Is attachment transmitted across generations? The plot thickens

Hope amidst crisis: exploring perinatal mental health and family dynamics in out-of-home care through virtual assessments during the UK COVID-19 response

Caring for a young child exposed to early trauma, along with caregiving stress and heightened by the impact of lockdowns as a result of the COVID-19 response, may compromise the development of the parent-child relationship. Understanding a foster carer's attachment history and considering relational dynamics through an attachment lens may shed light on areas they need support in, to enhance their parenting capacity for vulnerable children. The feasibility of collecting and coding observational data and attachment interviews of foster carers and their children, when conducted remotely during COVID-19, needs to be explored. This perspective piece considers the impact on infant and perinatal health in the context of COVID-19 with particular emphasis on relational dynamics and attachment assessments, using a case study of a foster carer and her child in an out-of-home-care placement. Understanding these dynamics is crucial for safeguarding the well-being of both caregivers and vulnerable children during this challenging time.

Associations of peripheral blood DNA methylation and estimated monocyte proportion differences during infancy with toddler attachment style

Attachment is a motivational system promoting felt security to a caregiver resulting in a persistent internal working model of interpersonal behavior. Attachment styles are developed in early social environments and predict future health and development outcomes with potential biological signatures, such as epigenetic modifications like DNA methylation (DNAm). Thus, we hypothesized infant DNAm would associate with toddler attachment styles. An epigenome-wide association study (EWAS) of blood DNAm from 3-month-old infants was regressed onto children's attachment style from the Strange Situation Procedure at 22-months at multiple DNAm Cytosine-phosphate-Guanine (CpG) sites. The 26 identified CpGs associated with proinflammatory immune phenotypes and cognitive development. In post-hoc analyses, only maternal cognitive-growth fostering, encouraging intellectual exploration, contributed. For disorganized children, DNAm-derived cell-type proportions estimated higher monocytes -cells in immune responses hypothesized to increase with early adversity. Collectively, these findings suggested the potential biological embedding of both adverse and advantageous social environments as early as 3-months-old.

Adult attachment is related to maternal neural response to infant cues: an ERP study

Maternal attachment security is an important predictor of caregiving . However, little is known regarding the neurobiological mechanisms by which attachment influences processing of infant cues, a critical component of caregiving. We examined whether attachment security, measured by the Adult Attachment Interview, might relate to neural responses to infant cues using event-related potentials. Secure (n=35) and insecure (n=24) mothers viewed photographs of infant faces and heard recordings of infant vocalizations while electroencephalography was recorded. We examined initial processing of infant faces (N170) and cries (N100), and attentional allocation to infant faces and cries (P300). Secure mothers were significantly faster than insecure mothers to orient to infant cries (N100), structurally encode their own infant's face (N170), and attend to infant faces (P300). These differences may elucidate mechanisms underlying how attachment may shape neural processing of infant cues and highlight the use ofsocial neuroscientific approaches in examining clinically relevant aspects of attachment.

Cerebellar engagement in the attachment behavioral system

Brain structural bases of individual differences in attachment are not yet fully clarified. Given the evidence of relevant cerebellar contribution to cognitive, affective, and social functions, the present research was aimed at investigating potential associations between attachment dimensions (through the Attachment Style Questionnaire, ASQ) and cerebellar macro- and micro-structural measures (Volumetric and Diffusion Tensor Imaging data). In a sample of 79 healthy subjects, cerebellar and neocortical volumetric data were correlated with ASQ scores at the voxel level within specific Regions Of Interest. Also, correlations between ASQ scores and age, years of education, anxiety and depression levels were performed to control for the effects of sociodemographic and psychological variables on neuroimaging results. Positive associations between scores of the Preoccupation with Relationships (ASQ subscale associated to insecure/anxious attachment) and cortical volume were found in the cerebellum (right lobule VI and left Crus 2) and neocortex (right medial OrbitoFrontal Cortex, OFC) regions. Cerebellar contribution to the attachment behavioral system reflects the more general cerebellar engagement in the regulation of emotional and social behaviors. Cerebellar properties of timing, prediction, and learning well integrate with OFC processing, supporting the regulation of attachment experiences. Cerebellar areas might be rightfully included in the attachment behavioral system.

Major depression as a predictor of the intergenerational transmission of attachment security: Findings from a pregnancy cohort study

OBJECTIVE

Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant-parent attachment classification at 12 months postpartum.

METHODS

Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant-parent attachment was measured using the Strange Situation Procedure at 12 months.

RESULTS

Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample.

CONCLUSION

While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment.

Diagnosis on the way out - personality on the way in? Priorities in treatment in child and adolescent psychiatry

The scientific basis for practice in child psychiatry has developed apace. And has thrown up several quandries for an accepted paradigm for good practice anchored to the diagnostic schema developed in adult psychiatry. This paper hopes to stimulate discussion about where alternative paradigms might lead us on a path to precision medicine as applied to child psychiatry.

Delivering Clinically on Our Knowledge of Oxytocin and Sensory Stimulation: The Potential of Infant Carrying in Primary Prevention

Oxytocin (OT) is one of the most intensively researched neuropeptides during the three past decades. In benign social contexts, OT exerts a range of desirable socioemotional, stress-reducing, and immunoregulatory effects in mammals and humans and influences mammalian parenting. Consequentially, research in potential pharmacological applications of OT toward human social deficits/disorders and physical illness has increased substantially. Regrettably, the results from the administration of exogenous OT are still relatively inconclusive. Research in rodent maternal developmental programming has demonstrated the susceptibility of offspring endogenous OT systems to maternal somatosensory stimulation, with consequences for behavioral, epigenetic, cognitive, and neurological outcomes. A translation of this animal research into practically feasible human parenting recommendations has yet to happen, despite the significant prevention potential implied by the maternal developmental programming research. Extended physical contact with full-term healthy infants in the months following birth (infant carrying) might constitute the human equivalent of those specific rodent maternal behaviors, found to positively influence emerging OT systems. Findings from both OT and maternal programming research parallel those found for infants exposed to such extended parental physical contact, whether through skin-to-skin contact or infant carrying. Clinical support of parents to engage in extended physical contact represents a feasible intervention to create optimum conditions for the development of infant OT systems, with potential beneficial long-term health effects.

