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Mother-child attachment and preschool behavior problems in children with developmental delay

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Mary LaMont
Abstract:
Secure mother-child attachment has been found to be an important factor in the healthy emotional development of children and has been shown to have effects on child, adolescent, and adult behavior. Previous research has primarily focused on attachment in children who are typically developing. However, little research has been conducted in populations of children with developmental delays. The research thus far has suggested that medical situations, child disabilities and maternal emotions may affect interaction patterns between the mother and the child which may in turn influence the security of the mother-child attachment in children with developmental delays. This study contributes to the literature now available. Seventy-four mothers of 1½- to 2-year-old children in an early intervention program completed a series of questionnaires. Two previously developed pencil-paper measures of attachment behaviors were selected for use in the study due to ease of administration and replication and the need for generalization of measures for use in early intervention programs. The Child Attachment Questionnaire (CAQ) and the Attachment Q-Sort Questionnaire (AQSQ) were completed along with measures of parent stress (Parent Stress Index; PSI), maternal psychological problems (Outcomes Questionnaire-45; OQ), socially desirable responses (Marlowe-Crowne Social Desirability Scale; MC), child temperament (Dimensions of Temperament-Revised; DOTS-R), child behavior problems (Child Behavior Checklist-1½-5; CBCL), and a demographic questionnaire. Compared to numbers published in the literature for typically developing children, the CAQ indicated similar percentages of children with developmental delays fell into secure and insecure categories of attachment while the AQSQ indicated a slightly lower degree of secure attachment for this sample. While parenting stress did predict lower attachment security in this study, social desirable responses were not significantly related to attachment. Maternal psychological problems weakly predicted a higher degree of security. For child factors, gender was not related to attachment and a higher degree of difficulty of temperament predicted lower attachment security. Both paper-pencil measures of attachment were statistically found to be stable over one year's time. As hypothesized, secure attachment was inversely related to behavior problems one year later. Conclusions and clinical implications of these findings are provided and may assist psychologists and early intervention programs in identifying attachment problems and treating with children with developmental delays.

CONTENTS

Page

ABSTRACT ................................................................................................................... iii

DEDICATION ............................................................................................................... v

ACKNOWLEDGMENTS ............................................................................................. vi

LIST OF TABLES ......................................................................................................... viii

CHAPTER

I. INTRODUCTION .......................................................................................... 1

II. LITERATURE REVIEW ............................................................................... 6

Attachment Theory ......................................................................................... 6 Assessment of Attachment .............................................................................. 12 Parent Factors that Influence Attachment Security ........................................ 20 Child Factors that Influence Attachment Security .......................................... 22 Emotional and Behavioral Correlates of Attachment ..................................... 23 Attachment in Children with Developmental Delays ..................................... 26 Summary ......................................................................................................... 31

III. METHOD ....................................................................................................... 33

Participants ...................................................................................................... 33 Demographic Characteristics .......................................................................... 33 Instruments ...................................................................................................... 34 Procedures ....................................................................................................... 41

IV. RESULTS ....................................................................................................... 43

Descriptive Statistics and Preliminary Analyses ............................................ 43 Attachment in Children with Developmental Delays ..................................... 45 Parent Factors that Predict Security ................................................................ 48 Child Factors that Predict Attachment Security .............................................. 50 Stability of Attachment Security Scores for One Year’s Time ....................... 51

V. DISCUSSION ................................................................................................. 55

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Page

Security of Attachment in Children with Developmental Delays .................. 55 Maternal Predictors of Attachment ................................................................. 58 Child Predictors of Attachment ...................................................................... 59 Stability of Attachment in Children with Developmental Delays .................. 61 Attachment as a Predictor of Behavior Problems in Children with Developmental Delays ........................................................................... 61 Limitations and Future Directions .................................................................. 62

REFERENCES .............................................................................................................. 67

APPENDICES ............................................................................................................... 82

Appendix A: Time 1 Letter and Parent Questionnaire ................................. 83 Appendix B: Time 2 Letter and Parent Questionnaire ................................. 86 Appendix C: Informed Consent.................................................................... 89 Appendix D: Measures ................................................................................. 92

