Cecilia Serena Pace

Adoptive parenting and attachment: Association of the internal working models between adoptive mothers and their late-adopted children during adolescence

Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Method: Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4–9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers’ state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents’ verbal intelligence was controlled for. Results: Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers’ AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure–insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents’ verbal intelligence made a significant contribution to this prediction. Discussion: Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children.

When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders

Introduction: In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients’ families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters’ evaluations of maternal alexithymia. Methods: 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of “ED” mothers (n = 20) and “non-ED” ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia. Results: Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs. Discussion: Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.

Maternal depression and attachment: the evaluation of mother-child interactions during feeding practice.

Internal working models (IWMs) of attachment can moderate the effect of maternal depression on mother–child interactions and child development. Clinical depression pre-dating birthgiving has been found to predict incoherent and less sensitive caregiving. Dysfunctional patterns observed, included interactive modes linked to feeding behaviors which may interfere with hunger–satiation, biological rhythms, and the establishment of children’s autonomy and individuation. Feeding interactions between depressed mothers and their children seem to be characterized by repetitive interactive failures: children refuse food through oppositional behavior or negativity. The aim of this study was to investigate parenting skills in the context of feeding in mothers with major depression from the point of view of attachment theory. This perspective emphasizes parents’ emotion, relational and affective history and personal resources. The sample consisted of 60 mother–child dyads. Mothers were divided into two groups: 30 with Major Depression and 30 without disorders. Children’s age ranged between 12 and 36 months The measures employed were the Adult Attachment Interview and the Scale for the Evaluation of Alimentary Interactions between Mothers and Children. Insecure attachment prevailed in mothers with major depression, with differences on the Subjective Experience and State of Mind Scales. Groups also differed in maternal sensitivity, degrees of interactive conflicts and negative affective states, all of which can hinder the development of adequate interactive patterns during feeding. The results suggest that IWMs can constitute an indicator for the evaluation of the relational quality of the dyad and that evaluations of dyadic interactions should be considered when programming interventions.

Assessing attachment representations among adoptees during middle childhood and adolescence with the Friend and Family Interview (FFI): clinical and research perspectives

Three trends of attachment research couldbeidentifiedintheadoptionfield.Thefirstwas focused on the comparisons betweenattachment patterns of adopted childrenand those of their non-adopted peers.It indicates a higher probability of inse-cure and disorganized patterns among theadoptees (Van den Dries et al., 2009).The second highlighted a significant inter-generational concordance of attachmentInternalWorkingModels(IWMs)betweenadoptive parents and their adopted chil-dren (Steele et al., 2003; Barone andLionetti, 2012). The third revealed—through longitudinal design—the increas-ing security of adopted children which ispositively affected by the parental attach-ment security, especially maternal one(Beijersbergenetal.,2012).Thistrendsug-geststhatadoptedchildrenhavetheabilityto generate new relationships of attach-ment with adoptive parents, although theimpact of their previous adverse expe-riences has not completely disappeared(Steele et al., 2008; Pace and Zavattini,2011).Recently, a new research trend has beenemerging: the assessment of adoptees’IWMs in the course of middle child-hood and adolescence, not exclusivelyfocused on their relationship with par-ents. Many important changes happenat the emotional, cognitive and behav-ioral level during these stages which arerelated to attachment systems (Steele andSteele, 2005; Allen, 2008). Adolescentsdevelop the meta-cognitive skills to checktheir mental states, as well as the abil-ity to recognize positive or negativeaspects in their relationships with par-ents. Moreover, they seek greater inde-pendence, greater autonomy and differ-entiation from their primary caregivers.Relationships with other people outsidethe family (friends, etc.) become muchmore important than they had ever beenbefore(Allen,2008).Duetothesechanges,middle childhood and adolescence couldbe considered periods of potential trans-formations at level of attachment repre-sentations. Therefore, they become rele-vant in the study of adoptees behavior(Palacios and Brodzinsky, 2010).

Re-enactment of intended acts from a video presentation by 18- and 24-month-old children

We used the Re-enactment of intention paradigm to investigate whether children would re-enact what an adult intended to do in a video presentation as they do when presented with a live demonstration (Meltzoff in Dev Psychol 31(5):838–850, 1995). Unlike the 18-month-old infants studied by Meltzoff (Dev Psychol 31(5):838–850, 1995), the 18- and 24-month-olds in the current study did not frequently imitate unsuccessful goal-directed actions presented in a video model. Children who performed better in the task also tended to share more of their attention with the experimenter during co-viewing of the video. Performance on the Re-enactment of intention task was positively related to categorization score, an independent measure of cognitive functioning.

