Infant Attachment Research Articles

In conversation: transgenerational attachment trauma, the infant, and the family therapist

AbstractThis paper shares a far‐ranging set of conversations between professors Jennifer McIntosh, Louise Newman, and Carol George, all child and family practitioners, and infant mental health (IMH) and attachment specialists. They explore the domain of infant–family work with high‐risk populations experiencing complex relational and intergenerational trauma. George and McIntosh discuss the intersection between family therapy and IMH from an attachment perspective. They explore what family therapy can offer to supporting coherence in caregiving states of mind, beyond the offerings of traditional dyadic mother–baby models of intervention. They highlight the infant's contribution to family work, and the application of attachment theory in a family therapy context. Newman and McIntosh discuss a sensitive and graded approach to high‐risk family work with an infant. Newman reflects on when and whom to invite to a family session and the power of enabling the family to speak the unspeakable in the presence of the baby, supporting a future focused path for trauma integration and recovery. For family therapists who may be new to IMH work, there are some important offerings about integrating these fields, bringing into play the family therapist's deep grasp of curiosity, circularity, and capacity to reconceptualise with an IMH perspective on early relational trauma.

Adverse experiences in early intimate relationships and next‐generation infant–mother attachment: findings from the ATP Generation 3 Study

AbstractChronic insecurities that emerge from adverse experiences in early intimate partner relationships in adolescence and emerging adulthood can have profound impacts on mental health and well‐being. Less clear is the extent to which these experiences for parents impact subsequent relationships within and across generations. We examine the extent to which secure, dismissing, pre‐occupied, and fearful intimate partner relationships in adolescence and emerging adulthood, well before becoming a parent, are associated with next‐generation patterns of attachment between mothers and infant offspring. Data were drawn from a nested study of infant–mother attachment (n = 220) within the Australian Temperament Project Generation 3 Study (N = 1167, est. 1983). Intimate partner relationships in adolescence and young adulthood were assessed by self‐report at 23–24 years of age. Over a decade later, infant–mother attachment security was assessed at 12 months post‐partum. Young adult intimate partner relationships defined by high levels of fearful, pre‐occupied, and dismissing attachment styles were reported in 11%, 17%, and 38% of young mothers, respectively. Increases in fear of intimacy in relationships were associated with an increase in the odds, by around 50%, of infant–mother insecure attachments (vs secure; OR = 1.56, 95% CI = 1.07, 2.28) and disorganised attachments (vs organised; OR = 1.49, 95% CI = 1.00, 2.22). A mother's self‐reported history of fear of intimacy within young adult relationships predicts later insecure and disorganised mother–infant attachments. Guidance and greater support for young people navigating their earliest intimate relationships may not only prevent adverse relational experiences at the time but also on becoming a parent. Findings have relevance for family and infant mental health therapies. Translating these findings into supported conversations may help prevent infant–mother attachment difficulties, or later repair them, through validation of the lingering effects of early fear of intimacy and empowerment of parents to prevent next‐generation infant experiences of distrust.

I'm with you, baby: Using parental embodied mentalizing in a pilot study to capture change following the circle of security parenting intervention.

Supported by a large body of work demonstrating the impact of infant attachment representations on subsequent development, numerous therapeutic programs have been developed to promote secure attachment, with increasing focus on parental mentalizing. Nonetheless, empirical evidence supporting their effectiveness has yet to be fully established. The current pilot study (N = 24) was designed to evaluate whether and to what extent parents' shifts in parental mentalizing following a brief attachment-based group intervention, namely circle of security parenting (COSP; Cooper, Hoffman & Powell, 2009) can be captured using the parental embodied mentalizing instrument (PEM; Shai & Belsky, 2017). Compared to a waiting list-control group, this small-scale study examined whether community-based low-risk mothers of infants aged 5-48 months show an increase in their observed PEM capacities following the intervention. Secondary self-reported outcome variables parental stress, feeling of competence, and self-compassion. Findings show that PEM ratings improved significantly over time in the COSP group, but not in the control group. Intervention group mother-infant dyads also presented significantly longer embodied interactions communication post intervention compared to the control group. No effects of the COSP on parental stress, competence, or self-compassion were found. Despite the small sample size, these results tentatively suggest that COSP can improve embodied mentalizing abilities.

A Feasibility Study to Assess Sleep and Subsequent Breast Milk Volume Among Mothers With Hospitalized Preterm Infants.

