Maternal Attachment Representations Research Articles

Visualizing the invisible tie: Linking parent-child neural synchrony to parents' and children's attachment representations.

It is a central tenet of attachment theory that individual differences in attachment representations organize behavior during social interactions. Secure attachment representations also facilitate behavioral synchrony, a key component of adaptive parent-child interactions. Yet, the dynamic neural processes underlying these interactions and the potential role of attachment representations remain largely unknown. A growing body of research indicates that interpersonal neural synchrony (INS) could be a potential neurobiological correlate of high interaction and relationship quality. In this study, we examined whether interpersonal neural and behavioral synchrony during parent-child interaction is associated with parent and child attachment representations. In total, 140 parents (74 mothers and 66 fathers) and their children (age 5-6 years; 60 girls and 80 boys) engaged in cooperative versus individual problem-solving. INS in frontal and temporal regions was assessed with functional near-infrared spectroscopy hyperscanning. Attachment representations were ascertained by means of the Adult Attachment Interview in parents and a story-completion task in children, alongside video-coded behavioral synchrony. Findings revealed increased INS during cooperative versus individual problem solving across all dyads (𝛸2(2)=9.37, p=0.009). Remarkably, individual differences in attachment representations were associated with INS but not behavioral synchrony (p>0.159) during cooperation. More specifically, insecure maternal attachment representations were related to higher mother-child INS in frontal regions (𝛸2(3)=9.18, p=0.027). Conversely, secure daughter attachment representations were related to higher daughter-parent INS within temporal regions (𝛸2(3)=12.58, p=0.006). Our data thus provide further indication for INS as a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of early parent-child interactions. RESEARCH HIGHLIGHTS: We assessed attachment representations using narrative measures and interpersonal neural synchrony (INS) during parent-child problem-solving. Dyads including mothers with insecure attachment representations showed higher INS in left prefrontal regions. Dyads including daughters with secure attachment representations showed higher INS in right temporo-parietal regions. INS is a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of parent-child interactions, especially within the mutual prediction framework.

Parenting during the COVID‐19 pandemic: Insecure or unresolved attachment representation is a risk factor for harmful parenting behavior

AbstractBackgroundThe current COVID‐19‐pandemic confronted a large number of young families with stressors. For mothers with a history of childhood maltreatment (CM), the distress during the current pandemic added to their already increased risk for a less sensitive, maltreating parenting behavior.ObjectiveThis study aims to investigate whether maternal attachment representation mediates the relationship between maternal CM experiences and changes in parenting behavior during the pandemic.MethodAs a part of a longitudinal study, mothers' experiences of CM and their attachment status were assessed. For the present study, 92 mothers (mean age: 38.14 years, SD = 4.08; attachment representation: 36% secure, 64% insecure and unresolved) completed an online SARS‐CoV‐2‐pandemic survey assessing their parenting behavior since the beginning of the pandemic.ResultsThe odds of an insecure maternal attachment representation in adulthood increased with higher levels of CM load. Mediation analyses revealed that maternal attachment representation fully explained the relationship between maternal CM load to changes in sensitive, endangering, and overall parenting quality.ConclusionsCM has lasting effects on maternal adult attachment representations. Mothers' attachment representations contribute to a further understanding of intergenerational transmission mechanisms of CM later in adulthood through a more endangered parenting approach in challenging times.ImplicationsThe results of this study should be considered in the development of programs offered to families facing stressful circumstances. In particular, we recommend increased implementation of telephone‐ or web‐based programs.

Negative effects of the SARS-CoV-2 pandemic: The interlinking of maternal attachment representation, coping strategies, parental behavior, and the child's mental health.

