EFFICACY OF THE 20-WEEK CIRCLE OF SECURITY INTERVENTION: CHANGES IN CAREGIVER REFLECTIVE FUNCTIONING, REPRESENTATIONS, AND CHILD ATTACHMENT IN AN AUSTRALIAN CLINICAL SAMPLE.

Circle of Security is an attachment theory based intervention that aims to promote secure parent-child attachment relationships. Despite extensive uptake of the approach, there is limited empirical evidence regarding efficacy. The current study examined whether participation in the 20-week Circle of Security intervention resulted in positive caregiver-child relationship change in four domains: caregiver reflective functioning; caregiver representations of the child and the relationship with the child; child attachment security, and attachment disorganization. Archived pre- and postintervention data were analyzed from 83 clinically referred caregiver-child dyads (child age: 13-88 months) who completed the Circle of Security intervention in sequential cohorts and gave permission for their data to be included in the study. Caregivers completed the Circle of Security Interview, and dyads were filmed in the Strange Situation Procedure before and after the intervention. Results supported all four hypotheses: Caregiver reflective functioning, caregiving representations, and level of child attachment security increased after the intervention, and level of attachment disorganization decreased for those with high baseline levels. Those whose scores were least optimal prior to intervention showed the greatest change in all domains. This study adds to the evidence suggesting that the 20-week Circle of Security intervention results in significant relationship improvements for caregivers and their children.

Commentary on Guild et al. (2020): The Importance of Well-Designed Intervention Studies for Advancing Attachment Theory and its Clinical Applications.

Guild and colleagues (this issue) report results of a long-term follow up after a randomized trial of the effectiveness of an attachment-theory-informed psychotherapeutic intervention for mothers with depression and their toddlers. Their paper shows the intervention can increase the likelihood of secure attachment in children of depressed mothers and that secure attachment explains more optimal social-emotional functioning in middle childhood in the treated group. This commentary discusses the contribution of the paper by Guild and colleagues and their broader body of work to our evolving understanding of developmental processes underpinning social-emotional competence in children of depressed parents, and to several ongoing controversies in the field: 1) the relevance of attachment-theory-informed interventions in the context of maternal depression; 2) the evidence gap regarding the efficacy and effectiveness of attachment-theory-informed interventions, particularly with respect to sustained benefits; 3) cost-benefits of early interventions; and 4) the need for theory driven research that explains how and under what circumstances attachment is related to later child outcomes.

Maternal mind-mindedness and children's school readiness: A longitudinal study of developmental processes.

This study aimed to test a 5-wave sequential mediation model linking maternal mind-mindedness during infancy to children's school readiness in kindergarten through a serial mediation involving child language and effortful control in toddlerhood and the preschool years. Among a sample of 204 mother-child dyads, we assessed maternal mind-mindedness when children were aged 1 year, child expressive vocabulary at age 2, effortful control at ages 3 and 4, and finally cognitive school readiness in kindergarten. The results corroborated the model, suggesting that the prospective association between early mind-mindedness and later cognitive school readiness was entirely mediated by the proposed sequence of mediators, all of which were necessary to account for this longitudinal association. These findings suggest that the potential of parental mind-mindedness to support children's cognitive development may have been underestimated, and that its putative positive influence may take the form of a developmental cascade unfolding during the preschool years and entailing the acquisition of basic skills that serve as building blocks for further learning and development. (PsycINFO Database Record

Unique Associations between Childhood Temperament Characteristics and Subsequent Psychopathology Symptom Trajectories from Childhood to Early Adolescence.

Existing research suggests that temperamental traits that emerge early in childhood may have utility for early detection and intervention for common mental disorders. The present study examined the unique relationships between the temperament characteristics of reactivity, approach-sociability, and persistence in early childhood and subsequent symptom trajectories of psychopathology (depression, anxiety, conduct disorder, and attention-deficit hyperactivity disorder; ADHD) from childhood to early adolescence. Data were from the first five waves of the older cohort from the Longitudinal Study of Australian Children (n = 4983; 51.2% male), which spanned ages 4-5 to 12-13. Multivariate ordinal and logistic regressions examined whether parent-reported child temperament characteristics at age 4-5 predicted the study child's subsequent symptom trajectories for each domain of psychopathology (derived using latent class growth analyses), after controlling for other presenting symptoms. Temperament characteristics differentially predicted the symptom trajectories for depression, anxiety, conduct disorder, and ADHD: Higher levels of reactivity uniquely predicted higher symptom trajectories for all 4 domains; higher levels of approach-sociability predicted higher trajectories of conduct disorder and ADHD, but lower trajectories of anxiety; and higher levels of persistence were related to lower trajectories of conduct disorder and ADHD. These findings suggest that temperament is an early identifiable risk factor for the development of psychopathology, and that identification and timely interventions for children with highly reactive temperaments in particular could prevent later mental health problems.

