Diane Benoit

Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap

Abstract The current meta-analysis examines the links between unresolved representations of attachment, anomalous parental behavior, and disorganized attachment relationships in 12 studies including 851 families. We found moderate effect sizes for the associations between unresolved states of mind and anomalous behavior (r = .26), unresolved states of mind and infant disorganized attachment relationships (r = .21), and anomalous behavior and disorganized attachment relationships (r = .34). Sample characteristics, observational context, and observational measure were not associated with differences in effect sizes. Only a small part of the association between unresolved states of mind and disorganized attachment relationships was explained by the mediation of anomalous parental behavior (.26* .34 = .09). Other factors yet to be uncovered must mediate the influence of unresolved states of mind on infant disorganized attachment; thus, further exploration of infant, parental, ecological, and genetic factors are warranted.

Sleep Disorders in Early Childhood: Association with Insecure Maternal Attachment

Psychological, family, and social characteristics relating to attachment relationships were measured in mothers of 20 sleep-disordered toddlers, comparing them with 21 mothers of toddlers without sleep problems. The groups were matched on measures of socioeconomic status, child and maternal age, maternal education, marital status, and family size. Results showed that 100% of mothers of sleep-disordered children were classified as insecure with respect to attachment, as assessed by the Adult Attachment Interview, compared with 57% of control group mothers (p less than 0.002). There were no group differences on measures of maternal defensiveness, self-esteem, marital satisfaction, and social support. These results suggest that maternal current perspectives on their relationship history, rather than general psychosocial adjustment, are crucial contributors to the onset and perpetuation of sleep disorders in early childhood.

Attachment and internalizing behavior in early childhood: a meta-analysis.

Empirical research supporting the contention that insecure attachment is related to internalizing behaviors has been inconsistent. Across 60 studies including 5,236 families, we found a significant, small to medium effect size linking insecure attachment and internalizing behavior (observed d = .37, 95% CI [0.27, 0.46]; adjusted d = .19, 95% CI [0.09, 0.29]). Several moderator variables were associated with differences in effect size, including concurrent externalizing behavior, gender, how the disorganized category was treated, observation versus questionnaire measures of internalizing behavior, age of attachment assessment, time elapsed between attachment and internalizing measure, and year of publication. The association between avoidant attachment and internalizing behavior was also significant and small to moderate (d = .29, 95% CI [0.12, 0.45]). The effect sizes comparing resistant to secure attachment and resistant to avoidant attachment were not significant. In 20 studies with 2,679 families, we found a small effect size linking disorganized attachment and internalizing behavior (observed d = .20, 95% CI [0.09, 0.31]); however, the effect size was not significant when adjusted for probable publication bias (d = .12, 95% CI [-0.02, 0.23]). The existing literature supports the general notion that insecure attachment relationships in early life, particularly avoidant attachment, are associated with subsequent internalizing behaviors, although effect sizes are not strong.

Atypical maternal behavior, maternal representations, and infant disorganized attachment

The data for 197 mother-infant pairs from two longitudinal studies were analyzed to assess relations between maternal attachment representations; atypical maternal behavior, coded with a new tool. Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE), and infant attachment. Both maternal and infant attachment were systematically related to atypical maternal behavior: mothers who were Unresolved on the Adult Attachment Interview and those whose infants were disorganized in the Strange Situation Procedure engaged in more atypical behaviors than those who were not Unresolved and whose infants showed organized patterns of attachment, respectively. Regression analyses indicated that when tested as a mediator, atypical maternal behavior as measured on the AMBIANCE did not reduce the association between maternal Unresolved status and infant disorganized attachment. This may, in part, reflect the fact that our low-risk sample did not include enough cases in the risk categories. These data provide preliminary empirical validation for the AMBIANCE and strengthen the evidence for links between atypical maternal behavior and disorganized attachment but indicate that in addition to maternal attachment representations, other factors must contribute to atypical maternal behavior.

Maternal attachment disturbances in failure to thrive

Psychological characteristics pertaining to attachment relationships were measured in mothers of 25 hospitalized failure-to-thrive (FTT) infants and mothers of 25 hospitalized, normally growing infants. The groups were matched for race, socioeconomic status, maternal education, and infants age and sex. Results showed that 96% of mothers of FTT infants were classified as insecure with respect to attachment, as assessed by the Adult Attachment Interview (George, Kaplan, & Main, 1985), compared to 60% of control group mothers. Lack of resolution of mourning over the loss of a loved one was found in 52% of the mothers in the FTT group and in 32% of mothers in the control group. Mothers of FTT infants reported receiving less support from their families and rated their current relationship with their partner as less satisfying. These findings provide empirical support for the widely held clinical notion that FTT in infants is often a relationship disorder between infant and caregiver.

