Attachment and social competence: a study using MCAST in low-risk Italian preschoolers

The Manchester Child Attachment Story Task (MCAST) is a story stem method suitable for children aged about 4 to 8, aimed at assessing children's attachment representations with a doll-play format that is evaluated with a series of dimensional scales and classifications. Although this instrument has already been validated in previous studies, not all of the findings have been conclusive. The aims of the present study were (1) to examine the factor structure of the MCAST scales, and (2) to test the association between children's dichotomized MCAST classifications and factors with social competence, using the Social Competence and Behavior Evaluation Scale (SCBE) with a normative group of Italian preschoolers (age range 4.4 to 6.1). Results obtained from a sample of 64 children confirm the association of MCAST attachment classifications (security vs. insecurity and organization vs. disorganization) with both social skills and behavioral problems. Further independent studies on the variables analyzed are recommended for corroborating the findings obtained.     

Unsolvable Fear, Trauma, and Psychopathology: Theory, Research, and Clinical Considerations Related to Disorganized Attachment Across the Life Span

This article features a selective review of attachment theory and research that have contributed knowledge about dynamics underlying early trauma, mechanisms by which maladaptive responses to trauma may be transmitted between generations, and trauma-related risk factors for psychopathology in children, adolescents, and adults. First, we focus on the foundations of attachment theory and discuss ways in which the attachment, exploratory, and fear behavioral systems interact to promote infants' survival. The second section of the paper examines the connection between frightening experiences and disorganized attachment. Infants who are regularly and seriously frightened by aspects of their caregiving environment are believed to be at risk for "unsolvable fear" in which organized attachment responses to fear are impossible. We describe the behaviors and representations characteristic of disorganized children and their parents. Next, we review recent research about relations among attachment, trauma, and psychopathology across the lifespan. Finally, we discuss implications of these findings for clinical practice.     

Disorganized attachment representation and atypical parenting in young school age children with externalizing disorder

We investigated the relationship of child attachment representation, psychopathology, and maternal atypical parenting in a high risk sample. Sixty-one consecutive clinical referrals with externalizing disorder aged 4 - 9 years were assessed for attachment representations measured with Manchester Child Attachment Story Task (MCAST), atypical parental expressed emotion (EE), maternal mood, and parent and teacher ratings of child behaviour. Disorganized attachment representations were found in 58% of cases, independent of ADHD symptoms. Pervasive disorganization was associated with very high maternal EE. Attachment status, maternal depression, and ADHD diagnosis were independently associated with parent-rated child behaviour problems; teacher ratings were associated with child's age and ADHD status. Disorganized attachment shows a high prevalence and independent associations with attention deficit symptomatology and maternal EE.     

Attachment representations of school-aged Korean children: comparing family drawing and narrative assessments in a clinical and a community sample

This study explored the links between two different methods of assessing children’s attachment representations, a narrative task (the Manchester Attachment Story Task, MCAST) and a drawing task (the Family Drawing Task, FDT), in a clinical sample of 51 and a community sample of 45 Korean children aged 7–9. In both samples, attachment classifications derived from the MCAST were related to attachment classifications and global ratings derived from the FDT. In addition, rates of insecure attachment determined by MCAST classifications and by FDT global scales indicative of insecure attachment were higher in the clinical sample than the community sample. Variations in attachment patterns for these Korean samples are discussed in relation to Korean child-rearing customs. Results of this study contribute to the cross-cultural validation of both of these instruments, as well as extending our understanding of patterns of attachment in Korea from infancy to middle childhood.     

Phobias of Attachment‐Related Inner States in the Psychotherapy of Adult Survivors of Childhood Complex Trauma

The clinical case described in this article illustrates the value of taking into account the dynamics of disorganized attachment in the assessment of attachment‐related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized patients. These seemingly opposite phobias typically coexist in the same patient, appear as phobias of both inner states (affect phobias) and relational experiences, and are linked to dissociated representations of self‐with‐other. Theory and research on attachment disorganization provide a clinician‐friendly conceptual framework for capturing both the intrapsychic (e.g., intrusive and nonintegrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment‐related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are examined.     

Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae

During the past 10 years nearly 80 studies on disorganized attachment involving more than 6,000 infant-parent dyads have been carried out. The current series of meta-analyses have established the reliability and discriminant validity of disorganized infant attachment. Although disorganized attachment behavior is necessarily difficult to observe and often subtle, many researchers have managed to become reliable coders. Furthermore, disorganized attachment shows modest short- and long-term stability, in particular in middle class environments, and it is not just a concomitant of constitutional, temperamental, or physical child problems. The predictive validity of disorganized attachment is established in terms of problematic stress management, the elevated risk of externalizing problem behavior, and even the tendency of disorganized infants to show dissociative behavior later in life. In normal, middle class families, about 15% of the infants develop disorganized attachment behavior. In other social contexts and in clinical groups this percentage may become twice or even three times higher (e.g., in the case of maltreatment). Although the importance of disorganized attachment for developmental psychopathology is evident, the search for the mechanisms leading to disorganization has just started. Frightening parental behavior may play an important role but it does not seem to be the only causal factor involved in the emergence of disorganized attachment.     

Associations between early caregiving and rural,low-SES,African-American children’s representations of attachment relationships

Little research has examined the legacy of early maternal care for later attachment representations among low-income and ethnic minority school-aged children. Using data from a sample of 276 rural, low-income, African-American families, this study examined associations between maternal care in infancy and children’s representations of attachment figures in middle childhood. Maternal care was coded from 10-min home-based observations at 6, 15, and 24 months of age. Representations of attachment figures were assessed using the Manchester Child Attachment Story Task at 6 years of age. Sensitive maternal care in infancy was not significantly related to attachment security or episodic disorganized behaviors in children’s representations. However, children exposed to more harsh–intrusive parenting during infancy displayed less secure representations of attachment figures in middle childhood and more episodic disorganized behaviors, even after controlling for numerous child and family contextual covariates. Findings inform conceptualizations of attachment formation among rural, low-income, African-American parent–child dyads.     

A new method of evaluating attachment representations in young school-age children: The Manchester Child Attachment Story Task

We describe a new instrument, using a doll-play vignette completion method, which applies concepts and methodologies from infant and adult attachment research to enable identification and detailed classification of internal representations of attachment relationships in young school-age children. Validation of the Manchester Child Attachment Story Task (MCAST) in a normal population (N = 53) shows good interrater reliability and content validity. Patterns of attachment representation identified show stability over time. Comparisons are made with existing methodologies, and potential applications of the instrument and directions for future research are discussed.     

Child, parent, and parent-child emotion narratives: implications for developmental psychopathology

Studies using narratives with children and parents offer ways to study affective meaning-making processes that are central in many theories of developmental psychopathology. This paper reviews theory regarding affective meaning making, and argues that narratives are particularly suited to examine such processes. The review of narrative studies and methods is organized into three sections according to the focus on child, parent, and parent-child narratives. Within each focus three levels of analysis are considered: (a) narrative organization and coherence, (b) narrative content, and (c) the behavior/interactions of the narrator(s). The implications of this research for developmental psychopathology and clinical work are discussed with an emphasis on parent-child jointly constructed narratives as the meeting point of individual child and parent narratives.     

Attachment in adults with high-functioning autism

The relationships among social skills, dysregulation of symbolic representations of attachment, and school readiness were examined. Participants were 74 preschool children from low-income families in Midwest America. Attachment representations and dysregulation of symbolic representations of attachment were assessed using a story completion task (George &; Solomon, 2000 George, C. and Solomon, J. 2000. Six-Year Attachment Doll Play Classification System Unpublished classification manual, Mills College, Oakland, CA [Google Scholar]) and teachers completed a survey of child behavior, which was used to assess social skills and school readiness skills. Dysregulated content in children's narratives and social skills were significant negative correlates of school readiness. There was also a marginally significant negative association between defensive dysregulation and school readiness skills for children classified as disorganized. Furthermore, a specific marker of dysregulation, controlling behavior toward the administrator, was negatively associated with school readiness, but only for children classified as disorganized. Results from this study suggest that a breakdown in the strategies of insecure/organized children may be a risk factor for low levels of school readiness and that different forms of disorganization may be associated with different types of risk. It may be useful for future studies to account for different forms of disorganization and evidence of a breakdown of strategy.     