Attachment-related dimensions in the epigenetic era: A systematic review of the human research

In recent years, an increasing number of studies documented potential links between parental care and epigenetic mechanisms. The present systematic review focuses on the potential association and interrelationship between attachment-related dimensions and DNA methylation in human studies. We performed a literature review using electronic databases such as PubMed, Scopus, Web of Science, and EBSCOhost. Thirteen papers were included in the review. Findings support significant associations between attachment-related dimensions and epigenetic status in studies which considered different populations, age ranges, attachment measures and peripheral tissues. Although research in this area is still under investigation, available results suggest that DNA methylation associated with attachment-related dimensions might affect the development of stress regulation system and social-emotional capacities, thus contributing to the emerging phenotypic outcomes. However, identifying mediator and moderator effects in the interrelationship between these parameters was problematic owing to heterogeneous methodologies. Finally, we discuss clinical implications, unanswered questions, and future directions for human development in epigenetics research.

Adult Attachment System Links With Brain Mu Opioid Receptor Availability In Vivo

BACKGROUND

Secure attachment is important in maintaining an individual's health and well-being. Attachment disturbances increase the risk for developing psychiatric disorders such as affective disorders. Yet, the neurobiological correlates of human attachment are poorly understood at the neurotransmitter level. We investigated whether adult attachment style is linked to functioning of the opioid and serotonergic systems in the human brain.

METHODS

We used positron emission tomography with radioligands [¹¹C]carfentanil and [¹¹C]MADAM to quantify mu opioid receptor (n = 39) and serotonin transporter (n = 37) availability in volunteers with no current psychiatric disorders. Attachment style was determined according to the Dynamic-Maturational Model of Attachment and Adaptation with the structured Adult Attachment Interview.

RESULTS

Secure attachment was associated with higher mu opioid receptor availability in the hippocampus, amygdala, thalamus, and prefrontal cortex when compared with insecure (i.e., avoidant or ambivalent groups combined) attachment. In contrast, attachment style was not associated with serotonin transporter availability.

CONCLUSIONS

Our results provide preliminary in vivo evidence that the opioid system may be involved in the neurocircuits associated with individual differences in adult attachment behavior. The results suggest that variation in mu opioid receptor availability may be linked with the individuals' social relationships and psychosocial well-being and thus contributes to risk for psychiatric morbidity.

CCPP's contribution to the maturing of the DMM

Over a decade, CCPP published many articles, a special issue and two special sections that enabled the DMM to become established as an alternative to both attachment disorganization and psychiatric diagnoses. New clinical authors from many countries contributed to an empirical set of assessment validity studies and findings regarding troubled and highrisk children and families. The outcome was a validated life-span series of assessments of attachment, a coherent body of important clinical findings, especially regarding school-aged children, and family functional formulations as laying the basis for DMM Integrative Treatment.

Attachment & Child Health (ATTACH) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress

Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function-parents' capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child-may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children <36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.

The relationship between attachment and somatoform symptoms in children and adolescents: A systematic review and meta-analysis

OBJECTIVE

Problems in childhood and adolescence are often present with recurring physical signs of illness, called somatoform symptoms. These symptoms are a common reason for consultation at both paediatric care and psychotherapeutic/psychiatric praxis. We propose that attachment is a possible predictive factor. This article provides a systematic overview of the existing research literature concerning the relationship between attachment and somatoform symptoms in children and adolescents.

METHODS

A systematic search for empirical articles from 1990 up to August 2018 focusing on this association was conducted. Out of six databases, 4994 studies were detected by using defined keywords. One study was added identified by checking reference lists. Finally, 15 studies were selected, which were the bases for the narrative review. Ten studies were included in meta-analysis.

RESULTS

Combining study results, we found that attachment cannot solely predict somatoform symptoms. Mixed results are shown. The quantitative analysis substantiated these narrative results, revealing a small but significant combined effect size of Δ ≈ .12 (95% CI .04 - .19).

CONCLUSIONS

The findings suggest that a relationship exists, but further investigations need to demonstrate that these are not only superficial. There are many developmental factors that affect the relationship between attachment and somatoform symptoms in children and adolescents. Further research should explore this interplay in order to gain a holistic and comprehensive understanding of the underlying mechanisms that lead to these correlations and to discover possible predicting factors.

A Comprehensive Analysis of Post-partum Depression Risk Factors: The Role of Socio-Demographic, Individual, Relational, and Delivery Characteristics

Postpartum depression is a common and complex phenomenon that can cause relevant negative outcomes for children, women and families. Existing literature highlights a wide range of risk factors. The main focus of this paper is to jointly investigate different types of risk factors (socio-demographic, psychopathological, relational, and related to labor and birth experience) in post-partum depression onset in women during first-child pregnancy, identifying which of these are the most important predictors. A cohort longitudinal study was conducted on 161 Italian nulliparous low-risk women (M_age = 31.63; SD = 4.88) without elective cesarean. Data was collected at three different times: Socio-demographic, prenatal anxiety and depression, and quality of close relationship network (with mother, father and partner, and the prenatal attachment to child) were assessed at T1 (week 31–32 of gestation); clinical data on labor and childbirth (mode and typology of delivery, duration of labor, duration of eventual administration of epidural analgesia, and child's APGAR index at birth) were registered at T2 (the day of childbirth); and the degree of post-natal depression symptomatology was measured at T3 (1 month after birth). Postpartum depression is associated with several risk factors (woman's age, woman's prenatal psychopathological characteristics, the level of prenatal attachment to child, the quality of romantic relationship, and some clinical delivery difficulties). Overall, the level of prenatal attachment to child was the most important predictor of post-partum depression. These findings emphasize the very important role of prenatal attachment for the onset of postpartum depression and the need to promote adequate and targeted prevention interventions. Limitations, strengths, and theoretical and clinical implications are discussed.