Sleep is essential for optimal health, and disturbed postpartum sleep is associated with compromised infant attachment. The postpartum experience of mothers with preterm infants is unlike the biological norm, as they are separated from their infants and often express breast milk. The purpose of this study was to examine the feasibility of conducting a clinical research study among women with hospitalized preterm infants. We also explored for associations between maternal sleep patterns and sleep-related psychological states and subsequent breast milk volume. Participants were recruited from Magee-Womens Hospital, located in Pittsburgh, Pennsylvania New mothers completed daily sleep and pumping logs and scales to measure stress, trauma, depression, fatigue, and sleep quality. A total of 78 women were screened, 18 women consented, and a total of 8 participants completed the study. Screening from the postpartum unit increased recruitment. The participants experience worsening sleep quality over time, moderate stress, and fatigue. Stress, postnatal depression, and fatigue are negatively associated with milk volume. Postpartum recruitment with frequent follow-ups improved recruitment and retention. We present a preliminary association between maternal stress, fatigue, and depression, and subsequent breast milk volume. Sleep-related psychological states may negatively influence milk volume.

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment

BackgroundMultiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women.MethodsA convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis.ResultsAccording to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was − 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was − 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect.ConclusionOur study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women’s social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

Parental representations after preterm birth: a narrative review.

Preterm birth accounts for nearly 15 million births annually worldwide and constitutes a considerable risk factor for atypical development. This birth context is a source of stress for the parents and often leads to an early separation between their child and them. Research on the influence of the birth status on the infant's attachment style has shown no systematic link between preterm birth and the development of insecure attachment in children born preterm. This has opened up research perspectives in understanding the role of environmental factors. A literature review was conducted to present an overview of the current findings on parental representations (PR), particularly maternal ones, and their role in the context of preterm birth. PR quality appears to be associated with specific dyadic interaction patterns, thus exposing vulnerability factors. Studies exploring PR have pointed out the importance of considering parental mental elaboration mechanisms and contextual moderators in supporting socio-emotional development among children born preterm. We discussed the challenges of investigating PR in the context of preterm birth for future studies and emphasized the need for research studies to be conducted according to a developmental and non-deterministic perspective. This narrative review also aimed to highlight the importance of family centered care interventions in the context of a public policy focused on the child's "First 1,000 days" of life.

EEtkili Emziren ve Emzirmede Yeterli Olduğunu Düşünen Annelerin Bebekleriyle Bağlanma Düzeyinin Belirlenmesi: Kesitsel Tipte Çalışma

Objective: This study aims to determine the relationship between breastfeeding success and breastfeeding self-efficacy and maternal infant attachment.&#x0D; Methods: The study was conducted in xxx Family Health Center between March -June 2017. The questionnaire form, the LATCH Breastfeeding Identification and Assessment Scale, the Breastfeeding Self-Efficacy Scale, and the Maternal Attachment Inventory were used to collect data in the study. The Kruskall Wallis Analysis Mann, Whitney-U Analysis, Spearman Correlation and Kurtosis and skewness coefficients, Internal consistency Cronbach α coefficient were used in data analysis.&#x0D; Results: The women who participated in the study had an average score of 9.87±0.42 in the LATCH Breastfeeding Identification and Assessment Scale, 63.51±10.71 in the Breastfeeding Self-Efficacy Scale and 101.58±2.28 in the Maternal Attachment Inventory. The difference between the average Breastfeeding Self-Efficacy Scores according to the level of education and time when breastfeeding started was statistically significant (p

Who cares for the mothers?: A narrative inquiry exploring substance use disorders among pregnant women

Background: The nexus between pregnancy and substance use disorders is usually studied from the perspective of the fetus, quantitatively examining the risks associated with in utero substance exposure. There is little regard for the mother and her experience. With an awareness of some of the challenges pregnant women with substance use disorders face, the purpose of this research was to explore how pregnancy and substance use disorders are situated within motherhood and to identify opportunities to shift the understanding of women’s experiences among health care professionals so more supportive care can be offered. Methods: Narrative inquiry was used for this research. The researcher engaged with three pregnant women who self-identified as having a substance use disorder. Formal and informal conversations, field notes, and a research journal were used to collect data. Narratives were co-constructed between the researcher and each woman. Results: The results are presented as excerpts from each woman’s narrative. Narratives extended beyond pregnancy and into a period of conditional motherhood where women were forced to meet state mandated conditions or risk loss of motherhood. Sobriety was fragile and impacted by stressful events such as child apprehension and treatment programs did not meet the needs of mothers. Conclusions: Ongoing, comprehensive services that support pregnant women and are continued into the postpartum period are needed. Peer support models may be an effective means for providing pregnancy specific substance use treatment. Treatment programs must be accessible and meet the distinct needs of women. Extensive breastfeeding support should be considered for women in recovery to promote mother infant attachment.

