Attachment theory, with its core concepts, perspectives, and insights developed over the past five decades, is influential for professionals working with young children. However, practitioners face challenges translating attachment theory and research into practical applications. This manifests in attachment myths, theoretical misinterpretations, and inconsistency of application. This state-of-the-art review is authored by 47 attachment researchers and practitioners and examines key insights from attachment theory to facilitate attachment-aware practice for professionals working with children and their caregivers. Following the ongoing debate on practical relevance in attachment theory, we present both 'strict' and 'expansive' translational perspectives on applications for addressing preventative or clinical attachment concerns. We first review core attachment propositions, based on replicated research of attachment and caregiving. We next address common misconceptions that hinder adequate practical applications. We present measures of attachment and sensitive parenting that might be helpful for practitioners. We also review evidence-based and promising attachment interventions, discussing core components of (preventative) support for parents or caregivers and the children in their care. We emphasize that attachment theory's clinical value lies not in assigning attachment classifications, but rather in understanding crucial insights into caregiving and early socioemotional development (e.g., secure base phenomena; the value of safe, stable, and shared good-enough care), developed in attachment research over the past 50 years, that may inform policy and clinical reasoning and areas for prevention and intervention.

BACKGROUND:A negative maternal birth experience can influence mother-child bonding, which in turn may influence children's emotional-behavioral development. This study examined these longitudinal associations across two cohort studies. METHODS:Data were drawn from the German DREAM study (N = 1608) and the Dutch Generations2 study (N = 1783). Negative birth experience was modeled as latent factor using three indicators measured two (DREAM) and three (Generations2) months postpartum. Child emotional-behavioral problems were assessed at ages three (DREAM) and four (Generations2), with the Strengths and Difficulties Questionnaire. Mother-child bonding was assessed at 12-14 months after birth using the Postpartum Bonding Questionnaire (DREAM) and the Attachment Scale of the Parenting Stress Index (Generations2). Structural equation modeling tested associations. RESULTS:Negative birth experience predicted mother-child bonding (DREAM: β = 0.11, p = .008, Generations2: β = 0.09, p = .040). Bonding difficulties were associated with increased emotional-behavioral problems, particularly conduct and hyperactivity-inattention problems (DREAM mothers: β = 0.17-0.27, p < .006; Generations2: β = 0.13-0.20, p < .022; DREAM partners: β = 0.15-0.17, p < .003). Small indirect effects of negative birth experience on conduct and hyperactivity-inattention problems through bonding were observed only in the German sample (DREAM mothers and partners: β = 0.02-0.03, p < .043). CONCLUSIONS:Results suggest that negative birth experiences may predict emotional-behavioral problems primarily through bonding difficulties. Promoting positive and empowering birth experiences, alongside early identification and support for bonding difficulties, may represent promising targets for preventive efforts aimed at improving child developmental outcomes.

Important breakthroughs in understanding the role of attachment for social functioning and wellbeing have always gone hand in hand with the construction of new measurement paradigms. In her 1986 book on five methods of assessment, Mary Main concluded that experiences and representations of attachment shape general, stable, and coherent categories of mental organization. The rules for classifying these categories were derived from data drawn from new, experimentally controlled measures. Taking inspiration from Main's approach, the current paper argues that a data-driven approach that leverages advances in naturalistic recording and computation may go further and also deliver a detailed understanding of how and when patterns of attachment behavior are formed during the first year of life. This paper describes how tools for long-term, fine-grained, multimodal recording can be embedded in daily family life and combined with high-throughput processing and supervised machine learning. Predictive models of dynamic interactions between features of infants' and caregivers' behaviors can be explored and interpreted to arrive at testable theory. By casting theory in the form of agent-based models, we can iteratively rebuild Bowlby's original conceptualization of behavioral control systems for attachment and caregiving, which provided the starting point of Main's empirical forays. We describe the theoretical gaps in current attachment research as well as the opportunities for multidisciplinary research that could be addressed by an approach that builds on Main's abductive logic.

