Maternal-infant Attachment Research Articles

Remaining or becoming secure: Parental sensitive support predicts attachment continuity from infancy to adolescence in a longitudinal adoption study.

In a longitudinal study with 125 early adopted adolescents, we examined continuity of attachment from infancy to adolescence and the role of parental sensitive support in explaining continuity or discontinuity of attachment. Assessments of maternal sensitive support and infant attachment (Strange Situation Procedure) were completed when infants were 12 months old. When the children were 14 years old, we observed mothers' sensitive support during a conflict discussion. The adolescents' attachment representations were assessed with the Adult Attachment Interview. Mothers of secure adolescents showed significantly more sensitive support during conflicts than did mothers of insecure adolescents. Overall, no continuity of attachment from infancy to adolescence was found. However, maternal sensitive support in early childhood and adolescence predicted continuity of secure attachment from 1 to 14 years, whereas less maternal sensitive support in early childhood but more maternal sensitive support in adolescence predicted children's change from insecurity in infancy to security in adolescence. We conclude that both early and later parental sensitive support are important for continuity of attachment across the first 14 years of life.

Breastfeeding and Its Relation to Maternal Sensitivity and Infant Attachment

To examine the association of breastfeeding with maternal sensitive responsiveness and infant-mother attachment security and disorganization. We included 675 participants of a prospective cohort study. Questionnaires about breastfeeding practices were administered at 2 and 6 months postpartum. At 14 months, maternal sensitive responsiveness was assessed in a 13-minute laboratory procedure using Ainsworth's sensitivity scales, and attachment quality was assessed with the Strange Situation Procedure. Mothers were genotyped for oxytocin receptor genes OXTR rs53576 and OXTR rs2254298. Linear regressions and analyses of covariance adjusted for various background variables were conducted. We tested for mediation and moderation by maternal sensitive responsiveness and maternal oxytocin receptor genotype. Continuous analyses showed that longer duration of breastfeeding was associated with more maternal sensitive responsiveness (B = 0.11, 95% confidence interval [CI] 0.02; 0.20, p < .05), more attachment security (B = 0.24, 95% CI = 0.02; 0.46, p < .05), and less attachment disorganization (B = -0.20, 95% CI -0.36; -0.03, p < .05). Duration of breastfeeding was not related to the risk of insecure-avoidant or insecure-resistant versus secure attachment classification, but longer duration of breastfeeding predicted a lower risk of disorganized versus secure attachment classification (n = 151; odds ratio [OR] = 0.81, 95% CI 0.66 to 0.99, p = .04). Maternal sensitive responsiveness did not mediate the associations, and maternal oxytocin receptor genotype was not a significant moderator. Although duration of breastfeeding was not associated with differences in infant-mother attachment classifications, we found subtle positive associations between duration of breastfeeding and sensitive responsiveness, attachment security, and disorganization.

Paid parental leave supports breastfeeding and mother‐infant relationship: a prospective investigation of maternal postpartum employment

To investigate the association between the mother-infant relationship, defined as maternal-infant emotional attachment, maternal separation anxiety and breastfeeding, and maternal employment status at 10 months following first childbirth. Samples of employed, pregnant women, over 18 years of age and with sufficient English literacy were recruited systematically from one public and one private maternity hospital in Victoria. Data were collected by structured interview and self-report questionnaire in the third trimester, and at 3 and 10 months postpartum. Socio-demographic, employment, and breastfeeding information was collected. Participants completed standardised assessments of maternal separation anxiety and mother-to-infant emotional attachment. Of 205 eligible women, 165 (81%) agreed to participate and 129 (78%) provided complete data. A reduced odds of employment participation was independently associated with continuing to breastfeed at 10 months (OR=0.22, p=0.004) and reporting higher maternal separation anxiety (OR=0.23, p=0.01) when maternal age, education, occupational status and use of paid maternity leave and occupational status were adjusted for in analyses. Employment participation in the first 10 months postpartum is associated with lower maternal separation anxiety, and shorter breastfeeding duration. Paid parental leave has public health implications for mothers and infants. These include permitting sufficient time to protect sustained breastfeeding, and the development of optimal maternal infant attachment, reflected in confidence about separation from her infant.

