Children's Attachment Representations Research Articles

The relationship between attachment representations and minimal intergroup bias in preschool-aged children.

Attachment theory proposes that young children's experiences with their caregivers has a tremendous influence on how children navigate their social relationships. By the end of early childhood, intergroup contexts play an important role in their social life and children build strong ties to their ingroups. Although both domains relate to the same psychological processes-children's affective ties to others-surprisingly very little research has addressed how children's attachment relates to their intergroup attitudes and behavior. In this study, we investigate the link. For that purpose, 5-year-old children (n=100) first underwent the German Attachment Story Completion Task (GEV-B). Then we allocated children into minimal groups based on T-Shirt color and assessed their intergroup attitudes and intergroup behavior. Results showed that while most children showed a strong and robust ingroup bias in their attitudes and behavior, children with an insecure-ambivalent attachment representation treated in- and outgroup similarly. Overall, this study provides novel perspectives on the relationship between children's attachment representation and their interactions in the social world. RESEARCH HIGHLIGHTS: This study provides novel insights into the relationship between children's attachment security and the development of intergroup bias in a minimal group context Children with secure, insecure-avoidant and disorganized attachment representation showed a strong intergroup bias in explicit attitudes and behavior Children with insecure-ambivalent attachment representation displayed no intergroup bias Insecure-ambivalent attachment representations might be detrimental to the formation of ingroup attachment.

Visualizing the invisible tie: Linking parent-child neural synchrony to parents' and children's attachment representations.

It is a central tenet of attachment theory that individual differences in attachment representations organize behavior during social interactions. Secure attachment representations also facilitate behavioral synchrony, a key component of adaptive parent-child interactions. Yet, the dynamic neural processes underlying these interactions and the potential role of attachment representations remain largely unknown. A growing body of research indicates that interpersonal neural synchrony (INS) could be a potential neurobiological correlate of high interaction and relationship quality. In this study, we examined whether interpersonal neural and behavioral synchrony during parent-child interaction is associated with parent and child attachment representations. In total, 140 parents (74 mothers and 66 fathers) and their children (age 5-6 years; 60 girls and 80 boys) engaged in cooperative versus individual problem-solving. INS in frontal and temporal regions was assessed with functional near-infrared spectroscopy hyperscanning. Attachment representations were ascertained by means of the Adult Attachment Interview in parents and a story-completion task in children, alongside video-coded behavioral synchrony. Findings revealed increased INS during cooperative versus individual problem solving across all dyads (𝛸2(2)=9.37, p=0.009). Remarkably, individual differences in attachment representations were associated with INS but not behavioral synchrony (p>0.159) during cooperation. More specifically, insecure maternal attachment representations were related to higher mother-child INS in frontal regions (𝛸2(3)=9.18, p=0.027). Conversely, secure daughter attachment representations were related to higher daughter-parent INS within temporal regions (𝛸2(3)=12.58, p=0.006). Our data thus provide further indication for INS as a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of early parent-child interactions. RESEARCH HIGHLIGHTS: We assessed attachment representations using narrative measures and interpersonal neural synchrony (INS) during parent-child problem-solving. Dyads including mothers with insecure attachment representations showed higher INS in left prefrontal regions. Dyads including daughters with secure attachment representations showed higher INS in right temporo-parietal regions. INS is a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of parent-child interactions, especially within the mutual prediction framework.

Antidote to Developmental Trauma: A Report on Findings from the “Adoption and Attachment Representations” Study

