from face-to-face to online methods. This study aimed to explore families experience of online DDP compared to face-to-face DDP, looking at the advantages and disadvantages of remote delivery methods and the implications this has on future service delivery for clinicians. Semi-structured interviews with 6 families were conducted online. Analysis of transcripts using Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes: environment and child engagement, non-verbal communication, travel and familiarity with remote interactions. Parents recognised the influence the physical and online environment had on their child's engagement levels, however, varied in their experience and hence preference of delivery method. All families emphasised the importance of non-verbal communication within DDP sessions and majority highlighted this may be lost online. For families who travelled to face-to-face DDP, car journeys provided a unique opportunity to decompress and reflect after sessions. For families where travel is unfeasible, online DDP was a lifeline, demonstrating the ability of remote therapy to widen access to specialist healthcare. Familiarity with online work emerged as a strong indicator of positive attitudes towards remote DDP, especially if the previous experience is positive and the child is confident using technology. Overall, families differed greatly in their experience of remote and face-to-face DDP indicating a new approach must be undertaken with each family beginning therapy, ensuring it is unique and individual to their needs.

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.

Trust-Based Relational Intervention® (TBRI®) Impact for Traumatized Children-Meaningful Change on Attachment Security and Mental Health after One Year

Children from vulnerable backgrounds often have insecure attachment or disorganized attachment, which are related to psychological troubles, and such children need interventions to help them heal. The attachment system reorganizes in middle childhood, and other important adults play a considerable role in children's lives. Thus, it is essential to weigh the impact of psychosocial interventions, while the main focus of the intervention is the staff member's direct work with the child through a trusting relationship. The primary purpose of this study is to investigate whether children's attachment security and mental health outcomes change after participating in a trauma-informed, attachment-based, Trust-Based Relational Intervention (TBRI) provided in a daycare center. It was a case-series study involving twelve children aged 8-11 years. The child attachment interview (CAI), CBCL/6-18, TRF/6-18, and clinical interviews for parents and children were used, measuring the change between the TBRI implementation in the daycare center and after one year. For ten participants, we noticed an improvement in mental health; for seven participants, security scales improved; for two participants, their disorganized attachment changed into insecure-dismissing. We have preliminary evidence that vulnerable children may benefit in terms of attachment security and mental health from the trusting relationship that staff build using the TBRI.

Taking stock to move forward: Where the field of developmental psychopathology might be heading

In this paper, dedicated to Dante Cicchetti's contributions and enduring influence, we explore the prospective directions of developmental psychopathology. Our focus centers on key domains where Cicchetti's significant achievements have continually shaped our evolving thinking about psychological development. These domains include (a) the concepts of equifinality and multifinality, along with the challenges in predicting developmental trajectories, (b) the imperative to integrate wider sociocultural viewpoints into developmental psychopathology frameworks, (c) the interplay of genetic and environmental influences in developmental courses, (d) the significance of mental state language, and (e) the progress, or its absence, in the development of prevention and intervention tactics for children, adolescents, and their caregivers. While many of our forecasts regarding the future of developmental psychopathology may not materialize, we maintain optimistic that the essential ideas presented will influence the research agenda in this field and contribute to its growth over the next fifty years.

Early childhood attachment stability to mothers, fathers, and both parents as a network: associations with parents' well-being, marital relationship, and child behavior problems

This study examines the stability of child attachment to mothers and fathers separately, and to both parents as a network between the infancy and preschool periods using a sample of 143 biparental families and their children (73 boys) recruited from the general population. Attachment was assessed at 15 months with the Strange Situation Procedure (SSP) and at 45 months with the Preschool Attachment Classification Coding System (PACS). First, results show no stability in attachment to mothers, to fathers, or to both parents as a network. Second, parents' mental health, life satisfaction, marital satisfaction, and child externalizing behavior are associated with attachment stability. Taken altogether, group comparisons reveal that children with a stable secure attachment to both parents as a network have parents with higher levels of well-being and exhibit less problem behaviors than children with 1) a stable secure attachment to one parent and an unstable attachment to the other parent (from secure to insecure or from insecure to secure), or 2) who never had a stable secure attachment to either parent. This study highlights the significance of attachment to both parents as a network over time as it is associated with developmental outcomes.

Attachment and mother-infant interactions in dyads with infants born full-term, moderate-to-late preterm, and very-to-extreme preterm

BACKGROUND

The impact of prematurity status on attachment quality remains indeterminate. Some studies found no differences between infants born preterm (PT) and infants born full-term (FT), while other investigations present opposite results.

