Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae

Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat

As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.

Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

The longitudinal interplay between insecure attachment behaviors and psychosocial strengths among children in child welfare services

Children who have experienced maltreatment are more likely to have disrupted attachments, fewer psychosocial strengths, and poorer long-term psychosocial outcomes. However, few studies have examined the interplay between attachment security and psychosocial strengths among children involved in therapeutic services in the context of the child welfare system. The present longitudinal study examines the insecure attachment behaviors and psychosocial strengths of 555 children referred to the Therapeutic Family Care program (TFCP) in Cobourg, Ontario between 2000 and 2019. The children were assessed by their caregivers on a regular basis using the Assessment Checklist for Children (ACC) and the complementary strengths-focused ACC+ measure. Average age of children at baseline was 9.57 years (SD = 3.51) and 229 (41.26%) were female. We conducted growth curve and random intercepts cross-lagged panel models to test the longitudinal interplay between insecure attachment behaviors and strengths. Results suggest that females' attachment security improved, males' attachment security worsened, and both males and females developed strengths over time. Further, analyses revealed a directional effect, whereby fewer insecure attachment behaviors predicted more psychosocial strengths approximately 6 months later. Implications for attachment-oriented and strengths-based services in the context of child welfare are discussed.

Infant attachment does not depend on neonatal amygdala and hippocampal structure and connectivity

Infant attachment is an antecedent of later socioemotional abilities, which can be adversely affected by preterm birth. The structural integrity of amygdalae and hippocampi may subserve attachment in infancy. We aimed to investigate associations between neonatal amygdalae and hippocampi structure and their whole-brain connections and attachment behaviours at nine months of age in a sample of infants enriched for preterm birth. In 133 neonates (median gestational age 32 weeks, range 22.14-42.14), we calculated measures of amygdala and hippocampal structure (volume, fractional anisotropy, mean diffusivity, neurite dispersion index, orientation dispersion index) and structural connectivity, and coded attachment behaviours (distress, fretfulness, attentiveness to caregiver) from responses to the Still-Face Paradigm at nine months. After multiple comparisons correction, there were no significant associations between neonatal amygdala or hippocampal structure and structural connectivity and attachment behaviours: standardised β values - 0.23 to 0.18, adjusted p-values > 0.40. Findings indicate that the neural basis of infant attachment in term and preterm infants is not contingent on the structure or connectivity of the amygdalae and hippocampi in the neonatal period, which implies that it is more widely distributed in early life and or that network specialisation takes place in the months after hospital discharge.

Pilot examination of independent and interactive effects of maltreatment and neighborhood risk on child attachment

Elucidating the influence of microsystem and exosystem factors on development is an important goal of developmental psychopathology. This study examined the effects of maltreatment and neighborhood risk on child-caregiver attachment. Maltreatment records, neighborhood risk indices, and Strange Situation data were collected from a diverse sample of 170 four-year-old children and their caregivers. Relative contributions of maltreatment, neighborhood risk, and their interaction on attachment insecurity and disorganization were explored via latent moderation. Maltreated children demonstrated higher rates of insecure attachment, but not attachment disorganization, independent of neighborhood risk. Controlling for maltreatment, preliminary results suggested no effects of neighborhood risk on attachment. Findings support prior research that has identified maltreatment as a salient risk to the formation of secure attachment relationships. However, results add heterogeneity to the limited research investigating effects of neighborhood on attachment. Overall, this study highlights the importance of examining multilevel ecological risk in relation to attachment relationship development.

A Concept Analysis of Paternal Bonding With Prematurely Born Infants

BACKGROUND

Maternal bonding in infancy has long been the focus of research and practice. Despite emerging evidence highlighting the importance of paternal bonding, little attention has been focused on fathers. Simultaneously, there is little clarity regarding possible differences between bonding and attachment.

PURPOSE

This article aims to clarify the concept of paternal bonding with infants born prematurely.

METHODS/SEARCH STRATEGY

Using Walker and Avant's approach to concept analysis, we selected databases and searched them for relevant studies published between 2012 and 2022. We identified 28 articles that (1) defined bonding specific to fathers of infants born prematurely, (2) were peer-reviewed, and (3) were in English. From the articles, we extracted and analyzed data specific to concept definitions, antecedents, and consequences.

RESULTS

Regarding paternal bonding with infants born prematurely, our analyses of the 28 studies yielded a conceptual definition of this topic that extends beyond the commonly used definition emphasizing emotional connection. The newly formulated definition covers the cognitive, behavioral, and dynamic, as well as emotional, attributes of bonding. We identify and discuss antecedents and consequences of bonding.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Our findings led to a consistent conceptual definition of the bonding phenomenon in question. The definition should serve as a conceptual basis for future guidelines governing clinical practice and research. Through our findings, nurses can better understand and promote paternal bonding with infants born prematurely. Finally, our findings can improve researchers' exploration of this topic.

Study protocol for a systems evaluation of an infant mental health service: Integration of 'Little Minds Matter' into the early years system

Infant Mental Health relates to how well a child develops socially and emotionally from birth to age three. There is a well-established link between parent-infant relationship quality, Infant Mental Health, and longer-term social and emotional development there is a lack of evidence-based interventions that support the parent-infant relationship and/or protect against poor Infant Mental Health. Little Minds Matter is a specialist Infant Mental Health service developed in Bradford (UK) to support parent-infant relationships by providing training and consultation for professionals and direct clinical work to families. The successful implementation of this intervention depends upon how well it becomes embedded within, or integrated into, the early years system. For the purposes of this study, the early years system includes health, social and education services that support child health and development from conception to primary school entry at age five. This study protocol aims to apply a systems approach to evaluate this service and provide a perspective on the process of embedding a complex service within a healthcare system. Multiple methods will be used to investigate embeddedness within the wider early years system. Routinely collected quantitative data about the service will be used to develop a system map showing interaction with related services. Qualitative data will be collected at two time points through interviews with individuals involved in the design and provision of the service, and professionals working within the early years system. Framework analysis will be used to analyse the data inductively and deductively within a systems approach. The findings from this study will provide evidence to inform the ongoing implementation of the service for providers and commissioning bodies. Exploring the application of a systems approach in this clinical context will have application more broadly for researchers evaluating complex interventions and services within a wider system.

Examination of risk factors for high Edinburgh postnatal depression scale scores: a retrospective study at a single university hospital in Japan

BACKGROUND

Perinatal mental health, such as postpartum depression, is an important issue that can threaten the lives of women and children. It is essential to understand the risk factors in advance and intervene before they can lead to postnatal depression. The risk factors of postpartum depression are reported to vary considerably in Japan. This study aimed to evaluate the risk factors for women with high Edinburgh Postnatal Depression Scale (EPDS) scores and to find women who may need our intervention to prevent postpartum depression.

