Tilburg University Love before first sight de Cock, Evi · Rubin (1967) first introduced maternal bonding as part of her theory on maternal role attainment. During this process of

Tilburg University

Love before first sight

de Cock, Evi

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Publication date:2017

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Citation for published version (APA):de Cock, E. (2017). Love before first sight: Parental bonding from pregnancy to toddlerhood. S.l.: Ridderprint.

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LOVE BEFO

RE FIRST SIGH

T Parental bonding from pregnancy to toddlerhood

Evi S.A. de Cock

LOVE BEFORE FIRST SIGHTParental bonding from pregnancy to toddlerhood

Evi S.A. de Cock

UITNODIGING

voor het bijwonen van de openbare verdediging

van mijn proefschrift

LOVE BEFORE FIRST SIGHT

Parental bonding from pregnancy to toddlerhood

Op vrijdag 8 september 2017 om 14:00 uur

in de Aula van Tilburg University,

Cobbenhagen gebouw, Warandelaan 2, 5037 AB Tilburg

Na afloop bent u van harte welkom op de receptie ter plaatse

Evi de [email protected]

PARANIMFENMargot BenninkJanneke Maas

Charlotte Vreeswijk

Vragen? Mail naar [email protected]

14765_EdeCock_OM.indd 1 25-07-17 14:24

Love before first sightParental bonding from pregnancy to toddlerhood

Evi S.A. de Cock

14765_EdeCock_BW kopie.indd 1 27-07-17 10:55

ISBN: 978-94-6299-648-9

© E.S.A. de Cock, 2017All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without permission of the author.

Cover: Evi de Cock & Nikki VermeulenLayout: Nikki Vermeulen – Ridderprint BVPrinting: Ridderprint BV – www.ridderprint.nl

AcknowledgementsWe would like to thank all families participating in this study. This study is conducted in collaboration with four midwifery practices in Eindhoven, the Netherlands, and we gratefully acknowledge their contributions to the study and their help in recruiting participants. We also collaborated with ZuidZorg National Health Care Centres in Eindhoven, the Netherlands, who provided information about children’s development throughout the first year of life. The “Expectant Parents” study was made possible by the financial support from the Netherlands Organization for Health Research and Development (ZonMW, Grant 80-82405-98-074/157001020) and Gemeente Eindhoven.


Love before first sightParental bonding from pregnancy to toddlerhood

Proefschrift

ter verkrijging van de graad van doctoraan Tilburg University

op gezag van de rector magnificus,prof. dr. E.H.L. Aarts,

in het openbaar te verdedigen ten overstaan van eendoor het college voor promoties aangewezen commissie

in de aula van de Universiteitop vrijdag 8 september 2017 om 14.00 uur

door

Evi Sophia Antonia de Cockgeboren op 11 maart 1987 te Veldhoven


PromotiecommissiePromotores: Prof. dr. H.J.A. van Bakel Prof. dr. W.H.J. Meeus

Copromotor: Dr. T.A. Klimstra

Overige leden: Prof. dr. A.J.J.M. Vingerhoets Prof. dr. J.J.S. Dubas Prof. dr. R. Keizer Prof. dr. G.J. Overbeek Dr. R. Beijers


CONTENTS

Chapter 1 General introduction 7

Chapter 2 Continuous feelings of love? The parental bond frompregnancy to toddlerhood

25

Chapter 3 Longitudinal associations between parental bonding, parenting stress, and executive functioning in toddlerhood

55

Chapter 4 Longitudinal associations between maternal and paternal bonding, parenting self-efficacy and child temperament

77

Chapter 5 Baby please stop crying: An experimental approach to infant crying, affect, and expected parenting self-efficacy

