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This study addresses the extent to which insecure and disorganized attachments increase risk for externalizing problems using meta-analysis. From 69 samples (N = 5,947), the association between insecurity and externalizing problems was significant, d = 0.31 (95% CI: 0.23, 0.40). Larger effects were found for boys (d = 0.35), clinical samples (d = 0.49), and from observation-based outcome assessments (d = 0.58). Larger effects were found for attachment assessments other than the Strange Situation. Overall, disorganized children appeared at elevated risk (d = 0.34, 95% CI: 0.18, 0.50), with weaker effects for avoidance (d = 0.12, 95% CI: 0.03, 0.21) and resistance (d = 0.11, 95% CI: -0.04, 0.26). The results are discussed in terms of the potential significance of attachment for mental health.

Using an accelerated longitudinal design, the development of externalizing problems from age 2 to 5 years was investigated in relation to maternal psychopathology, maternal parenting, gender, child temperament, and the presence of siblings. The sample consisted of 150 children selected at age 2-3 years for having high levels of externalizing problems. Parenting was measured using observational methods, and maternal reports were used for the other variables. Overall, mean levels of externalizing problems decreased over time, and higher initial levels (intercept) were related to a stronger decrease (negative slope) in externalizing problems. Results showed that higher levels of maternal psychopathology were related to less decrease in early childhood externalizing problems. Parental sensitive behavior predicted a stronger decrease in externalizing problems, but only for children with difficult temperaments. A stronger decrease of externalizing problems in children with older siblings also pertained only to children with difficult temperaments. Thus, temperamentally difficult children appear to be more susceptible to environmental influences on the development of externalizing behaviors. Our results indicate that the role of siblings in early childhood externalizing problems deserves more research attention, and that intervention efforts need to take into account temperamental differences in children's susceptibility to environmental influences.

The Still-Face Paradigm (SFP) designed by Tronick, Als, Adamson, Wise, and Brazelton (Tronick, E., Als, H., Adamson, L., Wise, S., & Brazelton, T. B. (1978). Infants response to entrapment between contradictory messages in face-to-face interaction. "Journal of the American Academy of Child and Adolescent Psychiatry, 17", 1-13) has been used for many different purposes in over 80 empirical studies. In the current paper, the nature and correlates of infant behavior in the SFP were examined in a systematic narrative review and a series of meta-analyses. The results of the meta-analyses confirmed the classic still-face effect of reduced positive affect and gaze, and increased negative affect, as well as a partial carry-over effect into the reunion episode consisting of lower positive and higher negative affect compared to baseline. The still-face effect is very robust as it was found regardless of most sample variations such as infant gender and risk status, and regardless of most procedural variations, such as the length of the SFP episodes and the use of intervals between episodes. The few moderator effects that were found in the meta-analyses tended to put findings from the narrative review in a new perspective. Additional meta-analyses confirmed the narrative review in finding that higher maternal sensitivity predicted more infant positive affect during the still-face. Infants' higher positive affect and lower negative affect during the still-face were predictive of secure attachment at age 1 year. The meta-analytic results for maternal depression were equivocal. Implications for future research include a need for studies testing the role of the adults' identity (parent versus stranger, mother versus father) to elucidate the relationship-specificity of the still-face effect. Also, the role of maternal sensitivity and temperament as potential moderators of the still-face effect need to be examined further. On a procedural level, the effects of the timing of the still-face and of the duration of the reunion on infant responses deserve future research attention. (Contains 8 tables and 1 figure.)

The present longitudinal study examined resting heart rate and heart rate variability and reactivity to a stressful gambling task in adopted adolescents with aggressive, delinquent, or internalizing behavior problems and adopted adolescents without behavior problems (total N=151). Early-onset delinquent adolescents showed heart rate "hypo"reactivity to the stress-eliciting gambling task compared to late-onset delinquent adolescents and adolescents without behavior problems. Heart rate, heart rate variability, and reactivity to stress were not related to environmental factors such as early-childhood parental sensitivity, parental socioeconomic status, or adoptee's health status at arrival. We conclude that the distinction between delinquency and aggression and between childhood-onset and adolescence-onset delinquency is important for the study of stress reactivity in adolescents.

Play helps to develop social skills. Children with autism show deviances in their play behavior that may be associated with delays in their social development. In this study, we investigated manipulative, functional and symbolic play behavior of toddlers with and without autism (mean age: 26.45, SD 5.63). The results showed that the quality of interaction between the child and the caregiver was related to the development of play behavior. In particular, security of attachment was related to better play behavior. When the developmental level of the child is taken into account, the attachment relationship of the child with the caregiver at this young age is a better predictor of the level of play behavior than the child's disorder.

