Attachment Quality in Very Low-Birthweight Premature Infants in Relation to Maternal Attachment Representations and Neurological Development

Objective. To study the development of attachment in very low-birthweight preterm infants with respect to neurological development and maternal attachment representations. Design. Emotional development in a high-risk sample (N = 79) of very low-birthweight preterm infants (≤ 1,500 g) is reported. The quality of attachment in preterm infants was classified using the Strange Situation Procedure at 14 postnatal months (corrected for prematurity) and was associated with maternal attachment representation assessed with the Adult Attachment Interview at 6 postnatal months. Neurological development at 14 months was taken into account. Results. The distribution of the quality of attachment in preterm infants (60.3% secure, 23.5% insecure - avoidant, 2.9% insecure - ambivalent, 10.3% insecure - disorganized, and 2.9% not classifiable) was comparable with results of studies of term infants. There was no correspondence between maternal representations of attachment and infant quality of attachment. However, neurologically impaired infants were more often insecurely than securely attached. Conclusions. Very low-birthweight preterm infants more often develop an insecure quality of attachment if their neurological outcome is impaired. Therefore, minimizing risk factors for the development of neurological deficits may have a preventive effect both on the somatic and on the emotional development of high-risk infants.     

Early Predictors of Attachment in Infants with Cleft Lip and/or Palate

Previous studies have found that children with cleft lip and palate (CLP) and isolated cleft palate (CP) have elevated risk for a variety of psychosocial problems, but the origins of such problems are unclear, We excted that early medical and other stressors during infancy—including feeding problems and facial disfigurement—would have adverse effects on the infant, his or her caregivers, and the family environment, leading to a higher than expected rate of insecure attachments among infants with clefts. Twelve-month attachment classifications of CLP, CP, and comparision group infants were examined. No significant group differences in attachment status were found. When 3-month infant, maternal, and social/family characteristics were examined as potential predictors of insecure attachment, predictors interacted with diagnostic status. For the cleft group, infant and maternal characteristics, but not family characteristics, significantly predicted insecure attachment. For the comparison group, maternal and family characteristics, but not factors associated with the infant, were predictive. Infants with clefts despite their special needs and caregiving requirements, seem not to have elevated risk for insecure attachments at the end of their first year. Contrary to social-psychological formulations, the facial appearance of infants with CLP had no adverse effect on the quality of their maternal attachment.     

Mothers of anxious/ambivalent infants: maternal characteristics and child-care context

A general model of the determinants of parenting was employed to explore the antecedents of the ambivalent attachment pattern in Israel. Specifically, three classes of variables were identified: maternal, infant, and child-care context. Participants were 98 mothers and their infants. This research was part of a longitudinal study on sleep patterns. Mothers filled out questionnaires and were observed with their infants in the Ainsworth Strange Situation laboratory procedure. Mothers of ambivalent infants showed lower education level, higher separation anxiety, and higher parenting stress than mothers of secure infants. Infants' perceived difficult temperament did not discriminate between the two groups. Longer hours spent at work and placement in group day-care were both associated with ambivalent attachment. The findings are discussed in light of the importance of considering distal factors such as maternal attitudes and general caregiving strategy in clarifying the antecedents of attachment patterns.     

Preschoolers' Attention to and Memory for Attachment-Relevant Information

This study examined the relation between attachment quality in infancy and attention and memory at 3¹/₂ years. Sixty-eight children participated in 2 attention tasks and 1 memory task. In the first attention task, children were shown several sets of drawings; each set depicted a different mother-child dyad engaged in positive, negative, and neutral interaction. Insecure/avoidant children looked away from the drawings; more than the other children. In the second attention task, children were shown different sets of drawings; each set depicted a mother-child dyad engaged in positive interaction and an adult dyad expressing neutral affect. Insecure/avoidant and insecure/ambivalent children looked away from the mother-child drawings more than the secure children; when children did look at a drawing, insecure children were less likely than secure children to look at the mother-childdrawing. in the memory task, children were read 6 stories in which a mother responds to her child's bid for help. In 2 stories the mother responds sensitively to her child, in 2 stories the mother rejects her child, and in 2 stories the mother provides an exaggerated response to her child. Secure children recalled the responsive stories better than insecure/avoidant children and the rejecting stories better than the insecure/ambivalent children. Findings are discussed in terms of the proposition from attachment theory that attachment experiences influence attention and memory process.     

