What is linked to consistency in caregivers responses to childrens behavioral cues

Parental Warmth and Sensitivity

The first dimension of parental engagement clusters around warm and sensitive responsiveness to the child's needs and cues. It includes all those behaviors variously described in the child development literature as loving nurturance, warmth and sensitivity, responsive contingency to children's cues, and emotional availability toward the child. Beginning in the neonatal period, parental responsiveness can be seen in adults imitating and highlighting infant behavior, pausing to give the infant an opportunity to respond, respecting the infant's needs for an occasional break from communication, responding enthusiastically and appropriately to the infant's interests, following the infant's attentional focus, and letting the infant initiate interactions. As children grow older, parental warmth and empathy have been identified as global qualities that lead children to interact more smoothly with their parents and to form a strong identification with parental values that extends outside the home to cooperation with other adults and peers as well.

Children's very survival and development depend on parental warmth and sensitivity because children are inherently relationship-seeking beings. From the beginning of life, children seek to engage and interact with the people around them. When comfortable and fed, they direct their attention and interest outward toward others who seem friendly, exciting, or loving. They reach out to get responses from these people and to send them signals of distress or pleasure as they try to help manage the pace, flow, and intensity of interaction. They actively strive to participate in the life around them. Without intimate, nurturing responses from others, children become too upset and exhausted to accept food and comfort. They cannot make sense of sensory stimulation and understand the world, connect to it, or care about it. Warm and sensitive parents create the framework for this vital interaction in the process of meeting their infant's basic needs.

Ample evidence exists that this first dimension of loving care is positively related to the all-critical development of the child's first attachments and close, secure relationships with a few significant others. Warm and sensitive caregiving that includes encouragement and support, lays the foundation for secure behavior and exploration such as through extended play episodes and pretend play (Ainsworth et al., 1972). Much of the evidence emanates from research conducted within the attachment paradigm. Securely attached children tend to engage in more spontaneous reading activities and perform better on emergent literacy measures than insecurely attached children. In preschool, observers describe securely attached children as more curious, self-directed, sensitive to others' needs, and eager to learn than children who were insecurely attached as infants. Children with less-secure relationships with their caregivers tend to have lower levels of behavioral and emotional control, less adaptive levels of autonomy, and to experience difficulties approaching learning tasks (e.g., Sroufe, 1983).

Parental interactions that include displays of affection, physical proximity, contingent positive reinforcement, and sensitivity have repeatedly related to children's cognitive growth over time. Specifically, research has identified that positive, early relationships between children and caregivers contribute to neural connections that facilitate children's long-term developmental success (National Scientific Council on the Developing Child, 2004). Children in more highly connected parent–child relationships tend to display more positive socioemotional outcomes, such as stronger prosocial orientations, more numerous and higher-quality friendships, and higher levels of peer acceptance in kindergarten (Clark and Ladd, 2000). Through connected interaction with parents, children appear to develop an empathic socioemotional orientation that serves as a foundation for interpreting social situations and responding more prosocially to age-mates and teachers.

Clearly, young children benefit in the short and long term from nurturant caregiving that is emotionally warm, available, and responsive. Yet, there are many styles in which this caregiving can be delivered. Nurturance can be demonstrated in many ways all of which seem to promote infant health and well-being. No single cultural group or set of parents uses all of the available techniques, but instead each selects out some of them to make the customary approach. Parents and communities often use styles that emphasize either a physical, social, or cognitive style of expressing warmth and sensitivity. For example, certain kinds of parents may emphasize a physical style of nurturance, for example, focusing on the child's desires for food, holding, and responsive touch (by day or night) (Edwards and Whiting, 2004; Whiting, 1994; Whiting and Whiting, 1975). Through provision of food, holding, and other primary care oriented to the child's survival, these parents communicate to their children that they love them and are devoted to them. Through gentle touch, physical games, or use of massage, they communicate their nurturing feelings and tell their child that they wish her to feel ease and comfort throughout her body. In contrast, other kinds of parents may take greatest pleasure in a social style of nurturing by singing to the child, grooming their child's hair, dressing the child up, taking her on visits, and teaching her social words and gestures. Indeed, in many cultures, adults take great delight in the social forms of nurturance and communicate their affection through beautifying their child and teaching the child the rudiments of good manners. Finally, a third kind of parents may emphasize a cognitive style of expressing warmth and sensitivity by responding to the child's developing interests and preferences, offering them objects to look at and manipulate, and following their eyes to see what they are looking at, in order to label those things and expand on the child's exclamations and words. These parents often are verbal in their interaction with even the youngest children, and they treat their babies as conversational partners and intelligent beings who wonder about how things work and what causes things to happen. Of course, all three styles can be combined.

