Parental reflective functioning in mothers and fathers of preschoolers: Associations with adult attachment and parenting behavior

Parental reflective functioning (PRF) is considered a key parental competence. Since most research on PRF has focused on infancy or the first years of life, there is a gap in our understanding of PRF among parents of older children. Therefore, we investigated PRF in mothers and fathers with preschool-aged children, examining associations between PRF, parent's romantic attachment, and observed parenting behavior. The sample comprised 50 mothers, 40 fathers, and their 5-year-old children. PRF was assessed using the parental reflective functioning questionnaire (PRFQ), parental romantic attachment was assessed using the experiences in close relationships scale-revised (ECR-R), and parenting behavior was assessed during a parent-child free-play interaction with the coding interactive behavior (CIB) coding system. Results showed that mothers scored higher on the interest and curiosity scale than fathers, indicating that mothers show a more active interest and curiosity in their child's mental states. Further, higher levels of attachment anxiety in fathers were associated with higher levels of pre-mentalizing modes. In mothers, higher levels of attachment avoidance were associated with lower levels of interest and curiosity. Finally, and unexpectedly, higher levels of interest and curiosity in mothers were associated with less sensitivity during free play. In summary, the study found meaningful associations between mothers' and fathers' romantic attachment and their PRF indicating a spill-over of their attachment strategies into their relationship with their child. Further, the study results suggest that very high levels of interest and curiosity in mothers reflect hypermentalizing.

Testing reliability and validity of practitioner-rated parental sensitivity: A novel tool for practice

Improving parental sensitivity is an important objective of interventions to support families. This study examined reliability and validity of parental sensitivity ratings using a novel package of an e-learning tool and an interactive decision tree provided through a mobile application, called the OK! package. Independent raters assessed parental sensitivity using the OK! package (N = 11 raters) and the NICHD Parental Sensitivity rating scales (N = 22 raters) on the basis of videotaped mother-child interactions at 10- or 12-months-old (N = 294) and at 24-months-old (N = 204) from the Dutch longitudinal cohort study Generation2 . Mothers reported on children's externalizing and internalizing problems and social competence when children were 4 and 7 years old. Results showed excellent single interrater reliability for raters using the OK! package (mean ICC = .79), and strong evidence for convergent validity at 10- or 12-month-old (r = .57) and 24-month-old (r = .65). Prospective associations of neither parental sensitivity rated using the OK! package or the NICHD Parental Sensitivity rating scales with child developmental outcomes were statistically significant (p > .05), with overlapping 95% confidence intervals for both measures. The OK! package provides a promising direction for testing alternatives to current training and instruction modalities.

Story stems in early mother-infant interaction promote pretend play at 30 months

During early childhood, play develops through levels of sensory exploration and manipulation, to functional activities and during the second year of life to the level of pretend and symbolic play. However, little is known about the factors contributing to individual variations in the development of play. The present study investigated associations between maternal sensitivity and play conditions with different ways of engaging and participating and children's development of pretend play. Participants were 64 primiparous mothers and their 30-months-old children. Sensitivity was assessed using the Coding Interactive Behavior (CIB) coding system, and children's play was coded using the 12 Step Play Scale. Analyses showed no significant associations between sensitivity and children's play development but a play condition introducing a story stem was associated with a higher developmental play level and longer duration of pretend play compared to free interactive play. The findings suggest that the use of a story stem may promote pretend play in interactive settings with the mother.

Pushing the boundaries of digital social contact: Experiences of people with disabilities and their social networks during the COVID-19 pandemic

During the COVID-19 pandemic, many people with intellectual disabilities living in care facilities could not receive visitors. Health authorities suggested the use of digital social contact as an alternative for in-person visits. We examined how people with intellectual disabilities living in care facilities experienced the use of digital social contact with their informal social network throughout 2020. Residents, their relatives, volunteer visitors, direct support staff, and care facility managers (N = 283) completed an online questionnaire, of whom 35 participated in an interview. Video calling and in-person visits were among the most common forms of staying in touch. Experiences with digital social contact depended on residents' abilities and support needs, and on preconditions, such as staff availability. The first phases of the pandemic led to experiences of possibilities and benefits of using digital social contact as complementary to in-person contact for people with different levels of intellectual disability, also after the pandemic.

