Attachment representation to caregivers and mentalizing ability in early adolescents with primary headache

Abstract

Primary headache (PH) is a common somatic disorder in childhood with a strong impact in terms of quality of life. There are several risk factors related to the development of this disorder including environmental factors as attachment bonds. However, studies in this direction are relatively few and have often used self‐report or semi‐projective measures looking at the only maternal attachment. Moreover, several studies have shown a link between somatoform pains and mentalizing abilities, but the relation between mentalizing and PH in childhood is unexplored. Therefore, this study aims at exploring attachment bonds, focusing on both maternal and paternal representations and mentalizing abilities in early adolescents with and without PH within a cross‐sectional case‐controlled design. A sample of 94 early adolescents aged 10–14 years (47 with PH and 47 without PH as a comparison group) completed the Child Attachment Interview to assess attachment representations to caregivers. Mentalizing abilities were assessed applying to the interviews in the Child and Adolescent Reflective Functioning Scale. PH adolescents showed a greater percentage of insecure‐preoccupied attachment to both parents, with higher level of preoccupied anger especially to father than the comparison group (p values from 0.000 to 0.014, effect size values from.31 to.45), while no differences emerged about mentalizing (p values from.264 to 0.312). The over‐representation of insecure–preoccupied attachment to both parents suggests a key role of parent–child interaction in early adolescents with PH, while the role of mentalizing abilities remains controversial and further studies are needed to address this issue. Clinical implications are discussed.

Attachment representations to parents and emotional-behavioral problems: A comparison between children with type 1 diabetes mellitus and healthy children in middle childhood

“…Although there is growing evidence for the role of attachment and emotional-behavioral problems in child somatoform disorders (e.g. Bizzi, 2019;Bizzi et al, 2015Bizzi et al, , 2018Bizzi et al, , 2019Bizzi, Riva et al, 2020), no study to date has simultaneously investigated the quality of child attachment to both parents and emotional-problems in T1D children. Therefore, the main purpose of this study was to compare children with T1D with a matched healthy group (HG) in middle childhood about attachment representations to both parents using an age-adapted semi-structured interview and emotional-behavioral problems through a parent-report.…”

Testing Children’s Mentalizing in Middle Childhood: Adopting the Child and Adolescent Reflective Functioning Scale with Clinical and Community Children

“…Considering the paucity of mentalizing measures in school-aged children, our findings are of paramount importance in that they permit the field to expand the previous studies already focused on the role of mentalizing in borderline personality pathology development during adolescence (Sharp et al, 2020;Vanwoerden et al, 2019) as well as in specific clinical conditions (Bizzi et al, 2019;2020b;Costa-Cordella et al, 2021) or abuse contexts (Ensink et al, 2015(Ensink et al, , 2016(Ensink et al, , 2017 in middle childhood. The capacity of CRFS to distinguish clinical from community children in middle childhood allows the clinician and researcher to have a measure useful in the assessment process as well as in the design of interventions for populations at risk and in the evaluation of child psychotherapy.…”

“…***p < 0.001 a post-hoc test: significant differences (p < 0.05) between groups in the following categories: yearly house income lower than 15.000 €yearly house income greater than 36.000 €; yearly household income between 15.000 and 36.000 € = yearly house income greater than 36.000 € been slow to emerge, representing a slowing progress in the field. The CRFS was developed to fill this need and researchers rushed to use the measure with children and adolescents with specific problems (Bizzi et al, 2019(Bizzi et al, , 2020bCosta-Cordella et al, 2021;Ensink et al, 2015Ensink et al, , 2016Ensink et al, , 2017Sharp et al, 2020;Vanwoerden et al, 2019). However, a particular focus on the psychometric proprieties of CRFS was lacking, particularly when it comes to clinical samples.…”

“…To date, the CRFS has been most frequently used to assess RF with children exposed to abuse (Ensink et al, 2015(Ensink et al, , 2016(Ensink et al, , 2017Tessier et al, 2016) and in community samples of school-aged children (Bizzi et al, 2020a;Borelli et al, 2018;Rosso & Airaldi, 2016). Some studies using the CRFS have focused on specific clinical groups, as children with disruptive behavior disorders, somatic symptom disorders (Bizzi et al, 2019(Bizzi et al, , 2020b, adolescents with borderline traits (Sharp et al, 2020;Vanwoerden et al, 2019), and children with Type 1 diabetes (Costa-Cordella et al, 2021). And yet, somewhat surprisingly, no studies to date have examined RF using the CRFS using a combined clinical-community sample.…”

“…On the basis of extant literature (Ensink et al, 2015;Rosso & Airaldi, 2016;Vanwoerden et al, 2019), we hypothesize that the CFRS assesses mentalizing independently of socio-demographic variables and verbal comprehension. Last, based on the argument that impairments in RF confer risk for a variety of specific psychological disorders (Bizzi et al, 2019(Bizzi et al, , 2020bCosta-Cordella et al, 2021;Ensink et al, 2015Ensink et al, , 2016Ensink et al, , 2017Sharp et al, 2020;Vanwoerden et al, 2019), we hypothesize that CRFS will be significantly lower within the clinical as compared to the community groups, and thus will discriminate between the two.…”