Table 4 - uploaded by Mary Target
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Source publication
This paper introduces a new measure of attachment in middle childhood (8 - 13 years), an interview extensively adapted from the AAI and with a new coding system. We report data from a series of studies with clinical and normal populations, in which the psychometric properties of reliability, stability and validity are tested and found to be satisfa...
Contexts in source publication
Context 1
... children were retested 3 months after the first CAI (Tables 4 and 5) to find out whether their attachment representations were similar on the two occasions. ...
Context 2
... all the children who were coded disorganized on one occasion were coded the same 3 months later. Thirty-three children were retested 1 year after their initial assessment (Tables 4 and 5). Not surprisingly, the stability of the scale scores was moderate across this longer interval, median correlation 0.40. ...
Citations
... Some years later, Stacks and colleagues (2014) replicated this finding in a study of 83 socioeconomically diverse mother-child dyads; maternal PRF and infant attachment were highly correlated (p < .01). Researchers have also examined the link between PRF and child attachment in school age children, using the Child Attachment Interview (CAI; Target et al., 2003). In a sample of 117 dyads in a highrisk community sample, Borelli and colleagues found that child but not self-focused PRF predicted attachment security on the CAI. ...
A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent–child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent–child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.
... Fifth, several measurement issues should be considered when evaluating these findings. For example, this study employed a validated youth self-report measure of attachment security that demonstrates convergent validity with interview measures of attachment (Furman et al., 2002), but interviews are considered the gold standard for assessing attachment representations beyond childhood (Target, Fonagy, & Shmueli-Goetz, 2003). Our measure of caregiver internalizing was limited to symptoms during the past week, which may not have captured caregivers' broader or traitlike internalizing problems. ...
Background
Post-traumatic stress symptoms (PTSS) were the most frequently reported mental health concern for youth during COVID-19, yet variations in youth's PTSS responses warrant empirical consideration. Features of the caregiving environment influence youth's responses to environmental stressors, and youth's parasympathetic nervous system regulation may qualify the magnitude and/or direction of these effects. This prospective investigation evaluated diathesis stress and differential susceptibility models of caregiving and parasympathetic influences on youth's PTSS responses to COVID-19.
Method
Participants were 225 caregiver-youth dyads (youth 49.8% female at birth; 88.4% non-white) followed from childhood through adolescence and COVID-19. Youth's resting respiratory sinus arrhythmia (RSA; M age = 6.11, s.d. = 0.21), caregiving features (i.e. attachment security [youth M age = 12.24, s.d. = 0.35] and caregiver internalizing psychopathology [caregiver M age = 39.29, s.d. = 6.78]) were assessed pre-pandemic. Youth's PTSS was assessed one year prior to the US COVID-19 pandemic ( M age = 14.24, s.d. = 0.50) and during the spring of 2020 at the height of the pandemic ( M age = 15.23, s.d. = 0.57).
Results
Youth's PTSS increased during COVID-19. Youth with relatively high resting RSA evidenced the lowest PTSS when their caregiving environment featured high attachment security or low caregiver internalizing problems, but the highest PTSS when their caregiving environment featured low attachment security or high caregiver internalizing problems. In contrast, PTSS levels of youth with relatively low or average resting RSA did not differ significantly depending on attachment security or caregiver internalizing.
Conclusions
Results are consistent with a differential susceptibility hypothesis, wherein relatively high resting RSA conferred heightened sensitivity to caregiving environments in a for-better-and-for-worse manner during COVID-19.
... The data of this study were collected using the full-length Child Attachment Interview [15]. The CAI is a well-known and effective instrument for measuring mentalization in children between the ages of 7 and 13. ...
... To find the dominant sub-theme in each interview, SES was considered an important variable, because research has shown that socioeconomic status has a significant effect on children's RF [15]. There were also differences in mentalizing profiles between the typically developing children and the clinical population. ...
