1. family and parenting
2. babies and toddlers

Developmental Psychology
1996, Vol. 32, No. 5,914-920
Copyright 19% by the American Psychological Association Inc
00I2-I649/96/S3.00
Attachment Security in Very Low Birth Weight Infants
Sarah C. Mangelsdorf
James W. Plunkett, Cynthia F. Dedrick,
Meryl Berlin, and Samuel J. Meisels
University of Illinois
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
University of Michigan
Jean L. McHale
Margo Dichtellmiller
University of Illinois
University of Michigan
Infants of very low birth weight (VLBW) (n = 34) and a comparison group of 40 full-term infants
were observed in Ainsworth's Strange Situation at 14 and 19 months and observed in the home at 14
months of age, using Waters's Attachment Q-set. Results indicated that at 14 months VLBW infants
were more likely than the full-term infants to be insecurely attached when rated using the Q-set but
not when using the Strange Situation. However, at 19 months VLBW infants were also more likely
than full-term infants to be insecurely attached in the Strange Situation assessment. There were no
associations between the Q-set and Strange Situation measures of attachment security. These results
are discussed in terms of the social-emotional development of VLBW infants.
In recent years there has been a growing interest in the development of preterm infants (Meisels & Plunkett, 1988). In part
this interest is a result of changing medical technologies that
make it possible for infants to survive at lower birth weights and
shorter gestational ages than ever before. This interest is also
due to increasingly broad conceptual models (e.g., Sameroff &
Chandler, 1975) that have suggested researchers adopt an integrative perspective about development. The study of preterm
infants offers researchers the opportunity to examine the interaction of biological, environmental, and social factors that
influence subsequent developmental outcomes.
Of particular interest to many researchers has been the development of infant-parent relationships. It has been thought that
the early interactions of preterm infant-parent dyads may be
disrupted because of the infants' potentially long hospital stays
and the often intrusive medical treatments. Indeed, there is considerable research that suggests that the interaction patterns of
preterm infants and their caregivers are quite different from the
interaction patterns of full-term infants and their caregivers
(Brachfeld, Goldberg, & Sloman, 1980; Brown & Bakeman,
1980; Crawford, 1982; Crnic, Ragozin, Greenberg, Robinson,
&Basham, 1983; DiVitto& Goldberg, 1979; Field, 1977, 1979;
Mann, Plunkett, Meisels, & Bozynski, 1988). In general, these
findings suggest that preterm infants are less socially responsive
and harder to soothe than full-term infants. It has also been
noted that mothers of preterm infants tend to be more highly
stimulating than mothers of normal infants.
Given the differences in interactional patterns noted between
preterm infants and their mothers, one might expect that attachment relationships would also differ in a preterm sample.
Particularly, if one sees the stimulating style of the mothers of
preterm infants to be maladaptive, then one might anticipate
that there would be a higher incidence of insecure attachment in
preterm infant-caregiver dyads. It is surprising that in studies
examining infant-caregiver attachment in preterm infants, the
distributions of the secure and insecure relationships have
generally been comparable to those in full-term samples
(Easterbrooks, 1989; Frodi & Thompson, 1985; Goldberg, Perrotta, Minde, & Corter, 1986; Rode, Chang, Fisch, & Sroufe,
1981). In fact, in a meta-analysis of attachment studies conducted on clinical samples, van IJzendoorn, Goldberg, Kroonenberg, and Frenkel (1992) examined the relative effects of maternal or child problems on security of attachment and found
that child problems (including prematurity) were less likely to
result in deviations from normal distributions than were maternal problems. However, in the meta-analysis the studies of premature infants focused on infants of relatively low risk by contemporary standards. For example, the mean birth weight of
infants in those studies was over 1,500 grams, and their gestational ages were over 30 weeks, whereas, in recent years infants
have been surviving when born at gestational ages of under 30
weeks and birth weights of less than 1,000 grams (Office of
Technology Assessment, 1987).
Sarah C. Mangelsdorf and Jean L. McHale, Department of Psychology, University of Illinois: James W. Plunkett, University Center for the
Child and Family, University of Michigan: Cynthia F. Dedrick, Samuel
J. Meisels, and Margo Dichtellmiller, School of Education, University
of Michigan; Meryl Berlin, Department of Psychology, University of
Michigan. Cynthia F. Dedrick is now at the Division of Child Development, Tampa General Hospital. Tampa, Florida: Meryl Berlin is now in
private practice in Boca Raton, Florida.
This research was supported by grants from the National Institute
of Disability and Rehabilitation Research. Special thanks to Dr. Mary
Bozynski who as one of the principal investigators of the larger research
project recruited the very low birth weight subjects. We thank Kate Restrick for help with data collection and Gregory Stuart for help with
coding. Thanks also to Marissa Diener, Karl Rosengren, and Brian
Vaughn for reading and commenting on an earlier draft of this paper.
