Taking perspective on attachment theory and research: nine fundamental questions.

Since its inception more than 50 years ago, attachment theory has become one of the most influential viewpoints in the behavioral sciences. What have we learned during this period about its fundamental questions? In this paper, we summarize the conclusions of an inquiry into this question involving more than 75 researchers. Each responded to one of nine "fundamental questions" in attachment theory. The questions concerned what constitutes an attachment relationship, how to measure the security of attachment, the nature and functioning of internal working models, stability and change in attachment security, the legacy of early attachment relationships, attachment and culture, responses to separation and loss, how attachment-based interventions work, and how attachment theory informs systems and services for children and families. Their responses revealed important areas of theoretical consensus but also surprising diversity on key questions, and significant areas of remaining inquiry. We discuss central challenges for the future.

Preventing early harsh parenting and toddler behavior problems: The role of neighborhood collective efficacy among low-income Latine families.

Harsh parenting behaviors are alarmingly prevalent during infancy and toddlerhood. From an ecological perspective, predicting and preventing harsh parenting requires probing not only micro- and exosystem-level processes but also the interactions among them. In the current longitudinal study, we examined associations among maternal depressive symptoms, harsh parenting, and neighborhood collective efficacy in 142 low-income Latina mothers and their infants (Mchild age = 14.11 months, SD = 3.60). We hypothesized that there would be a mediated pathway from maternal depressive symptoms to harsh parenting to toddler behavior problems, and that neighborhood collective efficacy would moderate this pathway. As predicted, maternal depressive symptoms predicted toddler behavior problems, and harsh parenting significantly mediated this association. Moreover, neighborhood collective efficacy was a significant moderator such that this indirect pathway was maintained in the context of low neighborhood collective efficacy only. When collective efficacy was high, this pathway was not significant. Results are discussed in terms of the buffering potential of neighborhood collective efficacy. Tentative implications for leveraging neighborhood supports to prevent early harsh parenting are suggested.

Las duras conductas de crianza son alarmantemente prevalentes durante la infancia y la primera etapa de la niñez. Desde una perspectiva ecológica, predecir y prevenir la dura crianza requiere investigar no sólo los procesos de micro niveles y niveles de exosistemas, sino también las interacciones entre ellos. En el presente estudio longitudinal, examinamos las asociaciones entre los síntomas depresivos maternos, la dura crianza y la colectiva efectividad del vecindario en 142 mujeres latinas de bajos recursos económicos y sus infantes (M edad del niño = 14.11 meses, SD = 3.60). Nuestra hipótesis fue que habría un camino mediador entre los síntomas depresivos maternos y la dura crianza y los problemas de conducta del pequeño infante, y que la efectividad colectiva del vecindario moderaría este camino. Tal como se predijo, los síntomas depresivos maternos predijeron los problemas de conducta de los pequeños infantes, y la dura crianza significativamente medió esta asociación. Es más, la efectividad colectiva del vecindario fue un moderador significativo, de tal manera que este indirecto camino se mantuvo sólo dentro del contexto de la baja efectividad colectiva del vecindario. Cuando la efectividad colectiva fue alta, este camino no fue significativo. Los resultados se discuten en términos de la potencialidad amortiguadora de la efectividad colectiva del vecindario. Se sugieren tentativas implicaciones para la nivelación de los apoyos del vecindario para prevenir una temprana dura crianza.

