View in EDS HTML Full Text PDF Full Text

Infant Attachment Disorganization and Moderation Pathways to Level and Change in Externalizing Behavior during Preschool Ages

Saved in:
Bibliographic Details
Title: Infant Attachment Disorganization and Moderation Pathways to Level and Change in Externalizing Behavior during Preschool Ages
Language: English
Authors: Wang, Feihong (ORCID 0000-0003-4412-7583), Willoughby, Michael, Mills-Koonce, Roger, Cox, Martha J.
Source: Grantee Submission. 2016 18(6):534-553.
Peer Reviewed: Y
Page Count: 21
Publication Date: 2016
Sponsoring Agency: Institute of Education Sciences (ED)
National Science Foundation (NSF)
Contract Number: R324B120002
NSFBCS0126475
Document Type: Journal Articles
Reports - Research
Descriptors: Infants, Infant Behavior, Attachment Behavior, Behavior Problems, Least Squares Statistics, Age Differences, Predictor Variables, Family Environment, Risk, Interaction, Mothers, Parent Influence, Young Children, Parent Child Relationship, Personality Traits, Correlation, Longitudinal Studies, Gender Differences, Ethnicity, Video Technology, Questionnaires, Statistical Analysis
Geographic Terms: North Carolina (Durham)
Assessment and Survey Identifiers: Rothbart Infant Behavior Questionnaire
DOI: 10.1080/14616734.2016.1243139
ISSN: 1461-6734
Abstract: This research examined the child, parent, and family conditions under which attachment disorganization was related to both level and change in externalizing behavior during preschool among a community sample. Using the ordinary least squares regression, we found that attachment disorganization at 12 months significantly predicted children's externalizing behavior at 36 months and this prediction was not contingent on any other factors tested. For predicting changes in externalizing behavior from 36 to 60 months, we found a significant main effect of family cumulative risk and an interaction effect between attachment disorganization at 12 months and maternal sensitivity at 24 months. Specifically, high disorganization was related to a significant decrease in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high. Our main-effect findings replicated the significant effect of attachment disorganization and cumulative risk on externalizing behavior with preschool-aged children. Our interaction finding provided support for understanding the parenting conditions under which infant attachment disorganization may be related to change in externalizing behavior during preschool ages. Implications of the findings were discussed.
Abstractor: As Provided
Number of References: 71
IES Funded: Yes
Entry Date: 2018
Accession Number: ED581282
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwH8hlgfNDHAT1EHbRZvLVzpAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDPagaAFTe6NVp66uIQIBEICBm5Ok7ETtawkyynxSaf9wDOCE50VwA96rGq9uKUyQV4tIylkBXVLz8HCm_moUtQl521Fd8EkqFzxUYmk02b_YQXpip_gccegqK8RS305FJZ8cIlkMOBOLCk9ZiEOGMxd4oMhLa4UL4tp9yVcOYSBbLlYYtB2Vov4xkWqVH1ye3H_1DOfejrLH3_jmC9w4gULHTtAaL-AGGQOL0BpG
Text:
  Availability: 1
  Value: <anid>AN0119278385;5aw01dec.16;2019Feb12.14:28;v2.2.500</anid> <title id="AN0119278385-1">Infant attachment disorganization and moderation pathways to level and change in externalizing behavior during preschool ages. </title> <p>This research examined the child, parent, and family conditions under which attachment disorganization was related to both level and change in externalizing behavior during preschool among a community sample. Using the ordinary least squares regression, we found that attachment disorganization at 12 months significantly predicted children's externalizing behavior at 36 months and this prediction was not contingent on any other factors tested. For predicting changes in externalizing behavior from 36 to 60 months, we found a significant main effect of family cumulative risk and an interaction effect between attachment disorganization at 12 months and maternal sensitivity at 24 months. Specifically, high disorganization was related to a significant decrease in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high. Our main-effect findings replicated the significant effect of attachment disorganization and cumulative risk on externalizing behavior with preschool-aged children. Our interaction finding provided support for understanding the parenting conditions under which infant attachment disorganization may be related to change in externalizing behavior during preschool ages. Implications of the findings were discussed.</p> <p>Keywords: Attachment disorganization; externalizing behavior; maternal sensitivity; cumulative risks; moderation effect</p> <hd id="AN0119278385-2">Introduction</hd> <p>Attachment disorganization indicates a disruption in children's organized behavioral and attentional strategies under attachment related stress (Main & Solomon, [<reflink idref="bib47" id="ref1">47</reflink>]). This disruption represents a failure in children's attempt to accomplish an early milestone in development, which is the establishment of trust in people around them (Erikson, [<reflink idref="bib24" id="ref2">24</reflink>]) as often shown in an organized secure attachment relationship with their primary caregiver in infancy (Macfie, Fitzpatrick, Rivas, & Cox, [<reflink idref="bib43" id="ref3">43</reflink>]). From a developmental psychopathology perspective, this failure may undermine children's subsequent negotiation of developmentally salient tasks and potentiate the development of pathological outcomes in children (Cicchetti & Rogosch, [<reflink idref="bib17" id="ref4">17</reflink>]). Indeed, empirical evidence supports that infant and childhood attachment disorganization is a robust predictor of children's externalizing behavior and social incompetence during school years (e.g., Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, [<reflink idref="bib28" id="ref5">28</reflink>]; Lyons-Ruth & Jacobvitz, [<reflink idref="bib42" id="ref6">42</reflink>]; Madigan, Brumariu, Villani, Atkinson, Lyons-Ruth, [<reflink idref="bib44" id="ref7">44</reflink>]), although the magnitude of the prediction is only small to moderate (Fearon et al., [<reflink idref="bib28" id="ref8">28</reflink>]; Madigan et al., [<reflink idref="bib44" id="ref9">44</reflink>]) suggesting that the prediction may occur more likely under some conditions than others. But, a cross-level examination of the child, parent, and family conditions that moderate the association of early attachment disorganization and children's externalizing behavior during preschool ages is still lacking.</p> <p>In this study, we examined the extent to which child, parent, and family factors moderated the association between attachment disorganization and both the level and change in children's externalizing behavior during preschool ages from 36 to 60 months. Using a family systems approach (Cox & Paley, [<reflink idref="bib19" id="ref10">19</reflink>]), we first considered a key child factor (i.e., child difficult temperament) as a potential moderator because it has been implicated in the development of behavior problems (Rothbart & Bates, [<reflink idref="bib55" id="ref11">55</reflink>]). Research also has suggested that difficult temperament may make children more susceptible to adverse experiences such as disorganized relationships with caregivers in setting their long-term development of competence and problems (Shaw, Owens, Vondra, Keenan, & Winslow, [<reflink idref="bib61" id="ref12">61</reflink>]). At the parent–child dyad level, we examined maternal sensitivity at 24 months as a possible moderator motivated by the finding that maternal sensitivity at 24 months moderated the association of secure/insecure attachment with later development of competence and problems in data from the National Institute of Child Health and Development Study of Early Child Care and Youth Development (Belsky & Fearon, [<reflink idref="bib8" id="ref13">8</reflink>]). Last, we considered an index of the family risk environment to ask if cumulative risk in the first three years of children's lives moderated the association between early attachment disorganization and later externalizing behavior given the evidence of the role of cumulative demographic risks in children's development of externalizing problems (Appleyard, Egeland, van Dulmen, & Sroufe, [<reflink idref="bib5" id="ref14">5</reflink>]) and its correlation with the incidence of attachment disorganization in children (Cyr, Euser, Bakermans-Kranenburg, & van Ijzendoorn, [<reflink idref="bib20" id="ref15">20</reflink>]).</p> <hd id="AN0119278385-3">Child difficult temperament at 12 months</hd> <p>Child temperament reflects individual differences in reactivity and regulation that are constitution based (Rothbart & Sheese, [<reflink idref="bib57" id="ref16">57</reflink>]), and may also be indicative of individual sensitivity to environmental influences. Many researchers were inspired by Thomas and Chess' ([<reflink idref="bib67" id="ref17">67</reflink>]) idea of difficult child temperament that refers to negative reaction, frequent crying, and slowness in accepting changes. In the modern literature, this can be operationalized by child reactivity and regulation (Putnam & Stifter, [<reflink idref="bib53" id="ref18">53</reflink>]). The differential susceptibility theory (Belsky, [<reflink idref="bib7" id="ref19">7</reflink>]) further specifies that children of difficult temperament may be more susceptible to the presence of either favorable or unfavorable environmental factors. Accumulating studies have supported the interplay between child difficult temperament and the parenting environment as related to child outcomes (e.g., Kochanska & Kim, [<reflink idref="bib38" id="ref20">38</reflink>]). Other research has demonstrated the interaction between child temperament and attachment security in predicting child outcomes (e.g., Lickenbrock et al., [<reflink idref="bib40" id="ref21">40</reflink>]; McElwain, Holland, Engle, & Wong, [<reflink idref="bib48" id="ref22">48</reflink>]; Stupica, Sherman, & Cassidy, [<reflink idref="bib66" id="ref23">66</reflink>]; Troxel, Trentacosta, Forbes, & Campbell, [<reflink idref="bib68" id="ref24">68</reflink>]). This supports the theoretical belief that temperament and attachment represent two separate domains of development contributing to children's developmental outcomes independently or through their interaction (Vaughn, Bost, & van IJendoorn, [<reflink idref="bib70" id="ref25">70</reflink>]). With regard to the interaction between child difficult temperament and attachment disorganization, one previous study showed that child difficult temperament at age 2, when combined with an early disorganized parent–child relationship, put children at high risk for aggressive behavior at age 5 (Shaw et al., [<reflink idref="bib61" id="ref26">61</reflink>]). Another study found that the co-occurrence of attachment disorganization and child difficult temperament predicted maladjustment in middle childhood, albeit in cognitive domains and ego-control (Stams, Juffer, & van IJzendoorn, [<reflink idref="bib64" id="ref27">64</reflink>]). But, no research exists examining the possible interaction between infant attachment disorganization and child difficult temperament in predicting level and change in externalizing behavior during the preschool years. To fill this gap in the literature, we test whether the association between children's attachment disorganization and their level and change in externalizing behavior during the preschool years is stronger for children with more difficult temperament at 12 months as compared to their counterparts with less difficult temperament.