This article was downloaded by: [b-on: Biblioteca do conhecimento online UEvora]On: 28 February 2013, At: 08:27Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Attachment & Human DevelopmentPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rahd20

Continuity and discontinuity ofattachment patterns: A short-termlongitudinal pilot study using a sampleof late-adopted children and theiradoptive mothersC.S. Pace a , G.C. Zavattini a & M. D'Alessio aa Department of Dynamic and Clinical Psychology, SapienzaUniversity of Rome, ItalyVersion of record first published: 23 Dec 2011.

To cite this article: C.S. Pace , G.C. Zavattini & M. D'Alessio (2012): Continuity and discontinuity ofattachment patterns: A short-term longitudinal pilot study using a sample of late-adopted childrenand their adoptive mothers, Attachment & Human Development, 14:1, 45-61

To link to this article: http://dx.doi.org/10.1080/14616734.2012.636658

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representationthat the contents will be complete or accurate or up to date. The accuracy of anyinstructions, formulae, and drug doses should be independently verified with primarysources. The publisher shall not be liable for any loss, actions, claims, proceedings,demand, or costs or damages whatsoever or howsoever caused arising directly orindirectly in connection with or arising out of the use of this material.

Continuity and discontinuity of attachment patterns: A short-term

longitudinal pilot study using a sample of late-adopted children

and their adoptive mothers

C.S. Pace, G.C. Zavattini* and M. D’Alessio

Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy

(Received 15 July 2010; final version received 20 July 2011)

This study analysed the attachment patterns of 28 late-adopted children (placedwhen they were between four and seven years of age) and their adoptive mothers.The change in the children’s internal working models (IWMs) within seven toeight months of their placement was evaluated. In addition, we wanted to observethe influence of a secure-autonomous maternal state of mind in facilitating thechange in the children’s IWMs and the possible associations between the maternalIWMs and the children’s IWMs in the adoptive dyads. The separation-reunionprocedure (SRP) was used for the late-adopted children in order to assess theirattachment behavioural patterns, and the Manchester Child Attachment StoryTask (MCAST) was used to evaluate their attachment narrative patterns. Theadoptive mothers completed the Adult Attachment Interview (AAI) in order toclassify their state of mind with regard to attachment. The results showed asignificant change in the attachment behavioural patterns of late-adoptedchildren, from insecure to secure (p ¼ .002). Furthermore, the children whopresented this change were predominantly placed with secure-autonomousadoptive mothers (p ¼ .047), although the link between the adoptive mothers’representations of their attachment history and their adopted children’scompleted narratives was not significant. In conclusion, it seems possible torevise the attachment behaviour of late-adopted children but, for about one-thirdof children, the adverse history will persist at a narrative/representational level.

Keywords: attachment; continuity/discontinuity; internal working models(IWMs); late-adopted children; adoptive mothers

Introduction

At the beginning of research based on attachment theory (Bowlby, 1969, 1973, 1980),many studies assessed the continuity and stability of internal working models(IWMs) from infancy to adulthood, particularly if an individual’s life conditions –both positive and unfavourable or maladaptive – were stable over time (Hamilton,2000; Waters, Merrick, Treboux, Crowell, & Albersheim, 2000). However, in morerecent years, the literature on attachment has been considering a more complextheoretical concept that encompasses the discontinuity of attachment representa-tions. Although adults’ internal models are conceived as being resistant to change,

*Corresponding author. Email: giuliocesare.zavattini@uniroma1.it

Attachment & Human Development

Vol. 14, No. 1, January 2012, 45–61

ISSN 1461-6734 print/ISSN 1469-2988 online

� 2012 Taylor & Francis

http://dx.doi.org/10.1080/14616734.2012.636658

http://www.tandfonline.com

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

some researchers have demonstrated the potential for IWMs to be revised over timein relation to a new environment (Grossman, Grossman, & Waters, 2005; Howes &Spieker, 2008; Oppenheim & Goldsmith, 2007; Steele, Hodges, Kaniuk, & Steele,2010; Steele & Steele, 2008).

In this context, adoptive and foster families have been the subject of a great deal ofinterest, as adoption has often been described as a ‘‘natural experiment’’ which is able– more than other types of social interventions – to affect the lives of children whohave often suffered traumas in their infancy and childhood (Dozier & Rutter, 2008;Rutter & O’Connor, 2004; van IJzendoorn & Juffer, 2005, 2006). The question iswhether children’s previous negative experiences – such as abandonment, neglect andabuse – can have a negative effect on their IWMs and therefore prevent any potentialchange, and whether these insecure and/or disorganised patterns could be processedinto secure models thanks to new and accessible caregivers (Steele, Henderson,Hodges, Kaniuk, Hillman, & Steele, 2007; Steele, Hodges, Kaniuk, Hillman, &Henderson, 2003; Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008).

The literature on adoption (Howe, 1997, 1998, 2003) tends to distinguish between‘‘early-adopted’’ (or ‘‘baby-adopted’’) and ‘‘late-adopted’’ (or ‘‘older-adopted’’) child-ren. Early-adopted children are those who were placed as babies (before the age of 12months old) and therefore could form their first attachment relationship with theirbiologically unrelated parents. Many studies have found that baby-adopted children,both in national and international adoptions, managed to almost completely catch upwith non-adopted children in terms of their cognitive, behavioural, relational andaffective development and attachment security (Juffer & van IJzendoorn, 2009; Vanden Dries, Juffer, van IJzendoorn, & Bakermans-Kranenburg, 2009; van IJzendoorn,Juffer, & Klein Poelhuis, 2005; Van Londen, Juffer, & van IJzendoorn, 2007).

Late-adopted children are those who were placed in their adoptive families afterthe age of 12 months old, and therefore experienced either at least one rupture in theirprimary attachment or the total absence of a stable figure in the period of attachmentformation. Research on older-adopted children have shown both difficulties (Howe,2001; Hushion, Sherman, & Siskind, 2006; Rutter et al., 2007) and the potential tocatch-up at cognitive and emotional levels (Bick & Dozier, 2008; Dozier, 2005; Juffer& van IJzendoorn, 2007). The majority of late-adopted children, and particularlychildren who were placed at pre-school- or school-age, have had a prolonged expo-sure to deleterious experiences with their biological parents, ranging from neglect,rejection and role-reversal to physical, psychological and sexual abuse (Howe, 1998).Given the children’s background, they may develop negative attachment representa-tions and their trust in adult attachment figures and their ability to build attachmentbonds could be notably compromised (Goldsmith, 2007). The most extremesituations, characterised by serious deprivation and ‘‘cumulative traumas’’, such asearly, long and severe periods of institutionalisation, prolonged maltreatment andmultiple placements, could have notably damaged the organisation of the attachmentsystems of these children who may subsequently present with pathologies such as‘‘secure base distortion’’ (Howe, 2003; O’Connor & Zeanah, 2003) and symptoms of‘‘reactive attachment disorder’’, such as a behavioural pattern of indiscriminatefriendliness (Balbernie, 2010; Dozier, 2003; Juffer, Hoksbergen, Riksen-Walraven, &Kohnstamm, 1997; van IJzendoorn & Bakermans-Kranenburg, 2003).

