Manchester Child Attachment Story Task Research Articles

The use and potential of artificial intelligence for supporting clinical observation of child behaviour

BackgroundObservation of child behaviour provides valuable clinical information but often requires rigorous, tedious, repetitive and time expensive protocols. For this reason, tests requiring significant time for administration and rating are rarely used in clinical practice, however useful and effective they are. This article shows that Artificial Intelligence (AI), designed to capture and store the human ability to perform standardised tasks consistently, can alleviate this problem.Case studyWe demonstrate how an AI‐powered version of the Manchester Child Attachment Story Task can identify, with over 80% concordance, children with insecure attachment aged between 5 and 9 years.DiscussionWe discuss ethical issues to be considered if AI technology is to become a useful part of child mental health assessment and recommend practical next steps for the field.

The contribution of Sensory Processing Sensitivity and internalized attachment representations on emotion regulation competencies in school-age children.

As captured by the individual trait of Sensory Processing Sensitivity (SPS), highly sensitive children perceive, process, and responds more strongly to stimuli. This increased sensitivity may make more demanding the process of regulating and managing emotions. Yet, developmental psychology literature also showed that other variables, as those related to the rearing environment, are likely to contribute to the process of regulating emotions. With the current contribution, we aim to bridge two lines of research, that of attachment studies and that of SPS, by investigating the additive and interactive contribution of SPS and internal working models of attachment representations on emotion regulation competencies in school-aged children. Participants were N = 118 Italian children (mean age: 6.5, SD = 0.58 years, and 51.8% female) with their mothers. Children's positive attachment representations were rated observationally through the Manchester Child Attachment Story Task procedure during an individual session at school. Mothers reported on children SPS trait and emotion regulation competencies completing the Highly Sensitive Child Scale-parent report and the Emotion Regulation Checklist. We performed and compared a series of main and interaction effect models. SPS was not directly associated with emotion regulation but it was significantly associated with positive attachment representations in predicting emotion regulation. Highly sensitive children showed poorer emotion regulation when the internalized representations were low in maternal warmth and responsiveness. When driven by sensitive and empathic attachment representation, highly sensitive children showed better emotion regulation than less-sensitive peers, suggesting a for better and for worse effect. Highly sensitive children are not only more vulnerable to adversities but also show better emotion regulation competencies when supported by positive internal working models of attachment relationships. Overall, findings shed light on the link between SPS and attachment and suggest that working for promoting secure attachment relationships in parent-child dyads may promote better emotion regulation competences, particularly in highly sensitive children.

Post-Traumatic Play in Child Victims of Adverse Childhood Experiences: A Pilot Study with the MCAST-Manchester Child Attachment Story Task and the Coding of PTCP Markers.

Background: Play is among the most frequently observed distorted behaviors in victims of Adverse Childhood Experiences (ACEs). Terr's (1981) studies helped to describe this behavioral distortion as post-traumatic child's play (PTCP). This study aimed to evaluate whether child victims of Adverse Childhood Experiences (ACEs) engaging in semi-structured play present the markers of post-traumatic child's play (PTCP) during the administration of the Manchester Child Attachment Story Task (MCAST), whose playful stories activate the attachment system. Methods: The sample comprised 17 child victims of ACEs (mean age = 6.76). Children were evaluated using the Manchester Child Attachment Story Task. Results: The analysis of the play clearly revealed the presence of markers associated with the characteristics of the post-traumatic play described by Terr (1981), namely, repetition, revisiting, hyperarousal, and danger. In particular, the intrusiveness dimension was observed, which can be identified in the post-traumatic play by the presence of recurrent memories, dreams, and dissociative symptoms. Conclusions: Post-traumatic play is characterized by repetition, containing aspects, scenes, or sequences of the traumatic event, expressed explicitly or symbolically.

The School Attachment Monitor-A novel computational tool for assessment of attachment in middle childhood.