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.

Editorial Perspective: On the need for clarity about attachment terminology

Part of the appeal of attachment language is that it feels near to our everyday experience, as terms like 'attachment', 'security' or 'disorganisation' feel readily recognisable. Yet, not one of these terms is used by academic attachment researchers in line with ordinary language. This has hindered the evidence-based use of attachment in practice, the feedback loop from practice to research and the dialogue between attachment researchers in developmental psychology and in social psychology. This paper pinpoints the difficulties arising from the existence of multiple versions of 'attachment theory' that use exactly the same terms, held by communities that assume that they are referring to the same thing and with little infrastructure to help them discover otherwise. When we talk past one another, the different communities with a stake in knowledge of attachment are obstructed from genuinely learning from one another, drawing on their respective strengths and pursuing collaborations. One factor contributing to this situation has been the use of attachment terminology with technical meanings, but often without setting out clear definitions. We here introduce a guide to attachment terminology used by the academic community, which has recently been published on the website of the Society for Emotion and Attachment Studies. The guide is meant for researchers, clinicians and everyone concerned with attachment to increase understanding of the technical meaning of important terminology used by researchers, and support the quality of discussions between researchers, and between researchers and clinicians and other publics.

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.

People with intellectual disabilities living in care facilities engaging in virtual social contact: A systematic review of the feasibility and effects on well-being

Background

During the initial phase of the COVID‐19 pandemic, many people with disabilities living in home care facilities could not receive visitors. The use of virtual social contact has been recommended by health authorities. This systematic review examined the scientific evidence of the use and feasibility of information and communication technology (ICT) for social contact by people with intellectual disabilities living in care facilities, and potential effects on well‐being.

Methods

Five databases were searched using traditional systematic screening and machine‐learning supported screening. Findings are presented in a narrative synthesis using thematic analysis.

Results

Nine studies were included. We described three themes: means of ICT used for social contact; effects on well‐being; and benefits, barriers, and preconditions.

Conclusions

Engaging in virtual social contact may be feasible for people with severe to mild intellectual disabilities, but there is little concrete evidence that this can be used as an alternative for in‐person contact.

Internalizing and externalizing problems in preschool children: The role of mothers' and fathers' observed parenting behavior in a well-resourced sample

Empirical evidence links sensitive parenting behavior to positive developmental trajectories in children, whereas parental intrusiveness, in contrast, has been found to increase the risk of socio-emotional problems in children of various ages. However, most studies investigating the effect of parenting behavior have been conducted with mothers. Thus, little is yet known about fathers' role in child development and if mothers' and fathers' parenting behaviors are linked to child socio-emotional outcomes in similar or different ways. To date, findings are ambiguous, and this is why more studies are needed. The present study examined associations between mothers' and fathers' observed sensitivity and intrusiveness and children's internalizing and externalizing problems as reported by parents and by children themselves. The sample compromised 52 mothers, 41 fathers and their preschool children. Results from hierarchical regression analyses showed a negative association between fathers' intrusiveness, at low levels, and children's internalizing problems. This result was unexpected. However, in line with this finding, a number of recent studies suggest that when fathers challenge and push their children's limits, it buffers against emotional problems such as anxiety. The present study highlights the importance of a continuous investigation into fathers' potentially unique contribution to children's socio-emotional development. No other associations were identified between mothers' and fathers' parenting behaviors and children's internalizing and externalizing problems. Most likely, because this study was conducted with a low-risk sample, where children were in general well-functioning.

Associations of maternal sensitivity and embodied mentalizing with infant-mother attachment security at one year in depressed and non-depressed dyads

Parental Embodied Mentalizing (PEM) captures the parent's capacity to extrapolate the child's mental states from movement and respond on a nonverbal level. Little is known about PEM's relation to other established measures of parent-child interactive behavior, such as maternal sensitivity and attachment. This is investigated in a sample of four months old infants and mothers with (n = 27) and without a diagnosis of postpartum depression (n = 44). Video-recorded infant-mother interactions were coded independently using PEM and Coding Interactive Behavior. Attachment was assessed at 13 months using the Strange Situation Procedure. Sensitivity and PEM was positively associated, but only sensitivity predicted attachment security and only the nonclinical group. This indicates that PEM and sensitivity are moderately related as well as capturing different aspects of infant-mother interactions. The study confirms previous findings of sensitivity predicting attachment in nonclinical groups. More research is required to further understand predictors of attachment in clinical samples.