</p> <hd id="AN0119278385-4">Maternal sensitivity at 24 months</hd> <p>Given negative early experiences, later experiences with parents may attenuate, amplify, or maintain the association between early risks and later maladjustment (Sroufe, Egeland, Carlson, & Collins, [<reflink idref="bib63" id="ref28">63</reflink>]). Numerous studies have suggested that sensitive and nurturant parenting in the early years is related to better emotion and behavior regulation and lower externalizing behavior in children (Dozier et al., [<reflink idref="bib22" id="ref29">22</reflink>]; NICHD Early Child Care Research Network, [<reflink idref="bib51" id="ref30">51</reflink>]; Propper et al., [<reflink idref="bib52" id="ref31">52</reflink>]; Van Zeijl et al., [<reflink idref="bib69" id="ref32">69</reflink>]). Research has demonstrated that children who showed an insecure attachment with mothers at 12 months had better outcomes in the first three years of life when they experienced high maternal sensitivity at 24 months as compared to children of secure attachment who experienced low maternal sensitivity at 24 months (Belsky & Fearon, [<reflink idref="bib8" id="ref33">8</reflink>]). This finding suggests the specific protective role of maternal sensitivity during the toddler years in altering the negative consequences evolving from the risk of early insecure attachment. This protective role may apply equally to children with infant attachment disorganization.</p> <p>Furthermore, a meta-analysis on 15 sensitivity-based intervention studies has shown that higher maternal sensitivity in toddlerhood through intervention for mothers of disorganized infants was associated with change of children's disorganized attachment into organized ones during the toddler years (Bakermans-Kranenburg, van IJzendoorn, & Juffer, [<reflink idref="bib6" id="ref34">6</reflink>]). Additional evidence corroborates the meta-analytic finding that negative maternal behavior was related to attachment disorganization (Gedaly & Leerkes, [<reflink idref="bib30" id="ref35">30</reflink>]) but enhanced maternal sensitivity was associated with change in children's disorganized attachment into organized ones around toddler ages (Forbes, Evans, Moran, & Pederson, [<reflink idref="bib29" id="ref36">29</reflink>]; Hoffman, Marvin, Cooper, & Powell, [<reflink idref="bib36" id="ref37">36</reflink>]). One randomized control trial research gave further evidence on the role of improved maternal sensitivity in reducing attachment disorganization as well as externalizing behavior among young children from maltreating families (Moss et al., [<reflink idref="bib50" id="ref38">50</reflink>]). Research, however, has not examined if subsequent high maternal sensitivity at 24 months would mitigate the association between infant attachment disorganization and both level and change in externalizing behavior during the preschool years.</p> <p>We were especially interested in maternal sensitivity during toddlerhood because it is both an important period in children's reorganization of infant disorganized attachment (Forbes et al., [<reflink idref="bib29" id="ref39">29</reflink>]; Hoffman et al., [<reflink idref="bib36" id="ref40">36</reflink>]), and a period when children peak in negativity (Belsky, Woodworth, & Crnic, [<reflink idref="bib11" id="ref41">11</reflink>]). This heightened negativity may create additional demands and challenges for parents to remain positive and sensitive to their toddlers. In addition, children with infant disorganized attachment were found as a group to experience decreases in maternal sensitivity between 6 and 36 months as compared to their secure or resistant counterparts (Mills-Koonce et al., [<reflink idref="bib49" id="ref42">49</reflink>]). Thus, the level of sensitivity that mothers show during the toddler years may function to either strengthen or weaken the association between infant attachment disorganization and externalizing behavior during preschool ages. Mothers with a high level of maternal sensitivity at 24 months may help reduce children's disorganization levels and facilitate re-organization of the attachment relationship during the challenging toddler years, but a low level of maternal sensitivity during this period may precipitate externalizing behavior in children with infant disorganization.</p> <hd id="AN0119278385-5">Cumulative risk in the first three years</hd> <p>Research suggests the accumulation of multiple sociodemographic risks (e.g., single parenthood, low family income, large household size, etc.) predicts children's developmental outcomes better than singular risk indicators (Evans, [<reflink idref="bib25" id="ref43">25</reflink>]; Rutter, [<reflink idref="bib59" id="ref44">59</reflink>]; Sameroff, Seifer, Baldwin, & Baldwin, [<reflink idref="bib60" id="ref45">60</reflink>]). Cumulative risk models (Evans, Li, & Whipple, [<reflink idref="bib26" id="ref46">26</reflink>]; Rutter, [<reflink idref="bib59" id="ref47">59</reflink>]) have suggested that the presence of multiple or cumulative sociodemographic risks is a powerful predictor of children's externalizing behavior (e.g., Appleyard et al., [<reflink idref="bib5" id="ref48">5</reflink>]). Furthermore, children who experience five out of six risks between the ages of 12 and 18 months are more likely to show disorganization in the Strange Situation Paradigm (SSP; Ainsworth, Blehar, Waters, & Wall, [<reflink idref="bib3" id="ref49">3</reflink>]) than their peers with fewer contextual risks (Cyr et al., [<reflink idref="bib20" id="ref50">20</reflink>]). However, whether or not high cumulative risk versus low cumulative risk places disorganized children at increased risk for later behavioral problems is still an empirical question.</p> <p>In a recent meta-analysis (Fearon et al., [<reflink idref="bib28" id="ref51">28</reflink>]), social economic status (SES) was considered as an approximation of a few proximal psychosocial risks and was tested as a moderator in the association between children's attachment and externalizing problems. Specifically, in this meta-analytic review, samples of qualified studies were categorized as low vs. middle/high SES samples to form a binary SES status variable. It was found that the association between attachment disorganization and externalizing behavior did not differ by SES differences in the samples. Fearon et al. ([<reflink idref="bib28" id="ref52">28</reflink>]) acknowledged that grouping samples into either low or middle/high SES status might have reduced the power to detect SES effects on the association between attachment disorganization and externalizing behavior. Furthermore, using SES as an approximation of multiple psychosocial risks is less statistically rigorous than creating a composite of cumulative risk based on multiple risk indicators. Therefore, it is important to further explore how cumulative risk, as a composite of multiple risk indicators, interacts with attachment disorganization in predicting externalizing behavior in children.</p> <p>A few studies have examined the interaction between attachment types and count-based cumulative risk (i.e., summation of the number of risk indicators), but with inconsistent findings. For example, Belsky and Fearon ([<reflink idref="bib9" id="ref53">9</reflink>]) initially did not find significant differences in children's total behavioral problems at 36 months between the disorganized group and the other attachment groups in an analysis that consider different levels of cumulative risk of individual children. But, in a later publication, Fearon and Belsky ([<reflink idref="bib27" id="ref54">27</reflink>]) did find a significant association between attachment disorganization and increases in boys' externalizing behavior in the primary school years when they experienced high level of cumulative risk.</p> <p>Some researchers suggest that a mean-based cumulative risk variable is preferable to a summed number of cumulative risk because mean-based cumulative risk has been found to have stronger associations with parenting and child outcomes than the count variable of the risk indices (Burchinal, Roberts, Hooper, & Zeisel, [<reflink idref="bib13" id="ref55">13</reflink>]; Burchinal, Vernon-Feagans, Cox, & Key Family Life Project Investigators, [<reflink idref="bib12" id="ref56">12</reflink>]). Mean-based cumulative risk variables are created by taking the mean of the standardized risk indicators without forcing the continuous risk indicators into binary indicators, thus they maintain more variation in the indicator. Cumulative risk as a mean-based variable has not yet been tested in interaction with attachment disorganization levels in predicting both level and change of externalizing behavior in preschool ages. Following a similar argument of preserving variation, attachment disorganization level as a continuous variable has been used instead of the binary disorganized/not disorganized distinction (i.e., Macfie et al., [<reflink idref="bib43" id="ref57">43</reflink>]) because it preserves the naturally occurring variation in the continuous nine-point rating of level of disorganization (Main & Solomon, [<reflink idref="bib47" id="ref58">47</reflink>]). In this study, we tested whether cumulative risk as a mean-based variable interacts with attachment disorganization levels in predicting both level and change in externalizing behavior in preschool ages.</p> <p>Common risk indicators for the cumulative sociodemographic risk composite in the relevant literature are single parenthood, low maternal education, low family income, child minority status, household children's size, and involuntary unemployment of the primary wage earners (Belsky & Fearon, [<reflink idref="bib9" id="ref59">9</reflink>]; Burchinal et al., [<reflink idref="bib12" id="ref60">12</reflink>]; Cyr et al., [<reflink idref="bib20" id="ref61">20</reflink>]). We have selected risk indicators based on the relevant literature and principal component analysis to create a cumulative risk composite that highlights sociodemographic aspects of risks. Although attachment disorganization could be part of cumulative psychosocial risks, we focused on understanding the child, parent, and sociodeomographic conditions under which the association between attachment disorganization and externalizing behavior would be strengthened or lessened. Therefore, attachment disorganization was used as a main predictor instead of a risk indicator in this study.</p> <hd id="AN0119278385-6">The current study</hd> <p>The current study uses longitudinal data to examine how child temperament, maternal sensitivity, and family cumulative risk may moderate the association between attachment disorganization in infancy and externalizing behavior during preschool ages. Whereas several previous studies have examined the direct association between attachment disorganization and later externalizing behavior, this study is one of the first to test moderation of risk and protective factors in this association over the preschool years.</p> <p>Our first hypothesis was that the association between attachment disorganization and later level and increase in externalizing behavior would be greater among children with more difficult as compared to less difficult temperamental characteristics. Our second hypothesis was that high rather than low maternal sensitivity at 24 months would be associated with an attenuated association between high attachment disorganization and later level and increase in externalizing behavior. Our third hypothesis was that high rather than low family cumulative risk would be related to an augmented association between attachment disorganization and level and increase in externalizing behavior.