Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception.

STUDY QUESTION: Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)? SUMMARY ANSWER: Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner. WHAT IS KNOWN ALREADY: Most studies have not found differences between ART and NC singletons in parent-adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships. STUDY DESIGN SIZE DURATION: This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit. PARTICIPANTS/MATERIALS SETTING METHODS: Mothers and fathers gave background information for this study during pregnancy, and during the child's first year and early school age (7-8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships-Relationship Structures) at 17-19 years of age. MAIN RESULTS AND THE ROLE OF CHANCE: Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055. LIMITATIONS REASONS FOR CAUTION: The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons. WIDER IMPLICATIONS OF THE FINDINGS: The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother-child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father-adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments. STUDY FUNDING/COMPETING INTERESTS: This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers.

AIM: This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother-infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. BACKGROUND: Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. METHODS: The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby's age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants' 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). FINDINGS: The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.

Emotional availability: conceptualization and research findings.

The emotional availability construct (based on observations of parent-child interactions) was first reconceptualized for research in 1991 as a way to describe the quality of parent-child interactions. Since then, there has been considerable refinement of the construct. EA refers to several parental dimensions (sensitivity, structuring, non-intrusiveness, non-hostility) and two child dimensions (responsiveness to parent and involvement of parent). The EA empirical link with attachment and parent-child relationship are reviewed and avenues for future research are suggested.

Adult Attachment Interview: linkages with dimensions of emotional availability for mothers and their pre-kindergarteners.

Maternal attachment representations were assessed using the George, Kaplan, and Main (1985) Adult Attachment Interview (AAI), and emotional availability during observed mother-child interactions was assessed using the third edition of the Emotional Availability (EA) Scales (Biringen, Robinson, & Emde, 1998). This edition of EA included four parental scales and two child scales (Maternal Sensitivity, Structuring, Nonintrusiveness and Nonhostility; and Child Responsiveness and Child Involvement). Separate Hierarchical Multiple Regressions (HMRs) were computed to examine the prediction of the separate EA dimensions from demographic information, the AAI classification, and AAI scales. These analyses indicated that each of the EA dimensions (with the exception of maternal nonintrusiveness and nonhostility) was predicted by the AAI classification and/or AAI scales. Using three-step HMRs, the strongest prediction was for maternal sensitivity where 54% of the total variance in maternal sensitivity was explained by maternal education, AAI classification, and AAI 'state of mind' scales. Maternal nonhostility was predicted by maternal education and gender of the child, with lower-income mothers and mothers of girls demonstrating greater hostility.

Maternal representation of the self as parent: connections with maternal sensitivity and maternal structuring.

Maternal representations of the self as parent were assessed via the Parent Attachment and Peer Relationship Interviews (Bretherton, Biringen, Ridgeway, Maslin-Cole, & Sherman, 1989; Biringen & Bretherton, 1988) when children were 39 months of age. Maternal sensitivity and maternal structuring during mother-child interactions were assessed at 18, 24 and 39 months. The central question of this study was whether maternal representations were related to aspects of observed maternal sensitivity and maternal structuring. We found that maternal sensitivity at 18 months predicted later maternal representations of the self as parent. But beginning at 24 months and continuing to 39 months maternal structuring proved to be a more important predictor of maternal representations of the self, in particular maternal self-esteem, even after controlling for maternal sensitivity.

Dyssynchrony, conflict, and resolution: positive contributions to infant development.

While most psychological research has emphasized the importance of conflict-free mother-infant interactions, a review of recent research suggests that dyssynchrony, conflict, and their successful resolution are also integral to normative mother-infant interactions and optimal infant outcomes. Theory and research incorporating these concepts are described, areas for research suggested, and clinical applications noted.

Affective reorganization in the infant, the mother, and the dyad: the role of upright locomotion and its timing.

Clinical theory is replete with rich observations that the onset of walking engenders an enhancement of emotional expression in the infant. Yet, no empirical research exists on this subject. Moreover, the importance of normal timing variations in the onset of developmental transitions has not been a topic of investigation in most developmental research. In this naturalistic home study, "earlier" and "later" walking groups were delineated on the basis of timing of entry into this developmental transition. Age-held constant analyses indicated that earlier walkers and their mothers generally showed a rise in positive exchanges as well as "testing of wills" across the transition to walking. These changes were less clear for the later walkers. Differences were observed also between the two groups even prior to walking. These findings suggest that future studies should take account of timing variations in the onset of a developmental transition.

Attachment theory and research: application to clinical practice.

Although Bowlby's attachment theory has had a profound effect on research in developmental psychology, its application to clinical practice has barely been explored. The theory and its origins are outlined, and attachment-theory concepts that may have clinical applicability are explored, with particular attention to the construct of internal working models. In addition, psychotherapeutic approaches using attachment-theory concepts are summarized.

Maternal sensitivity in the second year: gender-based relations in the dyadic balance of control.

In an investigation of gender-based differences in autonomy and relatedness in the mother-toddler dyad, gender-specific stylistic differences were found in mothers' sensitivity toward their toddlers. In the context of greater sensitivity, boys appeared to control the flow of interactions (initiation and maintenance) to a greater extent than did girls.

Emotional availability in mother-child interactions: a reconceptualization for research.

The literature on an earlier view of emotional availability as a maternal construct and on the related concepts of psychological unavailability, depression, sensitivity, and control is reviewed. A reconceptualization of emotional availability as a relational construct, incorporating maternal sensitivity and nonintrusiveness and child responsiveness and involvement of the mother, is presented. Several research issues are proposed for further exploration.

Infant attention to facial expressions and facial motion.

Three-month-old infants were shown moving faces and still faces on videotape in a paired-comparison situation. Motion type was clearly specified, and facial expression and motion were separately varied. Infants saw a still face, internal motion on the face (i.e., motion of the internal features), and whole object (i.e., side-to-side) motion, each with happy and neutral expressions. Infants showed preference for expressions when the face was still and when it showed internal motion. Facial expression and facial motion were equally preferred, and both appeared to be salient dimensions of the face for three-month-old infants.