ABSTRACT This paper is a summary of findings from the “Adoption and Attachment Representations” study which was a collaboration between the Anna Freud Centre, Great Ormond Street, and Coram that focused on the nature and development of parent and child attachment representations in an adoption context. The study began with Adult Attachment Interview assessments of both mothers and fathers who would go on to adopt a group of 58 previously maltreated children aged four to eight years. There was also a comparison group of 42 children, also aged four to eight years but who had been adopted in their infancy. The children were assessed early in their adoptive placement, with the Story Stem Assessment Profile in order to focus on their attachment representations along with a range of cognitive and psychological functioning assessments. The parents were interviewed using the Parent Development Interview to access their attachment representations of their children. These assessments were repeated one year and two years later with subsequent follow-ups in early adolescence and a recently completed phase in the adoptees’ adulthood. The study is unique in exploring aspects of intergenerational patterns of attachment in nonbiologically related parents and children in a longitudinal design. The findings suggest that parental attachment states of mind are associated with their children’s attachment representations and the “intervention” of adoption is powerful with “late placed” children adopting more secure themes in their story stem narratives over time while also retaining some less optimal features such as avoidance and disorganization. The paper makes links with previous developmental and psychoanalytic work in the field of adoption and explores the potential policy implications of the study.

Child Attachment Representations and Parenting Stress in Mothers and Fathers of School-Age Children with a Diagnosis of Autism Spectrum Disorder: A Pilot Cross-Sectional Study.

Mothers and fathers of autistic children (ASD) tend to report elevated levels of parenting stress. Thus, it is critically important to understand which factors contribute to an imbalance between the perceived demands of parenting and the available psychological resources. To date, little is known about the association between child attachment representations and parenting stress. In this study, we first examined group differences in parenting stress levels based on child diagnosis and parents' gender. Second, we explored the predictive role of child diagnosis, autism severity, and child attachment representations on parenting stress. The study involved 23 school-age children with ASD (IQ > 70), 27 without ASD (7-13 years), and their mothers (n = 50) and fathers (n = 50). Data were collected from 2017 to 2020. Parents completed the Social Responsiveness Scale 2 and the Parenting Stress Index-Short Form, while the children's attachment representations were assessed using the School-age Assessment of Attachment. Parents of children with ASD reported higher stress compared with controls. No differences were found between mothers and fathers. Implicit attachment representations have been found to be associated with parenting stress only in mothers, while the severity of social impairment showed a significant effect on parenting stress in both parents. These findings revealed the potential benefit of adaptive attachment representations not only for children themselves but also for mothers and the family system, suggesting the bidirectional nature of parent-child relationships in the context of ASD. The uniqueness of maternal and paternal parenting experiences should be considered when parenting stress is addressed.

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BackgroundChildren in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent–child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.MethodsThis is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4–17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.DiscussionThis trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children.Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.

The development of empathy in child maltreatment contexts

BackgroundDespite robust associations between child maltreatment experiences and emotional development, a paucity of research examines the influence of child maltreatment on empathy development, and still fewer studies differentiate these effects across maltreatment subtypes. ObjectiveThe present study examined the development of children's empathy from ages six to eight, as predicted by maltreatment, and as moderated by children's attachment representations. Participants and settingParticipants were a community sample of 250 children followed longitudinally and assessed in a laboratory setting with their primary caregivers. MethodChild maltreatment experiences from birth to age six were assessed by semi-structured interviews with caregivers, which were rated according to widely-used child maltreatment coding protocols, and by caregiver and child self-report measures. Child empathy was assessed at ages six and eight by caregiver-report. Attachment representations were observed in children using the MacArthur Story Stem Battery. ResultsChild emotional abuse (β = −0.150, p = .012) and child neglect (β = −0.137, p = .016) predicted decreased empathy at age eight, whereas child physical abuse (β = 0.132, p = .027) and child exposure to domestic violence (β = 0.164, p = .004) predicted increased empathy at age eight. Further, children's negative representations of mother figures moderated the positive association between child physical abuse and empathy (β = −0.177, p = .005), such that the association became weaker as negative representations increased. ConclusionsThese results highlight the nuanced ways in which child maltreatment experiences of different subtypes contribute to the development of empathy in school-aged children.