In today's postindustrial societies, it is the third style, focused on cognitively stimulating interactions, which seems to lead to the optimal outcomes for children's school readiness and academic success. Warm interactions of the mother provide the foundation for compliance and internalized controls in young children; and limit setting and discipline may be less effective in the absence of positive, warm relationships. The expressions of positive affect and emotional availability are also associated with improved short-term cognitive performance and long-term effects of positive academic performance. The emotional, social, and behavioral competence of young children predicts their academic performance in first grade over and above their cognitive skills and family backgrounds, whereas the absence of a secure attachment with a caregiver or multiple caregivers leaves a child at a distinctive disadvantage. Qualities of parental engagement have been linked to a number of adaptive characteristics in preschool children, such as good work habits, frustration tolerance, fewer behavior problems, and better social skills.

2.3 Reciprocity, synchrony, and mutuality

In some parent rating scales, such as the MBRS (Mahoney, 1999), parent–child reciprocity is one of the items used to code sensitive responsiveness, because responsiveness and reciprocity load on the same factor. Yet, perhaps because reciprocity is not a criterion for the Ainsworth sensitivity scale, a number of investigators have attempted to examine the effects of reciprocity on child development independently of measures of sensitive responsiveness or contingency.

For example, Poehlmann and Fiese (2001) examined how interactional reciprocity and maternal affect mediate the relationship between children's risk status associated with preterm birth and cognitive development. The sample included 44 full-term children, 20 low birthweight children, and 20 very low birthweight children and their mothers. Results from regression analyses indicated that neonatal risk status was significantly associated with children's cognitive development at 12 months of age (β = −0.23*). However, when interactional reciprocity and parental affect were added to the analysis, results indicated that reciprocity/affect mediated the relationship between children's risk status and cognitive functioning. When the effects of children's risk status were controlled, mother–child reciprocity was the only variable that accounted for differences in children's cognitive functioning (β = −0.23*).

Beckwith and Rodning (1996) reported a longitudinal study of 51 preterm and low SES children from the time children were 13–60 months of age, which highlighted the influence of parent–child reciprocity as versus other parameters of mothers’ interactive style. Global ratings were used to assess maternal affect and sensitivity as well as dyadic verbal reciprocity when children were 13 and 20 months old. Regression analyses were conducted to assess the relationship of parenting style to children's communication at 36 months of age and to children's cognition and social problem solving at 5 years of age. Results indicated that of the three parenting measures that were assessed when children were 13 months of age, only dyadic reciprocity was significantly associated with children's expressive (β = 0.47**) and receptive language (β = 0.39**) at 3 years of age. Similarly, dyadic verbal reciprocity at 20 months of age was the only parenting measure associated with children's social problem solving at 5 years of age (β = 0.49**). In general, these results suggest that parent–child reciprocity and responsiveness are correlated with each other, but that reciprocity may be a better predictor of children's development or social emotional problems.

2.1 Video-feedback intervention to promote positive parenting-sensitive discipline

Video-feedback Intervention to Promote Positive Parenting-Sensitive Discipline (VIPP-SD: Juffer et al., 2017) incorporates attachment theory's approach to the importance of sensitive responsiveness with coercion theory's focus on the importance of setting consistent limits (Patterson, 1982). VIPP-SD is implemented through seven home visitation sessions that focus on enhancing parental empathy and sensitive discipline for parents of young children. Following an initial session, the home visitor meets with the family once or twice a month for 2 h to present and discuss video clips of the parent and child from previous sessions that highlight parental sensitivity and sensitive discipline. Efficacy for VIPP-SD comes from 12 randomized clinical trials. Meta-analytic evidence across these studies demonstrates that VIPP-SD is efficacious in enhancing attachment security, reducing attachment disorganization, and reducing child behavior problems (Juffer et al., 2017).

Summary

The purpose of this chapter was to review briefly theory and research on what makes some people more secure in their attachment patterns than others. We highlighted some of the classic work that has examined the role of sensitive responsiveness as an antecedent to infant attachment patterns. We also reviewed some of the processes that may lead early attachment patterns to be sustained across time. However, we also emphasized the fact that attachment theory is not only a theory of selection, but a theory of socialization and, as such, attachment representations should be open to change over time. The consequence of this emphasis is that continuity in attachment should be considered an empirical issue rather than a strong assumption of the theory per se. Having said that, we should note that there is evidence of weak stability from infancy to adulthood (Fraley, 2002; Pinquart et al., 2013). And, as expected on the basis of canalization principles, there is evidence of higher levels of stability in adulthood than childhood. We believe that some promising research directions include examining canalization processes in more detail and exploring the implications of the hierarchical model of attachment for how we understand the dynamics of stability and change.

