Interventions with video feedback and attachment discussions: Does type of maternal insecurity make a difference?

Parents' insecure representations of attachment are associated with lower parental sensitivity and insecure infant–parent attachment relationships, leading to less optimal conditions for the children's socio-emotional development. Therefore, two types of short-term intervention were implemented in a group of lower middle-class mothers with an insecure representation of attachment as assessed with the Adult Attachment Interview. In one group of mothers, the intervention efforts were directed at promoting maternal sensitivity by means of written information about sensitive parenting and personal video feedback. In the other group, additional discussions about the mothers' early attachment experiences took place, aiming at affecting the mothers' attachment representation. The interventions were implemented during four home visits between the 7th and the 10th month after the baby's birth. Preliminary results on 30 mothers pointed at an intervention effect: Mothers in both intervention groups were more sensitive at 13 months than mothers in a control group, t(28) = −2.3, effect size d = .87, p = .01. Mothers who were classified as insecure dismissing tended to profit most from video feedback, whereas mothers who were classified as insecure preoccupied tended to profit most from video feedback with additional discussions about their childhood attachment experiences, F(1,16) = 1.9, d = .65, p = .19. © 1998 Michigan Association for Infant Mental Health     

Non-verbal and verbal parental mentalization as predictors of infant attachment security: Contributions of parental embodied mentalizing and mind-mindedness and the mediating role of maternal sensitivity

Interest in studying the relative contributions of verbal (e.g., maternal mind-mindedness [MM]) and non-verbal dimensions (i.e., parental embodied mentalizing [PEM]) of parental mentalization to child socio-emotional development is relatively recent. To date, only one study has addressed this issue in relation to child attachment security, suggesting a complementary and unique contribution of each one. The purpose of the present study was to further examine the specific contribution of PEM to infant attachment security by considering MM. In addition, this study aimed to explore the mediating role of maternal sensitivity linking PEM, MM to infant attachment security within 110 mother-infant dyads at moderate psychosocial risk. The two dimensions of parental mentalization (PEM and MM) were assessed on the basis of observations made during a videorecorded sequence of mother-child interactions in a context of free play with and without toys when the infants were 8 months old. The Maternal Behavior Q-Sort was used to measure the mothers’ sensitivity in a natural setting based on observations of daily mother-child interactions, also when the infants were about 8 months old. Attachment security was measured using The Strange Situation Procedure at infant age 16 months. The results showed positive correlations between maternal sensitivity and both verbal and non-verbal measures of parental mentalization. The mediation analyses first revealed that PEM had a significant indirect effect on attachment security, with sensitivity being identified as a mediator in this association. No indirect effect linking MM and attachment security via sensitivity was observed. These results highlight the contribution of PEM to maternal sensitivity and show maternal sensitivity to be a factor that partly explains the influence of PEM on attachment security in children.     

Examining antecedents of infant attachment security with mothers and fathers: An ecological systems perspective

Taking an ecological systems perspective, early parent–child relationships can be affected by interactions between systems where some are more proximally linked to the child than others. Socioeconomic status, a distal factor, is associated with social functioning during childhood, but research on its association with functioning during infancy, particularly attachment, is scant and inconsistent. Moreover, it is not clear how distal factors affect infant functioning. Other systems such as marital adjustment and parenting may moderate or mediate relations between distal factors and infant attachment. The current longitudinal study (n = 135) examined the role of various systems – parental resources, marital functioning, parental sensitivity and involvement – in early infancy (3-, 5-, 7-months) on infant–mother (12-months) and infant–father (14-months) attachment security. Findings supported moderating processes but in different ways for infant–mother versus infant–father dyads. Implications for future studies and interventions are discussed.     

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

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

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.     

