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Infant Attachment Strategies, Infant Mental Lag, and Maternal Depressive

Symptoms: Predictors of Internalizing and Externalizing Problems at Age 7

Article  in  Developmental Psychology · August 1997

DOI: 10.1037/0012-1649.33.4.681 · Source: PubMed

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Developmental Psychology Copyrighl 1997 by the American Psychological Association, Inc.
1997, Vol. 33, No. 4, 681-692 D012-1649/97/S3.00

Infant Attachment Strategies, Infant Mental Lag, and Maternal

Depressive Symptoms: Predictors of Internalizing and
Externalizing Problems at Age 7

Karlen Lyons-Ruth M. Ann Easterbrooks and

Harvard Medical School Cherilyn Davidson Cibelli
Hifts University

The predictive relations between assessments in infancy and parent- and teacher-reported behavior
problems at age 7 were investigated within a low-income sample. Infancy assessments indexed
family adversity, parent-infant interaction at home, infant attachment, infant anger-distress at home,
gender, and cognitive functioning. Among children at age 7 identified by teachers as highly externaliz-
ing, 83% were both disorganized in their attachment behavior in infancy and below the national
mean in mental development scores at 18 months, compared with 13% of nonexternalizing children.
Avoidant attachment behavior in infancy was associated with later internalizing symptoms rather
than with externalizing symptoms. The behavior problem data reported by mothers suggested the
possibility of attachment-related biases in maternal report data. The results indicate that mild mental
lag in the context of a disorganized attachment relationship constitutes 1 early step on the pathway
to school-age externalizing behavior.

