In the present study, there are several limitations. First, the use of a single case approach limits the generalizability of our results and conclusions; in addition, the exploratory nature of this study does not allow comparisons of our findings against previous data. Despite these limitations, the case study still occupies a central position within the psychology research field, as it appears well-suited for the observation of a phenomenon within its real-life context. Indeed, many researchers do believe that single case studies are appropriate for the exploratory stage of an investigation (Yin, 2009), and that in any case they can be confirmed or disconfirmed by following replication studies. Secondly, the procedure does not provide the opportunity to control wheatear the observed changes were due to the IM or

## References

to the process of the time. However, previous research (Field et al., 2004, 2010; O'Higgins et al., 2008) findings suggest the positive impact of the IM during the post-partum phase. Deepen empirical researches and control groups should be used for this purpose. Thirdly, the use of self-report is a limitation by itself. Indeed, the parental availability to participate in our study, and their desire to provide a positive image of themselves, also through the replies to the self-reports, may represent a significant *bias* to the reliability of these data, and it should be considered for further investigations on this topic. Lastly, we did not assess the impact of the IM on the baby's development. Additional measures and outcomes related to the baby should be taken into account and further considered.

With these limitations in mind, an important strength point should be highlighted. To date, no research observed the impact of the IM on both partners or on father only. According to a recent literature, and to significant social changes occurred in the caregiver roles, the investigation of the father role emerges as a central issue for the child's development (Cowan et al., 2009; Fletcher, 2009; Di Folco and Zavattini, 2014; Di Folco et al., 2015). Literature (Diego et al., 2008; Field et al., 2010; Ang et al., 2012; Moyer-Mileur et al., 2012; Ahmed et al., 2015) showed how the infant can take advantage from the massage provided by the mother, but more investigations are needed on the effects of the massage performed by the father, and to its impact on his relationship with the baby.

In sum, the results discussed in our study describe the importance to provide early interventions for those cases at risk to experience PPD. The IM training seems to be a valuable way to protect the couple by the establishment of post-partum difficulties, and to improve their parental skills. The IM training provides an opportunity for parents to communicate with their child not just verbally but also through the quality of touch, the movement, the rhythm, and the bodily sensations (Underdown et al., 2013).

social support, fathers' personality and prenatal expectations. *J. Reprod. Infant Psychol.* 24, 21–29. doi: 10.1080/02646830500475179

randomized controlled trial. *J. Consult. Clin. Psychol.* 79, 707–712. doi: 10.1037/a0024895

**Conflict of Interest Statement:** The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

*Copyright © 2015 Gnazzo, Guerriero, Di Folco, Zavattini and de Campora. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.*

# Influence of adult attachment insecurities on parenting self-esteem: the mediating role of dyadic adjustment

*Vincenzo Calvo\* and Francesca Bianco*

*Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy*

Background: Parenting self-esteem includes two global components, parents' selfefficacy and satisfaction with their parental role, and has a crucial role in parent–child interactions. The purpose of this study was to develop an integrative model linking adult attachment insecurities, dyadic adjustment, and parenting self-esteem.

#### *Edited by:*

*Gianluca Castelnuovo, Università Cattolica del Sacro Cuore, Italy*

#### *Reviewed by:*

*Michelle Dow Keawphalouk, Harvard and MIT, USA Jason Jones, University of Pennsylvania, USA*

#### *\*Correspondence:*

*Vincenzo Calvo, Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, via Venezia 8, Padova 35131, Italy<EMAIL_ADDRESS>
#### *Specialty section:*

*This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology*

*Received: 15 May 2015 Accepted: 11 September 2015 Published: 24 September 2015*

#### *Citation:*

*Calvo V and Bianco F (2015) Influence of adult attachment insecurities on parenting self-esteem: the mediating role of dyadic adjustment. Front. Psychol. 6:1461. doi: 10.3389/fpsyg.2015.01461* Methods: The study involved 118 pairs (236 subjects) of heterosexual parents of a firstborn child aged 0–6 years. They were administered the Experiences in Close Relationships-Revised (ECR-R) questionnaire, the Dyadic Adjustment Scale, and the Parenting Sense of Competence Scale.

Results: Path analysis was used to design and test a theoretical integrative model, achieving a good fit with the data. Findings showed that dyadic adjustment mediates the negative influence on parenting self-efficacy of both attachment anxiety and attachment avoidance. Parenting satisfaction is positively influenced by parenting self-efficacy and negatively affected by child's age. Attachment anxiety negatively influences parenting satisfaction.

Conclusion: Our findings are in line with the theoretical expectations and have promising implications for future research and intervention programs designed to improve parenting self-esteem.

Keywords: adult attachment, dyadic adjustment, parenting self-esteem, parenting self-efficacy, parenting satisfaction

## Introduction

It has been recognized in both developmental and clinical research that parents' cognitions and beliefs about parenting have a crucial role in parent–child interactions (Dix and Grusec, 1985; Johnston, 1996; Bugental and Johnston, 2000; Rubin and Chung, 2006), and relate to virtually every aspect of children's developmental accomplishments (Sigel and McGillicuddy-Delisi, 2002). Parents' cognitions and beliefs (i.e., their knowledge, values, attitudes, and goals) can have numerous functions (Bornstein, 2002), among which they may generate and shape parental behavior, and help to organize parenting activities (Murphey, 1992; Darling and Steinberg, 1993; Teti and Candelaria, 2002).

One form of parental cognition that has received increasing attention is parenting self-esteem, also known as parenting sense of competence. By definition, this concept encompasses two global, closely related components (Johnston and Mash, 1989): parents' perceived self-efficacy in their parental role, and the satisfaction they derive from parenting (Sabatelli and Waldron, 1995; Coleman and Karraker, 1997; Bugental et al., 1998; Ohan et al., 2000; Jones and Prinz, 2005; Carpenter and Donohue, 2006; Nunes et al., 2014).

Self-efficacy is about people's belief in their ability to achieve their goals (Bandura, 1997), and in the context of parenting this means how confident people feel about their capacity to deal competently with difficult childrearing situations. It stems from parents' cognitions and self-perceptions about how skillfully they accomplish tasks related to parenting (de Montigny and Lacharité, 2005; Jones and Prinz, 2005; Farkas and Valdés, 2010), and positively influence their children, fostering the latter's adjustment and development (Ardelt and Eccles, 2001). In other words, parenting self-efficacy refers to an instrumental dimension of parenting, notably the degree to which parents feel competent, capable of solving problems, and familiar with the demands of parenting (Johnston and Mash, 1989). Parenting satisfaction indicates a more affective dimension, reflecting the degree to which parents feel frustrated, anxious, gratified and motivated in their parenting role (Johnston and Mash, 1989).

Efficacious parenting beliefs are often associated with greater competence in performing parenting tasks: parents who feel more competent exhibit a greater confidence in acquiring and exercising effective parenting skills, strategies, and types of behavior than parents who feel less competent (Jones and Prinz, 2005). Feeling competent as a parent influences the quality of maternal adaptation during the transition to parenthood (Ngai et al., 2007), the care that parents give to their newborn (Teti and Gelfand, 1991; Tucker et al., 1998; de Haan et al., 2009; Dumka et al., 2010). When parents feel competent, they are likely to use more effective parenting practices, developing more secure, warm, and involving interactions with their child (Coleman and Karraker, 1997; Shumow and Lomax, 2002; Jones and Prinz, 2005). Parents who feel effective have also proved better able to provide an adaptive, motivating and nurturing childrearing environment (Locke and Prinz, 2002). To be more specific, mothers who feel efficacious and competent in their role as parents are more responsive (Parks and Smeriglio, 1986; Schellenbach et al., 1992) and less punitive, and their developmental expectations are more appropriate (East and Felice, 1996). They are also more strongly motivated to engage in further interactions that, in turn, provide them with additional opportunities to interact positively with their infants (Teti et al., 1996). Research has demonstrated that parenting self-esteem is a protective factor in the mother-child relationship, mediating the negative effects of maternal depression and temperamental offspring (Teti and Gelfand, 1991; MacPhee et al., 1996; Gondoli and Silverberg, 1997). On the other hand, a scarce confidence in one's parenting skills is associated with frustration and irritation, and a less supportive behavior (Bugental et al., 1984; Sanders and Woolley, 2005; de Haan et al., 2009), which increases the risk of the offspring developing externalizing problems (Hill and Bush, 2001; Sanders and Woolley, 2005; Dishion and Patterson, 2006; Grusec and Hastings, 2007; Prinzie et al., 2010), and delinquent behavior in adolescent age (Bogenschneider et al., 1997).

In the light of the apparent importance of parenting selfesteem in parent–child relationships and children's well-being (Teti and Gelfand, 1991; Tucker et al., 1998; de Haan et al., 2009; Dumka et al., 2010), it is crucial to investigate and clarify which factors influence the development of its cognitive and emotional components, such as parenting self-efficacy and parenting satisfaction (Sevigny and Loutzenhiser, 2010).

A growing body of empirical research shows that adult attachment profoundly influences parents' behavior, emotions, and cognitions (Jones et al., 2015). From the standpoint of attachment theory, parenting behavior, cognitions, and emotions are conceptualized as serving the caregiving bio-behavioral system, and thought to be influenced and shaped by previous experiences with caregivers in earlier phases of development (Cassidy and Shaver, 1999; Mikulincer and Shaver, 2007). Caregiving is seen as a primary component of parenting behavior, but also as a key constituent of romantic and marital relationships, and of all forms of prosocial behavior (Mikulincer and Shaver, 2007). Secure working models of attachment are thought to promote and sustain effective caregiving and parenting self-esteem (Mikulincer and Shaver, 2007).

In the tradition of attachment theory, numerous studies have investigated the connections between parenting characteristics and adult attachment, using both interview-based attachment measures, such as the Adult Attachment Interview (AAI; George et al., 1984, 1985, 1996), and also – more recently and with growing interest – self-report questionnaires designed to assess attachment styles, dimensions, and orientations (Jones et al., 2015).

Only relatively few studies have addressed the influence of adult attachment styles on such components of parenting self-esteem as parenting self-efficacy and parenting satisfaction, yielding a complex and variable picture. Some early studies provided preliminary support for the association between adult attachment orientations and parenting self-efficacy (Coleman and Karraker, 1997). Caldwell et al. (2011) studied the relationships between forms of maltreatment, adult attachment dimensions (anxiety and avoidance), maternal depression, and parenting self-efficacy in a group of at-risk mothers: they found that attachment anxiety has an indirect effect on parenting self-efficacy, mediated by maternal depressive symptoms, whilst the direct link between attachment anxiety and parenting selfefficacy was not significant. Similarly, Kohlhoff and Barnett (2013) examined the role of adult attachment and depression as predictors of parenting self-efficacy in a sample of primiparous mothers during the first year after childbirth: their results showed that both attachment anxiety and attachment avoidance have a significant indirect effect on parenting self-efficacy and this link is mediated by the presence of maternal major depression. Only attachment anxiety had a significant but moderate, direct relationship with parenting self-efficacy, after taking the mediating effect of depression into account. Another study explored the connections between fathers' romantic attachment style, as coded by means of the Hazan and Shaver (1987) three-category measure of attachment, parenting beliefs and the offspring's attachment security (Howard, 2010): consistently with expectations, fathers who rated themselves as secure scored higher for parenting efficacy and had a better knowledge of their child's development.

As for the other dimension of parenting self-esteem – parenting satisfaction – a recent review (Jones et al., 2015) examined the literature concerning the links between attachment styles and parenting satisfaction, generating a rather inconsistent picture. As expected, La Valley and Guerrero (2012) found that security was associated with more parenting satisfaction. Along the same lines, attachment avoidance correlated with less parenting satisfaction in four studies (Cohen and Finzi-Dottan, 2005; Rholes, 2006; Cohen et al., 2011; Vieira et al., 2012). One of these four studies only found this link for mothers (Cohen and Finzi-Dottan, 2005), however, and Vieira et al. (2012) only identified an indirect effect of attachment on parenting satisfaction, mediated by work-family conflict. Findings concerning attachment anxiety are less convincing: only Cohen et al. (2011) reported a negative relationship between anxiety and satisfaction (as expected); Rholes (2006) found no significant relationship between the two; Vieira et al. (2012) found both a positive direct effect of attachment anxiety on satisfaction and an indirect path linking anxiety with less parenting satisfaction via more severe work-family conflict; and (contrary to expectations) Lau and Peterson (2011) found no significant associations between attachment style and parenting satisfaction.

