Massimo Ammaniti

Internal working models of attachment during late childhood and early adolescence: an exploration of stability and change

This article addresses the question of how the transition from late childhood to early adolescence influences the organization of attachment. The applicability of a measure for attachment representations in early adolescence, the Attachment Interview for Childhood and Adolescence (AICA), was explored. The AICA is based on the Adult Attachment Interview, which was adapted in minor ways to the early adolescent age-group. It was hypothesized that attachment shows considerable stability from late childhood to early adolescence, although some changes might become manifest especially because distancing mechanisms toward the parents may be activated in this period. Also, stability may be different for the various secure and insecure attachment classifications. Lastly, because gender differences become larger during the transition from childhood to adolescence, attachment differences between boys and girls were explored. The same 31 Italian participants (14 girls, 17 boys) completed the AICA at 10 years and at 14 years of age. The AICA attachment classification distributions did not differ from Adult Attachment Interview (AAI) distributions in comparable but older adolescent or young adult samples. The stability of attachment security was considerable: 74% (k = .48). The stability of the dismissing and secure categories was somewhat higher than the stability of the (small) preoccupied and unresolved categories. The participants tended to show more dismissing strategies across the four years, and to report more rejection from their parents. It was suggested that the activation of dismissing defense mechanisms might be necessary to keep parental figures at some distance in order to achieve a more definite personal identity. Finally, no significant gender differences in attachment emerged during the transition from late childhood to early adolescence.

Neural Basis of Maternal Communication and Emotional Expression Processing during Infant Preverbal Stage

During the first year of life, exchanges and communication between a mother and her infant are exclusively preverbal and are based on the mothers ability to understand her infants needs and feelings (i.e., empathy) and on imitation of the infants facial expressions; this promotes a social dialog that influences the development of the infant self. Sixteen mothers underwent functional magnetic resonance imaging while observing and imitating faces of their own child and those of someone elses child. We found that the mirror neuron system, the insula and amygdala were more active during emotional expressions, that this circuit is engaged to a greater extent when interacting with ones own child, and that it is correlated with maternal reflective function (a measure of empathy). We also found, by comparing single emotions with each other, that joy expressions evoked a response mainly in right limbic and paralimbic areas; by contrast, ambiguous expressions elicited a response in left high order cognitive and motor areas, which might reflect cognitive effort.

Malnutrition and Dysfunctional Mother-Child Feeding Interactions: Clinical Assessment and Research Implications

Objectives: To evaluate the effects of age and the presence of feeding pathologies on the relational modes during meals in a sample of mother-child pairs (n = 333), comparing groups of children in the first three years of life with normal development (ND-group, n = 211) and clinical groups of children who presented a diagnosis of feeding disorder and failure to thrive (FD-group, n = 122), and to show an association between specific symptomatic characteristics of the mother, of the child and the dysfunctional modes of their relationship during meals in a subgroup of mother-child pairs (n = 50), selected at random from the total clinical sample and paired with a control group chosen for this study. Methods: All mother-child pairs in the sample were observed in twenty-minute video-recordings during a meal, using the procedure of the Feeding Scale in the Italian version. A subgroup of mothers, selected at random from the total clinical sample, and paired with a control group, were given two self-reporting instruments for the evaluation of their psychological symptom status: the Eating Attitude Test and the Symptom Checklist-90-Revised, as well as two instruments for the evaluation of the infant temperament and emotional/behavioral functioning: the Baby and Toddler Behavior Questionnaires (from 1 to 18 months) and the Child Behavior Checklist 1½-5 (from 18 to 36 months). Results: Analysis of variance showed that the FD-group present interactional dysfunctional patterns during feeding and raise higher scores in symptomatic characteristics both of the mother and of the child, compared to ND-group. A set of correlation analyses (Pearson coefficients) showed an association among specific symptomatic characteristics of the mothers (dysfunctional eating attitudes, anxiety, depression, hostility), of their children (in particular, anxiety/depression, somatic complaints and aggressive behavior) and of their dysfunctional relational modes during feeding (p < 0.05). Conclusions: Our study confirms that analysis of the individual characteristics of the child, of the mother and of their relationship during the development of feeding patterns in the first three years of the child’s life is extremely important in the clinical assessment of early feeding disorders, in order to establish a valid diagnostic methodology and formulate strategies for targeted and effective intervention. Furthermore, the results emphasize the clinical utility of our research in early identification of infants and toddlers at risk for feeding problems.