Longitudinal work on aggressive behavior disorders has em-
phasized the early onset of aggressive behavior in a sizable
subset of cases as well as the debilitating long-term course of
such disorders (Moffitt, 1990; Olweus, 1979). This emerging
database has led reviewers to call for studies beginning in in-
fancy to examine the earliest precursors and correlates of ag-
gressive behavior (Robins, 1991). The current study was con-
ducted to assess whether infant and family risk factors measured
during the first 2 years of life were predictive of externalizing
or internalizing behavior at school at age 7 among a cohort of
infants at social risk.
Child externalizing behavior was of greatest interest for three
reasons. First, externalizing behavior in childhood has been
more extensively studied than has internalizing behavior, with a
clear set of child and family correlates emerging in the literature.
Second, prior research has demonstrated continuity from age 3
in aspects of child aggressive behavior (Moffitt, 1990), so these
behaviors seemed most likely to be linked to aspects of adapta-
tion in infancy. Third, aggressive externalizing behavior has
been linked to infant attachment patterns in prior literature (Ly-
Karlen Lyons-Ruth, Harvard Medical School, Cambridge Hospital;
M. Ann Easterbrooks and Cherilyn Davidson Cibelli, Department of
Child Study, Tufts University
This study was presented at the biennial meeting of the Society for
Research in Child Development, Indianapolis, Indiana, March 1995. This
work was supported in part by grants from the Mailman Foundation and
from the Smith-Richardson Foundation.
Correspondence concerning this article should be addressed to Karlen
Lyons-Ruth, Harvard Medical School, Cambridge Hospital, 1493 Cam-
bridge Street, Cambridge, Massachusetts 02139. Electronic mail may
be sent via Internet to kruth@warren.med.harvard.edu.
681
ons-Ruth, Alpern, & Repacholi, 1993; Renken, Egeland, Mar-
vinney, Mangelsdorf, & Sroufe, 1989).
Reviewing an extensive literature on the correlates of aggres-
sive behavior among preschoolers and school-age children,
Greenberg, Speltz, and DeKlyen (1993) have pointed to four
general factors implicated in the onset of aggressive behavior
problems, including family adversity, coercive discipline, inse-
cure attachment relationships, and intrinsic child characteristics
such as temperamental or neuropsychological difficulties. Al-
though family adversity is associated with a higher incidence of
a range of childhood disorders, families of conduct-disordered
children have particularly elevated scores on cumulative indices
of adversity as well as higher rates of parental disorder, including
antisocial personality, major depression, and substance abuse
(Biederman, Munir, & Knee, 1987) compared with families of
children with attention deficit hyperactivity disorder alone
(Blanz, Schmidt, & Esser, 1991). Elevated rates of child inter-
nalizing disorders have also been associated with parental psy-
chopathology, however, and with parental depression in particu-
lar (Downey & Coyne, 1990). In addition, most investigators
have documented the relation between harsh and ineffective
discipline practices and child aggression (e.g., Patterson &
Bank, 1989), a relation noted as early as 3 years of age (Camp-
bell, Pierce, March, & Ewing, 1991). As Patterson and col-
leagues (e.g., Patterson & Bank, 1989) have pointed out, the
ensuing cycles of escalating coercive behavior by both parent
and child leave the direction of causality in the correlation be-
tween harsh discipline and child aggression unclear.
However, recent infancy studies have delineated aspects of
parental behavior and infant attachment behavior, assessed as
early as 6 to 12 months of age, that predict later aggression,
implicating interactive patterns that precede the onset of coercive
cycles. These interactive patterns are characterized by parental
682 LYONS-RUTH, EASTERBROOKS, AND CIBELLI
behavior that is intrusive and not readily modified by infant
communications so that infant initiatives are often ignored or
overridden. Covert or overt hostility may also accompany the
intrusive behavior (see review by Lyons-Ruth, 1996).
Although earlier attachment studies in low-income samples
implicated avoidant infant attachment behavior in the develop-
mental trajectory leading toward aggressive behavior (Renken
et al., 1989), studies of middle-income samples did not replicate
those findings (Fagot & Kavanagh, 1990; Goldberg, Perotta,
Minde, & Corter, 1986; Lewis, Feiring, McGuffog, & Jaskir,
1984). More recently, attachment studies have documented the
increased incidence of disorganized/disoriented forms of infant
attachment behavior among families at social risk. This is a
form of attachment behavior not included in earlier studies be-
cause coding procedures were not available before 1985
(Main & Solomon, 1990). This more recent literature indicates
that the incidence of disorganized infant attachment behavior
increases as the severity of family risk factors increases. The
disorganized behavior is also increasingly likely to include pro-
nounced avoidant behavior as family risk factors become more
severe (see Lyons-Ruth, Repacholi, McLeod, & Silva, 1991, for
review).
More recent studies of the link between attachment classifica-
tions and behavior problems have included three longitudinal
studies in high-social-risk samples, two cross-sectional studies
of clinic-referred preschoolers and their controls, and two stud-
ies of low-risk preschoolers. All assessed attachment behaviors
in the disorganized or controlling classification as well as in
the earlier described secure and insecure classifications; in all
studies, disorganized (or controlling) rather than avoidant or
ambivalent attachment behavior was associated with aggressive
or externalizing behavior (Greenberg, Speltz, DeKlyen, & En-
driga, 1991; Hubbs-Tait, Eberhart-Wright, Ware, Osofsky,
\ockey, & Fusco, 1991; Lyons-Ruth et al., 1993; Moss, Parent,
Gosselin, Rousseau, & St.-Laurent, 1996; Shaw, Owens, Vondra,
Keenan, & Winslow, 1996; Solomon, George, & DeJong, 1995;
Speltz, Greenberg, & DeKlyen, 1990). l To date, however, pub-
lished reports relating disorganized early attachment patterns to
clinically significant behavior problems have been limited to
the preschool period. Whether disorganized attachment behavior
in infancy is a risk factor for behavior problems after age 6 has
not yet been addressed.
Finally, the accumulated literature points to the contribution
of child factors, such as gender, temperament, or neurobiological
profiles, to the onset and maintenance of aggressive behavior
disorders. Gender has shown a robust relation to externalizing
disorders among school-age children, with boys substantially
outnumbering girls, although gender effects appear to be less
pronounced among preschoolers (Rose, Rose, & Feldman, 1989;
Lyons-Ruth et al., 1993). Maternal report of difficult child tem-
perament has also been related to aggressive behavior problems
in several investigations (e.g., Patterson & Bank, 1989). How-
ever, the validity of maternal reports of child temperament has
been questioned in recent literature, with poor parent-observer
agreement obtained (Seifer, Sameroff, Barrett, & Krafchuk,
1994), so the contribution of child temperament remains un-
clear. A more robust relation has been demonstrated between
mild verbal deficits and aggressive behavior, with verbal deficits
variously defined as poor school achievement, specific reading
deficits, or generally lowered 1Q scores (Hinshaw, 1992). Mof-
fitt (1993) has called attention to a specific pattern of relative
verbal deficits, in which verbal IQ scores show a consistent
half standard deviation lag behind performance scores among
conduct-disordered or delinquent children, an IQ pattern noted
as early as the preschool period.
In the current study, prospective longitudinal analyses from
infancy to age 7 were conducted, evaluating the prediction of
behavior problems available from infancy assessments of the
four domains of risk factors discussed above. This report fo-
cuses on the relations between assessments in infancy and inter-
nalizing and externalizing behaviors reported by both teachers
and mothers on the Achenbach Child Behavior Checklist
(CBCL; Achenbach, 1991). At 18monthsof age, abroad array
of data were collected assessing the following domains: (a)
family adversity, including demographic risk (e.g., low income,
low education, single parenthood, etc.) and maternal psyehoso-
cial problems (presence of depressive symptoms, psychiatric
hospitalization history, maltreatment petitions), (b) the quality
of infant-mother interactions at home, including maternal hos-
tile-intrusive behavior as well as involved-responsive behaviors,
(c) infant attachment classification, and (d) infant gender and
infant mental development scores on the Bayley Scales of Infant
Development (Bayley, 1969). Maternal depressive symptoms
were reassessed when the children reached age 5 and were also
added to the current database. Because earlier studies in high-
risk samples had documented links to externalizing behavior
from both avoidant and disorganized/disoriented attachment be-
havior, prediction from the attachment data was assessed in
relation both to disorganization status and to the presence of
pronounced avoidant behavior. These measures were collected
within a low-income cohort in which parents with serious diffi-
culties were oversampled, maximizing the likelihood that more
extreme family environments would be represented and that
child behavior problems would appear with sufficient frequency.
On the basis of previous findings, it was hypothesized that
child externalizing behavior would be predicted by a higher
level of family adversity in infancy, more hostile infant-mother
interactions, disorganized rather than avoidant infant attachment
behavior, lowered mental development scores, and male gender.
The only hypothesis related to child internalizing behavior was
that family adversity, and especially maternal depression, would
predict internalizing problems.
Method
Participants
The sample comprised 50 seven-year-olds (20 girls, 30 boys, M age
= 92 months). The sample was 80% Caucasian and 20% Latino, African
American, or biracial children. Sixty percent of the mothers were high
school graduates, 49% were single parents, almost half were under the
official poverty level (mean weekly per person income $90), and 35%
currently received Aid to Families with Dependent Children. During the
infant study, home visiting services were provided to 13 families in the
current cohort until infants were 18 months old. All infant assessments
1
The preschool analogue to disorganized attachment behavior in in-
fancy is termed controlling behavior (see Cassidy, Marvin, & MacArthur
Working Group on Attachment, 1992).
 DISORGANIZED ATTACHMENT STRATEGIES
were gathered at 18 months after the home visiting services had ended
and represent maternal and infant status postintervention.
Families originally were part of a study of 76 urban, low-income
families seen in infancy (see Lyons-Ruth, Cornell, Grunebaum, &
Botein, 1990). The infant sample consisted of 41 families referred to
the study by health or social service agency staff because of concerns
about the quality of the parent-infant relationship and 35 demographi-
cally matched families from the community who were screened for his-
tories of maltreatment or psychiatric hospitalization. At the 7-year assess-
ment, 5 families refused participation, and the remainder could not be
relocated (Easterbrooks, Davidson, & Chazen, 1993). The 50 families
who participated in the 7-year sample did not differ significantly from
the 26 who did not participate on any of the demographic, parent, or
infant measures described under Method. The infant attachment distribu-
tion of the 50 infants seen at age 7 was 42% secure, 16% avoidant, 10%