</p> <p>We examined externalizing behavior during preschool ages (i.e., 36 and 60 months) because difficulties in behavioral and emotional adjustment during this period often precede subsequent maladaptation (Caspi, Moffitt, Newman, & Silva, [<reflink idref="bib15" id="ref62">15</reflink>]; Egeland, Pianta, & Ogawa, [<reflink idref="bib23" id="ref63">23</reflink>]). There is evidence that 50% of preschoolers with externalizing behavior continue to display such behavior by middle childhood (Campbell & Ewing, [<reflink idref="bib14" id="ref64">14</reflink>]). Identifying the mechanisms responsible for behavioral difficulties in early and late preschool ages may have implications for preventing the development of later behavior problems in children.</p> <hd id="AN0119278385-7">Method</hd> <p></p> <hd id="AN0119278385-8">Participants</hd> <p>The participants in this study were drawn from the longitudinal Durham Child Health and Development (DCHD) study in North Carolina. In the DCHD study, 206 families from varied backgrounds were recruited through parenting classes, fliers distributed in the hospital, and phone calls using children's birth records when the children were 3 months old. The participating children were typically developing children without any problematic medical histories before or after birth. Efforts were made to achieve relatively equal representation of both African and European American families and of both poor and non-poor families. Sample size was 206, 180, 165, 182, 179, and 137 at the 3, 6, 12, 24, 36, and 60 months of assessment due to family withdrawal, relocation, or schedule unavailability. Maternal report of externalizing behavior was available at either 36 or 60 months or at both time points for 182 child participants. We used this sub-sample for analysis in the current study. No significant mean differences were found in the covariates (gender and minority) and in child difficult temperament, maternal sensitivity, and cumulative risk based on the general linear modeling group comparison procedure between the study sample and the group of children who were not in the study sample. Children in the study sample as compared to those not in the study sample had a significantly lower mean score on attachment disorganization (<emph>F</emph><subs>(<reflink idref="bib1" id="ref65">1</reflink>, 205)</subs> = 11.71, <emph>p</emph> < .001), higher average family incomes (<emph>F</emph><subs>(<reflink idref="bib1" id="ref66">1</reflink>, 205)</subs> = 6.13, <emph>p</emph> < .05), and higher average maternal education (<emph>F</emph><subs>(<reflink idref="bib1" id="ref67">1</reflink>, 205)</subs> = 4.27, <emph>p</emph> < .05) from 3 to 36 months. Males comprised 51% of the study sample, and females comprised 49%; 56% were African American, and 44% were European American. The average ages for the study children were.58, 1.11, 2.13, 3, and 5.09 years old at 6, 12, 24, 36, and 60 months of data collection with standard deviation of.08,.12, 1.33,.05, and.31 respectively.</p> <hd id="AN0119278385-9">Missing data</hd> <p>In this study sample, 24% had missing scores on attachment disorganization, 20% on difficult temperament, and 13% on maternal sensitivity at 24 months. Furthermore, 2% and 24.70% missed externalizing at 36 and 60 months, respectively. Eighty (44%) had complete data across all the measures over time. Sixty-three (34.31%) had missing data on one study variable, 30 (16.49%) on two study variables, 8 (4.40%) on three study variables, and 1 (.55%) on four study variables. There were four major reasons for the missing data: (a) failure to attend the Strange Situation Paradigm at 12 months and/or parent–child interaction tasks at age 24 months, (b) coding difficulties due to problems with video recordings for 12- or 24-month laboratory session, and (c) partial completion of the questionnaire on child temperament that led to their exclusion in the creation of child difficult temperament composite, and (d) failure in responding to the CBCL questionnaire. The varied reasons in missing data support missing at random (MAR) assumption for using multiple imputation in handing missing data.</p> <hd id="AN0119278385-10">Procedures</hd> <p>When children were 6 months old, mothers responded to the demographics questionnaire. When children were 12 months old, each participating pair of mother and infant was filmed in the Strange Situation Procedure (SSP; Ainsworth et al., [<reflink idref="bib3" id="ref68">3</reflink>]), and mothers also responded to the Infant Behavior Questionnaire-Revised (IBQ-R; Rothbart, [<reflink idref="bib54" id="ref69">54</reflink>]). At 24 months, mother-child pairs were filmed for 10 min in a semi-structured puzzle task interaction. At both 36 and 60 months, mothers completed the Child Behavior Checklist 1.5–5 questionnaire (CBCL/1.5–5; Achenbach & Rescorla, [<reflink idref="bib1" id="ref70">1</reflink>]) about their children's behavior.</p> <hd id="AN0119278385-11">Measures</hd> <p></p> <hd id="AN0119278385-12">Covariates</hd> <p>Given the gender and ethnic differences in externalizing behavior (Dodge, Coie, & Lynam, [<reflink idref="bib21" id="ref71">21</reflink>]; Laird, Pettit, Dodge, & Bates, [<reflink idref="bib39" id="ref72">39</reflink>]), gender and minority status were controlled in all the analysis. Additionally, attachment insecurity was controlled to single out its potential effect on children's externalizing behavior. Children with forced classification of B during Strange Situation Paradigm (Ainsworth et al., [<reflink idref="bib3" id="ref73">3</reflink>]) were coded as 0 indicating secure attachment and children with forced classification of A or C were coded as 1 indicating insecure attachment. See coding description below.</p> <hd id="AN0119278385-13">Attachment disorganization</hd> <p>This construct was assessed through a continuous 9-point scale of attachment disorganization (Main & Solomon, [<reflink idref="bib47" id="ref74">47</reflink>]) indexing the extent of disorganization based on children's behavior in the SSP at 12 months. A rating of "1" indicates no signs of attachment disorganization, and "9" indicates severe, extreme, and frequent signs of disorganization and/or disorientation. Examples of behavioral indicators of disorganization include freezing, vigilant body posture, and apprehensive affect at the sight of the parent. Boys had significantly higher disorganization scores than girls (F <subs>(<reflink idref="bib1" id="ref75">1</reflink>, 147)</subs> = 4.83, <emph>p</emph> = .03). Two coders, previously trained in addition to certified by Alan Sroufe and Elizabeth Carlson of the University of Minnesota, independently coded the procedure with 20% of the cases overlapping to estimate reliability (intraclass correlation = .90 for the continuous scores of attachment disorganization and Cohen's kappa = .85 for the classification data of attachment).</p> <hd id="AN0119278385-14">Child difficult temperament</hd> <p>There are individual differences in both reactivity and regulation that are constitutionally based and differentially expressed as early as infancy (Putnam & Stifter, [<reflink idref="bib53" id="ref76">53</reflink>]; Rothbart & Derryberry, [<reflink idref="bib56" id="ref77">56</reflink>]). This construct was assessed using parents' responses at 12 months on the IBQ-R (Rothbart, [<reflink idref="bib54" id="ref78">54</reflink>]), a refinement of the original IBQ with eight new subscales assessing the broad dimensions of reactivity and regulation. In the DCHD study, parents were asked to respond to four subscales from the IBQ-R: (<reflink idref="bib1" id="ref79">1</reflink>) distress to limitations, (<reflink idref="bib2" id="ref80">2</reflink>) fear, (<reflink idref="bib3" id="ref81">3</reflink>) soothability, and (<reflink idref="bib4" id="ref82">4</reflink>) rate of recovery from distress. Parents were asked to rate on a 7-point Likert scale the extent to which their infants acted in specific ways for the past one or two weeks in multiple routine situations such as feeding, bathing, and exposure to novel places and new people. <emph>Distress to limitations</emph> and <emph>fear</emph> subscales reflect reactivity aspect of infants' temperament, and <emph>soothability</emph> (reversely coded) and <emph>rate of recovery from distress</emph> subscales reflect the regulation aspect of infants' temperament. For the present purpose, difficult temperament was assessed through a composite of these four subscales of the IBQ-R by averaging infants' scores on <emph>distress to limitations, fear, soothability</emph> (reversed), and <emph>rate of recovery from distress</emph>. Such a composite was created to capture the constitutional variation in the combination of reactivity and regulation (Hill-Soderlund & Braungart-Rieker, [<reflink idref="bib35" id="ref83">35</reflink>]). Higher scores on the composite indicate higher reactivity and lower regulation in the child that make them difficult to handle from the caregiver's perspective. Cronbach's <emph>α</emph> was.54 for this composite in the current sample.</p> <hd id="AN0119278385-15">Maternal sensitivity</hd> <p>This construct was a mean composite of five subscales of maternal behavior rated by trained coders based on the 24-month, semi-structured videotaped mother-child interaction in the laboratory (Cox, [<reflink idref="bib18" id="ref84">18</reflink>]). The mother-child interaction task was a 10-minute challenging puzzle task in which three puzzles of increasing level of difficulty were presented to the child starting with the easiest. Parents were told that the task was meant for their child to complete, although they could help if they perceived the need.</p> <p>The subscales that formed the maternal sensitivity composite based on factor analysis (Mills-Koonce et al., [<reflink idref="bib49" id="ref85">49</reflink>]) are <emph>sensitivity</emph> (the level of emotional support from the mother to both the child's distress and non-distress), <emph>positive regard for child</emph> (the extent the parent showed positive feelings and expressions to the child), <emph>animation</emph> (the extent the parent showed excitement, interest, or affective and vocal energy to the child), <emph>stimulation of development</emph> (the extent to which the mother tried to promote the child's development), and reversed <emph>detachment</emph> (the extent to which the mother was uninvolved and disengaged with the child or being perfunctory to the child during the puzzle activities). The rating for each subscale ranges from "1" (<emph>not characteristic at all</emph>) to "7 (<emph>highly characteristic of the parent</emph>). Cronbach's α for the maternal sensitivity composite was.89. Intercoder reliabilities for the individual subscales were.80 and above between coders and master coders on at least 20% of the independently scored videotapes of puzzle tasks.