Validación Chilena del Cuestionario de Evaluación de Apego en el adulto CaMir versión abreviada

El Cuestionario de Evaluación de Apego en el adulto CaMir, es un instrumento de auto-reporte basado en la Teoría del Apego que evalúa los modelos de relación en adultos y permite describir las estrategias de apego. El objetivo de la presente investigación fue desarrollar una versión breve para el contexto chileno, para lo cual se llevaron a cabo dos estudios. En el Estudio 1 se obtuvo una versión reducida del CaMir bajo una estrategia de validación cruzada. En el Estudio 2, se aplicó la versión reducida obtenida en el estudio 1 a una amplia muestra de adultos/as chilenos/as (n=1246). Los resultados muestran evidencias que apoyan la estructura interna propuesta, y los análisis de invarianza apoyan la existencia de equivalencia/invarianza de medida entre hombres y mujeres. Adicionalmente, esta versión obtuvo correlaciones significativas con la Escala de Dificultades de Regulación Emocional, el cuestionario de Experiencias en Relaciones Cercanas y la Escala de Depresión del Centro de Estudios Epidemiológicos. En síntesis, los resultados muestran que esta nueva versión abreviada del CaMir, es un instrumento apropiado para el estudio de los modelos de relación y las estrategias de apego en adultos/as chilenos/as.

The CaMir Adult Attachment Assessment Questionnaire is a self-report instrument based on Attachment Theory that assesses relationship models in adults and allows describing attachment strategies. The objective of this research was to develop a short version for the Chilean context. The results of two studies are presented. In Study 1, a reduced version of CaMir was obtained under a cross-validation strategy. In Study 2, the reduced version obtained in Study 1 was applied to a large sample of Chilean adults (n=1246). The results show evidence that supports the proposed internal structure, and the invariance analysis support the existence of equivalence/invariance of measurement between men and women. Additionally, this version obtained significant correlations with the Difficulties in Emotion Regulation Scale, the Experiences in Close Relationships questionnaire and the Center for Epidemiologic Studies Depression Scale. In summary, the results show that this new abbreviated version of the CaMir is an appropriate instrument for the study of relationship models and attachment strategies in Chilean adults.

Mothers' and fathers' reflective functioning and its association with parenting behaviors and cortisol reactivity during a conflict interaction with their adolescent children.

We assessed parental reflective functioning (PRF) with the Parent Development Interview-Revised and investigated its association with parenting behaviors, that is, autonomy support and psychological control (operationalized in terms of behaviors promoting and undermining autonomy relatedness), and stress responses (cortisol reactivity) during a parent-child conflict interaction task (Family Interaction Task). Participants were 40 mothers and 28 fathers, who took part in the study together with their adolescent children (N = 49). Mothers had significantly lower PRF and displayed more psychologically controlling behaviors in the interaction with their children than fathers. Rather than sex per se, high levels of PRF were the best predictors of autonomy support, whereas lower levels of PRF predicted more psychological control. Higher levels of PRF were also the best predictor for lower levels of parenting stress. Stress in the context of parenting was neither related to autonomy support nor to psychological control, which were best predicted by divorced family status and, for psychological control only, by parental sex. The findings point to the potential utility of interventions aimed at improving PRF, especially in divorced families, given its protective effect on parenting behaviors and stress in the context of parenting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Disorganized attachment in adolescence: Emotional and physiological dysregulation during the Friends and Family Interview and a conflict interaction.

The current study examined the effects of attachment on autonomy, relatedness, and emotion regulation during an attachment interview (Friends and Family Interview; FFI) and a Parent×Child Conflict interaction (Family Interaction Task; FIT) in 49 adolescents (11 to 17 years old). Disorganized adolescents displayed behaviors promoting autonomy and relatedness less frequently and at a lower extent than organized ones in the FIT with mothers but not with fathers. Disorganized adolescents also showed a steeper decrease in heart rate variability (HRV) than organized ones, during both the FFI and the FITs. Moreover, disorganized adolescents responded with a more marked increase in skin conductance level to the FIT with mothers than organized individuals. Dismissing adolescents showed behaviors promoting autonomy and relatedness less frequently and to a lesser extent than secure ones, while displaying more often behaviors undermining autonomy and relatedness in the FITs. Dismissing adolescents also showed a more pronounced decrease in HRV during the FFI than secure and preoccupied individuals; no differences were found between these groups in HRV during the FITs. The results suggest that disorganized adolescents had more difficulties in regulating their emotions during both the FFI and the FITs, whereas dismissing individuals seemed effectively challenged only during the interview.

