Disorganized Attachment Representations Research Articles

Variants of Callous-unemotional traits in childhood: investigation of attachment profile and hostile attribution bias

ABSTRACT There is increasing evidence of interest in describing two variants of CallousUnemotional (CU) traits based on high (secondary variant) or low (primary variant) levels of anxiety. However, studies are limited in childhood. The present study aimed to further the understanding of the variants, specifically in association with hostile attribution bias (HAB) and attachment. In a community sample of children aged 4 to 9 (N = 70), the study examined whether anxiety moderated the association of CU traits with HAB, secure and disorganized attachment representations. Hierarchical regression analyses revealed that CU traits were positively associated with disorganized attachment, regardless of the anxiety level. In contrast, CU traits were not associated with secure attachment. A significant interaction revealed that CU traits were positively associated with HAB only at high levels of anxiety. Implications for understanding the variants of CU traits and hypotheses regarding their developmental trajectories are discussed.

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

Attachment quality may affect psychological functioning. However, evidence on attachment representations and their correlates in children born to parents with schizophrenia and bipolar disorder is sparse. We compared attachment representations in a Danish sample of 482 children aged 7 years at familial high risk of schizophrenia, bipolar disorder, and population-based controls and examined associations between attachment and mental disorders and daily functioning. Attachment representations were examined with the Story Stem Assessment Profile (SSAP). Mental disorders were ascertained in diagnostic interviews. Daily functioning was assessed with the Children's Global Assessment Scale. We found no between-group differences in attachment. Higher levels of secure attachment were associated with decreased risk of concurrent mental disorders in the schizophrenia high-risk group. Higher levels of insecure and disorganized attachment were associated with increased risk of mental disorders across the cohort. Higher levels of secure and insecure attachment were associated with better and poorer daily functioning, respectively. In the current study, results regarding defensive avoidance could not be reported due to methodological limitations. Familial high risk of schizophrenia (FHR-SZ) or bipolar disorder is not associated with less secure or more insecure attachment at age 7. Insecure and disorganized attachment representations index risk of mental disorders and poorer functioning. Secure attachment may be a protective factor against mental disorders in children at FHR-SZ. Validation of the SSAP is needed.

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.

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.

Attachment representations among school-age children with intellectual disability

BackgroundResearch data documenting a high risk of insecure and disorganized attachment among children with intellectual disability (ID) in infancy and early childhood raises the question of mutual influences between ID and attachment in later childhood. AimsThe objectives of the present study were to examine attachment among school-age children with ID and whether attachment varies according to level of intellectual functioning, adaptative functioning, and presence of a genetic syndrome (i.e. Down syndrome). MethodsAttachment among 54 children with ID aged 8−12 years (30 with Down Syndrome, 24 with non-specific ID) was assessed using the Attachment Story Completion Task, and compared with that of 108 typically developing children, 54 of the same chronological age and 54 of the same mental age. OutcomesResults show (1) less security among children with ID than among same-age controls (2) more disorganization among children with ID compared to the two control groups, (3) a link between attachment disorganization and level of adaptive functioning among children with ID and (4) no difference in attachment between children with DS and children with non-specific ID. ConclusionsChildren with ID remain vulnerable to disorganization during late childhood. More research is needed to understand the factors underlying disorganized attachment representations.

Emotional-behavioral problems, attachment and verbal skills in late-adopted adolescents: The role of pre-adoption adversities and adoption variables

BackgroundThere are few studies on late-adopted adolescents' outcomes -e.g., emotional-behavioral problems, attachment and cognitive status- and their possible predictive factors, none from Italy. Objective: This paper aimed to investigate emotional-behavioral problems, attachment representations, and verbal skills in late-adopted adolescents in Italy and to explore the predictive role of pre-adoption adversities and adoption variables for worse adoptees' outcomes. Participants and settingThe study included N = 79 late-adopted (mean age at adoption = 6 years) adolescents, between 11 and 18 years, placed via both intercountry and domestic adoption. MethodsParents provided information about pre-adoption and adoption history and filled the Children's Behavior Checklist 6–18 for measuring participants' emotional-behavioral problems. Attachment representations were assessed through the Friend and Family Interview administered directly to adolescents, like the verbal comprehension index of the Wechsler Intelligence Scale for Children (4th edition) for measuring participants' verbal IQ. ResultsMaltreatment and its interaction with multiple placements were the main predictors of other problems—i.e., social, thought, and identity difficulties (respectively, p = .007 and p = .029)—while intercountry adoption was the unique predictor of both externalizing and total problems (respectively, p = .047 and p = .015). However, domestic adoption was the most important predictor both for higher insecurity and disorganized attachment representations and lower verbal skills (all p < .044); even stronger if domestic adoption interacted with pre-adoptive institutionalization. ConclusionsPre-adoption adversities as well as domestic vs. intercountry adoption, but not the age at placement, contributed to adolescent adoptees' developmental outcomes.