METHODS

This was a retrospective observational study conducted at a single center. At the one-month check-up after birth, the EPDS test was performed in 1625 women who gave birth at our hospital from 2008 to 2016. We evaluated maternal, birth, neonatal and social factors and the breastfeeding status from medical records. Thereafter, we examined the factors that contributed to a high EPDS score.

RESULTS

There were 284 women in the high-score group with an EPDS of ≥ 9, and 1341 women in the low-score group with an EPDS score ≤ of 8. Maternal mental disorders and neonatal transport were significantly associated with high EPDS scores. Conversely, exclusive breastfeeding was significantly associated with the low-score EPDS group.

CONCLUSIONS

The principal factor for high EPDS scores was a mental disease. Based on this result, we suggest that early intervention in women at high risk for postpartum depression could prevent serious consequences such as abuse and suicide.

Adult Attachment Questionnaire: evidence of validity in a sample of IPVAW offenders

Introduction

Adult attachment can be understood as a cognitive and emotional system concerning oneself and others, based on previous attachment experiences throughout life. This system automatically affects relationships with others. Because of its importance in the interpersonal domain, it has been studied on numerous occasions in research on intimate partner violence. The aim of this study was to obtain evidence of validity of the Adult Attachment Questionnaire (AAQ) in a sample of 331 men convicted of intimate partner violence against women (IPVAW).

Methods

The AAQ assesses adult attachment style in four dimensions that, together, yield four attachment categories. A psychometric analysis was performed, including reliability analysis and confirmatory factor analysis of the items, which ratified the factorial structure of the questionnaire. For a correct fit of the model, it was necessary to eliminate 4 of the items from the original scale.

Results

A latent profile analysis was also carried out, which identified four attachment styles: secure, preoccupied/anxious, avoidant/dismissing and fearful. Reliability indices were adequate. In general, the attachment profiles obtained ranges and means similar to those found in the general population study. The distribution of attachment styles was not equal: 50.57% of the participants presented secure attachment, 4.57% avoidant/dismissing attachment, 36.9% preoccupied/anxious, and 8.57% fearful.

Discussion

In conclusion, a valid and reliable instrument was determined based on the original AAQ scale to measure attachment in men convicted of IPVAW.

Early childhood attachment stability to mothers, fathers, and both parents as a network: associations with parents' well-being, marital relationship, and child behavior problems

This study examines the stability of child attachment to mothers and fathers separately, and to both parents as a network between the infancy and preschool periods using a sample of 143 biparental families and their children (73 boys) recruited from the general population. Attachment was assessed at 15 months with the Strange Situation Procedure (SSP) and at 45 months with the Preschool Attachment Classification Coding System (PACS). First, results show no stability in attachment to mothers, to fathers, or to both parents as a network. Second, parents' mental health, life satisfaction, marital satisfaction, and child externalizing behavior are associated with attachment stability. Taken altogether, group comparisons reveal that children with a stable secure attachment to both parents as a network have parents with higher levels of well-being and exhibit less problem behaviors than children with 1) a stable secure attachment to one parent and an unstable attachment to the other parent (from secure to insecure or from insecure to secure), or 2) who never had a stable secure attachment to either parent. This study highlights the significance of attachment to both parents as a network over time as it is associated with developmental outcomes.

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

BACKGROUND

Here, we report new prevalence and temporal stability data for child attachment and parental caregiving behaviour, from infancy (1 year) to preschool (4 years).

METHODS

Attachment (SSP) and caregiving data (MBQS) were from observations of parents and their infants and preschoolers, who represent the third generation of participants within an Australian longitudinal cohort.

RESULTS

At 1 year (n = 314 dyads) and at 4 years (n = 368 dyads), proportions assessed secure were 59% and 71%, respectively. Proportions assessed avoidant were 15% and 11%; ambivalent 9% and 6%, and disorganised 17% and 12%, at 1 and 4 years. Continuity of attachment pattern was highest for the infant secure group. Of dyads initially classified disorganised in infancy, 36% remained so at the preschool assessment. Attachment and caregiving continuities across the infancy-preschool period were highest for the stable secure attachment group and lowest for the stable insecure attachment group. Loss of secure attachment to mother by age 4 years correlated with decreased maternal caregiving sensitivity, and acquisition of secure status by age 4 was associated with increased maternal sensitivity. We found no difference in caregiving sensitivity scores for mothers and fathers for female and male preschool children.

CONCLUSIONS

The contemporary infant and preschool attachment proportions we report here closely mirror the patterns of those reported in prior decades, with an inclination towards secure base relationships. Our findings alert practitioners anew to the responsiveness of early attachment status to change in caregiving responsiveness and support ongoing investment in early identification of disorganised attachment.

Long-term associations between early attachment and parenting and adolescent susceptibility to post-traumatic distress in a South African high-risk sample

BACKGROUND

It has been proposed that children and young people living in low- and middle-income countries (LMICs) are not only exposed more frequently to trauma but also have a higher likelihood of encountering traumas of greater severity than those living in high-income countries (HICs). This may lead to higher rates of post-traumatic stress symptoms (PTSS). However, developmental pathways to risk or resilience after trauma exposure in LMICs are underresearched.

METHODS

We examined early parenting and attachment as potentially important formative factors for later stress reactivity in a longitudinal cohort of South African children (N = 449). Parenting and attachment were assessed at child age 18 months, and interpersonal trauma exposure, PTSS and parenting stress were measured at 13 years (N = 333; core sample with data on all measures: N = 213). Following a vulnerability-stress approach, separate regression models were run to investigate whether parent-child attachment at 18 months, parental sensitivity and intrusiveness during play at 12 months, and current parenting stress at 13 years, interacted with adolescents' extent of interpersonal trauma exposure to predict their PTSS levels at 13 years.

RESULTS

We found no predictive effects of either early attachment or current parenting stress in relation to child PTSS. There was some evidence for predictive influences of parental early intrusiveness and sensitivity on adolescent outcomes, though associations were unexpectedly positive for the latter. No interaction effects supporting a vulnerability-stress model were found.

CONCLUSIONS

Overall, we found limited evidence that elements of the early parent-child environment predict child risk/resilience to trauma in LMIC children. Future studies should include more frequent assessments of relevant constructs to capture changes over time and consider further what comprises adaptive parenting in high-risk contexts.

Attachment representations in 7-year-old children at familial high risk of schizophrenia or bipolar disorder: Associations with mental disorders and daily functioning: The Danish High Risk and Resilience Study, VIA 7-A population-based cohort study

BACKGROUND

Attachment quality may affect psychological functioning. However, evidence on attachment representations and their correlates in children born to parents with schizophrenia and bipolar disorder is sparse.

METHODS

We compared attachment representations in a Danish sample of 482 children aged 7 years at familial high risk of schizophrenia, bipolar disorder, and population-based controls and examined associations between attachment and mental disorders and daily functioning. Attachment representations were examined with the Story Stem Assessment Profile (SSAP). Mental disorders were ascertained in diagnostic interviews. Daily functioning was assessed with the Children's Global Assessment Scale.