Disorganized infant attachment and preventive interventions: A review and meta‐analysis

Infant disorganized attachment is a major risk factor for problematic stress management and later problem behavior. Can the emergence of attachment disorganization be prevented? The current narrative review and quantitative meta‐analysis involves 15 preventive interventions (N = 842) that included infant disorganized attachment as an outcome measure. The effectiveness of the interventions ranged from negative to positive, with an overall effect size of d = 0.05 (ns). Effective interventions started after 6 months of the infant's age (d = 0.23). Interventions that focused on sensitivity only were significantly more effective in reducing attachment disorganization (d = 0.24) than interventions that (also) focused on support and parent's mental representations (d = ?0.04). Most sample characteristics were not associated with differences in effect sizes, but studies with children at risk were more successful (d = 0.29) than studies with at‐risk parents (d = ?0.10), and studies on samples with higher percentages of disorganized attachment in the control groups were more effective (d = 0.31) than studies with lower percentages of disorganized children in the control group (d = ?0.18). The meta‐analysis shows that disorganized attachments may change as a side effect of sensitivity‐focused interventions, but it also illustrates the need for interventions specifically focusing on the prevention of disorganization.     

INSIGHTFULNESS AND LATER INFANT ATTACHMENT IN CLINICALLY DEPRESSED AND NONCLINICAL MOTHERS

The aim of this pilot study was to investigate the relationship between maternal insightfulness and sensitivity and subsequent infant attachment security and disorganization in clinically depressed and nonclinical mother–infant groups. Nineteen depressed mothers with infants ages 3 to 11 months participated in this study. Twenty nonclinical mother–infant dyads were matched to the clinical sample according to infant sex and age. Maternal depression was assessed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994), insightfulness using the Insightfulness Assessment (IA), and sensitivity using the Maternal Sensitivity Scales (M.D.S. Ainsworth, 1969). IA classifications and subscales were considered separately. Later infant attachment was assessed by the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978). Depressed mothers tended to have less securely attached children than did nonclinical mothers. Within the clinical sample, the insightfulness categories correlated slightly moderately with attachment security, but were not related to attachment disorganization. Within the nonclinical sample, the IA categories were slightly moderately associated with attachment security and with disorganization. On IA subscales, relationship patterns differed in clinically depressed and nonclinical mother–infant dyads. These findings provide the first evidence of the predictive power of the IA categorization and subscales on subsequent infant attachment. They also may allow the development of different foci of intervention for enhancing insightful caregiving.     

On the relation between maternal state of mind and sensitivity in the prediction of infant attachment security

Attachment theorists assume that maternal mental representations influence responsivity, which influences infant attachment security. However, primary studies do not support this mediation model. The authors tested mediation using 2 mother-infant samples and found no evidence of mediation. Therefore, the authors explored sensitivity as a moderator, studying the (a) interaction of mental representation and sensitivity as it predicts infant attachment security and (b) level of sensitivity in mothers whose infants' attachment security is either concordant or discordant with their own. The interactional analyses were not significant. But the match-mismatch data showed that when mother-infant attachment strategies were discordant, maternal sensitivity was more consistent with infant than maternal attachment strategy. These findings are congruent with an interpretation of sensitivity as a moderator that can block transmission of attachment strategy.     

Early Temperament and Attachment Security with Mothers and Fathers as Predictors of Toddler Compliance and Noncompliance

This longitudinal study (n = 106) examined associations between temperament, attachment, and styles of compliance and noncompliance. Infant negative temperamental reactivity was reported by mothers at 3, 5 and 7 months. Infant attachment was assessed (Strange Situation) at 12 (mothers) and 14 months (fathers). Toddlers' styles of compliance/noncompliance were measured using two laboratory contexts (clean‐up/delay) at 20 months. Results indicated that temperament and attachment predicted toddler behaviour. Toddlers who were secure with mothers and low in temperamental negative reactivity showed more committed compliance than those who were insecure and low in negative reactivity or secure and high in negative reactivity. In addition, interactions revealed that relations between infant–mother attachment and defiance depended on infant–father attachment security, temperament and context. Findings highlight the differential and complex roles of temperament and attachment as potential precursors of later social competence. Copyright © 2013 John Wiley & Sons, Ltd.     