Attachment research has been limited by the lack of quick and easy measures. We report development and validation of the School Attachment Monitor (SAM), a novel measure for largescale assessment of attachment in children aged 5-9, in the general population. SAM offers automatic presentation, on computer, of story-stems based on the Manchester Child Attachment Story Task (MCAST), without the need for trained administrators. SAM is delivered by novel software which interacts with child participants, starting with warm-up activities to familiarise them with the task. Children's story completion is video recorded and augmented by 'smart dolls' that the child can hold and manipulate, with movement sensors for data collection. The design of SAM was informed by children of users' age range to establish their task understanding and incorporate their innovative ideas for improving SAM software. 130 5-9 year old children were recruited from mainstream primary schools. In Phase 1, sixty-one children completed both SAM and MCAST. Inter-rater reliability and rating concordance was compared between SAM and MCAST. In Phase 2, a further 44 children completed SAM complete and, including those children completing SAM in Phase 1 (total n = 105), a machine learning algorithm was developed using a "majority vote" procedure where, for each child, 500 non-overlapping video frames contribute to the decision. Using manual rating, SAM-MCAST concordance was excellent (89% secure versus insecure; 97% organised versus disorganised; 86% four-way). Comparison of human ratings of SAM versus the machine learning algorithm showed over 80% concordance. We have developed a new tool for measuring attachment at the population level, which has good reliability compared to a validated attachment measure and has the potential for automatic rating-opening the door to measurement of attachment in large populations.

Σταθερότητα και αλλαγή των αναπαραστάσεων για τον δεσμό: η επίδραση της επιληψίας στην ποιότητα του δεσμού τον πρώτο χρόνο μετά τη διάγνωση

A secure mother-child attachment early in life promotes healthy socio-emotional development. Security of attachment can be maintained through positive parental care over time. Life stresses can impact on maternal availability and sensitivity and lead to changes in attachment quality towards insecure patterns of attachment. The present study, which is part of a larger research project, aims to explore for the first time in a Greek population of preschool- and school-aged children and their mothers the impact of pediatric illness on stability and change of mother-child attachment representations. Twenty-five children, 9 boys and 16 girls, 4-9 years old with a recent diagnosis of epilepsy, were assessed using the Manchester Child Attachment Story Task (MCAST) at two time points, T1 and T2. Participants’ mothers completed the Social Support Questionnaire (SSQ) at both times (Τ1, Τ2). The results seem to confirm the stability and change of attachment representations during the first year after the diagnosis of epilepsy. The importance of perceived social support by mothers for positive change of mother-child attachment representations is also stressed by the authors.

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

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

Children’s attachment representations: A pilot study comparing family drawing with narrative and behavioral assessments in adopted and community children

This study compared an attachment-based coding system for family drawings with narrative and observational attachment measures in adopted children and those living with their natural parents (“community-based”) in Italy. Attachment patterns of 41 children (ages 5–8) were assessed by: a graphic measure, the Family Drawing (FD); a narrative measure, the Manchester Child Attachment Story Task (MCAST); and an observational measure, the Separation-Reunion Procedure (SRP). In the community sample, a significant association emerged between the FD and MCAST disorganized vs. organized classifications, and a number of expected correlations between the FD Global Scales and the MCAST Coherence and Mentalizing continuous scales were found. In the adopted group, some FD Global Scales linked with insecure and disorganized representations revealed negative correlations with the MCAST Mentalizing scale. No correlations were found between the children’s FD and SRP classifications and scales in both groups. The FD attachment-based coding system revealed a particular capacity to assess attachment representations during childhood capturing closely both insecure and disorganized patterns, both in adopted and community children. A special focus was put on the measurement of disorganization, as reflected in one drawing classified as disorganized.