Social and emotional contexts predict the development of gaze following in early infancy

The development of gaze following begins in early infancy and its developmental foundation has been under heavy debate. Using a longitudinal design (N = 118), we demonstrate that attachment quality predicts individual differences in the onset of gaze following, at six months of age, and that maternal postpartum depression predicts later gaze following, at 10 months. In addition, we report longitudinal stability in gaze following from 6 to 10 months. A full path model (using attachment, maternal depression and gaze following at six months) accounted for 21% of variance in gaze following at 10 months. These results suggest an experience-dependent development of gaze following, driven by the infant's own motivation to interact and engage with others (the social-first perspective).

Maternal postpartum depression is a risk factor for infant emotional variability at 4 months

Maternal postpartum depression (PPD) is a risk for disruption of mother-infant interaction. Infants of depressed mothers have been found to display less positive, more negative, and neutral affect. Other studies have found that infants of mothers with PPD inhibit both positive and negative affect. In a sample of 28 infants of mothers with PPD and 52 infants of nonclinical mothers, we examined the role of PPD diagnosis and symptoms for infants' emotional variability, measured as facial expressions, vocal protest, and gaze using microanalysis, during a mother-infant face-to-face interaction. PPD symptoms and diagnosis were associated with (a) infants displaying fewer high negative, but more neutral/interest facial affect events, and (b) fewer gaze off events.  PPD diagnosis, but not symptoms, was associated with less infant vocal protest. Total duration of seconds of infant facial affective displays and gaze off was not related to PPD diagnosis or symptoms, suggesting that when infants of depressed mothers display high negative facial affect or gaze off, these expressions are more sustained, indicating lower infant ability to calm down and re-engage, interpreted as a disturbance in self-regulation. The findings highlight the importance of not only examining durations, but also frequencies, as the latter may inform infant emotional variability.

Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity

Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.

Patterns of parenting: revisiting mechanistic models

This commentary argues for the need to revisit the foundations of attachment theory and its tradition of formulating testable mechanistic models of relationship development and change. Modeling and simulation may be useful to test novel theoretical propositions, such as the one stating that pleasure in parenting may be a determinant of secure father-infant attachment relationships (Brown & Cox, this issue). We discuss this proposition's plausibility, by relating parenting pleasure to the temporal patterning of parenting, a neglected property in parent-child interaction. Simulation work may not only offer first test runs of novel hypotheses, but may also guide empirical researchers to the most likely time-scale on which such hypotheses should be tested.

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static "trait" of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Are parents' anxiety and depression related to child fussy eating?

OBJECTIVE

To examine the association between parental anxiety and depression with child fussy eating-that is, consistent rejection of particular food items.

DESIGN

This study was embedded in Generation R, a prospective cohort from fetal life onwards in the Netherlands.

SETTING

Population-based.

PARTICIPANTS

4746 4-year-old children and their parents.

EXPOSURE

Parental internalising problems (ie, symptoms of anxiety and depression) were assessed with the Brief Symptoms Inventory during pregnancy and the preschool period (child age 3 years).

MAIN OUTCOME MEASURE

The food fussiness scale of the Children's Eating Behaviour Questionnaire.

RESULTS

Maternal anxiety during pregnancy and during the child's preschool period was related to higher food fussiness sum-scores in children. For instance, per point on the anxiety scale in pregnancy, children had on average a 1.02 higher sum-score (95% CI 0.59 to 1.46) on the food fussiness scale, after adjustment for confounders. Likewise, mothers' depressive symptoms at both time points were associated with fussy eating behaviour in their children (eg, in the antenatal period: per point on the depression scale, children had a 0.91 point higher sum-score on the food fussiness scale, 95% CI 0.49 to 1.33). We found largely similar associations between fathers' internalising problems and children's fussy eating. However, fathers' anxiety during the antenatal period was not related to child fussy eating.