Effects of Early Parenting Interventions on Parents and Infants: A Meta-Analytic Review

This systematic review evaluates the efficacy of parenting interventions on parent, infant and parent-infant relationship outcome measures for parents of infants under 12 months old. Parent outcomes examined included competence, and confidence; baby outcomes included infant behaviours of crying, settling, and sleeping problems and parent-infant relationship outcomes included parental responsiveness. Systematic searches of five databases were carried out. In total, 36 randomised controlled trials over the past 35 years were included in the meta-analyses, with a total of 4880 participants. Interventions were carried out either during pregnancy or within the first 12 months after birth and involved teaching specific strategies and provision of information on infant development and behaviour. Mean effect sizes were obtained using a structural equation modelling (SEM) approach to meta-analysis. Heterogeneity was found on parent responsiveness and infant sleep. Potential moderator variables were assessed for these two outcomes using the SEM approach. Results showed that early parenting interventions are effective in improving parental responsiveness (d?=?0.77), and improving or preventing infant sleep problems (d?=?0.24), but not crying problems (d?=?0.27) possibly due to low power. No conclusions could be drawn in regards to parental competence or confidence. Moderator analysis showed that for interventions aimed at improving responsiveness, briefer interventions were more effective than longer ones; and studies published more recently reported smaller effects than older studies. No other moderators influenced the assessed intervention outcomes. The findings of this study provide further evidence for the positive effects of early parenting interventions for infants under 12 months of age, however future research is needed to assess intervention effects on parental competence and confidence.     

My mother is sensitive,but I am too tired to know: Infant sleep as a moderator of prospective relations between maternal sensitivity and infant outcomes

This study investigated the moderating role of infant sleep in the connections between maternal sensitivity and three indicators of infant functioning: attachment security, theory of mind, and executive functioning (EF). Maternal sensitivity was assessed when infants (27 girls and 36 boys) were 1 year of age. Infant sleep was assessed with actigraphy at age 2; attachment security, theory of mind, and EF were also assessed at age 2. Results indicated that maternal sensitivity was positively related to attachment security only among infants who got more sleep at night, and to conflict-EF and theory of mind only for infants who got greater proportions of their sleep during the night. These results suggest that sleep may enhance the benefits of maternal sensitivity for some aspects of infants’ functioning, providing further support for the importance of sleep maturation as a salient developmental task of infancy.     

Which preventive interventions effectively enhance depressed mothers' sensitivity? A meta‐analysis

Improving depressed mothers' sensitivity is assumed to be a key element in preventing adverse outcomes for children of such mothers. This meta‐analysis examines the short‐term effectiveness of preventive interventions in terms of enhancing depressed mothers' sensitivity toward their child and investigates what type of intervention is most effective. Thirteen interventions, reported in 10 controlled outcome studies, met the inclusion criteria (N = 918). Meta‐analytic results showed a small to medium, significant mean effect size (g = 0.32) with large variation in individual effect sizes (?0.56–1.76). Interventions including baby massage were highly effective in improving maternal sensitivity (g = 0.85). In contrast, individual therapy for the mother proved ineffective in terms of improving maternal sensitivity (g = ?0.00). Two other significant predictors of greater effect sizes were the inclusion of a support group and the use of a higher number of intervention methods; however, the significance of these results was largely accounted for by one single study. Our meta‐analysis confirms that depressed mothers' sensitivity can be improved by preventive intervention and suggests that baby massage may be an effective intervention method to evoke short‐term changes in maternal sensitivity. It is unclear whether these changes are maintained over time.     

Infant carrying as a tool to promote secure attachments in young mothers: Comparing intervention and control infants during the still-face paradigm

Infants of adolescent mothers have a greater risk of developing insecure attachment types and attachment disorders into adulthood. Previous research suggests that skin-to-skin contact predicts secure attachment; however, it is largely unknown whether infant carrying or “babywearing” has similar benefits. We hypothesized that adolescent mothers (Mage=19.1 years, SD = 2.0; 40.6 % Hispanic; 40 %< = 11th grade) who were randomly assigned to an infant carrying condition at 2–4 weeks’ post-partum (n = 16; 1 h daily for 3 months), compared to a control group (n = 17; reading), would be more likely to have securely attached infants at 7 months (M = 29.0 weeks, SD = 3.4). We coded infant gaze orientation, fretfulness, affect, self-soothing behaviors, and vocalizations in the reunion phase of the Still-Face Paradigm, and used an algorithm derived from the infant Global Rating Scales to determine attachment type. Infants in the intervention condition were more likely to have secure attachments and less likely to have disorganized attachments compared to the control condition. Hours spent babywearing was positively correlated with secure attachment, r_pb = .40, and negatively correlated with disorganized attachment, r_pb =−0.36. There were no statistically significant differences between the conditions or babywearing hours for avoidant or resistant attachment types. The results suggest that infant carrying may be an effective tool at promoting secure attachments, particularly for mothers and infants at greater risk for attachment insecurity.     