Des comportements de parentage durs sont extrêmement prévalents durant la petite enfance (bébés et jeunes enfants). D'une perspective écologique, prédire et prévenir le parentage dur exige un examen non seulement des processus au niveau du microsystème et de l'exosystème mais aussi des interactions entre ces systèmes. Dans cette étude longitudinale nous avons examiné les liens entre les symptômes dépressifs maternels, le parentage dure et l'efficacité collective du voisinage chez 142 mères hispaniques ayant de faibles revenus et leurs bébés (M âge de l'enfant = 14,11 mois, SD = 3,60). Nous avons pris comme hypothèse qu'il y aurait une voie de médiation des symptômes dépressifs maternels au parentage dur et aux problèmes de comportement du petit enfant, et que l'efficacité collective du voisinage modérerait cette voie. Comme on l'avait prédit les symptômes dépressifs maternels ont prédit les problèmes de comportement du petit enfant, et le parentage dur a médiatisé ce lien. De plus, l'efficacité collective du voisinage s'est avéré être un modérateur important, à un tel point que cette voie indirecte était maintenue dans le contexte d'une efficacité collective de voisinage même faible. Quand l'efficacité collective était élevée cette voie n'était pas importante. Les résultats sont discutés en termes de potentiel de mise en tampon de l'efficacité collective du voisinage. De possibles implications pour tirer partie des soutiens des voisinages afin de prévenir un parentage dur précoce sont suggérées.

The value added of attachment theory, research, and intervention for US child care and early childhood education: Reflecting and carrying forward the legacy of Edward Zigler.

Edward Zigler pioneered and insisted upon the integration of science, practice, and policy development to support vulnerable children and families, reduce poverty, and improve US wellbeing, writ large. His far-reaching scholarship in turn critically shaped developmental science and US policy in multiple areas. This review reflects upon Zigler's influence on US child care, Head Start, Early Head Start, and prekindergarten programs. It describes the integration of one major area of developmental science, the field of attachment theory, research, and intervention, with US child care and early childhood education programs and policy. The integration of attachment into these systems not only epitomizes Zigler's overarching canon but also has improved services and advanced attachment theory and research. Throughout the review, I suggest next steps for leveraging attachment theory, research, and intervention to improve US child care and early childhood education systems in ways that both reflect and carry forward the legacy of Edward Zigler.

Maternal Psychological Risk Moderates the Impacts of Attachment-Based Intervention on Mother-Toddler Mutuality and Toddler Behavior Problems: A Randomized Controlled Trial.

Although there is robust evidence of the benefits of attachment-based parenting interventions, limited research has examined their impact on dyadic mutuality and toddler behavior problems. Given the central question in prevention research of what works for whom, and the documented relation of maternal psychological risk to parenting and intervention response, it is important to consider the moderating role of maternal psychological risk in the efficacy of attachment-based interventions. The current study extends prior research on a randomized controlled trial of Attachment and Biobehavioral Catch-up (ABC) by examining its impact on dyadic mutuality and the moderating role of maternal psychological risk in ABC's impact on dyadic mutuality and toddler behavior problems. ABC (10 sessions) was provided as a supplement to Early Head Start (EHS) for a sample of predominantly low-income Latinx families. Control families received home-based EHS plus 1 book per week for 10 weeks. We administered a psychosocial interview and video-recorded parent-toddler interaction pre- and post-intervention. Using intent-to-treat analyses, we found main effects of ABC on dyadic mutuality. We conducted latent class analysis to identify patterns of interrelationships among indicators of baseline maternal risk exposure to characterize a latent risk factor and used this factor to examine the moderating role of maternal psychological risk in ABC's impact on dyadic mutuality and toddler behavior problems. ABC seemed to be particularly beneficial for the development of positive, synchronous dyadic interactions and for reduction of toddler behavior problems in higher-risk EHS families. Findings are discussed in the context of designing and evaluating preventive interventions, with a specific focus on families at psychological risk.

Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families.

Disparities in childhood obesity highlight the need for research to identify its early predictors in high-risk populations, such as low-income, Latino families. In the current study, the first of its kind in a low-income Latino sample (N = 55; Mchild age = 12.74 months, SD = 3.96), we investigated whether mothers' self-reported attachment style predicted their infants' weight-for-length (WFL; an early indicator of childhood obesity). We also explored whether observed maternal sensitivity, coded from a video-recorded semi-structured play assessment, mediated this association. We found a significant direct effect of maternal attachment style on infants' WFL z-scores (c' = -0.68, SE = 0.22, p = .004). Infants of mothers who classified themselves as secure had lower WFL z-scores than infants of insecure mothers (avoidant or anxious). Maternal sensitivity did not mediate this association, but was positively associated with infant WFL z-scores. We discuss implications of these findings for future research.