Taken together, these results provide some support for links between adult attachment styles and parenting self-efficacy, but these links are likely to be indirect and mediated by other relevant variables; and the picture concerning parenting satisfaction is unclear. More research is needed on these topics to further investigate the association between attachment styles and parenting self-esteem in the general normative (non-clinical) population. The issue is important, given that sociological theory on family stress and role strain point to stress levels as a moderating variable that significantly affects the links between marriage quality, parent–child relationship, and parenting (Erel and Burman, 1995). Indeed, six out of the eight abovementioned studies examined parents dealing with stressful life circumstances, such as mothers on residential programs for early parenting difficulties (Kohlhoff and Barnett, 2013), at-risk mothers (Caldwell et al., 2011), war veteran fathers (some of them suffering from acute combat-induced stress reaction and post-traumatic stress disorder; Cohen et al., 2011), couples in the first year after divorce (Cohen and Finzi-Dottan, 2005), parents of children with Asperger syndrome (Lau and Peterson, 2011), or parents in the early months of their transition to parenthood (Rholes, 2006).

The extant literature has yet to investigate the mediating role of couple quality and dyadic adjustment in influencing parenting self-esteem, in families where both parents are present. A considerable amount of theoretical and experimental data suggests that the quality of the couple's relationship might be a salient mediator between adult attachment and parenting selfesteem. Empirical research has shown that adult attachment has a direct impact on couple quality and dyadic adjustment (Collins and Read, 1990; Carnelley et al., 1994, 1996; Collins, 1996; Frazier et al., 1996; Jones and Cunningham, 1996; Whisman and Allan, 1996; Cozzarelli et al., 2000; Frei and Shaver, 2002; Schmitt, 2002; Steiner-Pappalardo and Gurung, 2002; Shi, 2003; Kachadourian et al., 2004; Sumer and Cozzarelli, 2004; Williams and Riskind, 2004; Shaver et al., 2005), and that parental beliefs are strongly influenced by the quality of the relationship with the other parent (Belsky, 1984; Goldberg and Easterbrooks, 1984; Cox et al., 1989; Howes and Markman, 1989; Simons et al., 1992, 1993; Kerig et al., 1993; Erel and Burman, 1995; Cowan et al., 1996; Holloway et al., 2005; Schoppe-Sullivan et al., 2007; Suzuki, 2010). Moreover, Millings et al. (2012) found that attachment orientations have a significant indirect effect on parenting styles, mediated by responsive caregiving to partner.

In short, the literature highlights significant theoretical, conceptual and empirical links between adult attachment orientations, couple quality and parenting self-esteem. In particular, it is apparent that dyadic adjustment can mediate the influence of adult attachment on parenting self-efficacy. At the same time, there is contrasting evidence on the possible direct effect of attachment anxiety on parenting satisfaction, and this issue warrants further investigation.

The aim of the present cross-sectional research was therefore to extend our understanding of the effects of attachment on parenting self-esteem by developing an integrative model linking attachment insecurities (i.e., attachment anxiety and attachment avoidance) to parenting self-efficacy and parenting satisfaction, taking into account the possible role of dyadic adjustment with the partner as a mediator variable. Drawing from attachment theory and past empirical work, we consequently hypothesized a path analytical model of influences, postulating: (a) a direct effect of attachment orientations (attachment anxiety and attachment avoidance) on parenting self-efficacy and/or parenting satisfaction; and (b) a mediated influence of attachment orientations on parenting self-efficacy and parenting satisfaction, via dyadic adjustment. In particular, our hypotheses were that: (a) higher levels of attachment insecurity are directly associated with lower levels of parenting self-esteem; and (b) attachment insecurity negatively influences dyadic adjustment, which in turn reflects on parenting self-esteem. Finally, in accordance with Johnston and Mash (1989), we included in our model a path for the influence that links parenting selfefficacy with parenting satisfaction, hypothesizing that lower levels of parenting self-efficacy may result in less parenting satisfaction. The literature on parental cognitions has shown that beliefs concerning self-efficacy (specifically in the parenting domain) are a powerful variable explaining a significant portion of the variance observed in parenting skills and satisfaction (Coleman and Karraker, 1997). According to Bandura (1982), beliefs concerning their self-efficacy influence people's way of thinking and determine individuals' motivations and behavior. Parents with a strong sense of self-efficacy can be more at ease and effective in dealing with the everyday difficulties of being a parent, and this positively influences their satisfaction with their role. Vice versa, a weak sense of self-efficacy may negatively influence parenting practices, causing anxiety, depression, and stress, and reducing parenting satisfaction (Coleman and Karraker, 1997).

Our theoretical integrative model is outlined in **Figure 1**.

Some studies found significant gender-related differences in parenting self-esteem, suggesting that fathers tend to have higher levels of parenting satisfaction than mothers (Johnston and Mash, 1989; Rogers and Matthews, 2004; Gilmore and Cuskelly, 2009). Since mothers and fathers experience at least some parenting processes differently (Bretherton et al., 2005; Gamble et al., 2007; Gilmore and Cuskelly, 2009), we used a multiple group analysis without any specific *a priori* hypothesis to test the extent to which the proposed theoretical model is consistent across genders.

## Materials and Methods

### Participants and Procedure

The study group included 118 pairs (236 subjects) of heterosexual parents with a firstborn child aged 0–6 years. In most cases, the couples had only one child (87 couples, 73.7%), while 30 couples had two (25.4%), and one couple had three (0.8%). The firstborn children were a mean 2.58 years of age (*SD* = 22.27 months; range: 1–72 months); 52 (44.1%) of them were females, and 66 (55.9%) males.

All parents were Caucasian. The mean age of the mothers was 33.51 years (*SD* = 5.54; range: 19.10–47.16 years) and for the fathers it was 36.19 years (*SD* = 5.67; range: 24.54–51.15). The mean duration of the couples' relationships was 9.20 years (*SD* = 4.29; range: 2–22), and they had been living under the same roof for a mean 5.25 years (*SD* = 3.15; range: 0.5–22). The parents' formal education had lasted a mean 14.90 years (*SD* = 3.08) for the mothers, and 13.94 years (*SD* = 3.41) for the fathers.

The couples included in the study were enrolled using a chain sampling method. They were invited to participate in a study on the relationships between adult attachment, couple adjustment, and parenting self-esteem. The inclusion criteria were: (1) having a firstborn child aged 0 to 6; (2) being married to or living with the child's other parent. A psychologist administered all the questionnaires to both parents after informing participants about the aims of the study and asking them to give their written informed consent. The whole procedure took approximately 30 min. The study was approved by the Ethical Committee for the Psychological Research of the University of Padova.

### Instruments and Measures

All participants independently completed the following selfreport questionnaires to measure adult attachment, dyadic adjustment, and parenting self-esteem.

### Adult Attachment

The Experiences in Close Relationships-Revised (ECR-R; Fraley et al., 2000b) questionnaire is a self-report measure of adult attachment. It consists of 36 items, scored on a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The ECR-R assesses two dimensions of attachment (18 items for each scale): (a) attachment anxiety, which reflects variability in fear of abandonment and sensitivity to issues relating to rejection and loss (Fraley et al., 2000a); and (b) attachment avoidance, which reflects the degree of the individual's discomfort with intimacy, closeness, and dependence. Higher mean scores indicate greater degrees of anxiety and/or avoidance, and consequently lower levels of attachment security, which is therefore conceptualized as a low degree of attachment anxiety and/or avoidance. Individuals with low scores for both dimensions are willing and able to use their attachment figures as a safe haven during times of distress and danger, and as a secure base from which to explore their worlds. The scores for the two ECR-R dimensions were not used to assign participants to specific attachment categories (i.e., secure, fearful, dismissing, preoccupied) because it has been suggested that individual variation in attachment is modeled better using dimensions rather than categories (Fraley and Waller, 1998; Fraley and Spieker, 2003a,b; Roisman et al., 2007). The Italian version of the ECR-R has demonstrated good psychometric properties in terms of internal consistency, factorial and concurrent validity (Calvo, 2008; Busonera et al., 2014). In the present study, Cronbach's alpha reliability value was 0.82 for the attachment anxiety score, and 0.86 for the attachment avoidance score.

## Dyadic Adjustment

The Dyadic Adjustment Scale (DAS; Spanier, 1976) is a 32-item self-report questionnaire assessing marital dyadic adjustment, under four headings: dyadic consensus (13 items), dyadic satisfaction (10 items), dyadic cohesion (five items), and affective expression (four items). Dyadic consensus is the degree to which the couple agrees on matters of importance to the relationship, such as handling family finances or making major decisions. Dyadic cohesion is the degree of closeness and shared activities experienced by the couple. Dyadic satisfaction refers to the degree to which the partners are satisfied with their relationship. Affective expression concerns the demonstrations of affection and sexual relationships. For the purposes of the present study, we only used the DAS total score, computed as the sum of the four subscales, as a measure of overall dyadic adjustment. The Italian version of the DAS has demonstrated an adequate internal consistency and factorial structure (Gentili et al., 2002). In this study, Cronbach's alpha coefficients for the DAS total score, dyadic consensus, dyadic satisfaction, dyadic cohesion, and affective expression subscales were 0.89, 0.81, 0.81, 0.69, and 0.63, respectively.

## Parenting Self-Esteem

The Parenting Sense of Competence Scale (PSOC; Gibaud-Wallston and Wandersman, 1978, cited in Johnston and Mash, 1989) includes 17 items rated on a six-point Likert scale ranging from 1 (strongly agree) to 6 (strongly disagree), and designed to measure two related but distinct dimensions of parenting self-esteem, i.e., satisfaction with parenting and self-efficacy in the parenting role. Parenting satisfaction is an affective dimension reflecting parenting motivation, frustration, and anxiety (Johnston and Mash, 1989); parenting self-efficacy is as an instrumental dimension involving competence, problem-solving ability, and capability in the parenting role (Ohan et al., 2000). The PSOC has shown an adequate reliability, factor structure, and validity (Ohan et al., 2000). In the present study, in accordance with the Johnston and Mash (1989) method, parents were asked to complete the PSOC while thinking only about one target child in the family (their firstborn). The internal consistency of this measure for our sample was 0.75 for parenting satisfaction and 0.70 for parenting self-efficacy.

## Data Analysis

First, we examined descriptive statistics, gender-related differences in parenting self-efficacy and parenting satisfaction, and bivariate relationships between the measures. We had only two participants with one missing item in the DAS scale (in the DC subscale). In that case, we computed the mean for the non-missing responses. We had no missing data in the ECR-R and PSOC scales. Then we considered the pattern of relationships in our theoretical model using path analysis with the SPSS Amos software (Arbuckle, 2011). Path analysis enables direct and indirect dependence to be tested in a set of variables, providing estimates of the magnitude and significance of the causal connections hypothesized between variables. Path coefficients were estimated using the maximum likelihood method. Each parameter estimate was considered statistically significant if the *t*-test result was *p* < 0.05. At the beginning, we included in the model all direct paths from attachment anxiety and attachment avoidance to parenting self-efficacy and parenting satisfaction, as well as all paths from attachment to dyadic adjustment and from dyadic adjustment to parenting self-esteem. Then, as in the method used by Millings et al. (2012), the model was refined in a series of steps, in which a portion of the model was constrained and the reduction of the model fit verified. If a constraint did not decrease the model fit, then we accepted the simplified model and performed the next step. The following four indices were used to assess the goodness of fit of each model: (a) a chi-square statistic with *p* > 0.05 (i.e., statistically non-significant); (b) a goodness-of-fit index (GFI) above 0.95; (b) a comparative fit index (CFI) above 0.95; a root-mean-square error of approximation (RMSEA) smaller than 0.06. We then performed a bootstrap analysis (based on 2,000 replications) to calculate CIs for path coefficients for the model. Finally, we used a multiple group analysis with no *a priori* hypotheses to check whether the final model was consistent between genders.

## Results

## Effects of Parent's Gender and Demographic Data on Parenting Self-esteem

First, we used paired *t*-test comparisons on the PSOC scores of mothers and fathers belonging to the same family. Mothers rated their own parenting satisfaction significantly lower than fathers (*t*[117] = 3.37, *p* = 0.001), whereas there were no differences between the two on the parenting self-efficacy scale (*t*[117] = 0.79, *n.s.*).

To check the effects on PSOC scores of the child's gender and its interaction with the parent's gender, we conducted two analyses of variance, with parenting satisfaction and selfefficacy as dependent variables, and the child's and parent's gender as between-subjects factors. As expected, we found a significant effect of the parent's gender on parenting satisfaction (*F*[1,232] = 8.11, *p* = 0.005), while the child's gender (*F*[1,232] = 0.001, *n.s.*) and the interactions between factors were not significant. No significant effects or interactions were found for parenting self-efficacy.

Then, we separately analyzed the mothers' and fathers' ratings, calculating Pearson's bivariate correlations between the PSOC measures and the demographic data (the parent's age and years of formal education, duration of the couple's relationship, the child's age, and the number of children). Parenting satisfaction showed a significant negative correlation with the child's age, for both mothers (*r* = −0.21, *p* = 0.028) and fathers (*r* = −0.19, *p* = 0.037). Satisfaction also correlated negatively with the number of children in the family, but only for fathers (*r* = −0.18, *p* = 0.047). Satisfaction was not related with either parent's age or formal education, or the duration of their relationship.