Unresolved Trauma and Reorganization in Mothers: Attachment and Neuroscience Perspectives

The onset of motherhood is characterized by significant psychological and neurobiological changes. These changes equip the mother to care for her new child. Although rewarding, motherhood is also an inherently stressful period, more so for mothers with unresolved trauma. Past research has looked at how unresolved trauma can hamper a mother’s caregiving response toward her infant, which further affects the development of secure attachment in her own infant. The Dynamic Maturational Model of Attachment and Adaptation (DMM) has introduced a unique concept of “attachment reorganization” which can be described as a process whereby individuals with unresolved trauma are transitioning toward attachment security based on their enhanced understanding of past and present experiences. Preliminary results from one of our previous studies have shown that, among mothers with unresolved trauma, mothers who themselves demonstrated “reorganizing attachment” toward security, had infants with secure attachment, thereby indicating the potential to halt the intergenerational transmission of insecure attachment. While this concept is of great clinical relevance, further research is required to assess the benefits of attachment reorganization as a protective factor and its positive implications for child development. Thus, the aim of the current review is to expand on the concept of attachment reorganization in mothers with unresolved trauma from both attachment and neuroscience perspectives. To that effect, we will first review the literature on the transition to motherhood from attachment and neuroscience perspectives. Second, we will use attachment and neuroscience approaches to address deviations from normative experiences during motherhood with a specific focus on the role of a mother’s unresolved trauma. Lastly, we will expand on the concept of reorganization and the promise this concept holds in resolving or halting the intergenerational transmission of trauma from mothers to their children.

Pathways Relating the Neurobiology of Attachment to Drug Addiction

Substance use disorders constitute a significant public health problem in North America and worldwide. Specifically, substance addictions in women during pregnancy or in the postpartum period have adverse effects not only on the mother, but also on mother-infant attachment and the child's subsequent development. Additionally, there is growing evidence suggesting that parental addiction may be transmitted intergenerationally, where the child of parents with addiction problems is more likely to experience addiction as an adult. The current review takes a developmental perspective and draws from animal and human studies to examine how compromised early experience, including insecure attachment, early abuse/neglect, and unresolved trauma, may influence the development of neurobiological pathways associated with addictions, ultimately increasing one's susceptibility to addictions later in life. We approach this from three different levels: molecular, neuroendocrine and behavioral; and examine the oxytocin affiliation system, dopamine reward system, and glucocorticoid stress response system in this regard. Increased understanding of these underlying mechanisms may help identify key targets for early prevention efforts and inform needed intervention strategies related to both insecure attachment and addiction.

Assessing adult attachment: Relation and validity of two dynamic-maturational model approaches

Assessing attachment is essential yet challenging. The Adult Attachment Interview (AAI) provides the best appraisal of adult attachment but is time-intensive and costly. Likewise, concerns have been raised regarding the Berkeley-AAI coding and classification method. Meanwhile, self-report measures of adult attachment are time-efficient and low-cost, but their validity is questionable. The Dynamic-Maturational Model approach to the AAI (DMM-AAI) and a novel self-report measure – the Attachment Relationship Questionaire (ARQ) – may offer a solution. However, additional investigations regarding the validity of DMM-AAI are needed and the ARQ’s psychometric properties have not be tested. The validity of the DMM approach to the AAI and the predictive relationship between the ARQ and DMM-AAI classification were examined for 212 participants living the UK. Results indicated a strong positive relationship between high numbered attachment classification on the DMM-AAI and psychological treatment status, χ²(6) = 56.07, p < .001; Cramer’s V = .371, p < .001. Binomial logistic regressions between the ARQ and DMM-AAI found both single-statement and multi-statement predictive models were statistically significant. However, the ARQ accounted for only a small amount of the variance (R² ≤ 0.15). In conclusion, the DMM-AAI demonstrated strong construct validity, whereas the ARQ is not useful for assessment of adult attachment. Further investigation with a revised version of the ARQ that addresses psychometric concerns is suggested.

The Body Speaks: Using the Mirror Game to Link Attachment and Non-verbal Behavior

The Mirror Game (MG) is a common exercise in dance/movement therapy and drama therapy. It is used to promote participants' ability to enter and remain in a state of togetherness. In spite of the wide use of the MG by practitioners, it is only recently that scientists begun to use the MG in research, examining its correlates, validity, and reliability. This study joins this effort by reporting on the identification of scale items to describe the non-verbal behavior expressed during the MG and its correlation to measures of attachment. Thus, we explored the application of the MG as a tool for assessing the embodiment of attachment in adulthood. Forty-eight participants (22 females, mean age = 33.2) played the MG with the same gender-matched expert players. All MG were videotaped. In addition, participants were evaluated on two central measurements of attachment in adulthood: The Adult Attachment Interview (AAI) and the Experience in Close Relationship questionnaire (ECR). To analyze the data, we developed the "MG scale" that coded the non-verbal behavior during the movement interaction, using 19 parameters. The sub-scales were reduced using factor analysis into two dimensions referred to as "together" and "free." The free factor was significantly correlated to both measurements of attachment: Participants classified as having secure attachment on the AAI, received higher scores on the MG free factor than participants classified as insecure [t(46) = 7.858, p = 0.000]. Participants, who were high on the avoidance dimension on the ECR, were low on the MG free factor [r(48) = -0.285, p = 0.007]. This is the first study to examine the MG as it is used by practitioners and its correlation to highly standardized measures. This exploratory study may be considered as part of the first steps of exploring the MG as a standardized assessment tool. The advantages of the MG as a simple, non-verbal movement interaction demonstrate some of the strengths of dance/movement and drama therapy practice.

