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

Abstract

Type 1 diabetes mellitus (T1D) is one of the most demanding chronic diseases for children and their families, since controlling diabetes involves a process of co-regulation with attachment figures. However, there is insufficient evidence in middle childhood on psychological mechanisms involved that might complicate the adaptation of these children. Therefore, 106 children ( N = 31 with T1D and N = 75 as matched healthy group [HG]) aged 8 to 13 were assessed using the Child Attachment Interview, the Child Behavior Checklist, and the measure of glycated hemoglobin. Results showed that insecure T1D children did not have worse diabetes control than the secure ones. However, T1D children differed from HG for higher levels of idealization to father and withdrawn/depressed problems. Moreover, T1D children with insecure attachment to mother scored significantly higher in anxious/depressed, withdrawn/depressed, attention problems, and rule-breaking behavior, while T1D children with insecure attachment to father scored significantly higher only in the withdrawn/depressed scale compared to the remaining children. Therefore, diabetes does not in itself determine a psychological vulnerability in middle childhood, but the presence of an insecure attachment, especially to the mother, worsens the psychological adaptation of T1D children. Psychological support should be provided for these young patients and their families.

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

“…Coders use eleven 9-point scales, then placing children into one of four best-fitting attachment classifications (secure, insecure-dismissing, insecure-preoccupied, disorganized) on the basis of the distribution of the scale scores as well as a consideration of the child's non-verbal behavior. The CAI's psychometric properties have been demonstrated through a series of studies exploring its reliability and construct validity in both clinical and community samples across multiple cultures (e.g., Bizzi, 2019;Bizzi & Pace, 2020;Bizzi et al, 2018Bizzi et al, , 2021aBizzi et al, , 2021bCavanna et al, 2018;Shmueli-Goetz et al, 2008;Venta et al, 2014). In the current study, the CAI's inter-rater reliability (ICC (3, k) = 0.946) was demonstrated excellent in all cases (N = 159).…”

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

“…Moreover, considering early adolescence as a period of profound emotional, cognitive and physical changes in which individuals become more autonomous to regulate distress but continue to seek the proximity of attachment figures in case of distressing or fearful situations (Bosmans & Kerns, 2015), our sample show similar attachment representation to both parents. This may suggest that the process which leads to the development of a unified and integrated representation of attachment relationships occurs in early adolescents and is independent of the clinical status (Bizzi et al, 2015; Bizzi, Della Vedova, Prandi, Cavanna, & Manfredi, 2020; Shmueli‐Goetz et al, 2008).…”

High prevalence of depression in parents of children with Type 1 diabetes in a meta‐analysis of data from five continents

“…All of which have been associated with depression 20–22 . The presence of T1D may also affect parent‐child attachment, placing additional stressors on the relationship and increasing the risk of depression within the family 23 …”

“…[20][21][22] The presence of T1D may also affect parent-child attachment, placing additional stressors on the relationship and increasing the risk of depression within the family. 23 Parental emotional well-being and child health are intertwined.…”

“…Research has revealed a two-to-threefold increased risk of depression in children of mothers with depression. 23 Several studies have considered the transactional model of parent-child interaction for T1D, in which children affect parents and parents affect children, suggesting that it represents a 'family condition'. [24][25][26] Parental psychological distress has been shown to have health implications for the parent, the child with T1D and overall family functioning.…”