Contributions of attachment theory and research: A framework for future research, translation, and policy
TL;DR: The documented antecedents and consequences of individual differences in infant attachment patterns are focused on, suggesting topics for further theoretical clarification, research, clinical interventions, and policy applications.
Abstract: Attachment theory has been generating creative and impactful research for almost half a century. In this article we focus on the documented antecedents and consequences of individual differences in infant attachment patterns, suggesting topics for further theoretical clarification, research, clinical interventions, and policy applications. We pay particular attention to the concept of cognitive “working models” and to neural and physiological mechanisms through which early attachment experiences contribute to later functioning. We consider adult caregiving behavior that predicts infant attachment patterns, and the stillmysterious “transmission gap” between parental Adult Attachment Interview classifications and infant Strange Situation classifications. We also review connections between attachment and (a) child psychopathology; (b) neurobiology; (c) health and immune function; (d) empathy, compassion, and altruism; (e) school readiness; and (f) culture. We conclude with clinical–translational and public policy applications of attachment research that could reduce the occurrence and maintenance of insecure attachment during infancy and beyond. Our goal is to inspire researchers to continue advancing the field by finding new ways to tackle long-standing questions and by generating and testing novel hypotheses. One gets a glimpse of the germ of attachment theory in John Bowlby’s 1944 article, “Forty-Four Juvenile Thieves: Their Character and Home-Life,” published in the International Journal of Psychoanalysis. Using a combination of case studies and statistical methods (novel at the time for psychoanalysts) to examine the precursors of delinquency, Bowlby arrived at his initial empirical insight: The precursors of emotional disorders and delinquency could be found in early attachment-related experiences, specifically separations from, or inconsistent or harsh treatment by, mothers (and often fathers or other men who were involved with the mothers). Over the subsequent decades, as readers of this journal know, he built a complex and highly generative theory of attachment. Unlike other psychoanalytic writers of his generation, Bowlby formed a working relationship with a very talented empirically oriented researcher, Mary Ainsworth. Her careful observations, first in Uganda (Ainsworth, 1967) and later in Baltimore, led to a detailed specification of aspects of maternal behavior that preceded individual differences in infant attachment. Her creation of the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) provided a gold standard for identifying and classifying individual differences in infant attachment security (and insecurity) and ushered in decades of research examining the precursors and outcomes of individual differences in infant attachment. (A PsycInfo literature search using the keyword “attachment” yields more than 15,000 titles.) By the beginning of the 21st century, the National Research
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TL;DR: Since the early 1970s, Sroufe, Egeland, Carlson, Collins and others have been following a large cohort of children from the sixth month of the mother’s pregnancy through to the present, demonstrating that development is a lawful, understandable and predictable process when there have been multiple methods of assessment from multiple independent sources.
Abstract: Since the early 1970s, Sroufe, Egeland, Carlson, Collins and others have been following a large cohort of children from the sixth month of the mother’s pregnancy through to the present. Eighty-five percent of the 212 at 24 months are still in the study close to three decades later. Early losses occurred before the decision was made to change the initial shorter study (started by Egeland, a psychologist, and Deinard, a pediatrician) to a longitudinal study. The authors noted that the losses were in the most high stress and unstable of the families.
The families were chosen intentionally to include caregivers who may present parenting difficulties by selecting first born children to mothers who qualified for public assistance for prenatal care and delivery. Poverty was the marker that would ensure this. They were careful to note that these mothers had a wide variety of backgrounds and degrees of support available, thus also ensuring a wide range of outcomes 28 years later (the age now under study).
The authors started with an excellent overview of the challenges faced, the key claims and guide to the book, conceptual and theoretical supports, organizing perspective and assessments. Understanding the frequency, breadth and depth of the assessments with over 10,000 resultant variables is crucial to giving credence to the resulting conclusions. The strength of this work comes not just from the lessons learned about development, change and continuity but from the impressive evidence that places the lessons on a firm foundation and the even more fascinating predictability about development that emerged from the data.