Increasing maternal sensitivity to infant distress through attachment-based intervention: a randomized controlled trial.

Maternal sensitivity to infant distress is a key predictor of infant attachment security and social-emotional development. Preventive interventions that support mothers' sensitive responses to infant distress are crucial, as are rigorous evaluations that test for whom such interventions are effective. The current randomized controlled trial tested main and moderated effects of an attachment-based intervention on mothers' sensitivity to their infants' distress in 161 low-income, predominantly Latino mother-infant dyads. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start services. An intent-to-treat analysis with covariates revealed a positive main intervention effect on maternal sensitivity to distress following a brief novel and potentially fear-inducing procedure (d = 0.32). The intervention effect was not moderated by mothers' self-reported attachment security, avoidance, or anxiety. Findings are discussed in terms of the value and feasibility of increasing maternal sensitivity to infant distress through attachment-based intervention.

Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial.

Infant emotion regulation has long-term implications for human development, highlighting the need for preventive interventions that support emotion regulation early in life. Such interventions may be especially important for infants higher in emotional reactivity who need to regulate their emotions more frequently and intensely than infants lower in emotional reactivity. The current randomized trial examined main and moderated effects of an attachment-based intervention on (a) infants' use of mother-oriented and self-soothing emotion regulation strategies and (b) infant emotion dysregulation in 186 low-income, predominantly Latino infants. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start (EHS) services. Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses with covariates revealed main effects of the intervention on infants' use of mother-oriented emotion regulation strategies during a brief (40-s) novel and potentially fear-inducing procedure (d = 0.31). Infant emotional reactivity moderated intervention impacts on mother-oriented emotion regulation strategies and on infant emotion dysregulation: We found stronger effects of the intervention for infants relatively higher in emotional reactivity. Findings are discussed in terms of the preventive value of attachment-based interventions for supporting early emotion regulation.

Can typical US home visits affect infant attachment? Preliminary findings from a randomized trial of Healthy Families Durham.

US government-funded early home visiting services are expanding significantly. The most widely implemented home visiting models target at-risk new mothers and their infants. Such home visiting programs typically aim to support infant-parent relationships; yet, such programs' effects on infant attachment quality per se are as yet untested. Given these programs' aims, and the crucial role of early attachments in human development, it is important to understand attachment processes in home visited families. The current, preliminary study examined 94 high-risk mother-infant dyads participating in a randomized evaluation of the Healthy Families Durham (HFD) home visiting program. We tested (a) infant attachment security and disorganization as predictors of toddler behavior problems and (b) program effects on attachment security and disorganization. We found that (a) infant attachment disorganization (but not security) predicted toddler behavior problems and (b) participation in HFD did not significantly affect infant attachment security or disorganization. Findings are discussed in terms of the potential for attachment-specific interventions to enhance the typical array of home visiting services.

IMPLEMENTING AN ATTACHMENT-BASED PARENTING INTERVENTION WITHIN HOME-BASED EARLY HEAD START: HOME-VISITORS' PERCEPTIONS AND EXPERIENCES.

Implementation of evidence-based interventions in "real-world" settings is enhanced when front-line staff view the intervention as acceptable, appropriate, and feasible. This qualitative study addresses Early Head Start (EHS) home visitors' perceptions and experiences of an evidence-based parenting intervention, the Attachment and Biobehavioral Catch-up program (M. Dozier, O. Lindhiem, & J. Ackerman, 2005), when added to EHS services as usual within the context of a research-practice partnership. Thematic analysis of in-depth, qualitative interviews indicates that home visitors experienced the intervention as positive and helpful for EHS families. Some challenges included scheduling and uncertainty regarding the goals of the intervention. Concerns over participation in the research centered on information exchange, confidentiality, and time limitations.