RESULTS

We found no between-group differences in attachment. Higher levels of secure attachment were associated with decreased risk of concurrent mental disorders in the schizophrenia high-risk group. Higher levels of insecure and disorganized attachment were associated with increased risk of mental disorders across the cohort. Higher levels of secure and insecure attachment were associated with better and poorer daily functioning, respectively. In the current study, results regarding defensive avoidance could not be reported due to methodological limitations.

CONCLUSION

Familial high risk of schizophrenia (FHR-SZ) or bipolar disorder is not associated with less secure or more insecure attachment at age 7. Insecure and disorganized attachment representations index risk of mental disorders and poorer functioning. Secure attachment may be a protective factor against mental disorders in children at FHR-SZ. Validation of the SSAP is needed.

The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits

Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.

Variants of Callous-unemotional traits in childhood: investigation of attachment profile and hostile attribution bias

There is increasing evidence of interest in describing two variants of CallousUnemotional (CU) traits based on high (secondary variant) or low (primary variant) levels of anxiety. However, studies are limited in childhood. The present study aimed to further the understanding of the variants, specifically in association with hostile attribution bias (HAB) and attachment. In a community sample of children aged 4 to 9 (N = 70), the study examined whether anxiety moderated the association of CU traits with HAB, secure and disorganized attachment representations. Hierarchical regression analyses revealed that CU traits were positively associated with disorganized attachment, regardless of the anxiety level. In contrast, CU traits were not associated with secure attachment. A significant interaction revealed that CU traits were positively associated with HAB only at high levels of anxiety. Implications for understanding the variants of CU traits and hypotheses regarding their developmental trajectories are discussed.

Childhood Trauma and Its Link to Adult Dissociation: The Role of Mentalizing and Disorganized Attachment in a Chinese Adult Sample

Based on previous findings in a U.S. sample, the present study validated the relationship between childhood trauma and dissociation, as well as the mediating role of disorganized attachment and the moderating role of mentalizing (i.e. self-concept clarity and reflective functioning) in a group of 569 Chinese adults (i.e. a community sample). Results demonstrated a mediating role for disorganized attachment relationships in linking childhood maltreatment and dissociative symptoms. Moreover, self-concept clarity moderated this mediating relationship. An interesting finding that differs from the U.S. sample is that reflective functioning did not play a moderating role between insecure attachment and dissociation in Chinese adults. Chinese culture places greater emphasis on collectivism, altruism, and other-oriented, and thus the protective effect of the reflective function may not be as effective as in an individualistic culture. This study provides evidence for a better understanding of the relationship between childhood trauma, attachment, dissociation, and the moderating role of mentalizing in an Eastern culture, and it opens the door to further research examining whether more Western (such as the U.S.) and Eastern (particularly Chinese) relationships are similar in both social and clinical psychology.

Sequelae of infants' negative affectivity in the contexts of emerging distinct attachment organizations: Multifinality in mother-child and father-child dyads across the first year

Infants' high negative affectivity often initiates maladaptive parent-child relational processes that may involve both the parent's and the child's sides of the relationship. We proposed that infants' high negative affectivity triggers distinct sequelae in dyads classified as avoidant, resistant, and disorganized, compared to secure dyads. In 200 community families, at 8 months, we observed infants' negative affectivity; at 16 months, we assessed attachment organization and collected observations and reports of parent-related (responsiveness, resentment of child, power assertion, and intrusiveness) and child-related (social-emotional competence, opposition, and anger) constructs. In mother-child avoidant dyads, infants' high negative affectivity was a significant precursor of mothers' higher resentment and intrusiveness and children's lower social-emotional competence. Those associations were significantly different than in secure dyads (in which none were significant). In father-child disorganized dyads, infants' high negative affectivity was a significant precursor of fathers' lower responsiveness and higher resentment; there were no association in secure dyads. Regardless of infants' negative affectivity, compared to secure dyads, parents in resistant dyads expressed more resentment of child, and avoidant and resistant children were more oppositional to their fathers. The study illustrates multifinality in parent- and child-related processes that characterize unfolding early relational dynamics in dyads differing in just-emerging attachment.

Adolescent affective psychopathic traits: the long-term outcomes of mother-infant attachment across 14 years

Affective psychopathic traits have been associated with increased violence and aggression. The scholarly interest in the pathways leading to affective psychopathic traits in adolescence has been growing. Infant attachment security may be one of the early life factors that contribute to the development of affective psychopathic traits. In this study, we test the infant attachment styles measured with the Strange Situation Procedure as a predictor of adolescent affective psychopathic traits measured in three dimensions: remorselessness, unemotionality, and callousness, among 1149 families in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (SECCYD). Propensity scores for the four attachment styles were estimated with iterative tree-based regression models. After accounting for the potential confounding effects of demographic characteristics and child temperament with the inverse probability of treatment weighting, weighted generalized linear models revealed the association between insecure/avoidant attachment style measured one year after childbirth and higher levels of remorselessness, unemotionality, and callousness at 15 years. These findings provide insights into the long-term outcomes for attachment relationships established in early life.

Reflective functioning and mother-infant relationships among mothers with Borderline Personality Disorder post-therapy

The stressful nature of parenting infants exacerbates the characteristics of Borderline Personality Disorder (BPD). Consequently, mothers with BPD tend to be emotionally dysregulated, respond impulsively to their infants, and have poorer mother-infant relationships. Few parenting interventions target the specific skill deficits observed in mothers with BPD. This study explored the differences in parental reflective functioning (PRF) and mother-infant relationship quality at baseline and following a 24-week, group parenting intervention for mothers with BPD. PRF and mother-infant relationship quality were assessed from quantitative (N = 23) and qualitative (N = 32) perspectives. Quantitative data (Parental Reflective Functioning Questionnaire) showed a significant improvement in one of the three subscales, Interest and Curiosity, between baseline and post-intervention, and a significant moderate positive association between the subscale Certainty of Mental States and maternal-infant interaction quality post-intervention. Improvements in mother-infant relationship quality were not evident from the observational measure, Nursing Child Assessment Satellite Teaching scale. In contrast, semi-structured interview qualitative data found maternal improvements in parental reflection, coping strategies implemented post-intervention, and quality of mother-infant relationships. Overwhelmingly positive intervention feedback suggested perceived maternal benefits of group format and skills taught. Future studies with larger sample sizes would allow further clarification of such parenting interventions for mothers with BPD.

Attachment disorder symptoms in foster children: development and associations with attachment security

BACKGROUND

Children in foster care constitute a risk population for developing symptoms of attachment disorders. However, little is known about the longitudinal course of attachment disorders and their association with attachment security in foster children.