disorganized-forced secure, and 32% disorganized-forced avoidant or
ambivalent. The corresponding distribution for the full sample in infancy
was 36%, 20%, 13%, and 32%.
Assessment Procedures—Infancy
Maternal and infant functioning were assessed when the child was 18
months old.
Demographic data. A cumulative demographic risk index was cre-
ated by summing the following six factors: (a) mother's minority race,
(b) mother not a high school graduate, (c) mother under 20 years at the
birth of her first child, (d) mother a single parent, (e) family supported
by government assistance, and (f) family included three or more children
under age 6.
Maternal psychosocial problems. Maternal psychosocial problems
were coded as positive if the mother had a documented history of child
maltreatment or a history of inpatient psychiatric hospitalization. Nine
mothers received positive scores.
Maternal depressive symptoms. The Center for Epidemiological
Studies Depression (CES-D) Scale (Radloff, 1977) was administered
verbally to mothers when infants were IS months old and again when
the children were age 5. One mother with depression data when her
child was an infant was not assessed when the child was age 5. At each
testing, mothers who reported current depressive symptoms (past week)
on the CES-D Scale over the validated cutoff point for possible clinical
disorder ( ^ 1 6 ) were coded 1. All other mothers received a score of
0. Fifty percent of mothers scored over the cutpoint on at least one
assessment.
Maternal behavior at home. Naturalistic mother-infant interaction
was videotaped at home for 40 min. Maternal behavior was coded in
ten 4-min intervals on twelve 5-point rating scales and one timed vari-
able. Coders were blind to all other data on the families. Interobserver
reliabilities were computed on a randomly selected 20% of the video-
tapes. The 13 variables and their intraclass reliability coefficients were
as follows: sensitivity (.98), warmth (.96), verbal communication (.98),
quality (.98) and quantity (.98) of comforting touching (physical contact
in the service of communicating affection, "touching-base," or reducing
distress), quality (.88) and quantity (.94) of caretaking touching, in-
terfering manipulation (.76), covert hostility (.76), anger (.94), disen-
gagement (.97), flatness of affect (.89), and time out of room (.99).
The Sensitivity scale was that developed by Ainsworth and colleagues
(Ainsworth, Blehar, Waters, & Wall, 1978) but collapsed from a 9- to
a 5-point scale. The interfering manipulation scale rated the extent to
which the mother manipulated the infant's body with abrupt movements
or in ways that were not contingent on or responsive to the infant's
current activities. The covert hostility scale rated the extent to which
the mother's affective cues either did not match her own behavior or
communicated hostility, irritation, or disgust (e.g., smiling with sharp
voice tone, sweet voice with negative content, etc.).
683
Principal components analyses of the scales yielded two main factors.
Factor 1, labeled Maternal Involvement, accounted for 38% of the vari-
ance, and Factor 2, labeled Hostile-lntrusiveness, accounted for 26% of
the variance. Factor 1 included positive loadings for maternal sensitivity,
warmth, verbal communication, and quantity of comforting touch. Factor
2 included negative loadings for quality of comforting touch and quality
of caretaking touch and positive loadings for covert hostility, interfering
manipulation, and anger.
Infant behavior at home. Two measures of infant affect at home
were coded by different coders than those who coded maternal behavior:
(a) the number of 20-s intervals in which the infant displayed distress,
and (b) the total number of times resistance to contact, anger toward
mother, anger toward a sibling, or anger without a specific target were
displayed. Twenty minutes of the 40-min tape were coded, selecting
alternate 4-minute segments. Intraclass correlations between two coders
on 20 tapes were as follows: anger toward mother (r = .77). nonspecific
anger (r = .92), anger toward sibling (r = .92), resistance to mother
(r = .79), and distress (r = .74).
Infant development. The Bayley Scales of Infant Development
(Bayley, 1969), yielding a Mental Development Index (MDI) and a
Psychomotor Development Index (PDI), were administered to each in-
fant in a laboratory visit before assessment in the Ainsworth Strange
Situation.
Infant attachment security. Within 2 weeks of the home videotaping,
mothers and infants were videotaped in the Ainsworth Strange Situation
(Ainsworth et al., 1978). In this procedure, the infant is observed in a
playroom during a series of eight 3-min episodes in which the mother
leaves and rejoins the infant twice. Videotapes were coded for the three
attachment classifications as described by Ainsworth et al. and for disor-
ganized/disoriented behaviors as described by Main and Solomon
(1990). The three original attachment classifications (secure, avoidant,
ambivalent) were assigned in the first phase of the study by a computer-
ized multivariate classification procedure developed on the original Ains-
worth data (see Council, 1976, in Richters, Waters, & Vaughn, 1988)
and at a later phase of the study by a trained coder. Agreement between
the two sets of classifications was 86%. Seventy-five percent of the
disagreed-upon tapes were later found to meet criteria for the disorga-
nized/disoriented category. Agreement on the disorganized/disoriented
classification between a senior coder and a second coder for 32 randomly
selected tapes was 83% (K = .73).
As suggested by Main and Solomon (1990), all infants were classified
both by disorganization status (organized, disorganized) and by the best
fitting organized strategy displayed (secure, avoidant, ambivalent). Only
3 infants in this cohort (5 in the original infant sample) were classified
in the ambivalent group, and all 3 were also cross-classified as disorga-
nized, so the current sample contains no infants in the organized ambiva-
lent category. Figure 1 displays the ns for infants classified organized/
secure, organized/avoidant, disorganized/"best-fitting" secure, and
disorganized/' 'best-fitting'' avoidant.
Assessment Procedures—Age 7
When the children were age 7, data were collected on mothers' and
teachers' reports of children's behavior problems with the 113-item
Child Behavior Checklist (CBCL) from the Child Behavior Profile and
the Teacher Report Form for classroom teachers (Achenbach, 1978;
Achenbach & Edelbrock, 1979). Teachers completed questionnaires by
mail. Five teachers did not return questionnaires, and one additional
teacher failed to fill out the adaptive school functioning ratings form
only. Mothers were interviewed as part of a laboratory assessment lasting
approximately 75 min that included other interview and observational
measures. Five mothers did not participate in the laboratory procedure,
in some cases because they now lived at too great a distance. CBCL
scores for internalizing (CBCLint) and externalizing (CBCLext) behav-
684 LYONS-RUTH, EASTERBROOKS, AND CIBELLI
C
B
C
L
S
c
o
r
e
s
Secure Avoidant
Organized Strategies
n 20 5 4
Figure 1. Externalizing and internalizing symptoms in the classroom at age 7 predicted by attachment
behaviors in infancy. Three infants classified disorganized/ambivalent are omitted. CBCL = Child Behavior
Checklist.
iors were standardized (T scores). Teachers also completed the report
of adaptive school functioning, yielding a summary measure of school
adaptation (T score; CBCLadapt). For some analyses, scores for inter-
nalizing, externalizing, and adaptive functioning in school were dichoto-
mized according to the cutoffs representing the combined borderline and
clinical ranges (scores at or above 95th percentile of standardization
sample), cutoffs recommended by Achenbach (1991) as minimizing
false negatives and false positives. Numbers of children exceeding the
cutoff scores were as follows: maternal ratings (internalizing = 11,
externalizing = 13); teacher ratings (internalizing = 10, maladaptation
= 15, externalizing = 6). Most children rated as highly externalizing
were also highly aggressive, with 83% of teacher-rated externalizing
children and 77% of mother-rated externalizing children also reaching
clinical cutoff points on the Aggressive Problem subscale of the CBCL.
Results
Analytic Procedures
Analyses are presented by type of child problem (internaliz-
ing, adaptation to school, externalizing), with maternal report
data first, then teacher report data. For each type of data, analy-
ses of both continuous and clinical cutoff scores were conducted
because different developmental processes may contribute to
deviant behavior compared to behavior within a normative
range. Univariate associations between infancy predictors and
child outcomes were examined first, followed by analyses to
evaluate the unique contributions of multiple univariate pre-
dictors and their interaction effects. Because of the sample size,
i Externalizing • Internalizing
Secure Avoidant
Disorganized Strategies
13
only two-way interactions were assessed. Because both pre-
dictor and outcome variable sets contained continuous and di-
chotomous variables, univariate statistics varied by data type.
For two continuous variables, Pearson's r was computed; for
one dichotomous and one continuous variable, an F test yielded
the significance level, with eta as the measure of strength of
association; for two dichotomous variables, chi-square yielded
the significance level, with phi as the measure of strength of
association. AH multivariate analyses were conducted with all
main effects entered simultaneously on Step 1, so that Fciimgfi
statistics for main effects were adjusted for the effects of all
other main effects. All interaction effects were entered on Step
2, so that Change statistics for interaction effects were adjusted
for all main effects and all other interaction effects (paralleling
conventional analysis of variance procedure).
Associations Among Predictor Variables
The 11 predictor variables exhibited moderate to negligible
associations with one another. The largest association was be-
tween two home observation variables, maternal hostile-intru-
siveness and infant anger (r = .47, p < .001). The other seven
associations that reached significance were as follows: maternal
problems with hostile-intrusiveness (77 = .46, p < .001), mater-
nal problems with infant anger (77 = .38, p < .01), infant anger
with infant distress (r = .40, p < .01), demographic risk with
depressive symptoms (17 = .41, p < .01), depressive symptoms
 DISORGANIZED ATTACHMENT STRATEGIES
with hostile-intrusiveness {tj = .32, p < .04), MDI with mater-
nal involvement ( r = .30, p < .05), and MDI with infant
attachment disorganization (77 = .39, p < ,01). These relations
have been discussed in prior publications (Lyons-Ruth et al.,
1990; Lyons-Ruth et al., 1991; Lyons-Ruth & Block, 1996).
Assessments in Infancy and Child Problems at Age 7:
Univariate Predictors
Table 1 displays univariate strength of association statistics
between structured assessments in infancy and child problems
at age 7, for both continuous scores and scores over clinical
cutoff points. Associations between home observation variables
685
and child outcomes were not significant and are presented in
text below. As shown in Table 1, child problems were analyzed
for the prediction available from the organized/disorganized
attachment contrast and for prediction available from the secure/
avoidant attachment contrast (with best fitting classifications for
disorganized infants). The 3 infants classified as disorganized-
ambivalent were omitted from all analyses of the secure/avoid-
ant distinction.
Child Internalizing Symptoms—Multivariate Analyses
Maternal reports. As predicted, CBCLint scores reported by
mothers were related to maternal depressive symptoms during