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: the case of preterm birth.

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother-infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother-infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n=26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months' corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother-infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers' posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother-infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother-infant interactions.

Effects of perinatal stress and maternal traumatic stress on the cortisol regulation of preterm infants.

Preterm infants experience intense stress during the perinatal period because they endure painful and intense medical procedures. Repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis during this period may have long-term effects on subsequent cortisol regulation. A premature delivery may also be intensely stressful for the parents, and they may develop symptoms of posttraumatic stress disorder (PTSD). Usable saliva samples were collected (4 times per day over 2 days, in the morning at awakening, at midday, in the afternoon, and in the evening before going to bed) to assess the diurnal cortisol regulation from 46 preterm infants when the infants were 12 months of corrected age (∼ 14 months after birth). Mothers reported their level of PTSD symptoms. The results showed an interaction between perinatal stress and maternal traumatic stress on the diurnal cortisol slope of preterm infants (R(2) = .32). This suggests that the HPA axis of preterm infants exposed to high perinatal stress may be more sensitive to subsequent environmental stress.

The effect of sexual abuse on children's attachment representations in Chile.

Child sexual abuse is associated with problems in children's emotional development, particularly increased insecurity of attachment. However, few studies have examined its effect on the organization of attachment representations in preschoolers, and the findings of those that have been conducted have not been entirely consistent. Therefore, this study aims to analyze the effect of child sexual abuse on attachment representation quality in a sample of children 3 to 7 years old in Chile. The results indicate child sexual abuse does affect children's attachment representation quality. The attachment narratives of child sexual abuse victims scored significantly higher than nonvictims on the hyperactivity and disorganization dimensions of attachment. These results are discussed in terms of attachment theory, clinical findings on child sexual abuse, and clinical implications.

Posttraumatic stress symptoms and cortisol regulation in mothers of very preterm infants.

Previous studies have found that mothers of very preterm infants often report symptoms of posttraumatic stress, which has been related to cortisol dysregulation. However, the exact nature of this association is not clear and can be different regarding the predominance of some specific symptoms of posttraumatic stress, as suggested by a recent model. The objective of the present study is to assess the association between diurnal salivary cortisol and posttraumatic stress symptoms in mothers of very preterm infants. Seventy-four mothers of very preterm infants were included in the study. Mothers' cortisol regulation and posttraumatic stress symptoms were evaluated 12 months after child theoretical term (40 weeks of gestation). Results showed an association between higher re-experiencing symptoms and flatter cortisol slopes. These results may help to understand differences found in studies assessing the relation between severity of posttraumatic stress and cortisol levels, by supporting the symptoms' theory.

Early mother-child interaction and later quality of attachment in infants with an orofacial cleft compared to infants without cleft.

Objective : The main objective of this study was to assess mother-child patterns of interaction in relation to later quality of attachment in a group of children with an orofacial cleft compared with children without cleft. Design : Families were contacted when the child was 2 months old for a direct assessment of mother-child interaction and then at 12 months for a direct assessment of the child's attachment. Data concerning socioeconomical information and posttraumatic stress symptoms in mothers were collected at the first appointment. Participants : Forty families of children with a cleft and 45 families of children without cleft were included in the study. Families were recruited at birth in the University Hospital of Lausanne. Results : Results showed that children with a cleft were more difficult and less cooperative during interaction at 2 months of age with their mother compared with children without a cleft. No significant differences were found in mothers or in dyadic interactive styles. Concerning the child's attachment at 12 months old, no differences were found in attachment security. However, secure children with a cleft were significantly more avoidant with their mother during the reunion episodes than secure children without cleft. Conclusion : Despite the facial disfigurement and the stress engendered by treatment during the first months of the infant's life, children with cleft and their mothers are doing as well as families without cleft with regard to the mothers' mental health, mother-child relationships, and later quality of attachment. A potential contribution for this absence of difference may be the pluridisciplinary support that families of children with cleft benefit from in Lausanne.

Early Mother-Child Interaction and Later Quality of Attachment in Infants With an Orofacial Cleft Compared to Infants Without Cleft.