Fathers' parenting self-efficacy correlated negatively with the parent's age (*r* = −0.26, *p* = 0.005), the child's age (*r* = −0.24, *p* = 0.008), and the number of children (*r* = −0.23, *p* = 0.010), but was unrelated with formal education or duration of the couple's relationship. Mothers' parenting self-efficacy was independent of all these variables.

Correlations computed between mothers' and fathers' PSOC scores showed significant relations for parenting satisfaction (*r* = 0.23, *p* = 0.011), and parenting self-efficacy (*r* = 0.20, *p* = 0.027). The satisfaction and self-efficacy scores correlated significantly for both mothers (*r* = 0.39, *p* < 0.001), and fathers (*r* = 0.54, *p* < 0.001).

Before conducting the path analysis, we computed Pearson's bivariate correlations for adult attachment, dyadic adjustment, and parenting self-esteem (**Table 1**). As expected, this correlation analysis showed that the two dimensions of parenting selfesteem (satisfaction and self-efficacy) correlated negatively with the attachment measures in both parents, and positively with dyadic adjustment. Attachment anxiety was the predictor variable showing the strongest correlation with parenting satisfaction, and total score on the DAS with parenting self-efficacy. Lastly, we compared mothers' and fathers' scores of attachment dimensions and dyadic adjustment using independent samples *t*-test. Mothers scored significantly higher on attachment anxiety (*M* = 2.69, *SD* = 0.93) than fathers (*M* = 2.45, *SD* = 0.73); *t*(234) = −2.19, *p* = 0.029. There were no significant differences in the attachment avoidance (*t*[234] = 1.42, *n.s.*) and dyadic adjustment scores (*t*[234] = −0.13, *n.s.*) between mothers and fathers.

#### Path analysis

Initially, the overall model of parenting self-esteem shown in **Figure 1** (Model 1) was tested. Child's age was included in the model as covariate, because in the preliminary analyses it resulted significantly associated with parenting self-esteem in both mothers and fathers (parent's age and number of children were not included because they were both significantly correlated with child's age). Model 1 showed only a partial fit with the data: <sup>χ</sup>2(4) <sup>=</sup> 9.97, *<sup>p</sup>* <sup>=</sup> 0.041; GFI <sup>=</sup> 0.986; CFI <sup>=</sup> 0.984; RMSEA = 0.080 (90% CI [0.015, 0.143]). The path from child's age to parenting satisfaction was significant (β = −0.17, *p* < 0.001) and thus it was included in all the subsequent steps of the model refinement. Inspecting the direct paths from attachment to parenting self-esteem, the only significant direct effect was the negative path from attachment anxiety to parenting satisfaction (β = −0.48, *p* < 0.001).

Next, we verified the direct associations between attachment and parenting self-esteem by constraining all attachment paths to parenting self-esteem to zero (Model 2). This model fitted significantly worse than Model 1, <sup>χ</sup>2(4) <sup>=</sup> 56.48, *<sup>p</sup>* <sup>&</sup>lt; 0.001, and did not meet good-fit criteria: χ2(8) = 66.45, *p* < 0.001, GFI = 0.922; CFI = 0.840; RMSEA = 0.176 (90% CI [0.139, 0.217]).

Therefore, we next fixed to zero all attachment paths to parenting self-esteem except that from attachment anxiety to parenting satisfaction (Model 3). This step did not decrease model fit compared with Model 1, <sup>χ</sup>2(3) <sup>=</sup> 3.85, *<sup>p</sup>* <sup>&</sup>gt; 0.05, and Model 3 met satisfactory fit criteria: <sup>χ</sup>2(7) <sup>=</sup> 13.83, *p* = 0.054; GFI = 0.982; CFI = 0.981; RMSEA = 0.064 (90% CI [0.000, 0.114]). Examining the coefficients from dyadic adjustment and parenting self-esteem, it resulted that dyadic adjustment significantly predicted parenting self-efficacy (β = 0.30, *p* < 0.001) but not parenting satisfaction (β = −0.03, *p* > 0.05).

Consequently, in Model 4 we examined whether there were direct paths from dyadic adjustment to parenting self-efficacy and parenting satisfaction, by constraining both paths to zero. This model fitted significantly worse, χ2(2) = 21.79, *p* < 0.001, indicating that a meaningful effect of dyadic adjustment was present in the data.

Finally, we included in the model the direct path from dyadic adjustment to parenting self-efficacy, fixing to zero the path from dyadic adjustment and parenting satisfaction (Model 5). This model did not fit significantly worse than Model 3, <sup>χ</sup>2(1) <sup>=</sup> 0.26, *<sup>p</sup>* <sup>&</sup>gt; 0.05, and model fit was good: <sup>χ</sup>2(8) <sup>=</sup> 14.09, *p* = 0.079; GFI = 0.982; CFI = 0.983; RMSEA = 0.057 (90% CI [0.000, 0.105]). Therefore, we considered Model 5 as our final model for interpretation (see **Figure 2**).

In the final model, higher levels of attachment anxiety were associated with lower levels of parenting satisfaction (β = −0.46, *p* < 0.001).  Dyadic adjustment positively influenced parenting self-efficacy (β = 0.30, *p* < 0.001) which, in turn, increased parenting satisfaction (β = 0.31, *p* < 0.001). Child's age was negatively correlated with parenting satisfaction (β = −0.17, *p* < 0.001).

The squared multiple correlations indicated that our model could account for 44% of the variance in dyadic adjustment, 9% in parenting self-efficacy, and 39% in parenting satisfaction.

The significance of the (indirect) mediating effects of dyadic adjustment and parenting self-efficacy in the final

*Results for mothers (n* = *118) are shown below the diagonal; results for fathers (n* = *118) above the diagonal.* <sup>∗</sup>*p* < *0.05;* ∗∗*p* < *0.01.*

model were tested using the bootstrap estimation procedure in AMOS (specifying a bootstrap sample of 2000). **Table 2** shows the indirect effects and their associated 95% confidence intervals. None of the estimated values of the indirect paths overlapped with zero, indicating that both attachment anxiety and attachment avoidance have a significant indirect effect on both measures of self-esteem, mediated by the effect of dyadic adjustment.

Finally, we ran a multi-group analysis to see whether the path coefficients differed significantly between mothers and fathers. We compared the first model (which allowed for the structural paths to vary across genders) with the second (which constrained the regression paths to remain the same for mothers and fathers) in order to identify any genderrelated differences. The non-significant chi-square differences between the two models, <sup>χ</sup>2(6) <sup>=</sup> 12.18, *<sup>p</sup>* <sup>&</sup>gt; 0.05, suggest that the final model did not differ by gender. In other words, multi-group analysis indicated that gender did not moderate the association between the variables in the combined final model.

## Discussion

The purpose of this study was to examine the links between adult attachment insecurities, dyadic adjustment, and parenting selfesteem (i.e., parenting self-efficacy and parenting satisfaction) in a sample of non-clinical parents, and to develop and validate an integrative theoretical model of these connections.

Parenting self-efficacy and parenting satisfaction are crucial psychological components of parenting self-esteem that affect both the parent's personal well-being and the parent's relationship with his/her child. Adults who feel effective and satisfied as parents are more likely to be behave appropriately with their children, and to provide an adequate quality of care (Dix and Grusec, 1985; Johnston, 1996; Bugental and Johnston, 2000; Sigel and McGillicuddy-Delisi, 2002; Rubin and Chung, 2006). The importance of parents' beliefs concerning their parenting role has been seen in several phases of a family's life cycle, from the prenatal phase of the transition to parenthood (Palkovitz, 1992) to the offspring's adulthood (Schofield et al., 2014).

There is now convincing empirical evidence of parents' adult attachment influencing many facets of parenting and directly and indirectly affecting parents' behavior, emotions, and cognitions (Jones et al., 2015). So far, however, the relatively small number of studies on the influence of adult attachment styles – assessed by means of self-report measures focusing on aspects of parents' selfesteem such as parenting self-efficacy and parenting satisfaction – have yielded a complex and unclear picture. There is some evidence of adult attachment styles affecting parents' self-esteem, and their self-efficacy in particular, while findings concerning parenting satisfaction are less consistent and more difficult to interpret. Such preliminary findings are also difficult to extend to the general (non-clinical) population of families because they have often concerned parents at risk or facing challenging conditions or difficulties. It is also noteworthy that the extant literature fails to consider the plausible mediating role of dyadic adjustment in families where both parents are present.

TABLE 2 | Final model: standardized indirect effects and 95% confidence intervals based on 2000 bootstrap replications.

<sup>a</sup>*Empirical 95% confidence intervals do not overlap with zero.*

Based on these premises, we analyzed the determinants of parenting self-efficacy and parenting satisfaction in a sample of non-clinical families belonging to the general normative population, with a firstborn child aged from 0 to 6 years. We developed an integrative model linking attachment insecurities to parenting self-efficacy and parenting satisfaction, taking the mediating influence of the couple's dyadic adjustment into account. To obtain a complete picture of the couples involved, we only considered families in which both parents – married or living together – participated in the study.

In the current study, fathers reported higher levels of parenting satisfaction than mothers, whereas there was no difference between the parents' self-efficacy scores. These results replicate the findings reported by several researchers who found that fathers were more satisfied with their parenting role than mothers (Johnston and Mash, 1989; Rogers and Matthews, 2004; Gilmore and Cuskelly, 2009). According to Johnston and Mash (1989), an explanation for this may lie in the greater emphasis that fathers put on playing activities in their parenting role (Lamb, 1976), in contrast with the more instrumental and demanding nature of the mother's parenting role.

Additionally, parenting satisfaction was negatively influenced by child's age, for both mothers and fathers, i.e., both parents were more satisfied as parents when their children were younger, and they became less satisfied as their child grew older. This effect had already been found in some previous studies (Mash and Johnston, 1983; Rogers and Matthews, 2004), but not in others (Johnston and Mash, 1989; Ohan et al., 2000; Gilmore and Cuskelly, 2009), so this issue needs to be further investigated.

We also found that fathers' parenting satisfaction correlated negatively with the number of children in the family, whereas – consistently with previous research (Johnston and Mash, 1989; Ohan et al., 2000; Rogers and Matthews, 2004; Gilmore and Cuskelly, 2009) – parenting satisfaction was found unaffected by any of the other variables considered, such as age, years of formal education, and duration of the couple's relationship, for mothers or fathers.

Lastly, when considering the influence of such potential covariate or moderator variables on parenting self-efficacy, our findings showed that fathers who were younger, or had fewer children, or their children were younger, tended to perceive themselves as more effective in managing parenting tasks than older fathers, with older children, or in families with a larger number of children. These outcomes are consistent with previous reports of the father's role being less well-articulated and defined by social convention than the mother's (Belsky et al., 1991), and less stable in the father's involvement over time (Coley and Chase-Lansdale, 1999). It has been reported that, as their children grow up, fathers significantly reduce their level of involvement in absolute terms (Yeung et al., 2001; Parke, 2002), and this lesser involvement may result in a diminished sense of parenting self-efficacy.

In the preliminary correlation analyses, we found that attachment anxiety and attachment avoidance correlated negatively with dyadic adjustment and parenting self-esteem in both mothers and fathers. On the other hand, dyadic adjustment correlated positively with parenting self-efficacy and parenting satisfaction in both genders. In other words, consistently with theoretical expectations, attachment insecurities were significant *negative* predictors of couple quality and parenting self-esteem, and dyadic adjustment was a significant *positive* predictor of parenting self-esteem.

Path analysis revealed a theoretical integrative model in which dyadic adjustment mediates the influence of attachment insecurities on parenting self-efficacy and, at the same time, attachment orientations directly affect parenting satisfaction, which in turn is negatively influenced by child's age. The multiple group comparison also showed that the pattern of relationships between the variables was the same for mothers and fathers, which goes to show that adult attachment and dyadic adjustment may be equally important for women and men in terms of their parenting self-esteem.

Based on our results, we can draw some conclusions consistent with previous studies on the influence of attachment orientations on couple quality and parenting.

First, as hypothesized in our model, higher levels of attachment insecurity (attachment anxiety and attachment avoidance) are associated with lower levels of dyadic adjustment in the couple's relationship. This association is consistent with reports of attachment insecurities negatively affecting dyadic adjustment and dyadic satisfaction: insecure attached people report lower levels of couple adjustment and satisfaction in almost every phase of the family life cycle, and in various parenting conditions (Collins and Read, 1990; Carnelley et al., 1994, 1996; Collins, 1996; Frazier et al., 1996; Jones and Cunningham, 1996; Whisman and Allan, 1996; Cozzarelli et al., 2000; Frei and Shaver, 2002; Schmitt, 2002; Steiner-Pappalardo and Gurung, 2002; Shi, 2003; Kachadourian et al., 2004; Sumer and Cozzarelli, 2004; Williams and Riskind, 2004; Shaver et al., 2005; Calvo et al., 2015).

