title: [Infants' attachment security in a vulnerable French sample].
abstract: BACKGROUND
  Attachment is a long lasting emotional link established between infants and their caregivers. The quality of early relationships allows infants to safely explore their environment and contribute to the establishment of a broad range of social skills. Several intervention programs targeting infant attachment have been implemented in different contexts, showing diverse degrees of efficacy.
  
  
  OBJECTIVE
  The present paper describes, for the first time, children's attachment quality distributions in a French multi-risk population, with a preventive intervention, usual or reinforced.
  
  
  METHODS
  In the CAPEDP study (Parenting and Attachment in Early Childhood: reducing mental health disorder risks and promoting resilience), a sub-sample of 117 women was recruited to assess the effects of this home-visiting program on children's attachment security. With that intent, the Strange Situation Paradigm was used when infants were between 12 and 16 months of age.
  
  
  RESULTS
  In the intervention group, 63% (n=41) of the infants were coded as secure, while 15% (n=10) of them were coded as insecure-avoidant and 22% (n=14) as insecure-ambivalent/resistant. 56% (n=29) of control group infants (usual care) were coded as secure, while 27% (n=14) were coded as insecure-avoidant and 17% (n=9) as insecure-ambivalent/resistant. Even if the percentage of children with a secure attachment in the reinforced intervention group was higher than that of the control group, this difference did not reach the threshold of significance [Chi2(2)=2.40, P=0.30].
  
  
  CONCLUSIONS
  Intervention group distributions were closer to normative samples, and these distributions show the clinical impact of our program. In general, preventive interventions focused on attachment quality have moderate effects but, in our case, several factors might have contributed to lower the statistical impact of the program. Firstly, the control group cannot be considered has having received zero intervention for two reasons: (a) the French usual perinatal health system (Maternal and Infant Protection System) is particularly generous and (b) the effect of this usual system might have been increased by the project intensive assessment protocol (6 visits during 28 months). Secondly, it is possible that the full effect of the intervention had not yet been detected because, when a child's attachment was assessed, only two thirds of the intervention visits had been performed (29 of 44 visits). A "sleeper effect" is still possible: we hope that a more clear result will be seen when children are assessed again, at 48 months, in our follow-up study (CAPEDP-A II). By clarifying the mechanisms involved in the development of a secure attachment, our study aims to contribute and refine the development of early preventive intervention strategies in high perinatal and psychosocial vulnerability contexts.
authors.affiliation: Laboratoire de psychologie et processus de santé (LPPS-EA4057), institut de psychologie, université Paris Descartes, Sorbonne Paris Cité, 92100 Boulogne-Billancourt, France. Electronic address: susana.tereno@parisdescartes.fr.
authors.forename: S
authors.initials: S
authors.lastname: Tereno
authors.affiliation: Institut mutualiste Montsouris, université Paris Diderot, Sorbonne Paris Cité, 75005 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Guedeney
authors.affiliation: Service de périnatalité, centre hospitalier de Sainte-Anne, université Paris Diderot, Sorbonne Paris Cité, 75014 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Dugravier
authors.affiliation: Laboratoire de recherche, établissement public de santé Maison Blanche, 75019 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Greacen
authors.affiliation: Laboratoire de psychologie et processus de santé (LPPS-EA4057), institut de psychologie, université Paris Descartes, Sorbonne Paris Cité, 92100 Boulogne-Billancourt, France; Département de psychologie, université du Québec, O-H2X 3P2 Montréal, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Saïas
authors.affiliation: Département d'épidémiologie et recherche clinique, Inserm CIE 801, hôpital Bichat, université Paris Diderot, Sorbonne Paris Cité, AP-HP, 75018 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Tubach
authors.affiliation: Département de psychologie, université du Québec, O-H2X 3P2 Montréal, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ulgen
authors.affiliation: Laboratoire de psychologie et processus de santé (LPPS-EA4057), institut de psychologie, université Paris Descartes, Sorbonne Paris Cité, 92100 Boulogne-Billancourt, France.
authors.forename: I
authors.initials: I
authors.lastname: Matos
authors.affiliation: Inserm CIE 1178, hôpital Bichat-Claude-Bernard, université Denis-Diderot, Sorbonne Paris Cité, AP-HP, 75018 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Guédeney
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000502:physiology / Q000523:psychology; D007224:Infant Care / Q000523:psychology; D008297:Male; D008425:Maternal Behavior / Q000523:psychology*; D009034:Mother-Child Relations / Q000523:psychology; D009035:Mothers / Q000523:psychology; D009769:Object Attachment; D016487:Parenting / Q000523:psychology; D010353:Patient Education as Topic; D012054:Reinforcement, Psychology; D035862:Vulnerable Populations / Q000523:psychology*; D055815:Young Adult
keywords: Attachement; Attachment; Early intervention; Enfants; Infants; Intervention précoce; Multi-risk; Risques multiples; Security; Sécurité