Infant Disorganization Research Articles

Frightening maternal behavior over the first 2 years of life: effects on children’s behavior problems in middle childhood

ABSTRACT Frightening maternal behavior is linked to infant disorganization, which predicts child behavioral problems. We examined continuity in frightening maternal behavior across the first 2 years by developing a new measure of anomalous/frightening (AN/FR) behavior that incorporates changes in parent–child interactions as children acquire symbolic representation. Maternal AN/FR behavior in toddlerhood also was examined in relation to later internalizing and externalizing symptoms. First-time mothers (N = 125) completed the Adult Attachment Interview (AAI) prenatally, and mother–child dyads were observed interacting at 8 months, in Strange Situations at 12–15 months, and playing at 24 months. Teachers rated children’s behavior problems at 7 years. Mothers classified as Unresolved on the AAI displayed more Frightening (FR) behavior at 8 months. Mothers’ FR behavior predicted both attachment disorganization at 12–15 months and maternal AN/FR behavior at 24 months, which then predicted children’s internalizing symptoms at age 7. Infant disorganization was indirectly related to internalizing symptoms, mediated by maternal AN/FR behavior.

Disrupted affective communication characterizes mothers of infants with disorganized but also ambivalent attachments: An Israeli study.

This study examined whether maternal disrupted communication, which is associated with disorganized infant attachment, also characterizes mothers of ambivalent infants. The study, conducted in Israel, included a Jewish sample (N=163; 68 Girls) from diverse socioeconomic status, collected between 1991 and 1993 in an earlier study. The sample over-represented ambivalent and disorganized attachments. Attachment was assessed in the Strange Situation Procedure (SSP) at 12months and disrupted communication was coded from the SSP using the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Lyons-Ruth et al., 1999). Mothers of ambivalent infants showed higher disrupted communication than mothers of secure, avoidant, and disorganized infants. The findings shed further light on the correlates of ambivalent attachment and call for research regarding maternal and infant characteristics that differentiate ambivalent versus disorganized attachment.

Observed infant-parent attachment and brain morphology in middle childhood– A population-based study

Poor quality of the early infant-parent bond predicts later child problems. Infant-parent attachment has been suggested to influence brain development, but this association has hardly been examined. In adults, larger amygdala volumes have been described in relation to early attachment disorganization; neuroimaging studies of attachment in children, however, are lacking.We examined the association between infant-parent attachment and brain morphology in 551 children from a population-based cohort in the Netherlands. Infant-parent attachment was observed with the Strange-Situation Procedure at age 14 months and different brain measures were collected with magnetic resonance imaging at mean age 10 years.Children with disorganized infant attachment had larger hippocampal volumes than those with organized attachment patterns. This finding was robust to the adjustment for confounders and consistent across hemispheres. The association was not explained by cognitive or emotional and behavioral problems. Disorganized attachment did not predict any other difference in brain morphology. Moreover, children with insecure organized infant attachment patterns did not differ from those who were securely attached in any brain outcome.Causality cannot be inferred, but our findings in this large population-based study provide novel evidence for a long-term association between the quality of infant-parent attachment and specific brain differences in childhood.

Maternal mind-mindedness and its association with attachment: the case of Arab infants and mothers in Israel

ABSTRACTWe examined the association between maternal Mind-Mindedness (MM) and secure attachment in an Arab sample in Israel. Seventy-six infant–mother dyads were observed during free play to assess maternal MM and in the Strange Situation Procedure to assess attachment. Mothers of secure infants were hypothesized to use more appropriate and fewer non-attuned mind-related comments than mothers of insecure infants. The results showed that mothers of secure infants used more appropriate mind-related comments than mothers of disorganized infants, with no significant differences compared to mothers of ambivalent infants. Also, mothers of secure infants used less non-attuned mind-related comments than both mothers of disorganized infants and mothers of ambivalent infants. In addition, the findings showed that: (1) mothers of secure infants were most likely to show the combination of high appropriate and low non-attuned mind-related comments; (2) mothers of disorganized infants were most likely to show the combination of high non-attuned and low appropriate mind-related comments; and (3) a nonsignificant trend indicated that mothers of ambivalent infants were most likely to show a combination of high appropriate and high non-attuned mind-related comments.The findings support the relevance of MM in an Arab sample.