Correspondence concerning this article should be sent to Sarah C.
Mangelsdorf, Department of Psychology, University of Illinois. 603 East
Daniel, Champaign. Illinois 61820.
Furthermore, even in studies in which no main effect of pre914
915
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ATTACHMENT IN VLBW INFANTS
maturity on security has been noted when preterm infants have
been stratified according to various risk factors, differences in
attachment security do emerge. For example, when high-risk,
sick preterm infants are compared with healthy preterm infants, differences in attachment security have been noted
(Plunkett, Meisels, Stiefel, Pasick, & RolofT, 1986), with the
high-risk infants manifesting a higher rate of insecure-resistant
relationships than the healthy infants. Plunkett et al. (1986)
interpreted these findings to suggest that chronic illness may
create anxiety in caregivers, and this anxiety coupled with a
hard-to-soothe preterm infant may lead to a higher rate of insecure resistant relationships than among the healthy infants.
Likewise, in a study of high-risk preterm infants born to mothers of low socioeconomic status, a greater proportion of preterm
infants were found to be insecurely attached than was found in
a full-term control group (Wille, 1991). However, when Goldberg et al. (1986) also stratified preterm infants by risk status
and at 1 year of age, 75% of their participants were securely
attached and, surprisingly, severity of illness was associated with
greater security. Given the contradictory nature of the findings
from these various investigations, further research is necessary
to get a more complete picture of the effects of risk on the attachment security of preterm infants.
Although there have been numerous studies of parent-child
interaction in preterm infants, there have been few studies of
preterm infants that have examined parent-child interaction
in the home. One exception is the work of Goldberg and her
colleagues. Goldberg et al. (1986) rated mother and infant behavior during home observations at 6 weeks and at 3, 6, and 9
months in a sample of preterm infants. They found a significantly higher number of Bl and B4 (subclassifications of the
secure group) infants in their sample than is typically found,
and they described these infants as "marginally secure." Surprisingly, mothers of these marginally secure infants were rated
as being less sensitive than mothers of insecurely attached infants at 3, 6, and 9 months of age. Thus, it is clear that more
research is needed that examines the interaction of preterm infants and their caregivers in the home.
Home assessment of normative parent-infant interaction has
been advanced in recent years by the development of the Attachment Q-Set (Waters, 1995; Waters & Deane, 1985). A
number of investigators have used the Attachment Q-Set
(Pederson, Moran, Bento, & Buckland, 1992; Pederson et al.,
1990; Vaughn & Waters, 1990; Waters & Deane, 1985) to assess
attachment behavior in the home. One advantage of examining
secure base behavior in the home is that in doing so the observer
is provided with opportunities to witness a wide range of behaviors in an array of contexts. In contrast, laboratory procedures
such as the Strange Situation focus on behavior within a stressful or emotionally challenging situation. Given that the Strange
Situation was validated on healthy full-term infants, it makes
sense to examine whether the Attachment Q-Set and the
Strange Situation yield similar information about the attachment behavior of high-risk preterm infants. A number of investigations have explored the convergence between the Attachment Q-Set and the Strange Situation procedure in healthy fullterm infants. In general, some of those studies have indicated
that the data obtained from the Attachment Q-Set and the
Strange Situation are significantly associated (Howes & Hamil-
ton, 1992; Pederson et al., 1992; Vaughn & Waters, 1990).
However, some investigations have not noted this convergence
(Jaeger, Weinraub, Becker, & Jaeger, 1989; Pettit, 1991; van
Dam & van Uzendoorn, 1988).
Thus, although there is considerable information regarding
parent-child interaction and attachment in preterm infants,
few naturalistic observations of parent-child interaction have
been conducted. In addition, few studies have examined highrisk infants of very low birth weight (VLBW). Given the rapid
technological advancement in neonatology, there are significant
cohort differences among studies conducted over the last 15
years. Recent cohorts of high-risk preterm infants are significantly smaller, younger, and at higher risk than earlier cohorts.
Thus, differences between preterm and full-term infants have
to be reexamined in light of an increasingly high-risk population of preterm infants. Thus the goals of the current study are
(a) to examine whether there are differences in security of attachment in the Strange Situation among VLBW infants compared with full-term infants, (b) to examine the stability of attachment security from 14 to 19 months, (c) to compare
VLBW infants with a full-term comparison group on the attachment Q-sort, and (d) to compare associations of the attachment Q-sort and the Strange Situation in both VLBW and fullterm infants.