Objective : The main objective of this study was to assess mother-child patterns of interaction in relation to later quality of attachment in a group of children with an orofacial cleft compared with children without cleft. Design : Families were contacted when the child was 2 months old for a direct assessment of mother-child interaction and then at 12 months for a direct assessment of the child's attachment. Data concerning socioeconomical information and posttraumatic stress symptoms in mothers were collected at the first appointment. Participants : Forty families of children with a cleft and 45 families of children without cleft were included in the study. Families were recruited at birth in the University Hospital of Lausanne. Results : Results showed that children with a cleft were more difficult and less cooperative during interaction at 2 months of age with their mother compared with children without a cleft. No significant differences were found in mothers or in dyadic interactive styles. Concerning the child's attachment at 12 months old, no differences were found in attachment security. However, secure children with a cleft were significantly more avoidant with their mother during the reunion episodes than secure children without cleft. Conclusion : Despite the facial disfigurement and the stress engendered by treatment during the first months of the infant's life, children with cleft and their mothers are doing as well as families without cleft with regard to the mothers' mental health, mother-child relationships, and later quality of attachment. A potential contribution for this absence of difference may be the pluridisciplinary support that families of children with cleft benefit from in Lausanne.

Maternal interactive behaviour as a predictor of preschoolers' attachment representations among full term and premature samples.

BACKGROUND: Associations between maternal sensitivity and child attachment have been established in many samples, but the strength of the association varies across populations. The sensitivity-attachment link has never been examined at the level of representations nor among premature samples. OBJECTIVE: The present study is aimed at exploring associations between maternal interactive behaviour and children's attachment representations in a population of preterm and full-term infants. METHOD: Maternal interactive behaviour was assessed at 6 and 18 months (Ainsworth Sensitivity Scale & Care Index) and children's attachment representations were measured at 42 months (Attachment Story Completion Task) in a sample of preterm (N=48) and full-term (N=23) infants. RESULTS: Maternal unresponsiveness at 6 months and sensitivity at 18 months explained 54% of the variance of disorganized attachment representations in the full-term group but was not significantly related to attachment patterns in the preterm group. CONCLUSION: These results corroborate previous work on the causes of disorganized attachment and also point to the need to consider the development of attachment differently for children evolving in specific developmental contexts. They especially stress the importance of distinguishing between risk factors associated with the mother as opposed to the child.

Adult attachment representations predict cortisol and oxytocin responses to stress.

There are many factors contributing to individual variations in the response to stressful experiences. The present study evaluated the patterns of stress responses according to attachment representations in 28 adults from a community sample, plus 46 subjects expected to be particularly sensitive to stress, having been exposed during childhood and/or adolescence to traumatizing events such as abuse or potentially lethal illnesses. Subjects were given the Adult Attachment Interview, which provides attachment classifications, and the Trier Social Stress Test (TSST), involving an experimental psychosocial challenge. Subjective responses to the TSST, as well as saliva samples (assayed for cortisol) and blood plasma samples (assayed for ACTH and oxytocin) were collected before, during and after the stress procedure. The stress responses presented specific patterns according to attachment classifications. Subjects with an autonomous attachment classification reported relatively low subjective stress, they presented a moderate response of the hypothalamic-pituitary-adrenal (HPA) axis (ACTH and cortisol), and a high level of oxytocin. Subjects with a dismissing classification reported a moderate subjective stress, they presented an elevated response of the HPA axis, and moderate levels of oxytocin. Subjects with a preoccupied classification presented moderate levels of subjective stress, and of HPA response, and a relatively low level of oxytocin. Finally, subjects with an unresolved classification reported elevated subjective stress; they presented a suppressed HPA response, and moderate levels of oxytocin. These data support the notion that attachment representations may affect stress responses, and suggest a specific role of oxytocin in both the attachment system and the stress system.

Endocrine response and perceived stress test during an experimental challenge task in adult survivors of a childhood cancer.