CURRICULUM VITAE ................................................................................................ 103

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LIST OF TABLES

Table Page

1. Strange Situation Protocol ................................................................................. 13

2. Demographic Characteristics of Sample at Time 1 ........................................... 35

3. Descriptive Statistics for Measures .................................................................... 44

4. Percentages of Children in Each CAQ Attachment Category ........................... 45

5. Correlations Between Attachment, Time 1 Variables, and Time 2 Behavior Problems ............................................................................................................ 46

6. Percentages of Children in Each CAQ Attachment Category ........................... 47

7. Percentages of Children in CAQ Secure-Insecure Attachment Categories ....... 48

8. Contribution of Parent Factors to the Degree of Attachment Security (AQSQ) .............................................................................................................. 49

9. Contribution of Parent Factors to Secure Attachment (CAQ) ........................... 50

10. Contribution of Child Factors to Degree of Attachment Security (AQSQ) ....... 51

11. Contribution of Child Factors to Secure Attachment (CAQ) ............................ 52

12. Changes in Attachment Security (CAQ) Over 1 Year’s Time .......................... 53

13. Attachment Scores (Time 1) Prediction of Internalizing Behavior Problems (Time 2) ............................................................................................................. 53

14. Attachment Scores (Time 1) Prediction of Externalizing Behavior Problems (Time 2) ............................................................................................. 54

15. Attachment Scores (Time 1) Prediction of Behavior Problems (Time 2) ......... 54

CHAPTER I INTRODUCTION

Much research has been published in recent years regarding the importance of a secure mother-infant attachment for the healthy social and emotional development of children. Bowlby (1969/1982), who is credited with the origination of attachment theory, described attachment as the close emotional relationship between two persons. He proposed that the degree of secure attachment between a mother and her infant was shown by the amount affection shared by them and their mutual demonstration of desire to maintain proximity, especially in situation of distress (Bowlby, 1973). Subsequent researchers have suggested that infants with highly secure attachments to their mothers experience a sense of belongingness (Oppenheim, Koren- Kari, & Sagi, 1999), consistency, and trust (Cassidy, 2000). Researchers have found that when a secure attachment is present in infancy, behaviors of the child are likely to include high self-esteem, cooperation, social competence, management of aggression, emotional regulation, academic achievement, and an overall resilience to negative environmental risks (Bost, Vaughn, Washington, Cielinski, & Bradford, 1998; Sroufe, Duggal, Weinfield, & Carlson, 2000; Wittmer, Doll, & Strain, 1996). Although obtaining a secure attachment to their mother has been referred to as infants’ primary developmental task (Peterson, 1987), some infants develop what Bowlby (1969/1982) described as insecure attachment to their mothers. This less desirable type of attachment is typified by less stable or absent affection between the mothers and their infants and less secure behaviors of seeking proximity to one another. Insecure

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attachment has been named as a significant risk factor for a number of emotional and behavioral disorders both in childhood and adulthood (Sroufe et al., 2000). Some researchers have hypothesized that virtually all social and emotional problems exhibited in early childhood are due to relational problems of lack of secure attachment with the primary caregiver (Raver & Zigler, 1997). A number of characteristics of both a mother and her infant have been found to influence the security of their attachment relationship. The mother’s own attachment security in early childhood (Pederson, Gleason, Moran, & Bento, 1998), the degree of stress experienced with parenthood and other life stressors (Waters, Hamilton, & Weinfield, 2000) and the mother’s psychological problems (Teti, Gelfand, Messinger, & Isabella, 1995) are related to the degree of security or insecurity of a mother’s attachment with her infant. Infants with a difficult temperament, medical problems in the first year of life, abuse, and/or separation from the attachment figure, appear to be more likely to develop an insecure attachment (Grizenko, 1994). It has also been hypothesized that infants with developmental delays are more at risk than typically developing infants for insecure attachments to their mothers (e.g., Silber, 1989; Van Ijzendoorn, Goldberg, Kroonenberg, & Frenkel, 1992; Wasserman, Lennon, Allen, & Shilansky, 1987). Young children can experience developmental delays in different areas including speech/language, motor, cognitive and social emotional delays. Researchers have attempted to determine if attachment with their mothers, for infants with developmental delays is the same as that for typically developing children. The results of these studies have been mixed. Some researchers have suggested that the