Recent studies have supported the intriguing hypothesis that highly reactive infants are most susceptible to the effect of parenting. This study replicates and extends an earlier study on 4-year-olds concerning higher susceptibility of more fearful children to the quality of their relationships with their mothers, as shown by their physiological reactions to fear-inducing film clips. Two groups of children (4- and 7-year-olds) were shown the same fear-inducing and neutral film clips. During the film clips, their skin conductance and heart rate variability were measured. Both 4- and 7-year-olds responded to the fear-inducing film clips with increases in skin conductance and decreases in heart rate variability. A secure relationship affected the reactivity to fearful stimuli in temperamentally more fearful children but not in less fearful children irrespective of children's ages. Our findings add to the growing literature showing that children high in negative emotion are more susceptible to positive as well as negative rearing influences for better and for worse.

The current study examined whether adolescents' attachment representations were associated with differences in emotion regulation during the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1996) and during a mother-adolescent conflict interaction task (Family Interaction Task [FIT]; J. P. Allen et al., 2003). Participants were one hundred and fifty-six 14-year-old adolescents. Dismissing adolescents showed less interbeat interval (IBI) reactivity (indicating less stress) during the AAI than secure adolescents. However, during the FIT, dismissing adolescents showed more IBI reactivity. No differences in physiological reactivity were found between individuals with resolved or unresolved loss or trauma during the AAI or FIT. The results indicate that dismissing adolescents may effectively use a defensive strategy during the AAI but less so in direct conflict interaction with their attachment figure.

In a randomized controlled trial we tested the role of genetic differences in explaining variability in intervention effects on child externalizing behavior. One hundred fifty-seven families with 1- to 3-year-old children screened for their relatively high levels of externalizing behavior participated in a study implementing Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), with six 1.5-hr intervention sessions focusing on maternal sensitivity and discipline. A moderating role of the dopamine D4 receptor (DRD4) variable-number tandem repeat (VNTR) exon III polymorphism was found: VIPP-SD proved to be effective in decreasing externalizing behavior in children with the DRD4 7-repeat allele, a polymorphism that is associated with motivational and reward mechanisms and Attention Deficit Hyperactivity Disorder (ADHD) in children. VIPP-SD effects were largest in children with the DRD4 7-repeat allele whose parents showed the largest increase in the use of positive discipline. The findings of this first experimental test of (measured) gene by (observed) environment interaction in human development indicate that children may be differentially susceptible to intervention effects depending on genetic differences.

Gene-environment interactions interpreted in terms of differential susceptibility may play a large part in the explanation of individual differences in human development. Reviewing studies on the behavioral and molecular genetics of attachment, we present evidence for interactions between genetic and environmental factors explaining individual differences in attachment security and disorganization. In particular, the DRD4 7-repeat polymorphism seems associated with an increased risk for disorganized attachment, but only when combined with environmental risk. Gene-environment (G x E) interactions may be interpreted as genetic vulnerability "or" differential susceptibility. We found support for the differential susceptibility hypothesis predicting not only more "negative" outcomes for susceptible children in unfavorable environments, but also "positive" outcomes for susceptible children in "favorable" environments.

Children with Autism Spectrum Disorder (ASD) have severe and pervasive impairments in the development of social interaction, which may affect the attachment relationship with their parents and may have an impact on parenting. In the current investigation 89 families with young children (mean age 26.5 months) were involved, who were diagnosed as ASD, mentally retarded (MR), or language delayed (LD), or part of a non-clinical comparison group. Attachment security was observed with the Brief Attachment Screening Questionnaire, and several parental self-report questionnaires assessed the parenting style, parental efficacy, parental experiences of daily hassles, social support, and psychological problems. Children with ASD were rated as less secure compared to the other clinical and normal comparison groups. Parents of non-clinical children reported higher levels of authoritative parenting than parents in the ASD group and in the total clinical group, and they also received less social support. Parents of children with ASD coped remarkably well with the challenges of raising a child with ASD.

Attachment was assessed in toddlers with Autistic Disorder (n = 20), Pervasive Developmental Disorder (n = 14), Mental Retardation (n = 12), Language Development Disorder (n = 16), and a non-clinical comparison group (n = 18), using the Strange Situation Procedure (SSP). Children in the clinical groups were more often disorganized and less often securely attached. Severity of autism was associated with more attachment insecurity, and lower developmental level increased the chance for disorganized attachment. Attachment disorganization was related to increased heart rate during the SSP. Controlling for basal cortisol and developmental level, more autistic symptoms predicted lower cortisol responses to the SSP. The findings support the importance of disorganized attachment for children with autism.

