Child Attachment Interview Research Articles

Classification et représentations d'attachement et comportements intériorisés et extériorisés des enfants de la protection de l'enfance

IntroductionChildren who have experienced potentially traumatic situations within their first attachment relationships (e.g., abuse, neglect) are more at risk of presenting attachment insecurity and disorganization as well as insecure attachment representations. These children would also be more at risk of developing internalized (e.g., anxiety, depression) and externalized behaviors (e.g., aggressivity, opposition). ObjectivesThe study aims to provide a portrait of attachment classification and representations and internalized and externalized behaviors in children aged 7 to 12 from three groups: 35 maltreated children, 42 children from a clinical group, and 39 children from a normative group. The study also aims to evaluate associations between attachment and internalized and externalized behaviors and to detect predictors of internalized and externalized behaviors amongst attachment-related variables. MethodParticipants took part in The Attachment Story Completion Task (ASCT) and a semi-structured interview, the Child Attachment Interview (CAI). Caregivers completed the Child behaviour Checklist to assess internalized and externalized behaviors. ResultsResults show lower levels of attachment security as well as higher levels of insecure attachment representations and internalized and externalized behaviors in maltreated children. Only disorganized attachment was found to be associated with internalized and externalized behaviors. The ASCT could not differentiate the groups and showed little association with internalized and externalized behaviors. ConclusionDisorganized attachment is mainly associated with maltreatment and internalized and externalized behaviors, contrary to ASCT variables, thus generating questions regarding this tool's suitability for school-aged children.

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

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

Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing.

Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor. Participants were 273 adolescents aged 12-17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ). 27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor. CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.

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

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

Attachment in close relationships and glycemic outcomes in children with type 1 diabetes

BackgroundOur aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D).Research design and methods101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes.ResultsMore girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = −0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = −8.543, p = 0.002).ConclusionsAttachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D.

First data and translation of the Child Attachment Interview en Español.

The Child Attachment Interview (CAI) was designed to assess attachment representation in middle childhood-filling a gap between behavioral paradigms and adult interviews-and has demonstrated adequate psychometric properties in middle childhood and adolescence. To date, the CAI has not been available in Spanish, given the absence of an accepted translation and psychometric data. Spanish is the second most spoken language in the world, and assessment of attachment in an individual's native language is critical given differences in emotional processing, memory, and disclosure in first versus second languages. We translated the CAI (with consultation from its creator) utilizing standardized translation and back-translation procedures and examined its psychometric properties in a sample of Spanish-speaking high school students. In this study, we report on that process and data gathered from N = 94 Spanish-speaking adolescents in grades 9-12; 20% were double-coded and interrater reliability was acceptable. Findings support the single factor "Security-Dismissal" model, and relations between classifications and subscales were consistent with previous findings. Support for convergent and discriminant validity was provided for both classifications and subscales; however, concurrent validity varied across classifications and subscales. In sum, our translation demonstrates psychometric promise for the assessment of internal working models of attachment in Spanish-speaking high school students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Attachment style and children and young people with chronic dermatological conditions.

Dermatological conditions are common in childhood and, in their more severe forms, can cause pain, disability and social marginalisation. Despite attachment being a known factor contributing to psychological and physiological development in childhood and several adult studies showing associations between attachment and dermatology outcomes (Tomas-Aragones, 2018), attachment in young dermatology patients has not been investigated. This study examined if (1) 8-16-year-olds with chronic dermatological conditions were more likely to show attachment insecurity than general population peers; (2) attachment style was linked to psychological functioning; and (3) facial involvement was associated with attachment insecurity. One hundred and twenty-two 8-16-year-olds attending a specialist paediatric dermatological service were compared on the Child Attachment Interview (CAI) to general population data. The Strengths and Difficulties Questionnaire (SDQ) was used to measure psychosocial functioning. The dermatology group was significantly more likely to be insecurely attached than their general population peers (χ2 [1] = 4.76, p < .05). The secure group self-reported significantly better psychological functioning on all indices compared with the insecure group (Total Difficulties: F[1,89] = 15.30, p < .001). There were no significant differences between secure and insecure groups on parent-reported psychological measures (Total Difficulties: F[1,94] = 0.67, p = .42). Children with facial involvement were not significantly more likely to be insecurely attached. Increased risk of attachment insecurity, particularly in the anxious pre-occupied category, as well as an association between attachment and psychosocial functioning resonated with adult studies suggesting that further research about the role of attachment with young dermatology patients is warranted.