BACKGROUND: Although long-term implications of cancer in childhood or adolescence with regard to medical conditions are well documented, the impact on mental health and on response to stress, which may be an indicator of psychological vulnerability, is not yet well understood. In this study, psychological and physiological responses to stress were examined. PROCEDURE: Fifty-three participants aged 18-39 years (n = 25 survivors of childhood or adolescence cancer, n = 28 controls) underwent an experimental stress test, the Trier Social Stress Test (TSST). Participants were asked to provide repeated evaluations of perceived stress on visual-analogical scales and blood samples were collected before and after the TSST to measure plasma cortisol. RESULTS: The psychological perception of stress was not different between the two groups. However, the cancer survivors group showed a higher global plasma cortisol level as well as higher amplitude in the response to the TSST. The global cortisol level in cancer survivors was increased when depression symptoms were present. The subjective perception of stress and the plasma cortisol levels were only marginally correlated in both groups. CONCLUSIONS: It is suggested that the exposure to a life-threatening experience in childhood/adolescence increases the endocrine response to stress, and that the presence of depressive symptoms is associated with an elevation of plasma cortisol levels. A better knowledge of these mechanisms is important given that the dysregulations of the stress responses may cause psychological vulnerability.

Versión reducida del cuestionario CaMir (CaMir-R) para la evaluación del apego / Short version of CaMir questionnaire (CaMir-R) to assess attachment

El CaMir es un cuestionario que mide las representaciones de apego. Se fundamenta en las evaluaciones que realiza el sujeto sobre las experiencias de apego pasadas y presentes y sobre el funcionamiento familiar. Es un instrumento ampliamente utilizado tanto en el ámbito de la investigación como en el ámbito clínico. El objetivo del presente estudio consistió en desarrollar una versión reducida del CaMir en lengua castellana (CaMir-R) y en obtener evidencias acerca de su validez y de su fiabilidad en una muestra de 676 adolescentes (364 mujeres y 312 varones) pertenecientes a distintos colectivos (muestra clínica, muestra de maltratados y muestra comunitaria) con un rango de edad que oscilaba entre 13 y 19 años (M= 15,62; SD= 1,49). Se examinó su estructura interna, su validez convergente y de decisión, la relación entre sus dimensiones y los síntomas psicopatológicos, así como su consistencia interna y su estabilidad temporal. Se obtuvieron 7 dimensiones, cuyos índices de consistencia interna oscilaron entre 0,60 y 0,85. Exceptuando la dimensión de «Permisividad parental», que no mostró una buena fiabilidad, los resultados sugieren que el CaMir-R permite evaluar las representaciones de apego y la concepción acerca del funcionamiento familiar de forma válida y fiable (AU)

The CaMir is a questionnaire aimed at measuring attachment cognitions. It is based on subjects’ evaluations of past and present attachment experiences and family functioning. It is a widely used tool both in research and in clinical settings. The aim of this study was to develop a short version of CaMir in Spanish (CaMir-R) and to obtain evidence about its validity and reliability in a sample of 676 adolescents (364 female and 312 male) belonging to different groups (clinical, maltreated, and community samples) with an age range between 13 and 19 years (M= 15.62, SD= 1.49). We examined its internal structure, convergent, and decision validity, the relationship between its dimensions and psychopathological symptoms, as well as its internal consistency and temporal stability. The CaMir-R included 7 factors whose internal consistency indexes ranged between 0.60 and 0.85. With the exception of the «Parental Permissiveness» dimension, which did not show good reliability, the results suggest that the CaMir-R provides a valid and reliable assessment of attachment representations and of the conception of family functioning (AU)

[Short version of CaMir questionnaire (CaMir-R) to assess attachment]. / Versión reducida del cuestionario CaMir (CaMir-R) para la evaluación del apego.

The CaMir is a questionnaire aimed at measuring attachment cognitions. It is based on subjects' evaluations of past and present attachment experiences and family functioning. It is a widely used tool both in research and in clinical settings. The aim of this study was to develop a short version of CaMir in Spanish (CaMir-R) and to obtain evidence about its validity and reliability in a sample of 676 adolescents (364 female and 312 male) belonging to different groups (clinical, maltreated, and community samples) with an age range between 13 and 19 years (M = 15.62, SD = 1.49). We examined its internal structure, convergent, and decision validity, the relationship between its dimensions and psychopathological symptoms, as well as its internal consistency and temporal stability. The CaMir-R included 7 factors whose internal consistency indexes ranged between 0.60 and 0.85. With the exception of the «Parental Permissiveness¼ dimension, which did not show good reliability, the results suggest that the CaMir-R provides a valid and reliable assessment of attachment representations and of the conception of family functioning.

Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship.