Maternal representations during pregnancy and early infant-mother interactions

This paper deals with the influence of maternal representations during pregnancy on the subsequent mother-infant relationship and the infants style of attachment at 1 year of age. Psychoanalytic thinking, beginning with Freud to the most recent contributions, has considered the great importance of the mental dynamics between parents and children to which empirical research according to Bowlbys theoretical perspective has contributed. The current research project was planned in order to study the intergenerational processes. Starting during pregnancy, the woman was interviewed specifically to study maternal representations of herself as a mother and of the future baby. When the child was 1 year old, the style of attachment was studied during the Ainsworth Strange Situation paradigm and, at the same time, the mother was given the Adult Attachment Interview. Case studies are presented to illustrate, from the clinical point of view, the mental dynamics during pregnancy and the influence on the style of attachment of the baby. The clinical implications are discussed especially in terms of the fantasies in pregnancy and their relevance for the subsequent mother-infant relationship.

A prevention and promotion intervention program in the field of mother–infant relationship

The purpose of the study was to analyze the efficacy of early home-visiting intervention in enhancing the quality of mother–infant interaction in psychosocial risk and depressive risk mother–infant dyads. Thirty depressive risk, 28 psychosocial risk, and 33 low-depressed and low-risk mothers were randomly distributed between the Home Visiting Program and control groups. Attachment (Adult Attachment Interview; Main & Goldwyn, 1997) and maternal representations during pregnancy (Interview of Maternal Representations During Pregnancy; Ammaniti, Candelori, Pola, & Tambelli, 1999) and after the birth of the infant (Interview of Maternal Representations After the Birth; Ammaniti et al., 1999) were evaluated as well as depressive symptoms (Center for Epidemiological Studies-Depression Scale; Radloff, 1977) during the first year. Ratings of sensitivity, interference, affective state of the mother, cooperation, and infant self-regulation during mother–infant interactions were assessed at 3, 6, and 12 months. Results showed the efficacy of the home-visiting program in improving sensitive maternal behaviors toward the child after 6 months of intervention.

Neurobiological Correlates of EMDR Monitoring - An EEG Study

Background Eye Movement Desensitization and Reprocessing (EMDR) is a recognized first-line treatment for psychological trauma. However its neurobiological bases have yet to be fully disclosed. Methods Electroencephalography (EEG) was used to fully monitor neuronal activation throughout EMDR sessions including the autobiographical script. Ten patients with major psychological trauma were investigated during their first EMDR session (T0) and during the last one performed after processing the index trauma (T1). Neuropsychological tests were administered at the same time. Comparisons were performed between EEGs of patients at T0 and T1 and between EEGs of patients and 10 controls who underwent the same EMDR procedure at T0. Connectivity analyses were carried out by lagged phase synchronization. Results During bilateral ocular stimulation (BS) of EMDR sessions EEG showed a significantly higher activity on the orbito-frontal, prefrontal and anterior cingulate cortex in patients at T0 shifting towards left temporo-occipital regions at T1. A similar trend was found for autobiographical script with a higher firing in fronto-temporal limbic regions at T0 moving to right temporo-occipital cortex at T1. The comparisons between patients and controls confirmed the maximal activation in the limbic cortex of patients occurring before trauma processing. Connectivity analysis showed decreased pair-wise interactions between prefrontal and cingulate cortex during BS in patients as compared to controls and between fusiform gyrus and visual cortex during script listening in patients at T1 as compared to T0. These changes correlated significantly with those occurring in neuropsychological tests. Conclusions The ground-breaking methodology enabled our study to image for the first time the specific activations associated with the therapeutic actions typical of EMDR protocol. The findings suggest that traumatic events are processed at cognitive level following successful EMDR therapy, thus supporting the evidence of distinct neurobiological patterns of brain activations during BS associated with a significant relief from negative emotional experiences.

Maternal psychopathology and child risk factors in infantile anorexia.