FIRST-GENERATION LATINA MOTHERS' EXPERIENCES OF SUPPLEMENTING HOME-BASED EARLY HEAD START WITH THE ATTACHMENT AND BIOBEHAVIORAL CATCH-UP PROGRAM.

This qualitative pilot study examined first-generation Latina mothers' experiences of supplementing home-based Early Head Start (EHS) services with the evidence-based Attachment and Biobehavioral Catch-up (ABC; M. Dozier, O. Lindheim, & J. Ackerman, 2005) program. Ten low-income, first-generation Latina mothers with infants and toddlers enrolled in home-based EHS were provided 10 ABC home visits by a supplemental parent coach. Following delivery of ABC, mothers participated in in-depth, semistructured, qualitative interviews about their experiences. Interview themes included positive experiences of both EHS and the ABC, a high value placed on receiving both programs, and cultural relevance of the ABC program for Latino families. Participants offered several suggestions for improved program delivery. Study findings suggest that a model of EHS supplemented by ABC delivered to the Latino community is feasible, valuable to participants, and culturally relevant. Considerations for sustainability of this supplemental model are discussed.

Promoting supportive parenting in new mothers with substance-use problems: a pilot randomized trial of residential treatment plus an attachment-based parenting program.

This pilot randomized trial tested the feasibility and efficacy of supplementing residential substance-abuse treatment for new mothers with a brief, yet rigorous, attachment-based parenting program. Twenty-one predominantly (86%) White mothers and their infants living together in residential substance-abuse treatment were randomly assigned to the program (n = 11) or control (n = 10) group. Program mothers received 10 home-based sessions of Dozier's Attachment and Biobehavioral Catch-up (ABC) intervention. Postintervention observations revealed more supportive parenting behaviors among the randomly assigned ABC mothers.

Organizational influences on data use among child welfare workers.

This study addresses organizational factors associated with child welfare workers' data use in their day-to-day work. Survey data from 237 respondents were analyzed using logistic regression. Familiarity with data and supervisor support were significant predictors of child welfare workers' data use. Findings highlight the value of child welfare organizations (a) facilitating workers' familiarity with child welfare data and data use and (b) training or educating supervisors so that they can support workers' use of data.

Intergenerational Continuity in Child Maltreatment: Explicating Underlying Mechanisms.

The current study examined direct and indirect effects of a mother's history of childhood physical and sexual abuse on her child's officially reported victimization. This prospective, longitudinal study followed a community-based sample of 499 mothers and their children. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, and 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants' target child between birth and age 3.5. Whereas both types of maternal maltreatment history doubled the child's risk of child protective services investigation, mothers' sexual abuse history conferred significantly greater risk. Pathways to child victimization varied by type of maternal maltreatment history. Mothers who had been physically abused later demonstrated interpersonal aggressive response biases, which mediated the path to child victimization. In contrast, the association between maternal history of sexual abuse and child victimization was mediated by mothers' substance use problems. Study implications center on targeting child maltreatment prevention efforts according to the mother's history and current problems.

Intergenerational continuity in child maltreatment: mediating mechanisms and implications for prevention.

In the interest of improving child maltreatment prevention, this prospective, longitudinal, community-based study of 499 mothers and their infants examined (a) direct associations between mothers' experiences of childhood maltreatment and their offspring's maltreatment, and (b) mothers' mental health problems, social isolation, and social information processing patterns (hostile attributions and aggressive response biases) as mediators of these associations. Mothers' childhood physical abuse--but not neglect--directly predicted offspring victimization. This association was mediated by mothers' social isolation and aggressive response biases. Findings are discussed in terms of specific implications for child maltreatment prevention.

Preventing early child maltreatment: implications from a longitudinal study of maternal abuse history, substance use problems, and offspring victimization.

In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers' childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants' target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.

Early mother-child separation, parenting, and child well-being in Early Head Start families.