Method
Participants
Participants were enrolled from consecutive admissions to a neonatal
intensive care unit at the University of Michigan Hospital. The focus of
this research was on the highest risk preterm infants (see Table 1). Infants who had birth weights of less than 1,250 grams, lived within a 50mile radius of Ann Arbor, and did not have any of the exclusionary
criteria were included in the study. However, as can be seen in Table 1,
the average birth weight of the infants in this investigation was under
1,000 grams. Conditions for exclusion included retrolental fibroplasia,
multiple congenital anomalies or syndromes, bilateral severe sensorineural hearing loss, microcephaly, in utero infections such as Toxoplasmosis, rubella, and herpes that may cause congenital abnormalities, severe intrauterine growth retardation, maternal drug addiction, and maternal age of less than 17 years.
During the enrollment period, which spanned 2 years, 155 preterm
infants weighing less than 1,250 grams were born at the University of
Table 1
Birth, Neonatal, and Postnatal Characteristics
of VLBW Participants (N = 37)
Characteristic
M
SD
Birth weight (g)
Gestational ages (weeks)
Apgar: 1 min
Apgar: 5 min
Days hospitalized
Days ventilated
Days on oxygen
Days to regain birth weight
955.1
27.9
4.6
6.7
86.2
36.9
51.6
11.4
201.4
2.2
2.1
1.6
38.3
31.5
45.1
5.9
Note. VLBW = very low birth weight. The Apgar (V. Apgar, 1953) is
a standard neonatal assessment measure.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
916
MANGELSDORF ET AL.
Michigan Hospital. Of these infants, 46 died prior to discharge and 41
did not meet certain of the eligibility criteria. A total of 68 infants were
considered eligible for the study. Of this group, 1 infant died subsequent
to discharge, 8 refused to participate, and 1 infant was discharged before
the family could be recruited. The final sample consisted of 58 preterm
infants and their families. The 10 infants available for study who did
not participate did not differ from the 58 study participants on birth
weight or length of hospitalization.
All of the VLBW participants received respiratory ventilation and
received oxygen after birth. The participants were born on the average 3
months prematurely and were hospitalized for the first 3 months of their
lives. Finally, the average birth weight for this group was under 1000
grams. Characteristics of the sample are provided in Table 1.
Ten of the 58 VLBW participants either did not have Q-set data because the family was unable to be contacted (phone disconnected, etc.),
because of scheduling problems (e.g., the child was hospitalized at the
time of one of the assessments, a sibling was born), or because the Q-set
visits did not both take place within 3 weeks of the 14-month birthday
(corrected age). Six other participants were not able to be scored using
the Q-set because the child was severely delayed or impaired. An additional 7 infants were not seen in one of the two Strange Situation assessments or the assessments did not take place within 2 weeks of either
their 14-month or 19-month birthdays. For the purposes of this report,
the final sample of VLBW infants consisted of 37 infants who were seen
in the Strange Situation in the laboratory at both 14 and 19 months.
A full-term comparison group was enrolled from hospital records.
Infants had to be between 38 and 42 weeks gestation, have a birth weight
of between 3,100 and 3,700 grams, and not show evidence of abnormalities in the postpartum period. An attempt was made to match the
VLBW and full-term groups on basic demographics (see Table 2). The
focus of this study is the 37 VLBW infants and 42 full-term infants for
whom we have complete Strange Situation data at both 14 and 19
months. However, because these data included 3 twin pairs in the
VLBW group and 2 twin pairs in the full-term group, we randomly
selected one twin from each of these twin pairs; thus the resulting sample sizes were 34 VLBW and 40 full-term infants.
Measures
Infants were seen in Ainsworth's Strange Situation (Ainsworth,
Blehar, Waters, & Wall, 1978) at 14 months ( + or - 2 weeks) and 19
Table 2
Demographic Characteristics of VLBW
and Full-Term Participants
Demographic
characteristic
Maternal age (years)
M
SD
Parity (% primiparous)
Twins (no. of pairs)
Race (% Caucasian)
Sex (% male)
SES (%)
Class 1
Class 2
Class 3
Class 4
Class 5
VLBW
(« = 37)
Fullterm
(n = 42)
27.5
5.2
51.4
3
89.2
54.1
28.9
4.0
35.7
2
95.1
40.5
10.8
35.1
24.3
16.2
13.5
28.6
35.7
14.3
14.3
7.1
Note. VLBW = very low birth weight; SES = socioeconomic status as
measured by the Hollingshead (1975) index. All p values were nonsignificant.
months (+ or — 2 weeks). VLBW infants' ages were corrected for gestational age. Standard procedures and scoring were used. The 14-month
tapes were coded by Sarah C. Mangelsdorf and James W. Plunkett, who
were trained by L. A. Sroufe. The 19-month tapes were coded by two
students who had been trained by Sarah C. Mangelsdorf. The 19-month
coders began coding tapes only after they had achieved 95% reliability
with Sarah C. Mangelsdorf on a sample of 20 pilot tapes. Both sets of
coders had reliability (for the three attachment categories) of 90%. As a
check of the 19-month coders, 15% of the 19-month tapes were coded
by James W. Plunkett, and his agreement with the 19-month coders was
100%.
