A self-comfort oriented pattern of regulatory behavior and avoidant attachment are more likely among infants born moderate-to-late preterm

Infants born preterm (<37 gestational weeks, GW) are at increased risk for regulatory difficulties and insecure attachment. However, the association between infants' regulatory behavior patterns and their later attachment organization is understudied in the preterm population. We addressed this gap by utilizing a Portuguese sample of 202 mother–infant dyads. Specifically, we compared the regulatory behavior patterns of 74 infants born moderate-to-late preterm (MLPT, 32–36 GW) to those of 128 infants born full-term (FT, 37–42 GW) and evaluated the associations of these regulatory patterns with later attachment. Infants' regulatory behavior patterns (Social-Positive Oriented, Distressed-Inconsolable, or Self-Comfort Oriented) were evaluated in the Face-to-Face-Still-Face paradigm at 3 months, and their attachment organization (secure, insecure-avoidant, or insecure-ambivalent) was evaluated in the Strange Situation at 12 months corrected age. In both samples, the Social-Positive-Oriented regulatory pattern was associated with secure attachment; the Distressed-Inconsolable pattern with insecure-ambivalent attachment; and the Self-Comfort-Oriented pattern with insecure-avoidant attachment. However, compared to FT infants, infants born MLPT were more likely to exhibit a Self-Comfort-Oriented pattern and avoidant attachment. Most perinatal and demographic variables were not related to infant outcomes. However, infants with a higher 1-min Apgar were more likely to exhibit the Social-Positive-Oriented regulatory pattern and secure attachment.     

A discussion of current attachment research and its clinical applications

This article highlights Stern's recent conceptualization of the infant's development of internal working models of attachment and the relationship between internal working models and the narrative self. Research studies, including Ainsworth's and Main's seminal work on types of infant attachment models, are reviewed. These include secure, avoidant insecure, ambivalent insecure, and disorganized-disoriented types of infant attachment. Later research supports the continuation of these same attachment patterns in the children at age six. A clinical case, a sixteen year old and her infant, is presented to illustrate how the client's working model of attachment plays out in the treatment process.     

Mind‐Mindedness as a Multidimensional Construct: Appropriate and Nonattuned Mind‐Related Comments Independently Predict Infant–Mother Attachment in a Socially Diverse Sample

In a socially diverse sample of 206 infant–mother pairs, we investigated predictors of infants’ attachment security at 15 months, with a particular emphasis on mothers’ tendency to comment appropriately or in a non‐attuned manner on their 8‐month‐olds’ internal states (so‐called mind‐mindedness). Multinomial logistic regression analyses showed that higher scores for appropriate mind‐related comments and lower scores for non‐attuned mind‐related comments distinguished secure‐group mothers from their counterparts in the insecure‐avoidant, insecure‐resistant, and insecure‐disorganized groups. Higher scores for appropriate mind‐related comments and lower scores for non‐attuned mind‐related comments also independently predicted dichotomous organized/disorganized attachment. General maternal sensitivity predicted neither attachment security nor organization, although sensitivity was found to relate to dichotomous secure/insecure attachment specifically in the context of low socioeconomic status. The findings highlight how appropriate and non‐attuned mind‐related comments make independent contributions to attachment and suggest that mind‐mindedness is best characterized as a multidimensional construct.     

Individual Differences in Infants’ Joint Attention Behaviors With Mother and a New Social Partner

Relations between infant–mother attachment security at 15 months and infants’ (N = 206) joint attention behaviors (a) with an experimenter at 8 and 15 months, and (b) with their mothers at 15 months were investigated. No concurrent or longitudinal relations were observed between attachment security and infants’ tendency to respond to an experimenter’s bids for joint attention. Higher levels of initiating joint attention with an experimenter at 15 months were associated with insecure‐avoidant attachment. Insecure‐avoidant attachment was also associated with lower scores for initiating high‐level joint attention behaviors (pointing, showing, and giving) with the mother at age 15 months. The fact that security‐related differences in initiating joint attention with an experimenter were observed only once the attachment relationship was consolidated suggests that (a) attachment security may influence infants’ active engagement with new social partners, and (b) insecure‐avoidant infants may compensate for reduced social contact with the caregiver by initiating more interaction with other social partners.     