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attachment process and security of attachment is the same in children with delayed and typical developmental patterns (e.g., Speltz, Endriga, Fisher, & Mason, 1997). Other authors have indicated that a developmental delay interferes with interaction and proximity seeking between a mother and her infant and therefore the process of development of secure attachment is altered (Blacher & Meyers, 1983; Lederberg & Mobley, 1990; Vaughn & Bost, 1999). Some researchers have found a higher incidence of insecure attachment between mothers and their infants with chronic illness and/or developmental delays (e.g., Greenberg, Speltz, Deklyen, & Endriga, 1991; Mrazek, Casey, & Anderson, 1987; Speltz, Greenberg, & Deklyen, 1990), and others have suggested that a social-emotional delay, itself, may be the result of an insecure attachment (e.g., Sameroff & Emde, 1989). Due to the possibility that attachment for children with developmental delays may be different and/or less secure than for children who are typically developing, attachment behaviors have become a primary focus for early intervention and infant mental health treatment (Maldonado-Duran, 2002; Zeanah, Boris, & Leiberman, 2000). However, in order to better understand attachment in infants and young children with developmental delays, further study is needed. One particular area in need of study is the relationship between attachment in infants with developmental delays and their subsequent behavior problems at preschool age. This need is indicated by researchers who have shown a relationship between insecure attachment in children who are typically developing and behavior problems in preschool, adolescence, and adulthood (e.g., Bohlin, Hagekull, & Rydell, 2000; Park & Waters, 1989). These studies highlight the need for early identification and treatment of

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children who may (without treatment) later engage in criminal or harmful acts toward people and institutions in our society. These studies, however, did not include children who had been identified at a young age as having developmental delays. Because children with developmental delays are considered at risk for emotional and behavior problems, studies of early influences on problem behaviors in this population seems paramount. Therefore, the purpose of this study was to add specific information to the literature available concerning attachment in young children with developmental delays. The following research questions were used to guide this study. 1. What percentage of children with developmental delays falls into each attachment category (using both the secure, avoidant, resistant, disorganized categorization and the global secure and insecure categories)? 2. What parent factors and child factors predict the pattern of security of attachment in young children (1½-2 years) with developmental delays? 3. Are attachment security scores of children with developmental delays stable across one year’s time? 4. Does attachment at age 1½-2 predict behavior problems one year later in young children with developmental delays? In forming hypotheses, the past research in the area of attachment with both children who are typically developing and children with developmental delays has been considered. Likewise, researchers’ findings that there is an association between the degree of attachment security and preschool behavior problems of children who are typically developing, have been taken into account. The following outcomes were

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hypothesized. 1. The percentage of insecure attachment rating of children with developmental delays will be higher than what is reported in the literature for children who are typically developing. A higher percentage of children with developmental delays will fall into the insecure-resistant category than the percentage reported for typically developing children. 2. Parent factors (parenting stress and psychological problems) will contribute to the variance in attachment so that parents reporting less stress and fewer psychological problems will report more secure attachments with their children. 3. Child factors (gender, temperament) will contribute to the variance in attachment so that children with easier temperaments and children who are girls will have more secure attachments. 4. Attachment scores will remain stable over one year’s time. 5. Security of attachment scores will be inversely related to child behavior problem scores after one year’s time.

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CHAPTER II LITERATURE REVIEW

A review of literature was conducted in order to synthesize the available research results to meet the following objectives. 1. To provide the theoretical base for attachment theory. 2. To become aware of methods used to determine attachment security and insecurity. 3. To understand the correlates of secure and insecure attachment for children who are typically developing. 4. To review the current research on attachment in children with developmental delays.