105

Chapter 6 Summary and general discussion 121

Samenvatting 139

List of publications 145

About the author 149

Dankwoord 153



General introduction

Chapter 1



1

General introduction | 9

The transition to parenthood is a challenging life event that is often accompanied by strong and complex new emotions and cognitions. Parents may not always be aware that, from pregnancy onwards, they have a major impact on their child’s development. Both prenatally as well as in the first years after birth the infant’s brain is developing at a rapid pace and brain plasticity is high, creating a period of sensitivity to environmental effects such as caregiving (Fox, Calkins, & Bell, 1994; Knickmeyer et al., 2008; Kolb et al., 2012). Previous research on parental effects on child development has mostly focused on parental behavior. Observable parental behaviors such as parental sensitivity, responsiveness, harshness, and control have all been abundantly examined in relation to future child social-, behavioral-, and cognitive development (Fay-Stammbach, Hawes, & Meredith, 2014; Karreman, van Tuijl, van Aken, & Deković, 2006; Khaleque, 2013). The main conclusion is clear: early caregiving experiences are important in shaping a child’s developmental path. The less observable affective and cognitive domains of caregiving have not received as much attention by previous research. However, parental behaviors are preceded and accompanied by mental processes, such as parental feelings, emotions and cognitions. Previous research indicates that these parental emotions and cognitions are important predictors of parenting behavior and directly and indirectly affect child development (Bugental & Johnston, 2000; Dix, 1991; Jones & Prinz, 2005). Moreover, as parental emotions and cognitions are susceptible to external influences these areas provide promising opportunities for early prevention and intervention strategies. Therefore, more insight is needed into early parental feelings and cognitions, and their impact on parent as well as child functioning. In the current thesis the primary focus will be on parental feelings of bonding with the (unborn) child. Particularly the course of parental bonding from pregnancy onwards, bonding beyond the early postpartum period, and father-infant bonding are important, but relatively understudied research areas in this regard. In addition, associations with parenting stress and parenting self-efficacy (i.e., parental cognitions regarding caregiving) as well as child development will be studied as these associations are not yet sufficiently addressed in previous research. Executive functioning and temperament are two key child developmental domains which are important for later psychosocial functioning and will be covered in the current thesis. As child characteristics can also affect parents, lastly, child effects on parental feelings and cognitions will be addressed.

Parental bonding

Rubin (1967) first introduced maternal bonding as part of her theory on maternal role attainment. During this process of maternal role attainment, next to obtaining a sense of harmony, satisfaction, and confidence, the development of a bond with the infant was essential for the formation of a maternal identity (Mercer, 2004). Nowadays, the parental bond


10 | Chapter 1

is commonly defined as the emotional tie from parent to child. The core of parental bonding can be seen as a subjective feeling state or “love” (Condon, 1993; Condon & Corkindale, 1998; Condon, Corkindale, & Boyce, 2008). It is in principal a unidirectional construct originating from the parent, however, bidirectional influences from child to parent likely affect the parental bond in the postnatal period. The concept of parental bonding became more popular when pediatricians Klaus and Kennell (1976) published their views and findings about the topic. They proposed a ‘sensitive period’ shortly after birth in which it was essential for mothers to form a bond with their baby to ensure optimal developmental outcomes. Their conclusions about the important role of bonding led to positive changes in hospital care, facilitating early contact between mother and baby. However, the critical period that Klaus and Kennel proposed has long been abandoned (Myers, 1984) and it is currently believed that the parental bond already forms during pregnancy (e.g., Condon, 1993) and is not limited to mothers (e.g., Condon, Corkindale, Boyce, & Gamble, 2013). While in previous studies maternal (fetal or prenatal) attachment and maternal bonding are used interchangeably, in the present thesis the term ‘maternal bonding’ (or paternal bonding) is used to refer to the parent-to-child bond.

The course of parental bondingThe prenatal bond can be seen as the earliest form of preparation for parenthood and as a precursor for parenting behavior. Therefore, it provides an important and unique possibility for early interventions aimed at improving the parental bond. During pregnancy, feelings of bonding towards the fetus increase with gestational age, after quickening, and after visualization of the fetus through ultrasounds, when the presence of the baby becomes more concrete (Alhusen, 2008; van Bussel, Spitz, & Demyttenaere, 2010a). It is suggested that the process of postnatal bonding occurs primarily in the first year, but may continue throughout a child’s life (Kinsey & Hupcey, 2013). Yet, most previous studies focused on the early postnatal period (i.e. the first weeks or months after birth). In this early postnatal period feelings of maternal bonding tend to increase (Condon & Corkindale, 1998; van Bussel, Spitz, & Demyttenaere, 2010b). Subsequently, previous studies suggest that the strength of the maternal bond does not change from 4 months until 12 months postpartum (Condon & Corkindale, 1998), whereas for fathers a small increase during this period has been observed (Condon et al., 2008). Research on the developmental course of parental bonding and the consequences for later child development is still scarce and mostly focuses on the stability and change of either prenatal or postnatal (maternal) bonding (Jansen, Weerth, & Riksen-Walraven, 2008; Mason, Briggs, & Silver, 2011). Studying the course of maternal as well as paternal bonding from pregnancy onwards and beyond the early postnatal period could provide valuable new insights for further research and clinical practice.