Infant Distress and Regulatory Behaviors Vary as a Function of Attachment Security Regardless of Emotion Context and Maternal Involvement

Differences in infant distress and regulatory behaviors based on the quality of attachment to mother, emotion context (frustration versus fear), and whether or not mothers were actively involved in the emotion-eliciting tasks were examined in a sample of 98 16-month-old infants and their mothers. Dyads participated in the Strange Situation, a limiting task designed to elicit infant frustration, and a novelty task designed to elicit infant fear. Mothers were asked to remain uninvolved during the first minute of each task, and then instructed to engage with their infants as they wished for the remaining three minutes. Independent of concurrent maternal sensitivity, resistant infants were significantly more distressed than secure and avoidant infants. Avoidant infants engaged in fewer active mother-oriented regulation behaviors than secure and resistant infants and engaged in more self-soothing in the mother involved condition than the mother uninvolved condition. Resistant infants engaged in more physical comfort with their mothers and more venting than both secure and avoidant infants, and exhibited a smaller variety of adaptive non-mother-oriented strategies than did secure infants. There were few differences in infant distress and regulatory behaviors as a function of emotion task and maternal involvement. Limitations and implications for future research are discussed.     

The Child in the Family of a Drug-Using Father: Attachment Styles and Family Characteristics

SUMMARY

The study examined the impact of family characteristics and parental attachment styles on the children of drug-using (DU) fathers in fifty-six families (n = 168) in Israel. Of the DU fathers, 60.7% were characterized by avoidant attachment style. Among the non-DU mothers, 53.6% were characterized by secure attachment style, 42.9% by avoidant style, and 3.6% by anxious/ambivalent style. Surprisingly, family cohesion and adaptability scores were similar to the Israeli norm, perhaps because the DUs had completed detoxification treatment and participated in rehabilitation programs. Of the children, 61.8% were characterized by secure attachment style, 21.8% by avoidant style, and 16.4% by anxious/ambivalent style. Stepwise regression to predict children's attachment styles revealed that maternal security of attachment and paternal anxious/ambivalent style predict similar attachment styles among the children. The important combined effects of spousal attachment styles on the children are discussed.     

Viewing Telephone Therapy Through the Lens of Attachment Theory and Infant Research

This article discusses the use of the telephone for psychotherapy and applies basic tenets of attachment theory and research on infant development to understand the therapy process. Clinical case examples of four models of attachment (secure, insecure ambivalent, insecure avoidant, disorganized) illustrate diverse patient capacities to use the telephone during a planned 10-week break from ongoing, in-person treatment. It is suggested that telephone therapy may be variously effective based on the attachment system that becomes activated due to the separation, and patients with insecure avoidant or disorganized attachment patterns may have more difficulty managing the alternative treatment modality.     

Pathways Linking Childhood Maltreatment and Adolescent Sexual Risk Behaviors: The Role of Attachment Security

Previous research has shown an association between child maltreatment (sexual abuse, physical abuse, neglect, or witnessing interparental violence) and adolescent sexual risk behaviors (SRBs). The mechanisms explaining this association are not well understood, but attachment theory could provide further insight into them. This study examined the relationships between child maltreatment and SRBs and investigated anxious and avoidant attachment as mediators. The sample comprised 1,900 sexually active adolescents (13 to 17 years old; 60.8% girls) attending Quebec high schools. The results of path analyses indicated that neglect was associated with a higher number of sexual partners, casual sexual behavior, and being younger at first intercourse. Anxious attachment mediated the relation between neglect and number of sexual partners, whereas avoidant attachment explained the relation between neglect and number of sexual partners, casual sexual behavior, and age at first intercourse (for boys only). Sexual abuse was directly associated with all three SRBs. Neither anxious attachment nor avoidant attachment mediated these associations. Youth with a history of neglect and sexual abuse represent a vulnerable population that is likely to engage in SRBs. Interventions designed to induce a positive change in attachment security may reduce SRBs among victims of neglect.     

Using attachment theory to understand the treatment of adult depression

John Bowlby developed attachment theory to explain connections between infant and caregiver behavior and how these impacted children’s behavior. Extended and researched heavily in a variety of contexts, attachment theory has advanced clinical thinking over time. Its core ideas regarding infant and caregiver connections are very useful to mental health practitioners today and have particular ramifications for clinical work with adults. This paper discusses the application of Bowlby’s attachment theory to the clinical treatment of adult depression and explores a relevant case example.     