For more than two years, young families have been confronted with a large number of restrictions and following burdens as a result of the SARS-CoV-2 pandemic. In fact, it became evident, that the current circumstances are particularly stressful for child's mental health. With regard to the child's mental health in times of a pandemic, additional factors within the family, such as maternal attachment representations as well as coping strategies and parental behavior, may play an important role. This study aims to investigate the interplay of maternal attachment representation, coping strategies, parental behavior and child's mental health during the SARS-CoV-2 pandemic. In this longitudinal study, previously collected data regarding maternal attachment representation and newly attained data from the SARS-CoV-2-pandemic-assesment (lack of coping strategies, children's mental health and parental behavior) were combined and analyzed. The data were collected in an online survey since beginning of the pandemic, including N = 73 mothers. A path model was calculated in form of multiple linear regression. A path model could be confirmed, which indicates that insecure maternal attachment representation predicts lack of coping strategies during the pandemic [b = 5.55, 95%-CI = (4.51; 6.55), p = 0.001]. Furthermore, lack of coping strategies predicts harmful parental behavior during the pandemic [b = -0.77, 95%-CI = (-1.27; -0.21), p = 0.007], which in turn predicts children's mental health problems, namely behavioral problems [b = -0.08, 95%-CI = (-0.14; -0.01), p = 0.027]. Presence of short-time work and decrease in income since beginning of the pandemic were used as control variables. This means that since the pandemic mothers with insecure attachment representation have an increased risk of having only a few coping mechanisms available, leading to harmful parental behaviors and ultimately affecting the mental health of their children. In conclusion, the pandemic could potentially have a particularly negative influence on mothers with an insecure attachment type and therefore on their children. Therefore, tailored interventions for families should be offered that both focus on the different types of mental health problems in children and support parents in their coping skills.

Représentations d'attachement, comportements extériorisés et pro-sociaux d'enfants ayant vécu de la maltraitance et issus de la population générale

IntroductionMaltreatment engendered by parental figures may undermine attachment within parent-child relationships and has been associated with the emergence of behavioural problems. These symptoms have been negatively correlated with pro-social behaviour. ObjectiveThis study aims to report attachment representations, behavioural problems and pro-social behaviour of school aged children that have been victims of maltreatment and who receive services from the Enfant and Youth Protection Centre (EYPC) in Quebec and the therapeutic, educative and pedagogic institute (TEPT) in France. The study also aims to examine the links between these variables and to compare these children with the general population (GP) regarding these variables. MethodEighty children, aged 6 to 12 years old, divided in three groups (GP: n = 40; EYPC: n = 27; TEPI: n = 13) participated in the study. Parents and childcare workers completed measures on externalized and pro-social behaviours. Children participated in an activity exploring their attachment representations. ResultsSignificant associations were found between pro-social and externalized behaviors, as well as between attachment representations concerning the child's emotional dysregulation and two other variables: maternal attachment representations (supportive and rejecting) and pro-social behaviour. Furthermore, no significant differences were found between the attachment representations of children from the GP and those that have been victims of maltreatment and who receive services from EYPC and TEPI. However, significant differences were found between these groups regarding pro-social and externalized behaviours. ConclusionThe present study furthers our knowledge about the influence of maltreatment on children's attachment representations and behaviour.

Intergenerational Transmission of Attachment between Incarcerated Mothers and Their Co-residing Children.

Maternal attachment representations and children's attachment to their mothers have been shown to be related while this association varies according to socioeconomic risk factors that these mother-child dyads are experiencing. In this regard, this study aims to investigate the intergenerational transmission of attachment between highly disadvantaged incarcerated mothers and their co-residing children and the mediating role of maternal sensitivity in the relationship between maternal and children's attachment representations. The study sample consists of 84 incarcerated mothers and their co-residing children. The maternal attachment was evaluated using the Doll Story Completion Task. Children's attachment and maternal sensitivity were assessed based on a 45-minute semi-structured mother-child interaction observation and rated through structured coding instruments. Hierarchical regression analyses revealed that mothers' anxious and avoidant attachment positively predicted children's disorganized attachment behaviors. Moreover, analyses showed that maternal sensitivity did not mediate the relationship between maternal and child attachment representations. Findings partially supported the discussion emphasizing that attachment transmission, as well as the mediating role of maternal sensitivity on this transmission, appeared to be weaker for disadvantaged mother-child dyads. Implications for future intervention programs aiming to support the attachment security and reduce the disorganization of children co-residing with their incarcerated mothers are discussed.

Maternal Attachment Representations during Pregnancy, Perinatal Maternal Depression, and Parenting Stress: Relations to Child's Attachment.

