Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk.

BACKGROUND: Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap. METHOD: Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis. RESULTS: Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability. CONCLUSIONS: Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.

Concepts travel faster than thought: an empirical study of the use of attachment classifications in child protection investigations.

Scholarly discussion suggests prevalent, overconfident use of attachment classifications in child protection (CP) investigations but no systematic research has examined actual prevalence, the methods used to derive such classifications, or their interpretations. We aimed to cover this gap using survey data from a nationally representative sample of Swedish CP workers (N = 191). Three key findings emerged. First, the vast majority formed an opinion about young children's attachment quality in all or most investigations. Second, most did not employ systematic assessments, and none employed well-validated attachment methods. Third, there was overconfidence in the perceived implications of attachment classifications. For example, many believed that insecure attachment is a valid indicator of insufficient care. Our findings illustrate a wide researcher-practitioner gap. This gap is presumably due to inherent difficulties translating group-based research to the level of the individual, poor dissemination of attachment theory and research, and infrastructural pressures adversely influencing the quality of CP investigations.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Attachment in the time of COVID-19: Insecure attachment orientations are associated with defiance of authorities' guidelines during the pandemic.

Previous research has linked people's relational attachment orientations to emotional reactions and coping during crises, and to social trust and trust in societal institutions. The COVID-19 pandemic is a global crisis for which collective efforts, such as social distancing, are necessary to stop the spread of the virus. During previous pandemics, people high in trust have typically adhered to such efforts. In the present study, we investigated whether attachment orientations were related to people's adherence to authorities' guidelines to stop the spread of COVID-19. We also tested whether previous mediational findings-linking attachment-related avoidance to welfare state trust via social trust-would replicate. We used a web-based survey of 620 participants. Our findings showed that attachment-related anxiety was linked to low adherence to social distancing regulations. This finding was especially noteworthy because high attachment-anxious participants also experienced more negative emotions, yet negative emotions were generally linked to high adherence. Thus, people higher in attachment anxiety seem to have more difficulties in avoiding social situations despite heightened risk of catching and spreading the virus. In addition, attachment-related avoidance was negatively related to adherence and to welfare state trust, and its effects on welfare state trust were statistically mediated by low social trust.

Depression and mentalizing: A psychodynamic therapy process study.

The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression Inventory and the Reflective Functioning Questionnaire (RFQ). Data were analyzed using Latent Growth Curve (LGC) modeling with structured residuals. In the total sample, depressive symptoms improved on average from baseline to the end of treatment, while mentalizing skills did not. However, individual variations were observed in mentalizing skills, with some patients improving while others did not. Within-patient residual changes in mentalizing skills did not predict residual changes in depressive symptoms. Accordingly, the results did not support mentalizing as a mechanism of change at this level. Nonetheless, between-patient effects were found, showing that patients with higher levels of mentalizing at baseline and patients whose mentalizing skills improved over the course of therapy also had greater reductions in depressive symptoms. We suggest that the presence of relatively higher mentalizing skills might be a factor contributing to moderately depressed individuals' ability to benefit from treatment, while relatively poor or absent mentalizing capacity might be part of the dynamics underlying treatment resistance in individuals with severe depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The God, the blood, and the fuzzy: reflections on Cornerstones and two target articles.

In response to Cornerstones of attachment research and the target articles, I reflect on three questions. First, what is "attachment"? Although a natural kind, I argue against an essentialist understanding (i.e. in terms of necessary/sufficient conditions for class membership). Instead, the attachment concept must be allowed to have fuzzy boundaries, partly because of how attachments transform in both phylogeny and ontogeny. Second, how to think about the normative (species-typical) features of the theory vis-à-vis dyadic/individual differences in attachment? Whereas the former are foundational, I argue that the latter largely reflect surface variation. Despite this, the lion's share of attachment research has horned in on variation and its measurement, to some detriment to the theory's potential and applications. Finally, what is encouraging and discouraging about recent developments? While applauding large-scale cooperative endeavors (e.g. individual participant meta-analyses, consensus statements) I caution the field not to lose sight of the value of smaller-scale, creative explorations of uncharted territories.

Attachment, culture, and gene-culture co-evolution: expanding the evolutionary toolbox of attachment theory.

