Infant Attachment Status Research Articles

Prenatal predictors of childhood anxiety disorders: An exploratory study of the role of attachment organization.

Childhood anxiety disorders (CAD) are a common childhood mental disorder and understanding early developmental pathways is key to prevention and early intervention. What is not understood is whether early life stress predictors of CAD might be both mediated by infant cortisol reactivity and moderated by infant attachment status. To address this question, this exploratory study draws on 190 women recruited in early pregnancy and followed together with their children until 4 years of age. Early life stress is operationalized as maternal depression measured using the Structured Clinical Interview for the DSM, Childhood Trauma Questionnaire, Parenting Stress Index, and antenatal maternal hair cortisol concentrations. Infant cortisol reactivity was measured at 12 months together with the Strange Situation Procedure and CAD assessed at 4 years of age using the Preschool Age Psychiatric Assessment. There was no direct association between attachment classification and CAD. Furthermore, infant cortisol reactivity neither mediated nor attachment moderated the association of early life stress predictors and CAD. However, only for infants with organized attachment classifications, higher maternal antenatal depression, and hair cortisol were associated with a higher risk of CAD.

Exploring Perinatal Indicators of Infant Social-Emotional Development: A Review of the Replicated Evidence.

The importance of infant social-emotional development for outcomes across the lifecourse has been amply demonstrated. Despite this, most screening measures of social-emotional development are designed for children 18months of age and over, with a clear gap in earlier infancy. Nosystematicreview has yet harvested the evidence for candidate indicators in the perinatal window. This paper examines modifiable risk and protective factors for two seminal earlymarkers of social-emotional development: attachment security and behavioral regulation mid-infancy. We searched meta-analytic and longitudinal studies of developmental relationships between modifiable exposures in the perinatal window (pregnancy to 10months postpartum) and attachment and behavioral regulation status measured between 12 and 18months. Six electronic databases were used: ERIC, PsycINFO, Medline Complete, Informit, Embase, and Scopus. Twelve meta-analytic reviews and 38 original studies found replicated evidence for 12 indicators across infant, caregiving, and contextual domains predictive of infant behavioral regulation and attachment status between 12 and 18months. Key among these were caregiving responsiveness, maternal mental health, couple relationship, and SES as a contextual factor. Perinatal factors most proximal to the infant had the strongest associations with social-emotional status. Beyond very low birthweight and medical risk, evidence for infant-specific factors was weaker. Risk and protective relationships were related but not always inverse. Findings from this review have the potential to inform the development of reliable tools for early screening of infant social-emotional development for application in primary care and population health contexts.

The parental reflective functioning questionnaire: Development and preliminary validation.

This paper reports on three studies on the development and validation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief, multidimensional self-report measure that assesses parental reflective functioning or mentalizing, that is, the capacity to treat the infant as a psychological agent. Study 1 investigated the factor structure, reliability, and relationships of the PRFQ with demographic features, symptomatic distress, attachment dimensions, and emotional availability in a socially diverse sample of 299 mothers of a child aged 0–3. In Study 2, the factorial invariance of the PRFQ in mothers and fathers was investigated in a sample of 153 first-time parents, and relationships with demographic features, symptomatic distress, attachment dimensions, and parenting stress were investigated. Study 3 investigated the relationship between the PRFQ and infant attachment classification as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. Exploratory and confirmatory factor analyses suggested three theoretically consistent factors assessing pre-mentalizing modes, certainty about the mental states of the infant, and interest and curiosity in the mental states of the infant. These factors were generally related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status in the SSP. Yet, at the same time, more research on the PRFQ is needed to further establish its reliability and validity.

Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire.

Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test–retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends preliminary support for the RFQ as a screening measure of reflective functioning. Further research is needed, however, to investigate in more detail the psychometric qualities of the RFQ.

Insecure attachment during infancy predicts greater amygdala volumes in early adulthood.

BackgroundThe quality of the early environment is hypothesized to be an influence on morphological development in key neural areas related to affective responding, but direct evidence to support this possibility is limited. In a 22-year longitudinal study, we examined hippocampal and amygdala volumes in adulthood in relation to early infant attachment status, an important indicator of the quality of the early caregiving environment.MethodsParticipants (N = 59) were derived from a prospective longitudinal study of the impact of maternal postnatal depression on child development. Infant attachment status (24 Secure; 35 Insecure) was observed at 18 months of age, and MRI assessments were completed at 22 years.ResultsIn line with hypotheses, insecure versus secure infant attachment status was associated with larger amygdala volumes in young adults, an effect that was not accounted for by maternal depression history. We did not find early infant attachment status to predict hippocampal volumes.ConclusionsCommon variations in the quality of early environment are associated with gross alterations in amygdala morphology in the adult brain. Further research is required to establish the neural changes that underpin the volumetric differences reported here, and any functional implications.