Throughout the book, it is easily possible to pull out sentences that may have made intuitive clinical sense but are now backed up with statistics (kept to an appropriate minimum since background papers are well-referenced). For instance: by heightening and chronically emitting signals of need toward an only intermittently responsive caregiver, a resistant attachment organization is established which is correlated with anxiety disorders at age 17½. By minimizing signals of need that may further alienate rejecting caregivers, an avoidant attachment organization is established which shows a connection to externalizing behavioural disorders through early childhood and adolescence. Anxious attachment in general, with no distinction between avoidance and resistance, was associated with depression. There are remarkable parallels between how mothers responded to tasks with their children at 24 months and the same children more than 20 years later, responding to their own 24-month-old children.
Other conclusions have implications for prevention and intervention. In breaking the cycle of abuse, three relationship factors were most helpful for the mothers: (1) receiving emotional support from an alternative non-abusive adult, therapy experience of at least six months, supportive and satisfying relationship with a mate; (2) ability to predict high school dropping out with 77% accuracy using only quality of care measures up to age 42 months; (3) boundary violators during middle childhood were less competent in dealing with mixed gender relationships during adolescence and were more likely to have mothers who were abused.
As interesting as any individual observation or prediction may have been, it is the general observations and conclusions about development that pull the work together and provide a framework that will be useful to clinicians, program planners and researchers for years to come. They include implications for classification systems such as the Diagnostic and Statistical Manual, for treatment of specific disorders and for prevention and early intervention services. Above all, they have demonstrated that development is a lawful, understandable and predictable process when there have been multiple methods of assessment from multiple independent sources.
This is a book that I wish was written and that I had read as a resident. It’s not that there weren’t books about development, but they were based on the wisdom of clinical observation by gifted clinicians after years of work. What this group has contributed is the research basis for development, and in the process have given it a much more interactive and dynamic life than theory and clinicians have been able to do. They shift us from traits to interactions, from today’s preoccupation with genetics to the psychosocial environment, from blaming parents to acceptance of their unique histories and pasts, and, more importantly, from the unpredictable to the predictable.
Some time ago, when giving an invited talk about personality disorder from the perspective of a child and adolescent psychiatrist, I ended with the thought that we may be training our residents from the wrong end of life. They start out in the world of adult psychiatry and work backwards gradually. My thought was that we needed to start with infancy and the attachment process, then work forward into childhood, adolescence and adulthood. This book has shifted my ‘clinical’ thought into a research base. If we understood the results of this book and the developmental process and predictability, we would practice a more researched based therapy with each growing stage of life.
This book represents the summary of a lifetime dedication by many researchers to the mental health and well-being of children and youth and makes this dedication available to all of us who work with and care about children and youth in society. They deserve not only our thanks, but more importantly, our attention.
Now that the work has been done, the book has been written, it is time for you to read it and then recommend it to every psychiatry resident beginning their career.
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01 Jun 1991
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"Contributions of attachment theory ..." refers background in this paper
...…majority of existing studies have, however, not focused on clinically diagnosed psychopathology but have been concerned with relations between attachment and continuous measures of internalizing and externalizing symptoms (e.g., assessed with the Child Behavior Checklist [CBCL]; Achenbach, 1991)....
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01 Jan 1978TL;DR: In this article, the effects of repetition of the "strange situation" on infants' behavior at home and in the classroom were discussed, as well as the relationship between infants' behaviour in the situation and their mothers' behaviour at home.
Abstract: Part I: Introduction 1. Theoretical Background Part II: Method 2. Procedures 3. Measures and Methods of Assessment Part III: Results 4. Descriptive Account of Behavior in Each Episode 5. Normative Trends across Episodes 6. An Examination of the Classificatory System: A Multiple Discriminate Function Analysis 7. Relationships between Infant Behavior in the Strange Situation and at Home 8. Relationships between Infant Behavior in the Strange Situation and Maternal Behavior at Home 9. A Review of Strange-Situation Studies of One-Year-Olds 10. A Review of Strange-Situation Studies of Two- to Four-Year-Olds 11. The Effects of Repetition of the Strange Situation 12. Subgroups and Their Usefulness Part IV: Discussion 13. Discussion of Normative Issues 14. Individual Differences: In Light of Contrasting Paradigms 15. An Interpretation of Individual Differences Appendix I: Instructions to Mother Appendix II: Instructions for Coding and Tabulating Frequency of Behaviors Appendix III: Scoring System for Interactive Behaviors Appendix IV: Maternal Caregiving and Interaction Scales Appendix V: Secure Base Behavior At Home Appendix VI: Supplementary Statistical Findings
8,726 citations
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