Longitudinal associations between the quality of family interactions and school-age children's narrative abilities in the context of financial insecurity.

This longitudinal study investigates whether the quality of family interactions at 3-5 years of age predicts narrative abilities in 7-9-year-old children from socioeconomically disadvantaged families. The sample consists of 67 children and their parents receiving social welfare. Family interactions were filmed during mealtime at home and coded using the Mealtime Interaction Coding System. Children's narrative abilities were measured based on their capacity to coherently elaborate and resolve stories from the Attachment Story Completion Task. Results revealed that children exposed to family interactions of higher quality make their narratives more accessible and understandable and include more appropriate expression of affects in their stories 4 years later, even after accounting for maternal education and verbal abilities. The results of this study highlight the importance of considering family interactions in the context of financial insecurity when studying socioemotional competence in childhood.

Maternal Attachment Networks and Mother-Infant Bonding Disturbances among Mothers with Postpartum Major Depression.

The literature suggests that maternal insecure attachment is a risk factor for postpartum depression which, in turn, affects motherinfant bonding. However, recent research in attachment suggests that the investigation of attachment networks provides further insight in the understanding of psychological outcomes. This study aims to test a model according to which mothers' attachment towards each of their parents contributes to explain attachment towards their romantic partners, which itself is associated with maternal postpartum depression and, in turn, with motherinfant bonding. The Attachment Multiple Model Interview, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire were administered to 90 mothers of infants under 6 months of age (32 with postpartum major depression). Results showed that attachment towards the partner (1) is best explained by attachment to the father and (2) mediates the link between attachment to the father and depression severity. Also, depression severity mediates the link between attachment to the partner and motherinfant bonding. These results highlight the role of attachment models towards the romantic partner and the father in the perinatal period and the relevance of attachment-focused therapeutic programs in treating postpartum maternal depression.

Effects of intellectual disability and attachment on hostile intent attribution bias.

Understanding hostile intent attribution (HIA) seems important for prevention of problems in social adaptation. This study aimed to explore whether HIA in childhood is determined by both a cognitive factor (i.e. intellectual disability) and an affective factor (i.e. attachment representations). One hundred and eight 8- to 12-year-old children (54 with intellectual disability and 54 with typical development) passed the Attachment Story Completion Task and the Intention Attribution Test for Children. Results indicated that in ambiguous situations, attachment disorganization was associated with HIA, whereas intellectual disability was not. In nonintentional situations, both attachment hyperactivation and intellectual disability were linked with HIA. These results highlight the importance of helping children develop organized attachment representations and optimal activation of their attachment system to prevent social maladaptation.

A Prospective Observational Study to Assess Attachment Representations With Regard to Neurocognitive and Behavioral Outcomes in Children Born Very Prematurely in the Loire Infant Follow-Up Team (LIFT Cohort).

Context and purpose: Prematurity is a situation that can disrupt parent-child interactions. We hypothesize that establishing relationships with parents in a context of extreme prematurity can alter the development of secure attachment representations in the child. Furthermore, we hypothesize that secure maternal representations and their possible interactions with prematurity factors prevent the development of insecure or disorganized attachment in the child. In addition, maternal representations and their possible interactions with factors related to prematurity may prevent or accentuate the development of an insecure or disorganized attachment in the child. Methods and analysis: This is a longitudinal, prospective, exploratory, and bi-centric study. Children born in the neonatal intensive care units of Angers or Nantes University Hospitals with a gestational age of up to 28 weeks will be included in the study. The main objective is to describe the attachment representations at 3 and 5 years through the Attachment Story Completion Task scales and to analyze them in regard to the children's neurocognitive and behavioral outcomes as well as maternal attachment and mental health. Ethics: The study file received a favorable opinion for the implementation of this research on February 18, 2020 - ID-RCB no. 2019-A03352-55 (File 2-20-007 id6699) 2°HPS. This study has received authorization from the French Data Protection Authority (CNIL) under no. 920229. Discussion: A better understanding of attachment representations in extreme prematurity and their possible associations with children's neurocognitive and behavioral outcomes as well as maternal attachment and mental health could pave the way for individualized care at an early stage, or even interventions during the neonatal period to improve the outcome of these vulnerable newborns. Trial registration: [ClinicalTrials.gov], identifier [NCT04304846].

The role of multiple attachments in intergenerational transmission of child sexual abuse among male victims.