Making an effort to feel positive: insecure attachment in infancy predicts the neural underpinnings of emotion regulation in adulthood

BackgroundAnimal research indicates that the neural substrates of emotion regulation may be persistently altered by early environmental exposures. If similar processes operate in human development then this is significant, as the capacity to regulate emotional states is fundamental to human adaptation.MethodsWe utilised a 22-year longitudinal study to examine the influence of early infant attachment to the mother, a key marker of early experience, on neural regulation of emotional states in young adults. Infant attachment status was measured via objective assessment at 18-months, and the neural underpinnings of the active regulation of affect were studied using fMRI at age 22 years.ResultsInfant attachment status at 18-months predicted neural responding during the regulation of positive affect 20-years later. Specifically, while attempting to up-regulate positive emotions, adults who had been insecurely versus securely attached as infants showed greater activation in prefrontal regions involved in cognitive control and reduced co-activation of nucleus accumbens with prefrontal cortex, consistent with relative inefficiency in the neural regulation of positive affect.ConclusionsDisturbances in the mother–infant relationship may persistently alter the neural circuitry of emotion regulation, with potential implications for adjustment in adulthood.

The Longitudinal Link Between Parenting and Child Aggression: The Moderating Effect of Attachment Security

This study examined whether infant attachment security moderates the association between parenting in preschool and later aggressive behavior among a sample of children at high risk for developing conduct problems. Participants were 82 adolescent mother-child dyads recruited from the community. Infant attachment status at age 1year was measured using the Strange Situation. When children were aged 4.5years, mothers reported on their self-efficacy in regards to parenting, and mothers' positive parenting and criticism were coded from direct observations of parent-child interactions. In grade 1, mothers reported on their children's aggressive behavior. Infant secure attachment significantly moderated the association between observed maternal criticism and child aggression. That is, among insecurely attached children, higher levels of maternal criticism were associated with more severe aggression. This longitudinal finding suggests that a secure attachment may buffer the deleterious effects of harsh parenting on child aggression.

Cortisol regulation in 12-month-old human infants: Associations with the infants' early history of breastfeeding and co-sleeping

Experiences during early life are suggested to affect the physiological systems underlying stress responses, including the hypothalamic–pituitary–adrenal axis (HPA axis). While stressful early experiences have been associated with dysregulated HPA-axis functioning, positive early experiences, i.e. high maternal caregiving quality, contribute to more optimal HPA-axis functioning. Influences of other early caregiving factors, however, are less well documented. The goal of this study was to examine whether breastfeeding and co-sleeping during the first 6 months of life were associated with infant cortisol regulation, i.e. cortisol reactivity and recovery, to a stressor at 12 months of age. Participants were 193 infants and their mothers. Information on breastfeeding and co-sleeping was collected using weekly and daily sleep diaries, respectively, for the first 6 months of life. Co-sleeping was defined as sleeping in the parents' bed or sleeping in the parents' room. At 12 months of age, infants were subjected to a psychological stressor [Strange Situation Procedure (SSP); Ainsworth et al. 1978]. Salivary cortisol was measured prestressor and at 25, 40, and 60 min poststressor to measure reactivity and recovery. Regression analyses showed that after controlling for maternal sensitivity, infant attachment status, feeding, and sleeping arrangements at 12 months of age and other confounders, more weeks of co-sleeping predicted lower infant cortisol reactivity to the SSP. Also, more weeks of breastfeeding predicted quicker cortisol recovery. These results indicate that an early history of co-sleeping and breastfeeding contributes positively to cortisol regulation in 12-month-olds.

Promoting a secure attachment: A primary prevention practice model

It is increasingly recognized that early sensitive care-giving predicts a secure attachment in infancy and early childhood.This preliminary report details the development, implementation and evaluation of a clinical programme that used a targeted prevention approach following a universally-offered screening of parent-infant interactions. The CARE-Index was used to assign dyads to low, medium and high risk groups, and interventions - featuring reflective videotape-based feedback - were tailored to each risk group in order to increase maternal sensitivity and improve infant attachment status. Results showed improved maternal sensitivity in the intervention conditions compared to comparisons. In addition, infants in the intervention conditions were significantly more likely to be classified as secure, and significantly less likely to be classified as having DMM complex attachment strategies. Methodological shortcomings, however, mean that these findings should be regarded as tentative.