Table 1
Associations Between Structured Assessments at 18 Months and Behavior Problems Reported
by Teachers and Mothers at Age 7

Internalizing Externalizing Adaptive functioning

symptoms symptoms at school
Assessment results in infancy (B = 45) (B = 45) (n = 44)

Continuous scores
Maternal reports
Infant attachment: disorganization* .01 .14
Infant attachment: avoidance"1*1 -.08 (43) -.01 (43)
Infant mental development -.21 -.31*
Maternal psychosocial problems8 .06 .20
Maternal depression: 18 mos or 5 yrs" -.40** (44) .43** (44)
Cumulative demographic risk0 .12 .22
Infant sex8 .06 .03
Teacher reports
Infant attachment: disorganization8 .25f .31* -.34*
Infant attachment: avoidanceflb .42** (42) .23 (42) .12 (41)
Infant mental development6 -.33* -.33* .20
Maternal psychosocial problems8 -.02 .31* -.20
Maternal depression: 18 mos or 5 yrsa .37** (44) .34* (44) - . 2 0 (43)
Cumulative demographic risk0 .17 .03 -.01
Infant sex" .21 .21 .24

Clinical scores
Maternal reports
Infant attachment: disorganization11 -.04 -.02
Infant attachment: avoidance M - . 1 6 (43) - . 1 8 (43)
Infant mental development" -.23 -.18
Maternal psychosocial problemsd .14 .22
Maternal depression: 18 mos or 5 yrsd .30* (44) .32* (44)
Cumulative demographic risk6 .15 .07
Infant sex" .17 .05
Teacher reports
Infant attachment: disorganization*1 .17 .31* .31*
Infant attachment: avoidanceb"d .25t (42) .13 (42) .18 (41)
Infant mental development6 -.32* -.33* -.24
Maternal psychosocial problems'1 -.13 .13 .13
Maternal depression: 18 mos or 5 yrsd .39** (44) .13 (44) .16 (43)
Cumulative demographic riskc .30* .04 .00
Infant sexd .31* .17 .18

Note. Numbers in parentheses indicate cells with lower /is.