1


Determinants and consequences of pre- and postnatal bondingThe quality of the prenatal bond is affected by multiple determinants in the parental (e.g., personality, psychological wellbeing) and contextual (e.g., perceived stress, SES) domains (Alhusen, 2008; Maas, Vreeswijk, Braeken, Vingerhoets, & van Bakel, 2014; Yarcheski, Mahon, Yarcheski, Hanks, & Cannella, 2009). Bonding has also been linked to prenatal health care practices (e.g., related to diet, exercise, and sleep) hereby providing the child with a better prenatal environment (Lindgren, 2001). Longitudinal research indicates that prenatal feelings of bonding are related to postnatal feelings of bonding and to the quality of parent-infant interaction (Damato, 2004; Maas, de Cock, Vreeswijk, Vingerhoets, & van Bakel, 2016; Müller, 1996). Higher levels of maternal bonding during pregnancy, for example, predict more postnatal maternal involvement, sensitivity, and stimulation in interaction (Siddiqui & Hägglöf, 2000). Severe disturbances in the process of parental bonding can lead to rejection of the child, neglect, or even child abuse (Kumar, 1997). However, also milder problems with bonding can be stressful for parents and children. These milder problems may not only affect parenting abilities, but could also impact parents’ own psychological wellbeing. For example, lower levels of maternal bonding are found to be related to less parental psychological adjustment and more depressive symptoms (Goecke et al., 2012; Müller, 1994; Sockol, Battle, Howard, & Davis, 2014). To sum up, bonding with their children is a key developmental task for parents, but remains a neglected area of research. The determinants as well as consequences of parental bonding for both parents themselves and their children warrant further study.

The role of parental caregiving cognitions and child characteristics

Emotions can affect people’s beliefs and how situations are perceived. In other words: emotions influence cognitions (Dix, 1991; Frijda, Manstead, & Bem, 2000). In this way, parental feelings of bonding potentially affect parental cognitions regarding their child and the caregiving situation. Besides bonding -the more affective component of the parental tie to the infant-, parental caregiving cognitions might also exert important effects on child development. Parenting stress and parenting self-efficacy are two key aspects of parental cognitions concerning the caregiving role that will be addressed in the current thesis.

Parenting stressParenting stress can be defined as negative parental evaluations of the self and the child that grow in the process of parenting (Deater-Deckard, 1998). It pertains to the perception of not having enough resources (e.g., knowledge of, and competence in tasks of parenting) to cope with the demands of parenthood. Although daily hassles (e.g., constant demanding of attention or mealtime-difficulties), are not uncommon in most new families, the lack of


12 | Chapter 1

a strong bond might lead to an increased experience of these daily hassles as stressors (i.e., parenting stress). Cumulative early parenting stress has been found to negatively affect parental behavior and parent-infant interaction as well as predict later child behavior problems (Crnic, Gaze, & Hoffman, 2005). Parenting stress potentially creates a chaotic environment for children to grow up in, while a structured, stress-free caregiving situation is important for optimal child development (Crnic et al., 2005).

Parenting self-efficacyNext to parenting stress, parenting self-efficacy is another predictor of parental behavior and parent-infant interaction and is expected to be related to parental bonding. It refers to caregivers’ confidence in their ability to successfully perform the parental role and to positively affect their child’s development (Coleman & Karraker, 1998; Coleman & Karraker, 2000). Feelings of parenting self-efficacy have been frequently related to actual parenting competence and later child outcomes (for a review see Jones & Prinz, 2005). In addition, parents with more confidence in their parenting skills display more parental warmth and involvement (De Haan, Prinzie, & Deković, 2009; Teti & Gelfand, 1991). High parenting self-efficacy is related to the ability to provide a favorable and nurturing childrearing environment, hereby potentially affecting child development (Coleman & Karraker, 1998).