Another look inside the gap: ecological contributions to the transmission of attachment in a sample of adolescent mother-infant dyads

Ecological contributions to attachment transmission were studied in a sample of 64 adolescent mother-infant dyads. Maternal sensitivity was assessed when infants were 6 and 10 months old, and infant security was assessed at 15 and 18 months. Maternal attachment state of mind was measured with the Adult Attachment Interview (AAI) after the 1st assessment. Ecological variables considered were maternal education and depression, paternal support, and infant maternal grandmother support. Results indicated that when the contribution of ecological variables was statistically controlled for, sensitivity was a significant mediator and state of mind no longer contributed to infant security. Sensitivity also mediated an association between maternal education and infant attachment, suggesting that attachment transmission is embedded in a more global process of infant attachment development.     

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents’ psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers’ prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents’ reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.     

AQS security scores: What do they represent? A study in construct validation

In a sample of 129 Dutch 15‐month‐old infants, attachment security was assessed both with the Attachment Q‐Set (AQS; Waters, 1995) and with a short version of Ainsworth, Blehar, Waters, and Wall's (1978) Strange Situation (SSS). Infants classified as secure using the SSS had significantly higher AQS scores than insecure and disorganized infants in particular. At the AQS item level, disorganized infants were described as significantly more noncompliant, fussy, and angry relative to secure infants. When security as assessed using the SSS was controlled, the observed quality of parental interactive behavior, parental ego‐resilience, high levels of infant task orientation and pleasure, and low levels of infant anger proneness were found to explain significant and unique portions of the variance in the AQS security scores. The apparently unfavorable set of characteristics associated with low AQS security scores suggests such scores to predict later developmental problems. ©2004 Michigan Association for Infant Mental Health.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Infant emotion regulation: Relations to bedtime emotional availability,attachment security,and temperament

The present study examines the influences of mothers’ emotional availability toward their infants during bedtime, infant attachment security, and interactions between bedtime parenting and attachment with infant temperamental negative affectivity, on infants’ emotion regulation strategy use at 12 and 18 months. Infants’ emotion regulation strategies were assessed during a frustration task that required infants to regulate their emotions in the absence of parental support. Whereas emotional availability was not directly related to infants’ emotion regulation strategies, infant attachment security had direct relations with infants’ orienting toward the environment and tension reduction behaviors. Both maternal emotional availability and security of the mother–infant attachment relationship interacted with infant temperamental negative affectivity to predict two strategies that were less adaptive in regulating frustration.     

Mother's attachment representations of their premature infant at 6 and 18 months after birth

The effects of premature birth on attachment have generally been examined from the infant's perspective. There is a lack of data concerning parental attachment representations toward a premature child. Because of the psychological stress engendered in parents confronted with a premature birth, we hypothesized that their attachment representations would be altered during the first months after the hospital discharge. Fifty families with a premature infant (25–33 gestation weeks) and a control group of 30 families with a full‐term infant participated to the study. Perinatal risks were evaluated during hospitalization. To assess mothers' representations of their infant, the Working Model of the Child Interview (WMCI, Zeanah & Benoit, 1995 & Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997) were administered when their children were 6 and 18 months old. The severity of the perinatal risks was found to have an impact on the mothers' attachment representations. At six months, only 20% of the mothers of a prematurely born infant (30% at 18 months) had secure attachment representations, vs. 53% for the control group (57% at 18 months). Furthermore, mothers of low‐risk premature infants more often had disengaged representations, whereas distorted representations were more frequent in the high‐risk group of premature children. These findings suggest that the parental response to a premature birth is linked to the severity of postnatal risks. The fact that secure attachment representations are affected in mothers of low‐risk infants just as much as they are in mothers of high‐risk infants points to the need to conduct further studies aimed at evaluating whether preventive intervention for both low‐risk and high‐risk premature will be helpful.