Contributions of Attachment Research to Understanding Dissociative Attunement

This discussion elaborates the author’s use of attachment theory and research to understanding Susan’s clinical process (see Jacobs, this issue). I have delineated different patterns of attachment, its precursors in infancy, both in infant parent interactions and in parent’s state of mind with respect to attachment. I also link this to how dissociative process can be embedded in a combination of infant disorganization and trauma. I think that clinical applications of the ideas Jacobs and I subscribe to add a great deal to understanding how unformulated experiences with a frightened and frightening parent can lead to a person’s vulnerability to developing dissociative responses to later trauma. The dialogic nature of infant parent attachment experiences can further enrich an understanding of how certain transference–countertransference enactments are manifestations of certain kinds of procedural or relational knowing. In this way, clinicians can further understand the possibilities for psychic transformation as embedded in bearing that which was experienced but which cannot yet be known.

Mental collapse as “disorganized attachment”: A dynamic understanding for clinicians

Unresolved loss and unresolved trauma in adult mothers, and the commonly disorganized attachment pattern developed by their infants, have been repeatedly reported in longitudinal research literature as a crucial correlate or precedent of severe pathology. We describe and illustrate how unresolved loss and unresolved trauma are manifested in verbatim-transcribed language and how they are to be detected, so that psychoanalysts and clinicians in general are able to distinguish them and understand how such “states of mind” evidence the process of fragmentation they involve. We follow each example with a resolved transcript so it can be contrasted with a nonresolved case. We then describe excerpts of a taped “disorganized infant” – an example of infants who are usually babies of unresolved mothers, as shown during the Adult Attachment Interview. The analyst’s ability to identify and understand these “states of mind” and the subsequent sensitive reflection on the transcendental role of primary traumatic relations, which are involved in fear and the destructive dynamics of mental fragmentation – as seen in empirical research on attachment – can facilitate a resourceful integrative analytic scrutiny of the processes gone through by patients, and encourage the discovery of alternatives for working through the disturbing experience.

Assessing a change mechanism in a randomized home-visiting trial: Reducing disrupted maternal communication decreases infant disorganization.

Although randomized interventions trials have been shown to reduce the incidence of disorganized attachment, no studies to date have identified the mechanisms of change responsible for such reductions. Maternal sensitivity has been assessed in various studies and shown to change with intervention, but in the only study to formally assess mediation, changes in maternal sensitivity did not mediate changes in infant security of attachment (Cicchetti, Rogosch, & Toth, 2006). Primary aims of the current randomized controlled intervention trial in a high-risk population were to fill gaps in the literature by assessing whether the intervention (a) reduced disorganization, (b) reduced disrupted maternal communication, and (c) whether reductions in disrupted maternal communication mediated changes in infant disorganization. The results indicated that, compared to controls (n = 52), both infant disorganization and disrupted maternal communication were significantly reduced in the intervention group (n = 65) that received regular home-visiting during pregnancy and the first year of life. Furthermore, reductions in disrupted maternal communication partially accounted for the observed reductions in infant disorganization compared to randomized controls. The results are discussed in relation to the societal cost effectiveness of early attachment-informed interventions for mothers and infants, as well as the importance of formally assessing underlying mechanisms of change in order to improve and appropriately target preventive interventions.

New insight on intergenerational attachment from a relationship-based analysis.