The above finding may indicate that attachment security (i.e., low anxiety and low avoidance) is associated with a greater dyadic adjustment. In fact, the literature indicates that individuals more secure in their attachment generally show higher levels of satisfaction with their relationship and are better able to handle relationship stress without experiencing a loss of relationship quality (Amir et al., 1999; Rholes et al., 2001). More in general, this path confirms the important influence of adult attachment on many aspects of a couple's relationship (Mikulincer and Shaver, 2007). It has been well-established that secure individuals can facilitate the consolidation of a lasting positive relationship with their partners (Morgan and Shaver, 1999), whereas attachment insecurities are associated with less constructive attitudes and beliefs, and a dyadic behavior that may interfere with the construction of a couple's relationship as a secure base. As Mikulincer and Shaver (2007) showed in their review, people with insecure attachment styles report less intimacy (Knobloch et al., 2001; Treboux et al., 2004; Whiffen, 2005), lower levels of commitment (Tucker and Anders, 1999; Steiner-Pappalardo and Gurung, 2002; Treboux et al., 2004), and more difficulties with communication (Fitzpatrick et al., 1993; Feeney et al., 1994; Feeney, 1995, 1999), and with managing interpersonal conflict in their relationships (Feeney, 1994; Feeney et al., 1994; Roberts and Noller, 1998; Shi, 2003; Marchand, 2004; Marchand et al., 2004) than secure individuals.

Second, our model confirmed the hypothesis that parenting self-efficacy is affected directly by dyadic adjustment on the one hand, and indirectly by attachment dimensions on the other. As expected, parents' attachment insecurities impaired the quality of the couple's relationship, which in turn was associated with lower levels of parenting self-efficacy.

We postulated a causal connection between dyadic adjustment and parenting self-efficacy in accordance with the spillover hypothesis (Erel and Burman, 1995), because parenting selfefficacy is considered an instrumental dimension of parenting. The spillover hypothesis suggests that parents who have satisfying and supportive relationships as a couple will be more sensitive to the needs of their child (Easterbrooks and Emde, 1988), and experience less discord concerning discipline and fewer inconsistencies in their parenting (Erel and Burman, 1995). These aspects augment their personal instrumental feeling of being competent, capable of solving problems, and familiar with their parenting role (Johnston and Mash, 1989). On the other hand, according to the same spillover hypothesis, a couple's negative relationship may lead the parents to engage in stressful and dysfunctional interactions that leave them irritable and emotionally drained. They consequently become less efficacious as parents, less attentive and sensitive to their child's needs (Easterbrooks and Emde, 1988; Erel and Burman, 1995). Numerous studies have shown that a good relationship between the two parents – in terms of agreement, intimacy, warm interaction, and effective communication – can enhance parenting practices and have a significant positive impact on parenting self-efficacy (Belsky, 1984; Goldberg and Easterbrooks, 1984; Cox et al., 1989; Howes and Markman, 1989; Simons et al., 1992, 1993; Kerig et al., 1993; Erel and Burman, 1995; Cowan et al., 1996; Holloway et al., 2005; Schoppe-Sullivan et al., 2007; Suzuki, 2010), whereas parents' conflictual relationships with one another and hostile communication are negatively associated with optimal parenting behavior (Kerig et al., 1993).

As expected, parenting self-efficacy was positively associated with parenting satisfaction. Parents who have more positive perceptions of their efficacy as parents tend to experience higher levels of satisfaction with their parenting role. It has been shown that efficacious parents are likely to be more at ease and effective in dealing with parenting problems, and this reflects positively on the satisfaction they derive from being parents, whereas anxiety, stress and depression coincide with lower levels of selfefficacy and consequently less parenting satisfaction (Coleman and Karraker, 1997).

Taking these findings together, our model identified a significant indirect negative effect of attachment insecurities on parenting satisfaction, considering the mediating effect of both dyadic adjustment and parenting self-efficacy. Security of attachment is associated with higher levels of dyadic adjustment, which reinforces parenting self-efficacy, increasing parenting satisfaction as a result. It is noteworthy that this indirect path linking attachment, dyadic adjustment, parenting self-efficacy and parenting satisfaction applied to both parents. This finding is particularly relevant if we consider the repercussions that

satisfaction with fatherhood and caregiving have on the father's involvement. Several studies have reported significant links between fathers' satisfaction with their relationship with their partners and their participation in childcare (Levy-Shiff and Israelashvili, 1988; Volling and Belsky, 1991; Coley and Chase-Lansdale, 1999), and there is evidence of the couple's support for each other being more crucial to fathers' than to mothers' adequate parenting (Parke, 2002). Our model suggests that adult attachment is indirectly involved in this pathway of influences and may therefore play a relevant part in fathers' involvement too. Further research is warranted to confirm this implication of our findings.

Lastly, the results emerging from our model suggest that attachment anxiety has a direct negative association with parenting satisfaction. These results are consistent with previous reports of attachment anxiety being more associated with poor affect regulation and emotional control, and distress, than in the case of secure and avoidant attachment (Cooper et al., 1998; Feeney, 1999).

According to adult attachment theory, internal working models are thought to influence not only how individuals organize their behavior but also how they perceive, attend to, and process information of emotional significance (Niedenthal et al., 2002; Feeney and Cassidy, 2003; Fraley et al., 2006). Individuals with anxious attachment have been described as characterized by a chronic activation of the attachment system and by a major use of hyperactivating strategies in attachment-related situations (Cassidy and Kobak, 1988; Main, 1990; Shaver and Mikulincer, 2002; Mikulincer et al., 2003; Collins et al., 2006; Mikulincer and Shaver, 2007). These strategies may have a negative impact on emotional information processing, amplifying the individual's distress, and ultimately affecting their self-image and satisfaction with themselves (Mikulincer and Shaver, 2007). Consistently with theoretical expectations, attachment anxiety levels have been found to correlate inversely with satisfaction, not only with relationships in a couple, but also with life generally (Kirchmann et al., 2013), and even with the outcome of nasal plastic surgery (Saragusty et al., 2011). This link may also reflect anxious individuals' persistent feeling that they are not getting enough out of their relationships and want more, even in relationships with their children. They may feel they are not as close as they would like to be to their children and this may reduce satisfaction.

Contrary to our hypothesis, we found no significant direct negative path from attachment avoidance to parenting selfesteem. However, our model revealed a significant indirect effect linking attachment avoidance to parenting satisfaction, mediated by dyadic adjustment and parenting self-efficacy. From a theoretical standpoint, avoidant attachment is characterized by different emotional regulation strategies from anxious attachment. In the former, such strategies are termed deactivating (Cassidy and Kobak, 1988; Shaver and Mikulincer, 2002), and include creating an emotional distance from others in response to discomfort with interpersonal dependence (Mikulincer et al., 2003), the use of compulsive self-reliance, the suppression of distressing cognitions and memories (Shaver and Mikulincer, 2002; Gross and John, 2003; Mikulincer and Shaver, 2007; Velotti et al., 2015), and the minimization of negative feedback from the outside environment in order to maintain a positive self-image (Bartholomew, 1990; Bartholomew and Horowitz, 1991). As a result, the parenting self-esteem of avoidant individuals is less likely to suffer from negative self-perceptions deriving from a maladaptive emotional regulation.

To conclude, our findings are consistent with attachment theory and the related literature. They confirm the importance of using implicit dimensions of attachment, as well as global attachment classifications, to better understand an adult's psychological functioning (Salcuni, 2015), and better define their parenting profile (De Palo et al., 2014), particularly when considering such complex psychological traits as parenting selfesteem.

The present study has some limitations that need to be considered. First, our data was of a cross-sectional nature, and this hampered any effort to interpret the direct and mediating effects in a causal sense. Longitudinal investigations are needed to assess the processes underlying the associations in our model. Second, we only considered self-report questionnaires, which are vulnerable to same-source bias. Future directions of research should address this limit using different measures of parental selfesteem and integrating self-report assessments with qualitative analysis of in-depth interviews about parental cognitions and beliefs. Third, in this study we did not include any measure of parents' depression. In future work, it will be important to consider also this dimension, given the links between depression and parenting self-efficacy and satisfaction (Caldwell et al., 2011; Kohlhoff and Barnett, 2013). Finally, the current study included only parents of 0–6 years-old children. Further research should also examine parents of older children to investigate how parental self-esteem is influenced by attachment orientations and dyadic adjustment, in other child developmental stages, such as middle and late childhood or adolescence.

Despite these limitations, to the best of our knowledge, this is the first study to examine the connections among adult

## References

attachment insecurities, dyadic adjustment, and parenting selfesteem in a normative sample of parents, and to develop an integrative model of these links taking the mediating role of dyadic adjustment with the partner into account. Our sample was relatively large and our findings may be relevant to preventive, empowering, and clinical interventions. In fact, we identified dyadic adjustment as a potential "malleable mediator" (Fraser and Galinsky, 2010), a factor on which action may be taken in an effort to mitigate the negative influence of attachment insecurities on parenting self-esteem. This finding could have crucial practical implications because professionals could enhance parenting self-efficacy more effectively by intervening on couple quality. According to Jones and Prinz (2005), parenting self-efficacy should be considered one of the targets for prevention programs to improve the well-being of parents and children.

## Author Contributions

Design and conceptualization of the study: VC. Statistical analysis and interpretation of the data: VC. Drafting and revising the manuscript: VC, FB. Final approval of the version to be published: VC, FB. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: VC, FB.

## Acknowledgments

We are grateful to all participants for their efforts. We also thank Alessio Vieno, Gianmarco Altoè, and Frances Coburn for their skillful assistance. This study received no funding from third parties.

Chinese mothers. *Nurs. Res.* 56, 348–354. doi: 10.1097/01.NNR.0000289499.99 542.94

**Conflict of Interest Statement:** The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

*Copyright © 2015 Calvo and Bianco. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.*

# Antecedents of maternal parenting stress: the role of attachment style, prenatal attachment, and dyadic adjustment in first-time mothers

### *Claudia Mazzeschi, Chiara Pazzagli\*, Giulia Radi, Veronica Raspa and Livia Buratta*

*Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Perugia, Italy*

The transition to parenthood is widely considered a period of increased vulnerability often accompanied by stress. Abidin conceived parenting stress as referring to specific difficulties in adjusting to the parenting role. Most studies of psychological distress arising from the demands of parenting have investigated the impact of stress on the development of dysfunctional parent–child relationships and on adult and child psychopathology. Studies have largely focused on mothers' postnatal experience; less attention has been devoted to maternal prenatal characteristics associated with subsequent parental stress and studies of maternal prenatal predictors are few. Furthermore, no studies have examined that association exclusively with samples of first-time mothers. With an observational prospective study design with two time periods, the aim of this study was to investigate the role of mothers' attachment style, maternal prenatal attachment to the fetus and dyadic adjustment during pregnancy (7th months of gestation) and their potential unique contribution to parenting stress 3 months after childbirth in a sample of nulliparous women. Results showed significant correlations between antenatal measures. Maternal attachment style (especially relationship anxiety) was negatively correlated with prenatal attachment and with dyadic adjustment; positive correlations resulted between prenatal attachment and dyadic adjustment. Each of the investigated variables was also good predictor of parenting stress 3 months after childbirth. Findings suggested how these dimensions could be considered as risk factors in the transition to motherhood and in the very beginning of the emergence of the caregiving system, especially with first-time mothers.

#### Keywords: parenting stress, prenatal attachment, first-time mothers, risk factors, dyadic adjustment

## Introduction

Pregnancy, childbirth and the transition to motherhood involve complex cognitive, affective, and behavioral changes that require restructuring goals, behaviors, and responsibilities to achieve a new conception of self (Mercer, 2004). In addition to experiencing body changes, new mothers undergo the process of attaining their maternal identity (Hung et al., 2011a). The transition to parenthood is widely considered a period of increased vulnerability that is often accompanied by stress (Morse et al., 2000). A mismatch between parents' perception of the available resources for meeting the demands of parenthood and the perceived demands of the parenting role can cause parental stress (Deater-Deckard et al., 1998).

#### *Edited by:*

*Silvia Salcuni, Università degli Studi di Padova, Italy*

#### *Reviewed by:*

*Francesca Lionetti, University of Pavia, Italy Judi Walsh, University of East Anglia, UK*

#### *\*Correspondence:*

*Chiara Pazzagli, Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Piazza G. Ermini, n. 1 - 06123 Perugia, Italy<EMAIL_ADDRESS>
#### *Specialty section:*

*This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology*

*Received: 04 June 2015 Accepted: 09 September 2015 Published: 24 September 2015*

#### *Citation:*

*Mazzeschi C, Pazzagli C, Radi G, Raspa V and Buratta L (2015) Antecedents of maternal parenting stress: the role of attachment style, prenatal attachment, and dyadic adjustment in first-time mothers. Front. Psychol. 6:1443. doi: 10.3389/fpsyg.2015.01443*

In particular, Abidin (1995) conceived parenting stress as referring to specific difficulties in adjusting to the parenting role, reflecting parents' conscious perceptions of their child, their relationship with their child and themselves as parents. Parenting stress, as assessed by the Parenting Stress Index (PSI; Abidin, 1986), one of the most widely used instruments, is considered a factor that influences parenting behavior and a determinant of dysfunctional parenting (Belsky, 1984; Abidin, 1992; Rodgers, 1993).