Représentations d'attachement, comportements extériorisés et pro-sociaux d'enfants ayant vécu de la maltraitance et issus de la population générale

IntroductionMaltreatment engendered by parental figures may undermine attachment within parent-child relationships and has been associated with the emergence of behavioural problems. These symptoms have been negatively correlated with pro-social behaviour. ObjectiveThis study aims to report attachment representations, behavioural problems and pro-social behaviour of school aged children that have been victims of maltreatment and who receive services from the Enfant and Youth Protection Centre (EYPC) in Quebec and the therapeutic, educative and pedagogic institute (TEPT) in France. The study also aims to examine the links between these variables and to compare these children with the general population (GP) regarding these variables. MethodEighty children, aged 6 to 12 years old, divided in three groups (GP: n = 40; EYPC: n = 27; TEPI: n = 13) participated in the study. Parents and childcare workers completed measures on externalized and pro-social behaviours. Children participated in an activity exploring their attachment representations. ResultsSignificant associations were found between pro-social and externalized behaviors, as well as between attachment representations concerning the child's emotional dysregulation and two other variables: maternal attachment representations (supportive and rejecting) and pro-social behaviour. Furthermore, no significant differences were found between the attachment representations of children from the GP and those that have been victims of maltreatment and who receive services from EYPC and TEPI. However, significant differences were found between these groups regarding pro-social and externalized behaviours. ConclusionThe present study furthers our knowledge about the influence of maltreatment on children's attachment representations and behaviour.

Emotional Availability in Mother-Child and Father-Child Interactions as Predictors of Child's Attachment Representations in Adoptive Families.

Emotional availability (EA) in parent-child interactions is associated with positive child outcomes, including attachment security. However, little is known about EA in adoptive families. This study investigated the associations between secure representations of attachment in adopted children and the adoptive parents’ EA. The participants (n = 75) included 26 mothers, 23 fathers, and 26 children who were aged 3 to 9 years. Children completed the Attachment Story Completion Task. Adult-child dyadic relationships were assessed using the EA® System. The results showed that the children’s and parents’ EA, age when adopted, and time elapsed since adoption were associated with more secure children’s attachment representations. Implications for family support and public policy are discussed.

Intergenerational Transmission of Attachment between Incarcerated Mothers and Their Co-residing Children.

Maternal attachment representations and children's attachment to their mothers have been shown to be related while this association varies according to socioeconomic risk factors that these mother-child dyads are experiencing. In this regard, this study aims to investigate the intergenerational transmission of attachment between highly disadvantaged incarcerated mothers and their co-residing children and the mediating role of maternal sensitivity in the relationship between maternal and children's attachment representations. The study sample consists of 84 incarcerated mothers and their co-residing children. The maternal attachment was evaluated using the Doll Story Completion Task. Children's attachment and maternal sensitivity were assessed based on a 45-minute semi-structured mother-child interaction observation and rated through structured coding instruments. Hierarchical regression analyses revealed that mothers' anxious and avoidant attachment positively predicted children's disorganized attachment behaviors. Moreover, analyses showed that maternal sensitivity did not mediate the relationship between maternal and child attachment representations. Findings partially supported the discussion emphasizing that attachment transmission, as well as the mediating role of maternal sensitivity on this transmission, appeared to be weaker for disadvantaged mother-child dyads. Implications for future intervention programs aiming to support the attachment security and reduce the disorganization of children co-residing with their incarcerated mothers are discussed.

Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD).

Attention-Deficit/Hyperactivity Disorder (ADHD) in children is associated with several adverse family characteristics, such as higher parenting stress, more conflicted parent–child relationships, lower parental competence, and higher levels of parental psychopathology. Hence, children with ADHD more often grow up under suboptimal circumstances, which may impact the development of their attachment representations. Here, we investigated whether children with ADHD have more insecure and disorganized attachment representations than their typically developing peers, and which factors could explain this association. We included 104 children between 4 and 11 years old, 74 with ADHD (without Conduct Disorder) and 30 typically developing control children. Children completed a state-of-the-art story stem task to assess their attachment representation, and we measured parents’ expressed emotion (as an index of parent–child relationship quality), parents’ perceived sense of competence, parental education levels, and parent-rated ODD symptoms of the child. We found that, after controlling for multiple comparisons, children with ADHD had less secure and more ambivalent and disorganized attachment representations relative to their typically developing peers. These group differences were independent of comorbid ODD and parental education levels. There were no group differences on avoidant attachment representations. Explorative analyses within the ADHD group showed that attachment representations were not related to parent–child relationship quality, perceived parenting competence, parental education levels, and comorbid ODD symptoms. We conclude that children with ADHD disproportionately often have attachment problems. Although this conclusion is important, treatment implications of this co-occurrence are yet unclear as research on ADHD and attachment is still in its infancy.