BACKGROUND: According to Finkelhor (1984), difficulties child sexual abusers have in establishing adaptive adult relationships are a consequence of attachment problems with parents. Research shows that insecure attachment is associated with both the experience of child sexual abuse (CSA) as a victim and perpetration of CSA as an adult. Attachment may thus be a key factor in intergenerational transmission (IT) of CSA. OBJECTIVE: The study aims to examine the direct, interactive, and mediated effects linking attachment in different relationships (mother, father, romantic partner) to IT of CSA among male victims. PARTICIPANTS AND SETTING: Thirty-two abusing and 27 non-abusing male CSA survivors were recruited, respectively, in a prison and via networks of former foster children or CSA victims. METHOD: All participants completed the Attachment Multiple Model Interview to assess attachment along four dimensions (security, deactivation, hyperactivation, and disorganization) in the relationship with mother, father, and partner. RESULTS: Partial least square modeling suggests that the partner carries forward (mediates) the increased risk of committing sexual abuse associated with insecure/disorganized attachment with the father. A significant partner-mother interaction also suggests that the deleterious effects of attachment to the mother in terms of committing CSA are countered by more secure/organized attachment to the partner. CONCLUSIONS: Findings highlight the pivotal role of the romantic partner in IT of CSA. Beyond early intervention, therapy in adulthood aimed at fostering adaptive ways of finding emotional security in the relationship with an adult could thus be encouraged.

The role of attachment to the foster parent with regard to suicidal risk among adult survivors of childhood maltreatment.

BACKGROUND: Childhood maltreatment is associated with an increased risk of insecure/disorganized attachment and in turn with suicidal risk (SR). Out-of-family placement is aimed at interrupting child exposure to further abuse and at providing the necessary security for proper development via the establishment of an alternative attachment relationship. However, the actual protective role of this type of care is not clear given the high rates of SR among institutionalized or foster children. OBJECTIVE: The aim of this study was to examine whether 1) attachment to the biological parents mediates the association between abuse and SR and 2) attachment to a foster parent (whether from a foster home or an institution) moderates the effect of attachment to biological parents on SR. PARTICIPANTS: The sample consisted of 77 adults (52 female; 25 male; mean age: 26.6 years) who received out-of-home care during childhood. METHOD: The Childhood Trauma Questionnaire and the Mini International Neuropsychiatric Interview (for SR) were used. The Attachment Multiple Model Interview was also administered to assess attachment to each biological parent and to the foster parent. RESULTS: Results show that attachment (security and disorganization) to the biological mother mediates the link between abuse and SR and that attachment to the foster parent moderates the link between attachment to the biological mother and SR. CONCLUSIONS: Findings point to the importance of interventions aimed at supporting the establishment of a secure attachment relationship between children in care and their foster parents.

Attachment representations among school-age children with intellectual disability.

BACKGROUND: Research data documenting a high risk of insecure and disorganized attachment among children with intellectual disability (ID) in infancy and early childhood raises the question of mutual influences between ID and attachment in later childhood. AIMS: The objectives of the present study were to examine attachment among school-age children with ID and whether attachment varies according to level of intellectual functioning, adaptative functioning, and presence of a genetic syndrome (i.e. Down syndrome). METHODS: Attachment among 54 children with ID aged 8-12 years (30 with Down Syndrome, 24 with non-specific ID) was assessed using the Attachment Story Completion Task, and compared with that of 108 typically developing children, 54 of the same chronological age and 54 of the same mental age. OUTCOMES: Results show (1) less security among children with ID than among same-age controls (2) more disorganization among children with ID compared to the two control groups, (3) a link between attachment disorganization and level of adaptive functioning among children with ID and (4) no difference in attachment between children with DS and children with non-specific ID. CONCLUSIONS: Children with ID remain vulnerable to disorganization during late childhood. More research is needed to understand the factors underlying disorganized attachment representations.

Validation of the Intention Attribution Test for Children (IAC).

The Intention Attribution Test for Children (IAC) was created to assess hostile attribution bias in preschool- and early school-aged children. It comprises 16 cartoon strips presenting situations in which one character (either a child or an adult) causes harm to another, either intentionally, accidentally (nonintentional), or without his or her intention being clear (ambiguous). Its validity was tested on 233 children aged 4 to 12 years. Exploratory factor analysis and item response theory models demonstrated support for a single factor of hostile attribution bias for the ambiguous and nonintentional items. Analyses revealed, however, that the intentional items did not contribute to this same overall construct of hostile intention attribution bias. Correlations with the Social Perception Test and with sociometry suggest good validity of the IAC. The IAC may be a useful instrument for research and in the context of therapeutic intervention addressing socially inappropriate behavior in childhood.

Behavior problems in sexually abused preschoolers over a 1-year period: The mediating role of attachment representations.