Late-adopted children grown up: a long-term longitudinal study on attachment patterns of adolescent adoptees and their adoptive mothers

ABSTRACTThis paper reports on a long-term follow-up of a longitudinal study conducted in Italy that assessed attachment patterns of late-adopted children (placed between 4 and 8 years old) and their adoptive mothers, in three phases: T1, at placement; T2, in childhood (7–8 months after adoption); and T3, in adolescence (current study). The following hypotheses were tested: 1) children’ IWMs will shift from insecurity towards security in a long-term follow-up; and 2) there will be a significant association between adoptees’ and adoptive mothers’ IWMs in adolescence. Participants were 22 late-adopted adolescents (aged 11–16) and their adoptive mothers, all assessed in previous phases. Participants completed several measures of attachment, including the Separation-Reunion Procedure (T1, T2), Manchester Child Attachment Story Task (T2), Friends and Family Interview (T3), and Adult Attachment Interview (T1, T3). Late-adopted adolescents showed both an increase in attachment security and a decrease in disorganized attachment from childhood to adolescence. Adoptive mothers’ (T3) secure states of mind were associated significantly to their adopted children attachment security in adolescence. These findings reinforce the importance of taking attachment into account for adoptive families from the beginning of adoption.

Children's emotion understanding in relation to attachment to mother and father.

Although attachment plays a key role in children's socio-emotional development, little attention has been paid to the role of children's attachment to their father. This study examined whether insecure attachment to each parent was associated with reduced emotion understanding in children and whether children showed consistent attachments to their mother and father. We measured children's attachment to each parent using the Manchester Child Attachment Story Task and child emotion understanding using the Test of Emotion Comprehension (children's Mage =5.64years, SD=0.84). The results indicated that insecure father-child attachment and insecure mother-child attachment were each associated with lower emotion understanding in children after controlling for parent's depressive symptoms and children's age. There was significant concordance of child attachment to mother and father. The findings provide support for convergence of children's attachment across parents and suggest that father-child attachment is an important factor to consider when examining children's emotion understanding. Statement of contribution What is already known on this subject Secure mother-child attachment is positively associated with children's emotional competence. Children form similar representations of attachment to their mother and father. What the present study adds Both mother-child and father-child attachment are associated with children's emotion understanding. The study's findings highlight the importance of father-child attachment in their children's emotion understanding. The study provides support for concordance of children's attachment across parents.

Change in attachment predicts change in emotion regulation particularly among 5-HTTLPR short-allele homozygotes.

In view of the theory that the attachment relationship provides a foundation for the development of emotion regulation, here, we evaluated (a) whether change in attachment security from 4 to 6 years predicts change in emotion regulation from 6 to 8 years and (b) whether 5-HTTLPR moderates this relation in a Norwegian community sample (n = 678, 99.7% Caucasian). Attachment was measured with the Manchester Child Attachment Story Task, and teachers completed the Emotion Regulation Checklist. Attachment security was modestly stable, with children becoming more secure over time. Regression analyses revealed that increased attachment security from 4 to 6 forecasted increases in emotion regulation from 6 to 8 and decreased attachment security forecasted decreases in emotion regulation. This effect was strongest among the 5-HTTLPR short-allele homozygotes and, according to competitive model fitting, in a differential-susceptibility manner. (PsycINFO Database Record

Late Adoptions: Attachment Security and Emotional Availability in Mother–Child and Father–Child Dyads

A growing body of research suggests that a history of neglect, abuse and institutionalization can negatively affect late-adopted children’s attachment representations, and that adoptive parents can play a key role in enabling adopted children to earn secure attachments. Still, only a few studies have explored the quality of caregiver–child interaction in adoptive families. The present study aimed at verifying both the concordance of attachment in adoptive dyads (mother–children and father–children) and the relationship between attachment representations and parent–child interaction. The research involved 20 adoptive families in which the child’s arrival had occurred between 12 to 36 months before the assessment, and where children were aged between 4.5 and 8.5 years. Attachment was assessed through the Adult Attachment Interview for parents and through the Manchester Child Attachment Story Task for children. The emotional quality of parent–child interaction was assessed trough the Emotional Availability Scales. Our results pointed out the presence of a relation between attachment representations of late-adopted children and their adoptive mothers (75%, K = 0.50, p = .025). In addition, we found that both insecure children and mothers showed lower levels of EA than secure ones. Some explanations are presented about why, in the early post-adoption period, child attachment patterns and dyadic emotional availability seem to be arranged on different frameworks for the two parental figures.