Mothers With Mild Levels of Intellectual Disability: Emotion-Interpretation, Traumatization, and Child Attachment Representations.

Prior research indicates links between parents' experiences of interpersonal trauma and emotion-interpretation difficulties, and between such difficulties and child attachment insecurity and disorganization. Although mothers with mild levels of intellectual disability (ID) are at heightened risk for trauma and emotion-interpretation difficulties, and their children for attachment insecurity, corresponding links in this population have not been examined. We therefore investigated emotional interpretations among mothers with mild levels of ID (n = 23) and matched comparison mothers without ID (n = 25), in relation to mothers' experiences of trauma and their children's attachment representations. Mothers with mild levels of ID were not less accurate than comparison mothers with regard to general positive and negative emotion-interpretation accuracy, but they were significantly more likely to misinterpret shame and anger. Among mothers with mild levels of ID, misinterpretations of shame were positively related to maternal experiences of trauma, and to child attachment insecurity and disorganization.

Can Psychodynamically Oriented Early Prevention for "Children-at-Risk" in Urban Areas With High Social Problem Density Strengthen Their Developmental Potential? A Cluster Randomized Trial of Two Kindergarten-Based Prevention Programs.

Children who live on the margins of society are disadvantaged in achieving their developmental potential because of the lack of a necessary stable environment and nurturing care. Many early prevention programs aim at mitigating such effects, but often the evaluation of their long-term effect is missing. The aim of the study presented here was to evaluate such long-term effects in two prevention programs for children-at-risk growing up in deprived social environments focusing on child attachment representation as the primary outcome as well as on self-reflective capacities of teachers taking care of these children. The latter was a key component for promoting resilient behavior in children. Five hundred and twenty-six children aged 36 to 60 months at risk due to immigration status, low family socio-economic status and child behavior were examined in a cluster-randomized study comparing two preventions, the psychodynamic, attachment-based holistic approach EARLY STEPS (ES) with the classroom based FAUSTLOS (FA) for their efficacy. Primary outcome was the child attachment representation measured by the Manchester Child Attachment Story Task (MCAST). Secondary outcomes were derived from (a) the Caregiver-Teacher Report Form (C-TRF: problem behaviors, including anxiety/depressive symptoms, emotional-reactive and somatic problems, social withdrawal, aggressive behavior, and attention deficit), from (b) the Strength and Difficulties Questionnaire (SDQ, parent version: resilience and wellbeing) and (c) Self-Reflective Scales for teachers (SRS: self-reflective capacities of teachers). Compared to baseline, attachment and behavioral problems improved in both programs. ES led to more secure and more organized attachment representations (medium effect sizes). Aggressive behavior and externalizing problems were reduced in the FA group compared with ES, particularly in boys (medium effect sizes). Self-reflective capacities of the teachers increased only in the ES group. High correlation between children’s attachment type with the number of social risk factors and the increase of problematic social behavior strongly indicate that an increase in teachers’ self-reflective capacities helps to change children’s attachment patterns which thus strengthens the resilience of these children-at-risk [An ethical vote from LPPKJP 2009-02-25 was obtained and the trial registered; Clinical trial registration information: The trial was registered 14.02.2012 (DRKS00003500; https://www.drks.de)].

Externalizing behaviors and attachment disorganization in children of different-sex separated parents: The protective role of joint physical custody.