Secure attachment predicts lower societal cost amongst severely antisocial adolescents

BackgroundSocial and economic costs associated with antisocial behaviour are well-established, but little is known about the potential costs savings/benefits of secure attachment in this high-risk group. We aimed to provide the first test of attachment quality as a distinct predictor of economic costs.Methods111 adolescents (10–17 years of age, M = 15.0, SD = 1.6; 71% male) referred to young offender services due to high levels of antisocial behaviour were included. Costs were measured by detailed service-use interview, and attachment security to mother and father elicited through the Child Attachment Interview. The level of antisocial behaviour and callous-unemotional traits were assessed. Cost predictors were calculated using generalised linear models.ResultsMean 12-months service costs were £5,368 (sd 5,769) per adolescent, with justice system and educational service costs being the main components. After adjusting for covariates, economic costs were predicted by attachment quality to fathers, with a difference of £2,655 per year between those with secure (£3,338) versus insecure attachment (£5,993); significant cost effects were not found for attachment quality to mothers. Higher levels of callous-unemotional traits, lower verbal IQ, higher levels of antisocial behaviour, and older age were also significant cost predictors.ConclusionsSecure attachment to fathers is a predictor of reduced public cost in adolescents with severe antisocial behaviour. This novel finding for severely antisocial youth extends previous findings in less antisocial children and underscores the public health and policy benefits of good caregiving quality and the value of population-level dissemination of evidence-based interventions that improve caregiving quality.

Attachment, Emotion Regulation and Physiological Reactivity in middle-childhood: a pilot study

IntroductionAttachment, as an interpersonal motivational system, is the relational ground that allows emotions to be regulated through action on the Autonomic Nervous System resulting in better psychological outcomes during middle childhood. Emotion dysregulation and autonomic function are often connected to psychiatric symptoms observed in adolescence (e.g. borderline personality disorder traits) and thus middle childhood becomes a critical age for psychopathological trajectories.ObjectivesExamine the relationship between child’s attachment and both psychological and physiological emotional regulation.Methods20 children (Mage = 10.7, SD = 1.25; 65% males) were recruited from general population. Attachment was measured through the Child Attachment Interview (CAI), while emotional regulation was assessed with a multimethod approach, using questionnaires i.e. How I Feel (HIF) and Positive and Negative Affect (PANAS), and physiological measurements i.e. Heart Rate Variability (ratio between High Frequency and Low Frequency, HF/LF, labeled as the child’s sympathovagal balance) and Heart Rate (Beats Per Minute, BPM, as an index of physiological reactivity).ResultsStatistically significant correlations emerged between the HIF-Control scale and the Mother and Father Dismissal CAI scale, the PANAS-Negative Affect scale and the Mother and Father Preoccupied Anger CAI scale. Moreover, there was a non-significant but moderate effect (rs &gt; .30) between HF/LF and the Emotional Openness and the Resolution scales of the CAI, and between BPM and the Emotional Openness scale.ConclusionsDespite the small sample size, more secure children are able to connect with their emotions and properly use them in solving relational problems. Consequently, they are likely to succeed in understanding and regulating emotions as they manage to find more adaptive strategies their own. On the contrary, the presence of dismissal or anger (insecure attachment) towards parents would appear to lead to higher levels of psycho-physiological dysregulation, a core feature of Borderline Personality Disorder dimensions starting to emerge later in adolescence. Future studies should consider physiological dysregulation as an additional factor linked to psychopathological developmental trajectories.Disclosure of InterestNone Declared

Does coding internal working models of attachment have to be so hard?

The Child Attachment Interview (CAI) has demonstrated promise in youth, yet widespread use is thwarted by the need for interview transcription, face-to-face training, and reliability certification. The present study sought to examine the empirical basis for these barriers. Thirty-five archival CAIs were re-coded by: (1) expert coders (i.e., trained and reliable) without access to transcripts, (2) trained coders who had not completed reliability training, and (3) novice coders who had no formal training. Agreement with consensus classifications was computed with the expectation of moderate agreement. Results supported coding by experts without transcription of the interview. Near-moderate agreement preliminarily supported the use of trained coders who have not attempted reliability certification with appropriate caveats. While moderate agreement was not achieved for novice raters, findings suggest that self-paced training options for the CAI may hold future promise. These contributions erode a number of significant barriers to the current use of the CAI.