Children with autism are able to show secure attachment behaviours to their parents/caregivers. Most studies on attachment in children with autism used a (modified) Strange Situation Procedure (SSP) to examine attachment security. An advantage of the Attachment Q-Sort (AQS) over the SSP is that it can be attuned to the secure-base behaviour of children from special populations. In this study experts in the field of autism (both clinicians and researchers: N = 59) defined an AQS criterion sort for children with autism and tested its content validity. Separate criterion sorts were defined for the social subtypes aloof and active-but-odd, but the two criterion sorts could be combined into one AQS criterion sort for children with autism. It is concluded that with minor amendments the original Attachment Q-Sort is applicable in observing the attachment behaviour of children with autism. (Contains 2 tables.)

This study on sensitivity and attachment included 55 toddlers and their parents. Samples included children with autism spectrum disorder (ASD), mental retardation, language delay, and typical development. Children were diagnosed at 4 years of age. Two years before diagnosis, attachment was assessed with the Strange Situation procedure, and parental sensitivity and child involvement during free play were assessed with the Emotional Availability Scale. Parents of children with ASD were equally sensitive as parents of children without ASD, but their children showed more attachment disorganization and less child involvement. More sensitive parents had more secure children, but only in the group without ASD. Less severe autistic symptoms in the social domain predicted more attachment security. Autism challenges the validity of attachment theory.

The current article presents results from a twin study of genetic and environmental components of maternal sensitivity and infant attachment and their association. The sample consisted of 136 twin pairs from 2 sites: Leiden, the Netherlands, and London, UK. Maternal sensitivity was assessed in the home at 9-10 months, and infant attachment security was observed in the laboratory at 12 months. The study yielded little evidence that genetic factors are involved in variations between twins in maternal sensitivity ratings but did find that shared variance in maternal sensitivity was able to account for some of the similarity between twins in attachment security. Weak nonshared associations between sensitivity and attachment appeared to suppress the magnitude of the correlation between attachment and sensitivity in twin children. The results could indicate that the attachment security of one twin may depend on the relationship the parent has with the other twin. The results are brought to bear on the validity of attachment theory as a theory of primarily shared environmental effects in children's development and the continuing challenge posed to attachment theory by within-family differences in socioemotional processes.

Background: This study investigated the occurrence, cross-informant agreement, 1-year stability, and context characteristics of externalizing behaviors in 12-month-old children, as compared to 24- and 36-month-olds. Method: In a general population sample of 786 12-month-olds, 720 24-month-olds, and 744 36-month-olds, the CBCL/1 1/2-5 was obtained from mothers and fathers and again one year later for a subsample of 307 children. Mothers of 1,831 children also provided complete data on child, mother, and family characteristics. Results: Over three-fourths of the externalizing behaviors occurred in more than 10% of 12-month-olds, over one-third of the items in more than 25%. For almost all externalizing behaviors, the occurrence was significantly lower in 12-month-olds compared to 24- and 36-month-old children. Mother-father agreement and 1-year stability of externalizing behaviors in 12-month-old children were significant, but generally somewhat lower than in 24- and 36-month-olds. Context characteristics were related to externalizing behaviors in 12-month-olds as well as in older children. Some associations were less pronounced in 12-month-old children, but the overall pattern of correlates was similar across age groups. Conclusions: The results of this study show that externalizing behaviors in 12-month-old children merit further research and can be assessed with the CBCL in a valid way.

Background: As infant disorganized attachment is a serious risk factor for later child psychopathology, it is important to examine whether attachment disorganization can be prevented or reduced. Method: In a randomized intervention study involving 130 families with 6-month-old adopted infants, two attachment-based intervention programs were tested. In the first program, mothers were provided a personal book, and in the second program mothers received the same personal book and three home-based sessions of video feedback. The third group did not receive intervention (control group). Results: The intervention with video feedback "and" the personal book resulted in enhanced maternal sensitive responsiveness (d = 0.65). Children of mothers who received this intervention were less likely to be classified as disorganized attached at the age of 12 months (d = 0.46), and received lower scores on the rating scale for disorganization than children in the control group (d = 0.62). In the book-only intervention group children showed lower disorganization ratings compared to the control group, but no effect on the number of infants with disorganized attachment classifications was found. Conclusion: Our short-term preventive intervention program with video feedback and a book lowered the rate of disorganized attachment. The effectiveness of our intervention documents the importance of parenting in the development of infant attachment disorganization.