Maternal attachment, maternal responsiveness and infant attachment

Abstract Van IJzendoorn’s (1995) model of the intergenerational transmission of attachment was tested with data from 96 mother-infant dyads assessed prenatally, and at 6 and 12 months. In spite of efforts to explain or reduce the transmission gap by measuring all three components in the same study, improving or altering definitions of sensitivity, and considering infant dyadic contributions, the results remain surprisingly consistent with the original meta-analysis: only a limited portion of the link between maternal and infant attachment is transmitted via maternal sensitivity/responsiveness. In support of the notion that the link between unresolved maternal attachment and infant disorganization is mediated by processes other than maternal responsiveness, omission of unresolved and disorganized cases enhanced links between responsiveness and infant attachment and slightly reduced the transmission gap. Accumulating data indicate that 1) maternal attachment contributes to infant attachment through routes other than maternal responsiveness and 2) maternal sensitivity/responsiveness contributes to infant attachment independent of maternal attachment. New models of the transmission process that take account of this information are needed.

Attachment and selective attention: Disorganization and emotional Stroop reaction time

Although central to attachment theory, internal working models remain a useful heuristic in need of concretization. We compared the selective attention of organized and disorganized mothers using the emotional Stroop task. Both disorganized attachment and emotional Stroop response involve the coordination of strongly conflicting motivations under conditions of emotional arousal. Furthermore, much is known about the cognitive and neuromodulatory correlates of the Stroop that may inform attempts to substantiate the internal working model construct. We assessed 47 community mothers with the Adult Attachment Interview and the Working Model of the Child Interview in the third trimester of pregnancy. At 6 and 12 months postpartum, we assessed mothers with emotional Stroop tasks involving neutral, attachment, and emotion conditions. At 12 months, we observed their infants in the Strange Situation. Results showed that: disorganized attachment is related to relative Stroop reaction time, that is, unlike organized mothers, disorganized mothers respond to negative attachment/emotion stimuli more slowly than to neutral stimuli; relative speed of response is positively related to number of times the dyad was classified disorganized, and change in relative Stroop response time from 6 to 12 months is related to the match-mismatch status of mother and infant attachment classifications. We discuss implications in terms of automatic and controlled processing and, more specifically, cognitive threat tags, parallel distributed processing, and neuromodulation through norepinephrine and dopamine.

Maternal attachment and the communication of emotion through song

We explored the relationship between vocal expressiveness in song and maternal attachment representation. Mothers (N = 36), classified as Autonomous, Dismissing, or Preoccupied, sang a play song of their choice in their 6-month-old infants’ presence and absence. Raters ( N = 50) who were na¨ to maternal attachment classifications listened to excerpts of each song rendition and rated mothers’ emotional involvement. Mothers, regardless of their attachment classification, sang more expressively in their infants’ presence than otherwise. Unique patterns of vocal expressiveness were associated with different maternal attachment classifications, but only under conditions of infant distress. Unlike Autonomous and Preoccupied mothers, who sang less playfully to distressed than to nondistressed infants, the playfulness of Dismissing mothers’ performances was unrelated to infant affect. These findings support the hypothesis that maternal attachment influences the nature of emotive vocal communication, but only under conditions of infant distress.

Failure to thrive: Risk for clinical disturbance of attachment?

This study tests the hypothesis that infants with failure to thrive (FTT) are at risk for a clinical disturbance of attachment (defined as a combination of: (1) nonautonomous caregiver state of mind with respect to attachment, measured by the Adult Attachment Interview (AAI); (2) nonbalanced caregiver representation of the infant, measured by the Working Model of the Child Interview (WMCI); (3) problematic play interactions; and (4) problematic feeding interactions). Participants were 57 infants (30 FTT, 27 non-FTT) and their primary caregivers, recruited from outpatient pediatric clinics. Caregivers were interviewed with AAI and WMCI and observed interacting with their infants during play and feeding. Results show that more infants with FTT than infants without FTT met some of the criteria for risk for a clinical disturbance of attachment —nonautonomous AAI and nonbalanced WMCI classifications, and less dyadic reciprocity during feeding. However, there were no group differences in play. Future directions for research are discussed.

Reduction of disrupted caregiver behavior using modified interaction guidance

The present study is a reanalysis of a preexisting study examining the usefulness of the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Bronfman, Parsons, & Lyons-Ruth, 1999) measure as an indicator of efficacy in reducing disrupted caregiver behavior in two brief interventions. The current study examines the rate of change in the display of disrupted caregiver behavior over the course of an attachment-based intervention (Modified Interaction Guidance) in a group of 11 caregiver-infant dyads referred to a tertiary care clinic for feeding problems. The AMBIANCE was utilized as an indicator of change in disrupted behavior following an assessment feedback session and three intervention sessions. Results showed a significant decrease in the total display of disrupted caregiver behaviors, as well as a change in classification from disrupted to not-disrupted, after receiving both feedback from the assessment and the first treatment session. A qualitative analysis of the data further revealed different patterns of change between caregivers. These findings provide preliminary empirical support suggesting that a reduction of disrupted caregiver behavior can be observed relatively quickly after the commencement of the Modified Interaction Guidance intervention.