Mentalization, operationalized as reflective functioning (RF), is the ability to understand one’s own and another’s mental world implicitly or explicitly. RF is a newly discovered research field in Iran and is largely under-studied in Eastern cultures in general, underscoring the high need for cross-cultural studies in this field of research. A qualitative method was used to examine the ability to understand, process, and respond to high-arousal attachment situations in typical and clinical populations of Iranian children recruited from a Tehran primary school. A well-known semi-structured interview commonly used to assess RF in children was used to collect data. Required information on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of children were collected by parents. The results indicated the identification of four different profiles of RF in children, one of which was adaptive, while the other three were maladaptive. Also, the results showed that typically developing children and those having a high social and economic status (SES) were characterized as having a more adaptive profile of RF, while children from the clinical population and those with a low SES reported a more maladaptive profile (passive mentalizing, helpless mentalizing, narcissistic mentalizing) of RF. The present study is an important step in increasing our understanding of the development of mentalization in children and has significant educational and clinical implications.
... While a range of adult RF measures exist, corresponding tools for the youth population require refinement. Among the most frequently employed tools for evaluating adolescents' RF are the Child and Adolescent Reflective Function Scale (CARFS; Ensink et al., 2014), which is derived from the Child Attachment Interview (Target et al., 2003). Nevertheless, the implementation of these interviews necessitates extensive training, time, and resources (Hill et al., 2007). ...
Objective
This study investigated the psychometric properties, including the factor structure, validity, and reliability of the 13-item Reflective Function Questionnaire for Youth (RFQY-13), using a new scoring system.
Method
A community sample of 414 adolescents and a clinical sample of 83 adolescents (aged 12–21) completed the RFQY, the Borderline Personality Features Scale for Children (BPFS-C), the Beck Youth Inventories (BYI), the Child Behavior Checklist-Youth Self Report (CBCL-YSR) and the Movie for the Assessment of Social Cognition (MASC).
Results
Using the new scoring system, our results demonstrated configural and metric invariance, as well as adequate reliability and validity across both samples for the two-factor structure of the RFQY. The Uncertainty subscale also showed strong associations with psychopathology.
Discussion
The findings show that the RFQY-13, when used with the new coding system, has good psychometric properties and is a reliable measure of mentalizing for adolescents and young adults. We discuss clinical implications, limitations and future directions.
... Attachment security beyond toddlerhood is assessed via attachment questionnaires and representational measures, such as attachment interviews and story stem procedures. In interviews, such as the Child Attachment Interview (CAI; Target et al., 2003), participants are asked for evaluations of relationships and/or events as well as actual evidence supporting these evaluations. Assessments of attachment are based on the emotional openness in the description of the attachment relationship, balance of positive/negative references, use of examples, sense of having resolved the conflict, and coherent narrative (Privizzini, 2017). ...
... While the coherence of the reports is an important characteristic of security in attachment interviews, attachment questionnaires (Armsden & Greenberg, 1987) ask for self-categorizations as securely or insecurely attached (Bartolomew & Horowitz, 1991), or sum-up selfratings on feelings of trust, positive communication, and being accepted and supported in a close relationship with an attachment figure (e.g., Armsden & Greenberg, 1987). As some subscales of the CAI measure behaviors that are at least partially independent from specific attachment figures (e.g., expressing and labeling emotions, using examples, overall coherence, Target et al., 2003), associations of security with mothers and fathers may be stronger and mean-level differences may be weaker than in attachment questionnaires where each item addresses experiences with a specific attachment figure. ...
... Attachment was assessed with versions of the Inventory of Parent and Peer Attachment (IPPA; Armsden & Greenberg, 1987; 569 studies), the Security Scale (KSS; Kerns et al., 1996;98 studies), the Child Attachment Interview (CAI; Target et al., 2003; 32 studies), the Parental Attachment Questionnaire (PAQ; Kenny, 1987;22 studies), and related measures (105 studies). Regarding study quality, 93.6% of the studies applied validated attachment measures and 86.7% used community samples rather than clinical or at-risk samples; the median response rate was 75.2%. ...
As mothers and fathers remain important attachment figures beyond infancy and toddlerhood, comparisons of attachment security of older children with their mothers and fathers are relevant for family researchers and practitioners. We analyzed mean-level differences between verbal reports of attachment security with mothers and fathers, and correlations between both attachments. A systematic search in electronic databases identified 826 studies that were included in random-effects meta-analyses. Although security of attachment with fathers was, on average, lower than security of attachment with mothers, mean-level differences were small (g = −0.29). Large correlations were found between security with mothers and fathers (r = 0.53). While mean-level differences were larger in studies with questionnaires rather than interviews, the reverse was found when analyzing correlation. The size of mean-level differences increased with age, while the size of the correlation between security with mothers and fathers declined. More recent studies found smaller mean-level differences and larger correlations of security with both attachment figures. There were smaller differences between security with mothers and fathers as well as larger correlations of security with both parents if samples included more intact families. Mean level-differences were smaller and correlations were stronger if studies included more males. Finally, there were larger correlations of security with mothers and fathers in low-risk samples than in clinical/high-risk samples. We conclude that correlations and mean-level differences of self-reported attachment security are stronger than in studies with behavioral measures of observed security in younger children. Further research is recommended on factors that explain the observed correlations and mean-level differences.