AIMS

We aim to contribute to this body of research by studying mother-infant interactive behaviors and quality of attachment in 3 independent samples: Full-Term (FT), Moderate-to-Late Preterm (MLPT) and Very-to-Extreme Preterm (VEPT).

STUDY DESIGN

This is a longitudinal laboratory study conducted from 3 to 12 months of age (corrected-age in the case of infants born PT).

SUBJECTS

The participants are 213 Portuguese infants (FT = 105; MLPT = 52; VEPT = 56) and their mothers.

OUTCOME MEASURES

Mother-infant interactive behavior was observed in free-play at 3 and 9 months (corrected-age). Infant attachment was observed in Strange Situation at 12 months.

RESULTS

Secure attachment is more prevalent in infants born FT, and ambivalent attachment is more prevalent in infants born VEPT. Infants with a secure attachment have higher gestational age and weight at birth. Infant and maternal interactive behavior quality is associated with attachment patterns and varies according to infant prematurity status. Last, the results indicate changes in maternal sensitivity and infant difficult behavior from 3 to 9 months of infant's age.

CONCLUSIONS

Our findings indicate that prematurity status impacts attachment quality. Changes in maternal and infant behavior from 3 to 9 months suggest a period of rapid non-linear development, supporting a transactional multilayered approach to the study of mother-infant relationship.

Parent-Child Attachment Security and Depressive Symptoms in Early Adolescence: The Mediating Roles of Gratitude and Forgiveness

Although greater parent-child attachment security is linked with children's lower levels of depressive symptoms, little research has evaluated potential explanatory mechanisms. We investigated whether dispositional gratitude and interpersonal forgiveness explain the relation between attachment security with parents and early adolescents' depressive symptoms. Early adolescents (N = 105; M age = 12.3 years; 51% girls) completed questionnaires assessing their attachment security to mother and father figures, depressive symptoms, and dispositional gratitude, and an interview assessing interpersonal forgiveness. Results revealed that greater attachment security to mothers and fathers was associated with fewer depressive symptoms and greater levels of dispositional gratitude and interpersonal forgiveness. Further, dispositional gratitude and interpersonal forgiveness were negatively associated with depressive symptoms. Dispositional gratitude emerged as a mediator between attachment security with each parent and depressive symptoms. Our findings suggest that greater parent-child security may promote early adolescents' appreciation of positive events, which in turn may relate to fewer depressive symptoms.

Pathways from adolescent close friendship struggles to adult negative affectivity

This 19-year prospective study applied a social development lens to the challenge of identifying long-term predictors of adult negative affectivity. A diverse community sample of 169 individuals was repeatedly assessed from age 13 to age 32 using self-, parent-, and peer-reports. As hypothesized, lack of competence establishing and maintaining close friendships in adolescence had a substantial long-term predictive relation to negative affectivity at ages 27-32, even after accounting for prior depressive, anxious, and externalizing symptoms. Predictions also remained robust after accounting for concurrent levels of depressive symptoms, indicating that findings were not simply an artifact of previously established links between relationship quality and depressive symptoms. Predictions also emerged from poor peer relationships within young adulthood to future relative increases in negative affectivity by ages 27-32. Implications for early identification of risk as well as for potential preventive interventions are discussed.

Predicting attachment in Portuguese infants born very or extremely preterm: Understanding the roles of infant regulatory behavior, maternal sensitivity, and risk factors

A growing body of research shows that early attachment relationships are foundational for children's later developmental and psychosocial outcomes. However, findings are mixed regarding whether preterm birth predicts later attachment, but insecurity is generally more prevalent among infants at higher medical and/or social/familial risk. This longitudinal study aimed to identify specific relational, familial/demographic, and perinatal predictors of attachment in a sample of 63 Portuguese infants born very or extremely preterm (VEPT, <32 gestational weeks) and their mothers from diverse socioeconomic backgrounds. One-third of the mothers had social/family risk factors (e.g., single parent, immigrant, unemployed, low education, and/or low income). At 3 months (corrected age), dyads were observed during social interaction in the Face-to-Face Still-Face paradigm (FFSF) and during free play. At 12 months, mother-infant dyads were observed in Ainsworth's Strange Situation. Over half (58.7%) of the infants were classified as insecurely attached. Social-Positive Oriented regulatory behavior pattern, higher maternal sensitivity, higher infant cooperation during free play, number of siblings and an absence of social/family risk factors were associated with attachment security. Perinatal variables were unrelated to attachment. Findings indicate that both relational and social contextual factors contribute to attachment in this biologically vulnerable sample.