Associations between early caregiving and rural, low-SES, African-American children’s representations of attachment relationships

ABSTRACTLittle research has examined the legacy of early maternal care for later attachment representations among low-income and ethnic minority school-aged children. Using data from a sample of 276 rural, low-income, African-American families, this study examined associations between maternal care in infancy and children’s representations of attachment figures in middle childhood. Maternal care was coded from 10-min home-based observations at 6, 15, and 24 months of age. Representations of attachment figures were assessed using the Manchester Child Attachment Story Task at 6 years of age. Sensitive maternal care in infancy was not significantly related to attachment security or episodic disorganized behaviors in children’s representations. However, children exposed to more harsh–intrusive parenting during infancy displayed less secure representations of attachment figures in middle childhood and more episodic disorganized behaviors, even after controlling for numerous child and family contextual covariates. Findings inform conceptualizations of attachment formation among rural, low-income, African-American parent–child dyads.

Attachment to Mother and Father at Transition to Middle Childhood

The present study investigated concordance between representations of attachment to mother and attachment to father, and convergence between two narrative-based methods addressing these representations in middle childhood: the Manchester Child Attachment Story Task (MCAST) and the Secure Base Script Test (SBST). One hundred and twenty 6-year-old children were assessed by separate administrations of the MCAST for mother and father, respectively, and results showed concordance of representations of attachment to mother and attachment to father at age 6.5 years. 75 children were additionally tested about 12 months later, with the SBST, which assesses scripted knowledge of secure base (and safe haven), not differentiating between mother and father attachment relationships. Concerning attachment to father, dichotomous classifications (MCAST) and a continuous dimension capturing scripted secure base knowledge (MCAST) converged with secure base scriptedness (SBST), yet we could not show the same pattern of convergence concerning attachment to mother. Results suggest some convergence between the two narrative methods of assessment of secure base script but also highlight complications when using the MCAST for measuring attachment to father in middle childhood.

Child‐caregiver Attachment Representations in a Non‐Western Context: The Feasibility and Cultural Equivalence of Story Stems in Urban Ghana

AbstractStory stem measures are an increasingly popular method for assessing the attachment representations of young children, but little is known of their cross‐cultural applicability. This study aimed to characterise the attachment representations in 73 five‐ to eight‐year‐old children in urban Ghana, West Africa, using the Manchester Child Attachment Story Task (MCAST) to test its feasibility, psychometric characteristics and concurrent associations with caregiver‐ and teacher‐rated child behaviour, and to conduct a qualitative thematic analysis of methodological observations. Among the classifiable cases (92 percent), all attachment classifications were observed, yielding a higher rate of secure attachment than in European samples. Inter‐rater reliability, internal consistency, and internal structure were reasonable and largely similar to European studies, although one structural difference was the separation of ‘child assuagement of distress’ from other secure‐related items. MCAST narratives were associated with teacher‐ and caregiver‐rated hyperactivity, but internal consistency was low in most Strengths and Difficulties Questionnaire scales. Possible culturally‐sensitive explanations for our psychometric and qualitative findings are discussed. Overall, story stems are a promising tool for accessing attachment representations in non‐Western samples, although modifications are likely to improve cross‐cultural equivalence when applied to non‐Western cultures. Further investigation is needed to link MCAST outcomes to parenting and socio‐emotional development.

Secure attachment promotes the development of effortful control in boys

Although effortful control (EC), a regulatory aspect of temperament, is associated with a wide range of developmental outcomes, knowledge about EC promoters is scarce. This study explored whether secure attachment promoted the development of EC from preschool to school age in a community sample of 903 Norwegian children. EC was measured using the parent-reported Children’s Behavior Questionnaire at four (T1) and six (T2) years of age, and attachment was measured using the Manchester Child Attachment Story Task at T1. Previous research has indicated that a child’s gender and socioeconomic status are possible covariates of EC; hence, these factors were included in the analyses. Despite considerable rank-order stability in EC, secure attachment contributed to an increase in EC. Furthermore, gender moderated the effect of attachment: secure attachment promoted EC in boys only. These findings emphasize preschool boys’ need for emotional security to facilitate effortful capacities in their transition to school.