</p> <hd id="AN0119278385-16">Cumulative risk</hd> <p>This construct was a mean composite of six standardized risk indicators from 3 to 36 months supported by the relevant literature (e.g., Burchinal et al., [<reflink idref="bib12" id="ref86">12</reflink>]; Cyr et al., [<reflink idref="bib20" id="ref87">20</reflink>]). The risk indicators included <emph>frequency of single parenthood over time, maternal highest years of education over time, frequency of involuntary unemployment of the primary caregivers</emph> (working less than 10 h per week) over time, <emph>aggregated income-to-needs ratio over time, frequency of family on welfare over time</emph>, and <emph>average mean financial stress over time</emph>. Each indicator was standardized before the formation of the composite. The six risk indices all had loadings exceeding.6 on the principal component of the construct in principal component analyses. Cronbach's <emph>α</emph> was.84. See Table 1 for further descriptive and statistical details of the risk indicators.</p> <p>Table 1. Cumulative risk indicators.</p> <p> <ephtml> <table><thead><tr><td>Cumulative risk indicators</td><td>Time points</td><td>Definitions</td><td>Skewness/Kurtosis</td><td>Range</td></tr></thead><tbody><tr><td>Single parenthood</td><td>3, 6, 12, 18, 24, 30, 36 months</td><td>Average frequency of single parenthood over time</td><td>.89/–.91</td><td>−.72–1.80</td></tr><tr><td>Maternal education</td><td>3, 6, 12, 18, 24, 30, 36 months</td><td>Average years of education over time, reversed</td><td>.10/–.60</td><td>−2.14–2.20</td></tr><tr><td>Involuntary unemployment of the primary wage earner</td><td>3, 6, 12, 18, 24, 30, 36 months</td><td>Average frequency of involuntary unemployment over time</td><td>1.59/1.49</td><td>−.59–2.96</td></tr><tr><td>Family income</td><td>3, 6, 12, 30, 36 months</td><td>Average income-to-needs ratio (2003 cutoff) overtime, reversed</td><td>−1.28/1.92</td><td>−4.46–1.29</td></tr><tr><td>Welfare status</td><td>3, 6, 12, 30, 36 months</td><td>Average frequency of being on welfare over time</td><td>3.44/13.22</td><td>−.34–5.94</td></tr><tr><td>Financial stress</td><td>3, 6, 12, 30 months</td><td>Mean item scores with one item reversed and two items rescaled on the 4-pint scale with higher score reflecting higher financial stress</td><td>.18/–.66</td><td>−1.85–2.56</td></tr></tbody></table> </ephtml> </p> <p>4 Each indicator is the mean of the standardized score across time points. So means of the indicators are all 0, indicating the average level for that specific indicator.</p> <hd id="AN0119278385-17">Level and change in externalizing behavior</hd> <p>Externalizing behavior was assessed by maternal report on the CBCL/1.5–5 (Achenbach & Rescorla, [<reflink idref="bib1" id="ref88">1</reflink>]) when the child was 36 and 60 months of age. The CBCL includes 99 items regarding children's behavioral or emotional problems during the previous two months with seven syndrome scales. <emph>Level of externalizing behavior</emph> was a mean composite of the aggressive and attention problems raw scores at 36 months. Achenbach and Rescorla ([<reflink idref="bib1" id="ref89">1</reflink>]) indicated acceptable reliability and validity of the scores on this construct. <emph>Change in externalizing behavior</emph> was the difference in the mean externalizing behavior at 36 and 60 months. A negative value on this composite indicated a decrease in externalizing behavior from 36 to 60 months, whereas a positive value indicated an increase from 36 to 60 months.</p> <hd id="AN0119278385-18">Data analysis plan</hd> <p>Analyses were done in SAS 9.4. Preliminary analysis of the missing data was conducted to make sure the data were missing at random. It is recognized that multiple imputation is one of the best approaches to addressing missing data when the data is missing at random (Rubin, [<reflink idref="bib58" id="ref90">58</reflink>]), thus multiple imputation was used (with the proc MI command in SAS) with 30 imputed datasets to handle missing data (Yuan, [<reflink idref="bib71" id="ref91">71</reflink>]) in the study variables. Product terms between variables that were interactions were included in the imputation model. This ensures that the multiplied imputed data preserve any nonlinear associations between predictor and outcome variables, which were formally tested in the analysis model (Allison, [<reflink idref="bib4" id="ref92">4</reflink>]). Ordinary least squares regression models were estimated for each of the 30 imputed datasets with the first series of models predicting externalizing behavior at 36 months, and the second series of models predicting change in externalizing behavior from 36 to 60 months. PROC MIANALYZE in SAS 9.4 was used to generate aggregated beta estimates as well as F statistics and <emph>R</emph> squares. Each series of models started with the control model, then the main-effect model in which the block of main predictors was added to the control model, and last the interaction effect model in which the block of interaction terms was added to the main effect model. A non-significant <emph>F</emph> statistic served as a model trimming criterion to preserve the most parsimonious model. Predicting variables were grand mean centered to reduce non-essential multicollinearity (Aiken & West, [<reflink idref="bib2" id="ref93">2</reflink>]). Standard methods (Aiken & West, [<reflink idref="bib2" id="ref94">2</reflink>]) were used to probe significant interactions based on the aggregated beta coefficients across the 30 sets of estimates. Additional tests were conducted, when applicable, to test the robustness of the interaction between attachment disorganization and each of the moderators separately in a series of models that included the same set of covariates and predictors. In these longitudinal analyses, all the main predictors except for the cumulative risk composite that included the 36 month data were assessed prior to the assessment of the level and change in externalizing behavior during the preschool years to approximate the predictions in the models.</p> <hd id="AN0119278385-19">Results</hd> <p></p> <hd id="AN0119278385-20">Descriptive statistics</hd> <p>Univariate analysis suggested the skewness and kurtosis for the continuous predictors and the outcome variables were all within the absolute value of 1, except that attachment disorganization had a skewness of 1.49 and kurtosis of 1.23. This may reflect the fact that a substantial number (64%) of children had a disorganization score of 1. Pairwise descriptive statistics and bivariate correlations of the study variables were presented in Table 2. Infant attachment disorganization was significantly and positively correlated with externalizing behavior at 36 months (<emph>r</emph> = .25, <emph>p</emph> = .004) but not significantly correlated with change in externalizing behavior from 36 to 60 months. Neither child difficult temperament nor maternal sensitivity was related to level of externalizing behavior at 36 months or change in externalizing behavior from 36 to 60 months. Cumulative risk was positively correlated with change in externalizing behavior from 36 to 60 months (<emph>r</emph> = .18, <emph>p</emph> = .04). Externalizing behavior at 36 months was negatively correlated with change in externalizing behavior from 36 to 60 months (<emph>r</emph> = –.55, <emph>p</emph> < .0001). Also, the mean change in externalizing behavior is −1.97, indicating that on average, externalizing behavior is lower at 60 months than at 36 months by about one fourth standard deviation of the externalizing behavior at 36 months.</p> <p>Table 2. Descriptive statistics and bivariate correlations.</p> <p> <ephtml> <table><thead><tr><td>Variables</td><td>1</td><td>2</td><td>3</td><td>4</td><td>5</td><td>6</td><td>7</td><td>8</td><td>9</td></tr></thead><tbody><tr><td>1. Gender</td><td>1</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>2. Minority</td><td>.09</td><td>1</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>3. Insecurity</td><td>−.13</td><td>.11</td><td>1</td><td /><td /><td /><td /><td /><td /></tr><tr><td>4. Disorganization</td><td>−.18*</td><td>−.02</td><td>.27**</td><td>1</td><td /><td /><td /><td /><td /></tr><tr><td>5. Temperament</td><td>.19*</td><td>.35***</td><td>−.07</td><td>.02</td><td>1</td><td /><td /><td /><td /></tr><tr><td>6. Sensitivity</td><td>.02</td><td>−.4***</td><td>−.08</td><td>−.05</td><td>−.26**</td><td>1</td><td /><td /><td /></tr><tr><td>7. Cumulative risk</td><td>−.01</td><td>.43***</td><td>.04</td><td>.14</td><td>.34***</td><td>−.47***</td><td>1</td><td /><td /></tr><tr><td>8. Externalizing behavior at 36 M</td><td>−.14</td><td>−.03</td><td>.06</td><td>.25**</td><td>.15</td><td>−.10</td><td>.14+</td><td>1</td><td /></tr><tr><td>9. Changes in externalizing behavior</td><td>.18*</td><td>.03</td><td>−.02</td><td>−.08</td><td>.01</td><td>.01</td><td>.18*</td><td>−.55***</td><td>1</td></tr><tr><td>N.</td><td>182</td><td>182</td><td>139</td><td>139</td><td>146</td><td>159</td><td>182</td><td>178</td><td>133</td></tr><tr><td>Mean</td><td>.49</td><td>.55</td><td>.35</td><td>2.17</td><td>3.05</td><td>4.48</td><td>−.17</td><td>10.45</td><td>−1.97</td></tr><tr><td>S.D.</td><td>.50</td><td>.50</td><td>.48</td><td>1.85</td><td>.57</td><td>1.26</td><td>4.47</td><td>7.97</td><td>6.15</td></tr><tr><td>Min.</td><td>0</td><td>0</td><td>0</td><td>1</td><td>1.55</td><td>1</td><td>−9.24</td><td>0</td><td>−19</td></tr><tr><td>Max.</td><td>1</td><td>1</td><td>1</td><td>8</td><td>4.87</td><td>7</td><td>13.12</td><td>35</td><td>16</td></tr></tbody></table> </ephtml> </p> <p>5 <emph>N</emph> = 182. 0 = white, male. * <emph>p</emph> < .05, ** <emph>p</emph> < .01, *** <emph>p</emph> < .001.</p> <hd id="AN0119278385-21">Predicting externalizing behavior at 36 months</hd> <p>The first set of regression models predicted externalizing behavior at 36 months. Because the initial model that included all the main effects and three hypothesized two-way interactions did not yield any significant interaction effects, we used the main effect model as our final model. In the main effect model (<emph>F</emph><subs>(<reflink idref="bib7" id="ref95">7</reflink>, 7689.5)</subs> = 2.55 <emph>p</emph> = .01), attachment disorganization was uniquely and positively associated with externalizing behavior (<emph>b</emph> = .82, <emph>p</emph> = .04). The total set of predictors explained 11% of the variation in externalizing behavior at 36 months. See Table 3 for a summary of the estimates.</p> <p>Table 3. Predicting externalizing behavior during preschool ages.</p> <p> <ephtml> <table><thead><tr><td /><td>Predicting Externalizing Behavior Level at 36 Months<sup>a</sup></td><td>Predicting Changes in Externalizing Behavior from 36 to 60 Months<sup>b</sup></td></tr><tr><td /><td>Beta (95% CI)</td><td>SE</td><td>Beta (95% CI)</td><td>SE</td></tr></thead><tbody><tr><td>Gender</td><td>−1.79 (−4.19-.60)</td><td>1.22</td><td>1.35 (–.76–3.45)</td><td>1.07</td></tr><tr><td>Minority</td><td>−2.24 (−5.04-.56)</td><td>1.43</td><td>.06 (−2.32–2.44)</td><td>1.21</td></tr><tr><td>Insecurity</td><td>.41 (−2.38–3.20)</td><td>1.42</td><td>−.72(−3.20 – 1.76)</td><td>1.26</td></tr><tr><td>Disorganization (D)</td><td>.82* (.05–1.59)</td><td>.39</td><td>−.25 (–.95-.45)</td><td>.35</td></tr><tr><td>Temperament (T)</td><td>2.13 (–.28–4.55)</td><td>1.23</td><td>−.06 (−2.12–2.01)</td><td>1.05</td></tr><tr><td>Maternal sensitivity (MS)</td><td>−.53 (−1.71-.65)</td><td>.60</td><td>.24 (–.92–1.39)</td><td>.58</td></tr><tr><td>Cumulative risk (CR)</td><td>.14 (–.18-.46)</td><td>.16</td><td>.35* (.07-.63)</td><td>.14</td></tr><tr><td>D X T</td><td /><td /><td>.77 (–.59–2.14)</td><td>.69</td></tr><tr><td>D X MS</td><td /><td /><td>−.83*(−1.63 –.04)</td><td>.40</td></tr><tr><td>D X CR</td><td /><td /><td>−.20 (–.42-.02)</td><td>.11</td></tr><tr><td><italic>F</italic><sub>(7, 7689.5)</sub> = 2.55, <italic>p</italic> < .05</td><td><italic>F</italic><sub>(10, 1094.6)</sub> = 1.97, <italic>p</italic> < .05</td></tr><tr><td><italic>R</italic><sup>2</sup> = 11%, <italic>p</italic> < .05</td><td><italic>R</italic><sup>2</sup> = 23%, <italic>p</italic> < .05</td></tr></tbody></table> </ephtml> </p> <p>6 * <emph>p</emph> < .05. <emph>F</emph> statistics based on aggregated results out of 30 imputed datasets.