* For categorical predictors, strength of association is indexed by eta, with significance assessed by F test.
•The three participants classified disorganized/forced ambivalent were omitted. cFor continuous predictors,
strength of association is indexed by r. dFor categorical predictors, strength of association is indexed by
phi, with significance assessed by x2- *P°r continuous predictors, strength of association is indexed by eta,
with significance assessed by F test.
•\p < .10, two-tailed. *p < .05, one-tailed. **p < .01, one-tailed.
686 LYONS-RUTH, EASTERBROOKS, AND CIBELLI

Table 2 gender and to demographic risk. Multiple discriminant function

Unique and Cumulative Contributions of Infancy Variables analysis was performed to assess which of these four variables
to Teacher-Reported Behavior Problems: (depression, MDI, gender, demographic risk) or their two-way
Multivariate Analytic Results interaction terms contributed uniquely to the prediction of clini-
cal internalizing scores. Only gender and maternal depression
Teacher reports made significant unique contributions. Results of the analysis
are shown in Table 2. It should be noted, however, that an
Internalizing Externalizing
Assessment results in infancy symptoms symptoms equivalent degree of prediction was generated by substituting
demographic risk and MDI scores for maternal depression in
Continuous scores the equation, x 2 ( 3 , N = 45) = 13.29, p < .004, canonical
Regression analysis 3 correlation = .52, Wilks's \ = .73, with 71.1% of cases cor-
Infant attachment: rectly classified, x 2 ( l , N = 45) = 5.68, p < .025. Thus, as in
disorganization .38** the analysis of continuous scores, a substantial degree of overlap
Infant attachment: .42** existed in variance accounted for by maternal depression and
avoidanceb variance accounted for by MDI scores.
Maternal depression: 18 .38**
months or 5 years 4j**
R 51*** Child Adaptation at School
% variance accounted for 32 26
As seen in Table 1, the child's maladaptive functioning in
Clinical scores
school was significantly related only to the display of a disorga-
Multiple discriminant nized attachment strategy in infancy. Disorganized attachment
analysisc strategies predicted both continuous adaptation scores and
Male gender 4.62*
scores in the clinical range. Fifty percent of children classified
Maternal depression: J 8 5.51*
months or 5 years as disorganized in infancy were rated over the cutoff score for
Dis. Attach. X Mental Dev. 9.66** maladaptation at age 7 (regardless of best fitting underlying
Canonical correlation .45** .56*** strategy), compared with 21% and 20% of children classified
% cases correctly secure or avoidant in infancy, respectively.
classified 78*** 87***

Note. Dis. = disorganized; attach. = attachment; dev. = development.
a
Beta coefficients, with other variables controlled, are reported; signifi-
cance levels assessed by F change statistic. b The three participants
classified disorganized/forced ambivalent were omitted. c F change val-
ues with other variables controlled are reported.
*p < .05. • * / ? < . 0 1 . ***p < .001.
the first 5 years. Maternal depression predicted both continuous
internalizing scores and clinical-range scores and was the only
variable reaching significance for maternal reports (see Table 1).
Teacher reports—continuous scores. As predicted, teacher-
reported CBCLint scores were also reliably related to maternal
depressive symptoms during the first 5 years. However, in con-
trast to maternal reports, CBCLint scores reported by teachers
were also related to avoidant attachment strategies in infancy
and to lowered MDI at 18 months. Multiple regression analysis
of the three infant predictors of teacher-rated CBCLint scores
(depression, avoidant attachment, mental development) and the
three interaction terms indicated that only depression and avoid-
ant attachment accounted for unique variance, avoidant attach-
ment, FchangcO. 38) = 6.94, p < .01; depression, FchmgP(\, 38)
= 5.39, p < .03; MDI, Fchange(\, 38) = .79, ns. No interaction
effects were significant. Therefore, for internalizing symptoms,
the predictive power of lowered MDI scores derived from the
embeddedness of MDI scores in a context of maternal depres-
sion and infant avoidance. Effect sizes are shown in Table 2.
Teacher reports—clinical scores: Clinical levels of inter-
nalizing symptoms at school were not significantly related to
avoidant attachment classification in infancy, as were continuous
scores, but continued to be related to maternal depression and
infant MDI scores. Clinical scores were also related to male
Child Externalizing Symptoms—Multivariate Analyses
Maternal reports. Mother-reported CBCLext scores were
predicted only by lowered MDI scores at 18 months and by
maternal depressive symptoms during the first 5 years (see Table
1). Multiple regression analysis indicated that mother-reported
CBCLext scores were uniquely related only to the presence of
maternal depressive symptoms, F c t a n p f (l, 42) = 9.42,p < .004,
partial r = .42, with MDI scores making no further contribution
after variance related to maternal depression was controlled.
Mothers' reports of clinical-level externalizing symptoms were
related only to maternal depressive symptoms.
Teacher reports—continuous scores, ln contrast to mater-
nal reports, CBCLext scores reported by teachers were signifi-
cantly predicted by four variables: disorganized attachment,
MDI, depression, and maternal psychosocial problems (history
of psychiatric hospitalization or child maltreatment). Multiple
regression analysis of these predictors and their six two-way
interaction terms yielded a significant regression equation con-
taining all four predictors, F ( 4 , 40) = 4.20, p < .006, R = .54,
accounting for 30% of the variance in externalizing symptoms
at age 7.2 None of the interaction terms were significant. How-
ever, the results were somewhat anomalous in that no single
2
The original N for the depression variable was 44 because one
mother had no depression data at the 5-year assessment. Because all of
the infant data were available for this participant and because this mother
had reported low levels of depressive symptoms on all three other assess-
ments with the CES-D by age 7 (12 months, 18 months, 7 years),
this mother was coded * 'not depressed'' for purposes of including this
participant's data in the multivariate analyses.
 DISORGANIZED ATTACHMENT STRATEGIES
predictor made a significant unique contribution, disorganized
attachment, FchmJl, 40) = 3.78,/? < .06; depression, Fchange(l,
40) = 3.46, p < .07; MDI, f change (l, 40) = 1.09, p < .30;
maternal problems, ^dungeO. 40) = 1.06, p < .31. This was
not the case before MDI was added to the equation. Before its
addition, both disorganized attachment and maternal depression
made significant unique contributions to prediction, disorga-
nized attachment, Fchange(l, 41) = 6.66, p < .01; depression,
fchange(l, 41 ) = 5.73, p < .02; maternal problems, Fchaa$e(l,
41) = .78, ns; overall F ( 3 , 41) = 5.22, p < .004, R = .53.
Thus, the addition of MDI to the equation did not explain ad-
ditional unique variance but did reveal substantial overlap in
variance explained by MDI scores and variance explained by
attachment and depression. Effect sizes for the regression equa-
tion containing only the two significant predictors are shown in
Table 2.
Because children's CBCLint and CBCLext scores were pre-
dicted by different aspects of attachment behavior in infancy
and because each child was classified on both attachment dimen-
sions, the two CBCL scores and the two attachment contrasts
are presented jointly in Figure 1 to display the coexistence of
the two effects. As recommended by Main and Solomon (1990),
all disorganized infants were subclassified as to the best fitting
type of strategy displayed, as also shown in Figure 1. Figure
1 confirms that children who had been neither avoidant nor
disorganized in infancy received low scores on both types of
symptoms at age 7, whereas children who had been both disor-
ganized and avoidant received high scores on both internalizing
and externalizing symptoms.
Teacher reports—clinical scores. Clinical externalizing
scores were not predicted by depression or psychosocial prob-
lems as were the continuous scores but continued to be related
to disorganized attachment and MDI (see Table 1). Inspection
of the significant univariate effect of attachment revealed that
only 4% of infants with organized attachment strategies but
25% of disorganized infants later displayed clinical levels of
externalizing symptoms (regardless of best fitting underlying
attachment strategy).
Multiple discriminant function analysis including disorga-
nized attachment and MDI and their interaction term revealed
a robust interaction effect, attachment, FQhaaee(l, 42) = 2.25,
ns; MDI, -Fcbaiige(l, 42) = 2.85, ns; interaction, Fciange(l, 41)
= 9.66, p < .003. The resulting equation was highly reliable,
2
x ( 3 , N = 45) = 15.61, p < .001, Wilks's \ = .69. Effect
sizes are shown in Table 2.
To examine the interaction effect, we dichotomized MDI
scores at the normal population mean of 100. Fifty percent of
the 10 children with both disorganized attachment status and
MDI scores below 100 in infancy were rated as highly exter-
nalizing at age 7, compared to 3% of the remaining 35 children.
Looking backward from age 7, 83% of children with clinical
externalizing scores were in the disorganized/low mental score
group at 18 months, compared to only 13% of the remaining
39 children. The strength of the backward prediction suggests
that a majority of school-age externalizing children will have
experienced disorganized/low MDI status in infancy. The mean
MDI score of infants later classified as deviant in externalizing
behavior was 94.7 compared to a score of 106.8 for infants who
were later in the nondeviant group. Dichotomous infant MDI
687
scores (under 100 or 100+) were unrelated to maternal verbal
scores assessed during infancy (Similarities subtest scores from
the Wechsler Adult Intelligence Scales), F ( l , 39) = .07, ns,
and child clinical externalizing scores were also unrelated to
maternal verbal scores, F{\, 39) = .17, ns.
Figure 2 compares the distributions of continuous and clinical
CBCLext scores in relation to infancy predictors and confirms
that lowered MDI scores were a more important contributor to
CBCLext scores at clinical levels than to CBCLext scores at
nonclinical levels. Figure 2 also reveals that lowered MDI scores
did not occur outside the context of either maternal depression or
disorganized attachment. Figure 2 also makes clear that whereas
most infants with lowered MDI scores displayed disorganized
attachment strategies, # 2 ( 1 , N = 45) = 7.81, $ = .42, p <
.01, most infants who exhibited disorganized attachment strate-
gies did not have lowered MDI scores.
Teacher clinical scores and mental lag. As noted earlier,
one of the well-replicated cognitive findings in studies of con-
duct-disordered children is a pattern of mild verbal deficits in the
context of intact visuospatial skills (Moffitt, 1993). In previous
analyses of infancy data from this cohort, a similar pattern of
mental lag was identified at 18 months of age, in which mental
development scores ranged from 8 to 25 points below psychomo-
tor development (PDI) scores, with a mean lag of 17 points or
1 SD (Lyons-Ruth et al., 1991) .3 Seventy-nine percent of infants
displaying this pattern of mental lag were also classified as
disorganized in their attachment strategies. Because of the po-
tential relevance of this cognitive pattern to later externalizing
symptoms, analysis by chi-square was conducted to examine
the relation between mental lag in infancy (MDI % SD or more
below PDI) and clinical levels of externalizing behavior at age
7. The relation was robust, * 2 ( 1 , N = 43) = 10.64, p < .001,
<f> = .50, with 4 of the 6 highly externalizing children exhibiting
mental lag in infancy, and 4 of the 8 infants with mental lag
becoming highly externalizing by age 7, whereas only 2 of 35
infants without mental lag became highly externalizing. Al-
though a similar degree of predictive power was available with
only MDI scores (MDI < 100, <f> = .47), the lag scores indicate
that the cognitive profile characteristic of highly externalizing
children was evident in a subgroup of this sample by 18 months
of age, appearing in the infant cohort among 33% of children
with disorganized attachment strategies but only 8% of children
with organized attachment strategies.
Home Observation Data
The home observation data in infancy did not contribute to
the prediction of later child problems. Associations between
the four home scores (involvement, hostile-intrusiveness, infant
distress, and infant anger/resistance) and all maternal and
teacher scores ranged from ±.02 to ±.27, all ns. However, two
home predictors approached significant prediction of clinical-
level symptoms reported by teachers and may deserve continued
study. Frequency of infant distress was related to later deviant
3
The 1969 edition of the Bayley Scales of Infant Development was
used in this study. Because the later edition yields lower psychomotor
scores, this formula may need.adjustment if a newer edition of the
Bayley scales is used.
688 LYONS-RUTH, EASTERBROOKS, AND CIBELU