Background: This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child’s attachment at 15 months after childbirth. Methods: Mothers (n = 71), and their infants participated in a longitudinal study of maternal attachment, pre and postnatal depression, parenting stress and child attachment. Adult Attachment Interview (AAI) was conducted between 24 and 26 weeks of pregnancy (Time 1), depression was assessed using the Edinburgh Perinatal Depression Scale (EPDS) (at Time 1 and 6 months after childbirth, i.e., Time 2), parenting stress was assessed using the Parenting Stress Index—Short Form (PS-SF) (at Time 2) and the Strange Situation Procedure (SSP) at child’s 15 months of age (Time 3). Results: Free-autonomous maternal classification of attachment increases the likelihood of secure child classification in her offspring, while decreases that of avoidance and ambivalence. Insecure maternal representation of attachment evaluated during pregnancy and higher levels of parenting stress at six months after childbirth was associated with higher rates of infant insecure attachment at 15 months. Conclusions: Our study validates the importance of considering maternal representations of attachment crucial in determining the quality of the caregiving environment, thereby the healthy development of children, despite the presence of other contextual risk.

Maternal attachment representation, the risk of increased depressive symptoms and the influence on children\u2019s mental health during the SARS-CoV-2-pandemic

The social distancing measures and the related closure of education institutions have confronted young families, in particular, with various challenges. Additional risk factors such as an insecure or even unresolved maternal attachment representation may affect mental health of mothers and their children in times of increased stress such as during the ongoing pandemic. We aimed to analyze the interplay between maternal attachment representation and mother’s and children’s mental health before and during the SARS-CoV-2-pandemic. 91 mothers completed a “SARS-CoV-2 pandemic survey” examining the pandemic-related stress of their families including their own depressive symptomology and their children’s mental health. Our mediation analysis demonstrates that the mothers’ depressive symptomology significantly and fully mediated the relationship between maternal attachment representations and children’s mental health during the pandemic. In contrast, the indirect effect of the maternal attachment representation on children’s mental health before the pandemic through the depressive symptoms experienced by the mothers before the pandemic did not reach significance alongside the total and direct effect. The quality of the maternal attachment representation, promoted by childhood maltreatment, seems to be one relevant risk factor for the mothers’ and children’s mental health during a stressful time like a pandemic. The risk for mothers to develop depressive symptoms in times of a pandemic is significantly influenced by their current representation of previous attachment experiences. In addition, the mental well-being of mothers showed a considerable influence on the children’s mental health during a pandemic. The results underline the necessity to consider unique needs of family members and to offer specific support in the current crisis focusing on attachment issues.

Preconception and perinatal predictors of offspring attachment disorganization: Advancing the replicated evidence.

Attachment disorganization in early childhood is an influential yet modifiable risk factor for later mental health problems. Beyond established transmission through parents' unresolved attachment representations and caregiving sensitivity, little replicated evidence exists for wider determinants of offspring attachment disorganization. This study examined the replicated evidence for psychosocial risk factors in the preconception, prenatal, and postnatal periods. We identified all relevant longitudinal studies, and examined all risk relationships for which evidence existed in two or more cohorts (48 effects, 17 studies, N = 6,099). Study-specific and pooled risk associations were estimated and a range of moderators evaluated. Mothers' low socioeconomic status (r = .28, k = 2), perinatal loss of a child (r = .26, k = 2), caregiving intrusiveness (r = .31, k = 2), and infant male sex (r = .26, k = 4) predicted offspring attachment disorganization. Maternal sensitivity (r = -.25, k = 6) and higher metacognition during pregnancy (r = -.23, k = 3) predicted lower risk of offspring attachment disorganization. Findings suggest the origins of offspring disorganized attachment include but extend beyond maternal unresolved attachment representations and caregiving. We discuss implications for theory and for identification of modifiable risk pathways in the perinatal window.