Attachment Theory

Attachment is a construct that has been studied since the 1960s. Bowlby (1969/1982), a psychiatrist, used his observations of infants who were separated from their mothers to document the “grief reaction” that the infants appeared to exhibit with the separation. He theorized that the infants’ behaviors were a manifestation of an emotional bond between infants and their mothers that he referred to as mother-infant attachment. Bowlby (1973) defined attachment as the close emotional relationship between two persons, characterized by mutual affection and a desire to maintain proximity. The primary attachment relationship between a mother and her infant, he postulated, is formed in the first years of life and remains relatively stable throughout

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childhood, adolescence, and adulthood. Mother-infant attachment, proposed Bowlby (1973) is a critically important process for the healthy emotional development of the individual. In his attachment theory, Bowlby (1969/1982) suggested that if a primary caregiver (in most cases, the mother) is consistently sensitive to her infant’s cries or other signals of need, an attachment relationship begins to develop. By the last half of the first year, the infant begins to “have confidence” that his or her caregiver is emotionally responsive. According to Bowlby (1973), the infant’s trust in the mother’s positive responses leads to an internal representation within the infant of the mother-infant relationship as positive, rewarding, dependable, and safe. At the same time, the infant forms a representation of “the self” as worthy of love and care. This cognitive representation or working model (Bowlby, 1969/1982) is then generalized to the infant’s expectations of other relationships and serves to guide the infant’s behavioral reactions to distress. Thus, the working model becomes a source of continuity for infants in regard to their feelings, behaviors, and experiences. Bowlby (1969/1982) called the working model of this optimal and fundamental relationship a secure mother-infant attachment. He hypothesized that this secure working model becomes a cognitive framework for relationships throughout the child’s life. Bowlby (1969/1982) also observed that some infants developed a working model of insecure attachment when a mother was emotionally unavailable to her infant, or her sensitivity and/or responsiveness was inconsistent or negative in nature. The insecure working model of attachment also carried forth from the child’s primary relationship to subsequent relationships for that individual throughout life.

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Bowlby’s theory of attachment as a working model has been supported by research that shows the stability of the security of the mother-child relationship throughout childhood (Benoit & Parker, 1994). Studies have also indicated that attachment security or insecurity is transferred to relationships with peers (Seibert, 2010), romantic relationships (Feeney, 2004), and life partners (Creasey & Jarvis, 2009). Researchers (e.g., Colin, 1996) have suggested that approximately 90% of the time, the primary attachment figure for the infant is the mother, although situations do exist in which a grandmother, father, or other caregiver serves as the attachment figure. Other authors (e.g., Colin, 1996; Schaeffer & Emerson, 1984) have shown that attachments are often formed with more than one caregiver. In these cases, the security of the relationship may be somewhat different with each caregiver, but as a rule, if the attachment to the primary caregiver is highly secure, the attachment to other caregivers is also secure. Because almost all research has been focused on mother-infant relationships, this review of literature is focused only on the attachment relationship between mothers and their young children before the age of 3 years. Bowlby’s (1969/1982) observations led him to believe that infants’ working models, whether secure or insecure, influenced their behaviors when distressed. Bowlby and subsequent researchers (Ainsworth, Blehar, Waters, & Wall, 1978) identified infant behaviors that are related to a positive mother-infant relationship and are assumed to be indicators of a high degree of attachment security. They are: a negative reaction to separation from the mother, the ability to be comforted and return to exploration with the mother near, proximity seeking, and infant actions that are referred to as secure base

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behaviors (Bowlby, 1969/1982). Secure base behaviors are shown when the infant ventures away from the mother in order to explore the environment, but checks back with the mother periodically in order to feel save, elicit approval or attention, and gain assurance of the mother’s whereabouts. Proximity to the mother is consistently sought by more securely attached children when they are upset or frightened. Infants with negative or disturbed relationships with their mothers show different behaviors, including either an intense or an indifferent reaction to separation from their mother, anger, or a mixture of those reactions upon the mother’s return. These children, who are assumed to be more insecurely attached, seem to have either a coercive relationship with their mothers or might be seen as having no real relationship with their mothers. They are seen as clingy, angry, or unresponsive to their mothers during play. Infants with these more insecure attachments are typically inconsolable by their mothers when upset or frightened. Bowlby (1969/1982) and others have proposed that these attachment behaviors can be interpreted as the manifestation of the infants’ cognitive working models of the relationship they have with their mother, and simultaneously the representation they have of themselves (Mikulincer et al., 2003). Bowlby (1988) wrote, “the pathway followed by each developing individual and the extent to which he or she becomes resilient to stressful life events is determined to a very significant degree by the pattern of attachment developed during the early years” (p. 688). Subsequent researchers (e.g., Atkinson & Zucker, 1997) have confirmed his theory, including the importance of the development of highly secure mother-infant attachments. Study of the attachment relationship has led to a