Developmental correlates and predictors of emotional availability in mother–child interaction: A longitudinal study from infancy to middle childhood

In this investigation we examined the developmental correlates and predictors of maternal emotional availability in interactions with their 7-year-old children among a sample of families at psychosocial risk. We found developmental coherence in maternal interactive behavior, and in the relations between maternal emotional availability and children's functioning in middle childhood. Mothers and children were observed at home and in a laboratory playroom in infancy to assess maternal interactive behavior and child attachment security. When children were 7 years of age, dyads were observed in the lab; maternal emotional availability was coded using the Emotional Availability Scales, and children's disorganized and controlling attachment behavior was assessed. Classroom teachers reported on children's behavior problems; at age 8, children reported on their depressive symptoms. Results showed that aspects of maternal emotional availability (sensitivity, nonhostility, nonintrusiveness [passive/withdrawn behavior]) were associated with children's functioning in middle childhood: (a) controlling and disorganized attachment behavior, (b) behavior problems in school, and (c) self-reported depressive symptoms. Maternal emotional availability in childhood was predicted by early mother-infant relationship dysfunction (maternal hostility, disrupted communication, and infant attachment insecurity).

Maternal sensitivity and infant attachment security in Korea: Cross-cultural validation of the Strange Situation

The present study sought to analyze infant and maternal behavior both during theStrange Situation Procedure (SSP) and a free play session in a Korean sample (N = 87) to help understand whether mother–infant attachment relationships are universal or culture-specific. Distributions of attachment classifications in the Korean sample were compared with a cross-national sample. Behavior of mothers and infants following the two separation episodes in the SSP, including mothers' proximity to their infants and infants' approach to the caregiver, was also observed, as was the association between maternal sensitivity observed during free play session and infant security. The percentage of Korean infants classified as secure versus insecure mirrored the global distribution, however, only one Korean baby was classified as avoidant. Following the separation episodes in the Strange Situation, Korean mothers were more likely than mothers in Ainsworth's Baltimore sample to approach their babies immediately and sit beside them throughout the reunion episodes, even when their babies were no longer distressed. Also, Korean babies less often approached their mothers during reunions than did infants in the Baltimore sample. Finally, the link between maternal sensitivity and infant security was significant. The findings support the idea that the basic secure base function of attachment is universal and the SSP is a valid measure of secure attachment, but cultural differences in caregiving may result in variations in how this function is manifested.

Perinatal attachment in naturally pregnant and infertility-treated pregnant women in Taiwan

This article is a report of a study of the differences in maternal-foetal attachment and maternal-infant attachment among naturally pregnant and infertility-treated pregnant women in Taiwan. Studies have shown that infertility treatment is likely to make up an increasing proportion in the coming years. As these experiences are unique, the attachment relationship may be affected. The research data were collected from two obstetrics clinics which were located in central Taiwan. In 2008, all participants (n = 125) were asked to fill out the prenatal questionnaires at the beginning of the study and were followed up with postnatal questionnaires that were mailed to them 1-2 months after labour (n = 110). We used chi-square tests for categorical and t- tests for continuous variables. Multivariate analysis of variances was then performed, and changes in the maternal-foetal attachment and maternal-infant attachment Scales were assessed. Women who became pregnant after fertility treatment had higher maternal-foetus and maternal-infant attachment scores, and this result was statistically significant; pregnancy mode and level of education are the main factors that have a significant effect on maternal-foetus attachment; and pregnancy mode and participation in prenatal education have a main effect on maternal-infant attachment. Development of a specific support group for mothers, such as a group for prenatal education, and providing useful resources for pregnant women with a lower level of education are involved in the future research studies for therapeutic intervention.

Using Animal Models to Disentangle the Role of Genetic, Epigenetic, and Environmental Influences on Behavioral Outcomes Associated with Maternal Anxiety and Depression

The etiology of complex psychiatric disorders results from both genetics and the environment. No definitive environmental factor has been implicated, but studies suggest that deficits in maternal care and bonding may be an important contributing factor in the development of anxiety and depression. Perinatal mood disorders such as postpartum depression occur in approximately 10% of pregnant women and can result in detriments in infant care and bonding. The consequences of impaired maternal–infant attachment during critical early brain development may lead to adverse effects on socioemotional and neurocognitive development in infants resulting in long-term behavioral and emotional problems, including increased vulnerability for mental illness. The exact mechanisms by which environmental stressors such as poor maternal care increase the risk for psychiatric disorders are not known and studies in humans have proven challenging. Two inbred mouse strains may prove useful for studying the interaction between maternal care and mood disorders. BALB/c (BALB) mice are considered an anxious strain in comparison to C57BL/6 (B6) mice in behavioral models of anxiety. These strain differences are most often attributed to genetics but may also be due to environment and gene by environment interactions. For example, BALB mice are described as poor mothers and B6 mice as good mothers and mothering behavior in rodents has been reported to affect both anxiety and stress behaviors in offspring. Changes in gene methylation patterns in response to maternal care have also been reported, providing evidence for epigenetic mechanisms. Characterization of these two mouse inbred strains over the course of pregnancy and in the postpartum period for behavioral and neuroendocrine changes may provide useful information by which to inform human studies, leading to advances in our understanding of the etiology of anxiety and depression and the role of genetics and the environment.