METHOD

This longitudinal study assessed attachment disorder symptoms in a sample of foster children (n = 55) aged 12 to 82 months. Foster parents with a newly placed foster child were assessed at three points during the first year of placement. At all assessment points, the Disturbance of Attachment Interview (DAI; Smyke and Zeanah in Disturbances of attachment interview, Tulane University, New Orleans, 1999) and the Attachment Q-sort (AQS; Waters and Deane in Monogr Soc Res Child Dev 50:41-65, 1985 German version as reported (Schölmerich and Leyendecker in Deutsche Übersetzung des attachment behavior Q-Set, revision 3.2. Unpublished manual, Ruhr University Bochum, Bochum, 1999) were used to investigate the interplay between disorder symptoms and attachment security.

RESULTS

The results revealed that the symptoms of attachment disorders decreased. The decrease was more pronounced for the inhibited than for the disinhibited symptoms with marked changes in the first 6 months of placement. There was a noticeable gender difference in the development with boys showing a more pronounced decrease in inhibited attachment disorder symptoms and a stronger increase of attachment security. After 12 months, no significant gender effects were found. Regarding the association between symptoms of attachment disorders and attachment security, a significant negative correlation between the inhibited attachment disorder symptoms and attachment security was found 12 months after placement.

CONCLUSIONS

Attachment disorder symptoms decreased in the stable foster care environment. Thus, foster care seems to be an effective placement option regarding children's attachment development.

The effect of relationship-based interventions for maltreated children and adolescents: a systematic review and meta-analysis

Child maltreatment is characterized by a harmful relational environment which can have negative cascading consequences for the child's development. Relationship-based interventions may improve maltreated children's functioning by addressing key aspects of the parent-child relationship at various stages of development. The objective of the current study was to perform a systematic review on relationship-based interventions for maltreated children and a meta-analysis on the impact of these interventions on observed parent-child relational behavior. Data collection consisted of a comprehensive literature search in six databases and contacting experts in the field and hand searching relevant publications. In total, 5,802 abstracts were screened, of which 81 relevant publications were identified, representing 4,526 participants. The meta-analysis found large improvements in observed parent interactive behavior (g = 0.888), smaller improvements in child attachment (g = 0.403) and child interactive behavior (g = 0.274). The effect on parent interactive behavior was larger in interventions addressing middle childhood. Risk of bias assessments showed that a large number of studies suffer from poor reporting, which limits the conclusions of the findings. Future research should examine parent-child relationship behavior across multiple developmental stages, as well as the impact of developmentally appropriate intervention elements on maltreated children.

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

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

Heterotypic and homotypic continuity in psychopathology: a narrative review

Psychopathology is a process: it unfolds over time and involves several different factors. To extend our knowledge of such process, it is vital to understand the trajectories that lead to developing and maintaining a specific disorder. The construct of continuity appears very useful to this aim. It refers to the consistency, similarity, and predictability of behaviors or internal states across different developmental phases. This paper aims to present a narrative review of the literature on homotypic and heterotypic continuity of psychopathology across the lifespan. A detailed search of the published literature was conducted using the PsycINFO Record and Medline (PubMed) databases. Articles were included in the review based on the following criteria: (1) publication dates ranging from January 1970 to October 2022; and (2) articles being written in the English language. To ensure a thorough investigation, multiple combinations of keywords such as "continuity," "psychopathology," "infancy," "childhood," "adolescence," "adulthood," "homotypic," and "heterotypic" were used. Articles were excluded if exclusively focused on epidemiologic data and if not specifically addressing the topic of psychopathology continuity. The literature yielded a total of 36 longitudinal studies and an additional 190 articles, spanning the research published between 1970 and 2022. Studies on continuity focus on the etiology of different forms of mental disorders and may represent a fundamental resource from both a theoretical and clinical perspective. Enhancing our understanding of the different trajectories beneath psychopathology may allow clinicians to implement more effective strategies, focusing both on prevention and intervention. Since literature highlights the importance of early detection of clinical signs of psychopathology, future research should focus more on infancy and pre-scholar age.

The Role of Attachment in Gambling Behaviors and Gambling Disorder: A Systematic Review

In recent years, a growing number of attachment-based studies have contributed to the understanding of both substance and behavioral addictions. Although gambling is a form of addictive behavior widespread all over the world, both among young people and adults, the evidence on the association between attachment-related phenomena and gambling has not yet been systematized in literature. The aim of the present study, therefore, is to provide a systematic literature review aimed at summarizing the empirical evidence on this topic. Following the updated 2020 PRISMA guidelines, a systematic search in four electronic scientific databases (Scopus, PubMed, PsycInfo and Web of Science) was conducted. After removing duplicates, 146 records were double-screened, with 12 articles meeting the inclusion criteria. Additionally, by means of a backward search a further article was selected. Altogether, 13 articles were selected for the present systematic review. With few exceptions, the results underline the significant role played by attachment-related phenomena in gambling behaviors, highlighting that specific attachment contexts have a different influence on gambling, also depending on whether gamblers are youths or adults. In particular, while secure attachment has proven to be a protective factor for the onset of gambling behavior, insecure attachment has emerged to be a vulnerability factor in two ways. On the one hand, it directly favors gambling behaviors; on the other, it affects coping strategies and the individual's ability to identify and regulate emotions, which in turn predict gambling. Limitations, strengths, and implications of the present systematic review are discussed.

Longitudinal links among paternal and maternal harsh parenting, adolescent emotional dysregulation and short-form video addiction

BACKGROUND

Due to its diversifying and appealing content, short-form videos have developed very rapidly since its emergence, with more and more users enjoying the transient pleasures from such videos, which have triggered widespread concern over the detrimental influence of short-form video addiction on adolescent health.

OBJECTIVE

The present study intended to examine the longitudinal relations among paternal/maternal harsh parenting, adolescents' emotional dysregulation and their short-form video addiction using a cross-lagged longitudinal design.

PARTICIPANTS AND SETTING

We recruited a sample of 1064 adolescent students from two middle schools located in rural areas of eastern China.

METHODS

Adolescents reported on paternal and maternal harsh parenting, their own emotional dysregulation and short-form video addiction at three time points across two years. Autoregressive and cross-lagged models were analyzed using three-wave variables to test the associations among parental (maternal) harsh parenting, adolescent emotional dysregulation, and short-form video addiction. A multi-group analysis was used to test for potential gender differences in the model.

RESULTS

We found that harsh fathering but not harsh mothering contributed to adolescent emotional dysregulation, which in turn predicted adolescent short-form video addiction. However, the reverse longitudinal relationships did not exist. Multiple group analyses revealed that the predictive effect of harsh fathering on adolescent emotional dysregulation was stronger in boys.

CONCLUSIONS

Our findings help clarify the complex relationships among harsh parenting, adolescent emotional dysregulation and short-form addiction, providing more effective guidance for prevention against adolescent short-form video addiction.