Research on attachment transmission has focused on variable-centered analyses, where hypotheses are tested by examining linear associations between variables. The purpose of this study was to apply a relationship-centered approach to data analysis, where adult states of mind, maternal sensitivity, and infant attachment were conceived as being three components of a single, intergenerational relationship. These variables were assessed in 90 adolescent and 99 adult mother-infant dyads when infants were 12 months old. Initial variable-centered analyses replicated the frequently observed associations between these three core attachment variables. Relationship-based, latent class analyses then revealed that the most common pattern among young mother dyads featured maternal unresolved trauma, insensitive interactive behavior, and disorganized infant attachment (61%), whereas the most prevalent adult mother dyad relationship pattern involved maternal autonomy, sensitive maternal behavior, and secure infant attachment (59%). Three less prevalent relationship patterns were also observed. Moderation analyses revealed that the adolescent-adult mother distinction differentiated between secure and disorganized intergenerational relationship patterns, whereas experience of traumatic events distinguished between disorganized and avoidant patterns. Finally, socioeconomic status distinguished between avoidant and secure patterns. Results emphasize the value of a relationship-based approach, adding an angle of understanding to the study of attachment transmission.

Attachment quality is related to the synchrony of mother and infant monitoring patterns

ABSTRACTWe investigated whether attachment quality is related to infant–mother dyadic patterns in monitoring animated social situations. Sixty 12-month-old infants and their mothers participated in an eye-tracking study in which they watched abstractly depicted distress interactions involving the separation of a “baby” and a “parent” character followed by reunion or further separation of the two characters. We measured infants’ and their mothers’ relative fixation duration to the two characters in the animations. We found that infant attachment disorganization moderated the correspondence between the monitoring patterns of infant–mother dyads during the final part of the animations resulting in reunion or separation. Organized infants and their mothers showed complementary monitoring patterns: the more the mothers focused their attention on the “baby” character, the more the infants focused their attention on the “parent” character, and vice versa. Disorganized infant–mother dyads showed the opposite pattern although the correlation was nonsignificant: mothers and their infants focused on the same character. The attachment-related differences in the nature of the synchrony in the attentional processes of infants and their mothers suggest that by 12 months the dyads’ representations of social situations reflect their shared social–emotional experiences.

Unresolved loss, a risk factor for offspring, predicts event-related potential responses to death-related imagery.

This study investigates whether individual differences in attachment status can be detected by electrophysiological responses to loss-themed pictures. The Adult Attachment Interview (AAI) was used to identify discourse/reasoning lapses during the discussion of loss experiences via death that place speakers in the Unresolved/disorganized AAI category. In parents, Unresolved AAI status has been associated with Disorganized infant Strange Situation response, a known risk factor for psychopathology (e.g., internalizing/externalizing/dissociation). This association has been related to anomalous frightening (FR) parental behavior in the infant's presence, behavior presumed to be instigated by vulnerability to trauma-related fright. Here, psychophysiological methods were utilized to examine whether Unresolved AAI status could be detected in brain responses to subtle/symbolic reminders of loss. One year after AAI administration, 31 undergraduate women who had experienced loss (16 Unresolved) underwent continuous electroencephalogram (EEG) recording during a picture-viewing, valence-rating task. Picture onset-locked event-related potentials (ERPs) revealed millisecond responses to 4 picture categories: pleasant people, pleasant nature, cemetery (symbolic death), and gruesome death (dead or dying people). Participants' valence ratings did not differ between groups across picture categories. However, the N2 ERP, implicated in detecting stimulus salience, was selectively greater in Unresolved participants viewing cemetery scenes; it was in fact as high as the N2 for gruesome death images observed throughout the sample. Additionally, Unresolved participants exhibited a right-hemispheric P3 asymmetry across picture categories, suggestive of continuously heightened vigilance/arousal. Together, these results suggest that Unresolved AAI status is associated with greater neurophysiological sensitivity to subtle reminders of loss that may disrupt ongoing mental function. (PsycINFO Database Record

Deconstructing maternal sensitivity: Predictive relations to mother‐child attachment in home and laboratory settings