There were many issues we did not have space to discuss. For one, we know that individual differences in adult attachment styles are multidetermined. In other words, what makes someone secure is not simply a matter of what his or her early experiences were like with caregivers. There is a growing body of work suggesting that working models are sensitive to ongoing experiences and that the cumulative history—not just the origins—of a person’s interpersonal experiences is important for understanding who they become (Fraley, Roisman, Booth-LaForce, Owen, & Holland, 2013). We believe that there is still a lot of work that remains to be done at the interface of personality development and attachment theory.

Core Intervention Modalities for Children Exposed to Trauma

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Guided parent-child interaction

Utilizes play, physical contact, and language to encourage health exploration, manage overwhelming affect, clarify feelings, and correct misperceptions and distortions. The facilitator promotes the parent’s sensitive responsiveness to the child’s signals, safe and supportive physical contact, age-appropriate playful interactions, age-appropriate use of language to explain real situations and express feelings appropriately “using their words”.

Unstructured developmental guidance

An intervention modality that provides the parent with age-appropriate information about the child’s feelings and needs as they come up during the course of the therapy sessions.

Modeling appropriate protective behavior

A modality which involves taking action to intervene and stop the escalation of dangerous behavior, self-endangering behavior or intervening to prevent a child from harming another child. The focus is on the mutual reflection of care between a parent and child and the importance of being safe from danger.

Affective interpretation

A modified psychoanalytic technique which emphasizes linking the parent’s affective responses to life experiences coupled with current parenting practices.

Emotional support and empathic communication

Supportive and empathic interventions utilized through both words and actions the belief of accomplishing treatment goals which may seem overwhelming and out of reach. Emphasizing and reinforcing the satisfaction experienced in achieving personal goals and in meeting developmental milestones, reinforcing the use of effective coping strategies (and the reinforcing aspect of success) and giving feedback about progress.

Concrete assistance dealing with daily problems

A modality serving to take appropriate action to prevent or resolve the consequences associated with family crisis/stressful circumstances. Additionally, obtaining assistance of necessary resources and services that enhance and improve the family’s quality of life.

DeGangi (2000) promotes a family-centered approach that addresses parental concerns and offers parent guidance along with the use of child-centered activities. Dr DeGangi’s work with regulatory disordered young children and their families offers first hand experience associated with her years of work in the field. The family is recognized as a constant in the child’s life versus professionals who provide services being a potentially fluctuating factor. Additionally, there is full acknowledgement and use of the aspects of the dyadic relationship:

Behavioral quality of the interaction

Affective tone

Psychological involvement

The dyadic relationship is critical to development and adjustment. Therefore, the mother should be referred to a mental health provider/psychiatrist as well if (she):

Lacks empathy, makes hostile comments, or attributes persecutory intent to her baby

There is a lack of bonding or other mother–baby relationship problem

Is unable to follow advice

Feels persistently angry, or continues to report anxiety or depression symptoms even when any baby or child problem is improved.

*The father’s role is an invaluable source of practical and emotional support in the family-centered approach. The role of the father is often neglected, and they need to be actively engaged in all aspects of assessment and intervention (including appointments). Fathers are often concerned about how their partner is coping and is interested in being educated and developing their own tools to help their family. However, if a father presents as emotionally distant or other psychological/emotional problems are evident, he should be referred to treatment. If the marriage/union is unstable or there are concerns of domestic violence or severe/chronic acrimony, the couple should be referred for an evaluation and treatment if identified as necessary.

When an intervening professional hears from a mother that she cannot stand another minute of listening to her baby crying because it is driving her crazy, it is a direct indication of the significant impact an irritable child can have upon a caregiver and may reflect their own cry for help. Interestingly, most people who hear of this type of scenario are filled with the concerns of the “emotional” state of the caregiver. Although there are numerous reasons to be concerned about how the caregiver is responding warranting support/intervention, what is central to the case is the underlying emotional experience of the child. While the entire family system may be assessed for determining adequate support and intervention, it is the understanding of the internal experience of the infant/child that needs to be a clinical focus. If intervention ensues without a working hypothesis with associated understanding of what the infant/child is emotionally experiencing, the goal of soothing, reinforcing adjustment and resilience, and the longer term goal of maximal benefit will be fraught with missed opportunities.

Greenspan (1998, 2002; Casenhiser et al, 2007), an icon in the field of child development and intervention, felt it was crucial to conceptualize the child’s emotional and developmental needs and translate the identified needs into treatment. This translation is accomplished by answering questions like:

Is the child engaged or not engaged, in what situations does this occur, and how do they engage or disengage?

How does the child communicate, gesturally, by affective expressions, words?

Does the child organize affective experiences symbolically?

By observing the child along dimensions of engagement, intentional behavioral patterns, and representational elaboration, how are their difficulties conceptualized?