Once adopted, older children, and particularly those considered to be ‘‘specialneeds adoptions’’ (Clark, Thigpen, & Yates, 2006), meaning children with specialfeatures such as severe emotional and behavioural disorders or organic disabilities

46 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

after the age of four years old, frequently show contradictory behaviours towards theiradoptive parents, oscillating between compliance, dependence, passivity, withdrawal,rejection, hostility and provocation (Steele, Hodges, Kaniuk, & Steele, 2010). Thesebehaviours can make it hard to build an attachment relationship based on trust and asense of belonging and protection in the adoptive families (Slade, 2007; Steele et al.,2007a).

Some authors have underlined the importance of high quality adoptive parentingin order to manage the conflicting and vulnerable representations that late-adoptedchildren bring with them into their adoptive placements (Levy & Orlans, 2003;Schofield & Beek, 2005). According to attachment theory, this high level of parentingis strongly associated with the secure adults’ attachment state of mind which stemsfrom their own attachment histories. Some studies on foster care or adoptiveplacements have also taken into consideration the attachment state of mind of thenew caregiver, particularly maternal representations, as a central component in theolder-placed child’s development of new attachment relationships.

Dozier, Stovall, Albus, and Bates (2001) have examined the correlation betweenfoster mothers’ attachment state of mind, measured using the AAI (George, Kaplan,& Main, 1985), and foster infants’ attachment quality, assessed using the StrangeSituation Procedure (SSP; Ainsworth, Blehar, Waters, & Wall, 1978), for 50 fostermother–infant dyads. The results found that the degree of secure-insecurecorrespondence between the maternal state of mind and the infant’s attachmentquality was 72% (k ¼ .43), which is similar to the level found among biologicallyintact mother–infant dyads. Contrary to the expectations, variations in the child’s ageat placement were not associated with infant security status. Instead, a correlationbetween maternal state of mind and infant attachment was found for relatively late-placed babies (between 12–20 months of age), as well as early placed babies (within 12months of age). Based on these findings, the author proposed that foster children mayorganise their attachment behaviour around the availability of their foster parent.

A further study on adoption (Caspers, Yucuis, Troutman, Arndt, & Langbehn,2007) investigated sibling concordance on attachment by examining concordance foradult attachment in a sample of 126 genetically unrelated sibling pairs. The resultsshowed that the distribution of attachment classifications was independent ofadoptive status and attachment concordance rates were unassociated with genderconcordance and sibling age difference. The concordance for secure/non-secureclassifications was significant at 61%, as was the concordance for primaryclassifications at 53%, demonstrating the similarity of working models of attachmentbetween siblings, independent of their genetic relatedness.

Verissimo and Salvaterra (2006) evaluated the relationship between adoptivemothers’ attachment representations as measured using attachment script representa-tions (Waters & Waters, 2006), and children’s quality of attachment as measuredusing the Attachment Behaviour Q-Set (AQS; Waters, 1995) in a sample ofPortuguese children adopted between three weeks and 47 months of age. The resultsshowed that the AQS security scores of adopted children did not differ significantlyfrom those of biological dyads. In addition, neither the child’s age at the time ofadoption nor the age of the child at the time of assessment significantly predicted theirAQS security score. However, scores reflecting the presence and quality of maternalsecure base scripts did predict AQS security (R Spearman ¼ 0.38, p 5 0.01).

All participants in the studies mentioned above were children who were adoptedbefore they reached four years of age, and only a few studies have examined children

Attachment & Human Development 47

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

who were placed after this age. The ‘‘Attachment representations and adoptionoutcome study’’, which was a longitudinal study coordinated by Miriam Steele andconducted at London’s Anna Freud Centre, explored the development ofattachments in a group of 63 children aged between four and eight at the time ofplacement, all of whom had a history of separation, abandonment, maltreatmentand multiple placements. In addition, this study aimed to test whether or not securemothers (as coded by the AAI) transfer a sense of security to their recently adoptedchildren when compared to insecure and/or unresolved mothers. The children wereassessed using the story stem assessment technique, which provides them with a wayof displaying their expectations and perceptions of attachment figures using bothverbal and nonverbal means of representation. The results highlighted that late-adopted children showed a progressive improvement in their inner representations ofself, others and relationships, which were described as being more positive andbenevolent, and an increase in internal consistency (Hodges, Steele, Hillman, &Henderson, 2003; Hodges, Steele, Hillman, Henderson, & Kaniuk, 2003; Hodges,Steele, Hillman, Henderson, & Neil, 2000; Kaniuk, Steele, & Hodges, 2004).

Mothers who were judged to be insecure (either dismissing or preoccupied)according to their AAIs were likely to have adopted children who, three months aftertheir placement, provided story-completions with higher levels of aggressivenesswhen compared to the stories provided by children adopted by mothers with secure-autonomous AAIs. Children whose adoptive mothers’ AAIs were indicative ofunresolved (as opposed to resolved) mourning regarding past loss or traumaprovided story completions with higher scores for emotional themes such as ‘‘parentappearing child-like’’ and ‘‘throwing out or throwing away’’ (Steele et al., 2003).These results were confirmed by evaluations conducted two years after adoption.Children’s insecurity correlated significantly with the parental AAI variable (RSpearman ¼ 70.29, p 5 .05), in that the presence of one or more secure parents inthe children’s lives made the presence of insecure themes in the children’s storiessignificantly less likely. Similarly, and more significantly, the children’s disorganisa-tion correlated negatively with parental security (R Spearman ¼ 70.36, p 5 .01), inthat parental insecurity was strongly linked to elevated levels of disorganisation intheir adopted children. In other words, when neither parent’s AAI was secure at thetime of adoptive placement, at the time of the two-year follow-up, 86% of theirchildren were in the highest scoring group for disorganisation (Steele et al., 2008). Inaddition, children adopted by unresolved mothers had failed in their attempts toestablish secure attachments, and they did not manage to build up a positive imageof their parents (Steele et al., 2007a, 2007b, 2010).

All of these findings support a non-genetic mechanism for the intergenerationaltransmission of attachment, supporting the notion that the transmission ofattachment security across generations implicates a shared environment and involvesmutual exchanges and learning by the child, and that the exchanges leading to secureattachment need not begin at birth. These results have extended previous research byexamining the critical influence of maternal representations of attachment on thequality of children’s attachment security.

Adoption in Italy

Adoption in Italy is regulated by Law n. 183 (1984), which was supplemented bysuccessive modifications in 1998 (Law n. 476) and 2001 (Law n. 149). In Italy,

48 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

children are placed exclusively in the context of married couples. Couples wishing toadopt must first undergo a medical-psychiatric screening in order to assess whetherthey have any psychopathological disorders. Then they are involved in a selection-training course, which is conducted by an adoption team, a psychologist and a socialworker from the Social Health Services. The course comprises individual interviews,couple interviews, home-visits and occasionally involves standardised tests. Theadoptive parents are selected if they are free from psychiatric disorders and if theyshow enough sensitivity, empathy, personal autonomy, flexibility and the ability toadapt to new circumstances. If the adoption team’s report is positive, the couples canbe entered into the Juvenile Court databank for national adoption (NA) and/or theycould approach an authorised international adoption (IA) Agency.

