Attachment in Infants With Cleft Lip and/or Palate: Marginal Security and Its Changes Over Time

Abstract

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent-infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old-which can be considered marginally secure at that age-may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.

Association of cleft lip and palate on mother-to-infant bonding: a cross-sectional study in the Japan Environment and Children’s Study (JECS)

“…Boztepe et al also indicated that, in comparison with congenital heart disease, cleft lip was more likely to adversely affect maternal emotional connection toward the infant possibly due to the visual aspects of the condition [12]. Indeed, there is increasing evidence suggesting potential impairments of infant-maternal relationships among children with CL/P [13–15]. However, the association of childbirths of infants with CL/P on maternal emotional involvement toward infants still remains unclear.…”

Children with mixed developmental language disorder have more insecure patterns of attachment

“…Correlations have been reported with maternal AAIs, children’s self-representations and social competence at school. The ASCT has also been used in clinical group of children, such as children with cleft lip and/or palate in a recent longitudinal study [ 21 ].…”

Association of Cleft Lip and Palate on Mother-to-Infant Bonding: a Cross-Sectional Study in the Japan Environment and Children's Study (JECS).

“…Boztepe et al also indicated that, in comparison with congenital heart disease, cleft lip was more likely to adversely affect maternal emotional connection toward the infant possibly due to the visual aspects of the condition [12]. Indeed, there is increasing evidence suggesting potential impairments of infant-maternal attachments among children with CL/P [13][14][15]. However, the impact of CL/P birth on maternal emotional involvement toward infants still remains unclear.…”