Within-subject changes in methylome profile identify individual signatures of early-life adversity, with a potential to predict neuropsychiatric outcome

Background

Adverse early-life experiences (ELA), including poverty, trauma and neglect, affect a majority of the world's children. Whereas the impact of ELA on cognitive and emotional health throughout the lifespan is well-established, it is not clear how distinct types of ELA influence child development, and there are no tools to predict for an individual child their vulnerability or resilience to the consequences of ELAs. Epigenetic markers including DNA-methylation profiles of peripheral cells may encode ELA and provide a predictive outcome marker. However, the rapid dynamic changes in DNA methylation in childhood and the inter-individual variance of the human genome pose barriers to identifying profiles predicting outcomes of ELA exposure. Here, we examined the relation of several dimensions of ELA to changes of DNA methylation, using a longitudinal within-subject design and a high threshold for methylation changes in the hope of mitigating the above challenges.

Methods

We analyzed DNA methylation in buccal swab samples collected twice for each of 110 infants: neonatally and at 12 months. We identified CpGs differentially methylated across time, calculated methylation changes for each child, and determined whether several indicators of ELA associated with changes of DNA methylation for individual infants. We then correlated select dimensions of ELA with methylation changes as well as with measures of executive function at age 5 years. We examined for sex differences, and derived a sex-dependent 'impact score' based on sites that most contributed to the methylation changes.

Findings

Setting a high threshold for methylation changes, we discovered that changes in methylation between two samples of an individual child reflected age-related trends towards augmented methylation, and also correlated with executive function years later. Among the tested factors and ELA dimensions, including income to needs ratios, maternal sensitivity, body mass index and sex, unpredictability of parental and household signals was the strongest predictor of executive function. In girls, an interaction was observed between a measure of high early-life unpredictability and methylation changes, in presaging executive function.

Interpretation

These findings establish longitudinal, within-subject changes in methylation profiles as a signature of some types of ELA in an individual child. Notably, such changes are detectable beyond the age-associated DNA methylation dynamics. Future studies are required to determine if the methylation profile changes identified here provide a predictive marker of vulnerabilities to poorer cognitive and emotional outcomes.

The predictive validity of the strange situation procedure: Evidence from registered analyses of two landmark longitudinal studies

Meta-analyses demonstrate that the quality of early attachment is modestly associated with peer social competence (r = .19) and externalizing behavior (r = -.15), but weakly associated with internalizing symptoms (r = -.07) across early development (Groh et al., Child Development Perspectives, 11(1), 70-76, 2017). Nonetheless, these reviews suffer from limitations that undermine confidence in reported estimates, including evidence for publication bias and the lack of comprehensive assessments of outcome measures from longitudinal studies in the literature. Moreover, theoretical claims regarding the specificity of the predictive significance of early attachment variation for socioemotional versus academic outcomes had not been evaluated when the analyses for this report were registered (but see Dagan et al., Child Development, 1-20, 2023; Deneault et al., Developmental Review, 70, 101093, 2023). To address these limitations, we conducted a set of registered analyses to evaluate the predictive validity of infant attachment in two landmark studies of the Strange Situation: the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) and the NICHD Study of Early Child Care and Youth Development (SECCYD). Across-time composite assessments reflecting teacher report, mother report, and self-reports of each outcome measure were created. Bivariate associations between infant attachment security and socioemotional outcomes in the MLSRA were comparable to, or slightly weaker than, those reported in the recent meta-analyses, whereas those in the SECCYD were weaker for these outcomes. Controlling for four demographic covariates, partial correlation coefficients between infant attachment and all socioemotional outcomes were r ≤ .10 to .15 in both samples. Compositing Strange Situations at ages 12 and 18 months did not substantively alter the predictive validity of the measure in the MLSRA, though a composite measure of three different early attachment measures in the SECCYD did increase predictive validity coefficients. Associations between infant attachment security and academic skills were unexpectedly comparable to (SECCYD) or larger than (MLSRA) those observed with respect to socioemotional outcomes.

The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning

The present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. The study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). All families lived in Italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). The AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. Similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. Mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. The results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood.