I argue that attachment relationships, and particularly secure ones, are important contexts for social learning and cultural transmission. Bowlby originally treated the attachment-behavioral system as serving only one evolutionary function: protection, via physical proximity. Yet the time is ripe to consider learning, especially social learning, as an additional functional consequence of attachment. Updated accordingly, attachment theory has the potential to serve as a much-needed developmental anchor for models of cultural evolution and gene-culture co-evolution. To support my arguments, I review progress in evolutionary science since Bowlby's lifetime, highlighting the growing recognition of ecological flexibility and the cultural embeddedness of animal behavior. I also review research pointing to a facilitating role of secure attachment relationships for social learning from caregivers among humans. For illustrational purposes, I show how one important aspect of human culture - religion - is culturally transmitted within attachment relationships, and of how the generalization of attachment-related working models biases the cultural transmission of religion from parents to offspring. I end the paper with a call for empirical research to test the role of attachment in cultural transmission beyond religion.

Admissibility of attachment theory, research and assessments in child custody decision-making? Yes and No!

Attachment theory, research, and assessments have become increasingly applied to settle child custody cases. We discuss such applications in relation to admissibility criteria for scientific evidence and testimony proposed by Faigman et al. (2014). We argue that attachment theory and research can provide valid "framework evidence"; group-based attachment research has yielded general principles suitable as a frame of reference for pertinent court decisions. In particular, child custody decision-making should generally be guided by research indicating that children benefit from attachment networks. In contrast, assessments of attachment quality fall short of providing valid "diagnostic evidence"; information that a specific individual/dyad is a "true" instance of a general group-level principle. In particular, such assessments do not yield valid information about whether a particular caregiver has better caregiving skills than another caregiver and will better support child development. We conclude that attachment theory and research should be admissible for framework but not for diagnostic testimony.

ON EXACTITUDE IN SCIENCE: A MAP OF THE EMPIRE THE SIZE OF THE EMPIRE.

In the service of children's best interests, we argue for a sharpening of the evidentiary standards used in family court decision making, from preponderance of (occasionally substandard) evidence to "beyond a reasonable doubt." Second, we call for a move in child protection cases from static diagnoses (e.g., attachment classifications) to assessments of the potential for enhanced parenting. Finally, informed by the implications of the replication crisis in the biomedical and psychological sciences, we applaud the move of the attachment field forward to large-scale, collective research agendas and goals.

DIAGNOSTIC USE OF CRITTENDEN'S ATTACHMENT MEASURES IN FAMILY COURT IS NOT BEYOND A REASONABLE DOUBT.

We express serious doubt and cautioning regarding Spieker and Crittenden's (2010) claim that attachment measures associated with the dynamic-maturational model of attachment and adaptation (DMM; Crittenden, 2016) can be used for court decision-making. We demonstrate, using Crittenden's and coworkers' (e.g., Spieker & Crittenden, 2010) own data, that such measures have (a) insufficient reliability for use in individual diagnosis and (b) cannot retrodict maltreatment with sufficient sensitivity or specificity for court use. Just as atypical forms of attachment are sometimes observed among children reared adequately, typical (secure or mildly insecure) forms of attachment are sometimes observed among maltreated children and among children of caregivers struggling with psychopathology or socioeconomic adversity. The stakes are high, so it is imperative that court decisions accord with the rule of law. Certainty beyond a reasonable doubt is required, and DMM measures do not meet that requirement.

Diminished ability to identify facial emotional expressions in children with disorganized attachment representations.

The development of children's ability to identify facial emotional expressions has long been suggested to be experience dependent, with parental caregiving as an important influencing factor. This study attempts to further this knowledge by examining disorganization of the attachment system as a potential psychological mechanism behind aberrant caregiving experiences and deviations in the ability to identify facial emotional expressions. Typically developing children (N = 105, 49.5% boys) aged 6-7 years (M = 6 years 8 months, SD = 1.8 months) completed an attachment representation task and an emotion identification task, and parents rated children's negative emotionality. The results showed a generally diminished ability in disorganized children to identify facial emotional expressions, but no response biases. Disorganized attachment was also related to higher levels of negative emotionality, but discrimination of emotional expressions did not moderate or mediate this relation. Our novel findings relate disorganized attachment to deviations in emotion identification, and therefore suggest that disorganization of the attachment system may constitute a psychological mechanism linking aberrant caregiving experiences to deviations in children's ability to identify facial emotional expressions. Our findings further suggest that deviations in emotion identification in disorganized children, in the absence of maltreatment, may manifest in a generally diminished ability to identify emotional expressions, rather than in specific response biases.

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers.