CONCLUSIONS

Maternal and paternal internalising problems were prospectively associated with fussy eating in preschoolers. Healthcare practitioners should be aware that non-clinical symptoms of anxiety and depression in parents are risk factors for child fussy eating.

Trajectories of picky eating during childhood: A general population study

OBJECTIVE

This cohort study describes the prevalence of picky eating and examines prognostic factors for picky eating trajectories during childhood.

METHODS

4,018 participants of a population-based cohort with measurements from pregnancy onwards were included. Picky eating was assessed by maternal report when children were 1.5, 3, and 6 years old. The associations of child and family characteristics with trajectories of picky eating were examined using logistic regression. Never picky eaters were used as the reference group.

RESULTS

Prevalence of picky eating was 26.5% at 1.5 years of age, 27.6% at the age of 3 and declined to 13.2% at 6 years. Four main picky eating trajectories were defined: (1) never picky eating at all three assessments (55% of children), (2) remitting (0-4 years, 32%), (3) late-onset (6 years only, 4%), and (4) persistent (all ages, 4%). This implies that almost two thirds of the early picky eaters remitted within 3 years. Male sex, lower birth weight, non-Western maternal ethnicity, and low parental income predicted persistent picky eating. More often late-onset picky eaters were children of parents with low income and non-Western ethnicity.

DISCUSSION

We found that nearly half (46%) of children were picky eaters at some point during early childhood. Remittance was very high. This suggests that picky eating is usually a transient behavior and part of normal development in preschool children. However, a substantial group of persistent picky eaters, often from a socially disadvantaged background, continues to have problems beyond the preschool age.

The Prevalence of Child Sexual Abuse in Out-of-home Care: Increased Risk for Children with a Mild Intellectual Disability

BACKGROUND

Children without disabilities in out-of-home care have a higher risk of child sexual abuse [CSA (Euser et al. 2013)]. In this study, we examined the year prevalence of CSA in out-of-home care for children with a mild intellectual disability, and compared it with the prevalence in out-of-home care for non-disabled children and children in the general population.

MATERIALS AND METHODS

Professionals (N = 104) from out-of-home care facilities reported cases of CSA that occurred in 2010 for the children they worked with (N = 1650).

RESULTS

In out-of-home care for children with a mild intellectual disability, 9.8 per 1000 children were victims of CSA. This prevalence was significantly higher than in regular out-of-home care and in the general population.

CONCLUSION

Children with a mild intellectual disability in out-of-home care have an increased risk of CSA. Adequate education and support for both children and caregivers is necessary to recognize and prevent further sexual abuse.

Feeding practices and child weight: is the association bidirectional in preschool children?

BACKGROUND

Parental feeding practices are associated with children's body mass index (BMI). It has been generally assumed that parental feeding determines children's eating behaviors and weight gain, but feeding practices could equally be a parent's response to child weight.

OBJECTIVE

In longitudinal analyses, we assessed the directionality in the relation between selected controlling feeding practices and BMI in early childhood.

DESIGN

Participants were 4166 children from the population-based Generation R Study. BMI was measured at ages 2 and 6 y. With the use of the Child Feeding Questionnaire, parents reported on restriction, monitoring, and pressure to eat (child age: 4 y). BMI and feeding-behavior scales were transformed to SD scores.

RESULTS

With the use of linear regression analyses, there was an indication that a higher BMI at age 2 y predicted higher levels of parental restriction (adjusted β = 0.07; 95% CI: 0.04, 0.10) and lower levels of pressure to eat (adjusted β = -0.20; 95% CI: -0.23, -0.17) 2 y later. Restriction at age 4 y positively predicted child BMI at 6 y of age, although this association attenuated to statistical nonsignificance after accounting for BMI at age 4 y (β = 0.01; 95% CI: -0.01, 0.03). Pressure to eat predicted lower BMI independently of BMI at age 4 y (β = -0.02; 95% CI: -0.04, -0.01). For both restriction and pressure to eat, the relation from BMI to parenting was stronger than the reverse (Wald's test for comparison: P = 0.03 and < 0.001, respectively). Monitoring predicted a lower child BMI, but this relation was explained by confounding factors.

