Abstract
Comparing risk- and non-risk-groups, as is done in the study by Witting, Ruiz, and Ahnert (2016), is a favored approach in developmental psychopathology in order to learn more about underlying mechanisms of normal development, as well as developmental deviations (Sroufe & Rutter, 1984). Such an approach is best suited to inform practice about early prevention, e.g. for preterm born children. Witting and colleagues followed up this strategy to study variations in attachment mechanisms, comparing preterm and term born children in their case study, even including a boy with an extremely low birth weight of 460 g. They observed the boys in the laboratory in Ainsworth’s Strange Situation (SS) as well as in their home using Water’s Attachment Q-Sort (AQS), coded their attachment strategies, developed rating scales with regard to arousal and regulation at the behavioral level and assessed cortisol levels before and after the SS. They have thereby used a multilevel and multi-method approach as highly recommended by developmental psychopathologists (e.g., Leve & Chicchetti, 2016).
However, unfortunately, assessments at the representational level, which would have been important to address fathers’ “understanding of the vulnerability in their babies, especially in stressful situations”, were left out, even though this issue was raised by the authors in the discussion section. In a study involving only three cases, the authors could have carried out interviews with the parents and could have assessed their insightfulness or reflective functioning, which are important mechanisms in attachment regulation. In doing so, they would have more fully addressed the growing empirical support for the transactional nature of attachment and dyadic regulation (Roisman, Fraley, Halitgan, Cauffman, & Booth-LaForce, 2016). On the other hand, the study of the three cases selected out of a larger sample of preterm singletons, preterm twins, and full term infants can lead to hypotheses which can eventually be followed up in the larger sample. According to the transactional nature of development (Gottlieb, 1997), the authors consequently assessed regulation on the individual level in three SS-episodes: being alone in episode 6, being with the stranger in episode 7, and the reunion with the father or mother in episode 8. The dyadic nature of regulation can be seen in Table 4 with regard to stress (cortisol) and in Table 5 as reflected by behavioral scores: The presence of an attachment figure, and moreover the quality of attachment, is reflected in these results. In accordance with attachment theory, all three boys, who were securely attached to their mothers, displayed ‘good’ and ‘excellent’ regulation behavior in the reunion with mothers’ episodes. However, in the reunion with fathers’ episodes, the boy with the highest regulation capacities was insecurely attached to his father, highlighting the difficulties of generalizing findings from a case study in order to offer hypotheses from that. Research strategies that included features of disorganization would improve the understanding of those variations in attachment patterns among preterm infants. Specifically among infants born with varying degrees of maturity, disorganization might be central in studying regulation and variations in attachment mechanisms. However, this limitation of the study could easily be fixed since disorganization in SS-tapes can be coded for at any time by reliable coders.
In sum, the outline and the design of the study is suitable to serve as a model in order to inspire further research, and to inform practice for better supports of preterm children. As we better understand the transactional process, we may finally handle the empirically found vulnerabilities and long-lasting handicaps among some of the preterm children more effectively (Dammann et al., 1996), and might be able to improve preventive interventions in this area.