80 100

• Continuous scores
• % deviant
70 69 75
o
o
60

« 60 50
N 58
56 56 40

53
52

50 25
4S

40
n 10 7 11 3 0 3 5 5

No DIS DEP DIS MDI MDI MDI MDI

Risk DEP DEP DIS DIS
Factors DEP

Figure 2. Teacher-rated externalizing scores by the three significant risk factors. DIS = disorganized
attachment; DEP = mother high depressive symptoms; MDI = scores under 100 on Bayley Mental Develop-
ment Index.

externalizing behavior, F ( l , 39) = 3.00, p < .09, TJ = .27,
and lower maternal involvement was related to later deviant
internalizing behavior, F ( l , 43) = 2.95, p < .09,77 = - . 2 5 .
Relations Between Mother and Teacher Reports
Mother and teacher reports were only moderately correlated
(CBCLint scores, r = .38, p < .01; CBCLext scores, r = .49, p
< .001). In addition, as is evident from prior analyses, mothers'
reports differed from teachers1 reports primarily in their failure
to reflect the effects of infant attachment classifications. Mother-
reported scores did not reflect the significant associations be-
tween avoidant attachment and CBCLint scores, between disor-
ganized attachment and CBCLext scores, or between the combi-
nation of disorganized attachment/low MDI and clinical level
CBCLext scores. In addition, mothers with histories of hospital-
ization or maltreatment did not report elevated CBCLext scores
for their children even though teachers did report them.
Unexpectedly, the reports of mothers of infants with organized
secure strategies were most discrepant from teachers' reports,
with mothers of secure infants tending to report more symptoms
compared with teachers (CBCLint: mothers = 58, teachers =
52; CBCLext: mothers = 58, teachers = 52), whereas mothers
of infants with avoidant or disorganized-avoidant strategies
tended to report symptom levels closer to or lower than the
levels reported by teachers CBCLint: mothers = 57, teachers =
59; CBCLext: mothers = 59, teachers = 55). Stevenson-Hinde
and Shouldice (1990) have also reported that mothers of se-
curely attached preschoolers significantly overreported child in-
security and fearfulness, relative to laboratory observers,
whereas mothers of insecurely attached children significantly
underreported these characteristics. This suggests that mothers
of infants with secure strategies may be more open to perceive
and report vulnerable affects in their children than are mothers
of infants with insecure strategies. Further work is needed ex-
ploring the validity of maternal problem reports among the vari-
ous attachment groups.
Discussion
Results of the study indicate that assessments at 18 months
of age can provide significant prediction of internalizing and
 DISORGANIZED ATTACHMENT STRATEGIES
externalizing problems at age 7 in a high-risk sample. As hy-
pothesized, children's internalizing symptoms were primarily
predicted by high levels of maternal depressive symptoms dur-
ing the first 5 years. This relation was significant for both moth-
ers' and teachers' reports and for both continuous and clinical
scores. Thus, maternal depression scores appeared to be the
best overall index linking a climate of family adversity to later
internalizing symptoms, capturing variance shared with cumula-
tive demographic risk scores and lowered infant MDI scores.
Teacher ratings, but not mother ratings, also revealed an un-
predicted relation between internalizing symptoms and infant
avoidance, a relation that held true whether the avoidance was
displayed within an organized or a disorganized attachment pat-
tern, as was shown in Figure 1. It should be noted that infant
avoidance was only a risk factor for less severe levels of internal-
izing symptoms and did not reach significance for symptoms
within the clinical range. A relation between avoidant attach-
ment and internalizing problems has also been reported by Gold-
berg, Gotowiec, and Simmons (1995) in relation to parental
CBCL reports among 2- to 3-year-olds and by Moss et al. (1996)
for boys only, in relation to teacher reports among 5- to 7-year-
olds. Thus, in recent studies differentiating between organized
and disorganized presentations of avoidant behavior, researchers
have consistently found elevated internalizing problems among
organized avoidant participants in comparison to secure partici-
pants, rather than the externalizing behavior reported in earlier
studies that did not control for concurrent disorganization. The
increase in internalizing symptoms associated with avoidant at-
tachment strategies is also consistent with a large literature at
the infant, adolescent, and adult levels indicating that avoidant
attachment strategies are characterized by the relative absence of
direct expressions of distress and anger. The avoidant individual
attempts to self-regulate negative affect rather than acknowledge
vulnerability and enlist help from others (e.g., Koback & Sceery,
1988; Main et al., 1985). This avoidant stance has obvious
similarities to the "holding in" of negative affects that is the
hallmark of an internalizing stance.
Hypothesized relations between infancy predictors and later
externalizing problems were generally borne out in relation to
teacher reports but not in relation to maternal reports. Hypothe-
ses were that family adversity, hostile parent-child interactions,
disorganized attachment patterns, lowered MDI scores, and male
gender would be associated with later externalizing symptoms.
For maternal reports, a high level of maternal depressive symp-
toms was the only significant predictor of externalizing prob-
lems. For teacher reports, univariate predictors included two
measures of family adversity (maternal depression and maternal
psychosocial problems), infant disorganized attachment status,
and lowered MDI scores. Regression analyses indicated that
maternal depression and infant disorganization were the two
best predictors of continuous externalizing scores, accounting
for 26% of the variance and subsuming the variance also identi-
fied by maternal psychosocial problems and infant MDI scores.
The child's overall adaptation to school was also significantly
influenced by the disorganization of the early attachment rela-
tionship, with 50% of disorganized infants later displaying com-
promised adaptation compared to 21% of other infants. When
clinical levels of externalizing behavior were considered, the
subset of disorganized infants who also displayed lowered MDI
689
scores in infancy were at greatest risk, with 50% of that group
rated over the clinical cutoff point and 31% of the variance
accounted for in deviant externalizing behavior.
The failure of the home observational data to contribute to
long-term prediction may stem from the fact that the home
coding scales were constructed before disorganized attachment
behavior was described in the literature and were more closely
related to maternal depression than to infant disorganization
(Lyons-Ruth et al., 1990, 1993). A recently developed coding
system that targets maternal behaviors conceptually linked to the
construct of disorganization (including affective communication
errors, disoriented behavior, and role reversal, as well as intru-
sive and withdrawing behaviors) and that yields a single fre-
quency score for atypical maternal behaviors across both with-
drawing and intrusive presentations has proved capable of dis-
criminating infants who display disorganized attachment
behavior (Lyons-Ruth, Bronfman, & Parsons, 1996). Future
work will assess whether these maternal behaviors in infancy
provide better long-term prediction of child behavior.
Possible limitations to the generalizability of these results
include the relatively small sample size and the low socioeco-
nomic status of the sample. Low socioeconomic status may
potentiate the relationships obtained here so that other work is
needed to assess whether maternal depressive symptoms, disor-
ganized or avoidant attachment patterns, and low MDI scores
are related to later child symptoms in more advantaged
environments.
As in the current data, maternal depressive symptoms have
been related to both externalizing and internalizing child symp-
toms in a variety of other studies (see Downey & Coyne, 1990,
for review). Maternal depressive symptoms have also been con-
sistently related to more negative parenting behaviors regardless
of child age or parental income (Downey & Coyne, 1990).
Lyons-Ruth et al. (1993) have demonstrated that one route
through which maternal depressive symptoms influence child
symptomatology at age 5 is through the more irritable and intru-
sive interactive stance over time of the depressed mother with
her child. Maternal depressive symptoms also exert an indirect
effect on child symptoms because maternal depression is associ-
ated with increased insecurity in the early attachment relation-
ship (Lyons-Ruth et al., 1990; Teti, Gelfand, Messinger, & Isa-
bella, 1995), and attachment insecurity accounts for variance in
child symptoms in addition to that related to observed maternal
behavior.
Lowered infant mental development scores were a second
consistent predictor of later problems. However, lowered MDI
scores were predictive of continuous problem scores primarily
because they overlapped with other more powerful predictors.
Only in the case of clinical levels of externalizing symptoms
did lowered MDI scores independently contribute to the identi-
fication of a subset of disorganized infants who were particularly
at risk. How should we understand this potentiating effect of
infant MDI scores? Just as the mildness of the cognitive deficit
in older children does not seem to account directly for the
seriousness of their conduct disorder (Moffitt, 1993), the mild-
ness of the mental deficit in infancy is unlikely to account either
for the concurrent disorganization of the attachment relationship