The impact of adverse childhood experiences on depression: the role of insecure attachment styles and emotion dysregulation strategies

Objectives: The previous studies have reported that adverse childhood experiences (ACEs) can have detrimental effects on victims' attachment styles, emotion regulation strategies and depression. How the insecure attachment styles and emotion dysregulation strategies play a role in the relationship between ACEs and depression among Chinese university students remains unclear. Methods: The research was made known to students studying at universities in China. Five hundred and eighty-nine college students completed questionnaires measuring ACEs, insecure attachment styles, emotion dysregulation strategies and depression. Sequential chain mediation model was built by Mplus. Results: The model showed that insecure attachment styles and emotion dysregulation strategies mediated the relationship between ACEs and depression respectively. Moreover, the sequential chain mediation showed an indirect path (ACEs - insecure attachment styles - emotion dysregulation strategies - depression). Conclusion: Following childhood adversities, students can experience elevated depression which is influenced by attachment styles and emotion regulation strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04613-1.

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

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

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

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

Emotional and experiential factors that determine civilizational diseases

Background

The effects of adverse childhood experiences may persist in adult life and manifest themselves in various areas of function-ing. The aim of the study was to identify the emotional and experiential factors that determine civilizational diseases and the methods of regulating emotions and functioning in society.

Participants and procedure

The surveyed group was composed of 141 adults. The respondents defined the existence of adverse experiences and their attachment styles in retrospective. The methods of regulating emotions were also measured, as well as the presence of civilizational diseases.

Results

The authors found a correlation between the style of attachment and the traumatic events experienced during the first 18 years of life and the existence of civilizational diseases. Adverse experiences in childhood and attachment styles proved to be predictors of specific social behaviour aimed at regulating emotions.

Conclusions

The results emphasised the importance of the bond with a parent and of traumatic childhood experiences for the future health condition and for the social and emotional functioning. The study demonstrated that persons who experienced traumatic events in their families or in the peer environment in the first 18 years of their lives reported the presence of civilizational diseases. A correlation was found between peer violence, the threat of being abandoned by a caregiver, and diagnosed civilizational diseases in respondents. The fearful-ambivalent style in the relationship with the father proved to be a predictor of reported civilizational diseases. Adverse childhood experiences are linked to regulating emotions by tak-ing perspective. The attachment style developed in the relationship with parents determined the ways of regulating nega-tive and positive emotions in contact with other people. Persons who developed an avoidant attachment style in the rela-tionships with the mother or the father less frequently seek social support when they experience negative emotions.

Mother and clinician experiences of a trial of a video feedback parent-infant intervention for mothers experiencing difficulties consistent with 'personality disorder': A qualitative interview study

OBJECTIVES

We explored mothers' and clinicians' experiences of a video feedback intervention adapted for perinatal 'personality disorder' (VIPP-PMH) and the acceptability of a randomised controlled trial (RCT) examining its effectiveness.

DESIGN

In-depth qualitative interviews with participants from a two-phase feasibility study of the VIPP-PMH intervention. Participants were mothers experiencing enduring difficulties in managing emotions and relationships, consistent with a 'personality disorder', and their 6- to 36-month-old children.

METHODS

Forty-four qualitative interviews were conducted, including all nine mothers receiving VIPP-PMH during the pilot phase, 25 of the 34 mothers participating in the RCT (14 allocated to the VIPP-PMH arm and 9 from the control arm), 11 of the 12 clinicians delivering VIPP-PMH and one researcher. Interview data were thematically analysed.

RESULTS

Mothers described feeling motivated to take part in the research and understood the need for randomisation. Research visits were largely experienced positively, with some suggestions for improvement in questionnaire timing and accessibility. Almost all mothers initially felt anxious about being filmed, but reported positive experiences of the intervention, particularly valuing its non-judgemental, positive and child-focussed nature, their supportive relationship with the therapist and the insights they gained on their child.

CONCLUSIONS

The findings indicate the likely feasibility and acceptability of undertaking a future definitive RCT of the VIPP-PMH intervention in this population. In designing a future trial, a positive and non-judgemental therapeutic relationship will be important to allay mothers' anxieties about being filmed, and careful consideration should be given to the timing and accessibility of questionnaires used.

Associations of peripheral blood DNA methylation and estimated monocyte proportion differences during infancy with toddler attachment style

Attachment is a motivational system promoting felt security to a caregiver resulting in a persistent internal working model of interpersonal behavior. Attachment styles are developed in early social environments and predict future health and development outcomes with potential biological signatures, such as epigenetic modifications like DNA methylation (DNAm). Thus, we hypothesized infant DNAm would associate with toddler attachment styles. An epigenome-wide association study (EWAS) of blood DNAm from 3-month-old infants was regressed onto children's attachment style from the Strange Situation Procedure at 22-months at multiple DNAm Cytosine-phosphate-Guanine (CpG) sites. The 26 identified CpGs associated with proinflammatory immune phenotypes and cognitive development. In post-hoc analyses, only maternal cognitive-growth fostering, encouraging intellectual exploration, contributed. For disorganized children, DNAm-derived cell-type proportions estimated higher monocytes -cells in immune responses hypothesized to increase with early adversity. Collectively, these findings suggested the potential biological embedding of both adverse and advantageous social environments as early as 3-months-old.

Foster children avoidance-related interactive behaviors with caregivers

BACKGROUND

A lot of the research concerning foster children - often children who have suffered maltreatment in the family home - has focused on internalized and externalized symptoms. Few studies, however, have looked at the interactions between such children and caregivers.

PURPOSE

The purpose of this study is to explore the Emotion Regulation Strategies (ERS) of children in foster care and to highlight those most commonly employed in family or placement contexts. The parents' and foster carers' ERS are also analyzed in order to understand the co-regulatory processes at work.

METHOD

An in-depth analysis of observation sequences was performed. Three data collection times, spaced across a period of 6 months (t1, t2 and t3), were included in the observation protocol. Each observation, recorded using a video camera, comprised 45 min of free time and 15 min of structured tasks. Transcription and coding of ERS were performed for each sequence using a microanalytical method. Both children's and adults' ERS were coded.

RESULTS

Children tended to be readily distracted when interacting with adults, and more particularly so with their parents. While they tended to display relatively normative processes with a foster carer, they turned to pathological avoidance mechanisms with their parents such as physical venting or self-stimulation. Interactions during structured tasks showed a significant reduction in distraction processes.

CONCLUSION

This study highlights the prevalence of distraction behavior in foster children during their interactions with caregivers, and offers an insight into how structured interactions provide a framework that mitigates children's avoidance behaviors and so enhances adult-child collaboration.