Most studies of psychological distress arising from the demands of parenting have investigated the impact of stress on the development of dysfunctional parent–child relationships and on adult and child psychopathology (Deater-Deckard et al., 1998). Studies have largely focused on mothers' postnatal experience (i.e., Ostberg and Hagekull, 2000; Gray et al., 2012); less attention has been devoted to maternal prenatal characteristics associated with the subsequent onset of parental stress.

Studies of maternal prenatal predictors of postpartum parenting stress levels are few. The majority of studies investigate ante-partum depression and anxiety and postnatal parenting stress. Leigh and Milgrom (2008) in a study aiming to identify risk factors predictive of prenatal depression, postnatal depression, and parenting stress, found that prenatal anxiety, prenatal low self esteem and prenatal depression were related to postnatal parenting stress, although the strongest predictor of parenting stress was postnatal depression. Misri et al. (2010), in a study with pregnant women prospectively monitored for depression and anxiety during the third trimester and 3 and 6 months postpartum, found that prenatal depression and anxiety directly impact postnatal maternal parenting stress. In a recent longitudinal birth cohort study following sub-Saharan African women from the third trimester in pregnancy to 2 years postnatal and adjusting for confounders, Guo et al. (2014) found that prenatal depression was associated with parenting stress, while prenatal anxiety was not. Another study focused on the role of a woman's own parenting history in postnatal parenting stress. Specifically, Grant et al. (2012) examined the associations between perceived parental care and control in childhood assessed during the third trimester of pregnancy and maternal parenting stress at 7 months postpartum. A significant association was found between the maternal perception of parenting as characterized by low care or/and high control and postnatal parenting stress.

Researchers have emphasized the need to examine the relationships among the predictors of parenting stress to develop more comprehensive theoretical models (Abidin, 1992; Ostberg and Hagekull, 2000). Furthermore, no studies have examined the association between postnatal PSI and maternal prenatal characteristics exclusively with samples of first-time mothers. The relevance of studies conducted with nulliparous women arises from research showing that first-time mothers have more difficulties coping with life changes than pluriparous women do (Pridham and Chang, 1989; Cronin and McCarthy, 2003). The transition from the known reality to a new reality that characterizes the experience of the transition to motherhood in nulliparous mothers brings profound changes affecting the reorganization of the self and of the infant's representations together with transformations in the relationship with one's partner (Mac Beth-Williams et al., 1987; Lis et al., 2004; Mercer, 2004; Deave et al., 2008).

The mother's own attachment pattern is considered a powerful predictor of future parenting. The attachment pattern reflects early experiences of handling distress. A secure attachment pattern has been associated with the ability to cope with distress and to adjust to the tasks of parenthood (Alexander et al., 2001; Feeney, 2003; Jones et al., 2015; Pazzagli et al., 2015). Lionetti et al. (2015) found that in the postnatal period attachment state of mind, along with the current experience between partners, contributed to their adjustment to the task of parenting in terms of parenting stress.

Having a baby is a powerful experience that, according to attachment theory, should activate the attachment system and the related behavioral systems, such as caregiving behavior (Bowlby, 1988). The transition to motherhood requires a new organization of mental life that is adapted to the reality of caring for an infant (Stern, 1998). The development of a tie between the mother and her fetus has been conceptualized and assessed as antenatal attachment. Specifically, Condon (1993) conceived the term "parent-to-infant attachment", to refer to the emotional bond or tie of affection experienced by the parent toward the infant (Condon and Corkindale, 1998). So, a key component of the construct seems to be the protection for the fetus, expressed by maternal disposition toward the fetus of knowing, being with, protecting, gratifying needs, and avoiding loss (Condon, 1993; Walsh et al., 2014). Recent contributions have proposed that this bond, which involves attending to needs and providing protection, is indicative not of the attachment system but of the caregiving system (George and Solomon, 1999; Brandon et al., 2009; Walsh et al., 2014). During pregnancy, antenatal attachment to the fetus is associated with several maternal characteristics, such as attachment style and the quality of the relationship with one's partner (Condon and Corkindale, 1997; Bloom, 1998; Mikulincer and Florian, 1999; White et al., 1999; Barone et al., 2014; Walsh et al., 2014). In the postpartum period, studies have found associations between antenatal attachment and familial and parental functioning, such as the quality of mother– infant interaction and child attachment (Siddiqui and Hagglof, 2000; Cannella, 2005; Alhusen, 2008; Crawford and Benoit, 2009).

The transition to parenthood also requires adaptive changes in the couple's relationship (Hazan and Shaver, 1994). As observed by Durkin et al. (2001), if prospective parents feel emotionally distant from and unsupported by their partners, then their adjustment to parenthood is likely to be negatively affected. Studies show that family functioning contributes to parenting satisfaction and perceptions of negative marital quality is associated with higher degrees of parenting stress (Horowitz and Damato, 1999; Ostberg and Hagekull, 2000; Salonen et al., 2010). In particular, in a longitudinal study with a sample of first-time parents, Morse et al. (2000) found that poor relationship functioning at mid-pregnancy predicted vulnerability to postnatal distress. The quality of dyadic adjustment during the transition to parenthood has also been associated with attachment patterns (Paley et al., 2005; Velotti et al., 2011; Parker et al., 2013).

On the basis of the paucity of studies on maternal prenatal predictors of postnatal parenting stress and the lack of research conducted exclusively with first-time mothers, the aims of the present study were:

Specifically, using an observational prospective study with two time periods (pre – and postnatal), this paper explored the following in a group of nulliparous women:

On the basis of the reported studies, a relationship among the mother's attachment pattern, the emotional bond with the fetus and the quality of the relationship with the partner was expected. Furthermore, a prediction of each of these prenatal variables of the onset of postnatal maternal parenting stress was hypothesized.

## Materials and Methods

### Procedure and Participants

An observational prospective study focused on the investigation of certain psychological factors contributing to the construction of the caregiving system in nulliparous women and their power in predicting parenting stress with two time periods, before the child's birth, – at the 7th months of gestation (32nd weeks) – and 3 months after the child's birth was used.

The study was approved by the University of Perugia Ethics Committee and was conducted in accordance with the Helsinki Declaration.

Participants were enrolled at the Operative Unit of Obstetrics and Gynecology (OUOG) of a hospital in central Italy. The choice of the hospital resulted from the availability of the unit staff to participate in the study. Pregnant women in this unit received antenatal care from obstetricians. During childbirth classes, obstetricians invited pregnant women to participate in the study, providing a preliminary information session on the aims and two-step methodology of the research. The obstetricians received preliminary training by a study researcher to make them feel confident in responding to any women's questions about the study and its procedures.

For the enrollment, because of the use of questionnaires, the inclusion criteria required the women to be able to read and understand Italian; furthermore, because of the specificity of the questionnaire regarding the couple relationship, the women needed to have a romantic partner and to be in the 32nd weeks of gestation (plus or minus 1 week). This point of pregnancy was chosen because of the evidence of increased expectations regarding the unborn child during this phase of pregnancy as well as because of the increase of fetal movements (Lis et al., 2004).

After this presentation, the women were given a packet that included the consent form to participate to the first phase of the study and a consent form to be contacted for the second phase. At approximately the 32nd weeks of gestation, the women who had given written informed consent completed the prenatal measures (including a questionnaire on socio-demographic information) at the hospital before the beginning of a childbirth class. The time needed to complete the questionnaires in the first phase was approximately 50 min. Approximately 3 months after their children's birth, the women who had given consent to participate in the second phase of the study, were invited by phone to return to the hospital to complete the postnatal questionnaire. The time needed for this second phase was approximately 20 min.

A total of 130 packets were distributed; 95 (73%) women agreed to participate in both phases of the study; 5 (5%) questionnaires were not fully complete at the first step and were then excluded; and of the 90 (95%) women who agreed to participate, 20 (22%) refused to participate in the second phase when contacted because they could not reach the hospital. Only women who had completed both the first and second phase measures were included in the data analysis.

### Sample

The total sample consisted of 70 women recruited at the OUOG of a hospital in central Italy. All the women were nulliparous and were in the 32nd weeks of gestation (plus or minus 1 week). The mean age of the women was 32.75 (*SD* = 4.84); they belonged to a medium socio-economic status (SES) level (Mean = 36.67; *SD* = 12.26). Other socio-demographic information are reported in **Table 1**.

## Measures

## Prenatal Measures

### Socio-Demographic Questionnaire

This series of questions included the participants' age, level of education, employment status, family structure and the duration of the marital/conjugal relationship. Familial SES was calculated using the Hollingshead Index of Social Position (Hollingshead, unpublished manuscript).

### Attachment Style Questionnaire (ASQ; Feeney et al., 1994)

The ASQ is a 40-item Likert-type self-report questionnaire designed to measure five dimensions of adult attachment that are central to Hazan and Shaver's (1987) and Bartholomew's (1990) conceptualizations of attachment: Confidence in Self and Others (eight items), Discomfort with Closeness (10 items), the Need for Approval (seven items), Preoccupation with Relationships (eight items), and Relationships as Secondary (sevan items). Each item is rated on a 6-point scale ranging from 1 ("totally disagree") to 6 ("totally agree"). The ASQ has shown adequate reliability (Feeney et al., 1994; Fossati et al., 2003), with Cronbach's alpha coefficients for the five scales ranging from 0.81 to 0.87. According to previous studies (Alexander et al., 2001; Feeney, 2003), two major factors were computed for these scales.

#### Discomfort with Closeness and Relationship Anxiety

The former (16 items) measures the tendency to be uneasy with intimacy and dependency in relationships; the latter (15 items) measures concerns about the attachment other's feelings of love and fears of being rejected. In the present study, the Italian version of this measure was used (Fossati et al., 2007), with internal consistency in terms of Cronbach's alpha coefficients of 0.80 and 0.85 for the two major factors.

### Maternal Antenatal Attachment Scale (MAAS; Condon, 1993)

Developed to measure the emotional bond between a pregnant woman and her unborn child, the MAAS consists of 19 items focused on the past 2 weeks rated on a 5-point scale. Two scales Attachment Quality (AQ) and Attachment Intensity (AI) are combined to obtain a total score. The two scales, respectively, measure the quality of the emotional bond AQ and the time spent in attachment mode (the intensity of preoccupation). The internal consistency of the instrument is acceptable (Condon, 1993). In the present study, the Italian version of the MAAS was used (Righetti et al., 2005), with an internal consistency in terms of Cronbach's alpha of 0.81 for the total score, of 0.80 for AQ scale, and of 0.82 for AI scale.

#### Dyadic Adjustment Scale (DAS; Spanier, 1976)

Developed to measure conjugal adjustment, the DAS can be used with married or unmarried couples engaged in a dyadic romantic relationship. Consisting of 32 items, the scale has a range of scores from 0 to 151. Lower scores indicate distress and divergence in the dyadic relationship. The DAS has shown adequate psychometric properties and good internal consistency (α = 0.95; Carey et al., 1993). In the present study, the Italian validated version of the DAS was used (Gentili et al., 2002). The internal consistency coefficient in terms of Cronbach's alpha for the total score was 0.85.

#### Postnatal Measure

#### Parenting Stress Index: (PSI-SF; Abidin, 1986)

This self-report scale was developed to measure stress associated with the parenting role and is used as a screening instrument for dysfunctional parenting. It consists of 36 items rated on a 5-point scale indicating the degree to which each item has been a problem for the parent during the past week. The composite total score range is between 36 and 158, where lower scores indicate lower overall levels of parenting stress. The PSI-SF has shown good overall psychometric properties (Abidin, 1986). The internal consistency reliability for the composite total score was reported by the author to be 0.91. The Italian validated version of the PSI-SF (Guarino et al., 2008) was used in this study. The internal consistency coefficient for the present sample was 0.89 for the total score.