According to the developmental psychopathology framework, adverse childhood experiences, including child sexual abuse (CSA), may alter the course of normal development in children. Attachment security has been identified as a protective factor against psychopathology and may thus play a critical role in predicting victims' adaptation. The main objective of the present study was to investigate the mediating effect of attachment representations in the relation between CSA and behavior problems over a 1-year period. The sample consisted of 391 children (251 sexually abused) aged 3.5 to 6 years. The Attachment Story Completion Task and the Child Behavior Checklist were used. Disorganized attachment partially mediated the relation between CSA and children's internalizing and externalizing behavior problems 1 year following the initial assessment. This mediation effect was not found for ambivalent nor secure attachment dimensions. Child gender was found to moderate the association between CSA and disorganization, with larger effects of CSA among boys. These findings underscore the importance of considering attachment representations in treatment programs for preschool victims. Evidence-based practice focusing on trauma could be combined with an attachment-based intervention targeting the parent-child relationship. Moreover, interventions should be gender sensitive, as CSA appears to affect boys and girls differently.

Borderline Personality Disorder in Adolescence as a Generalization of Disorganized Attachment.

Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are more secure with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have.

Reconsidering the links between sibship size, maternal sensitivity, and child attachment: A multidimensional interactive approach.

Despite being a well-documented predictor of children's cognitive and social development, sibship has received remarkably little attention in the attachment and maternal sensitivity literature. The only study that has examined both sensitivity and attachment in relation to sibship found greater maternal sensitivity but no more secure attachment among first-born infants. In the current study, we sought to examine the same links while testing two related hypotheses: that sibship size relates only to some specific aspects of sensitivity, and that sibship size relates to sensitivity only among certain mothers, namely those who are at risk for suboptimal parenting because of an insecure attachment state of mind. We assessed three dimensions of maternal sensitivity at 12 months and child attachment at 15 and 25 months among 258 mother-infant dyads living in intact biparental families. Compared with mothers who had fewer children, those with more children were observed to be less accessible/available, less positive, but not less cooperative/attuned, when interacting with their infant. These links were moderated by maternal attachment state of mind, such that significant relations were observed only among mothers presenting a more insecure state of mind. Finally, sibship size was unrelated to attachment. These findings suggest that failure to consider different dimensions of sensitivity or important parental moderators may result in the erroneous conclusion that birth order and sibship size are inconsequential for parent-child relationships. (PsycINFO Database Record

The Multimodal Assessment of Adult Attachment Security: Developing the Biometric Attachment Test.

BACKGROUND: Attachment theory has been proven essential for mental health, including psychopathology, development, and interpersonal relationships. Validated psychometric instruments to measure attachment abound but suffer from shortcomings common to traditional psychometrics. Recent developments in multimodal fusion and machine learning pave the way for new automated and objective psychometric instruments for adult attachment that combine psychophysiological, linguistic, and behavioral analyses in the assessment of the construct. OBJECTIVE: The aim of this study was to present a new exposure-based, automatic, and objective adult-attachment assessment, the Biometric Attachment Test (BAT), which exposes participants to a short standardized set of visual and music stimuli, whereas their immediate reactions and verbal responses, captured by several computer sense modalities, are automatically analyzed for scoring and classification. We also aimed to empirically validate two of its assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. METHODS: A total of 59 French participants from the general population were assessed using the Adult Attachment Questionnaire (AAQ), the Adult Attachment Projective Picture System (AAP), and the Attachment Multiple Model Interview (AMMI) as ground truth for attachment security. They were then exposed to three different BAT stimuli sets, whereas their faces, voices, heart rate (HR), and electrodermal activity (EDA) were recorded. Psychophysiological features, such as skin-conductance response (SCR) and Bayevsky stress index; behavioral features, such as gaze and facial expressions; as well as linguistic and paralinguistic features, were automatically extracted. An exploratory analysis was conducted using correlation matrices to uncover the features that are most associated with attachment security. A confirmatory analysis was conducted by creating a single composite effects index and by testing it for correlations with attachment security. The stability of the theory-consistent features across three different stimuli sets was explored using repeated measures analysis of variances (ANOVAs). RESULTS: In total, 46 theory-consistent correlations were found during the exploration (out of 65 total significant correlations). For example, attachment security as measured by the AAP was correlated with positive facial expressions (r=.36, P=.01). AMMI's security with the father was inversely correlated with the low frequency (LF) of HRV (r=-.87, P=.03). Attachment security to partners as measured by the AAQ was inversely correlated with anger facial expression (r=-.43, P=.001). The confirmatory analysis showed that the composite effects index was significantly correlated to security in the AAP (r=.26, P=.05) and the AAQ (r=.30, P=.04) but not in the AMMI. Repeated measures ANOVAs conducted individually on each of the theory-consistent features revealed that only 7 of the 46 (15%) features had significantly different values among responses to three different stimuli sets. CONCLUSIONS: We were able to validate two of the instrument's core assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. Future validation of other of its dimensions, as well as the ongoing development of its scoring and classification algorithms is discussed.

Rehabilitation following cerebral anoxia: An assessment of 27 patients.