Infant – Mother Attachment among the Dogon of Mali

This study of mothers and infants from the Dogon ethnic group of Mali, West Africa examined three attachment hypotheses: (1) that infant attachment security is linked to the quality of mother-infant communication, (2) that mothers of secure infants respond more sensitively to their infants than do mothers of insecure infants, and (3) that infant disorganization is linked to maternal frightened or frightening behaviors. Participants were 27 mother-infant pairs from a rural town and 15 mother-infant pairs from two agrarian villages; infants ranged in age from 10 to 12.5 months at the first assessment. The distribution of the Strange Situation classifications was 67% secure, 0% avoidant, 8% resistant, and 25% disorganized. Infant attachment security was significantly related to the quality of mother-infant communication as observed in a well-infant exam. The correlation between infant attachment security ratings and maternal sensitivity (assessed in the home) was modest and approached significance. Mothers of disorganized infants had significantly higher ratings of frightened or frightening behaviors. Maternal sensitivity predicted little of the variance in infant security; however, the addition of the frightened/frightening variable in the regression equation tripled the explained variance. The findings are discussed in light of Dogon childrearing practices and key tenets of attachment theory.     

Temperament and attachment security in the strange situation: an empirical rapprochement

In response to Frodi and Thompson's recent demonstration that infants classified A1-B2 in the Strange Situation differ significantly in emotional expression from infants classified B3-C2, several longitudinal data sets were examined to determine whether these group differences might be a function of infant temperament. Data from 3 separate samples revealed significant concordance between infant-mother and infant-father Strange Situation classifications when scored in terms of A1-B2 versus B3-C2, but not when scored in terms of the traditional A-B-C system. In addition, in 2 samples on which newborn behavioral data were available, A1-B2 infants displayed more autonomic stability than B3-C2 infants, and in one of the samples the former infants were more alert and positively responsive as newborns (with means in the same direction in Sample 2). Moreover, mothers of A1-B2 infants described their babies as less difficult to care for at 3 months of age. Considered together, these findings suggest that infant temperament affects the manner in which security or insecurity is expressed rather than whether or not the infant develops a secure or insecure attachment. These findings are discussed in terms of their implications for the study of the interactional antecedents and the developmental consequences of attachment security.     

Nonmaternal care in the first year of life and the security of infant-parent attachment

Evidence from 2 longitudinal studies of infant and family development was combined and examined in order to determine if experience of extensive nonmaternal care in the first year is associated with heightened risk of insecure infant-mother attachment and, in the case of sons, insecure infant-father attachment. Analysis of data obtained during Strange Situation assessments conducted when infants were 12 and 13 months of age revealed that infants exposed to 20 or more hours of care per week displayed more avoidance of mother on reunion and were more likely to be classified as insecurely attached to her than infants with less than 20 hours of care per week. Sons whose mothers were employed on a full-time basis (greater than 35 hours per week) were more likely to be classified as insecure in their attachments to their fathers than all other boys, and, as a result, sons with 20 or more hours of nonmaternal care per week were more likely to be insecurely attached to both parents and less likely to be securely attached to both parents than other boys. A secondary analysis of infants with extensive care experience who did and did not develop insecure attachment relationships with their mothers highlights several conditions under which the risk of insecurity is elevated or reduced. Both sets of findings are considered in terms of other research and the context in which infant day-care is currently experienced in the United States.     