## Data Analysis

Standard descriptive statistics in the form of means and standard deviations or frequencies and percentages were used to summarize the sample's socio-demographic characteristics and used in the measures assessed. A series of one-sample Kolmogorov–Smirnov tests (Z), were conducted and showed that the measures were distributed normally. Pearson's correlation analyses were conducted on the prenatal measures to examine the associations between maternal attachment style, MAAS and dyadic adjustment. *p*-values of 0.05 or less were first identified as statistically significant; Bonferroni's correction was applied, with critical alpha value set to 0.001 (0.005/25 correlations). The effect size of the correlation was classified according to Cohen (1992): low effect size ≤0.30; medium effect size = 0.31–0.50; and large effect size ≥0.50. To measure the single contribution of each of the prenatal measures to the prediction of postnatal parenting stress, a regression analysis was conducted. Because of the paucity of the studies on maternal prenatal characteristics associated with the subsequent parental stress, the regression analysis was conducted separately for each of the variable investigated, in order to test the existence of each variable's unique effect, as a first investigation of their specific contribution. In the first and the second model two Multivariable Linear Regressions were performed separately in order to test the effect of the two factors of maternal attachment (Discomfort with Closeness and Relationship Anxiety) and of the maternal antenatal attachment AQ and AI. A Univariate Regression was also performed for testing the effect of conjugal adjustment. The data were analyzed using SPSS version 21.0.

## Results

Descriptive statistics for the sample socio-demographic characteristics are reported in **Table 1**.

Means (*M*) and standard deviations of the pre-natal and postnatal measures are reported in **Table 2**.

TABLE 2 | Descriptive statistics for the antenatal and postnatal measures.

*ASQ – DC, Attachment Style Questionnaire, Discomfort with Closeness; ASQ – RA, Attachment Style Questionnaire, Relationship Anxiety; MAAS – TOT, Maternal Antenatal Attachment, Total Score; MAAS – AQ, Maternal Antenatal Attachment, Attachment Quality; MAAS – AI, Maternal Antenatal Attachment, Attachment Intensity; DAS TOT, Dyadic Adjustment Scale Total Score; PSI – SF, TOT, Parenting Stress Index – Short Form, Total Score.*

Regarding MAAS, data were compared with a previous study conducted with women at 19–23 weeks of gestation in terms of confidence interval. Previous data revealed a slightly lower mean total score (*M* = 75.7, *SD* = 8.15), 95% CI (73.29, 78.11) than that obtained for this sample (Righetti et al., 2005). This was perhaps due to the specific time of measure in the present study: the last trimester of pregnancy is a time that is particularly rich in emotions and fantasies because of the increase in fetal movements (Ammaniti et al., 1992; Lis et al., 2004). The dyadic adjustment score for this group had a mean value of 121.84 (*SD* = 11.59). The data were consistent with previous Italian data on nulliparous women (Pazzagli et al., 2015). With regard to postnatal parenting stress, the mothers in the sample showed a mean value of 60.48 (*SD* = 14.54). Compared with the normative data for the age subgroup (1 month/2 years and 11 months) extracted from the total sample of the Italian validated version of the scale, the mean score for the present sample showed a lower value than the normative Italian sample (*M* = 69.27, *SD* = 16.91); 95% CI (68.13, 70.42; Guarino et al., 2008).

#### Prenatal Measures

The correlation analysis revealed the existence of significant associations between the antenatal measures after Bonferroni's correction was applied (**Table 3**). According with Cohen's criteria

*ASQ – DC, Attachment Style Questionnaire, Discomfort with Closeness; ASQ – RA, Attachment Style Questionnaire, Relationship Anxiety; MAAS – TOT, Maternal Antenatal Attachment, Total Score; MAAS – AQ, Maternal Antenatal Attachment, AQ; MAAS – AI, Maternal Antenatal Attachment, Attachment Intensity; DAS TOT, Dyadic Adjustment Scale Total Score.* ∗*p < 0.001 [Bonferroni correction (0.05/25 correlations; N* = *70].*

(Cohen, 1992), the effect sizes for the significantly correlated measures were generally moderate to large. The correlations between mothers' attachment style (ASQ) and MAAS revealed the existence of a significant small negative association of Relationship Anxiety with the MAAS – AQ score (*r* = −0.361, *p* = 0.001). Relationship Anxiety was also negatively correlated with dyadic adjustment (DAS TOT; *r* = −0.485, *p <* 0.001). The total score for dyadic adjustment (DAS TOT) was strongly and positively correlated with MAAS – TOT (*r* = 0.447, *p <* 0.001) and with AQ (*r* = 0.528, *p <* 0.001). The smaller low correlation for the AI subscale (*r* = 0.256, *p* = 0.033) was not significant after Bonferroni's correction.

#### Prediction of Postnatal Stress

Results of the regression analysis showed that mother's attachment style explained 38.1% of the variance (*R*<sup>2</sup> <sup>=</sup> 0.381, *F*(2, 68) = 3.699, *p* = 0.047). In detail, Relationship Anxiety (β = 0.516, *SE* = 0.496, *t* = 2.271, *p* = 0.041) significantly predicted postnatal parenting stress, whereas Discomfort with Closeness (β = 0.345, *SE* = 0.351, *t* = 1.519, *p* = 0.155) did not.

Maternal antenatal attachment accounted for 44.5% of the variance in parenting stress (*R*<sup>2</sup> <sup>=</sup> 0.445), which was significant [*F*(2, 68) = 4.807, *p* = 0.029]. AQ (β = −0.737, SE = 1.898, *t* = −3.094, *p* = 0.009) emerged as a significant predictor for postnatal parenting stress, while AI (β = 0.274, *SE* = 1.142, *t* = 1.149, *p* = 0.879) was not.

Total dyadic adjustment was a significant negative predictor of postnatal maternal parenting stress (β = −0.435, SE = 0.123, *t* = −4.402, *p <* 0.001) accounting for 18.9% of variance in maternal parenting distress [*F*(1,69) = 19.380, *p <* 0.001]. Results are reported in **Table 4**.

## Discussion

This study contributes to the research on parenting in firsttime mothers by investigating the relationships between some psychological aspects of maternal functioning in late pregnancy and their potential contribution to predict parenting stress during the early period of the mother–child relationship, after childbirth. Because, as noted previously, few empirical papers have addressed this issue, the present paper provides a contribution to the field of research devoted to identifying the contribution of prenatal variables to the onset of postnatal maternal parenting stress. Furthermore, this paper, which focuses on a sample of nulliparous women, contributes new data to a field of research that currently lacks information on this population.

Specifically pertaining to the first aim, this study examined the maternal attachment style, the maternal antenatal bond to the fetus and dyadic adjustment as prenatal factors, and the data showed interesting connections. The literature on parenting states that differences in attachment have implications for the transition to parenthood, with a positive link between attachment security and parenting (Rholes et al., 1995; Mikulincer and Florian, 1999). Conversely, attachment insecurity has been conceived as a risk factor in the development of parenting.

TABLE 4 | Results of regression analyses for antenatal measures on the Parenting Stress Index, Total Score, at 3 months after childbirth.

*ASQ – DC, Attachment Style Questionnaire, Discomfort with Closeness; ASQ – RA, Attachment Style Questionnaire, Relationship Anxiety; MAAS – TOT, Maternal Antenatal Attachment, Total Score; MAAS – AQ, Maternal Antenatal Attachment, AQ; MAAS – AI, Maternal Antenatal Attachment, Attachment Intensity; DAS TOT, Dyadic Adjustment Scale Total Score; PSI – SF, Parenting Stress Index – Short Form, Total Score (*∗*p < 0.05,* ∗∗*p < 0.01,* ∗∗∗*p < 0.001).*

Consistent with previous studies, particularly that of Grant (Grant et al., 2012), the findings of this paper showed the importance of attachment to others in adulthood during childhood in the transition to parenthood.

According to Feeney (2003), this study focused on two dimensions of attachment insecurity: discomfort with closeness and relationship anxiety, which, respectively, measure the tendency to be uneasy with intimacy and concerns about the attachment other's feelings of love, alongside fears of being rejected. Attachment anxiety was negatively correlated with maternal antenatal attachment, especially to the quality of the emotional bond, and to the adjustment in the couple relationship. Mothers-to-be who were found to be more anxious and preoccupied in their personal attachment have also less positive feelings about the fetus and were less confident in their relationship with their partner. The results of the present study appear to be consistent with previous studies showing such associations (Condon and Corkindale, 1997; Bloom, 1998; White et al., 1999; Barone et al., 2014; Walsh et al., 2014), especially studies devoted to exploring the link between adult attachment patterns and antenatal attachment. Moreover, this research contributes data on the relationship between antenatal attachment to the fetus and couple relationships, a field that has been little investigated by the previous literature (Alhusen, 2008). Antenatal attachment, previously explored as aspect connected to attachment system (Cannella, 2005), has recently been viewed as a bond that involves attending to the child's needs and providing protection. Recent studies have suggested considering antenatal attachment to be indicative of the caregiving system instead of (only) the attachment system (Brandon et al., 2009; Walsh et al., 2014) and thus to be particularly informative of the parental challenges connected to the transition to parenthood (George and Solomon, 1999). The couple relationship also faces challenge in the transition to parenthood because of the many re-organizations that this moment brings for the couple: in the partners' relationship quality, in their responsibilities and in their reciprocal routines (Antonucci and Mikus, 1988; Hazan and Shaver, 1994). Particularly, the birth of the first child has been found to have detrimental effects on partnerships (Cowan et al., 1985; Belsky and Rovine, 1990), and relationship quality can decrease as a result of the decline in marital satisfaction and feelings of love that can result from the challenging new task of caring for a newborn.

Based on the need to develop more comprehensive theoretical models to explore the relationships among the predictors of parenting stress (Abidin, 1992), the second aim of this study used a measure at 3 months after the child birth to show that each of the investigated variables was a good predictor of parenting stress 3 months after childbirth. In particular, the mother's adult attachment, specifically the anxiety dimension, contributed to this predictive power. These results are consistent with findings indicating the implications of differences in attachment for parenting (Jones et al., 2015). Secure mothers have less difficulty coping with parenthood tasks and are more capable in engaging in supportive parenting behavior. Conversely, in a paper studying the effect of child care on infant development, the authors found that parenting stress was significantly associated with insecure (child) attachment to mothers and fathers (Jarvis and Creasey, 1992). While attachment security can be considered a protective factor against parenting stress, attachment insecurity can be considered a risk factor in predicting parenting stress.

Moreover, maternal antenatal attachment to the fetus significantly predicted parenting stress 3 months postpartum, with the specific contribution of AQ. Previous findings that were largely focused on the association between these dimensions were not consistent, with some studies indicating an inverse correlation between stress and antenatal attachment and others unable to replicate such results (Cranley, 1981; Curry, 1987; Grace, 1989). Moreover, findings from the literature suggest that the correlation is also linked to the specificity of the postnatal period investigated. Our data are consistent with the few studies that have investigated this association from a longitudinal perspective (Alhusen, 2008). The findings of this study are consistent with those of Mikulincer, who found such a relationship during the first trimester (Mikulincer and Florian, 1999). According to our data, negative AQ during pregnancy seems to be a risk factor in predicting parenting stress during the first 3 months after childbirth. These findings contribute to filling the gap in evidence in the literature (Alhusen, 2008).

Regarding dyadic adjustment, findings showed its predictive role. According to the present data, a low level of dyadic adjustment during pregnancy was a risk factor for the onset of parenting stress during the initial period after childbirth. Previous data showed that if a woman lacks adequate social support during pregnancy, the result would be negative outcomes, such as postpartum depression and insensitive parenting behavior (Crockenberg, 1981; Cutrona, 1984). Conversely, women who receive support during pregnancy have more positive physical and mental health outcomes during the postnatal period (Collins et al., 1993). Moreover, Hung et al. (2011b) found that women with longer marriages had a significantly lower level of postpartum stress. According to Krieg (2007), being in a marital relationship buffers stress during the postpartum transition. Mothers with a longer length of marriage generally experience more positive qualities in their marriages, with decreased role differentiation and increased role satisfaction in the transition to motherhood (Knauth, 2001).

As noted previously in this paper, parenting stress is a construct that can be affected by different types of stressor. Parenting stress can be considered a function of many different variables (Crnic and Low, 2002). In this paper, the role of some of these variables was considered, but the results need to be interpreted with caution because the relative influence of the different sets of variables were not considered together in the same model. Moreover, the proposed models are not exhaustive. This is a another limitation of the study because other

## References

dimensions could affect and mediate the connections observed; for example, everyday tasks specifically associated with parenting as well as the role of children's characteristics (e.g., temperament) should be added to the model to increase understanding of the phenomenon. Notably, this sample of first-time mothers showed lower levels of parenting stress with respect to normative data (thus, low level of parenting stress) and it should be important to further investigate such connection with a larger first-time mothers sample. Moreover, this paper did not consider the specific role played by the women's partner. Another limitation of the study is the exclusive use of a self-report procedure to investigate both prenatal variables and postnatal parenting stress. Further studies should incorporate other psychological aspects, including also observational procedure, to obtain a richer picture of the dimensions that affect the initial emergence of the caregiving system and its first challenges, especially with first-time mothers. In spite of these limitations, findings from this study suggest how important is the role of prenatal characteristics in first-time mothers and underline the need to be considered in order to develop effective prevention plans.