The combined contribution of maternal sensitivity and disrupted affective communication to infant attachment in an Israeli sample

Maternal sensitivity and disrupted communication are usually considered independently as antecedents of attachment security and attachment disorganization, respectively. This study examined whether considering them jointly allows specific predictions of attachment classifications. The sample (N = 159) was selected from a previous study conducted in Israel between 1991-1993, and over-represented disorganized and ambivalent attachment. Attachment was assessed at 12 months in the Strange Situation Procedure (SSP), sensitivity was assessed from free-play observations at 6 and 12 months, and disrupted communication was coded from the SSP. As hypothesized, high sensitivity and low disruption predicted secure attachment; low sensitivity and high disruption predicted disorganized-insecure attachment or ambivalent attachment; and high sensitivity and high disruption predicted disorganized-secure attachment. Low sensitivity and low disrupted communication did not predict avoidant attachment. The results show that combining maternal sensitivity and disrupted communication improves the precision in identifying maternal antecedents of attachment.

Video feedback parent-infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial

OBJECTIVES

Parents experiencing mental health difficulties consistent with "personality disorder", often related to a history of complex trauma, may face increased challenges in parent-child relationships and child socioemotional development. There are no published randomised controlled trials (RCTs) evaluating perinatal parent-child interventions for this population. We evaluated the feasibility and acceptability of undertaking an RCT of the video feedback intervention for positive parenting adapted for perinatal mental health (VIPP-PMH).

DESIGN

Feasibility study incorporating a pilot RCT.

METHODS

Mothers with enduring difficulties in managing emotions and relationships, consistent with a "personality disorder", and their 6- to 36-month old infants were randomly allocated to receive six sessions of VIPP-PMH (n = 20) or usual care alone (n = 14).

RESULTS

76% of eligible mothers consented to participate. Intervention uptake and completion rates were 95% (≥1 VIPP-PMH session) and 70% (6 sessions), respectively. Follow-up rates were 85% at month 5 and 65% at month 8 post-baseline. Blinded observer-ratings of maternal sensitivity in parent-child interaction favoured the intervention group at month 5 (RR = 1.94, 95% CI 0.67-5.63) and month 8 (RR = 1.91, 95% CI 0.68-5.33). Small changes over time in self-rated parenting confidence and stress favoured the intervention group. There were no clear intervention effects on maternal non-intrusiveness or mental health, or on child behaviour problems, emotional functioning, or self-regulation.

CONCLUSIONS

An RCT of VIPP-PMH is feasible and acceptable to implement with mothers experiencing difficulties consistent with perinatal "personality disorder". A fully powered definitive RCT should be undertaken.

Japanese infants' attachment insecurity and externalizing/internalizing problems: Using strange situation and attachment Q-sort methods

According to attachment theory, an infant-mother attachment is universal, and infants who develop an insecure attachment relationship with their mother are likely to show mental health problems compared to those who develop a secure attachment relationship. These hypotheses have been empirically supported in Western cultures. However, the cross-cultural evidence is still insufficient. The purpose of this study was to examine the association between Japanese infants' attachment insecurity and mental health problems. We studied 81 Japanese infants (M_age = 14.64 months, SD = 1.43, females = 54%) mostly from middle-class families. The Strange Situation Procedure (SSP) and Attachment Q-sort (AQS) assessed infant attachment security. Infant externalizing and internalizing problems were rated concurrently by the mother and 6 months later by the mother and another adult (father or grandmother). Japanese infants' attachment insecurity measured by the AQS was associated with their externalizing problems concurrently and 6 months later. Infants with insecure-resistant attachment measured by the SSP had higher externalizing problems compared to those with secure attachment concurrently (not 6 months later). Attachment insecurity was not related to internalizing problems. These findings partly supported the association between attachment insecurity and mental health problems. This research also recommends observing infant attachment at home.

Interaction microanalysis of foster care research using THEME

Environmental stress is a key element to the understanding of the psychopathology of children in foster care. Such children often present a wide range of symptoms from anxiety to depression, including abnormal behaviors in their interactions with adults that can be related to experience suffered in their family of origin (e.g., abandonment, abuse, etc.). Foster care should provide a safe environment, both to protect children from abuse and to help them build a well-adjusted developmental trajectory. The relationships with the family of origin may also be maintained. How do children in foster care behave in relation to caregivers given the differences between the families they grow up in? This study focuses on three adult-child relationships: those with a foster carer, a mother and a father. Each adult-child interaction was recorded several times in a day-to-day environment. On each occasion the instruction was given to behave naturally while interacting with a child. No additional material was supplied. Our observations concern the verbal and non-verbal comportment of a 4-year-old foster child named Julia when entering the study, with her caregivers. Once the principal elements had been coded (behaviors, verbalizations), a sequential behavioral patterns analysis was performed using the THEME© program. For this purpose, a 2-min interaction was chosen from the third video of an event which appeared particularly representative of the relationship between Julia and her different caregivers. According to whom Julia was with, the results reveal very different interactive processes. We observe, for example, that with the foster carer the interaction patterns were primarily focused on play objects, whereas they involved more collaborative activity with the father and distraction/avoidance behaviors with the mother. The study identifies the use of disengaging and self-exciting behaviors in all types of interaction. Those emotion regulation strategies are particularly developed during parent–child sessions, showing pathological processes of relationship.

Benchmarking Trauma in Child Welfare: A Brief Report

Trauma exposure is common; however, considerably higher rates are reported in some vulnerable groups including adults and children involved in child welfare systems. In this context, early screening and service linkage may ameliorate its negative impact on the physical and mental well-being of adults and children alike. Using data from two Ohio-based child welfare interventions targeting co-occurring maltreatment and substance use (Ohio START¹ and EPIC2), the purpose of this brief report was to first describe the rate of trauma exposure among participating adults (Adverse Childhood Experiences or ACEs, N = 402), children 0-5 years (CTAC, N = 271) and youth 6-18 years (CTAC, N = 177), and second to benchmark observed rates against reported rates in other child welfare or similar populations across the United States. Results show that adults were exposed to 4.2 ACEs on average, a 24% increase over previous child welfare estimates. While mean CTAC scores were not significantly different among young children ages 0-5, older children reported on average 5.6 exposures which is 27% higher than previously reported estimates. Our findings highlight the difference in risk profiles between families involved child welfare due primarily to substance misuse and those without substance misuse concerns, or where substance misuse was not the primary cause of entry. We discuss implications for service provision and time-sensitive child welfare requirements.