OBJECTIVES: (1) To evaluate cognitive and emotional impairments, disability and quality-of-life for adults with cerebral anoxia institutionalized in residential care facilities. (2) To evaluate the efficacy of medication, psychotherapy, support group and therapeutic activities. METHODS: Twenty-seven persons with cerebral anoxia were recruited, on average 8 years post-injury. Only 20 went through the whole study. Over three consecutive 2-month periods, they were assessed four times to evaluate: baseline observations (T1-T2), adjustment of their medication (T2-T3); and the effect of psychotherapy, support group and therapeutic activities such as physical and artistic or cultural activities usually proposed in the facilities involved (T3-T4). Examined variables at all time points were cognitive status, anxiety and depression, anosognosia, alexithymia, disability and quality-of-life. RESULTS: All participants exhibited cognitive and emotional impairments comparable to those reported in the literature. Statistical analyses revealed good baseline stability of their condition and no significant effects of changes in medication (between T2 and T3). Conversely, following implementation of psychotherapy, support group and therapeutic activities (between T3 and T4), quality-of-life and social participation were significantly improved. CONCLUSION: Social participation and quality-of-life for persons instutionalized several years after cerebral anoxia were improved by psychotherapeutic and therapeutic activities.

Refining the assessment of internal working models: the Attachment Multiple Model Interview.

The Attachment Multiple Model Interview (AMMI) was developed to assess internal working models (IWMs) of specific relationships in adulthood (e.g., with mother, father, and romantic partner). In an initial effort to validate the AMMI, the interview was administered to participants who were followed from age 4 to 23. ANOVA and contrast tests confirmed the AMMI's capacity to discriminate between mother, father, and partner IWMs. AMMI security with each parent was correlated with coherence according to the Adult Attachment Interview, and AMMI disorganization with mother with unresolved trauma (N = 53). AMMI dimensions of security, deactivation, and hyperactivation with the mother were associated with cumulative lifetime scores of security (N = 23), avoidance, and resistance (N = 34), respectively. Intercorrelations between these AMMI scales were also theory-consistent. Associations with the AAI and between AMMI security scores of different relationships are consistent with previous findings suggesting a contribution from both parents in the development of a state of mind, but a more important role of the mother for representations of the partner.

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.

Alexithymia as a mediator between attachment and the development of borderline personality disorder in adolescence.

Insecure attachment and the inability to identify emotions have both been put forward as possible explanations for dysfunction of the emotional system in borderline personality disorder (BPD). This study aimed to test a model according to which the influence of attachment on the development of BPD in adolescence is mediated by alexithymia. Borderline severity was assessed by means of the Structured Interview for DSM-IV Personality Disorders. Attachment and alexithymia were measured respectively with the Relationship Styles Questionnaire and the Toronto Alexithymia Scale. Mediation analyses conducted on 105 participants (54 with BPD and 51 matched controls) suggest that the role of security and negative model of self (i.e., preoccupied and fearful attachment styles) in the development of BPD symptoms are mediated by alexithymia.

Intergenerational transmission of attachment representations in the context of single parenthood in France.

Despite a dramatic increase of single parenthood during the past decades, parent-child transmission of attachment has almost always been examined in intact families. A first objective of the current study was to examine child attachment in the context of single parenthood, both maternal and paternal. A second objective was to investigate intergenerational transmission of attachment in single parent-child dyads, compared with that observed in two-parent families. The samples consisted of 50 married couples and 43 single parents (22 mothers and 21 fathers), along with their 3- to 6-year-old children. Parental and child attachment representations were measured, respectively, with the Adult Attachment Interview and the Attachment Story Completion Task. Findings suggested that single parenthood per se was not linked to more insecure or disorganized child attachment representations. However, when the father was the sole caregiver, children exhibited more disorganized representations. Different patterns of mother-child associations were found according to family structure: associations were significant among married families but not among single-mother families. Results also replicated those of previous studies in finding a nonsignificant father-child association in two-parent families and a significant one in single-father families, specifically with respect to hyperactivation. Further research is needed to clarify whether the differences found are attributable to different circumstances leading to single parenthood for men and women, or to parental gender itself.

Initiating a Caregiving Relationship: Pregnancy and Childbirth Factors as Predictors of Maternal Sensitivity.

The aim of this study was to investigate the relations between pregnancy and childbirth factors and subsequent quality of maternal interactive behavior in a sample of 116 full-term infants and their mothers. Mothers reported on the conditions of childbirth when infants were 6-8 months of age, and their interactive behavior was observed during a home visit at 12 months. Results showed that mothers who did not report health problems during pregnancy and who had longer pregnancies, shorter hospital stays, natural deliveries, and infants with greater birthweight were found to be more sensitive during interactions with infants at 12 months. All these relations held after accounting for socio-economic factors and maternal psychological distress, except for the effect of type of delivery. This pattern of results, however, was almost exclusively due to mothers who already had at least one other child. Very few such relations were found among primiparous mothers.