CONCLUSIONS

Although the feeding-BMI relation is bidirectional, the main direction of observed effects suggests that parents tend to adapt their controlling feeding practices in response to their child's BMI rather than the reverse. Therefore, some components of current programs aimed at preventing or treating unhealthy child weight may need to be carefully scrutinized, especially those targeting parental food-related restriction and pressure to eat.

Toward an operative diagnosis of fussy/picky eating: a latent profile approach in a population-based cohort

Background

Definitions and assessment methods of fussy/picky eating are heterogeneous and remain unclear.

We aimed to identify an eating behavior profile reflecting fussy/picky eating in children and to describe characteristics of fussy eaters.

Methods

Eating behavior was assessed with the Child Eating Behavior Questionnaire (CEBQ) in 4914 4-year olds in a population-based birth cohort study. Latent Profile Analysis (LPA) was used to identify eating behavior profiles based on CEBQ subscales.

Results and discussion

We found a “fussy” eating behavior profile (5.6% of children) characterized by high food fussiness, slowness in eating, and satiety responsiveness in combination with low enjoyment of food and food responsiveness. Fussy eaters were more often from families with low household income than non-fussy eaters (42% vs. 31.8% respectively; Χ²(1) = 9.97, p < .01). When they were 14 months old, fussy eaters had a lower intake of vegetables (t [3008] = 2.42, p < .05) and fish (t [169.77] = 2.40, p < .05) but higher intake of savory snacks (t [153.69] = -2.03, p < .05) and sweets (t [3008] = -2.30, p < .05) compared to non-fussy eaters. Also, fussy eaters were more likely to be underweight at 4 years of age (19.3%) than non-fussy eaters (12.3%; Χ²(1) = 7.71, p < .01).

Conclusions

A distinct fussy eating behavior profile was identified by LPA, which was related to family and child characteristics, food intake, and BMI. This behavior profile might be used in future research and the development of interventions.

The prevalence of child sexual abuse in out-of-home care: a comparison between abuse in residential and in foster care

We investigated the 2010 year prevalence of child sexual abuse (CSA) in residential and foster care and compared it with prevalence rates in the general population. We used two approaches to estimate the prevalence of CSA. First, 264 professionals working in residential or foster care (sentinels) reported CSA for the children they worked with (N = 6,281). Second, 329 adolescents staying in residential or foster care reported on their own experiences with CSA. Sentinels and adolescents were randomly selected from 82 Dutch out-of-home care facilities. We found that 3.5 per 1,000 children had been victims of CSA based on sentinel reports. In addition, 58 per 1,000 adolescents reported having experienced CSA. Results based on both sentinel report and self-report revealed higher prevalence rates in out-of-home care than in the general population, with the highest prevalence in residential care. Prevalence rates in foster care did not differ from the general population. According to our findings, children and adolescents in residential care are at increased risk of CSA compared to children in foster care. Unfortunately, foster care does not fully protect children against sexual abuse either, and thus its quality needs to be further improved.

Attachment insecurity predicts child active resistance to parental requests in a compliance task

AIM

We studied the effects of early mother-child relationship quality and child temperament on the development of child compliance and active resistance in a large population-based cohort study (n = 534).

BACKGROUND

Parenting and the quality of the parent-child relationship can either hamper or support the development of child compliance directly or in interplay with child temperament.

METHODS

Mother-infant dyads were observed at 14 and 36 months and maternal and child behaviours were independently coded. The quality of compliance was assessed at 36 months in a clean-up task. Child behaviour was coded using a system differentiating between two dimensions: Compliance and Active Resistance.

RESULTS

Controlling for concurrent maternal sensitivity, child temperament, and gender children with a more insecure attachment relationship showed higher levels of active resistance during Clean-Up than more securely attached children. The effect was stronger for boys than for girls and mainly driven by attachment avoidance.

CONCLUSIONS

Early attachment is an important contributor to child socialization of moral behaviour.