Infant and preschool attachment, continuity and relationship to caregiving sensitivity: findings from a new population-based Australian cohort.

Here, we report new prevalence and temporal stability data for child attachment and parental caregiving behaviour, from infancy (1 year) to preschool (4 years). Attachment (SSP) and caregiving data (MBQS) were from observations of parents and their infants and preschoolers, who represent the third generation of participants within an Australian longitudinal cohort. At 1 year (n = 314 dyads) and at 4 years (n = 368 dyads), proportions assessed secure were 59% and 71%, respectively. Proportions assessed avoidant were 15% and 11%; ambivalent 9% and 6%, and disorganised 17% and 12%, at 1 and 4 years. Continuity of attachment pattern was highest for the infant secure group. Of dyads initially classified disorganised in infancy, 36% remained so at the preschool assessment. Attachment and caregiving continuities across the infancy-preschool period were highest for the stable secure attachment group and lowest for the stable insecure attachment group. Loss of secure attachment to mother by age 4 years correlated with decreased maternal caregiving sensitivity, and acquisition of secure status by age 4 was associated with increased maternal sensitivity. We found no difference in caregiving sensitivity scores for mothers and fathers for female and male preschool children. The contemporary infant and preschool attachment proportions we report here closely mirror the patterns of those reported in prior decades, with an inclination towards secure base relationships. Our findings alert practitioners anew to the responsiveness of early attachment status to change in caregiving responsiveness and support ongoing investment in early identification of disorganised attachment.

Effects of massage intervention on discharged premature infants’ weight, parental stress, and parent–child attachment: A randomized controlled trial

Infant massage enhances the growth and development of premature infants and promotes parent–child bonding. However, its effects on parental stress and parent–child attachment in premature infants, as well as gender differences thereof, remain unclear. In this randomized controlled trial, we used a repeated-measures design and included 61 premature infants (mean gestational age: 35.1 ± 1.5 weeks). Weight, parental stress, and parent–child attachment were measured at multiple time points: before massage and 1, 4, 8, and 12 weeks after commencing infant massage. The results revealed that the massage group infants had significantly higher weight gain than the control (no massage) group infants at all four time points. Moreover, parents in the massage group reported notably lower levels of stress than those in the control group, particularly in the parental distress and difficult children subscales. No significant between-group differences were observed in parent–child attachment. Furthermore, no significant differences were observed between fathers and mothers in parental stress and parent–child attachment. However, fathers reported higher levels of distress than mothers at 4 and 12 weeks. In conclusion, infant massage led to increased infant weight and reduced parental stress over time, and differences between fathers and mothers were not significant, except fathers exhibiting higher levels of distress than mothers over time. Healthcare professionals should educate and support parents on infant massage before discharge of premature infants.

Antibiotic Consumption, Illness, and Maternal Sensitivity in Infants with a Disorganized Attachment.

Prior research found an association between mother-infant attachment and antibiotic use. Ambivalent-attached infants are more likely to take antibiotics than other infants, and their mothers tend to be less sensitive to their needs than most. This finding is important because it shows the association between psychological processes, early relationships, and health outcomes. We aim to learn about children with high-risk attachment relationships, such as disorganized-attached infants. This study compares antibiotic use, infant-mother interactive behavior, and health indicators according to infant attachment patterns (including disorganized attachment). For this purpose, we observed mothers-infants' interactive behavior in free play at nine months and infants' attachment in the Ainsworth Strange Situation at twelve months. Participants included 77 girls and 104 boys (full-term and preterm) and their mothers. Paradoxically, mothers of disorganized-attached infants reported that their children were ill only 1.56 times on average, but 61% of their children used antibiotics in the first nine months. The other mothers reported that their children were sick 5.73 times on average, but only 54% of their children used antibiotics in the same period. Infants with disorganized attachment had mothers who were more literate and less sensitive. These results add to a body of research that shows that early high-risk relationships affect children's lives at multiple levels.