Waters's 90-item Attachment Q-Set (Waters, 1995) was used at 14
months (+ or — 3 weeks). The two home visits took place within 1 week
of each other and within 2 weeks of the 14-month Strange Situation
assessment. The sets of coders for the Strange Situation and the Q-set
observers were independent and unaware of the data obtained by the
others. After extensive training in consultation with the senior investigators and reliability checks, two advanced graduate students together
observed each child for two 1 '/2 hour sessions. The second visit occurred
within 7 days of the first visit. At the completion of each observation,
each observer independently completed a Q-sort. A composite sort for
each child was created from the average of these four observations. All
sorts were compared with the Criterion Security Sort provided by Waters (1995). Interrater generalizability and reliability coefficients for the
Attachment Q-Sort were .76 for full-terms and .85 for preterms
(Dedrick, Dedrick. & Berlin, 1992). It should be noted that although
all attempts were made to keep the research assistants unaware of the
birth status of the infants, it was sometimes impossible to conceal birth
status (e.g., some of the VLBW infants were still receiving oxygen at the
time of the home visits).
Results
The first set of analyses focused on how attachment security
as assessed in the Strange Situation varied as a function of birth
status. At 14 months, 55% (n = 19) of the VLBW infants were
rated as secure, 21 % (n = 7) as avoidant, 15% (n = 5) as resistant, and 8% (n = 3) were rated as exhibiting high levels of
avoidance and resistance in the reunion episodes and were thus
classified as A/C; 67.5% (n = 27) of the full-term infants were
classified as secure, 12.5% (n = 5) as avoidant, 17.5% (n = 7)
as resistant, and 2.5% (n = 1) as A/C. At 19 months, 47% (n =
16) of the VLBW infants were rated as secure, 26.5% (n = 9) as
avoidant, and 26.5% (n = 9) as resistant; 75% (n = 30) of the
full-term infants were classified as secure, 15% (n = 6) as avoidant, and 10% (« = 4) as resistant. To assess whether the VLBW
infants and the full-term infants differed on attachment classifications, chi-squares were performed on both the 14- and 19month data (see Table 3). Due to the very low frequency, infants classified as A / C were not included in this analysis, thus
the percentages differ from those just reported. There were no
significant differences in A, B, and C attachment distributions
as a function of birth status at 14 months, but at 19 months the
attachment distributions of the full-term and preterm infants
were significantly different, x 2 = 6.34 (2, N = 74), p < .05. To
increase the power of the tests, secondary analyses were performed on classifications of secure versus insecure (see Table
4). Infants classified as A / C were included in the insecure
group in these analyses. Once again there were no significant
differences at 14 months, but at 19 months VLBW infants were
less likely to be securely attached than full-term infants
(Fisher's exact test, p = .013).
917
ATTACHMENT IN VLBW INFANTS
Table 3
Strange Situation Classifications at 14 and 19
Months (in Percentages)
Assessment
14 month
VLBW
FT
19 month
VLBW
FT
n
A
B
C
X2
P
31
39
23
13
61
69
16
18
2.58
ns
34
40
26
15
47
75
26
10
6.34
.04
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Note. Participants classified as A/C are not reported in this table.
VLBW = very low birth weight; FT = full term.
We next examined the stability of Strange Situation attachment classifications from 14 to 19 months and whether the stability differed as a function of birth status. The stability of A, B,
and C classifications was 53% for the VLBW infants and 60%
for the full-term infants. The stability of the secure/insecure
groupings was 60% for the VLBW infants and 65% for the fullterm infants. Although there was slightly greater stability of attachment classifications from 14 to 19 months for the full-term
infants than for the VLBW infants, this difference was not statistically significant. Some investigators (e.g., Thompson,
Lamb, & Estes, 1982) have noted that there is higher stability
in B-group classifications than in A- and C-group classifications
and that there is a tendency for insecure babies to become secure over time. To explore this we examined the percentage of
babies that shifted toward security as a function of birth status.
For the full-term infants, 75% of the infants classified as insecurely attached at 14 months became securely attached at 19
months, whereas only 17% of the infants who had been classified as secure became insecure. In contrast, for the VLBW
infants the change rates for security and insecurity were identical, 41%.
We next examined group differences on the Attachment QSet. A t test was conducted comparing the scores of VLBW and
full-term infants on the attachment criterion sort. The results
of these analyses indicated that as predicted, on the criterion
sort VLBW infants were seen as less secure (t = 1.75, p < .05,
one-tailed).