Women who had positive relationships with their own mothers reported good attachments to their first child before and after birth

AIM

Bowlby's attachment intergenerational transmission theory suggests that a woman's attachment to her parents, particularly her mother, plays an important role in her future parenting. We studied whether there was any association between pregnant women's attachment to their baby before and after birth and their relationships with their mothers.

METHODS

A longitudinal study was carried out in 2015 on 201 first-time mothers recruited in the maternity ward of the level two Misericordia e Dolce Hospital in Prato, Italy. At 32 weeks of pregnancy, the women filled in the Parental Bonding Instrument and the Prenatal Attachment Inventory and their spontaneous attachment behaviour towards their newborn infants were observed in the nursery during the first two days after childbirth.

RESULTS

Having a good relationship with their own mothers was a positive predictor for the women's prenatal attachment to their baby and caregiving and attachment behaviour to their newborn infants. In addition, the mothers' prenatal attachment positively predicted their behavioural attachment pattern after birth.

CONCLUSION

We found that women who had positive relationships with their own mothers also had positive attachments to their unborn babies and in the period immediately after birth. Our findings supported Bowlby's attachment intergenerational transmission theory.

Brain activity underlying negative self- and other-perception in adolescents: The role of attachment-derived self-representations

One of teenagers’ key developmental tasks is to engage in new and meaningful relationships with peers and adults outside the family context. Attachment-derived expectations about the self and others in terms of internal attachment working models have the potential to shape such social reorientation processes critically and thereby influence adolescents’ social-emotional development and social integration. Because the neural underpinnings of this developmental task remain largely unknown, we sought to investigate them by functional magnetic resonance imaging. We asked n = 44 adolescents (ages 12.01–18.84 years) to evaluate positive and negative adjectives regarding either themselves or a close other during an adapted version of the well-established self-other trait-evaluation task. As measures of attachment, we obtained scores reflecting participants’ positive versus negative attachment-derived self- and other-models by means of the Relationship Questionnaire. We controlled for possible confounding factors by also obtaining scores reflecting internalizing/externalizing problems, schizotypy, and borderline symptomatology. Our results revealed that participants with a more negative attachment-derived self-model showed increased brain activity during positive and negative adjective evaluation regarding the self, but decreased brain activity during negative adjective evaluation regarding a close other, in bilateral amygdala/parahippocampus, bilateral anterior temporal pole/anterior superior temporal gyrus, and left dorsolateral prefrontal cortex. These findings suggest that a low positivity of the self-concept characteristic for the attachment anxiety dimension may influence neural information processing, but in opposite directions when it comes to self- versus (close) other-representations. We discuss our results in the framework of attachment theory and regarding their implications especially for adolescent social-emotional development and social integration.

Comparing Main, Goldwyn, and Hesse (Berkeley) and Crittenden (DMM) coding systems for classifying Adult Attachment Interview transcripts: an empirical report

Few studies have compared different systems in classifying Adult Attachment Interview (AAI) transcripts. In this study, the AAI was administered to 90 Italian parents (45 couples), and the AAI transcripts were independently classified according to Main, Goldwyn, and Hesse's (Berkeley) and Crittenden's (Dynamic-Maturational Model [DMM]) criteria. The two classification systems were not significantly associated, with some limited convergent results only when the interviews resulted in organized (Berkeley) and normative (DMM) attachment classifications. Otherwise, the Berkeley system identified more secure individuals than the DMM system, and many texts judged secure on the Berkeley system were identified as insecure on the DMM system. Since the Berkeley and the DMM systems rest on remarkably different conceptualizations of the nature and functioning of the attachment behavioral system (e.g. fear is conceived as organizing in the DMM and as potentially disorganizing in the Berkeley), the attachment classifications resulting from their applications should not be considered measurements of the same phenomena.

Mercy Pregnancy and Emotional Well-being Study (MPEWS): Understanding maternal mental health, fetal programming and child development. Study design and cohort profile

Maternal mental health represents a significant global health burden. The Mercy Pregnancy and Emotional Well-being Study (MPEWS) was established to provide a comprehensive investigation of early developmental mechanisms and modifiers for maternal, fetal and child emotional well-being. MPEWS is a prospective, longitudinal study from pregnancy to 36 months postpartum that includes diagnostic measures of maternal mental health, observational measures of the mother-infant relationship, measures of child development, and repeat biological sampling. A total of 282 pregnant women were recruited in early pregnancy from the Mercy Hospital for Women in Melbourne, Australia, including 52 women on antidepressant medication, 31 non-medicated women meeting diagnostic criteria for current unipolar depression or dysthymia, and 65 women with a past history of depression. Sample recruitment characteristics included a mean age of 31 years and average gestation of 16 weeks. The MPEWS cohort was comparable to national averages for Australia on key pregnancy and birth variables. Those participants taking antidepressant medication had higher mean Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI) scores than the cohort as a whole but were comparable on other key variables. The MPEWS protocol provides a unique opportunity to evaluate the impact of pregnancy mental health on future maternal mental health and child development to aid the development of evidence-based interventions. The study is open for collaborative proposals via approach to the principal investigators.

Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent-infant interaction with The Newborn Behavioral Observation

INTRODUCTION

Postpartum depression (PPD) is a prevalent disorder. Studying the factors related to PPD will help to identify families at risk and provide preventive interventions. This can in turn improve the developmental trajectories for the children. Several previous studies have investigated risk factors for PPD. However, few studies have focused on cognitive vulnerability factors. The first aim of the present study is to explore a range of protective and risk factors, including cognitive factors, for PPD, parent-infant interactions and child development. The second aim of the study is to evaluate the effectiveness of The Newborn Behavioral Observation (NBO) as a universal preventive intervention delivered in routine practice. The NBO is a brief relationship-enhancing intervention that may reduce depressive symptomatology in mothers.