Examining the Link Between Infant Attachment and Child Conduct Problems in Grade 1

We examined the extent to which infant attachment status is directly related to child conduct problems 6 years later, and assessed the potential mediating roles of hostile parenting and maternal depression. The sample included 84 adolescent mothers and their children (45 girls, 39 boys). Infant attachment status was assessed using the Strange Situation when the study children were 1-year-old. Hostile parenting was coded during a parent–child interaction task when the study children were 4.5-years-old. Maternal depression was self-rated, also when the study children were 4.5-years-old, using the Beck Depression Inventory. Mothers reported child conduct problems at Grade 1 on the Child Behavior Checklist. Infant attachment status at 1 year of age was directly related to child conduct problems but not to hostile parenting or maternal depression. Neither hostile parenting nor maternal depression mediated the relationship between infant attachment status and child conduct problems. However, the pattern of relations differed by attachment security. For securely attached children, maternal depression, but not hostile parenting, was directly related to conduct problems. For insecurely attached children, hostile parenting, but not maternal depression, was directly related to child conduct problems. Implications for intervention and future research are discussed.

Maternal sensory sensitivity, mother–infant 9-month interaction, infant attachment status: Predictors of mother–toddler interaction at 24 months

At 24-months of age, toddlers ( N = 62) and their mothers were observed in a free-play session to determine the contribution of (a) maternal sensory sensitivity to positive and negative infant facial expressions as measured in a signal detection task at 6 months, (b) maternal behavior and affect, infant behavior and affect, and dyadic interaction at 9 months, and (c) infant attachment status at 12 months in predicting maternal, toddler, and dyadic measures at 24 months. Hierarchical regression analyses revealed that over and above early maternal behavior, which was predictive of later maternal behavior at 24 months, sensory sensitivity to the positive infant expression at 6 months predicted maternal behavior at 24 months and sensory sensitivity to both the positive and negative expression was associated with later maternal affect. Infant attachment status emerged as the variable which predicted toddler behavior and dyadic interaction at 24 months.

A picture is worth a thousand words: Children's representations of family as indicators of early attachment

To ascertain whether attachment representations at age 7 are related to early attachment behaviour, family drawings of 123 7-year-olds of known infant attachment status (25 avoidant, 80 secure, 18 resistant) were scored in four ways. Three of these were based in previous attachment research and one was based on a clinical method. The attachment-based coding schemes included specific markers for each attachment pattern (Kaplan & Main, 1985), global ratings (Fury, Carlson, & Sroufe, 1997) and efforts to classify each drawing as belonging to one of the three primary infant attachment groups (secure, avoidant, resistant). In the clinical scheme, children who had been resistant infants were distinguished from the others by use of overlapping and encapsulated figures. For the attachment based schemes, although individual markers were not successful in discriminating attachment groups, the more global approaches (aggregation of markers, global rating scales and judgments of attachment classification) succeeded in this task. In regression analyses controlling for concurrent child and parent measures, infant attachment did not make a significant contribution to predicting insecurity markers in drawings, although child current emotional functioning did. These findings linking attachment relationships with later representations of family relationships were in accord with the conception that avoidant attachment strategies de-emphasize intimate relationships, while resistant attachment strategies are preoccupied with close relationships. These links are most evident in global interpretive strategies rather than those that rely on specific markers.

Maternal speech style with prelinguistic twin infants

AbstractThe mother–infant communicative speech of a group of mothers of 4‐month‐old first‐born twin infants was compared to the speech of a group of mothers of first‐born singleton infants. Maternal groups were matched on age, education level, mother–infant attachment status and infant gender, and maternal depression was assessed as a control variable. Maternal speech was coded for focus, content, complexity and syntax of mothers' utterances. The findings of earlier studies with toddler age twins, that maternal speech style was more directive and less infant‐focused, were replicated in this prelinguistic period of infancy. Compared to mothers of singletons, mothers of twins used less infant‐focused speech, were less responsive to their infants' cues, and attributed less agency to their infants. Mothers of twins also used fewer questions and requests but did not differ from mothers of singletons in their use of negatives and imperatives. These early differences in the language learning environments of twin and singleton infants may be due to the reduced opportunities that mothers of twins have to establish dyadic communicative routines with their infants and to familiarize themselves with their infants as interactive partners, and may have implications for the early language development of twins. Copyright © 2002 John Wiley & Sons, Ltd.

Attachment over time.