Actually, today was a good day, so today we're doing all right: Parental perspectives on a dyadic group art therapy intervention for parent and infant wellbeing and attachments

In this study we sought to capture the experiences of parents who had attended a parent-infant art therapy group to support their wellbeing and attachment relationships. The groups lasted 12 weeks and had a focus on using shared art making experiences to bring the dyads into positive interactions. 50 parents attended the groups with their children. We asked them to complete surveys at the end of the art therapy group and later followed up a sample of participants for in depth interviews. We analysed both of these using reflexive thematic analysis. Our organisation of themes lays out the difficulties facing parents, what enabled them to take part, the mechanisms of change within the art therapy intervention, and the outcomes parents observed. The analysis evidences the changes parents identified in how they felt themselves and how they felt about their baby, with an important shift to enjoying their role as parents, feeling more confident about their parenting, tuning in to their babies’ cues, and enjoying the emerging personalities of their babies. It highlights the potential of art therapy to support parental wellbeing and parent-infant attachment relationships.

The Evidence-Base for Psychodynamic Interventions with Children Under 5 Years of Age and Their Caregivers: A Systematic Review and Meta-Analysis

ABSTRACT Experiences in the first years of life can shape a range of outcomes throughout the lifespan. Effective early interventions have the potential to offset negative outcomes associated with early adversity. A broad range of psychodynamic interventions are available to children under five and their caregivers but there is a lack of research synthesizing the current evidence for their effectiveness. This paper presents a systematic review and meta-analysis of the evidence for the effectiveness of psychodynamic interventions for children under 5 years of age and their caregivers. Following a systematic search of 10 databases and screening for eligibility, 77 papers were included in the review. Most studies reported positive outcomes on a range of parent and infant domains. The meta-analyses of controlled studies found significant effects of psychodynamic interventions compared to control conditions on parental reflective functioning, maternal depression, infant behavior, and infant attachment. No significant differences between psychodynamic and control interventions were found for parental stress, and parent-infant interactions. Very few studies were rated as good quality and further high-quality research is needed.

Cross-modal coherence and incoherence of early infant interactive behavior: links to attachment in infants born very preterm or full-term

ABSTRACT Infants exhibit flexibly organized configurations of facial, vocal, affective, and motor behavior during caregiver-infant interactions that convey convergent messages about their internal states and desires. Prior work documents that greater cross-modal discrepancy at 4 months predicts disorganized attachment. Here, we evaluated whether: very preterm (VPT) or full-term (FT) status predicts cross-modal coherence or incoherence in infants’ behavior with the caregiver at 3 months; and, regardless of prematurity, whether cross-modal interactive coherence or incoherence predicts 12-month attachment. Participants included 155 infants (85 FT; 70 VPT), and their mothers followed from birth to 12 months (corrected age). Infants’ cross-modal coherent and incoherent responses were scored microanalytically from videotaped en-face interactions. Infants’ attachment security was evaluated during Ainsworth’s Strange Situation. Infants born VPT exhibited more incoherent cross-modal responses and insecure attachment than infants born FT. Regardless of prematurity, infants’ coherent and incoherent cross-modal interactive behaviors at 3 months predicted different attachment patterns at 12 months.

Dogs showed lower parasympathetic activity during mutual gazing while owners did not

The affiliative relationship between humans and dogs is compared to a mother–infant attachment relationship. We hypothesized that dog’s attachment behavior in negative emotional state aroused the owner’s attention toward the dog, that is, reduced parasympathetic activity. We measured heart rate variability in both dogs and humans during the Strange Situation Test to examine whether the owners' parasympathetic activity was decreased by being gazed at by their dogs. Our results in a short-term of 6 s before and after the moment the dog gazed at the human face indicated that dogs’ parasympathetic activity was lower when the dogs were gazing at their owners than when it was gazing at unfamiliar persons. Dog’s autonomic activity was also lower when the dogs were living with their owners for a longer period. However, we could not determine whether gaze from the dog affected the autonomic activity in humans as attachment behavior.

The effect of delayed umbilical cord clamping on the infant’s beta-endorphin level, mother-infant attachment and breastfeeding

ObjectivesTo examine the effect of delayed umbilical cord clamping on the infant’s betaendorphin level, mother–infant attachment and breastfeeding. Study designThis study had an experimental design with a control group. The study was undertaken between October and December 2017 in a maternity hospital in the east of Turkey. In total, 107 pregnant women [55 in the experimental group (delayed cord clamping) and 52 in the control group (early cord clamping)] participated in the study. ResultsThe beta-endorphin level in the umbilical cord was 775.80 ± 229.35 in the experimental group and 547.91 ± 290.01 in the control group, and the difference was significant (t = 4.492, p = 0.000). Similarly, the prolactin level in the umbilical cord was 174.26 ± 47.20 in the experimental group and 119.06 ± 47.74 in the control group, and the difference was significant (t = 6.012, p = 0.000). Mother–infant attachment and breastfeeding success were higher in the experimental group. ConclusionsBeta-endorphin and prolactin levels in the umbilical cord, mother–infant attachment and breastfeeding success were higher in the group which underwent delayed cord clamping.