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static "trait" of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Maternal Sensitivity in Mothers with Mild Intellectual Disabilities is Related to Experiences of Maltreatment and Predictive of Child Attachment: A Matched-Comparison Study.

BACKGROUND: Scientific knowledge on the quality of caregiving/maternal sensitivity among mothers with mild intellectual disabilities (ID) is limited and subject to many methodological shortcomings, but seems to suggest that these mothers are less sensitive than mothers without intellectual disabilities. METHODS: In this matched-comparison study (N = 48), the present authors observed maternal sensitivity for 20 min in four different laboratory play situations. The study also included semi-structured interviews to assess maternal experiences of maltreatment and child attachment. RESULTS: The present authors found significantly lower sensitivity among mothers with intellectual disabilities than among a comparison group of mothers without intellectual disabilities. Among mothers with intellectual disabilities, low sensitivity was related to maternal experiences of maltreatment and predictive of disorganized child attachment. In the comparison group, high maternal sensitivity was related to partner presence and social support, and predictive of child intelligence. CONCLUSIONS: The present authors highlight the importance of attending to intellectual disabilities mothers' history of receiving care to understand their capacity for giving adequate care.

Prior participation in the strange situation and overstress jointly facilitate disorganized behaviours: implications for theory, research and practice.

We seek to understand why a relatively high percentage (39%; vs the meta-analytic average, 15-18%) of disorganized/disoriented (D) classifications has accrued in the low-risk Uppsala Longitudinal Study (ULS) study, using experienced D coders. Prior research indicates that D behaviours do not always indicate attachment disorganization stemming from a history of frightening caregiving. We examined the role of two other presumed factors: participation in a previous strange situation and overstress. Our findings indicate that both factors were highly prevalent in the ULS sample and that they jointly predicted higher rates of D. First, participation in a previous strange situation was associated with significantly higher distress displays during the second visit than occurred among previously untested children, suggesting that prior participation in the strange situation had a sensitizing effect on child distress during the second visit. Second, unless separations were cut short in lieu of high distress during the second visit, re-tested children were disproportionately likely (ca 60%) to be classified D. We argue that these findings have important implications for theory, research, and practice. In particular, we conclude that practitioners must refrain from misattributing the appearance of any D behaviors observed to a history of maltreatment.

Traumatic and Adverse Attachment Childhood Experiences are not Characteristic of OCD but of Depression in Adolescents.

We investigated whether adverse attachment experience might contribute to the development of obsessive-compulsive disorder (OCD). We interviewed 100 adolescents, 25 each with primary OCD, depressive disorder (DD), OCD plus DD and general population controls (CTRs) using the adult attachment interview to assess attachment experiences (AEs), including traumatic and adverse AE (TAE). Adolescents with OCD, OCD+DD and DD had little evidence of secure base/safe haven parental behaviour and their childhood attachment needs judged to be rejected as compared to the controls. Overprotection was not characteristic of OCD, and parents using the child for their own needs (elevated levels of involving/role reversal) occurred only in DD, with low levels in OCD, OCD+DD and CTR. Traumatic experiences, often multiple, and/or attachment related were reported significantly more often in the DD group, and was less common in OCD+DD, CTR and particularly in the OCD group. In OCD, little TAE was reported and adverse AE were less serious and seem unlikely to contribute directly to OCD aetiology. In DD and to some degree in OCD+DD serious AE/TAE may have some etiological significance for the depressive states.

Is middle childhood attachment related to social functioning in young adulthood?

The aim of the present study (N = 69) was to examine whether middle childhood attachment, measured using the Separation Anxiety Test (Slough, Goyette & Greenberg, 1988), predicts aspects of social functioning (social initiative, prosocial orientation, social anxiety, loneliness) in young adulthood. Insecurity-avoidance at age 8.5 years was, as expected, negatively related to social initiative and prosocial orientation, and was also positively related to social anxiety and loneliness at age 21 years. In addition, insecurity-avoidance contributed to developmental change in social anxiety from middle childhood to young adulthood. Contrary to our expectations, the two security scales were generally unrelated to future social functioning. Taken together, these results extend previous research by showing that insecurity-avoidance is related to social functioning also beyond childhood and adolescence, and that it contributes to developmental change in social functioning over time. The scarcity of prospective links for the attachment security scales points to the need for future studies addressing when and why attachment does not contribute to future social functioning.

Mothers with intellectual disability, their experiences of maltreatment, and their children's attachment representations: a small-group matched comparison study.