Cohen et al (2005) offer an integrative continuum to improve early childhood social and emotional development as well as behavioral concerns which includes:

Promotion

Services designed to maintain social emotional well-being

Might include public/direct family education to increase awareness of factors which increase risk and how to minimize or alleviate risk, home visits, family support programs (educate primary caregivers on development, healthy relationships, environment and experiences)

Prevention

Focus on children at risk of poor developmental outcomes

Early identification and intervention strategies that decrease the risk of social and emotional development associated with mental health problems

Carried out via screenings provided through child-care setting, pediatrician office, home visit, comprehensive child development programs/child abuse programs (may address exposure to environmental toxins such as lead/mercury, quality of care of child, addressing domestic violence, etc.)

Treatment

Targets and develops individualized treatment for young children and their families currently exhibiting symptoms of mental health problems

Generally comprised of a skilled multidisciplinary team offering different points of intervention (therapeutic day care, child–parent psychotherapy, parent education, child occupational therapy, speech therapy, etc.)

How do early attachment experiences shape attachment patterns in infancy and early childhood?

One of the important goals of research on early attachment experiences is to uncover the antecedents of attachment security (see Belsky & Fearon, 2008, for a review). In Ainsworth’s early research, for example, she observed that children who were more confident in exploring the environment had parents who were more supportive and available than children who were less confident in exploring the environment (Ainsworth, 1967). Ainsworth, Blehar, Waters, and Wall, (1978) studied this issue systematically in a sample of parents and children in Baltimore, Maryland. Specifically, they studied approximately 23 infant–mother pairs in their homes. The investigators made notes of how the children behaved, how the mother responded to the child’s signals, etc. When the infants were 12 months of age, they were brought to the laboratory to participate in the strange situation procedure as a way of assessing their attachment organization (see chapter: What Is Attachment Theory?).

Children who were classified as secure at 12 months of age were more likely, than those who were not, to have had caregivers who were sensitively responsive to their child’s needs in the year prior to the strange situation. Conversely, children who were classified as insecure were more likely to have mothers who were neglectful or inconsistently responsive to their children’s needs. This observational research provided some of the first evidence that variations in the early caregiving environment are associated with the ways in which a child’s attachment behavior becomes organized in the first year of life.

After the publication of Ainsworth’s ground-breaking studies, a number of research teams began investigating factors that may determine whether children develop secure or insecure relationships with their primary attachment figures. One of the key predictors of the attachment patterns children develop is the history of sensitive and responsive interactions between the caregiver and the child (DeWolff & van IJzendoorn, 1997). Sensitive responsiveness is typically defined as the extent to which a parent is in-tune with a child’s emotional state, is able to decode those signals accurately, and able to respond appropriately and in a timely fashion (Ainsworth et al., 1978). When the child is uncertain or stressed, a sensitively responsive caregiver is one who correctly notes the child’s distress and is able to provide the child with comfort or the assistance that is needed. Ainsworth and colleagues believed that the ability of the caregiver to be sensitively responsive to the child is critical for the child’s psychological development. Such supportive interactions help the child learn to regulate his or her emotions, give the child the confidence to explore the environment, and provide the child with a safe haven during stressful circumstances.

Evidence for the role of sensitive and responsive caregiving in shaping attachment patterns comes from both longitudinal and experimental studies. For example, Grossmann, Grossmann, Spanger, Suess, and Unzner (1985) studied parent–child interactions in the homes of 54 families, up to 3 times during the first year of the child’s life. At 12 months of age, infants and their mothers participated in the strange situation. Grossmann and colleagues found that children who were classified as secure in the strange situation at 12 months of age were more likely than children classified as insecure to have mothers who provided sensitive and responsive care to their children in the home environment.

van den Boom (1990, 1994) developed an intervention that was designed to enhance maternal sensitive responsiveness. van den Boom identified a sample of babies who showed signs of irritability on a newborn behavioral assessment scale. She then randomly assigned half of those babies to an experimental group and the other half to a control group. Mothers in the intervention group were given individualized sessions on sensitive responsiveness—sessions that involved watching video-taped interactions between the mother and her child with coaching and discussion. The control group received no training. When the infants were 9 months of age, the mothers in the intervention group were rated as more responsive and attentive in their interaction with their infants. In addition, their infants were rated as more sociable, self-soothing, and more likely to explore the environment. At 12 months of age children in the intervention group were more likely to be classified as secure than insecure (anxious or avoidant) in the strange situation compared with the control group (see Bakermans-Kranenburg, van IJzendoorn, & Juffer, 2003; van IJzendoorn, Juffer, & Duyvesteyn, 1995, for an in-depth discussion of intervention research).