Foster children’s attachment representations: the role of type of maltreatment and the relationship with birth family

ABSTRACT Children in foster care are at risk of developing insecure and disorganized attachment, which is problematic for establishing new relationships in foster families. However, most previous studies have focused on attachment behaviors in young children rather than on attachment representations. We compared foster children’s attachment representations with those of a community group, analyzing also the contribution made by different factors to foster children’s attachment representations. We assessed the attachment representations of 109 children aged between 4 and 9 years (51 children in non-kin foster care and 58 community children) in southern Spain, using a narrative story stem measure. Case records information were collected for adversity and child protection variables. Foster children had fewer security and more avoidance indicators than their community counterparts, with those who had suffered more severe maltreatment scoring lower for security and higher for disorganization. Exposure to physical and emotional abuse and birth parents’ opposition to the foster placement predicted more disorganized attachment representations. Interventions with foster children should consider their heterogeneity in terms of attachment outcomes, and foster caregivers of abused children may need guidance in order to provide therapeutic caregiving.

Disorganized attachment representations, externalizing behavior problems, and socioemotional competences in early school-age

ABSTRACT Multifactorial research must examine if disorganized attachment is specifically associated with either ODD- or ADHD-symptoms,and the mechanisms through which disorganization may become associated with externalizing problems. The present short-term longitudinal study therefore examined attachment representations, and several competences important for socio-emotional functioning, in relation to ODD- and ADHD-symptoms at T1 (N = 105, M age = 80 months) and T2 (N = 80, M age = 104 months). There was a main effect of disorganized attachment on ODD-symptoms at both time points but not on ADHD-symptoms. Disorganized children also showed lowered attention to facial expressions, a diminished ability to discriminate facial expressions, and elevated emotional reactivity. Emotional reactivity mediated the link between disorganization and ODD-symptoms at T1, but not at T2. The findings support disorganized attachment as a risk-factor for ODD-symptoms rather than ADHD-symptoms, and suggest that disorganization may become associated with ODD-symptoms through broad effects on multiple competences.

Diminished ability to identify facial emotional expressions in children with disorganized attachment representations.

The development of children's ability to identify facial emotional expressions has long been suggested to be experience dependent, with parental caregiving as an important influencing factor. This study attempts to further this knowledge by examining disorganization of the attachment system as a potential psychological mechanism behind aberrant caregiving experiences and deviations in the ability to identify facial emotional expressions. Typically developing children (N=105, 49.5% boys) aged 6-7years (M=6years 8months, SD=1.8months) completed an attachment representation task and an emotion identification task, and parents rated children's negative emotionality. The results showed a generally diminished ability in disorganized children to identify facial emotional expressions, but no response biases. Disorganized attachment was also related to higher levels of negative emotionality, but discrimination of emotional expressions did not moderate or mediate this relation. Our novel findings relate disorganized attachment to deviations in emotion identification, and therefore suggest that disorganization of the attachment system may constitute a psychological mechanism linking aberrant caregiving experiences to deviations in children's ability to identify facial emotional expressions. Our findings further suggest that deviations in emotion identification in disorganized children, in the absence of maltreatment, may manifest in a generally diminished ability to identify emotional expressions, rather than in specific response biases.

Lower Oxytocin Plasma Levels in Borderline Patients with Unresolved Attachment Representations.

Interpersonal problems and affective dysregulation are core characteristics of borderline personality disorder (BPD). BPD patients predominantly show unresolved attachment representations. The oxytocin (OT) system is associated with human social attachment and affiliative behavior, and OT dysregulation may be related to distinct attachment characteristics. Here, we investigated whether attachment representations are related to peripheral OT levels in BPD patients. Twenty-one female BPD patients and 20 age-, gender-, and education-matched healthy controls (HCs) were assessed with clinical scales and measures of interpersonal and attachment-related characteristics, including the Adult Attachment Projective Picture System (AAP). Plasma OT concentrations were measured prior to and during social exclusion in a virtual ball tossing game (Cyberball). The majority of BPD patients (63.2%) but no HCs showed unresolved (disorganized) attachment representations. In this subgroup of patients, baseline OT plasma levels were significantly lower than in BPD patients with organized attachment representations. This pilot study extends previous findings of altered OT regulation in BPD as a putative key mechanism underlying interpersonal dysregulation. Our results provide first evidence that altered OT plasma levels are related to disorganized attachment representations in BPD patients.