Thefinalanalysis was conducted in order to examine the congruence of the Attachment Q-Set security ratings and Strange
Situation classifications at 14 months. A one-way analysis of
variance was conducted using the three attachment categories
as the grouping variables, and the Attachment Q-Set security
score as the dependent variable. The infants classified as A/C
were not included in this analysis. Surprisingly, this analysis indicated that there were no significant associations between the
attachment classifications from the Strange Situation and the
overall security scores from the attachment Q-sort. To increase
statistical power, the two insecure groups (A and C and A/C)
were combined to yield one group for insecure/secure comparison on the Attachment Q-Set security score. This analysis was
also not significant.
Discussion
Thefindingsof this investigation indicate that high-risk preterm infants may be at greater risk for insecure attachment than
full-term infants. This was noted using the Attachment Q-Set
at 14 months in the home and the Strange Situation in the laboratory at 19 months. Thisfindingis consistent with some earlier
research with high-risk preterm infants (Plunkett et al., 1986;
Wille, 1991) but not with all investigations. However, the current sample was very high-risk (average birth weight = 955
grams), and the infants were observed twice in the Strange Situation procedure. Only one other investigation of attachment
security in preterm infants has included more than one Strange
Situation assessment (Easterbrooks, 1989). If one only examines the Strange Situation data from the first assessment, the
data from this investigation do not appear different from other
earlier investigations. It is possible that with this group of particularly high-risk infants, the effects of prematurity do not dissipate over time, as has been found in preterm samples with
higher birth weight, but rather become more evident. More extensive longitudinal investigation of the socioemotional development of these children will allow for further examination of
these issues.
The stability of Strange Situation classifications from 14 to
19 months in this sample was comparable to that of a number of
other investigations (see Campos, Barrett, Lamb, Goldsmith,
& Stenberg, 1983) for a review. Thompson and his colleagues
(Thompson et al., 1982) in their examination of stability of attachment over time noted a higher stability in B-group classifications than in A- and C-group classifications and a tendency
for insecure babies to become secure over time. In our investigation this "self-righting tendency" (Sameroff & Chandler,
1975) was only noted for the full-term infants, as the preterm
infants were just as likely to shift from security to insecurity as
vice versa. It is possible that the stability of Strange Situation
classifications over time may have been higher if the same coders
had coded both the 14- and 19-month Strange Situations; however, given the high degree of reliability found between the 14
and 19 month coders, we do not believe using two different sets
of coders compromised the degree of stability obtained in this
investigation. Moreover, in the only other study (Easterbrooks,
1989) that has studied stability of attachment across time in a
sample of preterm infants (and a full-term comparison group)
a comparable stability rate, of 58%, was obtained. The tendency
for the VLBW infants to shift from security to insecurity over
time, rather than toward security, as is often found in full-term
groups, suggests that the effects of prematurity may become
more pronounced over time. For example, infant delay in the
Table 4
Insecure-Secure Classifications at 14 and 19 Months
Assessment
14 month
VLBW
FT
19 month
VLBW
FT
Fisher's
exact test
n
% secure
% insecure
34
40
55.9
67.5
44.1
32.5
ns
34
40
52.9
75
47.1
25
.013
Note. Participants classified as A/C were considered insecure. VLBW
= very low birth weight; FT = full term
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
918
MANGELSDORF ET AL.
VLBW infants may become increasingly obvious over the
course of the second year as full-term agemates are exhibiting
rapid change in locomotor abilities, cognitive abilities, and language skills. It is possible that parents of the VLBW infants shift
their comparison group over the course of the first two years,
beginning by comparing their infant to other hospitalized infants, but then later comparing their child to full-term infants.
If parents of preterm infants do shift their comparison group
over time this may be related to an increase in psychological
distress, as it has been documented that upward social comparisons tend to create negative affect and anxiety, particularly in
situations of uncertainty (e.g., Buunk, Taylor, Collins, VanYperen, & Dakof, 1990). Some support for this possibility comes
from the fact that parents of the preterm infants in the current
study reported experiencing increasing impact of their child's
prematurity on their family systems over time (Claflin, Bozynski, Meisels, Dichtellmiller, & Burns, 1992). It is plausible that
this increase in family impact may have adversely affected the
attachment relationship.