It is important to note that sensitive responsiveness is embedded in a network of contextual factors (eg, Cowan, 1997). That is, there are a number of factors that can facilitate or impair a parent’s ability to provide sensitive and responsive care to a child. If a mother, for example, is experiencing depression, she may not have the psychological resources available to be attentive to her child’s needs. Indeed, research shows that the children of parents who experience depressive episodes are more likely to be classified as insecure in the strange situation (Cummings & Davies, 1994; Teti, Gelfand, Messinger, & Isabella, 1995). Likewise, parents who are struggling financially are likely to experience stress. They are also likely to work multiple jobs in an effort to make ends meet, which is likely to add further stress. This stress may carry over into parenting, making it more difficult for the parent to provide a secure base and safe haven for the child. Indeed, research typically finds that the rates of insecure attachment are higher in economically disadvantaged families (eg, Belsky, 1996; Belsky & Isabella, 1998; Scher & Mayseless, 2000). In short, although attachment theorists tend to emphasize the role of sensitive, responsive caregiving in shaping the development of children’s attachment patterns, there are many factors that have the potential to influence caregiving quality. Sensitive responsiveness is not viewed as the sole predictor of attachment security; it is regarded as an organizing variable: one that can reflect a broad array of social-cultural and biological influences (eg, Pickles et al., 2013).

1.1 Historical, Cultural, and Biological Context

Attachment is not an invention of modern times; attachment behavior is not restricted to modern, industrialized countries and cultures, and it is not an exclusively human characteristic. About 3,000 years ago, Homer had already described an example of infant attachment behavior to mother, father, and professional caregiver. In the famous Iliad, the Trojan hero Hector returns from the battlefield to his family, smeared with mud and blood of the previous fights. Achilles is waiting for him to revenge earlier assaults on the Greek warriors, and he will defeat Hector in an atrocious fight. Hector wants to spend the remaining time with his wife, Andromache and his son, Skamander who is in the arms of his ‘nanny.’ Hector scares Skamander with his imposing helmet and with the traces of the earlier battle. In response to the reunion with Hector, Skamander seeks close physical contact with his nanny because he does not recognize his father. Hector notices the signs of fear that his son displays, takes off his helmet, and starts to play. His sensitive interactions stimulate Skamander to smile and play with his father; Andromache looks at this peaceful and moving scene in tears as she foresees the death of her husband in the fight with Achilles. After a while Hector carries his child to Andromache who cuddles him, and takes leave. Mother and son will never meet with their husband and father again.

The empirical study of attachment did not start in a Western culture. In fact, Ainsworth's first investigation of attachment was conducted in Uganda, a former British protectorate in East Africa. Here, she discovered the now-famous tripartite classification of insecure-avoidant, secure, and insecure-ambivalent attachment relationships (see later). It was in this African culture that she also studied, for the first time, the antecedents of attachment, in particular parental sensitive responsiveness. After this path-finding field-study of attachment, the development of attachment between parents and infants in several other African cultures has been studied, for example in the Gusii, the Dogon, the Hausa, the Efe, and the !Kung San. Furthermore, cross-cultural attachment research has been carried out in China, Japan, and Indonesia, and in the unique setting of the Israeli kibbutzim. In these diverging cultures attachments seem to emerge inevitably between helpless offspring and protective parents, similar patterns of associations between antecedents and sequelae of attachment security seem to arise, and similar perceptions of the value of a secure attachment relationship for the individual, the family, and for society seem to be prevalent. Cultural diversity in the expression of attachment is, however, acknowledged. In the Gusii culture, for example, infants are accustomed to being greeted by their returning mothers with a handshake instead of a hug, and accepting or refusing the handshake can be considered indications for the security of the attachment relationship in the Gusii dyad. The patterning of attachment behaviors is independent of the specific attachment behaviors that express the children's emotions, and these patterns of attachment have been found in all cultures studied thus far. Attachment, therefore, appears to be a universal phenomenon, and attachment theory claims universal validity (Van IJzendoorn and Sagi 1999, see also Cultural Variations in Interpersonal Relationships).

Attachment has been observed in many species, and John Bowlby drew heavily on the results of ethological investigations of attachment in nonhuman primates for the construction of attachment theory. Harlow's experiments with rhesus monkey infants showed that the development of attachments is not dependent on the provision of food and, thus, the result of reinforcement schedules, but seemed to be ‘instinctive’ behavior directed at objects providing warmth and protection. Field studies of rhesus monkeys showed that in the first few months after birth the infants develop enduring and unique bonds with the mother who protects the infants against predators and other environmental dangers. Rhesus monkey infants use their mother figure as a secure base to explore the environment, and to regulate their negative emotions and stresses. This role of a secure base is fulfilled uniquely by the mother and not by other members of the group or even by relatives. Bowlby derived from these ethological findings the idea that human infants were born with an innate bias to become attached to a protective adult because the affective bond would have evolutionary advantages (see also Psychological Development: Ethological and Evolutionary Approaches). Infants may differ in the expressions of their attachment ‘needs,’ and the patterns of their attachment behavior may diverge, but, basically, every representative of the human species would show attachment behaviors. In his later work he introduced the concept of ‘inclusive fitness’ into attachment theory to take into account the parental side of the first attachment relationship. It should be noted that nonhuman primates differ widely in the emergence and display of attachment relationships between infants and mothers. For example, capuchin monkey infants do not only rely on their mothers, but also on their peers and relatives for contact comfort and protection, and their bond with the mother seems much weaker than in the case of the rhesus monkey infants. The evolution of attachment theory might have been completely different if, in the 1950s and 1960s, ethologists had studied the social relationships of capuchin instead of rhesus monkey infants (Suomi 1999).