Treatment of post-partum depression: a review of clinical, psychological and pharmacological options

Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.

Placebo Response: A Consideration of its Role in Therapeutics

Placebo effects are a potentially inherent element in all treatment responses, and as such, they play a critical role in determining what is "therapeutic." However, the placebo response is also an area of substantial controversy. In the present review, the scientific issues that influence placebo effects are elucidated. The evolution of the concept of placebo and how this has affected its historical importance in therapeutics is considered. The importance of placebo responses in psychiatry and psychotherapy is specifically examined, and recent progress in determining the cognitive and neurobiological bases of placebo effects is reviewed. Finally, it is argued that the placebo response is a cardinal mind-body pathway that promotes salutogenesis and that evidence suggests its relationship to central nervous system activities that are responsible for the concomitant development of positive affects and somatic procedural memories that govern states of mind/body well-being during maternal-infant attachment.

Mind-mindedness in adult and adolescent mothers: Relations to maternal sensitivity and infant attachment

This article examines the quality of maternal mind-mindedness among adult and adolescent mothers, using an assessment of the appropriateness and emotional valence of maternal mind-related comments while interacting with their infants. Twenty-nine adult mothers and 69 adolescent mothers participated in two assessments with their 18-month-old infants. Results showed that adult mothers used more mind-related comments when interacting with their child, especially comments referring to infant mental states. Adult mothers also used more appropriate and positive mind-related comments. Home observations and strange situation assessments revealed that two dimensions of mind-mindedness were associated with maternal sensitivity and three with infant attachment in adult mothers, whereas only one dimension was associated with maternal sensitivity in adolescent mothers.

A Review of Attachment Theory in the Context of Adolescent Parenting

The purpose of this article is to review attachment theory and relate the attachment perspective to adolescent mothers and their children. Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world. With respect to cognitive, social, and behavioral domains, securely attached infants tend to have more favorable long-term outcomes, while insecurely attached infants are more likely to have adverse outcomes. Adolescent parenthood can disrupt normal adolescent development, and this disruption influences development of the emotional and cognitive capacities necessary for maternal behaviors that foster secure attachment. However, it appears that if specialized supports are in place to facilitate the process of developing attachment, infants of adolescent mothers can obtain higher rates of secure attachment than normative samples in this population.

Early Manifestations of Children's Theory of Mind: The Roles of Maternal Mind-Mindedness and Infant Security of Attachment.

This study investigated two aspects of mother-child relationships-mothers' mind-mindedness and infant attachment security-in relation to two early aspects of children's theory of mind development (ToM). Sixty-one mother-child dyads (36 girls) participated in testing phases at 12 (T1), 15 (T2), and 26 months of age (T3), allowing for assessment of maternal mind-mindedness (T1), infant attachment (T2), and child ToM understanding (T3). Results indicated that children's understanding of discrepant desires and visual perspectives was positively related to their mothers' earlier use of appropriate mind-related comments in certain contexts. Furthermore, more securely attached boys, but not girls, performed better on a task requiring comprehension of their mothers' visual perspective. Hence, the links previously found between competent parenting and older children's ToM performance appear to extend, to a certain degree, to toddlers' first manifestations of ToM understanding.

Intimate Partner Violence

Intimate Partner Violence

Effects of Early Contact on Maternal Infant Attachment.

The purpose of this study was to evaluate the effects of early contact between mothers and infants on attachment behaviors. The participants were purposely allocated to an experimental group (n=20) and a control group (n=20). For the experimental group, early contact between mothers and newborns took place for 10 minutes. Mother-infant attachment was assessed in the nursery. Data analysis was done using frequency, percentage, chi2 test, mean, standard deviation, and t-test with the SPSS/WIN program. The experimental group practicing early mother-infant contact, showed a higher degree of identifying behaviors (p<.05), modalities of interaction (p<.05), and caretaking behaviors (p<.05) than the control group. The early mother-infant contact at 2 hours post-delivery had positive effects on mother-infant attachment. Therefore an early contact can be recommended for all mothers-to-be as a way of improving mother-infant relationships.