Maternal interpersonal problems and attachment security in adolescent offspring

BackgroundResearch on parent-level factors linked to adolescent attachment security would inform interventions to prevent or reduce youth psychopathology and other negative outcomes. The current study examined one relevant parent-level variable: maternal interpersonal problems. Interpersonal problems, a key characteristic of personality pathology, are well described by the interpersonal circumplex (IPC) and have been shown to be associated with maladaptive adult attachment in close/romantic relationships; however, studies have not examined relationships with offspring attachment. Therefore, the first aim of the current study was to examine the relationship between maternal interpersonal problems and adolescent attachment insecurity. Based on previous evidence that parents’ recalled bonding with caregivers is associated with the quality of bonding and attachment with offspring, the second aim was to examine whether mothers’ recalled bonding with their own mothers partially explained this relationship.MethodsParticipants included 351 psychiatric inpatient adolescents (Mage = 15.26, 64.1% female) and their biological mothers. Logistic regressions tested whether maternal interpersonal problems were associated with Child Attachment Interview classifications (secure vs. insecure; secure vs. preoccupied vs. dismissing; not disorganized vs. disorganized). A mediation model (N = 210) tested whether the relationship between maternal interpersonal problems and adolescent attachment was mediated by the mother’s recalled maternal bonding.ResultsMaternal interpersonal problems were associated with insecure (vs. secure), dismissing (vs. secure), and preoccupied (vs. secure) attachment. There was no significant relationship between maternal interpersonal problems and disorganized attachment. Mediation analyses showed that maternal interpersonal problems were indirectly related to adolescent attachment security via the mother’s recalled maternal care, though only a small amount of variance (7%) in adolescent offspring attachment was accounted for by the model.ConclusionsResults provide the first evidence that maternal interpersonal problems are associated with higher likelihood of insecure attachment in adolescents. Therefore, researchers could consider drawing upon the IPC literature to further examine mechanisms of intergenerational risk and to tailor interventions aimed to improve parent-child relations and attachment. Additionally, findings highlight the mediating role of the mothers’ recalled experiences with caregivers in the transmission of risk, suggesting attachment-based or mentalization-based interventions may be helpful for mothers with interpersonal problems and personality pathology.

Multimethod Assessment of Mentalizing and its relations with Somatic Symptoms in Adolescents with Primary Headache

Introduction Difficulties in mentalizing (i.e., the ability to reflect on self and others’ internal mental states, operationalized as reflective functioning [RF]; Fonagy et al., 2012) have been associated with psychological symptoms (Luyten et al., 2020), including somatic symptoms (Bizzi et al., 2019). Therefore, the assessment of its dimensions may be clinically relevant for young patients with somatic symptoms, as with Primary Headache (PH), representing one of the most common somatic complaints in children and adolescents.ObjectivesThis study aimed to assess RF with a multi-method approach, exploring its relation with somatic symptoms.Methods 48 adolescents diagnosed with PH (Mage=14.83, SD=2.81; 67% females) were recruited from an Italian Child Neuropsychiatry Clinic. RF was measured both through the Child and Adolescent Reflective Functioning (CRFS) applied to the Child Attachment Interview transcripts and the self-report Reflective Functioning Questionnaire (RFQ), while the Children’s Somatization Inventory (CSI-24) was used to measure the perceived severity of somatic symptoms.ResultsDifferent relations with somatic symptoms depended on the method used to evaluate RF: no significant correlations were found with the CRFS subscales (General, Other, Self ), while a negative significant correlation was found with the RFQ subscale Certainty about mental states (RFQ_C) (r=-.46, p=.016). All subscales of CRFS were negatively correlated with RFQ_C (p=.05), but not with the other RFQ subscale (Uncertainty about mental states; RFQ_U).ConclusionsThis suggests that two measures may lead to different dimensions of the same construct, thus a multi-method assessment of RF would be advisable in clinical practice.DisclosureNo significant relationships.

Advancement in the child attachment interview and the child and adolescent reflective functioning scale using a PDM-2 framework: case reports.

The Child Attachment Interview (CAI) is a well-established semi-structured interview, widely used to identify attachment representations in middle childhood and adolescence. The application of the Child and Adolescent Reflective Functioning Scale (CRFS) to CAI narratives allows for an assessment of child mentalization, considered a strong predictor of attachment security. The 2nd edition of the Psychodynamic Diagnostic Manual (PDM-2) includes CAI and CRFS as valid and reliable assessment measures in order to assess the dominion of the Mental Functioning axis. The aim of the present paper is to investigate the informative power of CAI and CRFS for the overall understanding of mental functioning and personality in a PDM-2 framework. The present report includes the discussion of two clinical cases of school-aged children in applying the Psychodiagnostic Chart-Second Edition (PDC-2) to the CAI transcript. The first case concerns a young male, aged 10, suffering from Oppositional-Provocative Disorder (externalizing disorder), while the second case concerns a young female, aged 15, suffering from Somatic Symptoms Disorder (internalizing disorder). PDC-2 for children and adolescents was used. Data from the scoring of CAI and CRFS were combined with a systematic evaluation of the qualitative contents emerging from CAI transcripts. A detailed analysis suggests that both the CAI and CRFS are useful attachment-oriented measures, able to explore child’s mental states, and together with the application of PDC-2 they provide an essential contribution in the understanding of developmental psychopathology. Implications of this innovative approach for clinical assessment, treatment design, and interventions are further discussed.