B Modeling Enduring Effects Versus Revisionist Processes in the NICHD SECCYD

Crucially, the Fearon et al. (2010) and Groh et al. (in press) meta-analyses are also limited by their focus on attachment insecurity as a proxy for early interpersonal experience. Although substantial evidence suggests that infant attachment security reflects, in part, a caregiver's sensitive-responsiveness to the infant across the first year of life (De Wolff & van IJzendoorn, 1997), it is of course unwise to reach broad conclusions about the nature of early interpersonal experience solely based on the security or insecurity of a given attachment relationship at a particular point in development. Moreover, the quality of early interpersonal experiences can only be inferred when attachment security is considered as a proxy for early caregiving experiences; early parental caregiving and attachment security are neither conceptually nor operationally isomorphic.

For these reasons, together with JD Haltigan, we leveraged some of the insights from the simulation work previously reported in this chapter to explore the predictive significance of maternal sensitivity—a broadband assessment of early interpersonal experiences with primary caregivers typically assessed by examining how well caregivers scaffold the success of their children in the context of tasks designed to be just beyond the children's developmental capabilities (i.e., at the zone of proximal development). Given, as noted earlier, that the Enduring Effects and Revisionist models make different predictions about the pattern of associations that should be observed over time, it is possible to test them (and, hence, the enduring effects of early experiences) by estimating the parameters of these models and comparing their relative fit to data. The Revisionist model is nested within the Enduring Effects model, thereby enabling the two models to be compared in a direct fashion. To illustrate this approach, we have drawn on data from the NICHD SECCYD (NICHD ECCRN, 2005). This study is particularly well suited for examining questions related to the enduring significance of early caregiving experiences in the normative range because it is a long-term, prospective longitudinal study of over 1000 children tracked from infancy through the cusp of adulthood that includes extensive data on the observed quality of early and later interpersonal experiences as well as multi-method, multi-informant outcome measures of child adaptation.

As noted earlier, in our publications based on the SECCYD (see Fraley et al., in press; Haltigan et al., in press), we have concentrated on an operational definition of early experiences central to many theoretical accounts of developmental adaptation—maternal sensitivity. In addition, we have examined the consequences of the quality of participants' early interpersonal experiences in three domains central to developmental adaptation over time: (a) academic skills, (b) social competence, and (c) symptoms of psychopathology. For each domain, we focused on outcome data from two different informants using similar or identical methods across time from early in the life course through age 15. Although the core of our analyses examined the key distinction between revisionist and enduring effects processes in the way illustrated earlier, we also elaborated upon those basic models by examining a number of other processes that could potentially account for the long-term effects of sensitivity, including potential confounds (i.e., factors, such as maternal education, that correlate with maternal sensitivity and child outcomes), the ongoing stability and concurrent effects of maternal sensitivity, and transactional processes that sustain continuity in the outcomes themselves.

We began, however, by simply examining the predictive significance curves generated by plotting correlations between an early sensitive caregiving composite (assessed using observations of maternal caregiving in semistructured tasks when the participants were aged 6, 15, 24, and 36 months) and adaptation within the key outcome domains mentioned previously by method and/or informant. Predictive significance curves for academic skills (assessed by teachers using the academic skills subscale of the Social Skills Rating System and by objective testing using the mean of select subscales from Woodcock Johnson-Revised; Woodcock, 1990; Woodcock & Johnson, 1989), social competence (assessed by teachers and mothers using the Social Skills Rating System; Gresham & Elliott, 1990), externalizing problems (assessed by teachers using the Teacher Report Form [TRF] and by mothers using the Child Behavior Checklist [CBCL]; Achenbach, 1991; Achenbach & Edelbrock, 1986), and internalizing symptomatology (again, assessed by teachers using the TRF and by mothers using the CBCL) are reported in Figures 4–7, respectively. (Note that in Haltigan et al., in press, we did not present data separately for internalizing versus externalizing due to space constraints and because these constructs are moderately correlated. We instead reported analyses focused on total symptomatology assessed by teachers and parents separately over time.).