In recent years, three changes in the features of adoption in Italy have been noted.First, there has been a drastic reduction in the number of NAs since socialinterventions for the protection and support of parents at risk of psycho-socialdisorders have improved. Second, there has been a sharp increase in the number ofIAs, currently totalling approximately 75% of adopted children. Finally, within theseIAs, the age of the children at the time of placement has increased, and currentlychildren are adopted predominantly between three and eight years of age. This changeis probably due to an increasingly high number of countries adhering to the AjaConvention of 1993, which described IA as an ‘‘extra’’ intervention to be usedexclusively when all other attempts to help children to remain in their country oforigin have failed (e.g. home visiting, foster or adoptive placements with biologicallyrelated persons – such as grandparents or uncles – and national adoption). This,therefore, makes adoption an intervention which is often realised later on.

As the practice of adoption of children older than three years of age is relativelyrecent in Italy, it would be interesting to explore the continuity/discontinuity ofIWMs and to examine the attachment models of families that have adopted pre-school and school-age children who had suffered negative experiences in theirpre-adoption lives. The present study, therefore, proposes to assess the IWMs oflate-adopted children and their adoptive mothers during the first period after theirplacement. Our first objective is to investigate whether a positive revision – intendedas a change from insecurity towards security – in attachment behaviour patterns canbe seen in late-adopted children within seven to eight months of their adoption. Oursecond objective is to investigate whether such a change is seen predominantly inchildren placed with mothers who display secure states of mind. Finally, and forexploratory purposes only, we wanted to test the impact of adoptive mothers’attachment representations on the attachment narrative patterns presented by theirlate-adopted children in a story completion task.

Methodology

Participants

The main sample included 48 participants, comprising late-adopted children agedbetween four and seven years old (N ¼ 28) and their adoptive mothers (N ¼ 20), allrecruited via the Social Health Services and authorised IA agencies. Participation inthis research was voluntary. The sample of children had a mean age of 70 months(SD ¼ 12.75); 46% were male (N ¼ 13) and 54% were female (N ¼ 15). Fivechildren were born in Italy, while 23 (82%) children came from IAs. The pre-adoption histories of the children generally presented with multiple difficulties in

Attachment & Human Development 49

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

the family of origin, including serious neglect, abuse and maltreatment, as well aspsychiatric problems, alcoholism and psycho-social problems in the biologicalparents. In addition, 89% of the children (N ¼ 25) had experienced prolongedinstitutionalisation before being adopted (M ¼ 29.12 months and SD ¼ 18.37).Children with moderate or high level of physical disorders, mental retardation andpsychiatric diagnoses were excluded from the research. The adoptive mothers(N ¼ 20) were aged between 38 and 52 years old (M ¼ 44.50 years old andSD ¼ 4.37) and had between eight and 18 years of formal education (M ¼ 15.65and SD ¼ 2.98). All of them had been married, with a mean of 10 years of marriage(SD ¼ 4.83), and none of the mothers presented with psychiatric symptoms.

Measures

The separation-reunion procedure (SRP; Cassidy, 1988; Main & Cassidy, 1988) is alaboratory procedure based on the SSP model and designed for classifying thebehavioural attachment patterns shown by children at pre-school and school-age. In theSRP, the child experiences two separations from the mother and two reunions with her,both of which are coded. The first separation lasts for 10–15 minutes, the second forapproximately 45–60 minutes. The first coding comprises the assigning of scores on thescales of avoidance and security. The second coding classifies reunion behaviours intoone of the patterns of attachment. It is possible to assign one of the following three maincategories: secure (B), when the child appears relaxed and shows pleasure in the dyadicinteraction; insecure/avoidant (A), when the child tends to ignore the mother’s presenceand remains concentrated on their own activities; and insecure/ambivalent (C), whenthe child shows signs of passivity-immaturity and/or anger. In addition, reunionbehaviour could also be assigned to one of the two secondary categories: insecure/controlling (D), when the child seems to want to actively direct the caregiver’s attentionand behaviour, and insecure-unclassifiable (U), when the child appears extremelydepressed or scared by the parent. Studies using the SRP have shown test-retest relia-bility of 85% for the insecure/secure classifications at one month of distance (excludingthe D classification, which is the most unstable) and a 78–90% predictability for thethree main categories on the basis of the SSP classification at one year of age (Cassidy,1988; Kerns, 2008;Main & Cassidy, 1988; Speranza, 1994). The two SRP reunions werecoded by two independent raters trained by A.M. Speranza, an expert in the codingsystem set out by Main and Cassidy (1988), and in the SSP by Ainsworth et al. (1978),who directly supervised the first coding. One of the raters was completely blind to otherdata. The degree of agreement between the raters was 87.5% for the categories ofsecure/insecure (k ¼ .71) and 82% (k ¼ .73) for the three-way system (A, B and C).

The Manchester Child Attachment Story Task (MCAST; Barone, Del Giudice,Fossati, Manaresi, Actis Perinetti, Colle et al., 2009; Goldwyn, Stanley, Smith, &Green, 2000; Green, Stanley, Smith, & Goldwyn, 2000) is a story completion taskwhich is used to classify the attachment narrative representations of children betweenthe ages of four and eight years old. The interviewer shows the child a doll’s house anda set of dolls, and the child has to choose the doll which best represents himself (orherself) and the doll which best represents his or her mother. In our pilot study, theMCAST was intentionally set up without specifying birth or adoptive mother, inorder to leave the child free to decide on the caregiver him/herself, without asking thechild direct questions which might cause him or her undue conflict or anxiety (Steeleet al., 2010). The assessment is organised into six stories to be completed. The fourcentral stories are designed to activate the motivational system of attachment and

50 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

they concern: nightmares, a knee injury, a stomach ache, and getting lost in ashopping centre. Scores of 1–9 on 33 scales and a final classification (secure/avoidant/ambivalent/disorganised) are then assigned to each story. From these codes, it ispossible to add more scores from three global scales – coherence of mind, menta-lisation, and disorganisation – and a final classification to the whole MCAST. Thepattern is classified as secure (B) when the strategy of attachment is characterised bythe representation of an interaction of proximity with the caregiver that brings anassuagement of the discomfort. The pattern is rated as avoidant (A) when a restrictionis seen in the story content, or there is a representation of self-soothing ordisplacement. The strategy is assessed as resistant-ambivalent (C) when contact withthe caregiver causes an increase in and prolonging of unease. The disorganisedclassification (D) can be attributed if the score for episodic disorganisation,(disorganised, bizarre and unusual themes in the child’s narrative and behavioursdisplayed in the SSP episodes) is higher than five, or when pervasive disorganisationemerges that represents a complete absence of strategy or the presence of multipleinternally contradictory strategies. Studies on the MCAST have shown good contentvalidity, a short term stability of 75% after approximately 5.5 months (Green et al.,2000) and a concordance of 80% with respect to the separation anxiety test (SAT;k ¼ .41, p 5 .01) (Goldwyn et al., 2000; Green, Stanley, & Peters, 2007). OurMCASTs were independently coded by two raters trained by Jonathan Green, andone of them was completely blind to other data. Inter-rater agreement was 89%(k ¼ .82) for four-way (A, B, C, and D) classification.