The failure to find correspondence between the criterion Qsort and the 14-month Strange Situation in this investigation
was disappointing. Although this result is consistent with some
investigations (Jaeger, Weinraub, Becker, & Jaeger, 1989; Pettit,
1991; van Dam & van IJzendoorn, 1988), it is inconsistent with
Vaughn and Waters (1990) and a number of other investigations (e.g., Bosso, Corter, & Abramovitch, 1995; Seifer, Schiller,
Sameroff, Resnick, & Riordan, 1996) in which this correspondence has been obtained. However, there were a number of
differences between this investigation and others that have
found correspondence between the Q-Set and the Strange Situation, such as the Vaughn and Waters (1990) study. For example, the length of the home observations in the current study
totaled 3 hr (2 visits each done by 2 observers for 1 '/2 hours),
whereas in the Vaughn and Waters investigation the total number of hours for each observation was typically 6-12 hr. This
difference in the total duration of the observations may be partially responsible for the different pattern of results obtained
in this investigation. Perhaps in seeing participants for shorter
periods of time observers were less likely to see them in stressful
circumstances that might have been likely to evoke responses
comparable to those seen in the Strange Situation. Interestingly,
the Q-set ratings did relate to parents' ratings of temperament
(Mangelsdorf, Berlin, Dedrick, & Sussell, 1990), indicating
that the Q-set is sensitive to individual differences in child behavior even when used for shorter observation periods. However, longer observations may be necessary to obtain adequate
information regarding secure-base behavior.
erable value in that we will have multiple sources of information
regarding the mother-infant relationship.
The results of this study help to further our understanding of
the development of VLBW infants. Compared with low-risk,
full-term infants, there is some evidence to suggest VLBW infants may be at risk for less optimal attachment organization;
the VLBW infants were less secure at 14 months in the home
observation and more likely to be insecure in the 19-month
Strange Situation. Transactional models of parenting (e.g.,
Sameroff & Chandler, 1975) would suggest that a high-risk premature infant may tax the caregiving system. It has been well
documented that premature infants are more irritable (e.g.,
Goldberg, 1978) and have more aversive cries than full-term
infants (e.g., Frodi et al., 1978). As suggested by Plunkett et al.
(1986), this fussiness coupled with high parental anxiety about
having an infant who is at great risk medically may lead to a
higher incidence of insecure attachment than is typically found
in full-term samples or samples of low-risk premature infants.
It is interesting to note that the results of the Strange Situation
at 14 months did not reflect the higher rate of insecurity that
was evident in the Q-set at 14 months and the Strange Situation
at 19 months. There are a number of possible interpretations
for this finding. It is possible that although the premature infants were seen at 14 months corrected age, this correction for
gestational age did not adequately compensate for the extent of
their developmental delay. Thus, because of delays the attachment system may not have been firmly consolidated by 14
months. Therefore, the 14-month Strange Situation may not
have been an accurate assessment of the relationship. Support
for this interpretation comes from the fact that the VLBW infants in this sample scored significantly lower than the full-term
control infants on measures of mental and physical development, even after controlling for gestational age (Dichtellmiller,
1994). It is also possible, however, that both Strange Situation
assessments were accurate reflections of the relationship quality
but that the relationship may have been more stressed during
the second year. During the first year of life many parents of
VLBW premature infants receive a great deal of social support
and support from medical personnel in caring for their infant.
This support may diminish in the second year, and thus the
caregiving relationship becomes more stressful. It is also possible, as discussed earlier, that parents experience greater disappointment and frustration during the second year of their
child's life as the delays the child is experiencing become increasingly evident. These results suggest it may be beneficial to
continue to provide support for parents of high-risk premature
infants beyond the first year of life.
It will be interesting to examine over the course of our longitudinal investigation whether the Strange Situation or the Attachment Q-Set has better predictive power in the later socioemotional development of the children in this study. It may be
that both will have predictive power but that the two measures
will explain different portions of the variance in future assessments. One might anticipate that because of the stressful nature
of the Strange Situation and the nonstressful nature of the Qset that the two measures might vary in their predictive power
depending on the extent to which the future assessments are
stressful. If so, then the lack of concordance between the Q-Set
and the Strange Situation in this investigation will be of consid-
The finding that greater insecurity was observed in the preterm infants when they were observed in the home at 14 months
using the Attachment Q-Set but not in the Strange Situation
indicates that it may be necessary to expand our assessments of
high-risk preterm infants to include more intensive, naturalistic
observations if we hope to identify the ways in which high-risk,
preterm birth places these infants at risk for less optimal socioemotional development.
References
Ainsworth, M. D., Blehar, M. C, Waters, E., & Wall. S. (1978). Patterns
ofattachment. Hillsdale, NJ: Erlbaum.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ATTACHMENT IN VLBW INFANTS
Apgar, V. (1953). A proposal for a new method of evaluation of the
newborn infant. Current Researches in Anesthesia & Analgesia, 32,
260-267.
Bosso, O. R., Corter, C. M., & Abramovitch, R. (1995). Attachment
security in three-year-old first born children: Relations to Strange Situation classifications and to behavior toward a younger sibling. Unpublished manuscript, University of Toronto, Department of Psychology, Ontario, Canada.
Brachfeld, S., Goldberg, S., & Sloman, J. (1980). Parent-infant interaction in free play at 8 and 12 months: Effects of prematurity and immaturity. Infant Behavior and Development, 3, 289-305.