METHODS

The study is a longitudinal observational study with an intervention. The observational study uses a prospective cohort design, whereas the intervention study has a non-randomised cluster-controlled design comparing a group receiving NBO with a group receiving standard care. The intervention group will receive three NBO sessions within the first 4 weeks postdelivery. Between 2015 and 2018, approximately 200 families will be recruited in the municipality of Tromsø, Norway. Parents are recruited during pregnancy, and assessments will be performed during gestational weeks 16-22, 24-30 and 31, and at 6 weeks, 4 months and 6 months postdelivery. Predictor variables include several cognitive vulnerability factors including early maladaptive schemas, implicit attitudes and cognitive processing of emotionally valenced infant facial information.

ETHICS AND DISSEMINATION

The Regional Committee for Medical and Health Research Ethics in Northern Norway has approved the project. The research team has collaboration with local health services and can assist participants who need more extensive follow-up. Results from the project will be disseminated in international and national peer-reviewed journals, and at courses and conferences.

TRIALS REGISTRATION NUMBER

NCT02538497; Pre-results.

Caregiver maltreatment causes altered neuronal DNA methylation in female rodents

Negative experiences with a caregiver during infancy can result in long-term changes in brain function and behavior, but underlying mechanisms are not well understood. It is our central hypothesis that brain and behavior changes are conferred by early childhood adversity through epigenetic changes involving DNA methylation. Using a rodent model of early-life caregiver maltreatment (involving exposure to an adverse caregiving environment for postnatal days 1-7), we have previously demonstrated abnormal methylation of DNA associated with the brain-derived neurotrophic factor (Bdnf) gene in the medial prefrontal cortex (mPFC) of adult rats. The aim of the current study was to characterize Bdnf DNA methylation in specific cell populations within the mPFC. In the prefrontal cortex, there is approximately twice as many neurons as glia, and studies have recently shown differential and distinctive DNA methylation patterns in neurons versus nonneurons. Here, we extracted nuclei from the mPFC of adult animals that had experienced maltreatment and used fluorescence-activated cell sorting to isolate cell types before performing bisulfite sequencing to estimate methylation of cytosine-guanine sites. Our data indicate that early-life stress induced methylation of DNA associated with Bdnf IV in a cell-type and sex-specific manner. Specifically, females that experienced early-life maltreatment exhibited greater neuronal cytosine-guanine methylation compared to controls, while no changes were detected in Bdnf methylation in males regardless of cell type. These changes localize the specificity of our previous findings to mPFC neurons and highlight the capacity of maltreatment to cause methylation changes that are likely to have functional consequences for neuronal function.

Are mothers' protective attachment strategies related to their children's strategies?

AIMS

We explored the relation between mothers' protective attachment strategies and those of their school-age children.

METHODS

In total, 49 child-mother dyads participated in a short longitudinal study when the children were 5.5 and 6.0 years old. Their strategies were first assessed with the Preschool Assessment of Attachment (PAA) and then with the School-age Assessment of Attachment (SAA). Mothers were assessed with the Adult Attachment Interview (AAI). The Dynamic-Maturational Model of Attachment and Adaptation (DMM) was used to classify the assessments.

RESULTS

The validity and precision of the DMM-AAI were supported: Mothers' AAI classifications were related to their referral group (normative or clinical) and measures of stress and distress. The DMM categories were more associated with risk than the Ainsworth categories. Types A, C and A/C were differentiated by trauma, triangulation and depression. Mothers' and children's protective attachment strategies were related, with B mothers having B children and A or C mothers having children using the same or opposite strategy. Children whose classification changed from the PAA to the SAA had mothers with complex traumas.

CONCLUSION

When psychosocial treatment is needed, knowing whether mother and child use the same or different strategies and whether mothers have complex trauma can affect treatment success.

How does video interaction guidance contribute to infant and parental mental health and well-being?

This article describes the contribution of video interaction guidance (VIG) to the development of infant and parental and VIG practitioners' mental health and well-being. The theoretical core of VIG was depicted in terms of concepts such as intersubjectivity, attunement and mediated learning. The way the VIG principles alongside the underpinning values and beliefs promote a process of attunement between parent and infant, the VIG practitioner and parent, and the VIG practitioner and supervisor is described. This article also describes some of the evidence about the effectiveness of video feedback techniques more generally and the way in which the underpinning theory of change enables VIG to target key ports of entry in terms of areas that have been highlighted by numerous epidemiological studies as being important in terms of supporting or derailing infant attachment security. A case study is used to demonstrate the way in which VIG can be integrated within broader therapeutic approaches such as parent-infant psychotherapy to support the interaction of parents who have been deeply traumatised in childhood. It also demonstrates how the parallel process of practitioner 'attunement' to mother is key to the mother's recovery and her new ability to form attuned relationships herself with her children and other adults.

Epigenetic and Neural Circuitry Landscape of Psychotherapeutic Interventions

The science behind psychotherapy has garnered considerable interest, as objective measures are being developed to map the patient's subjective change over the course of treatment. Prenatal and early life influences have a lasting impact on how genes are expressed and the manner in which neural circuits are consolidated. Transgenerationally transmitted epigenetic markers as well as templates of enhanced thought flexibility versus evasion can be passed down from parent to child. This influences gene expression/repression (impacting neuroplasticity) and kindling of neurocircuitry which can perpetuate maladaptive cognitive processing seen in a number of psychiatric conditions. Importantly, genetic factors and the compounding effects of early life adversity do not inexorably lead to certain fated outcomes. The concepts of vulnerability and resilience are becoming more integrated into the framework of "differential susceptibility," speaking to how corrective environmental factors may promote epigenetic change and reconfigure neural templates, allowing for symptomatic improvement. Psychotherapy is one such factor, and this review will focus on our current knowledge of its epigenetic and neurocircuitry impact.