The Adult Attachment Interview (AAI; Bakermans-Kranenburg & vanIJzendoorn, 2009; Main, Goldwyn, & Hesse, 2008) is an hour-long semi-structuredinterview composed of 20 questions capable of evaluating and classifying adults’state of mind with respect to attachment with regard to their early attachmentexperiences. The interviews are valued on 17 ordinal scales of nine points each (Mainet al., 2008) and then assigned to one of the following classifications: secure/autonomous (F/A); dismissing (Ds); preoccupied-entangled (E); unresolved/dis-organised (U); and cannot classify (CC). The AAIs were coded by two independentand skilled raters, trained by Debra Jacobvitz and Nino Dazzi, of which one wasblind to all the other data. Inter-rater agreement was 85% (k ¼ .73) for four-way (F,Ds, E, and U) and 90% (k ¼ .79) for two-way (secure vs. insecure) classifications. Inorder to guarantee the accuracy of the measurements and in order to minimise bias,each of the attachment classification instruments – SRP, AAI, MCAST – werecodified by two independent, double-blinded and well-qualified raters, each of whomwas unaware of the coding assigned by the other to the same measure.

The Leiter International Performance Scale - revised (Roid & Miller, 1997) is atest to measure nonverbal IQ (conceptualisation, inductive reasoning and visualisa-tion) in individuals ranging in age from two to 20 years. It is useful for late-adoptedchildren, who cannot be reliably evaluated with traditional intelligence tests thatpredominantly utilise verbal components that are subject to cultural, social andeducative influences. From validation studies, nonverbal IQ has been shown to behighly correlated with the total IQ (.85), performance IQ (.85) and verbal IQ (between.77 and .80) scores of the Wechsler Intelligence Scale for Children-III (WISC-III).

The Peabody Picture Vocabulary Test - revised (PPVT-R; Dunn & Dunn, 1981;Stella, Pizzoli, & Tressoldi, 2000) is a vocabulary test designed to assess children’scomprehension level of standard Italian. The PPVT-III has been shown to be highlycorrelated with other validated instruments including the WISC-III (.82 to .92). Theinternal validity (Cronbach’s a) is equal to .93.

Attachment & Human Development 51

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

Research design and procedure

A short-term longitudinal research design was used in order to achieve the previouslydescribed objectives. The procedure was composed of two steps of data collection:

(1) The first (T1) was completed at the beginning of the adoption (approximately40 days after the children’s placement) to classify the attachment patternswhich the children exhibited at their meeting with their adoptive parents,which were probably still highly affected by their previous adverse experi-ences. At the first session, the children were assessed using the SRP (SRP-T1)and the Leiter Scale. The adoptive mothers were asked about their children’sbackground history and were assessed using the AAI, which was recordedand subsequently transcribed verbatim;

(2) The second step (T2) occurred six months after the first, within approxi-mately seven to eight months of adoption. In this session, the children wereassessed using the SRP-T2, the PPVT-R and the MCAST.

The two assessment sessions with mother and child occurred in a well-equippedvideo recording laboratory. Each session lasted approximately an hour and a halfand was entirely video-recorded. All of the mothers signed an informed consent sheetfor themselves and their children at the beginning of the study, written on the basisof the rights and limits set out in Law 675/96 ‘‘Privacy of the person and otheraspects with respect to the handling of personal data’’.

Data analysis

The results were analysed using the Statistical Package for the Social Science (SPSS,Version 12.0). We decided to use primarily non-parametric tests – appropriate forthis type of variable – because they do not require the population from which thesample is taken to be assumed to be normal. Moreover, they are appropriate forstatistically testing small samples, as in this pilot study (Siegel & Castellan, 1988).

The following tests were used for the quantitative variables on an ordinal scale:the U-Mann Whitney test for independent samples, the Wilcoxon test for dependentsamples, and Spearman’s correlation coefficient and linear regression statistic. Thedata analysis was carried out by categorising the children’s behaviours in theSeparation Reunion Procedure (SRP) and Manchester Attachment Story Task(MCAST), and the maternal AAI classifications into secure and insecure groups inpreparation for using more powerful statistical tests. The following tests were used:Fisher’s exact test for independent samples, McNemar’s test for dependent samples,the phi correlation coefficient and binary logistic regression. The level of significancefor all analyses was p 5 .05.

Results

Preliminary analyses

Distribution of attachment classifications

Table 1 shows the distribution of the children’s classifications in the SRP-T1, SRP-T2, MCAST and the adoptive mothers’ AAI categories. No child was classified as Daccording to the SRP and no adoptive mother was classified as CC. It is perhaps

52 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

surprising that the baseline SRP showed no D children, given their backgrounds, butwe can assume that, at the beginning of the placement, it could be hard for childrento display humiliating and embarrassing or solicitous and protective behaviourstowards their ‘‘new’’ parents. The MCAST distribution, instead, presented 37% ofthe children as D, perhaps revealing that the MCAST is a more sensitive test forcapturing disorganisation. The distribution of secure, dismissing, preoccupied, andunresolved mothers was in line with samples of nonclinical populations (Bakermans-Kranenburg & van IJzendoorn, 2009), although our sample of well-vetted adoptersshowed a higher proportion of interviews that were classified as autonomous-secure.

Classifications of attachment and descriptive variables

The SRP-T1, SRP-T2 and MCAST secure/insecure classifications did not present anysignificant links (the p values were always between .14 and .92) with any of the followingdemographic variables: gender; presence/absence of siblings; level of schooling; age atplacement; NA/IA; nonverbal IQ level (M ¼ 83.8 and SD ¼ 10); and languagecomprehension (M ¼ 78 and SD ¼ 8.80). The secure/insecure maternal states of mindwere not associated with their level of education (U-Mann Whitney: 69.500, p ¼ .27).

Revision of attachment behavioural patterns shown by late-adopted children

Ten (42%) out of the 24 children classified as insecure in the SRP-T1 were secureaccording to the SRP-T2, showing a statistically significant discontinuity (36%McNemar Test, p ¼ .002). All of the children classified as secure in the SRP-T1(N ¼ 4) remained secure in the SRP-T2. The children who had moved from beingclassified as insecure to secure (named ‘‘earned secure’’) had noticeably lower scores onthe avoidance scale (U Mann-Whitney ¼ 43.500, p ¼ .024) and significantly higherscores on the security scale (U Mann-Whitney ¼ 38.500, p ¼ .012) between SRP-T1and SRP-T2, compared to the children who remained insecure in both T1 and T2.

Impact of secure maternal states of mind on the revision of the children’s attachmentbehavioural patterns

Considering the group of insecure children in T1 (N ¼ 24), the results suggest thatthe adoptive mothers who displayed a secure-autonomous state of mind in the AAI

Table 1. Classifications according to the SRP-T1, SRP-T2, MCAST and AAI.