Attachment Representations in Mothers and Their Children Diagnosed with ADHD: Distribution, Transmission and Impact on Treatment Outcome

Little is known about the distribution and intergenerational transmission of attachment representations in ADHD populations and further how attachment may influence the prognosis of ADHD. In this study we aimed to investigate attachment distribution, intergenerational transmission and the potential impact of maternal and child attachment representations on treatment response in a sample of children with ADHD. Sixty mother-child dyads from families with offspring ADHD were recruited. Attachment representations were assessed with the Adult Attachment Interview (AAI) and the Child Attachment Interview (CAI). ADHD symptom severity was assessed at four time points with the ADHD-Rating Scale. Of the children, only 15% and among the mothers, only 23% were securely attached. Contrary to predictions, the association between maternal and child attachment representations (Secure versus Insecure) did not reach statistical significance as we found overall concordance rate to be 63% (kappa = −0.05). Neither child nor maternal attachment significantly predicted treatment response. In families with offspring ADHD, the prevalence of insecure attachment was remarkably high in the children as well as in the mothers. Intergenerational transmission of attachment was very low and in short-term follow up, attachment representations did not affect treatment outcome. Our findings support previous research in suggesting that the relationship between ADHD and Insecure attachment is complex. Nevertheless, the importance of considering attachment as a factor in the treatment, functional impairment and long term prognosis of children with ADHD remains.

Does Love Matter to Infants' Health: Influence of Maternal Attachment Representations on Reports of Infant Health

Although there is considerable support for the influence of maternal attachment on children's development (see Gerhardt, 2015), this is one of the first studies to examine the effects of maternal prenatal reports of attachment representations with close others on reports of infants’ health. Mothers (N = 483) completed surveys to assess attachment and depression in the second or third trimester of pregnancy, infants’ health over the first 6 months, and depression and infant temperament when infants were 6 months old. We found that insecure mothers, as compared to secure mothers, were more likely to report that their infants experienced colic and illnesses associated with immune, cardiovascular, and respiratory systems. It may be that secure mothers experience less anxiety associated with parenting and, as expected, were consistently found to report lower levels of infant illness symptoms. Alternatively, secure mothers would be expected to provide more consistent and responsive care compared to insecure mothers, which may also influence their infants’ physical health (see also Gerhardt, 2015). Future research needs to further explore this finding — do secure mothers simply perceive their infants to be healthier due to their own low anxiety or are infants of secure mothers healthier due to consistent and responsive care received?

ATTACHMENT AND MEMORY RESEARCH: REFLECTING ON A SHARED PAST AND A COLLABORATIVE FUTURE.

This commentary applauds the authors of the monograph, The Mother-Child Attachment Partnership in Early Childhood: Secure Base Behavioral and Representational Processes, for their thorough and elegant exploration of the development of attachment working models in the preschool years in relation to maternal sensitivity and attachment representations, mother-child co-constructions of attachment-relevant stories, and children's own secure base behavior. These findings are set against a backdrop of children's memory development, with the recommendation that future research delves even younger to explore the development of attachment working models in children under 3 years. A second recommendation is to continue the work with older children, with a particular focus on the conversations they are having with caregivers about actual attachment-related experiences. This new research poses challenges, especially with at-risk samples. Fortunately, the stage is now set for attachment and memory researchers to come together to continue to map the development of attachment working models.

Understanding maternal mentalizing capacity and attachment representations of children with reactive attachment disorder: Two case illustrations.

Understanding maternal mentalizing capacity and attachment representations of children with reactive attachment disorder: Two case illustrations.

Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms

In this study, we replicated a rigorous test of the proposed mechanisms of change associated with Mothering from the Inside out (MIO), an evidence-based parenting therapy that aims to enhance maternal reflective functioning and mental representations of caregiving in mothers enrolled in addiction treatment and caring for young children. First, using data from 84 mothers who enrolled in our second randomized controlled trial, we examined whether therapist fidelity to core MIO treatment components predicted improvement in maternal reflective functioning and mental representations of caregiving, even after taking fidelity to non-MIO components into account. Next, we examined whether improvement in directly targeted outcomes (e.g., maternal mentalizing and mental representations of caregiving) led to improvements in the indirectly targeted outcome of maternal caregiving sensitivity, even after controlling for other plausible competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Third, we examined whether improvement in targeted parenting outcomes (e.g., maternal mentalizing, mental representations of caregiving and caregiving sensitivity) was associated in improvement in child attachment status, even after controlling for competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Finally, we examined whether improvement in maternal mentalizing and caregiving representations was associated with a reduction in relapse to substance use. Support was found for the first three tests of mechanisms but not the fourth. Implications for future research and intervention development are discussed.

