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.     

Physical growth delays and stress dysregulation in stunted and non-stunted Ukrainian institution-reared children

To study the effect of institutional rearing on physical growth and stress regulation we examined 16 institution-reared children (3–6 years old) in Ukraine and compared them with 18 native family-reared children pair-matched on age and gender. Physical growth trajectories were examined on the basis of archival medical records and current measurements of height, weight, and head circumference. Stress regulation was studied on the basis of diurnal salivary cortisol sampled six times during 1 day. 31% of institution-reared children were stunted at 48 months whereas none of the family-reared children were. Substantial delays in physical growth were observed in institution-reared children especially during the first year of life. From 24 months onwards a tendency for improvement in physical growth was evident among the temporarily stunted institution-reared children, with complete catch-up in weight and partial catch-up in height by the time of assessment. Chronically stunted institution-reared children demonstrated persistent severe growth delays. Institution-reared and family-reared children showed similar patterns of diurnal cortisol production with decreases over the day. However, temporarily stunted institution-reared children had a significantly higher total daily cortisol production than both chronically stunted institution-reared children and family-reared children. These data confirm previous findings regarding physical growth delays and stress dysregulation associated with institutional care, but also point to differences in cortisol production between stunted and non-stunted institution-reared children.     

Differential susceptibility to discipline: the moderating effect of child temperament on the association between maternal discipline and early childhood externalizing problems.

This study investigated the interaction of child temperament and maternal discipline in the prediction of externalizing problems in early childhood. Interaction effects were evaluated in a sample of 227 one- to three-year-old children with relatively high externalizing problems scores on the Child Behavior Checklist/1 1/2-5. Child temperament was reported by the mothers, maternal discipline was observed in a laboratory session, and child outcome measures included both mother-reported externalizing problems and observed physical aggression. Results indicate that children with difficult temperaments are more susceptible to negative discipline (i.e., they showed more externalizing problems) as well as more susceptible to positive discipline (i.e., they showed fewer externalizing problems and less physical aggression), as compared with children with relatively easy temperaments. These findings provide empirical evidence for the differential susceptibility hypothesis and suggest directions for enhancing the effectiveness of interventions aimed at reducing early childhood externalizing problems.     

The many faces of the Still-Face Paradigm: A review and meta-analysis

The Still-Face Paradigm (SFP) designed by Tronick, Als, Adamson, Wise, and Brazelton (Tronick, E., Als, H., Adamson, L., Wise, S., & Brazelton, T. B. (1978). Infants response to entrapment between contradictory messages in face-to-face interaction. Journal of the American Academy of Child and Adolescent Psychiatry, 17, 1–13) has been used for many different purposes in over 80 empirical studies. In the current paper, the nature and correlates of infant behavior in the SFP were examined in a systematic narrative review and a series of meta-analyses. The results of the meta-analyses confirmed the classic still-face effect of reduced positive affect and gaze, and increased negative affect, as well as a partial carry-over effect into the reunion episode consisting of lower positive and higher negative affect compared to baseline. The still-face effect is very robust as it was found regardless of most sample variations such as infant gender and risk status, and regardless of most procedural variations, such as the length of the SFP episodes and the use of intervals between episodes. The few moderator effects that were found in the meta-analyses tended to put findings from the narrative review in a new perspective. Additional meta-analyses confirmed the narrative review in finding that higher maternal sensitivity predicted more infant positive affect during the still-face. Infants’ higher positive affect and lower negative affect during the still-face were predictive of secure attachment at age 1 year. The meta-analytic results for maternal depression were equivocal. Implications for future research include a need for studies testing the role of the adults’ identity (parent versus stranger, mother versus father) to elucidate the relationship-specificity of the still-face effect. Also, the role of maternal sensitivity and temperament as potential moderators of the still-face effect need to be examined further. On a procedural level, the effects of the timing of the still-face and of the duration of the reunion on infant responses deserve future research attention.     

Parental loss of close family members and propensities towards absorption in offspring

Parental unresolved/disorganized responses to loss assessed in the Adult Attachment Interview predict infant disorganized (D) attachment. Parental experiences of loss near the birth of an infant should therefore increase the likelihood of D attachment to that parent. Liotti (1992) suggested that D attachment may increase tendencies to altered states of consciousness, and some support for this hypothesis has been obtained in clinical and high-risk samples. Here, Tellegen's Absorption Scale was used to measure propensities to altered consciousness in two low-risk samples of young adults (N=136, N=308). In both studies, participants whose parents experienced familial loss within two years of their birth showed elevated levels of absorption. These outcomes (a) support the proposed connection between disorganized attachment and tendencies to altered consciousness, and (b) suggest that queries regarding parental loss experiences should be further explored as a ‘rough and ready’ estimate of disorganized attachment in large-scale studies.     

Bowlby before Bowlby: The sources of an intellectual departure in psychoanalysis and psychology

John Bowlby's first scientific papers express a viewpoint of the etiology of childhood disorders that gradually developed during his university years and the first years of his professional life. As becomes clear from, among other things, Bowlby's private correspondence, it was the period spent as a student at Cambridge, his work as a teacher at two progressive schools, and his work at a child guidance clinic that allowed him to articulate a view on childhood deviancy that was at variance with the Kleinian variant of psychoanalysis. Bowlby's position as an ‘independent’ thinker in the British Psycho-Analytical Society can be understood against the background of these intellectual influences. © 1998 John Wiley & Sons, Inc.     

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.     

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     

Balancing the family and the collective in raising children: why communal sleeping in kibbutzim was predestined to end

This article integrates research data about attachment in kibbutz-raised children with a review of the socio-historical processes that shaped the interrelations between the kibbutz family and the collective and influenced childrearing practices. It uses systems theory to evaluate the changing practices of kibbutz childrearing with particular focus on communal sleeping for infants and children away from their parents, and its impact on the formation of attachment relations to parents and caregivers, transmission of attachment across generations, and later school competence. It argues that artificial childrearing practices such as communal sleeping for infants and children created a unique and unprecedented "social experiment in nature," which, from the perspective of attachment theory, was predestined to be discontinued because it betrayed the essential attachment needs of most parents and children.     

Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study

This meta-analysis of 172 studies (N = 2,263 anxious,N = 1,768 nonanxious) examined the boundary conditions of threat-related attentional biases in anxiety. Overall, the results show that the bias is reliably demonstrated with different experimental paradigms and under a variety of experimental conditions, but that it is only an effect size of d = 0.45. Although processes requiring conscious perception of threat contribute to the bias, a significant bias is also observed with stimuli outside awareness. The bias is of comparable magnitude across different types of anxious populations (individuals with different clinical disorders, high-anxious nonclinical individuals, anxious children and adults) and is not observed in nonanxious individuals. Empirical and clinical implications as well as future directions for research are discussed.