METHODS USED BY MOTHERS TO HELP CHILDREN DURING SOLVING COGNITIVE PROBLEM TASKS: COMPARISON BETWEEN MOTHERS OF SECURELY AND INSECURELY ATTACHED PRESCHOOL CHILDREN

Abstract: Attachment is a permanent emotional bond activated in children by signals that they perceive as frightening, dangerous or stressful, while in the parents' attachment system of care, it is activated by the goal of satisfying children's needs. The aim of this research was to determine which strategies mothers use in their interaction with children, aged 5 to 7 (N = 80) during their cognitive problem solving. More specifically, the goal was to ascertain if there is a difference in the sensitivity to children's cognitive needs on the part of mothers of securely and mothers of insecurely attached children. Compared to mothers of insecurely attached children, mothers of securely attached children more often help their child by giving it appropriate instructions (scaffolding). Mothers of insecurely attached children, in situations when the child's solution is incorrect, more often help their children by giving them long explanations, regardless whether the child listens or understands what is been said (a monologue).Key words: attachment, preschool children, mothers, social interactions, strategy useIntroductionIntegrating the results of research by Lorenz and Harlow and conclusions from the field of evolutionary biology, ethology and psychoanalysis, Bowlby (1969/82) developed the theory of attachment between children and mothers. In his theory, he defines attachment as a strong emotional bond with the object of attachment. This bond is characterized by closeness and proximity to the particular person, especially during times of threat and distress. Bowlby believes the attempt of getting close to a particular person to be a basic form of human behavior, which increases the probability of protection and survival. Parental behavior is organized and managed by a behavioral system of care and protection, and it is connected to the attachment behavior system of a child.In 1969, Mary Ainsworth further elaborated on Bowlby's theory by drafting a method for evaluation of attachment (The Strange Situation) for children aged 12 to 20 months. In research using these techniques, children's reactions are described through two forms of behavior with the parent, which the author classifies as follows: securely attached children and insecurely attached children (anxious-ambivalent and anxious-avoidant). Main & Solomon (1986) also developed guidelines for classification of a third insecurely attached form of behavior, and they named it disorganized/disorientated.Later development of measures that use pictorial material and puppets, has enabled the evaluation of attachment for older children as well. In this research, we used the MCAST (The Manchester Child Attachment Story Task) techniques (Green, Stanley, Smith, & Goldwyn, 2000).According to the attachment theory, one of the parent's important roles is that the child's behavior, such as protection seeking and closeness (the role and goal of attachment for the child) changes into offering protection, comfort and care for the child (the role and goal for the parent). The parent's system of care is activated by internal and external signals associated with situations, which the parent perceives as frightening, dangerous or stressful for the child (George & Solomon, 2008).When this system is activated, the parent needs to decide how to behave. This behavior depends on the evaluation of information from different sources. One of the sources is the evaluation of the child's signal and the other is the parent's evaluation of the threat or danger. There are also situations when the parent's care system is activated while the child's system is not. For example, situations when the parent believes the child is in danger while child does not see the same situation as dangerous. In that case, the parent's behavior could be controlling or intrusive (George & Solomon, 2008). Moreover, the parent is constantly required to accommodate each of the developmental stages of the child (Moss & Dubois-Comtois, 2004). …

Catechol-O-methyltransferase Val158Met genotype moderates the effect of disorganized attachment on social development in young children.