Maternal psychological distress after preterm birth: Disruptive or adaptive?

BackgroundMaternal postpartum distress is often construed as a marker of vulnerability to poor parenting. Less is known, however, about the impact of postpartum distress on parenting an infant born prematurely. The present study investigated whether high distress levels, which are particularly prevalent in mothers of preterm born infants, necessarily affect a mother’s quality of parenting. MethodLatent Class Analysis was used to group mothers (N=197) of term, moderately, and very preterm born infants, based on their levels of distress (depression, anxiety, and PTSD symptoms) at one month postpartum, and their quality of parenting at one and six months postpartum. Parenting quality was assessed on the basis of maternal interactive behaviors (sensitivity, intrusiveness, and withdrawal) using observations, and maternal attachment representations (balanced, disengaged, or distorted) using interviews. ResultsA 5-Class model yielded the best fit to the data. The first Class (47%) of mothers was characterized by low distress levels and high-quality parenting, the second Class (20%) by low distress levels and low-quality parenting, the third Class (22%) by high distress levels and medium-quality parenting, the fourth Class (9%) by high distress levels and high-quality parenting, and finally the fifth Class (2%) by extremely high levels of distress and low-quality parenting. ConclusionsWhile heightened distress levels seem inherent to preterm birth, there appears to be substantial heterogeneity in mothers’ emotional responsivity. This study indicates that relatively high levels of distress after preterm birth do not necessarily place these mothers at increased risk with regard to poor parenting. Conversely, low distress levels do not necessarily indicate good-quality parenting. The results of the present study prompt a reconsideration of the association between postpartum distress and parenting quality, and challenge the notion that high levels of maternal distress always result in low-quality parenting practices.

The Effects of Parental Attachment Representations and Parenting Behavior on Young Children’s Self-Regulation

Objective The purpose of this research was to examine the effects of parents' childhood attachment representations and parenting behavior in developing early childhood self-regulation, a developmental skill. Methods This research was conducted with 171 preschoolers, 171 parent couples, and 22 teachers of 5-year-old classes in kindergartens and children's houses in Seoul. Results First, there was significant correlation among parental childhood attachment representations, parenting behavior, and child self-regulation. Second, parental attachment representations and parenting behavior were shown to affect self-monitoring, a subvariable of self-regulation, and were influenced by maternal independence-oriented parenting behavior, maternal attachment representation, and parental attachment representation. As factors affecting self-control, a subvariable of self-regulation, they were influenced by maternal attachment representation, and maternal and paternal affectionate parenting behavior. Lastly, as factors affecting self-control, they were influenced by attachment representation to parents of origin, maternal affectionate parenting behavior, and maternal independence-oriented parenting behavior. Conclusion This research revealed that parental childhood attachment representations and parenting behavior are important variables affecting the development of self-regulation in preschoolers. This finding can be used as basic data for parent education content to help preschoolers grow healthier and happier and as basic data for a program to improve parent-child attachment. Keywords: attachment representation, parenting behavior, self-regulation

Social cognition mediates the relation between attachment schemas and posttraumatic stress disorder.

A social-cognitive perspective on posttraumatic stress disorder (PTSD) has been proposed and posits that impaired social cognition, rooted in attachment insecurity, plays a role in the development of PTSD. Support for the role of impaired social cognition in PTSD has been found in adults, but the social-cognitive perspective on PTSD has not been examined in adolescents. This study sought to explore differences in social cognition and PTSD on the basis of attachment security, and it examined social cognition as a mediator in the relation between attachment security and PTSD and with regard to PTSD symptom change during inpatient treatment. We recruited 142 adolescents from an inpatient psychiatric hospital, where adolescents and their parents completed assessments at admission and discharge. Adolescents with a secure attachment demonstrated better social-cognitive skills than did those with an insecure attachment. Social cognition mediated the relation between adolescents' maternal attachment representations and PTSD at admission across 3 self- and parent-report measures. Social cognition also mediated the relation between adolescents' maternal attachment representations at admission and PTSD treatment outcome. This study provides the 1st support for the application of Sharp, Fonagy, and Allen's (2012) social-cognitive perspective of PTSD to adolescents by showing a link between clinically significant symptoms of PTSD and attachment security through social-cognitive impairment. Findings indicate that improvement in PTSD during medium-stay inpatient treatment is partially driven by baseline attachment security and social-cognitive abilities, highlighting the potential of social-cognitive skills as important targets of clinical intervention among adolescents with PTSD. (PsycINFO Database Record