Using Attachment and Biobehavioral Catch-up with young children with developmental delays: A multiple-baseline trial of attachment, sensitivity, and cortisol

The Attachment and Biobehavioral Catchup intervention potentially offsets psychosocial risks facing dyads in which children have intellectual disability or developmental delays. In this single-case multiple-baseline study the efficacy of this intervention was tested across three such South African families. Maternal sensitivity, attachment security, and child affect regulation were measured weekly during a baseline and intervention period, using the Ainsworth Maternal Sensitivity Scales, Attachment Q-sort and salivary cortisol, respectively. Furthermore, post-intervention interviews invited parents' and intervenors' evaluations of the intervention. Visual analysis broadly indicated improvement in maternal sensitivity and attachment security across subjects over time following the introduction of the intervention, although randomisation tests were not statistically significant. Effects on affect regulation were not clearly observed and may have been influenced by case-specific variables. Parent-participants and intervenors also identified particularly helpful contributions from the intervention. Findings underscore the importance of individual-level effects evaluation, especially when implementing interventions outside the original population.

Attachment representations in 7-year-old children at familial high risk of schizophrenia or bipolar disorder: Associations with mental disorders and daily functioning: The Danish High Risk and Resilience Study, VIA 7-A population-based cohort study

BACKGROUND

Attachment quality may affect psychological functioning. However, evidence on attachment representations and their correlates in children born to parents with schizophrenia and bipolar disorder is sparse.

METHODS

We compared attachment representations in a Danish sample of 482 children aged 7 years at familial high risk of schizophrenia, bipolar disorder, and population-based controls and examined associations between attachment and mental disorders and daily functioning. Attachment representations were examined with the Story Stem Assessment Profile (SSAP). Mental disorders were ascertained in diagnostic interviews. Daily functioning was assessed with the Children's Global Assessment Scale.

RESULTS

We found no between-group differences in attachment. Higher levels of secure attachment were associated with decreased risk of concurrent mental disorders in the schizophrenia high-risk group. Higher levels of insecure and disorganized attachment were associated with increased risk of mental disorders across the cohort. Higher levels of secure and insecure attachment were associated with better and poorer daily functioning, respectively. In the current study, results regarding defensive avoidance could not be reported due to methodological limitations.

CONCLUSION

Familial high risk of schizophrenia (FHR-SZ) or bipolar disorder is not associated with less secure or more insecure attachment at age 7. Insecure and disorganized attachment representations index risk of mental disorders and poorer functioning. Secure attachment may be a protective factor against mental disorders in children at FHR-SZ. Validation of the SSAP is needed.

Specificity of Insecure Attachment in Adolescents With Borderline Personality Disorder in Psychiatric Inpatient and Community-Dwelling Adolescents

Borderline personality disorder (BPD) has been conceptualized as a disorder of attachment. However, the specificity of attachment insecurity to BPD in adolescents remains unclear. In this study, an inpatient sample (n = 521), of which 173 (33.2%) met the criteria for BPD, and a control sample of community-dwelling adolescents (n = 294) ages 12-17 were compared on a self-report measure of attachment security. In addition, hierarchical regression analyses were carried out to examine the incremental contribution of BPD symptoms, over and above internalizing and externalizing symptoms, in predicting attachment security. Results showed expected group differences such that adolescents with BPD evidenced higher levels of attachment insecurity to both fathers and mothers than psychiatric and community-dwelling controls. BPD features also incremented internalizing and externalizing problems associated with attachment security. However, because psychiatric controls also evidenced high levels of attachment insecurity, we conclude that while attachment insecurity is particularly salient for BPD, it is not necessarily specific to the disorder.

Adolescent affective psychopathic traits: the long-term outcomes of mother-infant attachment across 14 years

Affective psychopathic traits have been associated with increased violence and aggression. The scholarly interest in the pathways leading to affective psychopathic traits in adolescence has been growing. Infant attachment security may be one of the early life factors that contribute to the development of affective psychopathic traits. In this study, we test the infant attachment styles measured with the Strange Situation Procedure as a predictor of adolescent affective psychopathic traits measured in three dimensions: remorselessness, unemotionality, and callousness, among 1149 families in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (SECCYD). Propensity scores for the four attachment styles were estimated with iterative tree-based regression models. After accounting for the potential confounding effects of demographic characteristics and child temperament with the inverse probability of treatment weighting, weighted generalized linear models revealed the association between insecure/avoidant attachment style measured one year after childbirth and higher levels of remorselessness, unemotionality, and callousness at 15 years. These findings provide insights into the long-term outcomes for attachment relationships established in early life.

