The Child Attachment Interview: A Narrative Review

Abstract

Attachment theory promoted an impressive body of research on the psychic developmental processes, resulting in studies on both typical and atypical development. Much of the diffusion of the attachment theory in the clinical field was related to the design of reliable instruments to evaluate the organization of attachment in infancy as well as in adulthood. Until recently, the lack of a suitable instrument to assess attachment in middle childhood as well as in adolescence hindered the expansion of research in these developmental phases during which the parent-child relationship takes on a different, albeit still crucial, role. The Child Attachment Interview (CAI), a measure that was recently designed to assess attachment at a representational level in middle childhood and adolescence, filled the measurement gap. The aim of the current review was to summarize previous empirical investigations concerning CAI in order to (a) provide an overview of the state of current research, (b) identify unanswered questions, and (c) propose future research directions. A narrative review was conducted to map the current research findings by searching for the term “Child Attachment Interview” in the Medline, Scopus, Web of Science, and PsychINFO databases, followed by a search in Mendeley. Limits were set to exclude dissertations, chapters in books, and qualitative or theoretical papers, while empirical studies were included if they used the CAI and were published in English language, peer-reviewed journals by July, 2016. The review, which ultimately included 39 studies meeting the criteria, showed that the CAI is a reliable instrument to assess attachment organization in clinical and non-clinical samples, thus providing a worthwhile contribution to the investigation of the influence of the parent-child relationship beyond infancy and early childhood. Nevertheless, the review pointed out a number of relevant open issues, the most critical of which concerned the CAI coding and classification system. In particular, some relevant questions arose about (a) how opportune it would be to maintain a distinct classification for mother and father, (b) coding challenges regarding both the father and the Preoccupied and Disorganized classification, and finally (c) the advantage of a dimensional vs. a categorical approach.

Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties.

“…In contrast, in this sample, only 14% of the CSA-exposed children were classified as having disorganized attachment. Previously, researchers have argued that the disorganized attachment classification is in need of additional investigation in terms of how it manifests in middle childhood in general and as measured on the CAI specifically Fearon, Shmueli-Goetz, Viding, Fonagy, & Plomin, 2014;Privizzini, 2017); for instance, some authors suggest that disorganization may present as dismissing attachment later in development (Fearon et al, 2014;Weinfeld, Whaley & Egeland, 2004). However, given the limited number of studies on this topic, at this point we cannot conclude whether rates of disorganized attachment are lower among CSA-exposed school-aged children than among children exposed to other forms of abuse, or whether the relatively lower rates of disorganized attachment in this sample pertain to the field's poorer understanding of disorganized attachment in this age range.…”

“…The resulting disorganization of attachment reflects an absence or collapse of strategy for dealing with attachment-related distress (Hesse & Main, 2000;Main & Solomon, 1990), thus increasing risk of psychological difficulties. In middle childhood, researchers can measure children's mental representations of attachment relationships using semi-structured interviews (e.g., the Child Attachment Interview [CAI]; Shmueli-Goetz, Target, Fonagy, & Datta, 2008); an initial validity study of the CAI revealed that 66% of children have secure attachment CSA AND ATTACHMENT IN MIDDLE CHILDHOOD 6 representations, 30% had organized-insecure representations, and 4% of which were classified as having disorganized attachment (see Privizzini, 2017, for a review).…”

Psychobiology of Attachment and Trauma—Some General Remarks From a Clinical Perspective

“…Important transformations in later stages of development, especially in adolescence, cannot be explained solely by the dynamics of early mother-child interactions. Rather, numerous biopsychosocial factors influence transformations during this particular developmental period (72)(73)(74). In this context, the empirical finding should also briefly mention that some adults in the commonly used Adult Attachment Interview achieve a secure attachment status, but report significant problems from their early relationships with parents.…”

“…Winnicott (28,29) so inspiringly introduced the psychodynamic concepts of "primary maternal care, " "good enough mothering, " "mirroring, " "holding environment, " and "ability to be alone in the presence of the other" decades ago, into psychoanalytic developmental psychology. His terms today may find their immediate neurobiological correlation in the development of relational and social cerebral maturation (30)(31)(32).…”

“…The main trajectory of this neural network extends from the limbic structure of the ventral tegmental area to the nucleus accumbens in the ventral striatum and is closely related to the amygdala on the one hand and the prefrontal cortex on the other. Thus, the evolutionarily highest system of stress regulation has been interactively practiced (31): -In the case of imminent danger, the most recent part in evolutionary terms in a hierarchical sequence is activated, e.g. the ventral vagus complex, the nucleus ambiguus and the motor cranial nerves; this initiates a social orientation reaction, a turn towards a familiar face, a contact search with vocalization that allows for verbal communication.…”