On the risks of secure attachment in infancy: Childhood irritability and adolescent depression predicted by secure attachment and high approach behaviours at 14-months towards a caregiver living with inter-parental violence

Introduction The secure infant turns to a caregiver for comfort when distressed or threatened. Does this level of openness create vulnerability where the caregiver is unsupportive or aggressive? In this study we examined prospectively whether secure attachment in infancy, and approach behaviours on reunion with a parent, were associated with childhood emotional dysregulation (irritability) and adolescent depression among children exposed to inter-parental violence. Methods We followed 219 families recruited from the general population during pregnancy (members of the Wirral Child Health and Development Study; WCHADS), with attachment assessments (Strange Situation Procedure; SSP) at 14 months, maternal interviews about inter-parental violence at 2.5, 5 and 7 years, and parent and teacher rated irritability at 9 years (CBCL). At age 13 years, 199 young people rated their levels of depression (SMFQ). In addition to the standard SSP classification, a latent variable reflecting approach behaviours during reunions was generated from the SSP dimensional scores and a factor score extracted. Analyses used path analysis using the gsem command in Stata. Results There were interactions between attachment security and inter-parental violence for age 9 irritability ( p = .084) and age 13 depression ( p = .039) which arose from greater levels of psychopathology among secure children exposed to inter-parental violence. Similarly, higher approach behaviours during SSP reunions among children exposed to inter-parental violence were associated with irritability (interaction term p = .004) and depression (interaction term p &amp;lt; .001). Among children who were not exposed to partner violence higher approach behaviours in the SSP were associated with lower irritability and depression. Conclusion Infant behaviours characteristic of attachment security in the Strange Situation Procedure may not equip children to deal with exposure to inter-parental violence and associated parental negativity.

Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment

BackgroundKnowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment. MethodsIn a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12–24 months. ResultsResults indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153). LimitationsParticipants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported. ConclusionsPAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.

Infant attachment in the Czech Republic: Categorical and dimensional findings from a post-communist country

Infant attachment remains virtually unexplored in former Eastern Bloc countries. The dimensional approach to infant attachment, which could ease common obstacles in cross-cultural attachment research, necessitates more empirical support. This study explores infant attachment in the Czech Republic, a post-communist country with a unique family policy, using both the categorical and the dimensional models. It also compares the Czech infant attachment distribution to infant attachment distributions in other countries and compares infant attachment distributions in European countries to the Baltimore study sample. In the Strange Situation Procedure, forty-nine (74 %) out of sixty-six mother-infant dyads (35 boys, M = 13.8, SD = 0.9) received the B classification. Despite the generous family policy and cultural emphasis on close mother-infant relationships, the Czech distribution of insecure categories did not differ from the Baltimore study sample. Out of other post-communist countries, only the infant attachment distribution in former East Germany differed from the Czech and the Baltimore study samples due to a lower proportion of type B and a higher proportion of type A infants. There were also more type A infants in the Italian sample. Interactive behavior scales accurately predicted attachment categories in 91 % of cases. Contact-maintenance and proximity-seeking scales substantially improve the assessment of insecure resistant behavior. Our findings support the universality and normativity of attachment and the utility of the dimensional approach.

Disrupted maternal communication and disorganized attachment in the Arab society in Israel.

Disrupted maternal communication during mother-infant interaction has been found to be associated with infants' disorganized attachment, but has been studied primarily in North American and European samples and not in Arab samples. To address this gap the study examined the association between disrupted maternal communication and infant attachment in a sample of 50 Arab mothers and their one-year-old infants in Israel. Attachment was assessed with the Strange Situation Procedure (SSP), and disrupted communication with the AMBIANCE. Disrupted communication was higher in mothers of infants with disorganized and ambivalent attachment than in mothers of securely attached infants. The findings support the link between disrupted communication and disorganized attachment in the Arab society in Israel and add to our understanding of maternal behavior associated with ambivalent attachment.