Quality of infants' attachments to professional caregivers: relation to infant-parent attachment and day-care characteristics

75 infants (mean age 15 months) were observed 3 times in the Strange Situation with their professional caregivers, mothers, and fathers. Sensitivity of these attachment figures to the infant's signals during free play, as well as a number of day-care characteristics, were assessed. Attachment classification distribution of infant-caregiver dyads did not differ significantly from infant-mother or infant-father attachment classification distributions. The quality of infant-caregiver attachment was independent of both infant-mother and infant-father attachments. About 10% of the infants had 3 insecure attachments. Professional caregivers observed with more than 1 infant did not have similar types of attachment classifications to all infants with whom they were observed. Infants who were securely attached to their professional caregivers spent more hours per week in day-care, and came from a middle-class background. Their caregivers appeared to be younger and more sensitive during free play than caregivers with whom the infants developed an insecure relationship.     

The Relations among Infant Temperament, Security of Attachment, and Behavioral Inhibition at Twenty-Four Months

The purpose of this study was to examine the relations among infant temperament, attachment, and behavioral inhibition. 52 infants were seen at 2 days, 5, 14, and 24 months of age. Assessments were made of temperament at 2 days and 5 months of age, and attachment and behavioral inhibition were assessed at 14 and 24 months, respectively. EKG was recorded at each assessment, and measures of heart period and vagal tone were computed. Distress to pacifier withdrawal at 2 days of age was related to insecure attachment at 14 months. 2 types of distress reactivity at 5 months, reactivity to frustration and reactivity to novelty, were identified and related to high vagal tone. Attachment classification at 14 months was directly related to inhibited behavior at 24 months. Infants classified as insecure/resistant were more inhibited than those classified as insecure/avoidant. In addition, an interaction of infant reactivity to frustration and attachment classification was found to predict inhibition at 24 months. Infants classified as insecure/resistant and who had not cried to the arm restraint procedure at 5 months were the most inhibited at 24 months. These findings are discussed in terms of hypotheses regarding multiple modes of distress reactivity and regulation in early infancy and their different social and behavioral outcomes.     

Infant Attachment and Maternal Sensitivity in the Arab Minority in Israel

This study is the first to examine infant–mother attachment in the Arab culture. Eighty‐five Arab 1‐year‐old infants from Israel were observed in the strange situation, and maternal sensitivity was assessed from home observations. Supporting attachment theory's normativity hypothesis, no differences were found between the Arab‐Israeli attachment distribution and Jewish‐Israeli, Western, and non‐Western distributions when examined at the two‐way secure versus insecure level, although a few differences emerged when examined at the four‐way ABCD level. Supporting the sensitivity hypothesis, mothers of secure infants were more sensitive than those of insecure infants but only in the case of Christian (and not Muslim) mothers. The findings provide support to attachment theory's generalizability but raise questions regarding the assessment of maternal sensitivity cross‐culturally.     

Newborn irritability moderates the association between infant attachment security and toddler exploration and sociability

This longitudinal investigation of 84 infants examined whether the effect of 12-month attachment on 18- and 24-month exploration and sociability with unfamiliar adults varied as a function of newborn irritability. As expected, results revealed an interaction between attachment (secure vs. insecure) and irritability (highly irritable vs. moderately irritable) in predicting both exploration and sociability with unfamiliar adults. For exploration, results supported a dual-risk model; that is, toddlers who had been both highly irritable and insecurely attached were less exploratory than other toddlers. For sociability, results supported the differential-susceptibility hypothesis; that is, highly irritable infants, compared to moderately irritable infants, were both less sociable as toddlers when they had been insecurely attached and more sociable when they had been securely attached.     

Origins of Attachment: Maternal Interactive Behavior across the First Year

This study built on attachment theory and previous research in examining the interactional origins of the secure, insecure-resistant, and insecureavoidant patterns of attachment. Maternal sensitive responsivity, rejection, and activity were the focus of repeated naturalistic observations when infants were 1, 4, and 9 months of age; quality of attachment was assessed at 1 year. Mothers of secure 1-year-olds were observed to be more sensitively responsive at 1 and 4 months and less rejecting at 1 and 9 months than mothers of insecure infants. Mothers of insecure-avoidant infants were more rejecting at 9 months, whereas mothers of insecure-resistant infants were least sensitively responsive and most rejecting at 1 month; the insecure groups were also differentiated on the basis of patterns of change from 1 to 9 months, with mothers of resistant infants becoming less rejecting and mothers of avoidant infants becoming more rejecting relative to other mothers.     