</p> <hd id="AN0119278385-22">Predicting change in externalizing behavior from 36 to 60 months</hd> <p>The second set of regression models predicted change in externalizing behavior from 36 to 60 months. In the final model (<emph>F</emph><subs>(<reflink idref="bib10" id="ref96">10</reflink>, 1094.6)</subs> = 1.97, <emph>p</emph> = .03, <emph>R<sups>2</sups></emph> = .22), there was a significant main effect for cumulative risk (<emph>b</emph> = .35, <emph>p</emph> = .01) such that higher cumulative risk was associated with greater <emph>increases</emph> in externalizing behavior, and a significant interaction between attachment disorganization and maternal sensitivity (<emph>b</emph> = –.83, <emph>p</emph> = .04). As depicted in Figure 1, the disorganization X sensitivity interaction indicated that higher attachment disorganization was associated with more <emph>decreases</emph> (<emph>b</emph> = −1.29, <emph>p</emph> = .04) in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high (1 SD above the mean). When maternal sensitivity was at the mean level or at the low level (1 SD below the mean), attachment disorganization was not significantly associated with change in externalizing behavior (<emph>b</emph> = –.25, <emph>p </emph>= .48, and <emph>b</emph> = .79, <emph>p</emph> = .20 respectively). The temperament X disorganization and the risk X disorganization terms were not significant at the.05 level. In our series of models that test the robustness of the interaction findings, we found that the effect of disorganization X maternal sensitivity was only significant when the other two interaction variables were present as reported here. See Table 3 for a summary of the estimates and Figure 1 for the plot of the interaction between attachment disorganization and maternal sensitivity.</p> <p>Graph: Figure 1. Interaction between attachment disorganization and maternal sensitivity (MS) in predicting changes in externalizing behavior from 36 to 60 months.The outcome is the change in externalizing behavior. b = –1.29, p = .04 for high maternal sensitivity slope. b = –.25, p = .48 for middle maternal sensitivity slope. b = .79, p = .20, for low maternal sensitivity slope.</p> <hd id="AN0119278385-23">Discussion</hd> <p>This study aimed to add to the literature on the sequelae of attachment disorganization by considering moderation pathways in the linkage between attachment disorganization and externalizing behavior during preschool ages. In predicting externalizing behavior at 36 months, we found a significant main effect of infant attachment disorganization, supporting other studies that suggest that attachment disorganization creates risk for later behavior problems in children (Fearson et al., [<reflink idref="bib28" id="ref97">28</reflink>]). This finding adds to the research literature on the linkages between infant and child attachment disorganization and children's externalizing behavior (Fearon et al., [<reflink idref="bib28" id="ref98">28</reflink>]; Lyons-Ruth & Jacobvitz, [<reflink idref="bib42" id="ref99">42</reflink>]; Madigan et al., [<reflink idref="bib44" id="ref100">44</reflink>]; Madigan, Moran, Schuengel, Pederson, & Otten, [<reflink idref="bib45" id="ref101">45</reflink>]). This finding indicates that the negative effect of infant attachment disorganization on externalizing behavior shows up as early as 36 months of child age.</p> <p>In predicting the change in externalizing behavior from 36 to 60 months, we found attachment disorganization was not a significant predictor. Instead, cumulative risk in the first three years was a significant predictor of increases in externalizing behavior consistent with other literature (e.g., Appleyard et al., [<reflink idref="bib5" id="ref102">5</reflink>]). Because attachment disorganization was assessed at 12 months whereas cumulative risk was based on the indicators assessed from 6 to 36 months, it could be that the cumulative risk variable was simply better measured and more proximal to the outcome, and thus the effect of the early relational risk was not apparent. Alternatively, by late preschool ages, as the environment of the child expands to include more experiences outside the home and with other adults, children's externalizing behavior may be more influenced by proximal sociodemographic disadvantages as implied in the cumulative risk variable than by early relationship risks.</p> <p>However, we were primarily interested in illuminating the conditions under which children may show differential changes in externalizing symptoms over the preschool years after experiencing disorganized attachment with their mothers as infants. Contrary to our expectations, attachment disorganization did not interact with child difficult temperament, maternal sensitivity at 24 months and cumulative risk in the first three years in predicting externalizing behavior at 36 months. This may suggest that very early intervention may profitably focus directly on reducing disorganized attachment relationship between the caregiver and the child in the first year if the goal is to prevent externalizing behavior at 36 months. Indeed, researchers have demonstrated success in reducing the incidence of disorganized attachment by improving maternal sensitivity in a pre-post intervention study (Hoffman et al., [<reflink idref="bib36" id="ref103">36</reflink>]), and a randomized clinical trial (Moss et al., [<reflink idref="bib50" id="ref104">50</reflink>]).</p> <p>More importantly, we found that maternal sensitivity at 24 months moderated the association of attachment disorganization levels at 12 months and change in externalizing behavior from 36 to 60 months. When maternal sensitivity was high at 24 months, higher attachment disorganization was associated with a decrease in externalizing behavior from 36 to 60 months. When maternal sensitivity was low or average at 24 months, there was a non-significant association between infant attachment disorganization and change in externalizing behavior from 36 to 60 months. This finding suggests that high level of sensitive care from parents at toddlerhood, as a proximal supportive factor, may help facilitate re-organization of the attachment relationship for children with high attachment disorganization in the first year. This finding is consistent with the meta-analysis of sensitivity-based intervention studies (e.g., Bakermans-Kranenburg et al., [<reflink idref="bib6" id="ref105">6</reflink>]) and other empirical studies (e.g., Forbes et al., [<reflink idref="bib29" id="ref106">29</reflink>]; Hoffman et al., [<reflink idref="bib36" id="ref107">36</reflink>]; Moss et al., [<reflink idref="bib50" id="ref108">50</reflink>]). The support of a sensitive mother for a child who has experienced high attachment disorganization may contribute to the child's enhanced behavioral and attentional control and foster regulation of behavior (Belsky, Fearon, & Bell, [<reflink idref="bib10" id="ref109">10</reflink>]) and decreases in externalizing behavior. Thus, for children who show disorganization in attachment relationships at the end of the first year, intervention efforts focusing on high sensitivity and responsiveness in maternal caregiving during toddlerhood may be an important avenue to reduce externalizing behavior during the preschool ages. While this study focused on the measure of maternal sensitivity at 24 months, future studies may further examine to what extent the change in maternal sensitivity from infancy to toddlerhood might moderate the association between infant attachment disorganization and later externalizing behavior.</p> <p>It is noted that the disorganization X maternal sensitivity effect was significant with the presence of the interactions between disorganization X temperament and disorganization X cumulative risk. It could be that the unique effect of disorganization X maternal sensitivity was able to stand out only when the potential effect of disorganization X temperament and disorganization X cumulative risk were accounted for. It is also noted that frightened/frightening (FR; Main & Hesse, [<reflink idref="bib46" id="ref110">46</reflink>]) and disrupted parenting (Lyons-Ruth, Bronfman, & Parsons, [<reflink idref="bib41" id="ref111">41</reflink>]), two major parenting precursors of attachment disorganization could potentially precipitate children's externalizing behavior. Future research may also be directed at examining the moderating role of FR and disrupted maternal behavior in the association between infant disorganization and level and change in children's externalizing behavior.</p> <p>We did not find that child difficult temperament and cumulative risk were significant moderators in the association between attachment disorganization and change in externalizing behavior during the preschool ages. Regarding the disorganization X child difficult temperament variable, it may be that maternal report of child difficult temperament is not the best measurement approach, and that observational measures of children's reactivity and regulation would have yielded a more robust index of difficult temperament such that a moderation effect would have emerged. Furthermore, the internal consistency of the child difficult temperament scores is relatively low. Testing this interaction effect in another sample with bigger sample size and higher internal consistency in the composite score of child difficult temperament is needed.</p> <p>Regarding the cumulative risk variable, its significant main effect instead of a moderating effect may suggest an alternative avenue for intervention to decrease children's externalizing behavior independent of early attachment disorganization levels. Nevertheless, the null finding in its interaction with attachment disorganization as assessed in a precise mean-based manner is consistent with the null finding from the meta-analysis by Fearon et al. ([<reflink idref="bib28" id="ref112">28</reflink>]) where the cumulative risk was assessed based on high versus low socioeconomic status. Neither this empirical study nor the meta-analysis yielded evidence for a diathesis stress model of attachment disorganization in which children with higher levels of disorganization are at heightened risk for externalizing behavior if they also experience higher levels of socioeconomic adversity. Still, we suggest further research to test the potential interaction between attachment disorganization and cumulative risk in samples where the range of cumulative risks may be larger to help explore a potential interaction effect.