Objective Assessment of parent-child interaction by practitioners is of great importance but hindered by a lack of instruments that withstand the constraints daily practice places on usage. Visuals may offer an alternative format. Visualizations were tested on reliability, accuracy, and feasibility in observational assessment of parent-child interaction, as alternatives for textual rating scales. Methods In Study 1, 95 students rated parent-child interactions with a video or text anchor scale, and in Study 2, 217 professionals rated the same interactions with a decision tree including visual components or a text anchor scale. Results Students using the video anchor scale were less reliable and accurate, slower, and had a less positive user experience than students using the text anchor scale. Professionals using the decision tree did not differ in reliability and were comparable in user experience with professionals using the text anchor scale. Rater accuracy showed similar dependency on quality of parental behavior for both scales: ratings were less accurate when the quality of the parent-child interaction was low, and more accurate when the quality was high. However, professionals were less accurate and slower in using the decision tree than the text anchor scale. Conclusion With a first iteration of a decision tree performing the same to or only slightly worse, efforts to further develop decision trees might be worthwhile. Innovation These nonintuitive findings underscore the value of experimental testing in assessment design in daily practice.

BACKGROUND:Fear of childbirth and negative birth experiences have suggested to been associated with parenting behaviour and thereby indirectly with child outcomes. The current study contributes to this knowledge by investigating fear of childbirth and birth experience as predictors of observed parenting behaviour. METHODS:We longitudinally tested the role of fear of childbirth and birth experiences in two dimensions of observed parenting behaviour: maternal sensitivity and disruptive maternal behaviour. We built two hierarchical regression models: maternal sensitivity as the dependent variable in the first model and disruptive maternal behaviour in the second model. In both models, fear of childbirth was added as an independent variable in the first step and birth experience in the second step. RESULTS:Results of the hierarchical regressions and post-hoc equivalence testing suggested that fear of childbirth may not predict mothers' postnatal parenting behaviour. Yet, the role of birth experience in maternal parenting behaviour remained unclear, as the results of hierarchical regression were non-significant, but equivalence testing resulted in inconclusive results. CONCLUSION:Fear of childbirth and negative birth experience may not necessarily stand in the way of sensitive parenting.

Objective. Some mothers with a tendency to experience stress may have been predisposed to parental burnout during the COVID-19 pandemic in response to the double jeopardy of high burden and low social support. By taking into account parental functioning before the pandemic, the extent of this double jeopardy may be gauged. Design. This longitudinal Dutch cohort study (N = 1,787) estimated the predictive role of stable maternal stress and the availability of social support during the pandemic for symptoms of parental burnout during the pandemic. Maternal stress was measured at 3 months, 12 months, 2 years, and 4 years after birth, and social support and parental burnout were assessed during the COVID-19 pandemic in 2020, when the children were 8-11 years old. The Trait-State-Occasion model was used to operationalize the underlying stable component of maternal stress from 3 months to 4 years after the birth of the first child, which enabled us to leverage longitudinal data to deliver a best estimate of the parents' conditions (i.e. how much stress they experienced) before the crisis. Results. Maternal stress was explained on average for 69% by stable and 31% by occasion-specific components. During the pandemic, stable maternal stress was associated with parental burnout, and higher social support was related to lower symptoms of parental burnout (even after controlling for stable maternal stress). Conclusions. Maternal stress should be considered as a continuous vulnerability factor in the face of heightened burden and low resources. Furthermore, mothers who experience little or no social support may be at increased risk for thoughts and feelings related to parental burnout when faced with a crisis.

Although studies have reported links between parental physical activity and their children’s motor and physical activity behaviors, understanding of this link remains incomplete and evidence inconclusive. This study explored whether children’s motor coordination, fitness, and sports participation are related not only to mothers’ sports participation but also to mothers’ perceptions of exercise and their parenting self-efficacy beliefs. A total of 190 Dutch children and their mothers participated in the study. Children participated in the Körperkoordinationstest für Kinder to assess motor coordination and in the shuttle run test to assess physical fitness. Sports participation of mother and child, maternal perceptions of exercise, and parenting self-efficacy were reported by the mothers. The expected association between maternal and children’s sports participation was not statistically significant. Yet, children of mothers who perceived more barriers to exercise themselves were found to have lower levels of physical fitness and motor coordination, and children of mothers who perceived more benefits of exercise had higher physical fitness levels. The strength of these associations did not statistically depend on parenting self-efficacy. Maternal perceptions of exercise may be a possible modifiable promotive factor for children’s motor coordination and participation in sport and physical activities, although this requires experimental testing.