or for the deviant behavior displayed at age 7. For example, in
a recent meta-analysis, van Uzendoorn, Goldberg, Kroonenberg,
690 LYONS-RUTH, EASTERBROOKS, AND CIBELLI
and Frenkel (1992) concluded that in samples of infants with
serious biological problems (prematurity, Down syndrome, au-
tism, deafness, cystic fibrosis, congenital heart disease), infant
attachment distributions were similar to those seen in normal
samples.
The current data indicate that lowered MDI scores are embed-
ded in other family risk factors and may constitute one index
of a more broadly disturbed caregiving context. Similar findings
have been discussed in the conduct disorder literature with older
children; several investigations have found overlap between
measures of family adversity and child verbal IQ in predicting
antisocial behavior (Moffitt, 1990; Olweus, 1983; Richman,
Stevenson, & Graham, 1982; Schonfeld, Shaffer, O'Connor, &
Portnoy, 1988). Richman et al. (1982) speculated that because
a major component of their family adversity measure was a
measure of maternal dysphoric symptoms, a particular type of
early caregiver unavailability may be important to the develop-
mental trajectory characterized by language delay, externalizing
behavior, and reading deficits. This speculation converges well
with the current finding that lowered MDI scores occurred
among a subgroup of the infants experiencing disorganized at-
tachment relationships.
The attachment literature expands this view of the potential
links between disturbed early relationships and mental develop-
ment scores. Aber and Allen (1987) have advanced a secure
readiness to learn hypothesis, theorizing that in caretaking envi-
ronments in which attachment security is constantly in jeopardy,
the infant is forced to allocate excessive attention to monitoring
the state of the relationship, detracting from attention in the
service of learning and exploration. The recently observed devel-
opmental transformation of infant disorganized attachment strat-
egies into preschool attachment strategies focused on controlling
the parent through caretaking or coercive behavior (Main et al.,
1985; Warmer, Grossmann, Fremmer-Bombik, & Suess, 1994)
adds further weight to the hypothesis that infants in disorganized
attachment relationships must pay excessive attention to moni-
toring the relationship to the parent. The quality of discourse of
mothers of disorganized infants is also particularly dysfluent
(see Lyons-Ruth, 1996, for review), suggesting that disorga-
nized attachment strategies are more likely to occur in the con-
text of generally disrupted communication patterns, which
would also be likely to affect mental development scores {see
also Jacobsen, Edelstein, & Hofmann, 1994).
A disorganized attachment strategy was the final important
predictor of both externalizing and more general adaptational
difficulties at age 7, As noted under Method, most children rated
as highly externalizing at age 7 also displayed high scores on
the Aggression subscale. Why should disorganized attachment
behavior constitute one early step on the pathway to later aggres-
sion and tnaladaptation? First, aggressive child behavior at clini-
cal levels is a relatively serious disorder in that it occurs in the
context of more extreme family stressors and is more predictive
of later problems than hyperactive or anxious behavior alone
(Alpern & Lyons-Ruth, 1993; Blanz et al., 1991; Harrington,
Ridge, Rutter, Pickles, & Hill, 1991). Thus, we might expect
that the more disturbed and adversity-related forms of child
social behavior would be preceded by the more disturbed and
adversity-related forms of infant social behavior. The disorga-
nized behaviors displayed in infancy are quite different from
the aggressive behaviors displayed at school age, however, so
how should we conceive of the processes that might underlie
such discontinuity in the child's presentation over time?
Briefly, the accumulated literature indicates that parents of
disorganized infants are more likely to have been exposed to
experiences that induce helpless (frightened) or hostile (fright-
ening) affect (Main & Hesse, 1990; van Ijzendoorn, 1995), and
these affects and their associated representational models are
carried into caregiving relationships (DeMulder & Radke-Yar-
row, 1991; George & Solomon, 1996; Lyons-Ruth & Block,
1996). The infant of a frightened or frightening caregiver is
thought to be more likely to experience fear in relation to the
caregiver and is less likely to reliably experience comfort and
protection, resulting in conflict behavior, dysphoria, and disor-
ganization of attachment behaviors, as well as heightened corti-
sol reactivity, when the attachment system is activated (Main &
Hesse, 1990; Lyons-Ruth, Bronfman, & Parsons, 1996; Main &
Solomon, 1990; Solomon, George, & Ivins, 1987; Spangler &
Grossman, 1993). However, with increasing cognitive capability
during the preschool period, some disorganized infants reorga-
nize their attachment behavior away from seeking comfort and
protection around their own needs and toward maintaining en-
gagement with the parent on the parent's terms, becoming either
controlling-punitive or controlling-caregiving in interaction with
the hostile or helpless parent (Main et al., 1985; Solomon et
al., 1995; Warmer et al., 1994). It is not known what factors
influence the development of a caregiving versus a punitive
stance, though these factors presumably include disposition^
characteristics of the individual as well as family interaction
patterns. Thus, one subgroup of disorganized infants begins to
display overtly aggressive behavior toward the parent during
the preschool years, whereas both subgroups are presumed to
be experiencing underlying frustration of attachment needs and
accompanying dysregulation of physiological stress responses,
which could also contribute to aggressive and maladaptive re-
sponses toward others.
On the basis of these data, one would expect disorganized
attachment relationships in infancy to predict more severe so-
cial-relational disorders of childhood across a range of symptom
presentations. The finding in the present data that 50% of chil-
dren with disorganized attachment histories were rated over the
clinical cutoff score for maladaptive behavior at school supports
this broader view of child risk but suggests that the forms of
later maladaptation associated with early disorganization may
not be captured entirely by conventional checklists for internal-
izing and externalizing symptoms (i.e., odd, intrusive, control-
ling, or incompetent but not aggressive social behavior). More
subtle assessments may be needed to examine the social adapta-
tion of children in the controlling spectrum who do not display
frankly aggressive behavior (see Solomon et al., 1995).
In summary, the results of the study document substantial
prediction from assessments of 18-month-olds to teacher-reports
of behavior problems at age 7 in a high-risk sample, although
cautioning against reliance on maternal report data. What the
current study adds to previous literature is the longitudinal dem-
onstration that risk factors for problem behavior identified in
cross-sectional studies of school-age children, including mild
IQ deficits, family adversity, and parental psychopathology, may
already be identifiable in infancy. Furthermore, the concomitant
 DISORGANIZED ATTACHMENT STRATEGIES
presence of a disorganized parent-infant attachment relation-
ship is particularly important to the prediction of later maladap-
tation and may be critical to the broader relational context in
which early mental lag, aggressive behavior, and later verbal
deficits develop.
References
Aber, J. L., & Allen, J. P. (1987 ). The effects of maltreatment on young
children's socioemotional development: An attachment theory per-
spective. Developmental Psychology, 23, 406-414.
Achenbach, X M. (1978). The Child Behavior Profile: I. Boys aged 6 -
11. Journal of Consulting and Clinical Psychology, 46, 478-488.
Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18,
YSR and TRF profiles. Burlington: University of Vermont, Department
of Psychiatry.
Achenbach, T M., & Edelbrock, C. (1979). The Child Behavior Profile:
II. Boys aged 12-16 and girls aged 6-11 and 12-16. Journal of
Consulting and Clinical Psychology, 47, 1275-1301.
Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns
of attachment Hillsdale, NJ: Erlbaum.
Alpern, L., & Lyons-Ruth, K. (1993). Preschool children at social risk:
Chronicity and timing of maternal depressive symptoms and child
behavior problems at school and at home. Development and Psycho-
pathology, 5, 371-387.
Bayley, N. (1969). The Bayley Scales of Infant Development. New \brk:
Psychological Corporation.
Biederman, J., Munir, K., & Knee, D. (1987). Conduct and oppositional
disorder in clinically referred children with attention deficit disorder:
A controlled family study. Journal of the American Academy of Child
and Adolescent Psychiatry, 26, 724-727.
Blanz, B., Schmidt, M. H., & Esser, G. (1991). Familial adversities and
child psychiatric disorder. Journal of Child Psychology and Psychia-
try, 32, 939-950.
Campbell, S. B., Pierce, E. W, March, C. L., & Ewing, L. J. (1991).
Noncompliant behavior, overactivity, and family stress as predictors
of negative maternal control with preschool children. Development
and Psychopathology, 3, 175-190.
Cassidy, J., Marvin, R. S., & MacArthur Working Group on Attachment.
(1992). Attachment organization in preschool children: Procedure
and coding manual Unpublished manuscript, Pennsylvania State Uni-
versity, University Park.
Connell, D. B. (1976). Multivariate classifierfor the Ainsworth Strange
Situation. (Available from the author at Abt Associates, 55 Wheeler
Street, Cambridge, MA, 02138).
DeMulder, E. K., & Radke-Yarrow, M. (1991). Attachment with af-