Bridging the Gap across the Transition to Coparenthood: Triadic Interactions and Coparenting Representations from Pregnancy through 12 Months Postpartum

Most family researchers agree that the coparenting relationship emerges some time during the transition to parenthood, though it is unclear whether it originates in pregnancy. Previous studies demonstrated that couples' positive representations of their future coparenting relationship and harmonious coparenting behaviors observed during prenatal triadic interactions predicted better postpartum functioning. However, previous studies did not simultaneously assess prenatal coparenting behaviors and representations as predictors of postpartum coparenting. If the coparenting relationship originates during pregnancy, these behavioral and cognitive aspects of prenatal coparenting should show associations with their postpartum counterparts. Based on family systems-, attachment-, and social-learning theory, the first aim in this study was to explore whether prenatal coparenting representations and behaviors are associated with postpartum coparenting, which would suggest that both cognitive and behavioral aspects of the coparenting relationship emerge during pregnancy. A second aim was to determine whether parental coparenting representations are consistent with concurrently observed coparenting behaviors. A sample of 55 couples expecting their first child was observed during triadic interactions during pregnancy and at 3- and 12-months postpartum. Observations were coded using the Coparenting and Family Rating System. Composite scores were formed to reflect harmonious and antagonistic coparenting behaviors. Parents' representations of harmonious and antagonistic coparenting were assessed via interviews and questionnaires during pregnancy and at 3- and 12-months postpartum. Results indicated that prenatal representations of harmonious and antagonistic coparenting were associated with and predicted unique variance in respective postpartum coparenting representations. Prenatal coparenting behaviors were also associated with coparenting behaviors observed during 3-months-play and 12-months-mealtime interactions and predicted unique variance in postpartum coparenting. Surprisingly, prenatal coparenting representations were not associated with prenatal behaviors, though representations and behaviors were associated at 3 months postpartum. Findings suggest that the coparenting relationship originates during pregnancy with prenatal coparenting representations and behaviors bridging the gap across the transition to coparenthood. Future studies should include assessments of both cognitive and behavioral facets of the prenatal coparenting relationship.

The Roots of Chronic Posttraumatic Stress Disorder: Childhood Trauma, Information Processing, and Self-protective Strategies

BACKGROUND

Although childhood endangerment often precedes adult posttraumatic stress disorder (PTSD), the mechanism from danger to disorder is unclear. We proposed a developmental process in which unprotected and uncomforted danger in childhood would be associated with "shortcuts" in information processing that, in adulthood, could result in PTSD if the adult experienced additional exposure to danger. Information processing was defined as the basic associative, dissociative, and integrative processes used by all humans. Individual differences in parents' (or primary caregivers') protective and comforting behavior were expected to force unprotected children to use psychological shortcuts that linked early trauma to later vulnerability for PTSD.

METHOD

We compared 22 adults with chronic PTSD to (a) 22 adults with other psychiatric diagnoses and (b) 22 normative adults without any diagnosis, in terms of information processing around childhood danger. The Adult Attachment Interview was used to derive information processing variables, including self-protective strategies, childhood traumas, and depression.

RESULTS

The two patient groups differed from the normative group on all variables. Adults with chronic PTSD differed from other psychiatric patients in having more childhood traumas and using more transformations of associative and dissociative processes. Within the PTSD group, there were three psychologically different subgroups.

CONCLUSION

Our findings suggest that (1) prediction of risk for adult PTSD may be possible, (2) treatment might be facilitated by provision of a protective and supportive therapist, (3) who included a focus on correction of information processing errors and use of more adaptive strategies, and (4) subgroups of adults with PTSD may require different forms of treatment.

New opportunities in vasopressin and oxytocin research: a perspective from the amygdala

In the present review, we discuss how the evolution of oxytocin and vasopressin from a single ancestor peptide after gene duplication has stimulated the development of the vertebrate social brain. Separate production sites became possible with a hypothalamic development, which, interestingly, is triggered by the same transcription factors that underlie the development of various subcortical regions where vasopressin and oxytocin receptors are adjacently expressed and which are connected by inhibitory circuits. The opposite modulation of their output by vasopressin and oxytocin could thus create a dynamic equilibrium for rapid responsiveness to external stimuli. At the level of the individual, nurturing early in life can long-lastingly program oxytocin signaling, maintaining a capability of learning and sensitivity to external stimuli that contributes to development of social behavior in adulthood. Oxytocin and vasopressin are thus important for the development of a vertebrate brain that supports bonding between individuals and building of an interactive community.

The maternal brain and its plasticity in humans

This article is part of a Special Issue "Parental Care". Early mother-infant relationships play important roles in infants' optimal development. New mothers undergo neurobiological changes that support developing mother-infant relationships regardless of great individual differences in those relationships. In this article, we review the neural plasticity in human mothers' brains based on functional magnetic resonance imaging (fMRI) studies. First, we review the neural circuits that are involved in establishing and maintaining mother-infant relationships. Second, we discuss early postpartum factors (e.g., birth and feeding methods, hormones, and parental sensitivity) that are associated with individual differences in maternal brain neuroplasticity. Third, we discuss abnormal changes in the maternal brain related to psychopathology (i.e., postpartum depression, posttraumatic stress disorder, substance abuse) and potential brain remodeling associated with interventions. Last, we highlight potentially important future research directions to better understand normative changes in the maternal brain and risks for abnormal changes that may disrupt early mother-infant relationships.

Emotional awareness as a pathway linking adult attachment to subsequent depression

Although research links insecure adult attachment with depression, the emotional processes accounting for this association over time remain relatively unexplored. To address this gap, this study investigated whether deficits in emotional awareness serve as one explanatory process. Adult female caregivers (N = 417, Mage = 37.83) completed questionnaires annually for 3 years. As anticipated, attachment avoidance exerted an indirect effect on depression via emotional awareness. Attachment anxiety directly predicted subsequent depression, but the indirect effect through emotional awareness was nonsignificant. These results suggest that an avoidant attachment style interferes with the effective processing of emotions, thereby placing women at risk for depression. This research implicates emotional awareness as a potential target for interventions aimed at reducing depressive symptoms in mothers with avoidant attachment styles.