Several patterns captured in Figures 4–7 are of note. First, there was clear evidence across these most basic analyses that the total association between early maternal sensitivity and these dependent measures varied in an absolute sense as a function of the outcome. Somewhat to our surprise (but consistent with other studies of observations of maternal sensitivity; Jaffari-Bimmel, Juffer, van IJzendoorn, Bakermans-Kranenburg, & Mooijaart, 2006), these associations were largest for assessments of academic skills (r ≅ 0.32 for teacher reports and r ≅ 0.44 for standardized tests), next largest for social competence (r ≅ 0.27 for teacher reports and r ≅ 0.31 for mother reports), weaker still for externalizing problems (r ≅ − 0.27 for teacher reports and r ≅ − 0.18 for mother reports), and weakest for internalizing symptomatology (r ≅ − 0.13 for teacher reports, r ≅ − 0.09 for mother reports). Overall, these data suggest enduring effects for most of the outcomes we examined—the two key exceptions being mother reports of externalizing and internalizing symptoms.

We followed up on these basic analyses by fitting these data (outcome set by outcome set) to the model described in Figure 2. In all cases except for the mother reports of symptoms of psychopathology reported on the CBCL, models in which the b paths noted in Figure 2 were constrained to zero (i.e., the pure Revisionist model) fit the data significantly poorer than the ones in which b paths were either allowed to vary freely or estimated but constrained to be equal (across outcome measures, the absolute size of the b paths, when constrained to be equal, was approximately 0.10, suggesting revisionist mechanisms could not fully account for the predictive significance of early maternal sensitivity; see Fraley et al., in press; Haltigan et al., in press, for details). One important caveat, however, is that none of these basic models achieved highly favorable fit in the absolute sense. More specifically, in these most basic analyses, RMSEA, CFI, and SRMR fit indices values exceeded the range that is typically taken to suggest adequate fit (0.05–0.08 for RMSEA, Browne & Cudeck, 1993; values > 0.90 for CFI, Hu & Bentler, 1999; and SRMR values less than 0.10, Kline, 2005). As such, we sought to modify the models in several theoretically driven ways.

The simplest modifications of our basic models involved the addition of covariates. We have done this in two distinct ways in our work, either by residualizing from maternal sensitivity potential confounders (Haltigan et al., in press) or by building a select set of potential confounders, such as maternal education and family income-to-needs, into our models as exogenous variables (Fraley et al., in press). Neither of the modifications of the model made the basic findings reported above go away. However, they also did not tend to improve model fit in the absolute sense either.

As noted previously, some scholars (e.g., Lamb et al., 1984; Lewis, 1997) have argued that, to the degree to which investigators find correlations between early experiences, such as maternal sensitivity, and later outcomes, one potential explanation for those associations is the stability of maternal experiences over time. According to this view, initially articulated by Lamb et al. (1984), there is no unique effect of early experience on later outcomes per se, but such associations may appear to persist because maternal sensitivity itself is relatively stable and can have ongoing, concurrent influences on the outcomes of interest. To model this possibility, we included measures of maternal sensitivity across different ages, focusing on the subset of assessments for which the NICHD SECCYD had concurrent measures for both maternal sensitivity and the outcome of interest. Moreover, in such models we assumed that maternal sensitivity at each age had an influence on the outcome of interest, also assessed at that same age. Once again, the basic findings were preserved and absolute fit of the models remained less than ideal.

Finally, to determine whether transactional (Sameroff & MacKenzie, 2003) processes could potentially account for long-term effects of early sensitivity on developmental outcomes, we modeled second order stability paths between outcome assessments (e.g., grade 1 → grade 3, grade 2 → grade 4, etc.). This modification was designed to approximate processes (e.g., transactional dynamics) that allow variation in social competence at grade 1, for example, to carry forward to grade 3 in ways that are not directly attributable to the path from grade 2 or from the enduring effects of early experience. This modification of the base model also did not affect the results reported earlier, but absolute fits of the model were in the acceptable range, suggesting that enduring effects of early sensitivity may well coexist with transactional processes that help sustain continuity in developmental domains (see Fraley & Roberts, 2005).

4.1 Levels of analysis in the study of perinatal maternal anxiety and neural correlates of processing infant cues

As discussed, maternal sensitive responsiveness can be conceptualized as the output of a series of processes (Fig. 1). Analyzing maternal anxiety in the context of these processes can provide insight into how, and in what stages, maternal anxiety (and psychopathology more generally) may impair adaptive parenting behaviors. This conceptual framework resonates with social-cognitive neuroscience perspectives (e.g., Marr, 1982; Ochsner and Gross, 2008), wherein multiple levels of analysis—behavioral, cognitive, and neural— can be employed to understand human behavior. Social-cognitive neuroscience largely focuses on drawing connections between levels of analysis by using them to inform or constrain one another, or to contrast competing theories (Krakauer et al., 2017; Turner et al., 2017). This perspective is highly useful in gaining insights into the modulating effects of psychopathology, especially in developmental contexts (Cicchetti and Posner, 2005). In conceptualizing early maternal caregiving, these three levels of analysis correspond to connections between maternal behavior during mother-infant interactions, cognitive and affective processing of infant cues, and their neural instantiations.