Attachment in Chronically Underweight Young Children

This study, conducted in Chile with a low-income population, was designed to assess quality of mother-infant attachment in 17-21-month-old children of different nutritional status. 43 nutritionally healthy and 42 chronically underweight children were seen with their mothers in the Ainsworth Strange Situation. Children were classified in the conventional B (secure) and A and C (anxious) attachment patterns. In addition, an A/C pattern of anxious attachment was found to be frequent among children who consistently fail to gain adequate weight-for-age. Results showed a greater proportion (93%) of anxious attachments in the underweight group as compared to the group of children without a history of nutritional deficits (50%). Children classified as A/C presented the most serious weight deficits within the underweight group, indicating an association between severity of the nutritional deficits and insecure/disorganized attachments. Various hypotheses concerning the association between chronic nutritional deficits and insecure/disorganized attachments in infancy are discussed.     

Shedding further light on the effects of various types and quality of early child care on infant-mother attachment relationship: the Haifa Study of Early Child Care

The Haifa Study of Early Child Care recruited a large-scale sample (N = 758) that represented the full SES spectrum in Israel, to examine the unique contribution of various child-care-related correlates to infant attachment. After controlling for other potential contributing variables--including mother characteristics, mother-child interaction, mother-father relationship, infant characteristics and development, and the environment--this study found that center-care, in and of itself, adversely increased the likelihood of infants developing insecure attachment to their mothers as compared with infants who were either in maternal care, individual nonparental care with a relative, individual nonparental care with a paid caregiver, or family day-care. The results suggest that it is the poor quality of center-care and the high infant-caregiver ratio that accounted for this increased level of attachment insecurity among center-care infants.     

The mother-infant relationship and infant attachment in a South African peri-urban settlement

A sample of 147 mother-infant dyads was recruited from a peri-urban settlement outside Cape Town and seen at 2- and 18-months postpartum. At 18 months, 61.9% of the infants were rated as securely attached (B); 4.1% as avoidant (A); 8.2% as resistant (C); and 25.8% disorganized (D). Postpartum depression at 2 months, and indices of poor parenting at both 2 and 18 months, were associated with insecure infant attachment. The critical 2-month predictor variables for insecure infant attachment were maternal intrusiveness and maternal remoteness, and early maternal depression. When concurrent maternal sensitivity was considered, the quality of the early mother-infant relationship remained important, but maternal depression was no longer predictive. Cross-cultural differences and consistencies in the development of attachment are discussed.     

Effects of maternal absence due to employment on the quality of infant-mother attachment in a low-risk sample

Recent reports have suggested that day-care experience initiated prior to 12 months of age is associated with increased proportions of infants whose attachment to mother is classified as "insecure-avoidant." However, reviewers have questioned the generality of these findings, noting that samples in which associations between early day-care experience and avoidant attachment patterns have been reported come from high-risk populations, and/or that the infants' day-care settings may not have been of high quality. In the present study, effects of maternal absences on infant-mother attachment quality were assessed in a low-risk, middle-class sample (N = 110). In all instances, substitute care had been initiated at least 4 months prior to the infant's first birthday and was provided in the infant's home by a person unrelated to the baby. Infants were assessed using the Ainsworth Strange Situation when they were 12-13 months of age. Analyses indicated that a significantly greater proportion of infants whose mothers worked outside the home (N = 54) were assigned to the category "insecure-avoidant" as compared to infants whose mothers remained in the home (N = 56) throughout the first year of life. Analyses of demographic and psychological data available for the sample indicated that this relation is dependent upon maternal parity (primi- vs. multiparous mother). The association between attachment quality and work status was significant only for firstborn children of full-time working mothers. The results are interpreted as evidence that the repeated daily separations experienced by infants whose mothers are working full-time constitute a "risk" factor for the development of "insecure-avoidant" infant-mother attachments.     