Attachment Representation in Institutionalized Children: A Preliminary Study Using the Child Attachment Interview

The experience of being removed from one's home and the transition to a residential care system pose enormous challenges for a child. Substantial evidence has been found regarding severe developmental effects due to early exposition to extreme psychosocial and affective deprivation. The research on Bowlby's theoretical proposals has highlighted the link between insecure, disorganized and atypical attachment patterns and children both living in foster care facilities and adopted out of those institutions. The goal of this pilot study is to investigate the attachment representation in an Italian sample of children in middle childhood (9-13 years old) who have been removed from their homes. Two compared groups of children participated in this study. The first group was composed of 24 Italian children who had been removed from their homes. The second group, considered as the control group, was composed of 35 Italian children who had never been in foster care placement. The quality of children's attachment to their primary caregivers was assessed by the Child Attachment Interview, an innovative semi-structured interview that seeks to bridge the measurement gap identified in middle childhood The children in foster care placement show a higher percentage of insecure and disorganized attachment representations and lower scores on the Child Reflective Functioning Scale. The clinical implications and enhancements to effective intervention for foster children's caretaking are discussed.

Fremdenfeindlichkeit durch erlebte Ausstoßungsprozesse - eine tiefenhermeneutische Reflexion eines Einzelfalls

A single case study is presented from a feasibility study on social, psychic and neurobiological causes of violence in adolescence focusing on right-wing extremist and xenophobic youth. Results from psychological assessments and a structured biografical reconstruction are analyzed. The case illustrates a typical developmental path of a right-wing, xenophobic and violent male adolescent who experienced early and repeated exclusion and social marginalization. Results from psychological testing demonstrated additional developmental risk factors, such as disorganized attachment representations and low mentalizing abilities. A depth-hermeneutic analysis ofa sequence during the attachment interview as well as a reflection of the research setting further illustrates how experiences of exclusion are re-enacted by a combination of fear of abandonment and aggression.

Mothers' borderline features and children's disorganized attachment representations as predictors of children's externalizing behavior.

Mothers' borderline features and children's disorganized attachment representations as predictors of children's externalizing behavior.

Maternal interactive behaviour as a predictor of preschoolers' attachment representations among full term and premature samples

BackgroundAssociations between maternal sensitivity and child attachment have been established in many samples, but the strength of the association varies across populations. The sensitivity–attachment link has never been examined at the level of representations nor among premature samples. ObjectiveThe present study is aimed at exploring associations between maternal interactive behaviour and children's attachment representations in a population of preterm and full-term infants. MethodMaternal interactive behaviour was assessed at 6 and 18months (Ainsworth Sensitivity Scale & Care Index) and children's attachment representations were measured at 42months (Attachment Story Completion Task) in a sample of preterm (N=48) and full-term (N=23) infants. ResultsMaternal unresponsiveness at 6months and sensitivity at 18months explained 54% of the variance of disorganized attachment representations in the full-term group but was not significantly related to attachment patterns in the preterm group. ConclusionThese results corroborate previous work on the causes of disorganized attachment and also point to the need to consider the development of attachment differently for children evolving in specific developmental contexts. They especially stress the importance of distinguishing between risk factors associated with the mother as opposed to the child.

Intergenerational transmission of attachment representations in the context of single parenthood in France.

Despite a dramatic increase of single parenthood during the past decades, parent-child transmission of attachment has almost always been examined in intact families. A first objective of the current study was to examine child attachment in the context of single parenthood, both maternal and paternal. A second objective was to investigate intergenerational transmission of attachment in single parent-child dyads, compared with that observed in two-parent families. The samples consisted of 50 married couples and 43 single parents (22 mothers and 21 fathers), along with their 3- to 6-year-old children. Parental and child attachment representations were measured, respectively, with the Adult Attachment Interview and the Attachment Story Completion Task. Findings suggested that single parenthood per se was not linked to more insecure or disorganized child attachment representations. However, when the father was the sole caregiver, children exhibited more disorganized representations. Different patterns of mother-child associations were found according to family structure: associations were significant among married families but not among single-mother families. Results also replicated those of previous studies in finding a nonsignificant father-child association in two-parent families and a significant one in single-father families, specifically with respect to hyperactivation. Further research is needed to clarify whether the differences found are attributable to different circumstances leading to single parenthood for men and women, or to parental gender itself.