AbstractDespite the well‐documented importance of parental sensitivity for child development, there is a lack of consensus regarding how best to assess it. We investigated the factor structure of maternal caregiving behavior as assessed at 12 months by the Maternal Behavior Q‐Sort (Pederson & Moran) with 274 mother‐infant dyads. Subsequently, we examined associations between these empirically‐derived dimensions and child attachment, assessed in the home and laboratory (final N = 157). Three dimensions of maternal behavior were identified, corresponding fairly closely to Ainsworth's original scales. They were labeled Cooperation/Attunement, Positivity, and Accessibility/Availability. Only Cooperation/Attunement consistently predicted home‐based attachment at 15 months and 2 years, and at comparable strength to the overall sensitivity score, suggesting that this construct may be central to sensitivity. At 18 months, compared to their primarily secure counterparts, different types of laboratory‐assessed insecure attachment were associated with different patterns of maternal behavior. Mothers in avoidant relationships (n = 18) were low on Cooperation/Attunement and Accessibility/Availability, but fairly high on Positivity. Mothers of disorganized infants (n = 11) were Cooperative/Attuned but somewhat less Positive toward, and less Accessible/Available to, their infants. A multidimensional approach to parental behavior may facilitate the identification of parenting precursors of insecure parent‐child relationships.

Disorganization, COMT, and Children's Social Behavior: The Norwegian Hypothesis of Legacy of Disorganized Attachment.

Why is disorganized attachment associated with punitive-controlling behavior in some, but caregiving-controlling in others? Hygen et al. (2014) proposed that variation in the Catechol-O-methyl transferase(COMT) Val158Met genotype explains this variation, providing preliminary data to this effect. We offer a conceptual replication, analyzing data on 560 children (males: 275) drawn from the NICHD Study of Early Child Care and Youth Development. As predicted, competitive model-fitting indicated that disorganized infants carrying Met alleles engage in more positive behavior and less negative behavior than other children at age 5 and 11, with the reverse true of Val/Val homozygotes, seemingly consistent with caregiving-controlling and punitive-controlling styles, respectively, but only in the case of maternal and not teacher reports, thereby confirmating a relationship-specific hypothesis.

Disorganized attachment in infancy predicts greater amygdala volume in adulthood

Early life stress in rodents is associated with increased amygdala volume in adulthood. In humans, the amygdala develops rapidly during the first two years of life. Thus, disturbed care during this period may be particularly important to amygdala development. In the context of a 30-year longitudinal study of impoverished, highly stressed families, we assessed whether disorganization of the attachment relationship in infancy was related to amygdala volume in adulthood. Amygdala volumes were assessed among 18 low-income young adults (8M/10F, 29.33±0.49years) first observed in infancy (8.5±5.6months) and followed longitudinally to age 29. In infancy (18.58±1.02mos), both disorganized infant attachment behavior and disrupted maternal communication were assessed in the standard Strange Situation Procedure (SSP). Increased left amygdala volume in adulthood was associated with both maternal and infant components of disorganized attachment interactions at 18 months of age (overall r=0.679, p<0.004). Later stressors, including childhood maltreatment and attachment disturbance in adolescence, were not significantly related to left amygdala volume. Left amygdala volume was further associated with dissociation and limbic irritability in adulthood. Finally, left amygdala volume mediated the prediction from attachment disturbance in infancy to limbic irritability in adulthood. Results point to the likely importance of quality of early care for amygdala development in human children as well as in rodents. The long-term prediction found here suggests that the first two years of life may be an early sensitive period for amygdala development during which clinical intervention could have particularly important consequences for later child outcomes.