Older maternal age and major depressive episodes in the first two years after birth: findings from the Parental Age and Transition to Parenthood Australia (PATPA) study.

BACKGROUND: This study examines whether (1) older maternal age is associated with increased risk of depressive episodes between four months and two years after first birth and (2) the role of subsequent reproductive, social and child factors in vulnerability to later onset depression. METHOD: 592 women were recruited in the third trimester of pregnancy in three age-groups (≤ 30 years; 31-36 years,≥37 years); 434 (73%) completed all assessments at four months and two years after birth. Major Depression episodes (MDE) were assessed at four months and two years using the Mini International Neuropsychiatric Interview (MINI). Maternal (age, mode of conception, prior mood symptoms, health), child (temperament, health), reproductive (subsequent fertility treatment, pregnancy, birth, pregnancy loss) and social contextual variables (language background, paid work, practical support, life stresses) were assessed in pregnancy and postnatally using validated questionnaires and structured interview questions. RESULTS: Maternal age was not related to prevalence or timing of MDE. Depression symptoms, poor child health, low practical support at four months and a non-English language background predicted episodes of depression between four months and two years, ps <0.05. LIMITATIONS: Life history risks for depression were not considered, nor symptom profiles over time. CONCLUSIONS: Findings indicate that despite a more complex reproductive context, older first time mothers are not more likely to report major depressive episodes in the first two years after birth. Prevalence for the whole sample was at the lower end of reported community ranges and was comparable early and later in the postpartum period. Screening for depression after childbirth should not be restricted to the early months.

Parents of 5-year-old in vitro fertilization children: psychological adjustment, parenting stress, and the influence of subsequent in vitro fertilization treatment.

Sixty-six parents who had conceived by in vitro fertilization (IVF) were compared with 46 matched naturally conceiving control parents regarding psychosocial adjustment and parenting stress 5 years after the birth of their first child. IVF mothers reported a more external locus of control than did control mothers but did not differ on other measures. Within the IVF group, higher levels of treatment predicted lower parenting stress and more defensive responding on the Parenting Stress Index (R. Abidin, 1990). The more positive reporting of high-treatment IVF parents may be attributable to either defensive responding or the fact that they are particularly highly motivated and competent parents. The study findings confirm a growing body of research regarding overall positive adjustment in IVF parents but also highlight the importance of considering individual differences among IVF mothers with respect to treatment experience.

Age, psychological maturity, and the transition to motherhood among English-speaking Australian women in a metropolitan area.

In the context of the trend toward delayed parenthood, this study examines whether older maternal age is associated with greater psychological maturity and whether greater psychological maturity provides any adaptive benefit during the transition to motherhood. A sample of 240 predominantly English-speaking Australian women in a metropolitan area expecting their 1st baby (mean age = 32.81 years; 41% conceived after fertility treatment) completed measures of psychological maturity (hardiness, ego development, and ego resiliency) and pregnancy adaptation (maternal fetal attachment and formation of a maternal identity) in the 3rd trimester of pregnancy and a measure of postnatal adjustment at 4-6 months postpartum. Structural equation modeling showed age was positively associated with a latent construct of psychological maturity, and psychological maturity was associated with more optimal adaptation in pregnancy and early motherhood. Both psychological maturity and pregnancy adaptation predicted positive postnatal adjustment. Age was indirectly related to adaptation through its relationship with psychological maturity. The relationships in the model applied regardless of mode of conception (fertility treatment or spontaneous). Potentially confounding contextual factors associated with older age at motherhood, higher education, and maternal and child health were included in the model. These results suggest that psychological maturity is a benefit of motherhood at older ages.

Older first-time mothers and early postpartum depression: a prospective cohort study of women conceiving spontaneously or with assisted reproductive technologies.