Attachment disorganization moderates the effect of maternal postnatal depressive symptoms on infant autonomic functioning

We examined associations of disorganized attachment and maternal depressive symptoms with infant autonomic functioning in 450 infant-mother dyads enrolled in the Generation R study. Maternal depressive symptoms were measured 2 months postpartum with the Brief Symptom Inventory. At 14 months, we assessed infant attachment with a slightly shortened Strange Situation and measured infant resting heart rate. Respiratory sinus arrhythmia (RSA) was calculated using spectral analysis. Higher levels of maternal postnatal depressive symptoms predicted lower resting RSA in disorganized infants (B = -0.31, SE = 0.15, p = .04, R(2)  = .05) but not in nondisorganized infants (B = 0.05, SE = 0.06, p = .36). This effect was buffered in disorganized infants with a secondary secure attachment classification. Disorganized infants were more vulnerable to the effect of maternal postnatal depressive symptoms on the physiological stress systems.

Maternal lifetime history of depression and depressive symptoms in the prenatal and early postnatal period do not predict infant-mother attachment quality in a large, population-based Dutch cohort study

We examined the effects of maternal history of depressive disorder and the effects of depressive symptoms during pregnancy and the early postpartum period on attachment insecurity and disorganization. A total of 627 mother-infant dyads from the Generation R Study participated in a population-based cohort from fetal life onwards. Maternal history of depression was assessed by diagnostic interviews during pregnancy; maternal peri- and postnatal depressive symptoms were assessed with questionnaires in 506 of these women at 20 weeks pregnancy and two months postpartum; and infant-mother attachment security was observed when infants were aged 14 months. A history of maternal depressive disorder, regardless of severity or psychiatric comorbidity, was not associated with an increased risk of infant attachment insecurity or disorganization. Likewise, maternal peri- and postnatal depressive symptoms were not related to attachment insecurity or disorganization at 14 months. These results are important because mothers from otherwise low risk backgrounds often have previously been depressed or are struggling with non-clinical depressive symptoms during pregnancy and after giving birth. Our findings are discussed in terms of protective factors that may limit the potentially negative effects of maternal depressive symptoms on the infant-mother attachment relationship in the general population. The role of selective attrition and lack of information about the mothers' attachment status for the current null-findings are also discussed.

The association between paternal sensitivity and infant-father attachment security: a meta-analysis of three decades of research

For almost three decades, the association between paternal sensitivity and infant-father attachment security has been studied. The first wave of studies on the correlates of infant-father attachment showed a weak association between paternal sensitivity and infant-father attachment security (r = .13, p < .001, k = 8, N = 546). In the current paper, a meta-analysis of the association between paternal sensitivity and infant-father attachment based on all studies currently available is presented, and the change over time of the association between paternal sensitivity and infant-father attachment is investigated. Studies using an observational measure of paternal interactive behavior with the infant, and the Strange Situation Procedure to observe the attachment relationship were included. Paternal sensitivity is differentiated from paternal sensitivity combined with stimulation in the interaction with the infant. Higher levels of paternal sensitivity were associated with more infant-father attachment security (r = .12, p < .001, k = 16, N = 1,355). Fathers' sensitive play combined with stimulation was not more strongly associated with attachment security than sensitive interactions without stimulation of play. Despite possible changes in paternal role patterns, we did not find stronger associations between paternal sensitivity and infant attachment in more recent years.

Dopaminergic, serotonergic, and oxytonergic candidate genes associated with infant attachment security and disorganization? In search of main and interaction effects

BACKGROUND AND METHODS

In two birth cohort studies with genetic, sensitive parenting, and attachment data of more than 1,000 infants in total, we tested main and interaction effects of candidate genes involved in the dopamine, serotonin, and oxytocin systems (DRD4, DRD2, COMT, 5-HTT, OXTR) on attachment security and disorganization. Parenting was assessed using observational rating scales for parental sensitivity (Ainsworth, Bell, & Stayton, 1974), and infant attachment was assessed with the Strange Situation Procedure.

RESULTS

We found no consistent additive genetic associations for attachment security and attachment disorganization. However, specific tests revealed evidence for a codominant risk model for COMT Val158Met, consistent across both samples. Children with the Val/Met genotype showed higher disorganization scores (combined effect size d = .22, CI = .10-.34, p < .001). Gene-by-environment interaction effects were not replicable across the two samples.

CONCLUSIONS

This unexpected finding might be explained by a broader range of plasticity in heterozygotes, which may increase susceptibility to environmental influences or to dysregulation of emotional arousal. This study is unique in combining the two largest attachment cohorts with molecular genetic and observed rearing environment data to date.