Are preventive early childhood interventions effective in improving home environments, as assessed with the HOME inventory (Caldwell & Bradley, 1984)? The authors traced 48 published articles, presenting 56 intervention effects (N = 7,350). The combined effect size on the HOME total score was d = 0.20 (p less than 0.001). Randomized intervention studies were effective, but the combined effect size was limited (d = 0.13). Nonrandomized studies showed inflated effects (d = 0.58). Interventions with middle-class, non-adolescent parents showed higher effect sizes than interventions with low-SES or adolescent samples. Effective interventions used a moderate number of sessions in a limited period and were home-based. Learning Materials, Involvement, and Responsivity showed significant intervention effects. Families in better living conditions profited more from parent education (the Matthew effect). (Contains 4 tables and 1 figure.)

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). VIPP-SD combines support of parental sensitive responsiveness with coaching parents in sensitive limit setting. Here, we present meta-analyses of 25 RCTs conducted with more than 2,000 parents and caregivers. Parents or children had various risks. We examined its effectiveness in promoting parental cognitions and behavior regarding sensitive parenting and limit setting, in promoting secure child–parent attachment, and reducing externalizing child behavior. Web of Science, MEDLINE, PubMed, and recent reviews were searched for relevant trials (until May 10, 2021). Multilevel meta-analysis with META, METAFOR, and DMETAR in R took account of the 3-level structure of the datasets (studies, participants, measures). The meta-analyses showed substantial combined effect sizes for parenting behavior (r =.18) and attitudes (r =.16), and for child attachment security (r =.23), but not for child externalizing behavior (r =.07). In the subset of studies examining effects on both parenting and attachment, the association between effect sizes for parenting and for attachment amounted to r =.48. We consider the way in which VIPP-SD uses video-feedback an active intervention component. Whether VIPP-SD indeed stimulates secure attachment through enhanced positive parenting remains an outstanding question for further experimental study and individual participant data meta-analysis. [ABSTRACT FROM AUTHOR]

Recent studies showed that attachment security can change within persons, suggesting that there might be an interplay between a rather stable (trait) and rather variable (state) part of attachment. The study's first aim was to investigate whether attachment priming could influence the level of state attachment. The second aim was to explore possible moderators explaining individual differences in the relation between state attachment responses to attachment versus neutral primes. This can shed light on individual differences in attachment prime-induced state attachment. We conducted a within-subjects priming study in which children (9–13 years) were allocated to three priming procedures (neutral, secure, avoidant). Results showed an increase in secure state attachment after secure attachment priming. Individual differences in the strength of this effect were moderated by trait attachment and state attachment volatility. First findings cautiously suggest that state attachment security can change in response to environmental cues under certain circumstances. [ABSTRACT FROM AUTHOR]

Method: Sixteen studies on attachment in children with autism were reviewed, and ten studies with data on observed attachment security (N = 287) were included in a quantitative meta-analysis. Results: Despite the impairments of children with autism in reciprocal social interaction, the majority of the studies found evidence for attachment behaviours in these children. In four samples using the Strange Situation procedure the average percentage of secure attachments amounted to 53% (n = 72). Meta-analytic results showed that children with autism were significantly less securely attached to their parents than comparison children, and the combined effect size for this difference was moderate (r = 0.24). Children with autism displayed less attachment security than comparisons without autism, but this difference disappeared in samples with children with higher mental development, and in samples in which autism was mixed with less severe symptoms of autistic spectrum disorders. Conclusions: It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachment insecurity.

The reliability and validity of the Attachment Q Sort (AQS; Waters & Deane, 1985) was tested in a series of meta-analyses on 139 studies with 13,835 children. The observer AQS security score showed convergent validity with Strange Situation procedure (SSP) security (r=31) and excellent predictive validity with sensitivity measures (r=39). Its association with temperament was weaker (r=16), which supports the discriminant validity of the observer AQS. Studies on the stability of the observer AQS are still relatively scarce but they have yielded promising results (mean r=28; k=4, n=162). It is concluded that the observer AQS, but not the self-reported AQS, is a valid measure of attachment.

This longitudinal study examined the development, antecedents, and concomitants of empathic concern in the second year of life among 125 first-born girls. Findings indicated that empathic concern for mother's simulated distress increased from 16 to 22 months, whereas empathy for a stranger's simulated distress decreased. Fearful temperament and less attachment security predicted less empathic concern for stranger distress. Antecedent and concurrent parenting measures had weak associations with girls' empathic concern. (Author/KB)