... The CAI is an interview-based assessment of attachment in middle childhood and adolescence (8-15 years) based on Ainsworth's Strange Situation (Ainsworth et al., 2015) and the Adult Attachment Interview (AAI; (George et al., 1984). Construct validity, internal consistency, test-retest reliability and inter-rater reliability were all reported to be high (Shmueli-Goetz et al., 2008;Target et al., 2003) and are generally considered the best measures of attachment in young people (Jewell et al., 2019). The questionnaire items were adapted in collaboration with the CAI authors to create a 12-item version that included questions such as 'What happens when someone is mean to you about the way that you look?'. ...
Background:
Dermatological conditions are common in childhood and, in their more severe forms, can cause pain, disability and social marginalisation. Despite attachment being a known factor contributing to psychological and physiological development in childhood and several adult studies showing associations between attachment and dermatology outcomes (Tomas-Aragones, 2018), attachment in young dermatology patients has not been investigated.
Objectives:
This study examined if (1) 8-16-year-olds with chronic dermatological conditions were more likely to show attachment insecurity than general population peers; (2) attachment style was linked to psychological functioning; and (3) facial involvement was associated with attachment insecurity.
Method:
One hundred and twenty-two 8-16-year-olds attending a specialist paediatric dermatological service were compared on the Child Attachment Interview (CAI) to general population data. The Strengths and Difficulties Questionnaire (SDQ) was used to measure psychosocial functioning.
Results:
The dermatology group was significantly more likely to be insecurely attached than their general population peers (χ2 [1] = 4.76, p < .05). The secure group self-reported significantly better psychological functioning on all indices compared with the insecure group (Total Difficulties: F[1,89] = 15.30, p < .001). There were no significant differences between secure and insecure groups on parent-reported psychological measures (Total Difficulties: F[1,94] = 0.67, p = .42). Children with facial involvement were not significantly more likely to be insecurely attached.
Conclusions:
Increased risk of attachment insecurity, particularly in the anxious pre-occupied category, as well as an association between attachment and psychosocial functioning resonated with adult studies suggesting that further research about the role of attachment with young dermatology patients is warranted.
... Adolescents' attachment security was assessed using the Child Attachment Interview (CAI) [22]. The CAI is a wellvalidated, semi-structured interview designed to elicit young people's mental representations of their parental attachment figures through asking them a series of questions about specific experiences of caregiving; it has been applied in diverse clinical settings. ...
... Attachment data could be assessed for 103 mothers, and for 75 fathers. The higher rate of missing data on fathers was due to the adolescent having had no contact with the father for several years, or their being uncontactable, an approach previously validated for this instrument [22]. For the purpose of this study, the Secure versus Insecure designation was used. ...
Background
Social and economic costs associated with antisocial behaviour are well-established, but little is known about the potential costs savings/benefits of secure attachment in this high-risk group. We aimed to provide the first test of attachment quality as a distinct predictor of economic costs.
Methods
111 adolescents (10–17 years of age, M = 15.0, SD = 1.6; 71% male) referred to young offender services due to high levels of antisocial behaviour were included. Costs were measured by detailed service-use interview, and attachment security to mother and father elicited through the Child Attachment Interview. The level of antisocial behaviour and callous-unemotional traits were assessed. Cost predictors were calculated using generalised linear models.
Results
Mean 12-months service costs were £5,368 (sd 5,769) per adolescent, with justice system and educational service costs being the main components. After adjusting for covariates, economic costs were predicted by attachment quality to fathers, with a difference of £2,655 per year between those with secure (£3,338) versus insecure attachment (£5,993); significant cost effects were not found for attachment quality to mothers. Higher levels of callous-unemotional traits, lower verbal IQ, higher levels of antisocial behaviour, and older age were also significant cost predictors.