Do infant behaviors following immunization predict attachment? An exploratory study

ABSTRACTObjectives. The relationship between infant behaviors during routine immunization, pre- and post-needle, and infant attachment was explored. Methods. A total of 130 parent–infant dyads were recruited from a larger longitudinal study and videotaped during routine immunization at 12 months and the Strange Situation Procedure (SSP) at 14 months. Six infant behaviors were coded for 1-minute pre-needle and 3-minutes post-needle. Attachment was operationalized according to the secure/avoidant/resistant/disorganized categories. Results. As expected, none of the pre-needle behaviors predicted attachment. Proximity-seeking post-needle significantly discriminated attachment categorizations. Secure infants were more likely to seek proximity to caregivers post-needle in comparison with avoidant and disorganized infants. Proximity-seeking following immunization was positively correlated with proximity-seeking during the SSP and negatively correlated with avoidance and disorganization during the SSP. Conclusions. Infant proximity-seeking during immunization is associated with attachment security and parallels behaviors observed during the SSP. More research is needed to identify behavioral markers of disorganization.

Caregiver Soothing Behaviors After Immunization and Infant Attachment: A Longitudinal Analysis.

There were 2 primary objectives to the current study: (1) to relate caregiver behavior trajectories across immunization appointments over the first year of life to subsequent infant attachment and (2) to relate caregiver behavior trajectories within each immunization appointment over the first year of life to subsequent infant attachment. A subsample of 130 caregivers and their infants were recruited from a sample of 760 caregivers who were part of an ongoing longitudinal cohort that videotaped infants' 2-, 4-, 6-, and 12-month immunization appointments. This subsample of caregivers and their infants (n = 130) were invited to participate in an assessment of attachment when infants were between 12 and 18 months of age at the local children's hospital. Caregiver proximal soothing behaviors were the only caregiver behaviors postimmunization that were related to subsequent infant attachment. Higher frequencies of caregiver proximal soothing at 12 months were related to infants' organized attachment, whereas steeper decreases in proximal soothing across the first year were associated with disorganized infant attachment. In addition, when caregivers engaged in proximal soothing for longer after their 12 month olds' immunizations, these infants were more likely to be secure or organized in their attachment. These results provide empirical support for the ecological validity of studying infant attachment in a pediatric pain context. The pediatric "well-baby" visit may provide a potential opportunity to feasibly integrate brief infant mental health screening and intervention.

Mother–Infant Joint Attention and Sharing: Relations to Disorganized Attachment and Maternal Disrupted Communication

ABSTRACTThe normative development of infant shared attention has been studied extensively, but few studies have examined the impact of disorganized attachment and disturbed maternal caregiving on mother–infant shared attention. The authors examined both maternal initiations of joint attention and infants’ responses to those initiations during the reunion episodes of the Strange Situation Procedure at 12 and 18 months of infant age. The mothers' initiations of joint attention and three forms of infant response, including shunning, simple joint attention, and sharing attention, were examined in relation to infant disorganized attachment and maternal disrupted communication. Mothers who were disrupted in communication with their infants at 18 months initiated fewer bids for joint attention at 12 months, and, at 18 months, mothers of infants classified disorganized initiated fewer bids. However, the infant' responses were unrelated to either the infant' or the mother' disturbed attachment. At both ages, disorganized infants and infants of disrupted mothers were as likely to respond to maternal bids as were their lower risk counterparts. Our results suggest that a disposition to share experiences with others is robust in infancy, even among infants with adverse attachment experiences, but this infant disposition may depend on adult initiation of bids to be realized.

Very extensive nonmaternal care predicts mother-infant attachment disorganization: Convergent evidence from two samples.

We examined whether a maximum threshold of time spent in nonmaternal care exists, beyond which infants have an increased risk of forming a disorganized infant-mother attachment. The hours per week infants spent in nonmaternal care at 7-8 months were examined as a continuous measure and as a dichotomous threshold (over 40, 50 and 60 hr/week) to predict infant disorganization at 12-15 months. Two different samples (Austin and NICHD) were used to replicate findings and control for critical covariates: mothers' unresolved status and frightening behavior (assessed in the Austin sample, N = 125), quality of nonmaternal caregiving (assessed in the NICHD sample, N = 1,135), and family income and infant temperament (assessed in both samples). Only very extensive hours of nonmaternal care (over 60 hr/week) and mothers' frightening behavior independently predicted attachment disorganization. A polynomial logistic regression performed on the larger NICHD sample indicated that the risk of disorganized attachment exponentially increased after exceeding 60 hr/week. In addition, very extensive hours of nonmaternal care only predicted attachment disorganization after age 6 months (not prior). Findings suggest that during a sensitive period of attachment formation, infants who spend more than 60 hr/week in nonmaternal care may be at an increased risk of forming a disorganized attachment.