Attachment Representations and Maternal Sensitivity in Low Socioeconomic Status Mothers

<p><em>According to attachment theory, mental representations are defined as dynamic cognitive guides that organize both perceptual and behavioral aspects of the self, attachment figure, and relationships with others. Based on this assumption, several studies had reported a relationship between attachment representations and the quality of care provided by mothers to their infants. This study explored on the relationship between maternal attachment representations, assessed by a narrative script task, and the quality of maternal care observed at home. Participants were 32 mothers between 19 and 44 years of age (M</em><em> </em><em>=</em><em> </em><em>29.6, SD</em><em> </em><em>=</em><em> </em><em>6.28) and their children between 8 and 10 months (M</em><em> </em><em>=</em><em> </em><em>8.91, SD</em><em> </em><em>=</em><em> </em><em>0.96). The results did not show a significant relationship between global scores of participants’ observed care (i.e.</em><em>,</em><em> maternal sensitivity) and their attachment representations. However, a specific association was found between two dimensions of sensitivity (acceptance and active/animated interactions) and the narrative script that refers to a child</em><strong>’</strong><em>s physical injury event. Additionally, mothers who reported early separation experiences with their children showed a significant association between sensitivity and attachment representations on mother-child scripts. Moreover, these mothers showed lower scores on global sensitivity and on specific behavioral care dimensions, such as sensitive response and acceptance to child’s signals, than those of mothers that did not report separations early in their children’ lives.</em><em><em></em></em></p>

Journal Watch review of Maternal attachment representation and neurophysiological processing during the perception of infants' emotional expressions.

Journal Watch review of Maternal attachment representation and neurophysiological processing during the perception of infants' emotional expressions.

Infant attachment, adult attachment, and maternal sensitivity: revisiting the intergenerational transmission gap

ABSTRACTThis study investigated the intergenerational transmission of attachment, utilizing the Adult Attachment Interview (AAI), the Strange Situation Procedure (SSP), and the Maternal Behavioral Q-Set (MBQS). We revisited fundamental questions in attachment theory and research by examining: (1) the level of intergenerational agreement between maternal attachment representations and infant attachment security, and (2) whether maternal sensitivity serves as an intergenerational mediator between adult and infant attachment security. Significant categorical matches between the AAI and the SSP as well as mean differences for MBQS scores between adult attachment secure-insecure groups were found. Consistent with earlier intergenerational research, maternal sensitivity only partially mediated the AAI-SSP link, indicating the transmission gap remains. Consistent with recent mediation studies, using more contemporary analytical techniques, it was confirmed that maternal sensitivity did mediate the direct pathway between AAI security and SSP security. Thus, the transmission gap appears somewhat different depending on the statistical method used to measure mediation. Post hoc analyses considered mothers’ childhood experiences of separation/divorce and this helped make sense of intergenerational mismatches.

Maternal Attachment Representation and Neurophysiological Processing during the Perception of Infants' Emotional Expressions.

The perception of infant emotions is an integral part of sensitive caregiving within the mother-child relationship, a maternal ability which develops in mothers during their own attachment history. In this study we address the association between maternal attachment representation and brain activity underlying the perception of infant emotions. Event related potentials (ERPs) of 32 primiparous mothers were assessed during a three stimulus oddball task presenting negative, positive and neutral emotion expressions of infants as target, deviant or standard stimuli. Attachment representation was assessed with the Adult Attachment Interview during pregnancy. Securely attached mothers recognized emotions of infants more accurately than insecurely attached mothers. ERPs yielded amplified N170 amplitudes for insecure mothers when focusing on negative infant emotions. Secure mothers showed enlarged P3 amplitudes to target emotion expressions of infants compared to insecure mothers, especially within conditions with frequent negative infant emotions. In these conditions, P3 latencies were prolonged in insecure mothers. In summary, maternal attachment representation was found associated with brain activity during the perception of infant emotions. This further clarifies psychological mechanisms contributing to maternal sensitivity.