fectively ill and well mothers: Concurrent behavioral correlates. De-
velopment and Psychopathology, 3, 227-242.
Downey, G., & Coyne, J. C. (1990). Children of depressed parents: An
integrative review. Psychological Bulletin, 108, 50-76.
Easterbrooks, M. A., Davidson, C. E., & Chazan, R. (1993). Psychoso-
cial risk, attachment, and behavior problems among school-aged chil-
dren. Development and Psychopathology, 5, 389-402.
Fagot, B. I., & Kavanagh, K. (1990). The prediction of antisocial behav-
ior from avoidant attachment classifications. Child Development, 61,
864-873.
George, C , & Solomon, J. (1996). Representational models of relation-
ships: Links between caregiving and attachment. Infant Mental Health
Journal, 17, 198-216.
Goldberg, S., Gotowiec, A., & Simmons, R. (1995). Infant-mother
attachment and behavior problems in healthy and chronically ill pre-
schoolers. Development and Psychopathology, 7, 267-282.
Goldberg, S., Perotta, M., Minde, K., & Corter, C. (1986). Maternal
behavior and attachment in low birthweight twins and singletons.
Child Development, 57, 34-46.
691
Greenberg, M. X, Speltz, M.L., & DeKlyen, M. (1993). The role of
attachment in the early development of disruptive behavior problems.
Development and Psychopathology, 5, 191-213.
Greenberg, M. T, Speltz, M. L., DeKlyen, M., & Endriga, M. C. (1991).
Attachment security in preschoolers with and without externalizing
problems: A replication. Development and Psychopathology, 3, 4 1 3 -
430.
Harrington, R., Fudge, H., Rutter, M., Pickles, A., & Hill, J. (1991).
Adult outcomes of childhood and adolescent depression: II. Links
with antisocial disorders. Journal of the American Academy of Child
and Adolescent Psychiatry, 30, 434-439.
Hinshaw, S. P. (1992). Externalizing behavior problems and academic
underachievement in childhood and adolescence: Causal relationships
and underlying mechanisms. Psychological Bulletin, 111, 127-155.
Hubbs-Tait, L., Eberhart-Wright, A., Ware, L., Osofsky, J., Yockey, W., &
Fusco, J. (1991, April). Maternal depression and infant attachment:
Behavior problems at 54 months in children of adolescent mothers.
In J. Osofsky & L. Hubbs-Tait (Chairs), Consequences of adolescent
parenting: Predicting behavior problems in toddlers and preschool-
ers. Symposium conducted at the biennial meeting of the Society for
Research in Child Development, Seattle, VfA.
Jacobsen, X, Edelstein, W., & Hofmann, V. (1994). A longitudinal study
of the relation between representations of attachment in childhood and
cognitive functioning in childhood and adolescence. Developmental
Psychology, 30, 112-124.
Kobak, R., & Sceery, A. (1988). Attachment in late adolescence: Work-
ing models, affect regulation, and representations of self and others.
Child Development, 59, 135-146.
Lewis, M., Feiring, C , McGuffog, C , & Jaskir, J. (1984). Predicting
psychopathology in six-year-olds from early social relations. Child
Development, 55, 123-136.
Lyons-Ruth, K. (1996). Attachment relationships among children with
aggressive behavior problems: The role of disorganized early attach-
ment patterns. Journal of Consulting and Clinical Psychology, 64,
64-73.
Lyons-Ruth, K., Alpern, L., &. Repacholi, B. (1993). Disorganized in-
fant attachment classification and maternal psychosocial problems as
predictors of hostile-aggressive behavior in the preschool classroom.
Child Development 64, 572-585.
Lyons-Ruth, K., & Block, D. (1996). The disturbed caregiving system:
Conceptualizing the impact of childhood trauma on maternal care-
giving behavior during infancy. Infant Mental Health Journal, 17,
257-275.
Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1996). Atypical maternal
behavior and disorganized infant attachment strategies. Manuscript
submitted for publication.
Lyons-Ruth, K., Connell, D., Grunebaum, H., & Botein, S. (1990).
Infants at social risk: Maternal depression and family support services
as mediators of infant development and security of attachment. Child
Development, 61, 85-98.
Lyons-Ruth, K., Repacholi, B., McLeod, S., & Silva, E. (1991). Disor-
ganized attachment behavior in infancy: Short-term stability, maternal
and infant correlates, and risk-related subtypes. Development and
Psychopathology, 3, 377-396.
Main, M., & Hesse, E. (1990). Parents' unresolved traumatic experi-
ences are related to infant disorganized attachment status: Is frightened
and/or frightening parental behavior the linking mechanism? In M.
Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in
the preschool years: Theory, research and intervention (pp. 1 6 1 -
184). Chicago: University of Chicago Press.
Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, child-
hood and adulthood: A move to the level of representation. In I.
Bretherton & E. Waters (Eds.), Growing points of attachment theory
692 LYONS-RUTH, EASTERBROOKS, AND CIBELLI
and research. Monographs of the Society for Research in Child Devel-
opment, 5 0 ( 1 - 2 , Serial No. 209), 66-104.
Main, M.f & Solomon, J. (1990). Procedures for identifying infants as
disorganized /disoriented during the Ainsworth Strange Situation. In
M. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment
in the preschool years: Theory, research and intervention (pp. 1 2 1 -
160). Chicago: University of Chicago Press.
Moffitt, T. E. (1990). Juvenile delinquency and attention deficit disorder:
Boys' developmental trajectories from age 3 to age 15. Child Develop-
ment, 65, 893-910.
Moffitt, T. E. (1993). The neuropsychology of conduct disorder. Devel-
opment and Psychopathology, 5, 135-151.
Moss, E., Parent, S., Gosselin, C , Rousseau, D., & St.-Laurent, D.
(1996). Attachment and teacher-reported behavior problems during
the preschool and early school-age period. Development and Psycho-
pathology, 8, 511-526.
Olweus, D. (1979). Stability of aggressive reaction patterns in males:
A review. Psychological Bulletin, 86, 852-875.
Olweus, D. (1983). Low school achievement and aggressive behavior
in adolescent boys. In D. Magnusson (Ed.), Human development: An
interactional perspective (pp. 353-365). San Diego, CA: Academic
Press.
Patterson, G. R., & Bank, L. (1989). Some amplifying mechanisms for
pathologic processes in families. InM. R. Gunnar&E. Thelen(Eds.),
Systems and development: The Minnesota symposia on child psychol-
ogy (Vol. 22, pp. 16-20). Hillsdale, NJ: Erlbaum.
Radloff, L. (1977). The CES-D scale: A self-report depression scale
for research in the general population. Applied Psychological Mea-
surement, 1, 385-401.
Renken, B., Egeland, B., Marvinney, D., Mangelsdorf, S., & Sroufe,
L. A. (1989). Early childhood antecedents of aggression and passive-
withdrawal in early elementary school. Journal of Personality, 57,
257-281.
Richman, N., Stevenson, J., & Graham P. (1982). Preschool to school:
A behavioral study. London: Academic Press.
Richters, J. E., Waters, E., & "Vaughn, B. E. (1988). Empirical classifi-
cation of infant-mother relationships from interactive behavior and
crying during reunion. Child Development, 59, 512-522.
Robins, L. N. (1991). Conduct disorder. Journal of Child Psychology
and Psychiatry and Allied Disciplines, 32, 193-212.
Rose, S. L., Rose, S. A., & Feldman, J. F. (1989). Stability of behavior
problems in very young children. Development and Psychopathology,
J, 5-19.
Schonfeld, I. S., Shaffer, D., O'Connor, P., & Portnoy, S. (1988). Con-
View publication stats
duct disorder and cognitive functioning: Testing three causal hypothe-
ses. Child Development, 59, 993-1007.
Seifer, R., Sameroff, A. J., Barrett, L. C , & Krafchuk, E. (1994). Infant
temperament measured by multiple observations and mother report.
Child Development, 65, 1478-1490.
Shaw, D., Owens, E., Vondra, J., Keenan, K., & Winslow, E. (1996).
Early risk factors and pathways in the development of early disruptive
behavior problems. Development and Psychopathology, 8, 679-700.
Solomon, J., George, C , & DeJong, A. (1995). Children classified
as controlling at age six: Evidence of disorganized representational
strategies and aggression at home and at school. Development and
Psychopathology, 7, 447-463.
Solomon, J.f George, C.» & Ivins, B. (1987). Mother-child interaction
in the home and security of attachment at age 6. Paper presented at the
biennial meeting of the Society for Research in Child Development,
Baltimore, MD.
Spangler, G., & Grossmann, K. E. (1993). Biobehavioral organization
in securely and insecurely attached infants. Child Development, 64,
1439-1450.
Speltz, M. L., Greenberg, M. T, & DeKlyen, M. (1990). Attachment in
preschoolers with disruptive behavior: A comparison of clinic-referred
and nonproblem children. Development and Psychopathology, 2, 31 -
46.
Stevenson-Hinde, J., & Shouldice, A. (1990). Ifear and attachment in
2.5-year-olds. British Journal of Developmental Psychology, 8, 319-
333.
Teti, D., Gelfand, D., Messinger, D., & Isabella, R. (1995). Maternal
depression and the quality of early attachment: An examination of
infants, preschoolers, and their mothers. Developmental Psychology,
31, 364-376.
van Uzendoom, M. H. (1995). Adult attachment representations, paren-
tal responsiveness, and infant attachment: A meta-analysis on the pre-
dictive validity of the Adult Attachment Interview. Psychological Bul-
letin, 117, 387-403.
van IJzendoorn, M. H., Goldberg, S., Kroonenberg, P., & Frenkel, O.
(1992). The relative effects of maternal and child problems on the
quality of attachment: A meta-analysis of attachment in clinical sam-
ples. Child Development, 63, 840-858.
Warmer, U. G., Grossmann, K., Fremmer-Bombik, E., & Suess, G.
(1994). Attachment patterns at age six in south Germany: Predictabil-
ity from infancy and implications for preschool behavior. Child Devel-
opment, 50, 821-829.
Received July 17, 1995
Revision received October 17, 1996
Accepted October 17, 1996 •