Attachment representations in sexually abused preschoolers: a comparative study

Attachment theory provides a relevant framework for understanding the psychosocial adjustment of victims of child sexual abuse (CSA). However, most studies have been conducted among adult populations and none have focused on the impact of both preschoolers’ and mothers’ experience of sexual abuse on attachment security. The aim of this study was to compare attachment representations in sexually abused (n = 258) and non-abused preschoolers (n = 133), and to explore the relation between maternal history of CSA and children’s attachment representations. A story completion task assessing attachment representations was administered to children (Bretherton, Ridgeway, & Cassidy, 1990). The results revealed that CSA preschoolers presented significantly higher levels of attachment disorganization compared to non-abused children, and that abused boys were at particular risk for hyperactivation and disorganization. Associations between mothers’ history of CSA and children’s attachment representations were non-significant. These findings support the need to consider victims’ attachment representations in the implementation of efficient treatment programs. Targeting parent–child relationships in interventions could help promote attachment security in a vulnerable population of preschool victims.     

A short-term longitudinal study of correlates and sequelae of attachment security in autism

In this short-term longitudinal study, 30 preschool-aged children with autism were first observed in Ainsworth’s Strange Situation Procedure and, separately, interacting with the primary caregiver in the home. One year later, each child completed both a developmental assessment and an observational assessment of empathic responding. Behaviors typical for children with autism were distinguished from behaviors suggestive of relationally based attachment disorganization. Forty-five percent of the children were classified as securely attached. The secure group demonstrated language skills superior to those of the insecurely attached group, concurrently and during the follow-up. Compared to parents of children who were insecurely attached, parents of securely attached children were rated as more sensitive. Compared to both organized insecure and disorganized children, secure children were rated as more responsive to an examiner’s apparent distress during the follow-up relative to their ratings at intake, whereas empathy ratings of children with insecure classifications did not increase. Importantly, attachment security was associated with empathy above and beyond the contribution of children’s language level. These results indicate that the sequelae of attachment security in autism may be similar to those documented for typically developing children.     

Naïve observers' perceptions of family drawings by 7-year-olds with disorganized attachment histories

Previous research has succeeded in distinguishing among drawings made by children with histories of organized attachment relationships (secure, avoidant, and resistant); however, drawings of children with histories of disorganized attachment have yet to be systematically investigated. The purpose of this study was to determine whether na?ve observers would respond differentially to family drawings of 7-year-olds who were classified in infancy as disorganized vs. organized. Seventy-three undergraduate students from one university and 78 from a second viewed 50 family drawings of 7-year-olds (25 by children with organized infant attachment and 25 by children with disorganized infant attachment). Participants were asked to (1) circle the emotion that best described their reaction to the drawings and (2) rate the drawings on 6 bipolar scales. Drawings from children classified as disorganized in infancy evoked positive emotion labels less often and negative emotion labels more often than those children classified as organized. Furthermore, drawings from children classified as disorganized in infancy received higher ratings on scales for disorganization, carelessness, family chaos, bizarreness, uneasiness, and dysfunction. These data indicate that naive observers are relatively successful in distinguishing selected features of drawings by children with histories of disorganized vs. organized attachment.     

The mediating role of parenting in the associations between household chaos and children’s representations of family dysfunction

Children’s drawings are thought to reflect their mental representations of self and their interpersonal relations within families. Household chaos is believed to disrupt key proximal processes related to optimal development. The present study examines the mediating role of parenting behaviors in the relations between two measures of household chaos, instability and disorganization, and how they may be evidenced in children’s representations of family dysfunction as derived from their drawings. The sample (N = 962) is from a longitudinal study of rural poverty exploring the ways in which child, family, and contextual factors shape development over time. Findings reveal that, after controlling for numerous factors including child and primary caregiver covariates, there were significant indirect effects from cumulative family disorganization, but not cumulative family instability, on children’s representation of family dysfunction through parenting behaviors. Results suggest that the proximal effects of daily disorganization outweigh the effects of periodic instability overtime.     