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greater understanding of the emotional health of very young children. Mary Ainsworth was one of the individuals (Ainsworth et al., 1978) who continued Bowlby’s work. She was interested in both maternal and child behaviors. The sensitivity and responsiveness of the mother are vital, according to Ainsworth and colleagues, for the secure attachment of young children. Ainsworth and her colleagues (1978) were the first to attempt to categorize secure and insecure mental representations of attachment. In their studies (Ainsworth et al., 1978) they found that approximately 60% of the infants in her sample, which was taken from throughout North America, exhibited behaviors that fell into a category she identified as securely attached. Infants in this category were most likely to have a mother who was warm, sensitive, and responsive to signals given by the child. In situations of stress, infants displayed little or no anger toward their mother and after receiving comfort would soon return to play. The majority of the remaining 40% of the infants in studies by Ainsworth and associates (1978) were identified as insecurely attached. Mothers of these infants lacked sensitivity to the feeling states of their children and were either directive and controlling or unresponsive to their baby’s cues. These insecure infants did not use the mother as a safe haven in times of stress, nor did they use their mother as a secure base from which to explore their environment. Ainsworth and others’ (1978) two different insecure categories were insecure- avoidant (or anxious-avoidant) and insecure-resistant (also called anxious-ambivalent). The insecure-avoidant infants were the most likely to have an unresponsive caregiver.

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These babies tended to ignore (avoid) their mothers and withdraw from their mothers’ attempts to comfort them. On the other hand, insecure-resistant children most often had a care giving environment in which they experienced both positive and negative interaction with their mothers. The problem was that they could not tell which to expect. These children were likely to show some anger (resistance) toward their caregiver in stressful situations, and were often difficult to sooth. Under stress, these infants fluctuated from aggressiveness and anger, to coy, needy and manipulative behavior. Sometime later, Main and Solomon (1999) suggested that it was possible to identify another category of insecure attachment in some of the children who did not fit into either the avoidant or resistant categories. Referred to as insecure-disorganized/ disoriented attachment, this has become the fourth major category of attachment. This category was found to be related to both “frightening” and “frightened” parenting styles (Abrams, 2001). Mothers of insecure-disorganized/disoriented infants tend to be either emotionally or physically abusive (frightening) or live in a state of fear or victimization themselves (frightened). Jacobsen, Hibbs, and Ziegenhain’s (2000) research showed that a mother’s high level of expressed emotion (intrusive and hostile maternal behavior) was related to a disorganized attachment style in her child. Children with this classification appear to lack a coherent or organized strategy to cope with stressful situations. When presented with those situations, they may appear to be depressed or exhibit mixtures of avoidance, anger, fear, and attachment behaviors. Children with this attachment style were found to lack stress management strategies and to aggressively act out or externalize behavior problems. Children with behaviors in this category have also been found to

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show medical failure-to-thrive (Ward, Lee, & Lipper, 2000) and dissociative behavior in later life (Van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999). It has been hypothesized that the negative behaviors associated with insecure attachments are actually adaptive behaviors. From an evolutionary perspective, these behaviors may be exhibited to elicit caregiving by adults, which, in turn, enhance the probability of survival (Balbernie, 2010). So although the research is clear that secure mother-child attachment is protective and insecure mother-child attachment is a risk factor in regard to prosocial behaviors (Bauminger & Kimhi-Kind, 2008), this perhaps does not reflect successful adaptation and survival of an individual despite negative circumstances. Although traditionally attachment has been conceptualized in a categorical manner, a number of researchers have suggested that it might better be understood as a dimensional construct. Waters and Deane (1985) have placed attachment on a linear continuum from secure to insecure, and Gardner, Lamb, Thompson, and Sagi (1986) found that differences between resistant and avoidant children are often weak and unreliable. Fraley and Spieker (2003) have suggested that the construct is better described as ranging from insecure, avoidantly attached (more distancing), youngsters on one end of the continuum to insecurely anxiously attached children on the opposite end, with securely attached children in the middle. It seems that the construct of attachment is still in development, and the methods of measuring that construct are developing as well.