Classification of attachment – frequency (%)

B (%) A (%) C (%) D (%) Total

Adopted childrenSRP-T1 4 (14%) 14 (50%) 10 (36%) 0 28SRP-T2 14 (50%) 9 (32%) 5 (18%) 0 28MCAST 13 (48%) 3 (11%) 1 (4%) 10 (37%) 27

1

F (%) Ds (%) E (%) U (%) TotalAdoptive mothersAAI 12 (60%) 3 (15%) 2 (10%) 3 (15%) 20

1One child did not fully complete the story completion task.

Attachment & Human Development 53

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

were more likely to have children who became ‘‘earned secure’’ between T1 and T2,compared to mothers classified as insecure following the AAI, whose children all‘‘remained insecure’’ (Fisher’s exact, p ¼ .047).

In order to fully explore the possible influence of maternal state of mind on thechange in children’s responses from insecure to secure (dependent variable),controlling for the effects of baseline SRP and the age of the children, we used ahierarchical binary logistic regression. In the first block, we included SRP-T1 and theage of the children as independent variables, while in the second block we added theAAI of the mothers. The analysis showed that the introduction of the first twovariables was not significant (w2(2) ¼ 3.989, p ¼ . 136), while the subsequent inclusionof the AAI produced a significant increase in the model fit (w2(1) ¼ 6.237, p ¼ . 013).No other potentially confounding variable were included given low and notsignificant correlations with the predictors and small size of the sample.

Upon examining the correlations between the scores on the AAI and SRP scales,it emerged that adoptive mothers with high scores on the coherence of transcriptscale had children whose scores on the security scale increased significantly betweenSRP-T1 and SRP-T2 (Spearman’s r ¼ .344, p 5 .05). In addition, mothers withhigh scores on the insistence on lack of recall scale had children who scored lower onthe security scale in SRP-T2 (Spearman’s r ¼ 7.428, p 5 .05).

Relation between the adoptive mothers’ state of mind and the children’s attachmentnarrative patterns

The correspondence between the mothers’ AAI classifications and the attachmentrepresentations of the children, as expressed at a narrative level and measured bythe MCAST, was 55.6% (k ¼ .12) for a two-way classification (secure vs. insecure)and did not show any statistical significance (phi ¼ .126, p ¼ .516 n.s.). Of thechildren, 37% (N ¼ 10) were classified as disorganised according to the MCAST,and among them, 40% were adopted by mothers with dismissing states of mind and10% were placed with unresolved mothers. Significant correlations were reportedfrom the analyses of scores on the ordinal scales of the AAI and the MCAST (Table2).

We ran a linear regression statistic with ‘‘global disorganisation’’ as the dependentmeasure, and ‘‘idealisation of mother’’ and ‘‘anger toward father’’ as the independentblocks. The regression summary shown in Table 3 indicates that ‘‘idealisation ofmother’’ alone makes a significant contribution to the prediction of high ‘‘globaldisorganisation’’ and low ‘‘coherence of mind’’, while ‘‘anger toward father’’ in theAAI did not produce a significant result in the linear regression model. None of theother independent contributors correlated with the children’s global D score.

Table 2. Correlations between the AAI scales of actual states of mind and the MCASTscales.

AAI states of mind MCAST global scale Spearman’s Rho

Idealisation of mother Coherence of mind 7.63**Idealisation of mother Global disorganisation score .60**Anger towards father Global disorganisation score .37*

*p 5 .05; **p 5 .01.

54 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

Discussion

Our first objective was to find a significant and positive change in late-adoptedchildren’s attachment behavioural patterns within seven to eight months of theiradoption. At the beginning of their adoptive placements (T1), almost all of thechildren in our sample, aged between four and seven years old, had shown insecureIWMs. It is probable that these late-adopted children, who had almost certainlyexperienced poor quality care prior to being placed, had internalised confusing,incoherent and conflicting models from unpredictable and often violent caregivers.When they started to live with their adoptive parents, these negative representationswere sometimes translated into insecure relational strategies predominantlycharacterised by avoidance, passive withdrawal or angry ambivalence. Within sevento eight months of their adoption, a significant percentage of the insecure children hadshown a positive change in their attachment behavioural patterns and were classifiedas (earned) secure, demonstrating more pleasure and responsiveness in theirinteraction with their adoptive mothers. These results indicate that once insertedinto a new, stable and nurturing environment, late-adopted children have a goodchance of revising their IWMs, changing them from insecure to secure, and buildingnew positive representations of attachment relationships. These results also show thatlate adoption does not seem to be a factor that can in itself impede children’s IWMrevision, as has been previously reported in some studies (Steele et al., 2007b, 2008;Verissimo & Salvaterra, 2006), although other studies have highlighted that, ifchildren are older, this can have a partially negative effect on the success of theadoption (Howe, 2001; van IJzendoorn, Bakermans-Kranenburg, & Juffer, 2007).

Although 42% of the children in our pilot study changed from insecure to securebehavioural patterns, their narrative attachment representations, measured by theMCAST after seven to eight months of adoption, revealed that 37% of the narrativeswere classified as disorganised, meaning that they were characterised mainly by‘‘bizarre themes’’ and ‘‘complete chaos’’. This is despite the fact, surprisingly, that48% of the narratives showed secure patterns. In accordance with researchers in thefield of attachment, we may suggest that although many secure attachments andpositive representations are achieved with the new parents, in a significant number ofcases the old, disorganised and traumatic representations continued to be presentand were triggered at stressful points in the relationship. The previous and negativerepresentations are not ‘‘extinguished’’, but continue to exert an influence, and thechange in behaviour seems to precede a change in the children’s narratives.

On the basis of our results, we could infer that a faster (than MCAST-indexed)changing relationship could be captured by the Separation Reunion Procedure

Table 3. Regression model predicting ‘‘global disorganisation’’ and ‘‘coherence of mind’’ inchildren according to the MCAST from maternal ‘‘idealisation of mother’’ and ‘‘angertowards father’’ in the AAI.

Factor Standardised beta t p

Global disorganisationIdealisation of mother .635 3.977 .001Anger towards father .072 .449 .658

Coherence of mindIdealisation of mother 7.494 72.877 .008

Attachment & Human Development 55

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

(SRP-T1 and T2) with first 14% then 50% showing security, pointing to the rapiddevelopment (for half the sample) of a new (more positive) attachment relationshipto the adoptive caregiver. In other words, the 37% of the children at T2 presentingstory-completions judged disorganised by the MCAST rating procedure suggeststhat the doll play and story beginnings elicited attachment representations linked toearly (troubled) experiences for a little more than a one-third of the sample. Thispersistence of trauma-based thoughts and feelings for some children was correlatedwith having an adoptive mother highly prone to idealise her own mother, a markerof being less effective (than other adoptive mothers) at promoting a new andorganised representational world in her late-adopted child. High idealisation may,accordingly, be an AAI-based indicator of a need for post-adoption support, addingto the AAI and story-stem based clues as to who may be most in need of therapeuticintervention or support following adoption (Steele et al., 2007a, 2007b, 2008).