Mothers who are securely attached in pregnancy show more attuned infant mirroring 7 months postpartum

This study contrasted two forms of mother-infant mirroring: the mother's imitation of the infant's facial, gestural, or vocal behavior (i.e., "direct mirroring") and the mother's ostensive verbalization of the infant's internal state, marked as distinct from the infant's own experience (i.e., "intention mirroring"). Fifty mothers completed the Adult Attachment Interview (Dynamic Maturational Model) during the third trimester of pregnancy. Mothers returned with their infants 7 months postpartum and completed a modified still-face procedure. While direct mirroring did not distinguish between secure and insecure/dismissing mothers, secure mothers were observed to engage in intention mirroring more than twice as frequently as did insecure/dismissing mothers. Infants of the two mother groups also demonstrated differences, with infants of secure mothers directing their attention toward their mothers at a higher frequency than did infants of insecure/dismissing mothers. The findings underscore marked and ostensive verbalization as a distinguishing feature of secure mothers' well-attuned, affect-mirroring communication with their infants.

Unresolved trauma in mothers: intergenerational effects and the role of reorganization

A mother's unresolved trauma may interfere with her ability to sensitively respond to her infant, thus affecting the development of attachment in her own child, and potentially contributing to the intergenerational transmission of trauma. One novel construct within the Dynamic Maturational Model of Attachment and Adaptation (DMM) coding of the Adult Attachment Interview (AAI) is "reorganization," a process whereby speakers are actively changing their understanding of past and present experiences and moving toward attachment security. We conducted a study of mothers with unresolved trauma, exploring their own attachment classification, attachment outcomes of their children, and the potential effects of reorganization on child attachment. Forty-seven first-time mothers participated in the AAI during pregnancy, and returned with their child at 11 months to assess child attachment using the Strange Situation Procedure. Mothers with and without unresolved trauma were compared. We found that mothers with unresolved trauma had insecure attachment themselves and were more likely to have infants with insecure attachment. However, the one exception was that all of the mothers with unresolved trauma who were reorganizing toward secure attachment had infants with secure attachment. These preliminary findings suggest that mothers who are reorganizing may be able to more sensitively respond to their child's cues, contributing to the development of secure attachment. While our results need to be replicated in a larger cohort, this study is the first to explore the construct of reorganization and its potential relationship with child attachment. If confirmed in future studies, it may provide clinical insight into the intergenerational transmission of insecure attachment within the context of unresolved trauma.

Mothers' unresolved trauma blunts amygdala response to infant distress

While the neurobiology of post-traumatic stress disorder has been extensively researched, much less attention has been paid to the neural mechanisms underlying more covert but pervasive types of trauma (e.g., those involving disrupted relationships and insecure attachment). Here, we report on a neurobiological study documenting that mothers' attachment-related trauma, when unresolved, undermines her optimal brain response to her infant's distress. We examined the amygdala blood oxygenation level-dependent response in 42 first-time mothers as they underwent functional magnetic resonance imaging scanning, viewing happy- and sad-face images of their own infant, along with those of a matched unknown infant. Whereas mothers with no trauma demonstrated greater amygdala responses to the sad faces of their own infant as compared to their happy faces, mothers who were classified as having unresolved trauma in the Adult Attachment Interview (Dynamic Maturational Model) displayed blunted amygdala responses when cued by their own infants' sadness as compared to happiness. Unknown infant faces did not elicit differential amygdala responses between the mother groups. The blunting of the amygdala response in traumatized mothers is discussed as a neural indication of mothers' possible disengagement from infant distress, which may be part of a process linking maternal unresolved trauma and disrupted maternal caregiving.

Maternal oxytocin response predicts mother-to-infant gaze

The neuropeptide oxytocin is importantly implicated in the emergence and maintenance of maternal behavior that forms the basis of the mother-infant bond. However, no research has yet examined the specific association between maternal oxytocin and maternal gaze, a key modality through which the mother makes social contact and engages with her infant. Furthermore, prior oxytocin studies have assessed maternal engagement primarily during episodes free of infant distress, while maternal engagement during infant distress is considered to be uniquely relevant to the formation of secure mother-infant attachment. Two patterns of maternal gaze, maternal gaze toward and gaze shifts away from the infant, were micro-coded while 50 mothers interacted with their 7-month-old infants during a modified still-face procedure. Maternal oxytocin response was defined as a change from baseline in the mother's plasma oxytocin level following interaction with her infant. The mother's oxytocin response was positively associated with the duration of time her gaze was directed toward her infant, while negatively associated with the frequency with which her gaze shifted away from her infant. Importantly, mothers who showed low/average oxytocin response demonstrated a significant decrease in their infant gaze during periods of infant distress, while such change was not observed in mothers with high oxytocin response. The findings underscore the involvement of oxytocin in regulating the mother's responsive engagement with her infant, particularly in times when the infant's need for access to the mother is greatest. This article is part of a Special Issue entitled Oxytocin and Social Behav.

Neurobiology of secure infant attachment and attachment despite adversity: a mouse model

Attachment to an abusive caregiver has wide phylogenetic representation, suggesting that animal models are useful in understanding the neural basis underlying this phenomenon and subsequent behavioral outcomes. We previously developed a rat model, in which we use classical conditioning to parallel learning processes evoked during secure attachment (odor-stroke, with stroke mimicking tactile stimulation from the caregiver) or attachment despite adversity (odor-shock, with shock mimicking maltreatment). Here we extend this model to mice. We conditioned infant mice (postnatal day (PN) 7-9 or 13-14) with presentations of peppermint odor and either stroking or shock. We used (14) C 2-deoxyglucose (2-DG) to assess olfactory bulb and amygdala metabolic changes following learning. PN7-9 mice learned to prefer an odor following either odor-stroke or shock conditioning, whereas odor-shock conditioning at PN13-14 resulted in aversion/fear learning. 2-DG data indicated enhanced bulbar activity in PN7-9 preference learning, whereas significant amygdala activity was present following aversion learning at PN13-14. Overall, the mouse results parallel behavioral and neural results in the rat model of attachment, and provide the foundation for the use of transgenic and knockout models to assess the impact of both genetic (biological vulnerabilities) and environmental factors (abusive) on attachment-related behaviors and behavioral development.