Mentalizing partially mediates the association between attachment insecurity and global stress in preservice teachers

Objective

Considering the fact that the teaching profession is a highly stressful occupation and that teachers' ineffective coping strategies contribute to higher levels of stress, the objective of the present study was to investigate whether insecure attachment is related to global stress experiences in preservice student teachers. Furthermore, it was examined whether this link is mediated by the preservice teachers' mentalizing-the capacity to perceive and consider one's own and others' behavior based on intentional mental states.

Methods

Data of this cross-sectional study came from 202 preservice student teachers using self-report instruments (attachment: Expectation in Close Relationships; mentalizing: Reflective Functioning Questionnaire; stress: Trier Inventory of Chronic Stress). The hypotheses were tested using structural equation modelling.

Results

Anxious attachment was positively related to stress and impairments in mentalizing. In addition, the link between attachment-related anxiety and stress was partially mediated by mentalizing. Avoidant attachment was not associated with stress or mentalizing.

Discussion

Results indicate that anxious attachment is associated with higher perceived stress in preservice student teachers. Consequently, attachment-related anxiety may be a risk factor which, in turn, may foster perceptions of higher global stress experiences.

Conclusion

Additional research needs to focus on exploring the link between attachment insecurity and global stress experiences among preservice student teachers. An examination of preservice student teachers' own attachment experiences proves to be useful, for example in the context of mentalization-based supervision or reflective practice.

Prenatal predictors of childhood anxiety disorders: An exploratory study of the role of attachment organization

Childhood anxiety disorders (CAD) are a common childhood mental disorder and understanding early developmental pathways is key to prevention and early intervention. What is not understood is whether early life stress predictors of CAD might be both mediated by infant cortisol reactivity and moderated by infant attachment status. To address this question, this exploratory study draws on 190 women recruited in early pregnancy and followed together with their children until 4 years of age. Early life stress is operationalized as maternal depression measured using the Structured Clinical Interview for the DSM, Childhood Trauma Questionnaire, Parenting Stress Index, and antenatal maternal hair cortisol concentrations. Infant cortisol reactivity was measured at 12 months together with the Strange Situation Procedure and CAD assessed at 4 years of age using the Preschool Age Psychiatric Assessment. There was no direct association between attachment classification and CAD. Furthermore, infant cortisol reactivity neither mediated nor attachment moderated the association of early life stress predictors and CAD. However, only for infants with organized attachment classifications, higher maternal antenatal depression, and hair cortisol were associated with a higher risk of CAD.

Heterotypic and homotypic continuity in psychopathology: a narrative review

Psychopathology is a process: it unfolds over time and involves several different factors. To extend our knowledge of such process, it is vital to understand the trajectories that lead to developing and maintaining a specific disorder. The construct of continuity appears very useful to this aim. It refers to the consistency, similarity, and predictability of behaviors or internal states across different developmental phases. This paper aims to present a narrative review of the literature on homotypic and heterotypic continuity of psychopathology across the lifespan. A detailed search of the published literature was conducted using the PsycINFO Record and Medline (PubMed) databases. Articles were included in the review based on the following criteria: (1) publication dates ranging from January 1970 to October 2022; and (2) articles being written in the English language. To ensure a thorough investigation, multiple combinations of keywords such as "continuity," "psychopathology," "infancy," "childhood," "adolescence," "adulthood," "homotypic," and "heterotypic" were used. Articles were excluded if exclusively focused on epidemiologic data and if not specifically addressing the topic of psychopathology continuity. The literature yielded a total of 36 longitudinal studies and an additional 190 articles, spanning the research published between 1970 and 2022. Studies on continuity focus on the etiology of different forms of mental disorders and may represent a fundamental resource from both a theoretical and clinical perspective. Enhancing our understanding of the different trajectories beneath psychopathology may allow clinicians to implement more effective strategies, focusing both on prevention and intervention. Since literature highlights the importance of early detection of clinical signs of psychopathology, future research should focus more on infancy and pre-scholar age.

Depression in middle childhood: secure base script as a cognitive diathesis in the relationship between daily stress and depressive symptoms

A better understanding of protective factors against childhood depression may allow for the mitigation of severe and chronic symptoms and the timely implementation of intervention strategies. This study investigated the protective effect of having a secure base script on depressive symptoms when children face daily stressors. To test this hypothesis, moderation analyses were performed in a cross-sectional study with 378 children (48.5% boys, 51.5%) aged 8-12 years (M = 10.20; SD = 0.57). The results provided some support for the moderation effect when secure base script knowledge was investigated as a categorical variable in middle childhood. However, the results did not support the moderation effect when investigating secure base script as a continuous variable. Therefore, future investigations may need to address whether a categorical approach could better elucidate the protective role of secure base script knowledge in childhood depression.