</p> <hd id="AN0119278385-24">Limitations and strengths</hd> <p>This study was limited by the moderately sized community sample such that the representation of clinically relevant symptomatology in the sample may be limited. Second, this study focused on moderation pathways in the association between attachment disorganization and children's externalizing behavior during preschool ages. Given this focus, we limited our exploration of interaction terms only to those involving attachment disorganization. Third, our measure of child difficult temperament was based on maternal report reflecting subjective perceptions of child temperament by mothers. This reporter bias of mothers of diverse demographic background, coupled with our relative small sample size, might have compromised the internal consistency of the scores in child difficult temperament composite (Charter, [<reflink idref="bib16" id="ref113">16</reflink>]; Green, Chen, Helms, & Henze, [<reflink idref="bib34" id="ref114">34</reflink>]). Future research may pursue other approaches in assessing child temperament that are more objective such as the use of observational or physiological measures (Karp, Serbin, Stack, & Schwartzman, [<reflink idref="bib37" id="ref115">37</reflink>]). Efforts should also be made to collect child temperament data with larger sample sizes to enhance the internal consistency of the data. Also, we only had two time points to measure change because of our focus on the preschool period. More time points of assessment of externalizing behavior would have allowed estimates of the trajectories of externalizing behavior within one model that includes both the initial point and change in children's externalizing behavior. Lastly, we had substantial missing data in our study sample for some of the key predictors. A small group of children who were relatively more at risk with higher average attachment disorganization score and lower average family income and maternal education than those in the study sample were lost to the analysis due to their missing data on externalizing behavior at both 36 and 60 months. Therefore, our findings may have yielded a conservative estimate of the association of attachment disorganization and later externalizing behavior as well as the relevant conditions that moderate such an association. Although we have taken advantage of multiple imputation procedures to offset the limitation of missing data, we acknowledge the need to replicate our findings in other samples with more complete data and more diverse ranges of attachment disorganization levels, family income and maternal education.</p> <p>Nevertheless, our study adds to the literature by suggesting attachment disorganization as a significant predictor of externalizing behavior as early as 36 months in an ethnically diverse sample at both higher and lower income levels. Many attachment studies involve mostly middle class white samples, so that the use of this sample adds significantly to the literature regarding the linkages between early attachment disorganization and later behavioral difficulties in children. We also add to the literature on cumulative risk with this ethnically and socioeconomically diverse sample as it relates to the increase in externalizing behavior from 36 to 60 months. More importantly, while the literature on attachment disorganization has focused mostly on the main effect prediction of attachment disorganization on child outcomes mostly at school ages, our study is one of the first to examine the conditions under which infant attachment disorganization predicts externalizing behavior during preschool ages. The only other study (Goldberg, Gotowiec, & Simmons, [<reflink idref="bib31" id="ref116">31</reflink>]) that has examined this topic focused on the different medical conditions in preschoolers in understanding the association between infant-mother attachment and behavior problems. Our study suggests that high maternal sensitivity at 24 months is especially crucial for children with high attachment disorganization in attenuating the link between infant attachment disorganization and increases in externalizing behavior from the early to the late preschool years.</p> <p>Our finding is also relevant to a recent discussion in <emph>Attachment and Human Development</emph> on the appropriateness of using observed disorganized attachment behaviors as part of risk assessment for maltreatment and custody decisions (Granqvist, [<reflink idref="bib32" id="ref117">32</reflink>]; Shemmings, [<reflink idref="bib62" id="ref118">62</reflink>]; Steele, [<reflink idref="bib65" id="ref119">65</reflink>]) and on the possibility of alternative non-parantal factors that contribute to attachment disorganization (Granqvist et al., [<reflink idref="bib33" id="ref120">33</reflink>]). Our finding suggests that even when children have developed high attachment disorganization behavior in the first year regardless of reasons, they are not doomed. When supported and nurtured by a high level of maternal sensitivity in toddlerhood, children with higher disorganized attachment actually respond with more decreases in externalizing behavior from the early to the later preschool years. Therefore, intervention for children with infant attachment disorganization may need to focus on supporting parents to be sensitive and responsive to their children's needs and teaching parents effective strategies to facilitate children's behavior organization. Removing these disorganized children from their own parents may not be optimal for both the child (for losing the dear contact with the parent) and the parent (for losing the opportunity to parent better).</p> <hd id="AN0119278385-25">Acknowledgements</hd> <p>This work was supported by The North Carolina Child Development Research Collaborative, which was funded by the National Science Foundation through Children's Research Initiative Grant [NSF-BCS-0126475]. Additional support for the first author in preparation for this work came from the Postdoctoral Research Training Fellowships in Early Intervention and Early Learning in Special Education at the University of Florida funded by the Institute of Educational Sciences [R324B120002]. The authors would like to thank the parents who participated in the Durham Child Health and Development study and the research assistants for their valuable help in collecting these data.</p> <hd id="AN0119278385-26">Disclosure statement</hd> <p>No potential conflict of interest was reported by the authors.</p> <ref id="AN0119278385-27"> <title> References </title> <blist> <bibl id="bib1" idref="ref65" type="bt">1</bibl> <bibtext> Achenbach, T.M., & Rescorla, L.A. (2000). Manual for the ASEBA preschool forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref80" type="bt">2</bibl> <bibtext> Aiken, L.S., & West, S.G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref49" type="bt">3</bibl> <bibtext> Ainsworth, M.D.S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale, NJ: Erlbaum.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref82" type="bt">4</bibl> <bibtext> Allison, P. (2001). Missing data — Quantitative applications in the social sciences (Vol. 136). Thousand Oaks, CA: Sage.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref14" type="bt">5</bibl> <bibtext> Appleyard, K., Egeland, B., van Dulmen, M., & Sroufe, L.A. (2005). When more is not better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry, 46, 235–245. doi:10.1111/j.1469-7610.2004.00351.x</bibtext> </blist> <blist> <bibl id="bib6" idref="ref34" type="bt">6</bibl> <bibtext> Bakermans-Kranenburg, van Ijzendoorn, M.J., van IJzendoorn, M.H., & Juffer, F. (2005). Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal, 26, 191–216. doi:10.1002/imhj.20046</bibtext> </blist> <blist> <bibl id="bib7" idref="ref19" type="bt">7</bibl> <bibtext> Belsky, J. (1997). Theory testing, effect-size evaluation, and differential susceptibility to rearing influence: The case of mothering and attachment. Child Development, 68, 598–600. doi:10.2307/1132110</bibtext> </blist> <blist> <bibl id="bib8" idref="ref13" type="bt">8</bibl> <bibtext> Belsky, J., & Fearon, R.M. (2002a). Early attachment security, subsequent maternal sensitivity, and later child development: Does continuity in development depend upon continuity of caregiving? Attachment & Human Development, 4, 361–387. doi:10.1080/14616730210167267</bibtext> </blist> <blist> <bibl id="bib9" idref="ref53" type="bt">9</bibl> <bibtext> Belsky, J., & Fearon, R.M. (2002b). Infant-mother attachment security, contextual risk, and early development: A moderational analysis. Development and Psychopathology, 14, 293–310. doi:10.1017/S0954579402002067</bibtext> </blist> <blist> <bibtext> Belsky, J., Fearon, R.M.P., & Bell, B. (2007). Parenting, attention, and externalizing problems: Testing mediation longitudinally, repeatedly and reciprocally. Journal of Child Psychology and Psychiatry, 48, 1233–1242. doi:10.1111/j.1469-7610.2007.01807.x</bibtext> </blist> <blist> <bibtext> Belsky, J., Woodworth, S., & Crnic, K. (1996). Trouble in the second year: Three questions about family interaction. Child Development, 67, 556–578. doi:10.2307/1131832</bibtext> </blist> <blist> <bibtext> Burchinal, M., Vernon-Feagans, L., Cox, M., & Key Family Life Project Investigators. (2008). Cumulative social risk, parenting, and infant development in rural low-income communities. Parenting: Science and Practice, 8, 41–69. doi:10.1080/15295190701830672</bibtext> </blist> <blist> <bibtext> Burchinal, M.R., Roberts, J.E., Hooper, S., & Zeisel, S.A. (2000). Cumulative risk and early cognitive development: A comparison of statistical risk models. Developmental Psychology, 36, 793–807. doi:10.1037/0012-1649.36.6.793</bibtext> </blist> <blist> <bibtext> Campbell, S.B., & Ewing, L.J. (1990). Follow-up of hard to manage preschoolers: Adjustment at age 9 and predictors of continuing symptoms. Journal of Child Psychology and Psychiatry, 31, 871–889. doi:10.1111/jcpp.1990.31.issue-6</bibtext> </blist> <blist> <bibtext> Caspi, A., Moffitt, T.E., Newman, D.L., & Silva, P.A. (1998). Behavioral observations at age 3 years predict adult psychiatric disorders: Longitudinal evidence from a birth cohort. In M. E. Hertzig & E. A. Farber (Eds.), Annual progress in child psychiatry and child development (pp. 319–331). Bristol, PA: Brunner Mazel.</bibtext> </blist> <blist> <bibtext> Charter, R.A. (2003). Study samples are too small to produce sufficiently precise reliability coefficients. The Journal of General Psychology, 130, 117–129. doi:10.1080/00221300309601280</bibtext> </blist> <blist> <bibtext> Cicchetti, D., & Rogosch, F.A. (1996). Equifinality and multifinality in developmental psychopathology. Development and Psychopathology, 8, 597–600. doi:10.1017/S0954579400007318</bibtext> </blist> <blist> <bibtext> Cox, M.J. (1997). Qualitative ratings of parent–child interaction at 24–36 months of age (Unpublished manuscript). Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC.</bibtext> </blist> <blist> <bibtext> Cox, M.J., & Paley, B. (2003). Understanding families as systems. Current Directions in Psychological Science, 12, 193–196. doi:10.1111/1467-8721.01259</bibtext> </blist> <blist> <bibtext> Cyr, C., Euser, E.M., Bakermans-Kranenburg, M.J., & van Ijzendoorn, M.H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22, 87–108. doi:10.1017/S0954579409990289</bibtext> </blist> <blist> <bibtext> Dodge, K.A., Coie, J.D., & Lynam, D. (2006). Aggression and antisocial behavior in youth. In N. Eisenberg (Vol. Ed.), D. William, & R. M. Ler- ner, Eds., Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th ed., pp. 719–788). Hoboken, NJ: Wiley.</bibtext> </blist> <blist> <bibtext> Dozier, M., Peloso, E., Lindhiem, O., Gordon, M.K., Manni, M., Sepulveda, S., ... Ackerman, J. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62, 767–785. doi:10.1111/j.1540-4560.2006.00486.x</bibtext> </blist> <blist> <bibtext> Egeland, B., Pianta, R., & Ogawa, J. (1996). Early behavior problems: Pathways to mental disorders in adolescence. Development and Psychopathology, 8, 735–749. doi:10.1017/S0954579400007392</bibtext> </blist> <blist> <bibtext> Erikson, E.H. (1963). Childhood and society (2nd ed.). New York: Norton.