OBJECTIVE: To evaluate whether older first-time mothers (≥37 years) have higher rates of postpartum depression compared with younger first-time mothers, controlling for mode of conception and known risk factors for postpartum depression. DESIGN: Prospective cohort study. SETTING: Assisted reproductive technology (ART) clinics in two large Australian cities and public and private antenatal clinics and/or classes in the vicinity of ART clinics. PATIENT(S): Nulliparous women who had conceived spontaneously (n = 295) or through ART (n = 297) in three age-groups: younger, 20 to 30 years (n = 173); middle, 31 to 36 years (n = 214); and older, ≥37 years (n = 189). INTERVENTION(S): Semistructured interviews and questionnaires. MAIN OUTCOME MEASURE(S): Major depressive disorder in the first 4 months after birth as assessed by structured diagnostic interview. RESULT(S): The study performed 592 complete pregnancy assessments and 541 postpartum assessments. The prevalence of major depressive disorder was 7.9%, at the lower end of community rates. Neither maternal age-group nor mode of conception was statistically significantly related to depression. CONCLUSION(S): Older first-time mothers, whether conceiving through ART or spontaneously, do not show increased vulnerability to postnatal depression.

Attitudes of couples with stored frozen embryos toward conditional embryo donation.

OBJECTIVE: To survey clients with stored frozen embryos regarding intention to donate embryos to other couples and attitudes toward conditional donation. DESIGN: Anonymous postal questionnaire. SETTING: A private IVF clinic in Sydney, Australia. PATIENT(S): Clients with embryos stored for 3 or more years. INTERVENTION(S): Patients completed a survey regarding attitudes to embryo donation and conditional embryo donation. Spontaneous written comments were also analyzed. MAIN OUTCOME MEASURE(S): Intentions regarding embryos, attitudes toward conditional donation, extent to which conditional donation would influence decision-making. RESULT(S): Of the clients surveyed, 99 women (35%) and 66 men (23%) responded. Only 4% indicated it was likely they would donate to other couples; 48% thought donors should be able to specify characteristics of recipients; and 41% indicated they would be more likely to donate if donation was conditional. A sense of ownership and responsibility for the well-being of the offspring underpinned reluctance to donate. Perceived control over the caretaking environment was seen as an advantage of conditional donation. Concerns were also raised about the need for donors to relinquish control and the potential for discrimination. CONCLUSION(S): An empirical understanding of the views of infertility patients regarding stored embryos is critical to informing public discourse, policy debates, and clinical practice as well as counseling, policy, and protocols on embryo donation.

The impact of postnatal and concurrent maternal depression on child behaviour during the early school years.

BACKGROUND: This prospective study explores the ongoing impact of early and subsequent maternal depression on offspring behaviour in the early school years. METHODS: Seventy five mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4, 12 and 15 months, 4 years and later when the children were 6-8 years of age. Mothers, fathers, and school teachers were asked to report on children's internalising and externalising behaviour problems. RESULTS: Exposure to maternal depression during the first postpartum year was related to mother reports of child internalising and externalising problems in the early school years. Although depression in the first year predicted later internalising problems, effects for externalising behaviour problems were mediated by concurrent depression. Relations between concurrent maternal depression and externalising problems were confirmed by teacher ratings. Interestingly, the severity of symptoms at four months was significantly correlated with behaviour problems seven years later. LIMITATIONS: Attrition over successive study contacts and therefore limited statistical power is acknowledged. Findings may be a conservative estimate of associations between maternal depression and later child behaviour problems. Also, the high prevalence of depressive symptomatology in the population from which the sample was drawn may limit the generalisability of results. CONCLUSIONS: Findings confirm the importance of early identification and treatment for mothers with postnatal depression, given the likelihood of ongoing depression and relations with later child behaviour problems. From a practical point, severity of early symptoms may be a reliable index of those mothers and children at greatest risk.

Maternal depression: relations with maternal caregiving representations and emotional availability during the preschool years.

This longitudinal study aimed to determine whether maternal depression was related to caregiving behavior and further whether this relationship was mediated and/or moderated by maternal caregiving representations. Ninety-two mothers were assessed for symptoms of depression when their children were 4, 12, and 15 months, and later at 4 years of age. At 4 years of age, mothers' caregiving representations of their child and their relationship were examined using the Parent Development Interview (PDI), and aspects of maternal behaviors were rated during mother-child play interactions using the Emotional Availability Scales (EA). The experience of chronic maternal depression was related to lower levels of maternal sensitivity, and this association was mediated by mothers' impaired capacity to take their child's perspective. The link between depression and lower maternal sensitivity was also moderated by perspective taking, indicating that poor perspective taking had a negative impact on sensitivity only for chronically depressed mothers. In conclusion, the current study demonstrated that mothers' representational models are affected by cognitive distortions associated with depression, and these distortions interfere with a mother's capacity to interact sensitively with her child.