ObjectivesDuring the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS.DesignDyadic longitudinal data from the Self-Hypnosis IntraPartum Trial.MethodsParticipants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum).ResultsCorrelations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS.ConclusionsFollowing previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.

Objective. Parental sensitivity is a precursor of child developmental outcomes, but other parental behaviors such as warmth, stimulation of cognitive development, intrusiveness, and hostility are also associated with those outcomes. The aim of the current study was to untangle unique linkages among parental sensitivity, other parental behaviors, and outcome domains deemed relevant for child welfare in an ethnically homogenous sample. Design. Data from European American dyads of the NICHD Study of Early Child Care and Youth Development (N = 1,097) across 13 waves from 6 months to 15 years of age were split into two datasets for cross validation. Twelve of 284 outcome measures were selected a priori as domain indicators. Only one measure was eligible for the domain Coping, therefore this measure and domain were omitted. Results. Confirmatory factor analysis revealed acceptable model fit for robust outcome domains of Emotional Regulation Problems, Self-Concept, and Problem Behavior assessed during childhood and adolescence. Using structural equation modeling, parental sensitivity statistically predicted Emotional Regulation Problems during primary school and Problem Behavior throughout primary school and adolescence. However, prediction in adolescence was no longer statistically significant after adding demographic confounders. Stimulation of cognitive development predicted Problem Behavior during primary school over and above parental sensitivity, yet, this effect was no longer statistically significant after adding demographic confounders. Parental intrusiveness and detachment, positive and negative regard, and flatness of affect showed no added predictive value. Conclusions. These findings may guide parsimonious assessment of the quality of the caregiving environment of young children.

Improving parental sensitivity is an important objective of interventions to support families. This study examined reliability and validity of parental sensitivity ratings using a novel package of an e-learning tool and an interactive decision tree provided through a mobile application, called the OK! package. Independent raters assessed parental sensitivity using the OK! package (N = 11 raters) and the NICHD Parental Sensitivity rating scales (N = 22 raters) on the basis of videotaped mother-child interactions at 10- or 12-months-old (N = 294) and at 24-months-old (N = 204) from the Dutch longitudinal cohort study Generation2 . Mothers reported on children's externalizing and internalizing problems and social competence when children were 4 and 7 years old. Results showed excellent single interrater reliability for raters using the OK! package (mean ICC = .79), and strong evidence for convergent validity at 10- or 12-month-old (r = .57) and 24-month-old (r = .65). Prospective associations of neither parental sensitivity rated using the OK! package or the NICHD Parental Sensitivity rating scales with child developmental outcomes were statistically significant (p > .05), with overlapping 95% confidence intervals for both measures. The OK! package provides a promising direction for testing alternatives to current training and instruction modalities.

A growing body of research suggests that, compared with single parent-child attachment relationships, child developmental outcomes may be better understood by examining the configurations of child-mother and child-father attachment relationships (i.e., attachment networks). Moreover, some studies have demonstrated an above-chance level chance of concordance between the quality of child-mother and child-father attachment relationships, and child temperament has been offered as a plausible explanation for such concordance. To assess whether temperament plays a role in the development of different attachment network configurations, in this preregistered individual participant data meta-analysis we tested the degree to which the temperament dimension of negative emotionality predicts the number of secure, insecure-avoidant, insecure-resistant, and disorganized attachment relationships a child has with mother and father. Data included in the linear mixed effects analyses were collected from seven studies sampling 872 children (49% female; 83% White). Negative emotionality significantly predicted the number of secure (d = -0.12) and insecure-resistant (d = 0.11), but not insecure-avoidant (d = 0.04) or disorganized (d = 0.08) attachment relationships. Nonpreregistered exploratory analyses indicated higher negative emotionality in children with insecure-resistant attachment relationships with both parents compared to those with one or none (d = 0.19), suggesting that temperament plays a small yet significant role in child-mother/child-father insecure-resistant attachment relationships concordance. Taken together, results from this study prompt a more in-depth examination of the mechanism underlying the small yet significantly higher chance that children with increased negative emotionality have for developing multiple insecure-resistant attachment relationships.