Assessment of Attachment

One of the first measures of attachment was the Strange Situation (Ainsworth et

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al., 1978). Since Bowlby’s (1969) theory was based upon observations of mothers and infants, Ainsworth used observations of behavior for her assessment process. In the Strange Situation, behaviors were coded and infants were assigned attachment classifications during a contrived laboratory separation procedure. The Strange Situation involved two brief (3-6 minute) separations from the mother (or primary caregiver) in an unfamiliar setting. Behaviors of both the infant and the mother were coded at separation and at reunion (see Table 1). Although Ainsworth and colleagues (Ainsworth et al., 1978) recognized that observation in the child’s natural environment would be a more valid measure of attachment, the Strange Situation provided a more objective and controlled measure. The Strange Situation has, therefore, become the “gold standard” of the measurement of attachment.

Table 1 Strange Situation Protocol

Episode People present Procedure 1 B, C, E E shows C where to put B and where to sit, then leaves. If necessary, C gets B to start playing with toys. 2 B,C C not to initiate interaction, but may respond. 3 B, C, S S enters, sits quietly for a minute, talks with C for a minute, and engages B in interaction or play for a minute. 4 B, S C exits, S lets B play. If B needs comfort, S tries to provide it. If B cries hard, episode can be terminated early. 5 B, C C calls to B from outside the door, enters, greets B, and pauses. If B needs comfort, C may provide it. When B is ready to play with toys, C sits in her chair. If B is very upset and needs extra time with C, episode can be prolonged. 6 B C exits. B is left alone. If B cries hard episode can be terminated early. 7 B, S S enters, greets B, and pauses. If B is OK, S sits. If B needs comfort, S tries to provide it. If B cries hard, episode can be terminated. 8 B, C C calls to B from outside the door, enters, pauses, picks B up, comforts B if necessary, and lets B return to play when ready. B = Baby, C = Caregiver, E = Examiner, S = Stranger.

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Ainsworth became more and more specific in the coding of behaviors in the Strange Situation. Within the original three categories (secure, insecure-avoidant, insecure-resistant), she outlined eight subgroups into which infant patterns of attachment behavior could be classified (Ainsworth, 1985). Later, the coding of Main and Solomon’s (1990) insecure-disorganized/disoriented category was added to the Strange Situation, as well. Yet even with this addition, there are still a number of children whose attachment behaviors do not fit into any of these categories. Identification of attachment security using the Strange Situation is a complex procedure, and by definition causes distress to both the mother and the infant. In 1985, Waters and Deane reported the development of a different measure of attachment. Based upon the attachment behaviors that Ainsworth and her colleagues (1978) identified broadly as either secure or insecure, Waters and Deane (1985) created a method that was meant to simplify the conceptualization of attachment to that of a continuum from secure to insecure, and eliminate the need for the Strange Situation. With their instrument, the Attachment Q-sort, a child’s ongoing observed behaviors were used to quantify the degree of attachment security. The degree of secure and insecure attachment identified by the Attachment Q-sort has been found to be correlated with the Strange Situation secure and insecure categories (Teti, Nakaqawa, Das, & Wirth, 1991; Van Bakel & Riksen-Walraven, 2004). The Attachment Q-sort is administered to someone who is familiar with the home situation and the mother-child relationship. It consists of 90 cards, each of which contains a description of child behaviors. Behaviors that are characteristic of securely and

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insecurely attached children are included, as well as a small number of distracter cards that describe non-attachment child behaviors. For the recommended observer Q-sort, the assessment requires two observers to make two home visits of 90-120 minutes each, and additional observations are sometimes needed. The card sorting portion of the assessment requires another 45-90 minutes. Cards describing child behaviors are sorted into 9 piles of 10 cards each. The cards are first ordered in the 9 piles by the degree to which behaviors are like or unlike the child. Next the cards within each pile are ordered along the same dimension. These 90 sequenced cards are then compared with those of a prototype of a securely attached infant. A score is given to indicate to what degree the infant’s behaviors match the secure infant prototype. The Attachment Q-sort (Waters & Deane, 1985) was later implemented using mothers as the observers (Tababulsy, Avgoustis, Phillips, Pederson, & Moran, 1997; Teti & McGourty, 1996). Reliability between the observer and mother completed Q-sorts was found to be .55 and .57, although this degree of reliability is not high, a number of authors have used the mother completed Attachment Q-sort to measure attachment security. In this case additional observation time is not needed, but it still takes approximately 45-90 minutes to administer. Scoring is done through a comparison of achieved scores compared to those of a hypothesized optimally securely attached child. Thus time involvement in both administration and scoring make the Attachment Q-sort difficult to implement on a routine basis in early intervention or clinical settings. Considering the evidence regarding the importance of secure mother-child attachment, researchers and practitioners have developed a number of attachment