Psychosocial adjustment during pregnancy for older couples conceiving through assisted reproductive technology.

BACKGROUND: The trend to older maternal age at first birth is well established in Western countries and biological risk factors, particularly declining fertility, are well documented. Less is known, however, about the psychosocial well-being of older first time parents. This study explores differences in psychosocial adjustment during pregnancy in older (maternal age >or= 38 years) and younger (maternal age < 35 years) couples after assisted reproductive technology (ART) conception. METHODS: Questionnaire data were collected from a consecutive cohort of pregnant nulliparous women and their partners recruited over a 12-month period from ART clinics in Sydney, Australia. RESULTS: There were more similarities than differences when comparing older and younger couples. Older couples took longer to conceive and were more likely to use donor eggs. Older pregnant women scored higher on a measure of psychological hardiness/resilience and reported a lower identification with motherhood compared with younger pregnant women. Older men differed only in reporting a less satisfying social orientation during pregnancy (lower satisfaction with sex life, relationship with partner and social life). CONCLUSIONS: Findings do not indicate problematic adjustment during pregnancy in older couples, but differences found need further investigation using larger samples and prospective designs.

Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment.

BACKGROUND: Empirical studies have revealed a significant, but modest association between maternal depression and insecure mother-child attachment. Across studies, however, a substantial number of mothers with depression are able to provide a sensitive caretaking environment for their children. This paper aimed to explore whether a mother's own state of mind regarding attachment moderated the association between postpartum depression and insecure mother-child attachment. METHODS: Mothers (n = 111), mainly middle-class mothers, and their infants participated in a longitudinal study of postnatal depression, maternal attachment state of mind and child attachment. Depression was assessed using a diagnostic interview (at 4 and 12 months) and symptom checklists (at 4, 12 and 15 months). The Adult Attachment Interview was conducted at 12 months and the Strange Situation procedure at 15 months. RESULTS: Mothers diagnosed as depressed were more likely to have an insecure state of mind regarding attachment. Infants of chronically depressed mothers were more likely to be insecurely attached; however, the relationship between maternal depression and child attachment was moderated by maternal attachment state of mind. CONCLUSIONS: Results are discussed with reference to resiliency factors for women with postnatal depression and implications for intervention.

Community concerns about sex selection: research as a way forward - response to Edgar Dahl's 'The presumption in favour of liberty'.

This commentary argues that notwithstanding the implicit logic underpinning philosophical and moral arguments regarding individual rights to access sex selection for non-medical reasons, community concerns about the psychosocial impact of the technology cannot be dismissed or ignored. It is true, however, that such concerns are often based on unsupported assumptions about the impact of the technology on individuals, families and communities and about the propensity of scientists, unless restrained, to act in ways that are irresponsible or dangerous. The research conducted to date has dispelled many of the myths and assumptions about IVF children and their families. Further careful research is now needed to test the extent to which fears and assumptions regarding 'designer babies' are justified.

Embryo donation for medical research: attitudes and concerns of potential donors.

BACKGROUND: The recent derivation of embryonic stem cell lines from human blastocysts and related implications for regenerative medicine has intensified a longstanding debate about the use of human embryos for research purposes. However, studies have shown that few couples with stored embryos opt to donate them for research. Herein, the attitudes and concerns of potential embryo donors to donation of surplus embryos for medical research were examined. METHODS: From a total of 509 couples who had stored frozen embryos and who had received a questionnaire about embryo donations for medical research, 152 women (30%) and 123 male partners (24%) responded. Embryos had been stored for a mean of 2.25 years (range 3 months to 12 years). RESULTS: Some 10% of respondents indicated it probable, and 34% possible, that they would donate their surplus embryos for research in the future. Women respondents whose embryos had been stored longer, and those committed to the practice of a religion, were more worried about their embryos. Respondents positively disposed to donation commented on their desire not to waste embryos, a desire to help infertile couples, and/or to advance scientific knowledge. Those with negative views commented on the embryo as a potential child and expressed concerns about a perceived lack of control over the type of research to be carried out. CONCLUSIONS: Findings indicate a need for tailored education and counselling about embryo donation for medical research.