Validation of Parenting Your Baby and Parenting Your Toddler and Associations with Engagement in Parenting Intervention

Infants and toddlers are dependent on supportive and nurturing parenting to promote optimal child development. Assessments of parenting can identify need for parenting intervention, however measures are needed that can predict whether parents reporting challenges will engage in intervention. We validated the Parenting Your Baby (PYB) and Parenting Your Toddler (PYT) parenting measures and examined associations with engagement in parenting intervention. Participants included 403 primary caregivers and their newborns from a multisite longitudinal randomized control trial of the Smart Beginnings (SB) parenting intervention across two urban cities. Caregivers completed the PYB (6 months) and PYT (18 and 24 months) and other self-report measures of parenting and infant and toddler temperament and social-emotional functioning for validation. Observed parenting (6, 18, and 24 months) was coded from observed caregiver-child interactions. Engagement in ongoing intervention (SB) was recorded across infancy and toddlerhood. Factor structure was adequate for the PYB and strong for the PYT. Both measures demonstrated reliability and validity across concurrent and future self-report and observed measures of parenting and caregiver-reported infant and toddler functioning. Parent-reported desire for change in parenting scores on the PYT at 18 months were associated with engagement in parenting intervention 18 through 30 months. The PYB and PYT are reliable and valid measures of the parenting of young children, though more work is needed on the factor structure of the PYB. An important direction for future research is to understand and support engagement in parenting intervention for those who report desire for change but do not engage.

Maternal depressive symptoms and child behavior problems: Attachment security as a protective factor

Maternal depressive symptoms (MDS) have been linked to both child internalizing and externalizing behavior problems. Theory suggests that child attachment security may be a protective factor against the negative effects of MDS. This study examined child attachment security as a buffer of the link between MDS and child internalizing and externalizing behavior problems at two time points in a predominantly African American sample. Participants included mothers (N = 164; Mage = 29.68 years; 76% African American) and their preschool-aged children (60% girls; Mage = 44.67 months) recruited from four Head Start centers in low-income neighborhoods in Baltimore, Maryland. MDS were concurrently associated with child internalizing and externalizing behavior problems at both time points. No significant main effects of child attachment security on behavior problems emerged; however, child attachment moderated the association between MDS and child internalizing behavior problems at Time 2, such that MDS predicted greater child internalizing problems when attachment security was low, and the effect was attenuated when attachment security was high. No interaction emerged for child externalizing problems. Findings suggest that secure attachment in early childhood can serve as a protective factor in the context of parental risk. We discuss implications for intervention and the intergenerational transmission of psychopathology.

History of "Serve and Return" and a Synthesis of the Literature on its Impacts on Children's Health and Development

Parent/caregiver sensitivity and responsiveness are important for children's health and development. The "serve and return" metaphor was created to help providers and caregivers understand the importance of sensitive and responsive early caregiving. In this review, we explain the concept of "serve and return", outline historical and theoretical principles that culminated in this metaphor, highlight parent and child constructs associated with "serve and return" interactions, and synthesize literature on sensitive and responsive caregiving and children's health and developmental outcomes. Nurses and other healthcare professionals in public policy, clinical, community, education, and research roles need knowledge of "serve and return" interactions.

Effects of school environment on depression among Black and White adolescents

While the school environment is critical for adolescents' psychological development, how the school environment influences depression among different racial groups has not been fully explored. This study aims to identify the effects of the school environment (school connectedness, school climates, trouble with peers and teachers) on depressive symptoms among Black and White adolescents. It also compares how the effects of school environments differ between Black and White adolescents. This study analyzed wave 6 of the Fragile Families and Child Well-being Study, a longitudinal birth cohort study in 20 major cities across the United States. Almost three-fourth (73.39%) of the adolescents were Black, and 26.61% were White. About half (50.46%) of the adolescents were females, and the mean age of adolescents was 15.39. Multiple regression analysis showed that higher school connectedness and less frequent troubles with teachers were associated with lower depression among Black adolescents. In contrast, only school connectedness was associated with depression among White adolescents. Higher school connectedness was associated with lower depressive symptoms for both Black and White adolescents. However, the magnitude of the effects of school connectedness was found to be statistically weaker among Black adolescents. These findings suggest a need for creating a racially equitable school environment that makes every student feel more connected to their schools, especially Black students.