Spot the red herring: breastfeeding, fruitpurée, and infant autonomic functioning-the generation R study

Several studies have suggested that breastfeeding is related to infant autonomic functioning. The authors investigated whether this is a causal relation. In all, 444 mothers reported breastfeeding practices 2 mo postpartum. Infant autonomic functioning was assessed by heart rate variability at age 14 mo, after discontinuation of breastfeeding. The dose-dependent association between breastfeeding and infant autonomic functioning was tested with linear regression models adjusted for multiple confounders. The authors investigated the relation of fruitpurée consumption with infant autonomic functioning. Fruitpurée consumption has similar socioeconomic epiphenomena but is not related via the same causal mechanism to autonomic regulation as breastfeeding. Nonbreastfed infants had high sympathetic modulation [7.87 log (ms)/SD, 95% CI: 7.71-8.02], partially breastfed infants had intermediate sympathetic modulation [7.75 log (ms)/SD, 95% CI: 7.51-7.82], sympathetic modulation of exclusively breastfed infants was low [7.63 log (ms)/SD, 95% CI: 7.50-7.77]. However, this association could be explained by socioeconomic confounders. Furthermore, fruitpurée consumption was similarly associated with reduced infant sympathetic modulation. The association between breastfeeding practices and infant sympathetic modulation was accounted for by socioeconomic and environmental factors. We found a similar association between fruitpurée consumption and autonomic functioning, further suggesting that the association between breastfeeding and infant autonomic functioning is noncausal.

The influence of attachment and temperament on venipuncture distress in 14-month-old infants: the Generation R Study

OBJECTIVE

This study examined the effects of attachment and temperament on infant distress during venipuncture.

METHOD

The study was embedded in the Generation R Study, a prospective population-based study. Two different research procedures (i.e., blood sampling and the Ainsworth Strange Situation Procedure) yielded measures of venipuncture distress and attachment security and disorganization in 246 infants aged 14 months. Four temperament traits (distress to limitations, fear, recovery from distress, and sadness) were assessed using the maternally reported Infant Behavior Questionnaire-Revised, at the age of 6 months.

RESULTS

There were no differences between mean levels of distress during venipuncture in infants classified as having insecure attachment, but there was a trend for disorganized attachment. The temperament traits were not related to distress. However, children with a disorganized attachment and higher temperamental fear had more venipuncture distress.

CONCLUSION

When different risk factors are present simultaneously, infant distress is heightened.

Attachment, depression, and cortisol: Deviant patterns in insecure-resistant and disorganized infants

Both attachment insecurity and maternal depression are thought to affect infants' emotional and physiological regulation. In the current study, Strange Situation Procedure (SSP) attachment classifications, and cortisol stress reactivity and diurnal rhythm were assessed at 14 months in a prospective cohort study of 369 mother-infant dyads. Maternal lifetime depression was diagnosed prenatally using the Composite International Diagnostic Interview (CIDI). Insecure-resistant infants showed the largest increase in cortisol levels from pre- to post-SSP; the effect was even stronger when they had depressive mothers. Disorganized children showed a more flattened diurnal cortisol pattern compared to nondisorganized children. Findings are discussed from the perspective of a cumulative risk model.

FKBP5 and resistant attachment predict cortisol reactivity in infants: gene-environment interaction

Quality of the parent-infant attachment relationship influences physiological stress regulation. Genetic factors also contribute to the stress regulatory HPA-axis. Quality of attachment as an index of the rearing environment (measured with the Strange Situation Procedure, SSP), and HPA-axis related SNPs (BclI, rs41423247; TthIIII, rs10052957; GR-9β, rs6198; N363S, rs6195; ER22/23EK, rs6189 and 6190; and FKBP5, rs1360780) were hypothesized to be related to cortisol reactivity in the stressful SSP. In this large population based sample, FKBP5 rs1360780, but not GR haplotype, was related to cortisol reactivity. Moreover, we found a significant interaction effect for insecure-resistant attachment and FKBP5 rs1360780, indicating a double-risk for heightened cortisol reactivity levels in infants with one or two T-alleles of the FKBP5 SNP and an insecure-resistant attachment relationship with their mother. Findings are discussed from the perspective of gene-environment interaction.