Maternal Reflective Functioning and Attachment Security in Girls and Boys: A Closer Look into the Middle Childhood.

Child attachment undergoes major changes during middle childhood. Maternal reflective functioning (RF) is hypothesized to be an important correlate of a child’s attachment security during this period; however, the child’s gender role in this association has not been examined yet. In the present study, we used 64 mother-child (6–11 years old) dyads from a community sample to analyze the association between maternal RF and child attachment security and whether this link is moderated by gender. Maternal RF was assessed on the Parent Development Interview Revised (PDI-R2) and child attachment classifications were examined by the Child Attachment Interview (CAI). Results revealed the positive and statistically significant association between maternal RF and child attachment security in the whole sample. Further evaluations of this link in the groups of girls and boys separately indicated its significance for girls only. Finally, moderation analysis demonstrated the relation between child attachment security and maternal RF to be moderated by gender. These findings provide a new knowledge on gender role in attachment security in relation to maternal RF as well as suggest possible differentiation in the correlates on the pathway of secure attachment between girls and boys during middle childhood.

Remarkable high frequency of insecure attachment in children with ADHD persists in a three-year follow-up

Background Studies have pointed to a complicated and mutual relationship between attention deficit hyperactivity disorder (ADHD) and attachment. In an observational follow-up study conducted in 2015 60 children from 7 years to 12 years recently diagnosed with ADHD were included and assessed according to attachment representation showing 85% of the children to be insecurely attached. Aim The aim of this study was to investigate the stability of this remarkably high frequency of insecure attachment in the same cohort of children. Methods Children previously assessed using the child attachment interview (CAI) when diagnosed with ADHD were contacted three years later for a follow-up CAI assessment. Results At follow-up, 31 children participated in the CAI-interviews. Since their diagnosis with ADHD, the children had received treatment as usual. The CAI-interviews showed a continued high rate of insecure attachment with 90% of the children classifying as insecurely attached compared to expected 38% in the normal population. Of these, the majority of children (77%) were classified as dismissing. Conclusion Our findings suggest that targeting ADHD-symptoms with our current treatment strategies does not in itself improve attachment security. Attachment security may in turn be a factor of importance when evaluating general functioning and prognosis.

Reflective Functioning in Children and Adolescents With and Without an Anxiety Disorder

Reflective functioning (RF), meaning the capacity to interpret mental states (intentions, emotions, thoughts, desires, and beliefs) underlying one’s own and others’ behaviors, may help understand the dysfunctional self-regulation associated with anxiety disorders. However, research on anxiety and RF in clinical samples is scarce. This study aimed to assess whether mothers’ and youths’ RF was associated with youths’ (a) anxiety disorders and symptoms and (b) internalizing symptoms. Another goal was to explore whether RF predicted anxiety and internalizing symptoms beyond the more commonly established effect of attachment. Canadian children and adolescents aged between 8 and 16years, and their mothers were recruited in an outpatient psychiatric clinic (clinical group with a diagnosed anxiety disorder, n=30, mean age=11.5±2.8years) and in the general population (non-clinical group, n=23, mean age=11.5±2.1years). The Child Attachment Interview was used to assess youths’ attachment along with three dimensions of RF (global, regarding self, regarding others). Mothers’ attachment and RF were assessed with the Adult Attachment Interview. Children’s and adolescents’ anxiety and internalizing symptoms were measured with the Behavior Assessment Scale for Children, second version. The clinical and non-clinical groups did not differ in mothers’ or youths’ RF. However, in the overall sample, youths’ RF regarding themselves and maternal attachment preoccupation were associated with internalizing symptoms. Sequential regression analyses revealed that higher RF regarding self predicted a higher level of self-reported internalizing symptoms, beyond the effect of maternal attachment (β=0.43, p<0.05). This study’s finding suggests that clinically anxious children and adolescents have adequate RF. We propose that the sustained hypervigilance and apprehension associated with anxiety make anxious youths sensitive to their own and others’ mental states. Our findings suggest that psychotherapeutic treatments for anxiety should make use of patients’ RF abilities to help them make sense of their symptoms and thus reduce them.