Maternal intellectual disability (ID) is regarded a risk factor in child development, but there is no scientific evidence on maternal ID in relation to children's attachment. Using a matched comparison design, a small group (n = 23) of mothers diagnosed with ID was studied to help fill this gap. Besides maternal ID, we examined the role of abuse/trauma/maltreatment (ATM) in the mothers' biographies, along with potential confounds. Comparison group mothers (n = 25) had normal variations in intelligence and matched mothers with ID on residential area, income, child age, and sex. History of maternal ATM was assessed using a semi-structured interview and was found to be significantly more likely in the ID group mothers' experience than the comparison group mothers. Children's (M age = 77 months) attachment representations were assessed with the Separation Anxiety Test. Among children of mothers with ID, a substantial minority (35%) had a secure and the vast majority (>80%) an organized attachment representation. Mothers with ID who had suffered elevated ATM were significantly more likely to have children who were scored high on disorganization and insecurity. We discuss possible implications of our findings for societal considerations regarding parenting and child attachment in the context of parental ID status.

Mothers' attachment security predicts their children's sense of God's closeness.

The current research reports that mothers' security of attachment predicts their children's sense of God's closeness. A total of 71 mother-child dyads participated (children's M age = 7.5). Mothers' attachment organization was studied with the Adult Attachment Interview (AAI; Main, Goldwyn, & Hesse, 2003 ) and their religiosity and attachment to God were measured with questionnaires. Children were told stories about visually represented children in attachment-activating and attachment-neutral situations, and placed a God symbol on a felt board to represent God's closeness to the fictional children. Children of secure mothers placed the God symbol closer (d = .78) than children of insecure mothers across both types of situations, suggesting that children's experiences with secure-insecure mothers generalize to their sense of God's closeness. Also, girls (but not boys) placed the God symbol closer in attachment-activating than in attachment-neutral situations, giving partial support for an attachment normative God-as-safe-haven model. Finally, mothers' religiosity and attachment to God were unrelated to child outcomes.

Interlinkages between attachment and the Five-Factor Model of personality in middle childhood and young adulthood: a longitudinal approach.

In this paper, we examine concurrent and prospective links between attachment and the Five-Factor Model (FFM) of personality from middle childhood to young adulthood (n = 66). At age 8.5 years, attachment was measured with the Separation Anxiety Test and at 21 years with the Adult Attachment Interview, whereas the personality dimensions were assessed with questionnaires at both time points. The results showed that attachment and personality dimensions are meaningfully related, concurrently and longitudinally. Attachment security in middle childhood was positively related to extraversion and openness, both concurrently and prospectively. Unresolved/disorganized (U/d) attachment was negatively related to conscientiousness and positively related to openness in young adulthood. U/d attachment showed a unique contribution to openness above the observed temporal stability of openness. As attachment security was also associated with openness, the duality of this factor is discussed together with other theoretical considerations regarding attachment theory in relation to the FFM.

Experiences of Interpersonal Trauma Among Parents With Intellectual Disabilities: A Systematic Review.

Research has suggested highly elevated levels of interpersonal trauma (IPT) among parents with intellectual disabilities (ID), and that such experiences may contribute to the caregiving and child developmental problems often seen in this population. Conflicting results have however been reported, and there is no systematic review on this matter. This study therefore systematically reviewed the empirical evidence concerning (a) prevalence of IPT among parents with ID, and links with (b) caregiving-relevant and (c) child developmental outcomes, in accordance with the PRISMA 2020 guidelines. Searches were conducted in MEDLINE, CINAHL, PsycINFO, and PTSDpubs. Peer-reviewed empirical articles reporting exposure to any form of systematically assessed IPT (unspecified IPT, physical, sexual, and emotional abuse, neglect, prolonged childhood separations from caregivers, witnessing abuse in the family) among parents with ID were included, yielding a final selection of 20 studies. Findings consistently indicated markedly elevated levels of IPT among parents with ID, with a majority (>50%) having experienced some form of IPT. Estimates for both unspecified and specific forms were typically higher than corresponding estimates in other groups at elevated risk, and than meta-analytical general population estimates in comparable countries. Findings regarding caregiving-relevant outcomes were mixed but indicated links with adverse outcomes, particularly regarding parental mental health. Reports pertaining to child developmental outcomes were scant and inconsistent. We highlight important limitations in the extant literature and provide directions for future research and clinical practice.