Borderline and antisocial personality scores as mediators between attachment and intimate partner violence

Court-mandated male batterers (n = 192) attending an intervention program completed measures examining adult attachment orientations (anxious and avoidant), personality disorders (borderline and antisocial), type of violence (psychological and physical), and social desirability. Structural equation modeling was used to determine whether there were significant relationships between anxious attachment and physical and psychological violence that are mediated by either borderline or antisocial personality disorders. Social desirability was included in both models as a covariate. Results indicated that personality disorders fully mediated the relationship between avoidant attachment and physical as well as psychological violence. Personality disorders only partially mediated the relationship between anxious attachment and psychological violence. Implications for intervention are discussed.     

Additional Components of the Still‐Face Effect: Commentary on Adamson and Frick

Adamson and Frick (2003/this issue) provide an informative and often fascinating history of the still‐face paradigm and its applications in infancy research. With benefit of their review, one can identify several potentially important components of the still‐face paradigm that have been neglected in past research. These are the influence of the still face on parent and infant behavior during the reunion episode and expanded measurement of the still‐face effect to include theoretically important components of facial expression and the temporal organization of parent and infant behavior and physiology. In particular, by expanding what is meant by the still‐face effect to encompass aspects of the reunion episode, we may discover robust probes into the parent–infant relationship and individual differences in infant attachment and emotion regulation extending across infancy and childhood.     

Costs of Not Getting to Know You: Lower Levels of Parental Reflective Functioning Confer Risk for Maternal Insensitivity and Insecure Infant Attachment

Parental reflective functioning (PRF) is a robust predictor of parenting sensitivity and secure infant attachment, but its assessment requires extensive resources, limiting its integration into research and clinical practice. The Mini‐Parent Reflective Functioning Interview (Mini‐PRFI) assesses the parent's capacity to mentalize for his/her 6‐month‐old infant (rated using the PRF coding system; Slade et al., 2004, PRF coding system and Slade REF, Unpublished protocol, New York, NY: The City University of New York). In the current study, we examined whether Mini‐PRFI scores were associated with theoretically related constructs; to establish a point of comparison, we evaluated links between Mini‐PRFI scores alongside RF assessed from the Adult Attachment Interview (AAI). Mother–infant dyads (N = 88) completed the AAI before the birth of the infant, the Mini‐PRFI and an interaction task (rated for insensitive parental behavior) when infants were 6 months old, as well as the Strange Situation Procedure when infants were 16 months old. Mini‐PRFI scores were strongly positively associated with AAI RF and negatively associated with maternal insensitivity. Mini‐PRFI scores predicted infant attachment organization (secure/insecure, organized/disorganized) at 16 months, and this effect was mediated by parenting insensitivity. These findings suggest that the Mini‐PRFI predicts theoretically related attachment constructs, demonstrating the promise of the Mini‐PRFI to increase the accessibility of interview‐based PRF measurements to clinicians and researchers.     

Insecure Attachment Predicts History of Divorce,Marriage, and Current Relationship Status

The goal of this research was to test the predictive ability of attachment styles and dysfunctional relational communication patterns to predict adults’ relationship status (i.e., single/partnered and ever-married/ever-divorced). Anxious and avoidant attachment styles and dysfunctional relational communication patterns (i.e., criticism, defensiveness, contempt, stonewalling) were predictors of relationship status in 413 adults who participated in an online survey. The results indicated that anxious and avoidant attachment styles significantly predicted both history of divorce and single versus partnered relationship status. The dysfunctional communication patterns did not explain a great deal of variance in relationship history and status above and beyond insecure attachment, although dysfunctional communication was significantly and consistently associated with insecure attachment. These results indicate that some of the individual characteristics that generate a risk for divorce might also pose a barrier to repartnering after a divorce.     