With respect to the 63% of children who were not disorganised in response to theMCAST and the full sample of children who showed no disorganisation in the SRPobservations, this may be taken as evidence of marked and positive change achievedsoon after placement. Yet we cannot be sure that this change would be stable, or thatit is actually a sign of lasting psychological well-being. Attachment researchers andclinicians have noticed that older-adopted children all have in common experiencesof having lost birth parents or having been abandoned and, in many instances, thesame caregiver was the perpetrator of abuse and neglect. These deleteriousexperiences obviously make them more vulnerable to negative outcomes in termsof their mental health and psychological functioning. The overrepresentation of late-adopted children in mental health and special educational services is reflected inlower levels of achievement at school and self esteem, and higher rates ofexternalising and internalising behavioural problems in childhood, adolescenceand early adulthood (Howe, 1997; Juffer et al., 1997; Juffer & van IJzendoorn, 2009;Steele et al., 2010).

The second objective was to investigate whether the secure-autonomous IWMs ofadoptive mothers were able to positively influence the change in attachment patterns(from insecure to secure) of their late-adopted children. In our sample, all of the‘‘earned secure’’ children were adopted by mothers who were shown to be secure intheir AAI, while the children placed with insecure mothers were also classified asinsecure at both data collection points. Secure maternal states of mind are usuallyassociated with a style of parenting which emphasises affective relationships andvalues attachment experiences. These results suggest that secure adoptive motherscould enable insecure children to mobilise affect and positively activate needs,feelings and behaviours linked to their attachment systems. Secure-autonomousmothers seems to produce positive effects in both avoidant children, enabling themto abandon their defensive behaviours that are directed towards the de-activation ofattachment needs in favour of a stronger expression of feelings, and ambivalent-resistant children, permitting them to free themselves from dependent-passive orhostile behaviours that display a hyper-activation of the attachment system andtowards a more balanced and clear expression of their needs.

These results, therefore, highlight that it could be not only adoption in itself, butalso the opportunity to be adopted by mothers with secure IWMs who are capable ofbalanced emotional regulation, that guarantees late-adopted children the possibilityof revising their insecure IWMs. Secure-autonomous adoptive caregivers, who havean attentive, sensitive and responsive style of parenting, are probably able to look

56 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

beyond what may otherwise be seen as hostility, defensiveness and rejection. Theymay tend to respond in a ‘‘counter-complementary’’ way (Lieberman, 2003), withoutshowing retaliatory rejection, and therefore challenging the insecure and/ordisorganised representations of their children.

Although in our work we did not use instruments to assess parent–childinteraction, we may also hypothesise, as suggested by Steele et al. (2007a), thatmothers with secure states of mind tend to spontaneously demonstrate ‘‘attachmentfacilitating behaviours’’ (Steele et al., 2007a, p. 68), involving the use of the child’sname, references to we or us when interacting with their child, and references toshared past experiences. These aspects appear to be associated with the developmentof positive relationships in adoptive families.

In addition, it is always reassuring to find that the proportion of secure-autonomous adopters according to their AAIs is high (60%), and that very few areunresolved (15%), giving some credit to adoption services workers and their abilityto prepare and select substitute parents. While not surprising, this is very pleasing, asit offers implicit evidence of the careful work performed by the social workers whoundertook the assessment of the adopters (Steele et al., 2007a). Given the influencesupon the internal world of children exerted by their adoptive mothers’ state of mind,those assessing the adopters will need to take their final selection of adopters veryseriously in the hope of facilitating the difficult task of matching child with adopterand reducing the amount of disruption in placements.

Finally, the third objective of our study was to examine the possible associationbetween adoptive mothers’ state of mind and the attachment narrative representa-tions of their children. The level of concordance between the secure/insecure AAIclassifications and the results of the MCAST (55.6%) in our sample did not reacheither the level of significance of 75% indicated by van IJzendoorn’s (1995) meta-analysis conducted on the AAI and SSP results of 854 ‘‘normal’’ dyads, nor the levelof significance of 72% found by Dozier et al. (2001) in a sample of 50 foster dyads.On the other hand, analysis of the dimensional scale scores of the two instrumentsshowed that idealisation scores in the mothers’ AAIs significantly and inverselycorrelated with scores for general coherence of mind and positively correlated withthe disorganisation scores on the MCAST. In other words, it was more probable thata mother who tended to speak about her own childhood and past relationships in ageneric, unbelievable and untruthful manner would have an adopted child whocompleted the story completion task in an incoherent, confused and irrelevant way,and therefore showed aspects of disorganisation such as bizarre themes and chaoticbehaviours.

In general, it is noteworthy that only two scales – insistence on lack of recall andidealisation of the mother – were connected with the dismissing classification andwith difficulty on the part of the mother in connecting present and past and semanticand specific memories. These were linked with the worst outcomes in late-adoptedchildren, who have to deal with the hard task of integrating the past and the present.

The placement of late-adopted children who have suffered adverse anddysfunctional experiences represents a context of affective ties and of care thatchallenges the maladaptive representations of the children. Steele et al. (2007b)hypothesised that it is easier for traumatised children to take on new and positiverepresentations rather than change the early negative representations that continueto exert their influence. The security of the adoptive parents’ IWMs, along with thecapacity to offer adopted children the opportunity to slowly revise their negative

Attachment & Human Development 57

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

representations of the self and others, can be considered as a factor that is able tofacilitate the revision of the children’s IWMs.

Limitations and future developments

This work has some evident methodological limitations. First, the sample size issmall and a bigger sample size could be useful in order to further elaborate our data,confirming or disconfirming these initial results. On the other hand, our small samplehas the advantage of having been observed from the beginning of their placement. Infact, the few studies conducted on samples of adopted children in Italy, which arealways quite small in terms of size, have tended to focus on pre-adolescent oradolescent children who have been adopted for a long time. This pilot study is thefirst contribution to examine ‘‘newly’’ adoptive dyads and to enable the measuring ofpossible changes to late-adopted children’s IWMs. Collecting data from a sample ofnewly formed adoptive families has been quite difficult because often, just afterplacement, adopters tend to shut themselves away and are not particularly amenableto external interference, such as participation in research.

Second, the T2 session was approximately eight months after the placementsbegan and, although it was possible to observe a shift towards security, the period oftime between the two assessment sessions was not enough long to establish whetherthe modifications were really stable. The follow-up is probably too soon for anydefinitive view on the changes made in placements, even if some research has foundassociations between the state of mind of adoptive mothers and emotional narrativesin previously maltreated children within only three months of adoption (Steele et al.,2003). It would therefore be interesting to carry out a follow-up longitudinal study inthe medium to long term in order to explore the development of the IWMs of late-adopted children throughout their childhood, adolescence and adulthood.

Acknowledgements

Our thanks to Professor Pietro San Martini for his methodological supervision, and also to allthe workers and adoptive families for their involvement in this study.

References

Ainsworth, M.D.S., Blehar, M.C., Waters, E., & Wall, S. (1978). Patterns of attachment: Apsychological study of Strange Situation. Hillsdale, NJ: Erlbaum.

Bakermans-Kranenburg, M.J., & van IJzendoorn, M.H. (2009). The first 10,000 AdultAttachment Interviews: Distributions of adult attachment representations in clinical andnon-clinical groups. Attachment & Human Development, 11, 223–263.

Balbernie, R. (2010). Reactive attachment disorder as an evolutionary adaptation. Attachment& Human Development, 12(3), 265–381.