**Conflict of Interest Statement:** The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

*Copyright © 2015 Mazzeschi, Pazzagli, Radi, Raspa and Buratta. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.*

# Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence

*Cecilia S. Pace1\*, Simona Di Folco2, Viviana Guerriero3, Alessandra Santona4 and Grazia Terrone5*

*<sup>1</sup> Department of Educational Sciences, University of Genoa, Genoa, Italy, <sup>2</sup> Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy, <sup>3</sup> Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy, <sup>4</sup> Department of Psychology, University of Milano-Bicocca, Milano, Italy, <sup>5</sup> Department of Humanities, Literature, Cultural Heritage, University of Foggia, Foggia, Italy*

#### *Edited by:*

*Silvia Salcuni, Università degli Studi di Padova, Italy*

#### *Reviewed by:*

*Raffaella Calati, IRCCS Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy Ingrid Erhardt, University of Kassel, Germany*

#### *\*Correspondence:*

*Cecilia S. Pace, Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128 Genoa, Italy<EMAIL_ADDRESS>
#### *Specialty section:*

*This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology*

*Received: 30 April 2015 Accepted: 08 September 2015 Published: 23 September 2015*

#### *Citation:*

*Pace CS, Di Folco S, Guerriero V, Santona A and Terrone G (2015) Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence. Front. Psychol. 6:1433. doi: 10.3389/fpsyg.2015.01433* Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence.

Method: Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4–9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers' state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents' verbal intelligence was controlled for.

Results: Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers' AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure–insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents' verbal intelligence made a significant contribution to this prediction.

Discussion: Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children.

Keywords: attachment, adoption, adolescence, internal working models (IWMs), Friend and Family Interview

## Introduction

Attachment theory stressed the importance of early parent–child relationships for normative development of socio-emotional functioning across the life span (Thompson, 1999). These relationships play a significant role on the development of a child's internal working models (IWMs) of the self, others, and relationships influencing the child's attachment security (Bowlby, 1969), and they guide the construction and the expectations of future social interactions. IWMs of caregivers are expected to affect parenting and caregiving transactions that mothers enact both consciously and unconsciously in their interactions with the child (Bretherton and Munholland, 2008; Dazzi and Zavattini, 2011; Velotti et al., 2011). Literature also established that parents' IWMs, manifested in discussions about childhood experiences during the Adult Attachment Interview (AAI; George et al., unpublished), predicted the quality of the infant-parent attachment relationship as observed in Ainsworth's Strange Situation procedure (SSP; Ainsworth et al., 1978; van IJzendoorn, 1995; Steele et al., 1996; Tini et al., 2003; Verhage et al., 2015).

Overall, literature suggested parents' IWMs that form the basis of parenting behaviors (sensitivity, attunement, monitoring, etc.) may influence the child's IWMs from early childhood to adolescence (Karavasilis et al., 2003; Gamble and Roberts, 2005; Bosmans et al., 2006; Gallarin and Alonso-Arbiol, 2012). However, only a few studies assessed the concordance of attachment representations between parent–children dyads (mostly "mother–son") in this stage of life (Rosenstein and Horowitz, 1996; Zimmerman et al., 1997; Allen et al., 2003; Scharf et al., 2012), providing evidence of a weak to moderate intergenerational effect. Further, the measurement of attachment in adolescence presents some weaknesses. Literature showed that, when assessing IWMs, the AAI (Bakermans-Kranenburg and van IJzendoorn, 2009) and the Attachment Interview for Childhood and Adolescence (AICA; Ammaniti et al., unpublished) were used, but without taking into account the specificity of this stage. Moreover, conscious attachment styles may be captured by questionnaires, such as the Inventory of Parent and Peer Attachment (IPPA; Armsden and Greenberg, 1987; Pace et al., 2011), which measures attachment security and its factors (trust, communication, and alienation) in adolescence, but presents obvious limitations characterizing self-reports. Finally, in recent years, the Friends and Family Interview (FFI; Steele and Steele, 2005) were developed to assess attachment representations in late childhood and adolescence, including important relationships beyond the child–parent relationships and provided encouraging results (Kriss et al., 2012; Pace, 2014; Steele et al., unpublished).

Growing literature has recently examined attachment among adoptive families in the years following adoption. Adoption in Italy is a very common phenomenon. In the period between 2000 and 2013, 42,048 children were legally authorized to enter the country for adoption. Children were adopted by 33,820 couples with an average of 1.24 children per couple (Italian Commission for International Adoptions, 2013). Internationally adopted children's mean age at arrival was 5.5 years with four children out of 10 (42.1%) between 1 and 4 years old and 43.8% of adopted children between 5 and 9 years old; 8.8% were 10 years or older, while only 5.4% of adopted children were younger than 1 year old.

As reported in a 2009 meta-analysis (van den Dries et al., 2009), children who were adopted before 12 months of age were as securely attached as their non-adopted peers, whereas children adopted after their first birthday were less securely attached than non-adopted children (*d* = 0.80, CI = 0.49– 1.12). Moreover, adopted children showed more disorganized attachment compared to their non-adopted peers (*d* = 0.36, CI = 0.04–0.68), but they were less often disorganized compared to institutionalized children. Thus, early adoption is a considerable and effective intervention in the domain of attachment relationships (Lionetti, 2014).

However, as mentioned above, in the Italian adoption practice, almost 95% of internationally adopted children were placed after 1 year of life, and, thus, they should be considered as lateadopted children (Howe, 1998). Late adoption represents an exceptional intervention aimed at influencing and reprocessing representations of children who often suffered traumas, abuse, and neglect in their early infancy or childhood (Rutter and O'Connor, 2004; Juffer and van IJzendoorn, 2005; van IJzendoorn and Juffer, 2006; Dozier and Rutter, 2008). Furthermore, no differences were found in the attachment patterns between international and domestic adopted children probably because similar early negative experiences were suffered by the adopted children, independently from the type of adoption (van den Dries et al., 2009). On the one hand, late-adoption represents a window for the investigation of the impact of children's negative pre-adoption experiences on the development of insecuredisorganized IWMs of attachment (Steele et al., 2007; Pace et al., 2015b). On the other hand, late adoption embodies the opportunity for children's schemas to be revised and reprocessed based on the "new" relationships with adoptive caregivers (Steele et al., 2003, 2008; Juffer and van IJzendoorn, 2005). Some studies highlighted that previously maltreated and neglected children placed after 4 years of age and assessed both through a behavioral procedure and narrative tasks (Pace and Zavattini, 2011; Pace et al., 2012) showed increasing attachment security over 2 years after adoption. Additional findings showed that late adopted children improve markedly in the positive representations of the self, the caregiver, and in the relationship with others and also in the narrative's coherence (Hodges et al., 2003; Kaniuk et al., 2004). As suggested from these empirical findings, further positive revision may be possible, even in older adopted children, and, therefore, exploring which parental characteristics could foster their "earned" security deserves attention (Pace et al., 2012). In the Attachment Representations and Adoption Outcome study (Steele et al., 2003, 2007) mothers' insecurity of attachment (either dismissing or preoccupied) as assessed by the AAI 3 months after adoption was correlated with children's (4–8 years old) negative narratives and disorganized or bizarre themes proposed in an attachment story completion. In addition, children with unresolved adoptive mothers failed to establish secure attachment and positive representations of self and others (Steele et al., 2003). Both parents' attachment insecurity was strongly associated with high levels of disorganization or insecurity in the adoptees and confirmed even 2 years later. When neither parents' AAI was secure at the time of placement, 2 years later 86% of adopted children scored high for disorganization (Steele et al., 2008). Veríssimo and Salvaterra (2006), assessing a sample of Portuguese children adopted between 3 weeks and 47 months of age, found that the scores reflecting the presence and quality of maternal secure representations predicted the level of attachment security of adopted children, as measured by Secure Base Scripts (SBS; Waters and Waters, 2006) and assessed by the Attachment Behavior Q-Set (AQS; Waters, 1995) (Spearman rho = 0.38, *p <* 0.01) with no correlations either with child's age at time of adoption or the child's age at time of assessment. Barone and Lionetti (2012), assessing parents' attachment state-of-mind using the AAI and children's (3–5 years old) attachment patterns, administered a doll story completion task 12–18 months after placement and found 80% concordance with respect to two attachment classifications in mother–child dyads and 60% concordance with respect to threeway attachment classification. Concerning father–child dyads, no significant associations were found. Pace and Zavattini (2011) and Pace et al. (2012) found that late-adopted children (4–7 years old) who presented significant enhancing attachment security were predominantly placed with secure adoptive mothers (*p <* 0.05). However, the concordance between the adoptive mothers' attachment representations and their adopted children's narratives on the two-way system (secure vs. insecure) was not significant (56%).

All these studies focus on the few years after late-adopted children's placement, usually during middle childhood, while only a few studies examine what happens during later stages, such as late-childhood and adolescence. These studies show a percentage of secure attachment of adolescent adoptees that range between 32% (Beijersbergen et al., 2012) and 63% (Riva Crugnola et al., 2009), using the AAI or AICA and from 32% (Escobar and Santelices, 2013) to 51% (Groza et al., 2012) and 60% (Barcons et al., 2012), using the FFI. Most of these studies found no unresolved or disorganized (U/D) classifications either by the AAI or the FFI (only 2% in Barcons et al., 2012), meaning that adoptees were able to develop an organized attachment strategy, despite their early negative experiences. This data is worthwhile given that the disorganized attachment could be considered a strong predictor of short- and long-term psychopathological problems (van IJzendoorn et al., 1999; West et al., 2001). Except for Escobar and Santelices (2013), no study found a significant association between the age of adoption and attachment patterns, meaning that older age at adoption did not automatically imply high attachment insecurity.

Given that parenting seems to continue to influence children's attachment representations, even during adolescence (Hoeve et al., 2011), attachment researchers have recently questioned the role of adoptive parents in influencing attachment in adopted adolescents. A longitudinal adoption study (Beijersbergen et al., 2012), assessed through the AAI, revealed that mothers of secure adolescents showed significantly more sensitive support during conflicts than did mothers of insecure adolescents. The authors concluded that both early and later maternal sensitive support were important for continuity of secure attachment for the first 14 years of life of early adopted adolescents. Another study (Riva Crugnola et al., 2009) assessing attachment in adopted adolescents and their adoptive parents, using the AAI and the AICA (Ammaniti et al., unpublished), did not find any significant concordance between mother–child and father–child two-way attachment systems. However, they suggested that the majority of parents who were secure with respect to attachment had children who were also secure, while those who were insecure had adopted children who were equally distributed in the two-way attachment classifications (secure vs. insecure). Limitations of this study, however, should be addressed due to both the wide variability of the sample characteristics and the lack of control for background variables.

Given the growing importance of assessing attachment bonds between adoptive parents and their children, especially in adolescence where there is a shortage of literature, in the current correlational study we investigated attachment concordance between late-adopted adolescents and their adoptive mothers. We expected correspondence between mothers' AAI attachment representations and children's FFI attachment representations (AAI and FFI categories and state-ofmind scales), mostly at the level of secure vs. insecure partition, as we controlled for demographic variables, adolescents' verbal cognitive status, that can foster secure attachment patterns (West et al., 2013), and maternal psychopathological symptoms.

## Materials and Methods

## Participants

The adoptive families were recruited through two authorized international adoption agencies [e.g., Centro Italiano di Aiuti all'Infanzia-CIAI (Italian Center for Supporting Childhood) and Associazione Teresa Scalfati (Teresa Scalfati's Association)], an association supporting adoptive families [Genitori si Diventa (Becoming Parents)] and the social-health service specialized on adoption working in Rome. All the participants lived in the following cities of the Center of Italy: Rome, L'Aquila, and Teramo.

The eligible criteria for this study were the following: age range of late-adopted adolescents between 11 and 16 years old, age of adoption after 4 years of age, length of placement equal to 4 years at least (considered a sufficient length of time for stabilizing adoptive child–parent relationships, van den Dries et al., 2009), absence of children's special needs, absence of maternal clinical diseases, parents with medium-to-high education level, married couples still living together, and families living in urban contexts.

This study included 76 participants: 46 late-adopted adolescents (23 female) and their 30 adoptive mothers. Of the adolescents, 14 were "only" children, while 32 were siblings both involved in the study. 21 mother–child dyads had already participated in a longitudinal study (Pace and Zavattini, 2011; Pace et al., 2012). The pre-adoption histories of the adoptees were characterized by severe adversities, such as serious neglect, physical maltreatment, sexual abuse, and widely variable periods of institutionalization.

## Variables and Measures Late-adopted Adolescents

#### *Adolescents' attachment representations*

Attachment representations of adolescents were assessed using the Italian version of the FFI (Steele and Steele, 2005), authorized by the author Howard Steele. The FFI is a semi-structured interview informed by, yet distinct from, the AAI (Main et al., 2008). Interviews are video-recorded and transcribed verbatim.