Positive Interactions and Avoidant and Anxious Representations in Relationships with Parents,Friends, and Romantic Partners

We examined associations between positive interactions and avoidant and anxious representations in relationships with parents, friends, and romantic partners. Two hundred adolescents completed questionnaires, observations, and attachment interviews. From a between‐person perspective, those adolescents with more positive interactions overall had less avoidant representations. Within persons, the more positive interactions were relative to one's own average level in relationships, the less avoidant representations were for that type of relationship. Adolescents were less anxious about a particular type of relationship if they had positive interactions in their other types of relationships. Finally, representations were primarily predicted by interactions in the same type of relationship; interactions in other relationships contributed little. The findings underscore the importance of examining representations of particular types of relationships.     

Infant Nutrition and 12 and 18 Months Secure Base Behavior: An Exploratory Study

A notable omission in studies of developmental links to early nutritional deficiencies is infant attachment. In those few studies investigating associations between infant nutrition and attachment, nutrition was defined solely by physical growth, and infants had moderate–severe growth retardation. In this study, we utilized multiple markers of infant nutrition. Our sample consisted of 172 12‐month‐old Peruvian infants and their mothers from low‐income families, with a follow‐up assessment on 77 infants at 18 months. Infants were not severely malnourished, but did have micronutrient deficiencies. Anthropometry, dietary intake, and iron status were used as measures of infant nutrition. Based on infant behavior in a structured laboratory situation, Q‐sort techniques were used to rate three attachment markers: infant secure base behavior, interaction quality, and negative emotionality with mother. At 12 months, infant weight was positively related to interaction quality. At 18 months, infant iron status was positively related to secure base behavior. This pattern of findings remained even after statistically controlling for family socioeconomic status and maternal education. Our findings indicate that infant nutritional status is associated with markers of infant attachment and these associations are not restricted just to severely malnourished infants.     

Attachment,Conflict Resolution,and Sexual Satisfaction in Adoptive Couples

Abstract

Attachment theory affirms that one’s partner is vital to fostering support and security. It is important for adoptive couples to be mindful of this support because it is at the forefront of healthy family functioning. With a sample of adoptive couples (n?=?166), this study examines the influence of attachment style on conflict resolution and sexual satisfaction. Significant findings indicate that an avoidant attachment style is directly associated with lower conflict resolution and sexual satisfaction. Better conflict resolution significantly predicts greater sexual satisfaction. These findings demonstrate the importance of establishing a more secure romantic attachment in clinical work with adoptive couples.     

Predictors of attachment styles of children in foster care: an attachment theory model for working with families

The purpose of this study was to examine the attachment styles of children in foster care and to use this information to inform clinical practice (N = 110). When examining the relationship between attachment style and child characteristics, no significant differences were found. A structural equation model hypothesizing the relation of individual characteristics, losses, and family contact to avoidant attachment was then tested. Results provided tentative support for the hypothesized model. Implications for therapists include being attentive to attachment injuries, and working to create safe therapeutic environments when working with families involved in the foster care system.     

Positive Attentional Bias,Attachment Style,and Susceptibility to Peer Influence

Susceptibility to peer influence may be related to activation in reward‐related brain regions. The current study extends research on the role of reward sensitivity in peer influence by examining whether preferential attention to positive emotional stimuli predicts behavior in peer interactions, and whether this association is moderated by attachment style in a sample of 36 same‐sex peer dyads. Positive attentional bias was associated with lower autonomy and greater avoidance with peers. This association was attenuated among individuals with secure attachment style. Attention to negative stimuli was associated with less avoidant and more hostile behavior during peer interactions. Results suggest that preferential attention to positive emotional stimuli is associated with greater susceptibility to peer influence, particularly in individuals low in secure attachment.     

Associations Among Attachment Style,Burnout, and Compassion Fatigue in Health and Human Service Workers: A Systematic Review

Health and human service workers are at risk for developing burnout or compassion fatigue due to the demanding nature of their work. Attachment theory makes specific predictions that may help explain why some workers experience burnout or compassion fatigue and others do not. The purpose of this systematic review is to identify and attempt to explain patterns and inconsistencies in results across studies that have examined the association between adult attachment style and burnout or compassion fatigue. Ten studies representing a diverse range of disciplines within the health and human service sectors were included in the research synthesis. The findings demonstrated consistent results for secure and anxious attachment, suggesting that attachment security is associated with lower levels of burnout, whereas attachment anxiety is associated with higher levels of burnout. Some studies found an association between avoidant attachment and burnout, whereas others did not. The results are discussed in terms of their implications for the selection, training, and supervision of health and human service workers.