Association between poor sleep for infants to two years and subsequent mental health symptoms: A systematic review and meta-analysis

Sleep plays a complex bidirectional role in the life span of most mental health illness. How soon poor sleep becomes an indicator of future mental illness is unknown. Infant sleep is a complex concept which can impact greatly on both baby and family well-being. Thus, a systematic review and meta-analysis were conducted to investigate whether poor infant sleep to age two is associated with future mental health symptoms. A systematic search of Medline, Embase, CINAHL, PsycINFO, Web of Science and Cochrane was conducted, using PRISMA guidelines. The search resulted in 17 articles to include in this review. A combined adjusted odds ratios of 1.65 (95% CI = 1.34, 2.05) for infant sleep problems leading to subsequent mental health symptoms resulted. A variety of outcome measures for both poor infant sleep and mental health symptoms/diagnosis were used, limiting the generalisability of results. Poor sleep in infancy should be considered one of many risk factors for future mental health disorder signifying the importance of early intervention.

A modified video-feedback intervention for carers of foster children aged 6 years and under with reactive attachment disorder: a feasibility study and pilot RCT

BACKGROUND

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder. However, access to interventions varies widely and there are no evidence-based interventions for this disorder.

OBJECTIVES

(1) To adapt an existing video-feedback intervention to meet the specific needs of foster children in the UK with reactive attachment symptoms, (2) to conduct a case series to road-test the treatment manual and study procedures, (3) to conduct a scoping study of the key hurdles in a pilot trial and (4) to conduct a pilot randomised controlled trial of the adapted intervention to determine the feasibility of a future full-scale trial.

DESIGN

This was a mixed-methods study. The adapted treatment manual was developed with expert input and tested on a small case series. Qualitative interviews with key stakeholders were used in the scoping study in preparation for the trial and later with foster carers who received the new intervention. The final stage was a feasibility and pilot randomised controlled trial of the new intervention, compared with usual care. Researchers assessing the outcomes were blinded to group assignment.

SETTING

The study was set in outpatient child and adolescent mental health services and partner social services departments. Sites included urban and rural/semirural areas.

PARTICIPANTS

Participants were foster carers with children aged ≤ 6 years presenting with difficulties in the domain of reactive attachment disorder. Key stakeholders included children's services managers and mental health service practitioners in the scoping study. Foster carers who received the modified intervention participated in qualitative interviews.

INTERVENTION

The video-feedback intervention to promote positive parenting and sensitive discipline is an extensively evaluated and effective treatment approach. This intervention was modified (based on the adapted version for foster care in the Netherlands) to suit the needs of young children with reactive attachment symptoms in foster care in the UK and was delivered to improve the sensitive responding of foster carers, foster carer-child relationships and child outcomes. The modified intervention was delivered in-home by trained mental health professionals over a period of 4-6 months.

MAIN OUTCOME MEASURE

The main outcome was reactive attachment symptom scores on the Disturbances of Attachment Interview.

RESULTS

A series of minor changes to the intervention programme were introduced, which focused on improving its suitability for the UK foster care context. Challenges in recruitment meant that, despite numerous modifications to the protocol and the inclusion of additional sites, only 30 families (target, n = 40) were recruited to the randomised controlled trial (15 allocated to each group). However, most other trial parameters were deemed feasible and acceptable, particularly the high levels of data and treatment completeness. All randomised families were available for baseline analyses, but two in the treatment arm were not available for post-treatment analyses. The revised intervention was positively received by practitioners and foster carers.

LIMITATIONS

Only three-quarters of the target sample size was recruited. Furthermore, the sites' own exclusion of potential participants and the low return rates of screening questionnaires raise the possibility of non-randomness of non-responses.

CONCLUSION

A larger-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended. Central resourcing of intervention capacity to supplement NHS staff is also recommended.

TRIAL REGISTRATION

This trial is registered as ISRCTN18374094.

FUNDING

This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 35. See the NIHR Journals Library website for further project information.

Disorganized attachment behaviors in infancy as predictors of brain morphology and peer rejection in late childhood

Studies show robust links between disorganized attachment in infancy and socioemotional maladjustment in childhood. Little is known, however, about the links between disorganized attachment and brain development, and whether attachment-related differences in brain morphology translate into meaningful variations in child socioemotional functioning. This study examined the links between infants' disorganized attachment behaviors toward their mothers, whole-brain regional grey matter volume and thickness, and peer rejection in late childhood. Thirty-three children and their mothers took part in this study. The Strange Situation Procedure was used to assess mother-infant attachment when infants were 18 months old. Magnetic resonance imaging was performed when they were 10 years old to assess cortical thickness and grey matter volumes. Children and teachers reported on peer rejection 1 year later, as an indicator of socioemotional maladjustment. Results indicated that disorganized attachment was not associated with grey matter volumes. However, children who exhibited more disorganized attachment behaviors in infancy had significantly thicker cortices in bilateral middle and superior frontal gyri, and extending to the inferior frontal gyrus, as well as the orbitofrontal and insular cortices in the right hemisphere in late childhood. Moreover, children with thicker cortices in these regions experienced greater peer rejection, as rated by themselves and their teachers. Although preliminary, these results are the first to indicate that disorganized attachment may play a role in cortical thickness development and that changes in cortical thickness are associated with differences in child socioemotional functioning.

A Prospective Longitudinal Study of Mother-Child Attachment and Externalizing Trajectories in Boys and Girls

In clinically referred children, boys and those with disorganized mother-child attachments tend to show the most maladaptive externalizing trajectories; however, additional research is necessary to test whether these findings hold in a community sample. Therefore, 235 community children (106 boys) were followed from ages 6 to 15 years across six time points. Multiple-group linear growth curves with mother-child attachment as a time-invariant covariate were fit to the data to explore externalizing trajectories for boys and girls. Results showed that boys had higher initial externalizing levels than girls, and children generally experienced a decline in symptoms over time. No significant trajectory differences were found for girls, and boys with different attachment classifications did not differ on their initial externalizing levels; however, boys with avoidant attachments (with resistant attachments trending) experienced a steeper decline in externalizing symptoms longitudinally. Implications for intervention and prevention are discussed.

Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology

Introduction

Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach.

Methods

Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood.

Results

Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences.

Conclusion

We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.

Effect of Attachment and Child Health (ATTACHTM) Parenting Program on Parent-Infant Attachment, Parental Reflective Function, and Parental Depression

High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACHTM, a 10−12 session manualized one-on-one parental Reflective Function (RF)-based parenting program designed for high-risk families. Outcomes of parent-child attachment and parental RF were assessed via the Strange Situation Procedure (SSP) and Reflective Function Scale (RFS), respectively. The protective role of ATTACHTM on parental depression was also assessed. Data were available from caregivers and their children < 6 years of age who participated in five pilot randomized control trials (RCTs) and quasi-experimental studies (QES; n = 40). Compared with the control group, caregivers who received the ATTACHTM-program demonstrated a greater likelihood of secure attachment with their children (p = 0.004) and higher parental RF [self (p = 0.004), child (p = 0.001), overall (p = 0.002)] in RCTs. A significant improvement in parental RF (p = 0.000) was also observed in the QES within ATTACHTM group analysis. As attachment security increased, receiving the ATTACHTM program may be protective for depressed caregivers. Results demonstrated the promise of ATTACHTM for high-risk parents and their young children.