</bibtext> </blist> <blist> <bibtext> Evans, G.W. (2003). A multimethodological analysis of cumulative risk and allostatic load among rural children. Developmental Psychology, 39, 924–933. doi:10.1037/0012-1649.39.5.924</bibtext> </blist> <blist> <bibtext> Evans, G.W., Li, D., & Whipple, S.S. (2013). Cumulative risk and child development. Psychological Bulletin, 139, 1342–1396. doi:10.1037/a0031808</bibtext> </blist> <blist> <bibtext> Fearon, R.M., & Belsky, J. (2011). Infant-mother attachment and the growth of externalizing problems across the primary-school years. Journal of Child Psychology and Psychiatry, 52, 782–791. doi:10.1111/j.1469-7610.2010.02350.x</bibtext> </blist> <blist> <bibtext> Fearon, R.P., Bakermans-Kranenburg, M.J., van IJzendoorn, M.H., Lapsley, A.-M., & Roisman, G.I. (2010). The significance of insecure attachment and disorganization in the development of children's externalizing behavior: A meta-analytic study. Child Development, 81, 435–456. doi:10.1111/j.1467-8624.2009.01405.x</bibtext> </blist> <blist> <bibtext> Forbes, L.M., Evans, E.M., Moran, G., & Pederson, D.R. (2007). Change in atypical maternal behavior predicts change in attachment disorganization from 12 to 24 months in a high-risk sample. Child Development, 78, 955–971. doi:10.1111/j.1467-8624.2007.01043.x</bibtext> </blist> <blist> <bibtext> Gedaly, L.R., & Leerkes, E.M. (2016). The role of sociodemographic risk and maternal behavior in the prediction of infant attachment disorganization. Attachment & Human Development, 1–16. Advance online publication. doi:10.1080/14616734.2016.1213306</bibtext> </blist> <blist> <bibtext> Goldberg, S., Gotowiec, A., & Simmons, R.J. (1995). Infant-mother attachment and behavior problems in healthy and chronically ill preschoolers. Development and Psychopathology, 7, 267–282. doi:10.1017/S0954579400006490</bibtext> </blist> <blist> <bibtext> Granqvist, P. (2016). Observations of disorganized behaviour yield no magic wand: Response to Shemmings. Attachment & Human Development, 1–5. Advance online publication. doi:10.1080/14616734.2016.1189994</bibtext> </blist> <blist> <bibtext> Granqvist, P., Hesse, E., Fransson, M., Main, M., Hagekull, B., & Bohlin, G. (2016). Prior participation in the strange situation and overstress jointly facilitate disorganized behaviours: Implications for theory, research and practice. Attachment & Human Development, 18, 235–249. doi:10.1080/14616734.2016.1151061</bibtext> </blist> <blist> <bibtext> Green, C.E., Chen, C.E., Helms, J.E., & Henze, K.T. (2011). Recent reliability reporting practices in Psychological Assessment: Recognizing the people behind the data. Psychological Assessment, 23, 656–669. doi:10.1037/a0023089</bibtext> </blist> <blist> <bibtext> Hill-Soderlund, A.L., & Braungart-Rieker, J.M. (2008). Early individual differences in temperamental reactivity and regulation: Implications for effortful control in early childhood. Infant Behavior and Development, 31, 386–397. doi:10.1016/j.infbeh.2007.12.007</bibtext> </blist> <blist> <bibtext> Hoffman, K.T., Marvin, R.S., Cooper, G., & Powell, B. (2006). Changing toddlers' and preschoolers' attachment classifications: The circle of security intervention. Journal of Consulting and Clinical Psychology, 74, 1017–1026. doi:10.1037/0022-006X.74.6.1017</bibtext> </blist> <blist> <bibtext> Karp, J., Serbin, L.A., Stack, D.M., & Schwartzman, A.E. (2004). An observational measure of children's behavioural style: Evidence supporting a multi-method approach to studying temperament. Infant and Child Development, 13, 135–158. doi:10.1002/icd.346</bibtext> </blist> <blist> <bibtext> Kochanska, G., & Kim, S. (2013). Early attachment organization with both parents and future behavior problems: From infancy to middle childhood. Child Development, 84, 283–296. doi:10.1111/j.1467-8624.2012.01852.x</bibtext> </blist> <blist> <bibtext> Laird, R.D., Pettit, G.S., Dodge, K.A., & Bates, J.E. (2005). Peer relationship antecedents of delinquent behavior in late adolescence: Is there evidence of demographic group differences in developmental processes?. Development and Psychopathology, 17, 127–144. doi:10.1017/S0954579405050078</bibtext> </blist> <blist> <bibtext> Lickenbrock, D.M., Braungart-Rieker, J.M., Ekas, N.V., Zentall, S.R., Oshio, T., & Planalp, E.M. (2013). Early temperament and attachment security with mothers and fathers as predictors of toddler compliance and noncompliance. Infant and Child Development, 22, 580–602. doi:10.1002/icd.1808</bibtext> </blist> <blist> <bibtext> Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. In J. Vondra & D. Barnett (Eds.), Atypical patterns of infant attachment: Theory, research, and current directions. Monographs of the Society for Research in Child Development (Vol. 64(3, Serial No. 258), pp. 67–96). New York, NY: Blackwell.</bibtext> </blist> <blist> <bibtext> Lyons-Ruth, K., & Jacobvitz, D. (2008). Attachment disorganization: Genetic factors, parenting contexts, and developmental transformation from infancy to adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 666–697). New York, NY: Guilford Press.</bibtext> </blist> <blist> <bibtext> Macfie, J., Fitzpatrick, K.L., Rivas, E.M., & Cox, M.J. (2008). Independent influences upon mother-toddler role reversal: Infant-mother attachment disorganization and role reversal in mother's childhood. Attachment & Human Development, 10, 29–39. doi:10.1080/14616730701868589</bibtext> </blist> <blist> <bibtext> Madigan, S., Brumariu, L., Villani, V., Atkinson, L., & Lyons-Ruth, K. (2016). Representational and questionnaire measures of attachment: A meta-analysis of relations to child internalizing and externalizing problems. Psychological Bulletin, 142, 367–399. doi:10.1037/bul0000029</bibtext> </blist> <blist> <bibtext> Madigan, S., Moran, G., Schuengel, C., Pederson, D.R., & Otten, R. (2007). Unresolved maternal attachment representations, disrupted maternal behavior and disorganized attachment in infancy: Links to toddler behavior problems. Journal of Child Psychology and Psychiatry, 48, 1042–1050. doi:10.1111/j.1469-7610.2007.01805.x</bibtext> </blist> <blist> <bibtext> Main, M., & Hesse, E.D. (1990). Parents' unresolved traumatic experiences are related to infant Disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M. Greenberg, D. Cichetti, & M. Cummings (Eds.), Attachment in the preschool years. Chicago: Chicago University Press.</bibtext> </blist> <blist> <bibtext> Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In M. Greenberg, D. Cicchetti, & M. Cummings (Eds.), Attachment in the preschool years: Theory, Research, and Intervention (pp. 121–160). Chicago, IL: University of Chicago Press.</bibtext> </blist> <blist> <bibtext> McElwain, N.L., Holland, A.S., Engle, J.M., & Wong, M.S. (2012). Child anger proneness moderates associations between child-mother attachment security and child behavior with mothers at 33 months. Journal of Family Psychology, 26, 76–86. doi:10.1037/a0026454</bibtext> </blist> <blist> <bibtext> Mills-Koonce, W.R., Propper, C.B., Gariepy, J.-L., Blair, C., Garrett-Peters, P., & Cox, M.J. (2007). Bidirectional genetic and environmental influences on mother and child behavior: The family system as the unit of analyses. Development and Psychopathology, 19, 1073–1087. doi:10.1017/S0954579407000545</bibtext> </blist> <blist> <bibtext> Moss, E., Dubois-Comtois, K., Cyr, C., Tarabulsy, G.M., St. Laurent, D., & Bernier, A. (2011). Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: A randomized control trial. Development and Psychopathology, 23, 195–210. doi:10.1017/S0954579410000738</bibtext> </blist> <blist> <bibtext> NICHD Early Child Care Research Network. (2004). Trajectories of physical aggression from toddlerhood to middle childhood: Predictors, correlates, and outcomes. Monographs of the Society for Research in Child Development. Serial No. 278, 69(4), 1–129. doi:10.1111/j.0037-976X.2004.00312.x</bibtext> </blist> <blist> <bibtext> Propper, C., Moore, G.A., Mills-Koonce, W.R., Halpern, C.T., Hill-Soderlund, A.L., Calkins, S.D., & Cox, M. (2008). Gene-environment contributions to the development of infant vagal reactivity: The interaction of dopamine and maternal sensitivity. Child Development, 79, 1377–1394. doi:10.1111/j.1467-8624.2008.01194.x</bibtext> </blist> <blist> <bibtext> Putnam, S.P., & Stifter, C.A. (2008). Reactivity and regulation: The impact of Mary Rothbart on the study of temperament. Infant and Child Development, 17, 311–320. doi:10.1002/icd.583</bibtext> </blist> <blist> <bibtext> Rothbart, M.K. (1981). Measurement of temperament in infancy. Child Development, 52, 569–578. doi:10.2307/1129176</bibtext> </blist> <blist> <bibtext> Rothbart, M.K., & Bates, J.E. (2006). Temperament. In W. Damon, R. Lerner, & N. Eisenberg (Eds.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th ed., pp. 99–166). New York: Wiley.</bibtext> </blist> <blist> <bibtext> Rothbart, M.K., & Derryberry, D. (1981). Development of individual differences in temperament. In M. E. Lamb & A. L. Brown (Eds.), Advances in developmental psychology (Vol. 1, pp. 37–86). Hillsdale, NJ: Erlbaum.</bibtext> </blist> <blist> <bibtext> Rothbart, M.K., & Sheese, B.E. (2007). Temperament and emotion regulation. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 331–350). New York, NY: Guilford Press.</bibtext> </blist> <blist> <bibtext> Rubin, D.B. (1987). Multiple imputation for nonresponse in surveys. New York, NY: John Wiley & Sons.</bibtext> </blist> <blist> <bibtext> Rutter, M. (1985). Resilience in the face of adversity. Protective factors and resistance to psychiatric disorder. TheBritish Journal of Psychiatry, 147, 598–611. doi:10.1192/bjp.147.6.598</bibtext> </blist> <blist> <bibtext> Sameroff, A.J., Seifer, R., Baldwin, A., & Baldwin, C. (1993). Stability of intelligence from preschool to adolescence: The influence of social and family risk factors. Child Development, 64, 80–97. doi:10.2307/1131438</bibtext> </blist> <blist> <bibtext> Shaw, D.S., Owens, E.B., Vondra, J.I., Keenan, K., & Winslow, E.B. (1996). Early risk factors and pathways in the development of early disruptive behavior problems. Development and Psychopathology, 8, 679–699. doi:10.1017/S0954579400007367</bibtext> </blist> <blist> <bibtext> Shemmings, D. (2016). Letter. Attachment & Human Development, 1–3. doi:10.1080/14616734.2016.1189995</bibtext> </blist> <blist> <bibtext> Sroufe, L.A., Egeland, B., Carlson, E.A., & Collins, W.A. (2005). The development of the person: The Minnesota study of risk and adaptation from birth to adulthood. New York, NY: Guilford Press.</bibtext> </blist> <blist> <bibtext> Stams, G.J.M., Juffer, F., & van IJzendoorn, M.H. (2002). Maternal sensitivity, infant attachment, and temperament in early childhood predict adjustment in middle childhood: The case of adopted children and their biologically unrelated parents. Developmental Psychology, 38, 806–821. doi:10.1037/0012-1649.38.5.806</bibtext> </blist> <blist> <bibtext> Steele, H. (2016). Disorganized attachment and risk assessment: A topic for ongoing discussion. Attachment & Human Development, 1. Advance online publication. doi:10.1080/14616734.2016.1189996</bibtext> </blist> <blist> <bibtext> Stupica, B., Sherman, L.J., & Cassidy, J. (2011). Newborn irritability moderates the association between infant attachment security and toddler exploration and sociability. Child Development, 82, 1381–1389. doi:10.1111/j.1467-8624.2011.01638.x</bibtext> </blist> <blist> <bibtext> Thomas, A., & Chess, S. (1977). Temperament and development. New York: Brunner.