Continuity in attachment classification from infancy to late adolescence was examined and related to autobiographical memories of childhood, divorce, and maladjustment. Eighty-four White middle-class children (48 girls) were seen in a modified Strange Situation at 12 months and given the Adult Attachment Interview at 18 years. In addition, data were collected on 13-year-olds' childhood recollections as well as adolescent, mother, and teacher ratings of maladjustment at 13 and 18 years of age. Divorce status of parents also was obtained. Results indicated no continuity in attachment classification from 1 to 18 years of age and no relation between infant attachment status and adolescent maladjustment. Divorce was related to 13-year-olds' childhood recollections as well as to insecure attachment status at 18 years. Eighteen-year-olds with insecure attachment classification were more likely to rate themselves as maladjusted. The results support the idea of attachment as an evolving representation dependent upon the nature of the family environment as indexed by divorce.

Mothers' fantasy representations and infant security of attachment: A Rorschach study of first pregnancy.

The relation between aspects of pregnant women's fantasy representations on the Rorschach test and infant attachment status at 1 year was studied. The Manual for Assessing Primary Process Manifestations in Rorschach Responses (Holt 1968) was used to score Rorschach protocols gathered from 25 women during their first pregnancies. Twelve-months-old and their mothers were later videotaped in the Strange Situation, a laboratory procedure that assesses infant attachment behaviors.

Towards Breaking the Cycle of Intergenerational Abuse

A quantitative single case study of an adolescent mother with a history of being abused as a child is presented. It illustrates the diagnostic and treatment issues during an intervention designed to break the cycle of intergenerational abuse. Drawing upon an ecological, transactional model of development, the case study utilized a multimethod, longitudinal approach to assess the mother's history and current psychosocial functioning, the infant's developmental competence and attachment status, patterns of mother-infant interaction and components of the family's social ecology. Measures were administered during a baseline period and systematically repeated throughout the one-year period of intervention. The treatment involved two weekly therapy sessions; one, an individual session for the mother and the other, a session in which mother and infant were seen together. The findings at the one-year evaluation showed improved maternal psychosocial functioning, the infant's shift from an insecure to a secure attachment classification and improved patterns of mother-infant interactions. The implications of this therapeutic approach and the use of single-case methodology are discussed.

Preventive intervention with a depressed mother with mental retardation and her infant: A quantitative case study

A quantitative single case study is presented to illustrate how an early intervention program treated a depressed mother with mental retardation and her infant son. Drawing upon an ecological model of development, the case study utilized a multimethod, longitudinal approach to assess the infant's developmental competence and attachment status, the mother's history and current emotional and intellectual functioning, mother-infant social transactions, and components of the family's social ecology. Measures were administered during a baseline period, systematically repeated throughout the 1-year period of intervention, and repeated at the conclusion of treatment. The treatment consisted of individual therapy sessions for the mother. The infant was present in these sessions in order to make the interaction problems immediately salient and therefore more easily explored in the therapeutic relationships. The findings indicated increased maternal and infant competence and more adaptive patterns of mother-infant social transaction. Therapeutic issues in providing preventive intervention to this high-risk population of mothers and infants are discussed.

The use of multitreatment modalities in early intervention: A quantitative case study

A quantitative single case study is presented to illustrate how an early intervention program used two therapeutic modalities to treat a depressed mother and her 2-month-old son. Drawing upon an ecological, transactional model of development, the case study utilized a multimethod, longitudinal approach to assess the infant's developmental competence and attachment status, the mother's history and current psychosocial functioning, patterns of mother-infant interaction, and components of the family's social ecology. Measures were administered during a baseline period to assess pre-intervention functioning and were systematically repeated throughout the 2-year period of intervention. The treatment modalities included psychodynamically oriented individual therapy and Parent-Infant Relationship Treatment (PIRT) in which the dyad was also seen by a second therapist to foster more adaptive mother-infant transactional patterns. The findings indicated increased infant developmental competence and a shift from an insecure to a secure attachment classification, improved maternal psychosocial functioning, and a decline in the dyadic interactional pattern of maternal intrusiveness and infant withdrawal. The advantages of using two treatment modalities and a single case approach to evaluation are discussed.

Attachment theory, personality development, and psychotherapy

Attachment theory, currently a dominant theme in the study of early social development, is beginning to have a presence in clinical psychology as well. A review of the theory as proposed by Bowlby is followed by an examination of the related research literature. Research using Ainsworth's Strange Situation paradigm suggests that the infant's attachment status is a genuine product of the interaction between mother and child rather than a measure of infant temperament, and is related to a broad array of developmental variables. Relatively little research has effectively examined the link between the mother-infant relationship and adult social functioning, however, due in part to difficulties with the measurement of attachment-related constructs. It is concluded that while the theory continues to evolve and some critical issues remain unresolved, attachment may be a useful construct for conceptualizing many disorders, and has the potential to provide valuable insights regarding the process and techniques of psychotherapy.