The aim of this study was to examine the relationship between externalizing behaviors and the quality of attachment representations in preschool children, and to determine if family type and custody arrangement had a moderating effect on this relationship. The participants were 33 girls and 31 boys (n=64) aged between three and six years (M=4.75; SD=0.87years) and their mothers. Among them, 36 came from "intact" families, 13 were living mainly with their mothers and 15 were in joint physical custody. Children's attachment representations were assessed with the Attachment Story Completion Task (Bretherton, Ridgeway & Cassidy, 1990). Mothers reported on their child's behavior problems using the Child Behavior Checklist (Achenbach & Rescorla, 2001) and on their alliance with the father using the Parenting Alliance Inventory (Abidin & Brunner, 1995). Although children's externalizing behaviors were found to be associated with the disorganization of their attachment representations, this relationship was significantly weaker and was non-significant for children in joint physical custody. Thus, the results of this pilot study suggest that joint custody may protect children of separated parents from the effects of attachment disorganization on externalizing behaviors.

Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps.

Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent-child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.

Attachment representations in children with disruptive behavior disorders: A special focus on insecurity in middle childhood.

According to the emotional and social problems encountered in disruptive behaviour disorder (DBD), there is little available information regarding the attachment processes during middle childhood. Therefore, this study aims to investigate the attachment representations to both caregivers in a sample of 84 children, aged 8-12 years (N = 42 with a diagnosis of DBD; N = 42 as a comparison group). Attachment is assessed through the Child Attachment Interview, a semi-structured interview that incorporates both narrative and behavioural assessments of attachment, permits the assessment of attachment representations using dimensional and categorical approaches, and allows for the detection of disorganisation to both parents individually. Our results point to the presence of high frequencies of insecure attachment (more than 80%) in the DBD group, with a higher percentage of dismissing attachment, and an over-representation of disorganised attachment (more than 50%). Higher levels of dismissal and lower levels of security are found in DBD than in the comparison group. No attachment differences with respect to both parents are found. Understanding how different aspects of attachment during a specific developmental phase plays a role within the broader emotional functioning of DBD has great potential to lead to innovations in evaluations and treatment processes.

Bindungsrepräsentationen, belastende Lebensereignisse und ADHS bei Jungen im Alter von 6 bis 10 Jahren

Attachment Representations, Critical Life Events and ADHD in Boys at 6 to 10 Years of Age The importance of the attachment theory was repeatedly pointed out in the literature for understanding children with attention deficit hyperactivity disorder (ADHD) with regard to their emotional state. Symptoms of ADHD, like attention deficits, motor agitation and impulsivity are seen as risk factors for insecure attachment in the parent-child relationship. The acquisition of attachment representations in children with ADHD might help to describe - and individual classify - the syndromes of this behavioural disorder better. The aims of the present study are, therefore, the investigation of attachment representations and critical life events in boys with ADHD. We focused on boys only, since they are particularly prone to develop ADHD. Using the story-completion technique, we investigated whether boys with ADHD showed insecure attachment more frequently compared to boys without ADHD. 31 boys with ADHD at six to ten years of age were recruited in two different clinics. Of these, 29 % showed a secure and 71 % showed an insecure attachment representation. Within insecure attachment, the ambivalent attachment representation occurred most frequently (41 %). On average, we found 2.3 critical life events. The enhanced frequency of the ambivalent attachment representation indicates that ADHD might be linked to externalizing behaviour. The results support the hypothesis that ADHD is increasingly associated with insecure attachment. The binding theory is able to contribute to a better understanding of the emotional state in boys with ADHD.

Attachment disorder and attachment theory – Two sides of one medal or two different coins?

IntroductionCurrently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts.We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9. MethodsA total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development. ResultsThe prevalence of AR in children with AD was 28.6% for the ‘secure’ form of AR, 17.1% for the ‘insecure-avoidant’ form, 25.7% for the ‘insecure-ambivalent’ form, and 28.6% for the ‘disorganized’ form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills. ConclusionsLongitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

Attachment Representations in Mothers and Their Children Diagnosed with ADHD: Distribution, Transmission and Impact on Treatment Outcome