Brown, J. V., & Bakeman, R. (1980). Relationships of human mothers
and their infants during the first year of life: Effect of prematurity. In
R. W. Bell & P. Smotherman (Eds.), Maternal influences and early
behavior (pp. 353-373). New York: Spectrum.
Buunk, B. P., Taylor, S. E., Collins, R. L., VanYperen, N. W., & Dakof,
G. A. (1990). The affective consequences of social comparison: Either direction has its ups and downs. Journal of Personality and Social Psychology, 59(6), 1238-1249.
Campos, J., Barrett, K., Lamb, M., Goldsmith, H., & Stenberg, C.
(1983). Socioemotional development. In M. Haith & J. Campos
(Series Eds.) & P. Mussen (Ed.), Infancy and developmental psychobiology: Vol. 2. Handbook ofchild psychology (pp. 783-915). New
York: Wiley.
Claflin, C , Bozynski, M., Meisels, S., Dichtellmiller, ML, & Burns, C.
(1992, April). Relationship of extremely low birth weight infant morbidity patterns to maternal reports of family impact during the first
two years of life. Paper presented at the International Conference on
Infant Studies, Miami, FL.
Crawford, J. W. (1982). Mother-infant interaction in premature and
full-term infants. Child Development, 53. 957-962.
Crnic, K. A., Ragozin, A. S., Greenberg, M. T., Robinson, N. M., &
Basham, R. B. (1983). Social interaction and developmental competence of preterm and full-term infants during the first year of life.
Child Development, 54, 1199-1210.
Dedrick, C. F., Dedrick, R. F., & Berlin, M. A. (1992, April). An evaluation of the reliability of the attachment Q-Set. Paper presented at the
International Conference on Infant Studies, Miami, FL.
Dichtellmiller, M. E. (1994). A longitudinal investigation of mother-infant interaction and its relationship to cognitive development: Differences between very low birlhweighl and full-term infants. Unpublished doctoral dissertation, University of Michigan, Ann Arbor.
DiVitto, B., & Goldberg, S. (1979). The effects of newborn medical
status on early parent-child interaction. In T. M. Field, A. Sostek, S.
Goldberg, & H. Shuman (Eds.), Infants born at risk: Behavior and
development (pp. 311 -332) New York: Spectrum.
Easterbrooks, A. (1989). Quality of attachment to mother and to father: Effects of perinatal risk status. Child Development, 60, 825-831.
Field, T. (1977). Effects of early separation, interactive deficits, and experimental manipulations on infant-mother face-to-face interaction.
Child Development, 48, 763-771.
Field, T. (1979). Games parents play with normal and high-risk infants.
Child Psychiatry and Human Development, 10, 41-48.
Frodi, A. M., Lamb, M. E., Leavitt, L. A., Donovan, W. L., Neff, C , &
Sherry, D. (1978). Fathers' and mothers' responses to the faces and
cries of normal and premature infants. Developmental Psychology,
14, 490-498.
Frodi, A. M., & Thompson, R. (1985). Infants' affective responses in
the strange situation: Effects of prematurity and of quality of attachment. Child Development, 56, 1280-1290.
Goldberg, S. (1978). Prematurity: Effects on parent-infant interaction.
Journal ofPediatric Psychology, 3(3), 137-144.
Goldberg, S., Perrotta, M., Minde, K., & Corter, C. (1986). Maternal
919
behavior and attachment in low-birth-weight twins and singletons.
Child Development, 57, 34-46.
Hollingshead, A. (197 5). Fourfactor index ofsocioeconomic status. Unpublished manuscript, Yale University, Department of Sociology,
New Haven, CT.
Howes, C , & Hamilton, C. E. (1992). Children's relationships with
caregivers: Mothers and child care teachers. Child Development, 63,
859-866.
Jaeger, E., Weinraub, M., Becker, N., & Jaeger, M. (1989, April). Attachment, dependency and separation distress in infants of employed
mothers. Paper presented at the biennial meeting of the Society for
Research in Child Development, Kansas City.
Mangelsdorf, S., Berlin, M., Dedrick, C , & Sussell, A. (1990, April).
The relation between temperament ratings and attachment Q-sort
scores. In R. Seifer (Chair), Temperament and primary social relations. Symposium conducted at the International Conference of Infant Studies, Montreal.
Mann, J., Plunkett, J., Meisels, S., & Bozynski, M. (1988, April). Home
observations of very-low-birth-weight infants. Paper presented at the
International Conference of Infant Studies, Washington, DC.
Meisels, S. J., & Plunkett, J. W. (1988). Developmental consequences
of preterm birth: Are there long-term effects? In P. B. Baltes, D. L.
Featherman, & R. M. Lerner (Eds.), Life-span development and behavior: Vol. 9 (pp. 87-128). Hillsdale, NJ: Erlbaum.