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intervention programs for use in early intervention, infant mental health and at-risk programs throughout the country (e.g. Arhin, 2006; Bialy, 2006; Klopfer, 2009; Svanberg, 2009). There is growing evidence that attachment-based interventions can significantly enhance the quality of the parent child relationship and the security of attachment in at-risk populations (Berlin, Ziv, Amaya-Jackson, & Greenberg, 2005; Heinicke, Rineman, Ponce, & Guthrie, 2008; Lieberman & Van Horn, 2007; Marvin, Cooper, Hoffman, & Powell, 2002; Oppenheim & Goldsmith, 2007). Some of these intervention programs use either the Strange Situation or the Attachment Q-sort to assess attachment security, but in the interest of the best use of time, many interventions are conducted without the assessment of attachment security, or by inferring the security or insecurity of attachment through the results of other measures (Murphy, 2010). A number of instruments have been developed in an attempt to measure mother-child attachment quickly and effectively. Besides the Strange Situation and the Attachment Q-sort, there are currently seven other measures which are purported to specifically measure attachment security between mothers and infants. These measures are: the California Attachment Procedure (Clarke-Stewart, Goossens, & Allhusen, 2001), the Maternal Postnatal Attachment Scale (Condon & Corkindale, 1998), the Mother-Infant-Toddler- Attachment System (MITAS; Egblomasse, 1999), the Child Attachment Questionnaire (CAQ; Huggar, 1999), the Differential Social Reaction Procedure (Klein, Suwalsky, McCarthy, & Gist, 1982), the Maternal Attachment Inventory (Muller, 1994), and the Attachment Q-Sort Questionnaire (AQSQ; Robinson, 1995). None of these measures have been used extensively and psychometric information is limited.

Full document contains 115 pages
Abstract: Secure mother-child attachment has been found to be an important factor in the healthy emotional development of children and has been shown to have effects on child, adolescent, and adult behavior. Previous research has primarily focused on attachment in children who are typically developing. However, little research has been conducted in populations of children with developmental delays. The research thus far has suggested that medical situations, child disabilities and maternal emotions may affect interaction patterns between the mother and the child which may in turn influence the security of the mother-child attachment in children with developmental delays. This study contributes to the literature now available. Seventy-four mothers of 1½- to 2-year-old children in an early intervention program completed a series of questionnaires. Two previously developed pencil-paper measures of attachment behaviors were selected for use in the study due to ease of administration and replication and the need for generalization of measures for use in early intervention programs. The Child Attachment Questionnaire (CAQ) and the Attachment Q-Sort Questionnaire (AQSQ) were completed along with measures of parent stress (Parent Stress Index; PSI), maternal psychological problems (Outcomes Questionnaire-45; OQ), socially desirable responses (Marlowe-Crowne Social Desirability Scale; MC), child temperament (Dimensions of Temperament-Revised; DOTS-R), child behavior problems (Child Behavior Checklist-1½-5; CBCL), and a demographic questionnaire. Compared to numbers published in the literature for typically developing children, the CAQ indicated similar percentages of children with developmental delays fell into secure and insecure categories of attachment while the AQSQ indicated a slightly lower degree of secure attachment for this sample. While parenting stress did predict lower attachment security in this study, social desirable responses were not significantly related to attachment. Maternal psychological problems weakly predicted a higher degree of security. For child factors, gender was not related to attachment and a higher degree of difficulty of temperament predicted lower attachment security. Both paper-pencil measures of attachment were statistically found to be stable over one year's time. As hypothesized, secure attachment was inversely related to behavior problems one year later. Conclusions and clinical implications of these findings are provided and may assist psychologists and early intervention programs in identifying attachment problems and treating with children with developmental delays.