Conclusions
Secure attachment to fathers is a predictor of reduced public cost in adolescents with severe antisocial behaviour. This novel finding for severely antisocial youth extends previous findings in less antisocial children and underscores the public health and policy benefits of good caregiving quality and the value of population-level dissemination of evidence-based interventions that improve caregiving quality.
... A range of measures were used to assess attachment style and PTSS which are summarized in Table 1. Fourteen attachment assessments were used, ranging from self-report (e.g., Experiences in Close Relationships -Short Form; Wei et al., 2007), interview-based assessments (e.g., Child Attachment Interview; Target et al., 2003), and observation-based assessments (e.g., Strange Situation Procedure; Ainsworth et al., 1978). This led to varying types of reporting of attachment such as classification and dimensions. ...
The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies (N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS (r = -.16) and a positive correlation between insecure attachment (r = .20), avoidant attachment (r = .20), anxious attachment (r = .32), and disorganized attachment (r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.
... Child Attachment Interview. Child reflective functioning was assessed using the Child Attachment Interview (CAI; [44]), and was used to code audio-recorded and transcribed data, CAI is a semi-structured interview for children aged 8 to 13 years. The CAI is a 15-item assessment that aims to activate the attachment system and elicit narratives about the child and their relationship with attachment figures. ...
... The CAI includes a set of questions about the child's self-representation, representations of his/her primary caregivers, as well as questions about times of conflict, distress, illness, hurt, separation and loss). The predictive validity was between 69% to 72%, the internal consistency was 0.92, and the standard item alphas was moderate: in relation to mother 0.65 and father 0.55, and Inter-rater Reliability was 0.87, and stability coefficient were 0.63 [44]). For the purpose of the present study, the CAI was translated into Farsi and then back-translated to assure equivalence with the original version. ...
... For the present study, CAI was the most suitable instrument that had the ability to measure RF and its dimensions [44]. Since there are no instructions for extracting dimensions of RF on the CAI, and considering the cultural differences we anticipated identifying in the dimensions of mentalization, we deemed it necessary to examine the dimensions of RF in Iranian children without imposing the frameworks obtained in the West. ...
Mentalization refers to the ability to understand the mental states of oneself and those of others that motivate action and behavior. Mentalization has generally been linked to adaptive development and healthy functioning whereas diminished mentalization has been associated with maladaptive development and psychopathology. The vast majority of research on mentalization and developmental trajectories, however, is based on Western countries. The overall aim of this study was therefore to examine mentalizing abilities in a novel sample of 153 typically developing and atypically developing Iranian children (Mage = 9.41, SDage = 1.10, Range = 8–11, 54.2% females) recruited from a primary school and health clinic in Tehran. The children completed semi-structured interviews that were later transcribed and coded for mentalization. The parents provided reports on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of the children. The results pointed at general age and sex differences across the two groups. Older children showed more adaptive mentalization compared to the younger children; boys and girls used different mentalizing strategies when facing difficult situations. The typically developing children were better at mentalizing than the atypically developing children. Finally, more adaptive mentalization was associated with lower externalizing and internalizing symptoms among all children. The findings of this study contributes with expanding mentalization research to also encompass non-Western populations and the results hold crucial educational and therapeutic implications.
... Based on their work, future research could move toward incorporating the story-stems to measure changes in children's function post-treatment. Moreover, other narrative-based attachment tools, such as the Child Attachment Interview (CAI; Target, Fonagy, and Shmueli-Goetz 2003) could be used with older children for this purpose. ...
Recent developments in psychodynamic work with children and adolescents have made empirical research a higher priority in the field. In order to support the evidence-base of psychodynamic child and adolescent psychotherapy, more research is needed to identify the underlying therapeutic processes that make psychodynamic psychotherapy effective for different kinds of children and adolescents and contribute to the literature on therapeutic mechanisms of change. Drawing on the expertise of a range of contributors, this special section describes recent child and adolescent psychodynamic psychotherapy research illustrating a range of quantitative and qualitative methodologies that have been developed to investigate different clinical phenomena, processes of psychotherapy and outcome. These papers will serve as a vital resource helping researchers and clinicians develop clinically relevant research agendas to improve clinical practice and care with children and adolescents.