Illness beliefs and self-management in children and young people with chronic illness: a systematic review

To review the extent to which illness representations, based on Leventhal's Common Sense Model, relate to self-management in children and young people with chronic physical health conditions. A systematic literature review was carried out to identify relevant studies and each included paper was assessed for risk of bias. Fifteen papers met criteria for inclusion within the review. The majority of studies were cross-sectional, and small sample sizes for some studies made it difficult to generalise findings. The method of measuring both illness representations and outcomes varied. Timeline, identity, control and consequences beliefs were the most frequently assessed domains of illness representations included within the studies. While there is variability, there are indications that control beliefs, specifically treatment control beliefs, are more consistently and strongly associated with self-management than other representation domains. Control beliefs should be targeted for intervention in studies trying to improve adolescent self-management. In addition, the relationship between illness representations and self-management needs to be considered within both developmental and systemic contexts. It is likely that the variation in self-management will be more fully explained in future research that explores the combined effects of individual representations and the influence of wider contexts.     

The impact of maternal psychopathology on child–mother attachment

This review aims to consider evidence for the impact of maternal psychopathology on the child’s attachment to the mother, and the role of this in mediating the known transmission of developmental and clinical risk to children. The studies reviewed focus on mothers with depression and psychotic disorder. A number of studies (mainly of mothers with depression) demonstrate an association between insecure/disorganised infant attachments and severe maternal psychopathology, whether chronic or current, in the presence of comorbid disorder, maternal insecure or unresolved attachment state of mind, trauma/loss, or low parenting sensitivity. Whether such effects last into middle childhood, however, is unclear. Our understanding of the role of attachment in determining developmental trajectories in this group is at an early stage. Some evidence suggests that attachment may have a role in mediating the intergenerational transmission of internalising and other problems in this group, although the presence of co-occurring contextual risk factors may account for the variability in findings. A multifactorial longitudinal approach is needed to elucidate such factors. However, the current literature highlights which subgroups are likely to be vulnerable and provides an evidence-based rationale for taking an attachment-based approach to intervention in this group.     

Screening for autistic spectrum disorder at the 18-month developmental assessment: a population-based study

The objectives of this study were to assess the feasibility of administering the CHecklist for Autism in Toddlers (CHAT) at the 18-month developmental check, estimate the prevalence of screening positive for autism at the first and second administrations of the CHAT and estimate the prevalence of diagnosed cases of autism. A cross-sectional study design was utilised and data was collected at child developmental screening clinics in counties Cork and Kerry. The sample group consisted of infants attending the routine 18-month developmental assessment, who were broadly representative of infants in the catchment area. The main outcome measure was a medium or high-risk score following two administrations of the CHAT screening instrument and a positive diagnosis of autism after clinical assessment. The CHAT was administered to 2117 infants (79% of those approached) of whom 29 were scored at medium or high risk at first screening, resulting in a prevalence rate of 137 per 10,000 (95% CI: 87-187). A total of 7 of the 29 first screen positive infants were positive (medium or high risk) at second screening, 12 were low risk and 10 parents refused to participate. On subsequent clinical assessment of the 7 infants screening positive on first and second assessment and assessment of 5 of the 10 infants whose parents declined second screening, 7 children received a diagnosis of autism. Thus the overall prevalence of clinically diagnosed autism following this screening exercise was 33.1 per 10,000 (95% CI: 13.3 to 68.0). The CHAT instrument is a useful tool to help identify childhood autism among infants. Routine use of this instrument at 18-month developmental assessment merits consideration.     

Developmental correlates and predictors of emotional availability in mother-child interaction: a longitudinal study from infancy to middle childhood

In this investigation we examined the developmental correlates and predictors of maternal emotional availability in interactions with their 7-year-old children among a sample of families at psychosocial risk. We found developmental coherence in maternal interactive behavior, and in the relations between maternal emotional availability and children's functioning in middle childhood. Mothers and children were observed at home and in a laboratory playroom in infancy to assess maternal interactive behavior and child attachment security. When children were 7 years of age, dyads were observed in the lab; maternal emotional availability was coded using the Emotional Availability Scales, and children's disorganized and controlling attachment behavior was assessed. Classroom teachers reported on children's behavior problems; at age 8, children reported on their depressive symptoms. Results showed that aspects of maternal emotional availability (sensitivity, nonhostility, nonintrusiveness [passive/withdrawn behavior]) were associated with children's functioning in middle childhood: (a) controlling and disorganized attachment behavior, (b) behavior problems in school, and (c) self-reported depressive symptoms. Maternal emotional availability in childhood was predicted by early mother-infant relationship dysfunction (maternal hostility, disrupted communication, and infant attachment insecurity).     

Anxiety in children and adolescents with autism spectrum disorders

Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.