Testing Children\u2019s Mentalizing in Middle Childhood: Adopting the Child and Adolescent Reflective Functioning Scale with Clinical and Community Children

Beginning with Ensink’s seminal study (2015), the field entered a new era in which we were able to measure mentalizing in school-aged children. The goal of this work is to continue developing the state of the research within this tradition by exploring the psychometric properties of the Child Reflective Functioning Scale (CRFS) - a measure applied to the Child Attachment Interview and designed to assess RF during middle childhood - within both clinical and normative groups, and to examine if it differentiates between both groups. Participants were 159 Italian children (age range 8–12 years, Mage = 10.66, SD =1.83; 57% males) divided into two groups: 71 children with emotional-behavioral problems (‘clinical group’) and 88 children without emotional-behavioral problems (‘community group’). Demographic data and Verbal Comprehension Index were collected. A two-factor model of CRFS (self- and other-focused RF) was confirmed in both groups, revealing that these intrapersonal and interpersonal indicators of children’s RF are important domains of mentalizing abilities in middle childhood. The results revealed adequate inter-rater reliability of the CRFS. Controlling for the effect of potentially confounding demographic variables, significant differences on CRFS scales between clinical and community groups were found. The clinical group showed lower levels of CRFS scores than normative group, but importantly, the self-focused RF score uniquely predicted clinical/community status. Taken together, the findings showed that the CRFS is a reliable and validity measure for assessing RF in middle childhood with clinical and normative groups, contributing important information to the scientific literature on mentalizing in middle childhood.

Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor.

The aim of the present study was to examine the hypothesis that attachment and childhood sexual abuse (CSA) interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing post-traumatic stress disorder (PTSD) and trauma symptoms. Participants (n = 111, ages 7–12) comprised two groups, child CSA survivors (n = 43) and a matched comparison group of children (n = 68) recruited from the community. Children completed the Child Attachment Interview (CAI) as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate the identification of children most at risk and has important implications for understanding risk and resilience processes.

Can attachment predict core and comorbid symptoms of attention-deficit/hyperactivity disorder beyond executive functions and emotion regulation?

Previous findings propose an association between attachment and symptoms of attention-deficit/hyperactivity disorder (ADHD). However, the predictive ability of attachment beyond deficits in executive functioning (EF) and emotion regulation is understudied. Using a dimensional perspective, we examined the longitudinal role of attachment on ADHD and comorbid symptoms, accounting for EF and emotion regulation. The sample consisted of 84 children (aged 8-13 years), oversampled for ADHD symptoms (42% had a diagnosis of ADHD). We assessed attachment with the Child Attachment Interview, EF with laboratory tests, and emotion regulation with parental ratings. Parents and teachers rated symptoms at baseline (T1) and at follow-up 2 years later (T2). Attachment insecurity was positively correlated with ADHD symptoms at T2 but with no unique contribution to symptoms beyond EF and emotion regulation. In contrast, poor EF and emotion regulation contributed to more ADHD and ODD/CD symptoms at T2. Poor emotion regulation contributed to more anxiety at T2. The results have important implications for understanding the mechanisms underpinning symptom expression in middle childhood/early adolescence and may guide the search for tailored interventions to reduce and prevent symptoms. Executive functions and emotion regulation should be explored as targets for intervention in personalized treatment. The current results do not support attachment as a target for intervention at a group level, although this does not rule out that individuals/families with attachment difficulties may benefit from training programmes promoting secure attachment bonds.

Carer's Attachment Anxiety, Stressful Life-Events and the Risk of Childhood-Onset Type 1 Diabetes.

Background/Objective: Type 1 diabetes (T1D) is among the most common chronic diseases in children/adolescents, and the incidence continues to rise worldwide. Different environmental factors have been evaluated in the etiology. In the present study, we investigated the role of attachment examining whether insecure attachment to carers or carers' own attachment insecurity was related to a higher risk of T1D in children.Methods: We included 101 children with T1D (mean age 11.8 years), 106 healthy controls (11.6 years), and one of their carers. We assessed children's attachment using the Child Attachment Interview and carers' attachment using the Relationship Structures Questionnaire. We constructed binary multinomial logistic regression models using attachment to mothers, carers' attachment representations, and stressful life-events as T1D predictors.Results: Higher carer attachment anxiety was associated with the child's T1D diagnosis (p < 0.05; R2 = 0.0613) while security of attachment to mothers showed no significant association. When mothers' education was included in the model, both attachment anxiety in higher educated mothers and stressful life events showed a significant association with the child's T1D (p < 0.001; R2 = 0.293).Conclusions: Our findings suggest that higher attachment-related anxiety in carers with high education and stressful life events are associated with T1D in children.