Assessment of Attachment Representations in Basque Adolescents and their Relationship with Internalizing and Externalizing Problems

Research has shown a relationship between attachment style and psychosocial adjustment in adolescents. Whereas secure attachment is related to fewer internalizing and externalizing symptoms, the opposite is the case for the various insecure attachment styles. The aim of the two studies reported in this paper was to adapt and validate the CaMir-R (a self-report measure of attachment that has shown adequate psychometric properties) for use among Basque adolescents, and to analyse the relationship between attachment and internalizing and externalizing symptoms. In Study 1, the instrument was adapted using the back translation method and applied to a sample of 203 adolescents and young adults. Confirmatory factor analysis supported the theoretical dimensions of the scale, and its psychometric properties were found to be adequate. In Study 2 we obtained additional validity evidence by applying, in a sample of 786 adolescents and young adults, the attachment representations section of the CaMir-R alongside other measures of attachment and clinical symptoms. The results once again supported the dimensional structure of the instrument, and evidence of convergent validity was obtained based on correlations between CaMir-R scores and scores on the Inventory of Parent and Peer Attachment (IPPA). In addition, scores on the five dimensions of attachment representations (Security, Family concerns, Parental interference, Self-sufficiency and resentment of parents and Childhood trauma) were correlated with scores on other measures of internalizing and externalizing symptoms. Based on these results, we conclude that the Basque version of the CaMir-R is a valid instrument for assessing the quality of attachment representations among adolescents, and also that internalizing and externalizing problems are related to attachment style. We discuss the importance of attachment in relation to behaviour problems and clinical symptoms.

Attachment, Mentalizing and Trauma: Then (1992) and Now (2022)

This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the review then considers recent neurobiological work on mentalizing and trauma and suggests areas of new development and implications for clinical practice.

Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems

Mentalization, the high-order function of detecting and interpreting one's own and others' mental states, has gained interest in the fields of clinical and developmental psychopathology. However, little is known about mentalization's associations with anxiety and broader internalizing problems. Using the framework of the multidimensional model of mentalization, the aim of this meta-analysis was to quantify the strength of the association between mentalization and anxiety/internalizing problems and to identify potential moderators of this association. A systematic review of the literature led to the inclusion of 105 studies (N = 19,529) covering all age groups. The global effect analysis showed a small negative association between mentalization and the overall anxious and internalizing symptomatology (r = -0.095, p = .000). Various effect sizes were found for associations between mentalization and specific outcomes (unspecified anxiety, social anxiety, generalized anxiety, and internalizing problems). The methods of assessment of mentalization and anxiety moderated their association. Findings support the presence of modest impairments in the mentalizing capacities of anxious individuals, likely influenced by their vulnerability to stress and the context in which they mentalize. Further studies are needed to draw a clear profile of mentalizing capacities with regard to specific anxious and internalizing symptomatologies.

Attachment to Mother and Father, Sleep, and Well-Being in Late Middle Childhood

The security of attachment has been related to several advantageous developmental outcomes, such as good sleep quality and higher well-being indicators. However, few studies concern the associations between attachment dimensions to both parents, sleep, and well-being in late middle childhood. Our study aims to expand knowledge in this area, clarifying the above-mentioned associations by considering the secure base and safe haven dimensions of attachment. We also investigate the role of sleep as a mediator of the relationship between attachment and well-being. The 258 participants (49.2% girls, mean age = 11.19, SD = 0.85) completed self-report questionnaires regarding attachment (KSS), sleep (SSR), and well-being (CHIP-CE). The results show significant associations between attachment to both parents (0.40 ** ≤ r ≤ 0.61 **) and between attachment security, sleep (-0.21 ** ≤ r ≤ -0.35 **) and child well-being (0.42 ** ≤ r ≤ 0.47 **). Besides, sleep quality partially mediated the relations between all attachment dimensions to both parents and well-being. The results are discussed in light of attachment theory, focusing on the comparison between attachment to mother and father as a valid framework to unravel differences in child well-being, with sleep as a process that can help to explain the mechanisms through which attachment security enables subjective perceptions of well-being.

Impact of preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in preschool children

BACKGROUND

Internalizing problems are common in young children, often persist into adulthood, and increase the likelihood for subsequent psychiatric disorders. Problematic attachment, parental mental health problems, and stress are risk factors for the development of internalizing problems. COVID-19 lockdown measures have resulted in additional parental burden and especially their impact on preschool children has rarely been investigated as of now. The current study examined the impact of sustained preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in a sample of preschool children in Germany.