Supporting insensitive mothers: the Vilnius randomized control trial of video‐feedback intervention to promote maternal sensitivity and infant attachment security

This randomized control trial examined the effects of a short-term, interaction-focused and attachment-based video-feedback intervention (VIPP: video-feedback intervention to promote positive parenting). Design VIPP effect on mothers' sensitive responsiveness and infant-mother attachment security was evaluated in a sample (n = 54) of low sensitive, non-clinical, middle class Lithuanian mothers. Maternal sensitivity was assessed in a free play session with the Ainsworth's sensitivity scale, and attachment security was observed using the Attachment Q sort for home observations. We found that the intervention mothers indeed significantly improved their sensitive responsiveness through participation in our VIPP. The effect size was large according to Cohen's criteria, d = 0.78. VIPP enhanced maternal sensitive responsiveness even when maternal age, educational level, depression, daily hassles, efficacy, infant gender, and infant negative and positive affect were controlled for. However, attachment security in the VIPP infants was not enhanced after the intervention, compared with the control infants, and the infants did not seem to be differentially susceptible to the increase in maternal sensitivity dependent on their temperamental reactivity. We suggest that a relatively brief and low-cost programme can provide effective support for mothers who lack sensitivity in the interactions with their infants.

Nighttime maternal responsiveness and infant attachment at one year

This study examined associations between mother–infant nighttime interactions and mother–infant attachment when infants were 12 months old. Forty-four mother–infant pairs participated in this study. For three consecutive nights at home, babies were observed in their cribs using a digital video system. Mothers reported on their nighttime interactions with their babies using a self-report diary and completed a questionnaire regarding child temperament. Attachment was assessed in the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978). Mothers of securely attached infants had nighttime interactions that were generally more consistent, sensitive and responsive than those of insecurely attached infants. Specifically, in secure dyads, mothers generally picked up and soothed infants when they fussed or cried after an awakening.

Parent relationship quality and infant–mother attachment

This project examined interrelations between father–mother conflict, father support of mother, maternal behavior, and infant–mother attachment within a sample of 79 African American families living in a highly stressed urban community. Father support of mother was not related to maternal parenting behavior or infant attachment. Conflicted mother–father relationships were associated with problematic maternal behavior, low maternal sensitivity, infant attachment insecurity, and infant attachment disorganization. The associations between parental conflict and both infant attachment disorganization and insecurity were buffered in families in which fathers co-resided with the mother. Consistent with theory and prior research, links were also observed between maternal sensitive-responsiveness and infant attachment security and between problematic maternal parenting and infant attachment disorganization. However, maternal parenting behavior did not mediate the relation between parental conflict and infant attachment. Results are discussed with respect to whether and under what circumstances child exposure to parent conflict can have a direct effect on infant–mother attachment that is not mediated through dyadic infant–mother interaction.

A Comparative Study on Maternal-Infant Attachment and Infant Temperament according to the Feeding Methods

A Comparative Study on Maternal-Infant Attachment and Infant Temperament according to the Feeding Methods

Associations between maternal mind-mindedness and infant attachment security: Investigating the mediating role of maternal sensitivity

In the last 20 years, three meta-analyses suggested that the relation between maternal sensitivity and infant attachment security was lesser in magnitude than originally believed. This led to a search for other parental behaviors likely to contribute to the development of attachment security. Based on previous theoretical propositions and empirical findings suggesting that maternal mind-mindedness may contribute to infant attachment security by favoring maternal sensitivity, the aim of this study was to examine whether sensitivity mediates the relation between maternal mind-mindedness and infant attachment security. Fifty mother–infant dyads took part in two home visits (12 months and 15 months), allowing for assessment of maternal sensitivity (T1), mind-mindedness (T1), and infant attachment (T2). The results confirmed that maternal sensitivity mediates the relation between mind-mindedness and infant attachment. The findings are discussed in light of the assessments used in this and previous studies.

Promoting Maternal Confidence in the NICU

The technological intensive care environment of the neonatal intensive care unit (NICU) presents a challenge for nurses to integrate care that supports the development of premature and critically ill term infants while supporting mothers as collaborators in the care of their infant. The purpose of this article is to discuss the attributes of maternal-infant attachment, examine the challenges the NICU environment presents, and propose nursing interventions that facilitate and support the development of maternal confidence in the NICU. These interventions create an environment that facilitates maternal-infant attachment by offering mothers meaningful, positive experiences with their infants.