OBJECTIVE This study examines a transactional and multirisk model for Infantile Anorexia (IA) and investigates the contributions of the parent, the child, and dyadic interactional variables related to this feeding disorder. METHOD The sample consisted of 371 mother-child pairs (children aged 6-36 months), of which 187 pairs of mothers and normally developing children (ND-group), and 184 mothers and IA children. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their childrens temperament and emotional/ behavioral functioning. RESULTS Analyses revealed that the IA-group showed higher scores in symptomatic characteristics both of the mother and of the child, and dysfunctional interactions during feeding as compared with the ND-group. Further analyses revealed that both child and maternal characteristics are significant predictors of dyadic interactional conflict. DISCUSSION Results confirm that a multidimensional assessment is critical in the evaluation of IA.

Attachment models affect brain responses in areas related to emotions and empathy in nulliparous women

Background: The attachment model, as assessed by means of the Adult Attachment Interview (AAI), is crucial for understanding emotion regulation and feelings of security in human interactions as well as for the construction of the caregiving system. The caregiving system is a set of representations about affiliative behaviors, guided by sensitivity and empathy, and is fully mature in young‐adulthood. Here, we examine how different attachment models influence brain responses in areas related to empathy and emotions in young‐adult subjects with secure and dismissing attachment models. Methods: By means of AAI, we selected 11 nulliparous young‐adult females with a secure model and 12 with a dismissing model. Subjects underwent functional magnetic resonance, whereas imitating or observing and empathizing with infant facial expressions. Subjects were tested for alexithymia and reflective functioning. Results: Dismissing subjects activated motor, mirror, and limbic brain areas to a significantly greater extent, but deactivated the medial orbitofrontal cortex (mOFC) and the perigenual anterior cingulated cortex (pACC). During emotional faces, increased activity in dismissing women was seen in the right temporal pole. Furthermore, greater alexithymia was correlated with greater activity in the entorhinal cortex and greater deactivation in the pACC/mOFC. Conclusions: These findings provide evidence of how the attachment model influences brain responses during a task eliciting attachment. In particular, hyperactivation of limbic and mirror areas may reflect emotional dysregulation of infantile experiences of rejection and lack of protection, whereas increased deactivation of fronto‐medial areas may be the expression of the inhibition of attachment behaviors, which is a typical aspect of dismissing attachment. Hum Brain Mapp, 2013.

How New Knowledge About Parenting Reveals the Neurobiological Implications of Intersubjectivity: A Conceptual Synthesis of Recent Research

Observations of early mother–infant interactions have shown that intersubjectivity is a primary motivation and have underscored the importance of maternal competencies in this development. In our paper we propose a conceptual overview of the different perspectives according to which parental caregiving has been formulated. Psychoanalytical theory has fundamentally promoted the exploration of maternal and paternal intrapsychic constellation, by stressing the role of unconscious processes in parental attitude as well as in infant development. In contrast with psychoanalytical theory, the conceptual framework of attachment has mostly considered real interactions between parents and infant, underlining parental abilities in providing the infant with a secure base. Finally, infant research has explored the complexity of communicative system between parents and infants, which appears already active from the birth of the baby. Recently, these different viewpoints have been broadened by neurobiological research, which has begun to explore maternal brain functioning and structure, by means of new scientific instruments such as fMRI techniques. From these perspectives, we provide an overview of motherhood, underlining both neurobiological and psychological transformations, which begin from pregnancy and run through the first year of the infant, when the mother–infant intersubjective matrix is built. This matrix influences the construction of the infants Self and support the development of the sense of “we,” a sort of connective net, which ties the baby to parents, letting him feel as a part of the familiar world.

Pretreatment, Intratreatment, and Posttreatment EEG Imaging of EMDR: Methodology and Preliminary Results From a Single Case

Electroencephalography (EEG), due to its peculiar time and spatial resolution, was used for the first time to fully monitor neuronal activation during the whole eye movement desensitization and reprocessing (EMDR) session, including the autobiographical script. The present case report describes the dominant cortical activations (Z-score >1.5) during the first EMDR session and in the last session after the client processed the index trauma. During the first EMDR session, prefrontal limbic cortex was essentially activated during script listening and during lateral eye movements in the desensitization phase of EMDR. In the last EMDR session, the prevalent electrical activity was recorded in temporal, parietal, and occipital cortical regions, with a clear leftward lateralization. These findings suggest a cognitive processing of the traumatic event following successful EMDR therapy and support evidence of distinct neurobiological patterns of brain activations during lateral eye movements in the desensitization phase of EMDR.