Barone, L., Del Giudice, M., Fossati, A., Manaresi, F., Actis Perinetti, B., Colle, L., et al.(2009). Psychometric properties of the Manchester Child Attachment Story Task: AnItalian multicentre study. International Journal of Behaviour Development, 33, 185–190.

Bick, J., & Dozier, M. (2008). Helping foster parents change: The role of parental state ofmind. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult AttachmentInterview (pp. 452–470). New York, NY: Guilford Press.

Bowlby, J. (1969). Attachment and loss. Vol. 1. Attachment. New York, NY: Basic Books.Bowlby, J. (1973). Attachment and loss. Vol. 2. Separation: Anxiety and anger. New York, NY:

Basic Books.Bowlby, J. (1980). Attachment and loss. Vol. 3. Loss: Sadness and depression. New York, NY:

Basic Books.

58 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

Caspers, K., Yucuis, R., Troutman, B., Arndt, S., & Langbehn, D. (2007). A sibling adoptionstudy of adult attachment: The influence of shared environment on attachment states ofmind. Attachment & Human Development, 9(4), 375–391.

Cassidy, J. (1988). Child–mother attachment and the self in six-year-olds. Child Development,59, 121–134.

Clark, P., Thigpen, S., & Yates, A.M. (2006). Integrating the older/special needs adoptivechild into the family. Journal of Marital and Family Therapy, 32(2), 181–194.

Dozier, M. (2003). Attachment-based treatment for vulnerable children. Attachment & HumanDevelopment, 5(3), 253–257.

Dozier, M. (2005). Challenges of foster care. Attachment & Human Development, 7(1), 27–30.Dozier, M., Stovall, K.C., Albus, K.E., & Bates, B. (2001). Attachment for infants in foster

care: The role of caregiver state of mind. Child Development, 72(5), 1467–1477.Dozier, M., & Rutter, M. (2008). Challenges to the development of attachment relationships

faced by young children in foster and adoptive care. In J. Cassidy & P.R. Shaver (Eds.),Handbook of attachment. Theory, research, and clinical applications (2nd ed., pp. 102–129).New York, NY: Guilford Press.

Dunn, L.M., & Dunn, L. (1981). Peabody Picture Vocabulary Test - Revised manual for formsL and M. Circle Pines, MN: American Guidance Service.

George, C., Kaplan, N., & Main, M. (1985). Adult Attachment Interview Protocol (2nd ed.).Unpublished manuscript, University of California at Berkeley.

Goldsmith, D.F. (2007). Challenging children’s negative internal working models: Utilizingattachment-based treatment strategies in a therapeutic preschool. In D. Oppenheim &D.F. Goldsmith (Eds.), Attachment theory in clinical work with children (pp. 203–225).New York, NY: Guilford Press.

Goldwyn, R., Stanley, C., Smith, V., & Green, J. (2000). The Manchester Child AttachmentStory Task: Relationship with parental AAI, SAT, and child behaviour. Attachment &Human Development, 2(1), 71–84.

Green, J., Stanley, C., & Peters, S. (2007). Disorganized attachment representation andatypical parenting in young school age children with externalizing disorder. Attachment &Human Development, 9(3), 207–222.

Green, J., Stanley, C., Smith, V., & Goldwyn, R. (2000). A new method of evaluatingattachment representations in young school-age children: The Manchester ChildAttachment Story Task. Attachment & Human Development, 2(1), 48–70.

Grossman, K.E., Grossman, K., & Waters, E. (Eds.) (2005). Attachment from infancy toadulthood. The Major Longitudinal Studies. New York, NY: Guilford Press.

Hamilton, C.E. (2000). Continuity and discontinuity of attachment from infancy throughadolescence. Child Development, 71, 690–694.

Hodges, J., Steele, M., Hillman, S., & Henderson, K. (2003). Mental representations anddefences in severely maltreated children: A story stem battery and rating System forclinical assessment and research applications. In R. Emde, D. Wolf, & D. Oppenheim(Eds.), Revealing the inner worlds of young children: The MacArthur Story Stem Batteryand parent–child narratives (pp. 240–267). Oxford: Oxford University Press.

Hodges, J., Steele, M., Hillman, S., Henderson, K., & Kaniuk, J. (2003). Change inattachment representations over the first year of adoptive placement; narratives ofmaltreated children. Journal of Child Clinical Psychology, 8, 351–367.

Hodges, J., Steele, M., Hillman, S., Henderson, K., & Neil, M. (2000). Effects of abuse onattachment representations: Narrative assessments of abused children. Journal of ChildPsychotherapy, 26(3), 433–455.

Howe, D. (1997), Parent-reported problems in 211 adopted children: Some risk and protectivefactors. Journal of Child Psychology and Psychiatry, 38(4), 401–411.

Howe, D. (1998). Patterns of adoption. Nature, nurture and psychosocial development. Oxford:Blackwell Science.

Howe, D. (2001). Age at placement, adoption experience and adult adopt people’s contactwith their adoptive and birth mothers: An attachment prospective. Attachment & HumanDevelopment, 3(2), 222–237.

Howe, D. (2003). Attachment disorders: Disinhibited attachment behaviours and secure basedistortions with special reference to adopted children, Attachment & Human andDevelopment, 5(3), 265–270.

Attachment & Human Development 59

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

Howes, C., & Spieker, S. (2008). Attachment relationships in the context of multiplecaregivers. In J. Cassidy & P.R. Shaver (Eds.), Handbook of attachment. Theory, research,and clinical applications (2nd ed., pp. 317–332). New York, NY: Guilford Press.

Hushion, K., Sherman, S.B., & Siskind, D. (2006). Understanding adoption. Clinical work withadults, children and parents. Lanham, Maryland: Jason Aronson.

Juffer, F., Hoksbergen, R.A.C., Riksen-Walraven, J.M., & Kohnstamm, G.A. (1997). Earlyintervention in adoptive families: Supporting maternal sensitive responsiveness, infant–mother attachment, and infant competence. Journal of Child Psychology and Psychiatry,38(8), 1039–1050.

Juffer, F., & van IJzendoorn, M.H. (2007). Adoptees do not lack self-esteem: A meta-analysisof studies on self-esteem of transracial, international and domestic adoptees. PsychologicalBulletin, 133, 1067–1083.

Juffer, F., & van IJzendoorn, M.H. (2009). International adoption comes of age: Developmentof international adoptees from a longitudinal and meta-analytical perspective. In G.M.Wrobel & E. Neil (Eds.), International advances in adoption research for practice (pp. 169–192). London: John Wiley and Sons.

Kaniuk, J., Steele, M., & Hodges, J. (2004). Report on a longitudinal research project,exploring the development of attachments between older, hard-to-place children andtheir adopters over the first two years of placement. Adoption & Fostering, 28,61–67.

Kerns, K.A. (2008). Attachment in middle childhood. In J. Cassidy & P.R. Shaver (Eds.),Handbook of attachment. Theory, research, and clinical applications (2nd ed., pp. 366–382).New York, NY: Guilford Press.

