Unresolved maternal attachment representations, disrupted maternal behavior and disorganized attachment in infancy: links to toddler behavior problems

Madigan, Sheri; Moran, Greg; Schuengel, Carlo; Pederson, David R.; Otten, Roy

doi:10.1111/j.1469-7610.2007.01805.x

Cited by 120 publications

(105 citation statements)

References 29 publications

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“…In this regard, it has been hypothesized that the strongest effect of combat PTSD on offspring occurs from the emotional inaccessibility of the father (Harkness, 1993;Reich et al, 1996;Rosenheck, 1986). Similarly, faulty attachment behavior might explain increased vulnerability to psychopathology from mothers (Madigan et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

Yehuda

Bell

Bierer

et al. 2008

Journal of Psychiatric Research

289

225

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Background-A significant association between parental PTSD and the occurrence of PTSD in offspring has been noted, consistent with the idea that risk for PTSD is transmitted from parent to child. Two recent reports linking maternal PTSD and low cortisol in offspring prompted us to examine the relative contributions of maternal vs. paternal PTSD in the prediction of PTSD and other psychiatric diagnoses.

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Section: Discussionmentioning

confidence: 99%

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

Yehuda

Bell

Bierer

et al. 2008

Journal of Psychiatric Research

289

225

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“…Building on previous research linking unresolved loss, maternal interactions, and insecure attachment, 40,41 we hypothesized that the association between maternal grief resolution and infant attachment would be partially mediated by maternal interactive behavior. Although we did not find evidence for mediation, maternal interaction quality was an independent predictor of infant attachment.…”

Section: Discussionmentioning

confidence: 99%

“…We expected the association between grief resolution and security to persist after adjustment for infant and maternal covariates identified a priori. Because unresolved grief was associated previously with specific maternal behaviors (eg, frightening behavior), [39][40][41][42][43] we also expected that the quality of maternal parenting at postterm age of 9 months would partially mediate (ie, explain) the association between maternal grief resolution at postterm age of 9 months and attachment at postterm age of 16 months (Fig 1).…”

mentioning

confidence: 96%

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

Shah

Clements²,

Poehlmann

2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:For mothers of children with chronic medical conditions or disabilities, such as epilepsy or cerebral palsy, a history of maternal unresolved grief regarding the child's diagnosis has been associated with insecure infantmother attachment. WHAT THIS STUDY ADDS:Unresolved grief related to a preterm birth is associated with the development of insecure infantmother attachment. Mothers with resolved grief after preterm birth are 2.9 times as likely to have securely attached infants, compared with mothers with unresolved grief. abstract OBJECTIVE: This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. METHODS:This longitudinal study focused on 74 preterm infants (age of Ͻ36 weeks) and their mothers who were part of a larger study of high-risk infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. RESULTS:The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. CONCLUSION:Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.

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“…122 This form of attachment has been found to mediate disrupted maternal behaviour and children's behavioural difficulties and dysregulation. 786 Children's behavioural level and biobehavioural level dysregulation is characterised by externalising behaviour problems, conduct difficulties and disrupted cortisol patterns (which are associated with stress reactivity). 125,126 Attachment and Biobehavioral Catch-up (ABC) is a manualised didactic intervention which was designed to decrease parental frightening behaviour and increase parental sensitivity.…”

mentioning

confidence: 99%

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Unresolved maternal attachment representations, disrupted maternal behavior and disorganized attachment in infancy: links to toddler behavior problems

Cited by 120 publications

References 29 publications

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

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