OBJECTIVE: Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother-infant dyadic interactions. METHODS: The study enrols 47 preterm (GA<34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index. RESULTS: Full-term mothers were more likely to follow a "Cooperative" dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a "Controlling" dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a "Heterogeneous" group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads. CONCLUSION: Premature birth affects both mother-infant interaction characteristics and maternal representations of attachment with the infant. In particular, a "Controlling" dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent-infant relationship in order to plan supportive, preventive interventions in the neonatal period.

Impact of a cleft lip and/or palate on maternal stress and attachment representations.

OBJECTIVE: The announcement, prenatally or at birth, of a cleft lip and/or palate represents a challenge for the parents. The purpose of this study is to identify parental working internal models of the child (parental representations of the child and relationship in the context of attachment theory) and posttraumatic stress disorder symptoms in mothers of infants born with a cleft. METHOD: The study compares mothers with a child born with a cleft (n  =  22) and mothers with a healthy infant (n  =  36). RESULTS: The study shows that mothers of infants with a cleft more often experience insecure parental working internal models of the child and more posttraumatic stress symptoms than mothers of the control group. It is interesting that the severity or complexity of the cleft is not related to parental representations and posttraumatic stress disorder symptoms. The maternal emotional involvement, as expressed in maternal attachment representations, is higher in mothers of children with a cleft who had especially high posttraumatic stress disorder symptoms, as compared with mothers of children with a cleft having fewer posttraumatic stress disorder symptoms. DISCUSSION: Mothers of children with a cleft may benefit from supportive therapy regarding parent-child attachment, even when they express low posttraumatic stress disorder symptoms.

Quality of attachment, perinatal risk, and mother-infant interaction in a high-risk premature sample.

Thirty-three families, each with a premature infant born less than 33 gestational weeks, were observed in a longitudinal exploratory study. Infants were recruited in a neonatal intensive care unit, and follow-up visits took place at 4 months and 12 months of corrected age. The severity of the perinatal problems was evaluated using the Perinatal Risk Inventory (PERI; A.P. Scheiner & M.E. Sexton, 1991). At 4 months, mother-infant play interaction was observed and coded according to the CARE-index (P.M. Crittenden, 2003); at 12 months, the Strange Situation Procedure (SSP; M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978) was administered. Results indicate a strong correlation between the severity of perinatal problems and the quality of attachment at 12 months. Based on the PERI, infants with high medical risks more frequently tended to be insecurely attached. There also was a significant correlation between insecure attachment and dyadic play interaction at 4 months (i.e., maternal controlling behavior and infant compulsive compliance). Moreover, specific dyadic interactive patterns could be identified as protective or as risk factors regarding the quality of attachment. Considering that attachment may have long-term influence on child development, these results underline the need for particular attention to risk factors regarding attachment among premature infants.

Niños nacidos prematuramente: una mirada atenta a los resultados cognitivos y conductuales / Preterm infants: a close look at cognitive and behavioral outcomes

Un total de 47 niños prematuros y un grupo control de 25 bebés nacidos a término fueron evaluados a los 6 y 18 meses (edad corregida) y a los 46 meses (edad no corregida9. Se computó un cociente de desarrollo (CD) para cada momento de observación y las madres fueron entrevistadas sobre los problemas conductuales de sus hijos, además de rellenar un cuestionario sobre síntomas postraumáticos después del nacimiento. La diferencia entre ambos grupos desapareció al corregirse el CD en el tercer momento de observación, según la fecha de nacimiento esperada e introducirse el nivel socioeconómico como covariable. Estos hallazgos ponen de manifiesto que tales factores de confusión deberían de ser objeto de mayor atención al comparar los resultados de los nenes prematuros con los nenes nacidos a término (AU)

Forty-seven prematurely born children and a control group of 25 full-term infants were evaluated at 6 months, 18 months (corrected ages), and at 46 months (non-corrected age). At each observation point, a developmental quotient (DQ) was computed and mothers were interviewed regarding their children´s behavioral problems. At the second observation point, mothers also completed a questionnaire on post traumatic symptoms following birth. However, when the DQ was corrected for expected term at the third observation point and socio-economic status was introduced as a covariate in the analysis, there was no longer any difference between the two groups. These findings suggest that control group studies comparing the outcomes of prematurely born children with those of children born full term should investigate such confounding factors more closely (AU)