Office of Technology Assessment. (1987). Neonatal intensive care for
low birthweight infants: Costs and effectiveness (Health Technology
Case Study 38). Washington, DC: Congress of the United States.
Pederson, D. R., Moran, G., Bento, S., & Buckland, G. (1992, May).
Maternal sensitivity and attachment security: Concordance ofhomeand lab-based measures. Paper presented at the International Conference on Infant Studies. Miami Beach, FL.
Pederson, D. R., Moran, G., Sitko, C , Campbell, K., Ghesquire, K., &
Acton, H. (1990). Maternal sensitivity and the security of infantmother attachment: A Q-sort study. Child Development, 61, 19741983.
Pettit, P. (1991). A comparison of attachment behaviors measured in
the laboratory and in the home and their relations with maternal sensitivity. Unpublished master's thesis. University of Western Ontario,
London, Ontario.
Plunkett, J. W., Meisels, S. J., Stiefel, G. S., Pasick, P. L., & Roloff,
D. W. (1986). Patterns of attachment among preterm infants of varying biological risk. Journal of the American Academy of Child Psychiatry, 25,794-800.
Rode, S., Chang, P., Fisch, R., & Sroufe, L. A. (1981). Attachment
patterns of infants separated at birth. Developmental Psychology, 17,
188-191.
Sameroff, A. J., & Chandler, M. (1975). Reproductive risk and the continuum of caretaking casualty. In F. D. Horowitz, M. Hetherington,
S. Scarr-Salapatek, & G. Siegel (Eds.), Review of child development
research: Vol. 4 (pp. 187-244). Chicago: University of Chicago Press.
Seifer, R., Schiller, M., Sameroff, A. J., Resnick, S., & Riordan, K.
(1996). Attachment, maternal sensitivity, and infant temperament
during the first year of life. Developmental Psychology, 32, 12-25.
Thompson, R. A., Lamb, M. E., & Estes, D. (1982). Stability of infantmother attachment and its relationship to changing life circumstances in an unselected middle class sample. Child Development, 53,
144-148.
van Dam, M., & van Uzendoorn, M. H. (1988). Measuring attachment
security: Concurrent and predictive validity of the parental attachment Q-set. Journal of Genetic Psychology, 149, 447-457.
van Uzendoorn, M. H., Goldberg, S., Kroonenberg, M., & Frenkel,
O. J. (1992). The relative effects of maternal and child problems on
the quality of attachment: A meta-analysis of attachment in clinical
samples. Child Development, 63, 840-858.
920
MANGELSDORF ET AL.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Vaughn, B. E., & Waters, E. (1990). Attachment behavior at home and
in the laboratory: Q-Sort observations and strange situation classifications of one-year-olds. Child Development, 61, 1965-1973.
Waters, E. (1995). The Attachment Q-Set. In E. Waters, B. E. Vaughn,
G. Posado, & K. Kondo-Ikemuia (Eds.), Caregiving, cultural and
cognitive perspectives on secure-base behavior and working models:
New growing points of attachment theory and research. Monographs
of the Society for Research in Child Development, 6 0 ( 2 - 3 , Serial No.
244), 234-246.
Waters, E., & Deane, K. E. (1985). Denning and assessing individual
differences in attachment relationships: Q-methodology and the or-
ganization of behavior in infancy and early childhood. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and
research (pp. 41-65). Monographs of the Society for Research in
Child Development, 50(1-2, Serial No. 209).
Wille, D. (1991). Relation of preterm birth with quality of infantmother attachment at one year. Infant Behavior and Development, 14,
227-240.
Received June 23, 1993
Revision received January 18, 1996
Accepted February 9, 1996 •
Low Publication Prices for APA Members and Affiliates
Keeping you up-to-date. All APA Fellows, Members, Associates, and Student Affiliates
receive—as part of their annual dues—subscriptions to Xh&A merican Psychologist and APA
Monitor. High School Teacher and International Affiliates receive subscriptions to the APA
Monitor, and they may subscribe to (he American Psychologist at a significantly reduced
rate. In addition, all Members and Student Affiliates are eligible for savings of up to 60%
(plus a journal credit) on all other APA journals, as well as significant discounts on
subscriptions from cooperating societies and publishers (e.g., the American Association for
Counseling and Development, Academic Press, and Human Sciences Press).
Essential resources. APA members and affiliates receive special rates for purchases of
APA books, including the Publication Manual of the American Psychological Association,
and on dozens of new topical books each year.
Other benefits of membership. Membership in APA also provides eligibility for
competitive insurance plans, continuing education programs, reduced APA convention fees,
and specialty divisions.
More information. Write to American Psychological Association, Membership Services,
750 First Street, NE, Washington, DC 20002-4242.