METHODS AND FINDINGS

N = 128 parents of preschool children filled out a one-time online survey about children's internalizing problems, externalizing problems, and attachment for three time points: before a nation-wide lockdown (T1), during the most difficult time of the lockdown (T2) and after the lockdown (T3). Additionally, parents answered questions about their own depressive and anxious symptomatology for the three time points and parental stress for T1 and T2. Linear-mixed effect models were computed to predict children's internalizing / externalizing behavior. Preschool children showed a significant increase in internalizing and externalizing problems over time, highest at T2 with small decreases at T3. Parental depressive and anxious symptomatology increased significantly from T1 to T2, but also remained high at T3. Parental stress levels were comparable to community samples at T1, but attained average values reported for at-risk families at T2. Linear-mixed effect models identified higher parental stress, parental anxiety, attachment problems, parental education, and less preschool attendance as significant predictors for internalizing and externalizing problems in preschoolers with more specific associations shown in separate models. A limitation is the retrospective assessment for the times T1 and T2.

CONCLUSIONS

Preschool children's mental health is strongly and negatively influenced by the ongoing COVID-19 pandemic and its lockdown measures. Sustained preschool attendance may serve as a protective factor.

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.

Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging

Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.

A Family Systems Perspective on Attachment Security and Dependency to Mother and Father in Preschool: Differential and Reciprocal Effects on Children's Emotional and Behavioral Problems

Attachment security and dependency play a decisive role for children's mental health. From a family systems perspective, reciprocal effects of dyadic attachment to each parent within the same family on child symptomatology may well offer additional insights in developmental processes as parents and children influence each other consistently. This study examined the influence of child-mother as well as child-father attachment security and dependency on maternal, paternal, and observed ratings of children's emotional and behavioral problems. A total of 124 families with preschool children participated in this study. Attachment security, dependency, and symptomatology of the children were independently observed during home visits. Furthermore, mothers and fathers rated child symptoms. Results revealed promotive effects of attachment security to both parents on observed child symptoms. Furthermore, we found a significant actor effect of child-mother attachment security, as well as a significant partner effect of child-father dependency on maternal ratings of child symptomatology. Attachment security to both parents is promotive for child mental health. The family systems perspective clarifies the meaning of child-father relationships for maternal perception of the own child.

Testing an attachment- and trauma-informed intervention approach for parents and young children after interparental violence: protocol for a randomized controlled trial

BACKGROUND

Interparental violence has persistent adverse effects on victimized parents and children. Young children, including infants and toddlers, are at particular risk to develop long-lasting negative outcomes, and yet specific evidence on effective intervention approaches for this vulnerable group is still lacking. This study will test the effectiveness of an attachment- and trauma-informed intervention approach in a sample of parent-child dyads who have experienced severe interparental violence. We test the individual and combined effects of two interventions: (1) "Nederlandse Interventie Kortdurend op Atypisch oudergedrag" (NIKA; Dutch, short-term intervention focused on atypical parenting behavior) aimed at improving the attachment relationship and (2) eye movement desensitization and reprocessing (EMDR) therapy aimed at reducing parental post-traumatic stress disorder (PTSD) symptoms.

METHODS

This study uses a multicenter randomized controlled design across multiple domestic violence shelters in the Netherlands. We aim to recruit 150 parent-child dyads with children aged between 0.5 and 6 years old. The study design consists of two phases. During the first phase for testing the effect of NIKA only, eligible dyads are randomly allocated to either NIKA or a waitlist usual care group. A pre-test is conducted prior to the treatment period and a post-test takes place directly afterwards (6 weeks after the pre-test). Phase 2 follows directly for testing the effects of EMDR and the combination of NIKA and EMDR. Parents who report clinical PTSD symptoms are randomly allocated to either EMDR therapy or a waitlist usual care group. Parents who do not report clinical PTSD symptoms only receive care as usual. Six weeks later, a post-test of phase 2 is conducted for all participating dyads. Primary study outcomes are disrupted parenting behavior, sensitive parenting behavior, and parental PTSD symptoms. Secondary study outcomes include PTSD symptoms and behavioral and emotional problems of the child.

DISCUSSION

This study will inform and enhance the clinical field by providing new insights regarding effective treatment combinations for traumatized parents and their young children after interparental violence.

TRIAL REGISTRATION

Netherlands Trial Register (NTR) NL9179 . Registered 7 January 2021.