</bibtext> </blist> <blist> <bibtext> Troxel, W.M., Trentacosta, C.J., Forbes, E.E., & Campbell, S.B. (2013). Negative emotionality moderates associations among attachment, toddler sleep, and later problem behaviors. Journal of Family Psychology, 27, 127–136. doi:10.1037/a0031149</bibtext> </blist> <blist> <bibtext> Van Zeijl, J., Mesman, J., Van IJzendoorn, M.H., Bakermans-Kranenburg, M. J., Juffer, F., Stolk, M.N., ... Alink, L.R. (2006). Attachment-based intervention for enhancing sensitive discipline in mothers of 1- to 3-year-old children at risk for externalizing behavior problems: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 994–1005. doi:10.1037/0022-006X.74.6.994</bibtext> </blist> <blist> <bibtext> Vaughn, B.E., Bost, K.K., & van Ijzendoorn, M.H. (2008). Attachment and temperament: Additive and interactive influences on behavior, affect, and cognition during infancy and childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 192–216). New York, NY: Guilford Press.</bibtext> </blist> <blist> <bibtext> Yuan, Y.C. (2014). Multiple imputation for missing data: Concepts and new development. the University of California Los Angeles, Institute for Digital Research and Education Retrieved from <ulink href="http://www.ats.ucla.edu/stat/sas/library/multipleimpution.pdf">http://www.ats.ucla.edu/stat/sas/library/multipleimpution.pdf</ulink></bibtext> </blist> </ref> <aug> <p>By Feihong Wang; Michael Willoughby; Roger Mills-Koonce and Martha J. Cox</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib47" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib24" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib43" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib17" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib28" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib42" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib44" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib19" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib55" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib61" firstref="ref12"></nolink> <nolink nlid="nl11" bibid="bib20" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib57" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib67" firstref="ref17"></nolink> <nolink nlid="nl14" bibid="bib53" firstref="ref18"></nolink> <nolink nlid="nl15" bibid="bib38" firstref="ref20"></nolink> <nolink nlid="nl16" bibid="bib40" firstref="ref21"></nolink> <nolink nlid="nl17" bibid="bib48" firstref="ref22"></nolink> <nolink nlid="nl18" bibid="bib66" firstref="ref23"></nolink> <nolink nlid="nl19" bibid="bib68" firstref="ref24"></nolink> <nolink nlid="nl20" bibid="bib70" firstref="ref25"></nolink> <nolink nlid="nl21" bibid="bib64" firstref="ref27"></nolink> <nolink nlid="nl22" bibid="bib63" firstref="ref28"></nolink> <nolink nlid="nl23" bibid="bib22" firstref="ref29"></nolink> <nolink nlid="nl24" bibid="bib51" firstref="ref30"></nolink> <nolink nlid="nl25" bibid="bib52" firstref="ref31"></nolink> <nolink nlid="nl26" bibid="bib69" firstref="ref32"></nolink> <nolink nlid="nl27" bibid="bib30" firstref="ref35"></nolink> <nolink nlid="nl28" bibid="bib29" firstref="ref36"></nolink> <nolink nlid="nl29" bibid="bib36" firstref="ref37"></nolink> <nolink nlid="nl30" bibid="bib50" firstref="ref38"></nolink> <nolink nlid="nl31" bibid="bib11" firstref="ref41"></nolink> <nolink nlid="nl32" bibid="bib49" firstref="ref42"></nolink> <nolink nlid="nl33" bibid="bib25" firstref="ref43"></nolink> <nolink nlid="nl34" bibid="bib59" firstref="ref44"></nolink> <nolink nlid="nl35" bibid="bib60" firstref="ref45"></nolink> <nolink nlid="nl36" bibid="bib26" firstref="ref46"></nolink> <nolink nlid="nl37" bibid="bib27" firstref="ref54"></nolink> <nolink nlid="nl38" bibid="bib13" firstref="ref55"></nolink> <nolink nlid="nl39" bibid="bib12" firstref="ref56"></nolink> <nolink nlid="nl40" bibid="bib15" firstref="ref62"></nolink> <nolink nlid="nl41" bibid="bib23" firstref="ref63"></nolink> <nolink nlid="nl42" bibid="bib14" firstref="ref64"></nolink> <nolink nlid="nl43" bibid="bib54" firstref="ref69"></nolink> <nolink nlid="nl44" bibid="bib21" firstref="ref71"></nolink> <nolink nlid="nl45" bibid="bib39" firstref="ref72"></nolink> <nolink nlid="nl46" bibid="bib56" firstref="ref77"></nolink> <nolink nlid="nl47" bibid="bib35" firstref="ref83"></nolink> <nolink nlid="nl48" bibid="bib18" firstref="ref84"></nolink> <nolink nlid="nl49" bibid="bib58" firstref="ref90"></nolink> <nolink nlid="nl50" bibid="bib71" firstref="ref91"></nolink> <nolink nlid="nl51" bibid="bib10" firstref="ref96"></nolink> <nolink nlid="nl52" bibid="bib45" firstref="ref101"></nolink> <nolink nlid="nl53" bibid="bib46" firstref="ref110"></nolink> <nolink nlid="nl54" bibid="bib41" firstref="ref111"></nolink> <nolink nlid="nl55" bibid="bib16" firstref="ref113"></nolink> <nolink nlid="nl56" bibid="bib34" firstref="ref114"></nolink> <nolink nlid="nl57" bibid="bib37" firstref="ref115"></nolink> <nolink nlid="nl58" bibid="bib31" firstref="ref116"></nolink> <nolink nlid="nl59" bibid="bib32" firstref="ref117"></nolink> <nolink nlid="nl60" bibid="bib62" firstref="ref118"></nolink> <nolink nlid="nl61" bibid="bib65" firstref="ref119"></nolink> <nolink nlid="nl62" bibid="bib33" firstref="ref120"></nolink>
CustomLinks:
  – Url: https://eric.ed.gov/contentdelivery/servlet/ERICServlet?accno=ED581282
    Name: ERIC Full Text
    Category: fullText
    Text: Full Text from ERIC
Header DbId: eric
DbLabel: ERIC
An: ED581282
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Infant Attachment Disorganization and Moderation Pathways to Level and Change in Externalizing Behavior during Preschool Ages
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Wang%2C+Feihong%22">Wang, Feihong</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-4412-7583">0000-0003-4412-7583</externalLink>)<br /><searchLink fieldCode="AR" term="%22Willoughby%2C+Michael%22">Willoughby, Michael</searchLink><br /><searchLink fieldCode="AR" term="%22Mills-Koonce%2C+Roger%22">Mills-Koonce, Roger</searchLink><br /><searchLink fieldCode="AR" term="%22Cox%2C+Martha+J%2E%22">Cox, Martha J.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Grantee+Submission%22"><i>Grantee Submission</i></searchLink>. 2016 18(6):534-553.
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 21
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2016
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: Institute of Education Sciences (ED)<br />National Science Foundation (NSF)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: R324B120002<br />NSFBCS0126475
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Infants%22">Infants</searchLink><br /><searchLink fieldCode="DE" term="%22Infant+Behavior%22">Infant Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Attachment+Behavior%22">Attachment Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Least+Squares+Statistics%22">Least Squares Statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Risk%22">Risk</searchLink><br /><searchLink fieldCode="DE" term="%22Interaction%22">Interaction</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Influence%22">Parent Influence</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Personality+Traits%22">Personality Traits</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+Studies%22">Longitudinal Studies</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Ethnicity%22">Ethnicity</searchLink><br /><searchLink fieldCode="DE" term="%22Video+Technology%22">Video Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+Analysis%22">Statistical Analysis</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22North+Carolina+%28Durham%29%22">North Carolina (Durham)</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Rothbart+Infant+Behavior+Questionnaire%22">Rothbart Infant Behavior Questionnaire</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/14616734.2016.1243139
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1461-6734
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This research examined the child, parent, and family conditions under which attachment disorganization was related to both level and change in externalizing behavior during preschool among a community sample. Using the ordinary least squares regression, we found that attachment disorganization at 12 months significantly predicted children's externalizing behavior at 36 months and this prediction was not contingent on any other factors tested. For predicting changes in externalizing behavior from 36 to 60 months, we found a significant main effect of family cumulative risk and an interaction effect between attachment disorganization at 12 months and maternal sensitivity at 24 months. Specifically, high disorganization was related to a significant decrease in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high. Our main-effect findings replicated the significant effect of attachment disorganization and cumulative risk on externalizing behavior with preschool-aged children. Our interaction finding provided support for understanding the parenting conditions under which infant attachment disorganization may be related to change in externalizing behavior during preschool ages. Implications of the findings were discussed.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 71
– Name: CodeSource
  Label: IES Funded
  Group: SrcInfo
  Data: Yes
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2018
– Name: AN
  Label: Accession Number
  Group: ID
  Data: ED581282
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=ED581282
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/14616734.2016.1243139
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 21
        StartPage: 534
    Subjects:
      – SubjectFull: Infants
        Type: general
      – SubjectFull: Infant Behavior
        Type: general
      – SubjectFull: Attachment Behavior
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Least Squares Statistics
        Type: general
      – SubjectFull: Age Differences
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Risk
        Type: general
      – SubjectFull: Interaction
        Type: general
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Parent Influence
        Type: general
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Personality Traits
        Type: general
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Longitudinal Studies
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Ethnicity
        Type: general
      – SubjectFull: Video Technology
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Statistical Analysis
        Type: general
      – SubjectFull: North Carolina (Durham)
        Type: general
      – SubjectFull: Rothbart Infant Behavior Questionnaire
        Type: general
    Titles:
      – TitleFull: Infant Attachment Disorganization and Moderation Pathways to Level and Change in Externalizing Behavior during Preschool Ages
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Wang, Feihong
      – PersonEntity:
          Name:
            NameFull: Willoughby, Michael
      – PersonEntity:
          Name:
            NameFull: Mills-Koonce, Roger
      – PersonEntity:
          Name:
            NameFull: Cox, Martha J.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2016
          Identifiers:
            – Type: issn-print
              Value: 1461-6734
          Numbering:
            – Type: volume
              Value: 18
            – Type: issue
              Value: 6
          Titles:
            – TitleFull: Grantee Submission
              Type: main
ResultId 1