The role of attachment to the foster parent with regard to suicidal risk among adult survivors of childhood maltreatment

BACKGROUND

Childhood maltreatment is associated with an increased risk of insecure/disorganized attachment and in turn with suicidal risk (SR). Out-of-family placement is aimed at interrupting child exposure to further abuse and at providing the necessary security for proper development via the establishment of an alternative attachment relationship. However, the actual protective role of this type of care is not clear given the high rates of SR among institutionalized or foster children.

OBJECTIVE

The aim of this study was to examine whether 1) attachment to the biological parents mediates the association between abuse and SR and 2) attachment to a foster parent (whether from a foster home or an institution) moderates the effect of attachment to biological parents on SR.

PARTICIPANTS

The sample consisted of 77 adults (52 female; 25 male; mean age: 26.6 years) who received out-of-home care during childhood.

METHOD

The Childhood Trauma Questionnaire and the Mini International Neuropsychiatric Interview (for SR) were used. The Attachment Multiple Model Interview was also administered to assess attachment to each biological parent and to the foster parent.

RESULTS

Results show that attachment (security and disorganization) to the biological mother mediates the link between abuse and SR and that attachment to the foster parent moderates the link between attachment to the biological mother and SR.

CONCLUSIONS

Findings point to the importance of interventions aimed at supporting the establishment of a secure attachment relationship between children in care and their foster parents.

The role of multiple attachments in intergenerational transmission of child sexual abuse among male victims

BACKGROUND

According to Finkelhor (1984), difficulties child sexual abusers have in establishing adaptive adult relationships are a consequence of attachment problems with parents. Research shows that insecure attachment is associated with both the experience of child sexual abuse (CSA) as a victim and perpetration of CSA as an adult. Attachment may thus be a key factor in intergenerational transmission (IT) of CSA.

OBJECTIVE

The study aims to examine the direct, interactive, and mediated effects linking attachment in different relationships (mother, father, romantic partner) to IT of CSA among male victims.

PARTICIPANTS AND SETTING

Thirty-two abusing and 27 non-abusing male CSA survivors were recruited, respectively, in a prison and via networks of former foster children or CSA victims.

METHOD

All participants completed the Attachment Multiple Model Interview to assess attachment along four dimensions (security, deactivation, hyperactivation, and disorganization) in the relationship with mother, father, and partner.

RESULTS

Partial least square modeling suggests that the partner carries forward (mediates) the increased risk of committing sexual abuse associated with insecure/disorganized attachment with the father. A significant partner-mother interaction also suggests that the deleterious effects of attachment to the mother in terms of committing CSA are countered by more secure/organized attachment to the partner.

CONCLUSIONS

Findings highlight the pivotal role of the romantic partner in IT of CSA. Beyond early intervention, therapy in adulthood aimed at fostering adaptive ways of finding emotional security in the relationship with an adult could thus be encouraged.

The Experiences of Parents and Infants Using a Home-Based Art Intervention Aimed at Improving Wellbeing and Connectedness in Their Relationship

During the period of COVID-19 restrictions, we offered vulnerable families with 0 to 3 year old children boxes of art resources and guided creative activities to do together at home. This paper explores families' experiences of this intervention, highlighting their perceptions of change in wellbeing and attachment. There is a developing case for the social benefits of art, including the impact of arts on mental health and on the wellbeing of children. However, we know that social factors impact upon arts participation, and existing inequalities and mental health difficulties have been exacerbated in the context of the pandemic. This project aimed to adapt to restrictions, to provide a meaningful remote intervention, supporting parent-infant dyads to have positive interactions through art making. We sought to explore the benefits of this intervention for infants and parents with a view to understanding more about the psychological benefits of art participation and about ways to engage families into art making, as well as thinking about how best we can evidence these kinds of arts in health interventions. Preliminary findings showed promising outcomes from the art boxes and this paper brings together the full results, primarily based on interviews with sixteen parents and four referrers alongside collected feedback. We highlight potential mechanisms for change within the intervention and detail the perceived impact of the art boxes in supporting attachment. Parents felt that the art-boxes facilitated changes in their own wellbeing that would make them more available to connection, and recognised changes for babies that reflected their increased capacity to mentalise about their child. Importantly, there were also concrete changes for the dyad that represented improved connection, such as more playful time together and increased shared attention and eye contact. Our observations suggest that the quality of the parent-infant relationship benefited from home-based art intervention, and we speculate about the potential efficacy of this approach beyond the pandemic.

Child attachment in adjusting the species-general contingency between environmental adversities and fast life history strategies

Extrinsic mortality risks calibrating fast life history (LH) represent a species-general principle that applies to almost all animals including humans. However, empirical research also finds exceptions to the LH principle. The present study proposes a maternal socialization hypothesis, whereby we argue that the more human-relevant attachment system adds to the LH principle by up- and down-regulating environmental harshness and unpredictability and their calibration of LH strategies. Based on a longitudinal sample of 259 rural Chinese adolescents and their primary caregivers, the results support the statistical moderating effect of caregiver-child attachment on the relation between childhood environmental adversities (harshness and unpredictability) and LH strategies. Our theorizing and findings point to an additional mechanism likely involved in the organization and possibly the slowdown of human LH.

The Personal Sociability and Connections Scale (PeSCS): Development and initial assessment at a primary care facility

PURPOSE

An individual's lack of social connections and social isolation is often associated with feelings of loneliness which is regarded as having a negative effect on health. This paper describes the development and assessment of a 10 item 'Personal Sociability and Connections Scale' (PeSCS) to measure individual's disposition and accompanying skills to seek out companionship and engage in interpersonal relations.

METHODS

The study was conducted at a rural primary care unit in Northern Greece. A total of 199 attenders were recruited over a 6-week period in 2020 and questionnaires completed. This informed the 10-items PeSCS that comprises Social, Behavioral, and Emotional components focusing on the expression of social comfort, willingness to share experiences, stories and concepts, and feelings of similarity at first contact. Reliability of the PeSC scale was assessed and the relationship with scale scores examined as an indicator of convergent validity. A multivariate linear regression analysis was performed to examine the relationship of PeSC scale score with the characteristics of participants.

RESULTS

Assessment of reliability of PeSC scale produced a Cronbach's alpha of 0.809. The relationship between components and the total PeSCS scores identified significant correlations (p < .001). At a multivariate level, male gender was the sample characteristic with a significant association with scale levels (p < .05) and higher annual income with Social component (p < .05). Otherwise the distribution of sociability dispositions was similar across population groups.

CONCLUSION

The 10-item PeSC scale forms a simple and quick to complete measure whose overall reliability was rated as 'meritorious'. The PeSC instrument may be a useful tool for assessing the causes and appropriate responses to the negative health effects of loneliness and social isolation.