Echoing general trends in cognitive neuroscience (Krakauer et al., 2017; Niv, 2021), the bulk of research on maternal anxiety and the neural correlates of processing infant cues has overlooked links between maternal brain and maternal behavior and cognition. To the authors’ knowledge, only one study has related neural data and observed maternal behavior in the context of maternal anxiety (Guo et al., 2018). Illuminating questions are therefore left unanswered—such as whether neural responses elicited by infant cues mediate the relations between maternal anxiety and compromised sensitive responsiveness. Considering the importance of temporal dynamics in maternal processing of infant cues and behavioral responsivity to these cues, future studies should especially focus on aspects of parenting that depend on timely and appropriate understanding of, and responsiveness to, infant cues, such as mind-mindedness (Meins, 2013), sensitivity (Ainsworth et al., 1974), contingency (Beebe et al., 2010), non-intrusiveness (Biringen et al., 2014), and affect synchrony (Feldman, 2012).

Further, only a handful of studies have incorporated cognitive or affective measures in their examination of maternal anxiety (Kim et al., 2015; Roos et al., 2011). Because different levels of analysis tap into different information, leaving out any level would limit the field’s understanding of maternal caregiving (c.f. Cacioppo et al., 2010) and increase susceptibility to reliance on reverse inference in interpreting studies’ results (Krakauer et al., 2017; Poldrack, 2006). While neuroimaging provides information that cognitive-behavioral measures may miss, measures tapping into cognitive and affective processes can shed light on the mechanisms connecting neural processing and behavior. For example, to bolster interpretations that increased prefrontal reactivity among anxious mothers reflects the selection of self-regulation strategies (Noriuchi et al., 2008; Roos et al., 2011), it would be necessary to incorporate additional validating measures, such as emotion regulation choices (Shafir et al., 2016).

Considering the robust association between LPP response to neutral infant (and child) cues and maternal anxiety (Kungl et al., 2020; Malak et al., 2015; Rutherford et al., 2017), further investigation of this link through multiple levels of analysis constitutes a particularly promising future direction. Cognitive-behavioral measures of negative interpretation bias can be incorporated to test the hypothesis that the LPP elicited by neutral cues marks a tendency to interpret neutral cues as more negative in maternal anxiety. This negativity bias may manifest in the perinatal period in frequent misinterpretation of neutral infant expressions as if they convey distress states; at the level of maternal behavior, an increased saliency of distress in the dyad would likely elicit inadequate responses to the infant, noncontingent to the signals the baby is displaying. The infant’s reaction, in turn, may be incompatible with the mother’s anticipations, further validating her anxiety and leading to a vicious cycle whereby the dyad is continuously dysregulated. These aspects of mother-infant interactions can be tested by incorporating measures of sensitivity, non-contingency, intrusiveness, and affect synchrony. Over time, the infant may consequently develop hypersensitivity to potentially negative stimuli, manifesting in fearful temperament, and later in behavioral inhibition and child negativity bias (as may be suggested by the association between prenatal maternal anxiety and child LPP; van den Heuvel et al., 2018). As this example illustrates, including multiple levels of analysis within the same (longitudinal) sample can be used to promote more complete mechanistic accounts of the impact of anxiety on maternal sensitivity and mechanisms in the intergenerational transmission of anxiety.

Transmission of attachment: connection of two core hypotheses

A first core hypothesis of attachment theory is the crucial role of parental sensitive responsiveness to infant attachment signals in shaping individual differences in attachment. Parental sensitive responsiveness has been defined as the capacity of caregivers to take notice of the child's attachment signals, to interpret them correctly, and to respond to them promptly and adequately [5]. Correlational as well as experimental studies have documented that more sensitive parents elevate the chance that their child becomes securely attached, meaning that the child strikes a balance between exploration and proximity seeking. The secure child is free to explore the environment and at the same time is ready to seek proximity to the trusted caregiver in times of stress. By contrast, insensitive parents trigger an insecure attachment in their child who remains vigilant and stressed even when the caregiver is nearby [6,7••].

A second core hypothesis of attachment theory is the influence of early attachment experiences on later socioemotional functioning, which may extend to adult attachment and parenting. Attachment relationships with parents and other attachment figures in childhood and thereafter serve as mental models that shape parents’ interactions and attachment relationships with their offspring [8••]. This is the hypothesis of intergenerational transmission of attachment, which states that the current mental representation of childhood attachment experiences, that is, adult attachment, influences their child's attachment relationship with them. Note that the mental representation of attachment need not coincide with actual attachment experiences during childhood — there is a crucial move to the level of representation.