The missing link: mothers' neural response to infant cry related to infant attachment behaviors

This study addresses a gap in the attachment literature by investigating maternal neural response to cry related to infant attachment classifications and behaviors. Twenty-two primiparous mothers and their 18-month old infants completed the Strange Situation (SS) procedure to elicit attachment behaviors. During a separate functional MRI session, mothers were exposed to their own infant's cry sound, as well as an unfamiliar infant's cry and control sound. Maternal neural response to own infant cry related to both overall attachment security and specific infant behaviors. Mothers of less secure infants maintained greater activation to their cry in left parahippocampal and amygdala regions and the right posterior insula consistent with a negative schematic response bias. Mothers of infants exhibiting more avoidant or contact maintaining behaviors during the SS showed diminished response across left prefrontal, parietal, and cerebellar areas involved in attentional processing and cognitive control. Mothers of infants exhibiting more disorganized behavior showed reduced response in bilateral temporal and subcallosal areas relevant to social cognition and emotion regulation. No differences by attachment classification were found. Implications for attachment transmission models are discussed.

Neuroscience of human social interactions and adult attachment style

Since its first description four decades ago, attachment theory (AT) has become one of the principal developmental psychological frameworks for describing the role of individual differences in the establishment and maintenance of social bonds between people. Yet, still little is known about the neurobiological underpinnings of attachment orientations and their well-established impact on a range of social and affective behaviors. In the present review, we summarize data from recent studies using cognitive and imaging approaches to characterize attachment styles and their effect on emotion and social cognition. We propose a functional neuroanatomical framework to integrate the key brain mechanisms involved in the perception and regulation of social emotional information, and their modulation by individual differences in terms of secure versus insecure (more specifically avoidant, anxious, or resolved versus unresolved) attachment traits. This framework describes how each individual's attachment style (built through interactions between personal relationship history and predispositions) may influence the encoding of approach versus aversion tendencies (safety versus threat) in social encounters, implicating the activation of a network of subcortical (amygdala, hippocampus, striatum) and cortical (insula, cingulate) limbic areas. These basic and automatic affective evaluation mechanisms are in turn modulated by more elaborate and voluntary cognitive control processes, subserving mental state attribution and emotion regulation capacities, implicating a distinct network in medial prefrontal cortex (mPFC), superior temporal sulcus (STS), and temporo-parietal junction (TPJ), among others. Recent neuroimaging data suggest that affective evaluation is decreased in avoidantly but increased in anxiously attached individuals. In turn, although data on cognitive control is still scarce, it points toward a possible enhancement of mental state representations associated with attachment insecurity and particularly anxiety. Emotion regulation strategies such as reappraisal or suppression of social emotions are also differentially modulated by attachment style. This research does not only help better understand the neural underpinnings of human social behavior, but also provides important insights on psychopathological conditions where attachment dysregulation is likely to play an important (causal) role.

Maternal neglect: oxytocin, dopamine and the neurobiology of attachment

Maternal neglect, including physical and emotional neglect, is a pervasive public health challenge with serious long-term effects on child health and development. I provide an overview of the neurobiological basis of maternal caregiving, aiming to better understand how to prevent and respond to maternal neglect. Drawing from both animal and human studies, key biological systems are identified that contribute to maternal caregiving behaviour, focusing on the oxytocinergic and dopaminergic systems. Mesocorticolimbic and nigrostriatal dopamine pathways contribute to the processing of infant-related sensory cues leading to a behavioural response. Oxytocin may activate the dopaminergic reward pathways in response to social cues. Human neuroimaging studies are summarised that demonstrate parallels between animal and human maternal caregiving responses in the brain. By comparing different patterns of human adult attachment, we gain a clearer understanding of how differences in maternal brain and endocrine responses may contribute to maternal neglect. For example, in insecure/dismissing attachment, which may be associated with emotional neglect, we see reduced activation of the mesocorticolimbic dopamine reward system in response to infant face cues, as well as decreased peripheral oxytocin response to mother-infant contact. We are currently testing whether the administration of intranasal oxytocin, as part of a randomised placebo controlled trial, may reverse some of these neurological differences, and potentially augment psychosocial and behavioural interventions for maternal neglect.

Childhood sexual abuse and attachment: An intergenerational perspective

Childhood sexual abuse (CSA) is a recognized risk factor for various negative outcomes in adult survivors and their offspring. We used the Dynamic-Maturational Model of attachment theory as a framework for exploring the impact of maternal CSA on children's attachment relationships in the context of a longitudinal sample of adult survivors of CSA and non-abused comparison mothers and their children. Results indicated that children of CSA survivors were more likely to have extreme strategies of attachment than the children of non-abused mothers. However, because both groups were at socioeconomic risk, both were typified by anxious attachment. Explanations for findings and implications for children's development are explored.

Quality of attachment in St Petersburg (Russian Federation): A sample of family-reared infants

The study aimed to describe the quality of attachment in the sample of children living in St Petersburg (Russian Federation). Up to the present there were no studies on quality of attachment relationship among infants living in families in the Russian Federation (RF), including families living in St Petersburg. The study results have an important value for understanding of development of attachment patterns in a changing society with a previous history of being a totalitarian state. The St Petersburg sample consisted of 130 children, living in families, aged 11-16 months old (mean = 13.3 months). Children were living in largely normative low-risk families. The Strange Situation Procedure was used (Ainsworth Blehar, Waters, & Wall, 1978). The attachment categories were classified according to the criteria of the DMM model (Crittenden, 2002). Results presented show that 50% of children showed the complex strategies (pre-A3-4 compulsive caregiving and compliant, pre-C3-4 aggressive and feigned helpless, A/C). It was found that among a St Petersburg sample of families there was small number of children with secure attachment pattern and many children with complex attachment strategies.