Drawing on theories of attachment and family instability, this study examined associations between early mother-child separation and subsequent maternal parenting behaviors and children's outcomes in a sample of 2080 families who participated in the Early Head Start Research and Evaluation Project, the vast majority of whom were poor. Multiple regression models revealed that, controlling for baseline family and maternal characteristics and indicators of family instability, the occurrence of a mother-child separation of a week or longer within the first two years of life was related to higher levels of child negativity (at age three) and aggression (at ages three and five). The effect of separation on child aggression at age five was mediated by aggression at age three, suggesting that the effects of separation on children's aggressive behavior are early and persistent.

Testing maternal depression and attachment style as moderators of Early Head Start's effects on parenting.

This study examined maternal depression, attachment avoidance, and attachment anxiety as moderators of Early Head Start's effects on four parenting outcomes assessed at age three. Participants (N = 947) were drawn from six sites of the Early Head Start National Research and Evaluation Project, a multi-site randomized trial. Findings suggest more positive program effects for mothers with less initial attachment avoidance or attachment anxiety. First, baseline attachment avoidance moderated Early Head Start program effects on observed maternal supportiveness, such that program mothers with lower baseline attachment avoidance were rated as more supportive of their three-year-olds than program mothers with higher baseline attachment avoidance. Second, program effects on spanking varied depending on mothers' baseline attachment anxiety.

Enhancing the Transition to Kindergarten: A Randomized Trial to Test the Efficacy of the "Stars" Summer Kindergarten Orientation Program.

This randomized trial tested the efficacy of an intensive, four-week summer program designed to enhance low-income children's transition to kindergarten (n's = 60 program children, 40 controls). Administered in four public schools, the program focused on social competence, pre-literacy and pre-numeracy skills, school routines, and parental involvement. Hierarchical linear modeling indicated that the program significantly improved teachers' ratings of (a) the transition to the social aspect of kindergarten for girls (but not boys); and (b) the transition to kindergarten routines for the subgroup of children who had the same teacher for kindergarten as for the summer program. Findings are discussed in terms of practices and policies for supporting children's transition to school.

Correlates and consequences of spanking and verbal punishment for low-income white, african american, and mexican american toddlers.

This study examined the prevalence, predictors, and outcomes of spanking and verbal punishment in 2,573 low-income White, African American, and Mexican American toddlers at ages 1, 2, and 3. Both spanking and verbal punishment varied by maternal race/ethnicity. Child fussiness at age 1 predicted spanking and verbal punishment at all 3 ages. Cross-lagged path analyses indicated that spanking (but not verbal punishment) at age 1 predicted child aggressive behavior problems at age 2 and lower Bayley mental development scores at age 3. Neither child aggressive behavior problems nor Bayley scores predicted later spanking or verbal punishment. In some instances, maternal race/ethnicity and/or emotional responsiveness moderated the effects of spanking and verbal punishment on child outcomes.

Improving infants' stress-induced cortisol regulation through attachment-based intervention: A randomized controlled trial.

Attachment-based parenting interventions have shown positive effects on early cortisol regulation, a key biomarker. Evaluations to date have focused on diurnal cortisol production in high-risk infants. It is important to understand whether attachment-based intervention may also improve stress-induced cortisol production in typically developing infants. This randomized controlled trial tested an enhanced model of U.S. Early Head Start (EHS) services that combined home-based EHS with a brief, attachment-based parenting intervention, Attachment and Biobehavioral Catch-up (ABC). The trial included 153 low-income mothers and their infants (M age 12.4 months [SD = 4.1]). Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses using multilevel models revealed a significant indirect intervention effect on infants' rates of cortisol change in response to a series of mild stressors. The intervention increased maternal sensitivity, which in turn improved cortisol regulation, particularly infants' rates of cortisol recovery. The findings illustrate the efficacy of EHS plus ABC for supporting infants' stress-induced cortisol regulation and implicate sensitive maternal behavior as the underlying driver of the intervention effect. Findings are discussed in terms of the preventative value of attachment-based parenting interventions that improve both parenting and infants' physiological regulation.