Attachment representations in late-adopted children: the use of narrative in the assessment of disorganisation, mentalising and coherence of mind

Late-adopted children have often suffered a wide range of deprivations in their pre-adoption lives. These early adverse experiences can have a negative effect on children’s attachment representations even after they have been adopted. This study assesses the attachment representations of 61 late-adopted children over the first year of placement, exploring the risk and protective factors of age at placement, length of adoption and gender. The attachment representations were captured using the Manchester Completion Attachment Story Task (MCAST), a doll-play narrative that provides four different attachment classifications – secure, avoidant, ambivalent and disorganised – and three global scorings for disorganisation, mentalising and coherence of mind. The age of adoption was negatively associated with disorganisation, while length of placement was positively correlated with mentalising. Males seemed to be more vulnerable to insecurity and disorganisation than females. The data also suggested that for children placed after the attachment-sensitive phase, the longer the time spent in the adoptive families and being female were protective factors. Moreover, attachment narratives seemed to be a useful tool to explore the inner world of late-adopted children from the first year of placement.

Children’s mental representations with respect to caregivers and post-traumatic symptomatology in Somatic Symptom Disorders and Disruptive Behavior Disorders

Introduction: In line with literature, the quality of adult–infant interactions and mental representations of the caregivers play an essential role in influencing the children’s well-being. Many studies focused the attention on the role of attachment for a better evaluation of child psychopathological outcomes. The flexibility of the child’s attachment model gives the opportunity to parents to be helped in modifying their own caregiving quality, encouraging the reflection on the children’s state of mind with respect to attachment. The aims of this study were to evaluate: (1) the attachment models in young patients diagnosed with Disruptive Behavior Disorders (DBDs) and Somatic Symptoms Disorders (SSDs); (2) the levels of post-traumatic symptomatology; (3) the association between the attachment models and post-traumatic symptomatology. Methods: Forty Italian patients, aged from 8 to 15, recruited at Gaslini Paediatric Hospital of Genoa, previously diagnosed with SSD (N = 20) and DBD (N = 20) were assessed using the Child Attachment Interview (CAI), the Separation Anxiety Test (SAT), the Trauma Symptom Checklist for Children (TSCC-A). Socio-demographic data were collected. Results: In both the clinical samples, the findings on the distribution of attachment models showed a significant presence of insecure attachment with respect to both parents in more than a half of the patients and high levels of disorganized attachment. No significant differences between DBD and SSD samples were found on post-traumatic symptomatology (Post-Traumatic Stress and Dissociation). Significant differences were found on Depression, Anxiety, and Fantasy subscales. Discussion: This study can provide a detection of dysfunctional aspects in clinical populations. The findings suggest that the quality of the attachment to parents may be a fundamental element to better assess SSD and DBD in children and adolescents. Clinical implications of this study aimed at improving parental caregiving are highlighted.

Representations of health and illness by Eastern European, South American and Italian care workers: a qualitative study.

This qualitative research examined the representations of health and illness presented by 30 individuals who work as care workers, from three different locations: Eastern Europe, South America and Italy. We led three focus groups for people who came from the same geographical area (intra-ethnic) and two for those from ‘mixed’ areas (inter-ethnic). From our content analyses, certain similarities and differences between the conceptualizations of health and illness emerged: in the intra-ethnic focus groups, Eastern Europeans focused on ‘inner strengths’, South Americans on ‘love’ and Italians on ‘personal autonomy’. These peculiar traits were levelled in the inter-ethnic focus groups.

Attachment in eating-disordered outpatients with and without borderline personality disorder.

This study aims at examining the attachment states of mind in 50 female outpatients with eating disorders compared with 50 matched control participants using the Adult Attachment Interview. Moreover, the differences in attachment states of mind among eating-disordered women with and without borderline personality disorders’ diagnosis were explored. The results showed an over-representation of insecure-dismissing and unresolved states of mind in clinical group compared to controls. Patients with both diagnosis showed higher scores on involving anger and unresolved loss compared with those with only eating disorder. Implications for further research and clinical practice are discussed.

Attaccamento adulto e matching di coppia.

Premesse teoriche: L’Adult Attachment Interview e uno strumento narratologico che, sebbene sia impiegato prevalentemente nell’ambito della ricerca sull’attaccamento, appare sempre piu utilizzabile all’interno di setting clinici, contribuendo allo svilupparsi di un’area di particolare interesse quale la relazione tra status dell’attaccamento individuale e relazioni sentimentali. Obiettivo: Nel presente lavoro si intende studiare la dimensione di reciprocita sottesa al tipo di matching al fine di comprendere le caratteristiche del legame di coppia relativamente alle rappresentazioni della storia infantile e a quelle inerenti al rapporto con il partner. Metodologia: In questo saggio viene proposta un’esemplificazione clinica relativa ad una coppia seguita in psicoterapia psicoanalitica utilizzando due interviste narratologiche: l’Adult Attachment Interview (AAI, Main, Goldwyn e Hesse, 2002) e la Current Relationship Interview (CRI, Crowell e Owens, 1996). Discussione critica e conclusioni: Gli autori mettono in evidenza come nella spiegazione della relazione di coppia la discrepanza tra il matching delle due interviste AAI (marito F2/F4 e moglie DS1/DS2) e quella delle due interviste CRI (marito S1/D3 e moglie P1/P2) porti a considerare che il costrutto dell’attaccamento adulto non vada visto soltanto in termini di continuita, ipotesi del “prototipo”, ma valutato anche rispetto alla prospettiva della discontinuita, ipotesi della “natura diadica della relazione”.