Frightened versus not frightened disorganized infant attachment: Newborn characteristics and maternal caregiving.

The disorganized infant has been described as experiencing "fright without solution" (Hesse & Main, 1999, p. 484) within the attachment relationship. Using a sample at risk because of poverty (n = 157), this study evaluated the role of newborn characteristics in predicting disorganized attachment and explored the existence of 2 subgroups of disorganized infants, based on whether they display direct indices of fear. For the entire sample, regression analyses revealed that newborn characteristics did not predict ratings of disorganization directly or via moderation by caregiving. Regarding subgroups, it was hypothesized that, if direct expressions of fear resulted from interaction with a frightening or frightened caregiver, it could be expected that infants in the Not Frightened subgroup would become disorganized in part because of other factors, such as compromised regulatory abilities at birth. Results supported this hypothesis for emotional regulation, but not for orientation; infants in the Not Frightened subgroup displayed limited emotional regulation as newborns. Findings suggest that the disorganized attachment category may be comprised of 2 subgroups, with direct expressions of fear as the key differentiating factor. Specifically, disorganized infants who do not display direct fear in the presence of the caregiver may have started out with compromised emotional regulation abilities at birth.

Attachment disorganization moderates the effect of maternal postnatal depressive symptoms on infant autonomic functioning

We examined associations of disorganized attachment and maternal depressive symptoms with infant autonomic functioning in 450 infant-mother dyads enrolled in the Generation R study. Maternal depressive symptoms were measured 2 months postpartum with the Brief Symptom Inventory. At 14 months, we assessed infant attachment with a slightly shortened Strange Situation and measured infant resting heart rate. Respiratory sinus arrhythmia (RSA) was calculated using spectral analysis. Higher levels of maternal postnatal depressive symptoms predicted lower resting RSA in disorganized infants (B = -0.31, SE = 0.15, p = .04, R(2) = .05) but not in nondisorganized infants (B = 0.05, SE = 0.06, p = .36). This effect was buffered in disorganized infants with a secondary secure attachment classification. Disorganized infants were more vulnerable to the effect of maternal postnatal depressive symptoms on the physiological stress systems.

Maternal antenatal depression and infant disorganized attachment at 12 months

Although high rates of attachment disorganization have been observed in infants of depressed mothers, little is known about the role of antenatal depression as a precursor to infant attachment disorganization. The primary aim of this study was to examine associations between maternal antenatal depression and infant disorganization at 12 months in a sample of women (N = 79) at risk for perinatal depression. A secondary aim was to test the roles of maternal postpartum depression and maternal parenting quality as potential moderators of this predicted association. Among women with histories of major depressive episodes, maternal depressive symptoms were assessed at multiple times during pregnancy and the first year postpartum, maternal parenting quality was measured at three months postpartum, and attachment disorganization was assessed at 12 months postpartum. Results revealed that infants classified as disorganized had mothers with higher levels of depressive symptoms during pregnancy compared to infants classified as organized. Maternal parenting quality moderated this association, as exposure to higher levels of maternal depressive symptoms during pregnancy was only associated with higher rates of infant disorganized attachment when maternal parenting at three months was less optimal. These findings suggest that enhancing maternal parenting behaviors during this early period in development has the potential to alter pathways to disorganized attachment among infants exposed to antenatal maternal depressive symptoms, which could have enduring consequences for child wellbeing.