Mother-infant attachment in adoptive families

Data from 2 separate samples using the Strange Situation paradigm were combined to assess the quality of attachment relationships in adoptive and nonadoptive mother-infant pairs. Infants were between 13 and 18 months at the time of observation. Results indicated no differences in mother-infant attachment between nonadopted and intraracial adopted subjects or between intraracial and interracial adopted subjects. Interracial adoptive mother-infant pairs did show a higher incidence of insecure attachment in comparison to nonadoptive pairs. Mothers of interracial adopted infants also were less comfortable having others care for their babies and perceived less emotional support from extended family and friends for their decision to adopt a child prior to the actual adoption than did other mothers. No relation was found, however, between quality of mother-infant attachment and either perceived social support, infant developmental quotient, infant temperament, number of foster homes experienced by the infant, or infant's age at the time of adoption placement. It was suggested that the higher incidence of psychological problems found among adoptees in middle childhood and adolescence cannot be explained in terms of insecure attachment relationships during the infancy years.     

Infant Day-Care, Attachment, and the "File Drawer Problem"

The research literature on infant day-care and attachment may be biased by the unavailability of "file drawer" studies, unpublished data showing no statistically significant effects. Replication studies, whether showing an effect or not, are essential to clarify the relation between day-care and attachment. This study of 105 12-month-olds is an attempt to replicate four similar studies summarized and combined by Belsky to show that infants in day-care are at risk for insecure attachment. In the present study, no results were robust enough to emerge consistently, although there was a trend for more negative attachment outcomes to be associated with little or part-time day-care rather than with full-time day-care. In general, the results suggest that the specific measures, definitions of full- and part-time, and statistical techniques used in studies examining the relation between day-care and attachment are likely to affect the outcome of such studies.

For any given research area, one cannot tell how many studies have been conducted but never reported. The extreme view of the "file drawer problem" is that journals are filled with the 5% of the studies that show Type I errors, while the file drawers are filled with the 95% of the studies that show nonsignificant results. [Rosenthal, 1979, p. 638]

     

Maternal Representations of Attachment during Pregnancy Predict the Organization of Infant-Mother Attachment at One Year of Age

While strong retrospective and concurrent associations between maternal and infant patterns of attachment have been noted, this is one of the first reports of a prospective investigation of such associations. The Adult Attachment Interview was administered to 100 mothers expecting their first child, and, at 1-year follow-up, 96 of these were seen with their infants at 12 months in the Strange Situation. Maternal representations of attachment (autonomous vs. dismissing or preoccupied) predicted subsequent infant-mother attachment patterns (secure vs. insecure) 75% of the time. These observed concordances, as well as the discordances, are discussed in terms of the uniquely powerful contribution the Adult Attachment Interview makes to the study of representational and intergenerational influences on the development of the infant-mother attachment.     

Attachment Patterns at Age Six in South Germany: Predictability from Infancy and Implications for Preschool Behavior

A cross-cultural replication of concordance between attachment patterns to mother in infancy and patterns of reunion responses to mother at age 6 was tested for 40 children in Regensburg, South Germany. Concordance between the 4 types of attachment status (A, B, C, D) in infancy and at age 6 was 82%. When observed in preschool at age 5, children classified securely attached (B) at age 6 were more competent in their play quality and conflict resolution, showed fewer behavior problems, and attributed less hostility in a social perception picture test compared to the insecurely attached (A, D) children. Children classified disorganized (D) at age 6 were found almost as often in the incompetent preschool behavior groups as the avoidantly attached (A) children, independent of best-fitting alternative attachment pattern. Thus, disorganization at age 6 may be considered as an insecure attachment.