Children with histories of disorganized attachment exhibit diverse problems, possibly because disorganization takes at least two distinctive forms as children age: controlling-punitive and controlling-caregiving. This variation in the developmental legacy of disorganization has been attributed primarily to variations in children's rearing experiences. Here an alternative explanation of these divergent sequelae of disorganization is evaluated: one focused on genotype. Structural equation modeling was applied to data on 704 Norwegian children to test whether the catechol-O-methyltransferase Val158Met genotype moderates the effect of disorganized attachment, which was measured dimensionally at 4 years of age using the Manchester Child Attachment Story Task, on changes in aggressive behavior and social competence from ages 4 to 6. Children who scored high on disorganization and were homozygous for the valine allele displayed significantly greater increases in aggression and decreases in self-oriented social skills (e.g., self-regulation and assertiveness) over time than did their disorganized counterparts carrying the methionine allele, whereas disorganized children carrying the methionine allele increased their other-oriented social skill (e.g., cooperation and responsibility) scores more than did valine-homozygous children. These results are consistent with the controlling-punitive and controlling-caregiving behaviors observed in disorganized children, suggesting that the children's genotype contributed to variations in the social development of disorganized children.

How do children make sense of their experiences? Children’s memories of wellbeing and distress from an attachment perspective

Attachment’s role in children’s memories of wellbeing and distress was evaluated through the Manchester Child Attachment Story Task in 30 Italian children, aged 6 years (15 secure and 15 insecure). Their mothers’ coherence of discourse was determined using the Adult Attachment Interview. A mediation model examining whether children’s attachment mediated the relation between mothers’ ability to talk coherently about their past and children’s memories was tested. Children’s attachment was associated with their ability to describe memories of wellbeing and distress and mediated the influence of maternal coherence on the same ability. A regression model was estimated to further evaluate the association between children’s attachment and ability to describe memories. Results suggest that attachment influences how children understand and recollect emotional experiences.

Risk factors for vulnerable youth in urban townships in South Africa: The potential contribution of reactive attachment disorder

Reactive attachment disorder (RAD) is a psychiatric disorder developing in early or middle childhood as a consequence of significant failures in the caregiving environment. RAD results in children failing to relate socially, either by exhibiting markedly inhibited behaviour or by indiscriminate social behaviour and is associated with significant socio-behavioural problems in the longer term. This study examined RAD in South Africa, a setting with high environmental risks.We recruited a sub-sample of 40 10-year-old children from a cohort enrolled during pregnancy for whom early attachment status was known. Children were purposefully selected to represent the four attachment categories using the data available on the strange situation procedure (SSP) at 18 months. The Manchester Child Attachment Story Task (MCAST) assessed current attachment and RAD was diagnosed using a standardised assessment package. A high proportion of the children (5/40% or 12.5%) fulfilled diagnostic criteria for RAD; all were boys and were displaying the disinhibited type. SSP classification at 18 months was not significantly associated with RAD symptoms at age of 10 years, while current MCAST classifications were. This suggests that children in this sample are at much higher risk of RAD than in high-income populations, and despite a fairly typical attachment distribution in this population at 18 months, RAD was evidenced in later childhood and associated with current attachment disorganisation.The strengths of this research include its longitudinal nature and use of diagnostic assessments. Given increasing evidence that RAD is relatively stable over time and introduces longer term socio-behavioural risks; the high rate of RAD in this sample (12.5%) highlights potential developmental threats to children in low- and middle-income countries (LMICs). Our results should be interpreted with caution given sample size and risk of selection bias. Further research is needed to confirm these findings.

Can behaviour during immunisation be used to identify attachment patterns? A feasibility study

BackgroundInfant attachment is a strong predictor of mental health, and current measures involve placing children into a stressful situation in order to observe how the child uses their primary caregiver to assuage their distress. ObjectivesThis study aimed to explore observational correlates of attachment patterns during immunisation. Participants and setting18 parent–child pairs were included in the study. They were all recruited through a single general medical practice. MethodsInfant immunisation videos were observed and coded for parenting behaviours as well as pain promoting and pain reducing strategies. Results were compared between different attachment groups, as measured with the Manchester Child Attachment Story Task. ResultsParents of securely attached children scored higher on positive Mellow Parenting Observational System behaviours, but not at a statistically significant level. Parents of securely attached children were also significantly more likely to engage in pain reducing behaviours (p<0.01) than parents of insecurely attached children. ConclusionsRobust composite measures for attachment informative behaviours in the immunisation situation should be developed and tested in a fully powered study.