Little is known about the distribution and intergenerational transmission of attachment representations in ADHD populations and further how attachment may influence the prognosis of ADHD. In this study we aimed to investigate attachment distribution, intergenerational transmission and the potential impact of maternal and child attachment representations on treatment response in a sample of children with ADHD. Sixty mother-child dyads from families with offspring ADHD were recruited. Attachment representations were assessed with the Adult Attachment Interview (AAI) and the Child Attachment Interview (CAI). ADHD symptom severity was assessed at four time points with the ADHD-Rating Scale. Of the children, only 15% and among the mothers, only 23% were securely attached. Contrary to predictions, the association between maternal and child attachment representations (Secure versus Insecure) did not reach statistical significance as we found overall concordance rate to be 63% (kappa = −0.05). Neither child nor maternal attachment significantly predicted treatment response. In families with offspring ADHD, the prevalence of insecure attachment was remarkably high in the children as well as in the mothers. Intergenerational transmission of attachment was very low and in short-term follow up, attachment representations did not affect treatment outcome. Our findings support previous research in suggesting that the relationship between ADHD and Insecure attachment is complex. Nevertheless, the importance of considering attachment as a factor in the treatment, functional impairment and long term prognosis of children with ADHD remains.

I. INTRODUCTION: THE CO-CONSTRUCTION OF MOTHER-CHILD ATTACHMENT RELATIONSHIPS IN EARLY CHILDHOOD.

Attachment relationships are formed, organized, and elaborated through interactions between an attachment figure and her/his child. The parent-child codetermination process that establishes their relationship in infancy extends and expands during the preschool years. A child's developing ability to use her/his mother as a secure base requires support, time, and practice during early childhood. Moreover, experiences with attachment figures provide information that children use to build internal representations of their relationship. Thus, the organization of attachment behavior is expected to be related to the structure of a child's attachment representations. Yet, questions about how the structure of those representations develop remain unanswered. In moving into the preschool years, we anticipate that building of mental representations of secure base support and use will be guided by parent-child co-construction processes. The child's improving language and advancing information processing skills increase the opportunities for verbally based interactions between caregiver and child. The mother-child co-construction process of secure base relationships includes now a verbal-representational component, but the nonverbal, behavioral building blocks remain in play as well.

Making Sense of Adopted Children's Internal Reality Using Narrative Story Stem Techniques: A Mixed-Methods Synthesis.

Background: Extant research on adopted children has consistently shown that early adverse experiences confer vulnerability to myriad developmental problems, which may be mitigated by the “natural intervention” of adoption itself and/or by treatment efforts. Narrative Story Stems Techniques (NSSTs) have been used in research and clinical practice to assess adopted children's developmental profiles in middle childhood. However, no study to date has systematically reviewed this body of literature.Objectives: This paper presents a systematic review of research using NSSTs to make sense of adopted children's internal reality (i.e., perceptions, experiences, and representations), in terms of exploring theoretical perspectives as well as critically synthesizing findings and discussing implications.Methods: State-of-the-art PRISMA guidelines were followed throughout, resulting in the identification of 18 records, comprising six qualitative, 10 quantitative, and two mixed-methods primary papers, reporting on seven unique studies. All records were assessed with regard to methodological quality. Data were extracted and synthesized narratively using an integrated design for mixed-methods synthesis.Results: The findings suggest that, although NSST research with adopted children is still in its infancy, there is relatively robust evidence supporting the use of these techniques to assess and track developmental change in adopted children's attachment representations. In this regard, the non-verbal (aside from the verbal) approach to children's complex internal reality, as well as a more fine-grained (aside from a categorical or dimensional) perspective on children's NSST responses, are highlighted as particularly valuable in tailoring treatment to a particular child's needs and vulnerabilities. Moreover, several promising avenues for future research and clinical application of NSSTs, including the extension to affect-regulatory and mentalizing perspectives, may further our knowledge and understanding of, and thus treatment efforts toward, these often vulnerable children. However, these findings should be interpreted with caution, due to the limited number of studies characterized by considerable methodological heterogeneity.Conclusions: In light of the findings of the present review, we strongly advocate future studies using NSSTs in theoretically and empirically consistent ways, in order to gain a better understanding of adopted children's internal reality in terms of attachment representations, affect-regulatory strategies, and mentalizing processes, and to track changes therein.