The FFI's coding system comprises eight scales, each including subscales as follows: (1) *Coherence*, based on Grice's well-known maxims of good conversation—truth, economy, relation, and manner, and overall coherence; (2) *Reflective Functioning*—developmental perspective, theory of mind, diversity of feelings; (3) *Evidence of Secure Base*—father, mother, and other significant figure; (4) *Evidence of Self–Esteem* social competence, school competence, and self-regard; (5) *Peer Relations*—frequency of contact and quality of best friendship; (6) *Sibling Relations*—warmth, hostility and rivalry; (7) *Anxieties and Defense*—idealization, role reversal, anger, derogation, adaptive response; and (8) *Differentiation of Parental Representations*.

The interview also includes the following global *attachment classifications* (Steele et al., unpublished): (1) *secure* classification indicates that the person's narrative reflects flexibility, ease, and ability to turn to others for support when in distress; (2) *insecure-dismissing* classification describes people who use derogation or idealization as a defense and show restriction when they have to acknowledge or express distressing feelings; (3) *insecure-preoccupied* classification describes adolescents rated highly in anger or passivity; and finally, (4) *insecuredisorganized* classification describes people showing some lapses in monitoring or reasoning as well as contradictory or incompatible strategies in the attachment narratives.

The scales are scored on a 7-point scale from 1 to 4 (1 = no evidence; 2 = mild evidence; 3 = moderate evidence; 4 = marked evidence), including mid-points.

In the FFI coding system, the interviews have both a final classification (the above-mentioned secure, dismissing, preoccupied, and disorganized categories) like in the AAI and a scoring (1–4) for each classification, which is unlike the AAI. This double coding system captures attachment representations both at categorical and dimensional levels.

For this study, two blinded raters (both trained by Howard Steele and reliable coders for the FFI) coded 14 of the 46 interviews (30.4%). Inter-rater agreement was 100% (*k* = 1, *p <* 0.001) on the four-way classification system (secure, dismissing, preoccupied, and disorganized). Spearman's rho correlations for the five coherence scales ranged from 0.66 for the relation scale (*p <* 0.05) to 0.86 for the manner one (*p <* 0.01). The other FFIs were coded only by one trained coder. To our knowledge, this is the first study assessing attachment representations of late-adopted adolescents with the FFI in Italy.

## *Adolescents' Cognitive Status*

Given the contrasting findings on the links between attachment representations and cognitive level of participants at developmental stages (Steele and Steele, 2005; Stievenart et al., 2011; Beijersbergen et al., 2012; West et al., 2013), we assessed the verbal intelligence of late-adopted adolescents.

Participants' verbal IQ was measured by the vocabulary subtest from the Wechsler Intelligence Scale for Children (verbal WISC-III, Wechsler, 1991; Italian validation, Orsini and Picone, 2006) for participants aged between 6 and 16 years and 11 months. The verbal WISC III consists of the following subtests: information, similarities, arithmetic reasoning, vocabulary, comprehension (CV), memory figures. The child's verbal IQ is obtained from the sum of the weighted points of the first five verbal subtests, while the factor score of verbal CV is obtained based on the weighted score received in the last subtest.

### Adoptive Mothers

## *Maternal attachment states of mind*

The states of mind with respect to attachment of adoptive mothers were assessed through the AAI (George et al., unpublished; Main et al., unpublished), a well-known and semistructured interview with 20 questions lasting approximately 1 h. The AAIs are audio-recorded and transcribed verbatim.

The transcripts were used to assess possible past experiences with attachment figures in infancy (Loving, Rejection, Neglecting, Role Reversal, and Pressure to Achieve) and current states of mind (Idealization, Lack of Memory, Anger, Derogation, Passivity, Transcript Coherence, Mental Coherence, Metacognitive Monitoring, Fear of Loss, Unresolved Loss, Unresolved Trauma) on 25 1-to-9 scales.

The coding system classifies attachment states of mind into one of three principal categories: (1) *free-autonomous and secure* (F/A), where individuals freely describe their attachment experiences with balance and coherence; (2) *insecuredismissing* (Ds), where they are unable to give evidence for the positive evaluations of their parents showing idealization or normalization strategies; (3) *insecure-preoccupied* (P), where they use angry or vague language when talking about their attachment relationships. One of two transversal categories can also be added: *insecure-unresolved/disorganized loss or trauma* (U), where transcripts presented lapses in monitoring of reasoning or discourse or reports of extreme behavioral reactions during discussion of these specific topics, or *cannot classify* (CC), where completely contradictory attachment patterns (e.g., dismissing/entangled) emerged.

Psychometric studies in many countries have shown that attachment classifications provided by the AAI are steady across periods of up to 15 months and are independent of the interviewer. The AAI categories were not correlated with the interviewees' cognitive level, social desirability, memory, or general discourse style (Bakermans-Kranenburg and van IJzendoorn, 1993; Crowell et al., 1996).

For our study, all the AAIs were coded by a reliable coder. For inter-rater reliability, 10 interviews (30%) were also classified by another expert evaluator. Both coders were trained by Deborah Jacobvitz and Nino Dazzi and they were provided with AAI's reliability and unaware of the other data collected. Inter-rater agreement was 88% (*k* = 0.77, *p <* 0.01) for fourway classifications (free-autonomous, dismissing, entangled, or unresolved). Spearman's rho correlation of 0.72 was found for the coherence of transcript's scale (*p <* 0.05), 0.74 for coherence of mind (*p <* 0.05), and 0.97 for unresolved loss (*p <* 0.01).

#### *Socio-demographic and Adoption Data*

Ad-hoc questions were developed for this research and they were answered by adoptive mothers to collect personal data (age of birth, education level, year of marriage, etc.) and information concerning the details of adoption (children's age at arrival, country of origin, length of adoption, pre-adoption information, etc.). A part of this sheet was designed to investigate the children pre-adoption histories, especially the motivations for which they were placed for adoption (e.g., parental abandonment, death, drug abuse, etc.) and the events leading to change of guardianship, such as neglect, physical and sexual abuse, institutionalization, and multiple placements. In the last part we asked about physical condition, mental retardation, and psychiatric diagnoses of the children.

#### *Maternal psychopathology*

Before adoption, parents seeking to adopt were assessed to examine their psychopathological risk, but at the time of this study's assessment, some years had passed since this pre-adoption selection. Therefore we checked the psychopathology level of adoptive mothers to ensure they were free from mental disorder symptoms and no psychological problems had emerged after adoption.

Mental health problems of mothers were measured using the Symptom Checklist 90 (SCL-90-R; Derogatis, 1994), a 90 item standardized instrument designed to measure current symptom severity grouped in 10 main symptom dimensions (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and other symptoms, such as problems with sleep) and an index of psychopathology (Global Severity Index, GSI). This measure provides a reliable estimate of the likelihood of being diagnosed with a mental health disorder (*T* score above 63 on the GSI for any two symptom dimensions).

### Procedure

The data were collected during a session lasting approximately 2 h at the university's laboratory. Mothers and children were assessed separately: the FFI and the WISC-III were administered to the adolescents, while the AAI, the socio-demographic questionnaire, adoption sheet, and the SCL-90 were used with their adoptive mothers. Participation in this research was voluntary. Before the session, written informed consent was obtained from all families. The research protocol had been previously approved by the University Ethical Committee.

## Data Analysis

Results were analyzed using the Statistical Package for Social Science (SPSS, Version 21.0). We decided to use primarily non-parametric tests, which are appropriate for variables of this type because they do not require that the sample is drawn from a normally distributed population (Siegel and Castellan, 1988). The significance level for all analyses was set at *p <* 0.05.

First, we presented descriptive statistics of all of the study variables and then we investigated whether FFI and AAI classifications were associated with background and control variables. Next, we tested the study's hypotheses with respect to the association of attachment between mothers and late-adopted adolescents. Specifically:

## Results

## Descriptive Variables

**Table 1** presents descriptive results concerning background variables and attachment classification for both adolescents and mothers.

### Late Adopted Adolescents

The statistical analyses with adolescents' FFI categories were conducted using a secure vs. insecure partition with preoccupied adolescents included in the insecure group together with dismissing ones. Adolescents' FFI classifications were not associated with gender (*p* = 0.35), continent of origin (*p* = 0.10), age at arrival (*p* = 0.50), length of adoption (*p* = 0.60), age at assessment (*p* = 0.27), educational level (*p* = 0.26), or presence or absence of siblings (*p* = 0.69). However, secure adolescents (*M* = 104.39, *SD* = 23.62) showed a significantly higher level of verbal IQ (*T* = 3.49, df = 44, *p <* 0.01) than insecure ones (*M* = 79.67, *SD* = 20.05). Hence, we decided to include verbal IQ as a covariate in the regression model.

#### Adoptive Mothers

The statistical analyses using maternal AAI categories were conducted using a free-autonomous vs. non-free-autonomous partition with dismissing mothers included in the non-freeautonomous group together with unresolved ones. Mothers' AAI classifications were not associated with age (*p* = 0.87), years of education (*p* = 0.28), length of marriage (*p* = 0.16), or level of psychopathological symptoms (*p* = 0.13).

## Attachment IWMs in Adolescent-Mothers Dyads

#### Classifications

**Table 2** presents the distributions of the attachment classifications of adoptive mothers' AAI and late-adopted adolescents' FFI.

We found a significant of 70% (32 dyads) on the two-way AAI and FFI systems (rphi = 0.31, *p* = 0.04) and a concordance of 61% (28 dyads) on the four-way system approaching significance (χ<sup>2</sup> <sup>=</sup> 8.29; df <sup>=</sup> 4, *<sup>p</sup>* <sup>=</sup> 0.08). To further examine the possibility of interaction, we conducted multinomial logistic regression analyses predicting adolescents' secure–insecure FFI categories from mothers' AAI free-autonomous vs. not-free-autonomous,

#### TABLE 2 | The concordance between adolescents' FFI and maternal AAI classifications1.

<sup>1</sup>*The number of adoptive mothers was counted on the base of the number of their children (N* = *46; e.g., if a mother had two children, she was counted twice).*

adding verbal IQ as a covariate. The multinomial logistic regression model indicated that free-autonomous adoptive mothers showed a tendency to have secure late-adopted children (β = 1.42, *p* = 0.08), although adolescents' high verbal IQ appeared to be a better predictor of their secure classification (β = 0.05, *p* = 0.01).

#### Scales

**Table 3** shows the correlations between the FFI and the AAI stateof-mind scales.

The FFI scales were highly correlated with verbal IQ scorings (*r* between 0.35 and 0.63, *p <* 0.01), while no correlations were found between maternal AAI scale of states of mind and adolescents' verbal IQ scorings (*r* between −0.17 and 0.29, *p* = ns). Based on these correlations, we ran two linear regression analyses (**Table 4**). The first entered the secure pattern as the dependent measure and the second entered the disorganized pattern as the dependent variable. For both regressions, we inserted coherence of transcript, coherence of mind, and idealizing father as independent variables; for the first two, we added unresolved loss in the independent blocks. Verbal IQ was added as a covariate.

The regression summary indicated that high coherence of transcript and low unresolved loss of adoptive mothers could predict high secure attachment of their late-adopted children, even if the adolescents' verbal intelligence made a significant contribution to their prediction. Moreover, high cognitive status of adoptees made a significant contribution to the prediction of low scores on their disorganized patterns of attachment.

## Discussion

Our sample of late-adopted adolescents was classified through the FFI with 67.4% as secure, 26.1% as dismissing, 6.5% as preoccupied, and none disorganized, showing attachment representation distribution overlap with those both from the Italian AAI meta-analysis of non-clinical adolescent samples (Cassibba et al., 2013, 62% free-autonomous, 24% dismissing, 10% preoccupied, and 4% unresolved), and adoption studies using the AICA (Riva Crugnola et al., 2009) and the FFI (Barcons et al., 2012; Stievenart et al.,

∗*p < 0.05,* ∗∗*p < 0.01.*

2012). These data confirms that adoption can be seen as a positive intervention also for late-adopted children who were considered a high risk group due to their adverse pre-adoption experiences.

Concerning the distribution of AAI classifications of adoptive mothers, we found a high percentage of free-autonomous classifications (70%), similar to those in the Italian AAI meta-analysis of non-clinical mothers (Cassibba et al., 2013, 62% free-autonomous, 24% dismissing, 10% preoccupied, and 4% unresolved-disorganized), post-adoption studies including parents assessment (Steele et al., 2008, 2010; Barone and Lionetti, 2012; Pace et al., 2012), and studies on couples seeking to adopt (Cavanna et al., 2011; Calvo et al., 2015; Pace et al., 2015a).

We found a significant concordance between the attachment states of mind of adoptive mothers using the AAI and the attachment representations of lateadopted adolescents using the FFI (70% for two-way and 61% for four-way attachment classification). This result confirmed findings from most of the studies on adoptions, although some research did not find significant associations (**Table 5**).