Levy, T.M., & Orlans, M. (2003). Creating and repairing attachments in biological, foster, andadoptive families. In S.M. Johnson & E. Wiffen (Eds.), Attachment process in couple andfamily therapy (pp. 165–190). New York, NY: Guilford Press.

Lieberman, A.F. (2003). The treatment of attachment disorder in infancy and early childhood:Reflections from clinical intervention with later adopted foster care children. Attachment& Human Development, 5(3), 279–282.

Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age six:Predicted from attachment classifications and stable over a one-month period.Developmental Psychology, 24, 415–426.

Main, M., Goldwyn, R., & Hesse, E. (2008). Adult Attachment Scoring and ClassificationSystem. Unpublished manuscript, Department of Psychology, University of California atBerkeley.

O’Connor, T., & Zeanah, C.H. (2003). Attachment disorders: Assessment strategies andtreatment approaches. Attachment & Human Development, 5(3), 223–244.

Oppenheim, D., & Goldsmith, D.F. (Eds.) (2007). Attachment theory in clinical work withchildren. New York, NY: Guilford Press.

Roid, G.H., & Miller, L.J. (1997). Leiter International Performance Scale – Revised. WoodDale, IL: Stoelting Co. Italian translation (2002) International Performance Scale –Revised. Florence: O.S. Organizzazioni Speciali.

Rutter, M., Colvert, E., Kreppner, J., Beckett, C., Castle, J., Groothues, C., et al. (2007). Earlyadolescent outcomes for institutionally deprived and non-deprived adoptees: Disinhibitedattachment. Journal of Child Psychology and Psychiatry, 48(1), 17–30.

Rutter, M., O’Connor, T.G., & the English and Romanian Adoptees Study Team. (2004). Arethere biological programming effects for psychological development? Findings from astudy of Romanian adoptees. Developmental Psychology, 40, 81–94.

Schofield, G., & Beek, M. (2005). Providing a secure base: Parenting children in long-termfoster family care. Attachment & Human Development, 7(1), 3–26.

Siegel, S., & Castellan, N.J., Jr. (1988). Nonparametric statistics for the behavioural sciences(2nd ed.). New York: McGraw-Hill.

Slade, A. (2007). Disorganized mother, disorganized child: The mentalization of affectivedysregulation and therapeutic change. In D. Oppenheim & D.F. Goldsmith (Eds.),Attachment theory in clinical work with children (pp. 226–250). New York, NY: GuilfordPress.

Speranza, A.M. (1994). Infant attachment stability and intergenerational transmission ofattachment patterns (Unpublished doctoral dissertation). La Sapienza, University ofRome.

60 C.S. Pace et al.

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3

Steele, M., Henderson, K., Hodges, J., Kaniuk, J., Hillman, S., & Steele, H. (2007b). In thebest interests of the late-placed child: A report from Attachment Representations andAdoption Outcome study. In L. Mayes, P. Fonagy, & M. Target (Eds.), Developmentalscience and psychoanalysis. Integration and innovation (pp. 159–182). London: Karnac.

Steele, M., Hodges, J., Kaniuk, J., Hillman, S., & Henderson, K. (2003). Attachmentrepresentations and adoption: Associations between maternal states of mind and emotionnarratives in previously maltreated children. Journal of Child Psychotherapy, 29(2), 187–205.

Steele, M., Hodges, J., Kaniuk, J., & Steele, H. (2010). Mental representation and change:Developing attachment relationships in an adoption context. Psychoanalytic Inquiry, 30,25–40.

Steele, M., Hodges, J., Kaniuk, J., Steele, H., D’Agostino, D., Blom, I., et al. (2007a).Intervening with maltreated children and their adoptive families: Identifying attachment-facilitative behaviors. In D. Oppenheim & D.F. Goldsmith (Eds.), Attachment theory inclinical work with children (pp. 58–89). New York, NY: Guilford Press.

Steele, M., Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K. (2008). Forecastingoutcomes in previously maltreated children. The use of the AAI in a longitudinal adoptionstudy. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult AttachmentInterview (pp. 427–451). New York, NY: Guilford Press.

Steele, H., & Steele, M. (Eds.) (2008). Clinical applications of the Adult Attachment Interview.New York, NY: Guilford Press.

Stella, G., Pizzoli, C., & Tressoldi, P.E. (2000). Peabody. Tests of receptive vocabulary. Turin:Omega Eds.

Van den Dries, L., Juffer, F., van IJzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2009).Fostering security? A meta-analysis of attachment in adopted children. Children and YouthServices Review, 31, 410–421.

van IJzendoorn, M.H. (1995), Adult Attachment representations, parental responsiveness, andinfant attachment: A meta-analysis on the predictive validity of the Adult AttachmentInterview. Psychological Bulletin, 117, 387–403.

van IJzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2003). Attachment disorders anddisorganized attachment: Similar and different. Attachment & Human Development, 5(3),313–320.

van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., & Juffer, F. (2007). Plasticity of growthin height, weight and head circumference: Meta-analytic evidence of massive catch-up afterinternational adoption. Journal of Developmental and Behavioral Pediatrics, 28, 334–343.

van IJzendoorn, M.H., & Juffer, F. (2005). Adoption is a successful natural interventionenhancing adopted children’s IQ and school performance. Current Directions inPsychological Science, 14, 326–330.

van IJzendoorn, M.H., & Juffer, F. (2006). The Emanuel Miller Memorial Lecture 2006:Adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity inphysical, socio-emotional, and cognitive development. Journal of Child Psychology andPsychiatry, 47, 1228–1245.

van IJzendoorn, M.H., Juffer, F., & Klein Poelhuis, C.W. (2005). Adoption and cognitivedevelopment: A meta-analytic comparison of adopted and non-adopted children’s IQ andschool performance. Psychological Bulletin, 131(2), 301–316.

Van Londen, W.M., Juffer, F., & van IJzendoorn, M.H. (2007). Attachment, cognitive andmotor development in adopted children: Short-term outcomes after internationaladoption. Journal of Pediatric Psychology, 32, 1259–1263.

Verissimo, M., & Salvaterra, F. (2006). Maternal secure base scripts and children’s attachmentsecurity in an adopted sample. Attachment & Human Development, 8(3), 261–273.

Waters, E. (1995). The Attachment Q-set (Version 3). In E. Waters, B.E. Vaughn, G. Posada, &K. Kondo-Ikemura (Eds.), Caregiving, cultural, and cognitive perspectives on secure-basebehavior and working models: New growing points of attachment theory and research. Mono-graphs of the Society for Research inChildDevelopment (pp. 234–246), 60 (2-3, SerialNo. 244).

Waters, E., Merrick, S.K., Treboux, D., Crowell, J., & Albersheim, L. (2000). Attachmentsecurity from infancy to early adulthood: A 20 year longitudinal study. Child Development,71, 684–689.

Waters, H.S., & Waters, E. (2006). The attachment working models concept: Among otherthings, we build script-like representations of secure base experiences. Attachment &Human Development, 8(3), 185–197.

Attachment & Human Development 61

Dow

nloa

ded

by [

b-on

: Bib

liote

ca d

o co

nhec

imen

to o

nlin

e U

Evo

ra]

at 0

8:27

28

Febr

uary

201

3