Attachment Representation in Mothers of Children with Attention Deficit Hyperactivity Disorder

Attachment research so far rarely has focused on attention deficit hyperactivity disorder (ADHD). This study is the first to examine the distribution of the attachment representation in mothers of children with ADHD. Considering results of clinical attachment studies we formulated the following hypothesis: the prevalence of maternal insecure and unresolved attachment representations increases with the degree of severity of children’s ADHD symptoms. Therefore it is highest in mothers of children with ADHD who are treated clinically (group A). It is expressed less strongly in mothers of children with ADHD symptoms without need for clinical treatment (group B). In a control group of mothers whose children have no ADHD diagnosis (group C), there is the lowest prevalence of insecure and disorganized attachment representations. Within a period of 6 months from a total of 72 recruited children and their mothers screened according to participation criteria (e.g. ICD-10: F90 Hyperkinetic disorders), 13 mothers could be assigned to group A, 19 mothers to group B, and 19 mothers to group C. The attachment representation was assessed using the Adult Attachment Projective. To test the sequence order hypothesis we used the Jonckheere-Terpstra test (u = 3.78; p < 0.001). The increasing clinical conspicuity in the groups obviously is connected to a reduced prevalence of the autonomous attachment representations as well as to an increase of the insecure and unresolved attachment representations of the mothers. We interpret this result with respect to the treatment of children with ADHD as a vote for considering the family context as well as early intervention strategies which aim at the improvement of the quality of maternal sensitivity.

Disorganized attachment representation and atypical parenting in young school age children with externalizing disorder

We investigated the relationship of child attachment representation, psychopathology, and maternal atypical parenting in a high risk sample. Sixty-one consecutive clinical referrals with externalizing disorder aged 4 – 9 years were assessed for attachment representations measured with Manchester Child Attachment Story Task (MCAST), atypical parental expressed emotion (EE), maternal mood, and parent and teacher ratings of child behaviour. Disorganized attachment representations were found in 58% of cases, independent of ADHD symptoms. Pervasive disorganization was associated with very high maternal EE. Attachment status, maternal depression, and ADHD diagnosis were independently associated with parent-rated child behaviour problems; teacher ratings were associated with child's age and ADHD status. Disorganized attachment shows a high prevalence and independent associations with attention deficit symptomatology and maternal EE.

Defensive Dysregulation in Preschool Children's Attachment Story Narratives and its Relation to Attachment Classification and Externalizing Behaviour

This study examines the relationship between disorganized attachment representations, defensive dysregulation in preschool children's doll play story narratives and child externalizing behaviour. Preschool children ( n = 53) participated in the George and Solomon (1990, 1996, 2000) Six-Year Attachment Doll Play Procedure and their mothers completed a measure on child behaviour. Disorganized children's stories contained the most dysregulated content and their behaviour during the doll play interview was the most dysregulated. Ambivalent children exhibited the highest level of externalizing behaviour and dysregulated story content was only associated with externalizing behaviour for children classified as ambivalent. Implications for interventions and teacher—student relationships are discussed.

Attachment Representations in 6-Year-Old Children from One and Two Parent Families in Germany

Viewed from the perspective of attachment theory, coping with the separation and divorce of parents requires that children reorganize their mental model of attachment. Secure attachment models may be disrupted, while insecure attachment models may be strengthened. According to findings from research on divorce, this process of family reorganization takes about two years. Attachment representations in middle childhood can be assessed by new methods that rely on the symbolic medium of story completion in doll play. Based on five coded attachment story narratives, the Attachment Story Completion Task (ASCT) by Bretherton and Ridgeway, and the German Coding and Classification System by Gloger-Tippelt and König, permits the assessment of secure, avoidant, ambivalent and disorganized attachment representations reliably, and to rate attachment security on a four-point-scale. In this study we compare the attachment representations in ASCT of 51 children from two parent families with 60 six-year-old children from one parent, all mother families who experienced separation/divorce, and were still in the phase of family reconstruction. The children of single mothers demonstrated fewer secure and more insecure attachment representations, in particular more avoidant ones. Moreover, in the children from one parent, but not from two parent families a significant gender effect emerged. Results have been discussed considering further risk factors in the one parent families and possible influences of children's attachment representations in the school setting.

Attachment representations and representations of the self in relation to others: a study of preschool children in inner-city London.

The study examined the relationship between attachment representations and representations of the self in relation to others in a sample of 42 children aged between 4 and 5.9 years. The relationship between children's attachment representations and parents' style of regulating negative affect was also explored. The families were using local authority day-care facilities in a deprived inner-city area of London. The quality of attachment representations was assessed using a modified version of the Separation Anxiety Test. Assessments of the representation of the self in relation to others consisted of (a) assessment of the child's view of self within the relationship with the attachment figure, using an incomplete doll story procedure; and (b) assessment of the child's perceptions of the way others view them using a puppet interview. Significant connections between attachment representations, representations of self in relation to others, and parents' negative affect regulation were found. Children with secure attachment representations had a significantly more positive view of the self in the relationship with the attachment figure than children with disorganized attachment representations, and a significantly more positive perception of the way others view them than children with avoidant attachment representations. Children with secure attachment representations had parents with more adaptive ways of regulating their own negative affect than children with ambivalent or disorganized attachment representations.