Parenting stress, parenting self-efficacy, and parental bondingAs mentioned before, parental bonding is related to parental psychological wellbeing. When parents feel less of a connection to their infant, this might lead to feelings of stress or insecurity regarding parenting skills. A few previous studies indeed found associations between maternal bonding and experienced parenting stress and maternal confidence in the early postnatal period (Fuchs, Möhler, Reck, Resch, & Kaess, 2016; Mason et al., 2011; Williams et al., 1987). Mothers with lower levels of bonding experienced more parenting stress and felt less confident about their parenting skills. However, the knowledge about linkages between parental bonding and parental cognitions is still limited. Next to being potentially affected by parental feelings of bonding, parenting stress and parenting self-efficacy are two important forms of parental cognitions that have an impact on child outcomes. Examining the effect of parental feelings and cognitions on child development is therefore a potentially fruitful research area that is relatively understudied compared to parental behavior.

Child effects Although parental feelings and cognitions towards the infant are assessed from the parent’s perspective and are usually portrayed as the sources of the parent-child relationship, from birth onwards characteristics and behavior of the child can also affect the development of these


1


parental feelings and thoughts. This transactional view is supported by previous longitudinal studies examining child effects on parental affect and cognition. For example, studies show that difficult child behaviors, such as externalizing problems and emotion dysregulation, have a detrimental effect on feelings of parenting self-efficacy and increases parenting stress (Slagt, Deković, de Haan, van den Akker, & Prinzie, 2012; Williford, Calkins, & Keane, 2007). As it is not possible to exclude the potential influence of an already established parent-child relationship or to experimentally manipulate child behavior, bidirectionality of effects can often not be ruled out in research examining parental caregiving and child outcomes. However, new possibilities arose to test unidirectional effects in an experimental design. Using an infant simulator (Voorthuis et al., 2013) to exclusively examine child effects could help clarifying the direction of associations between parental cognitions and child behavior.

Parental bonding, caregiving cognitions and child self-regulation

Early caregiving experiences are important in shaping children’s developmental course. Previous research has shown that maternal emotions and stress during pregnancy can affect infant neurobehavioral development (Van den Bergh, Mulder, Mennes, & Glover, 2005). Postnatally, parents are significant external regulators of their children’s behavior before they learn to self-regulate (Bernier, Carlson, & Whipple, 2010). Thus, in multiple ways, parents can exert strong effects on their child’s development of self-regulation.

Child self-regulation: executive functioning and temperamentSelf-regulation is a crucial predictor of childhood externalizing problems and other psychopathology (Eisenberg et al., 2000; Posner & Rothbart, 2000). Child executive functioning and child temperament are two key developmental outcomes that are strongly related to child self-regulation. Both are important for child psychological functioning and can be affected by the caregiving environment (i.e., the parental bond and caregiving cognitions). Executive functioning refers to an umbrella construct for higher order cognitive processes that regulate and direct cognitive activity, emotional response, and behavior (Garon, Bryson, & Smith, 2008; Gioia, Espy, & Isquith, 2003; Isquith, Crawford, Espy, & Gioia, 2005). Early executive functioning has been frequently related to later academic achievement (e.g., math and reading abilities) as well as internalizing and externalizing problem behavior (e.g., Blair & Razza, 2007; Garon et al., 2008; Roman, Ensor, & Hughes, 2016). Temperament is defined as individual differences in emotional, motor, and attentional reactivity to changes in the environment, and self-regulatory processes (i.e., effortful control) that modulate this reactivity (Rothbart, 2007; Rothbart & Derryberry, 1981). Individual differences in early child temperament are a precursor for later personality and a strong predictor of future behavior problems (Caspi, Henry, McGee, Moffitt, & Silva, 1995; Caspi &


14 | Chapter 1

Silva, 1995; Muris & Ollendick, 2005). As executive functioning and temperament are important indicators of children’s psychosocial development and wellbeing it is essential to examine their antecedents early in life. Parental bonding and caregiving cognitions are possible factors contributing to the development of children’s self-regulation. There are several theories explaining the mechanisms through which the caregiving environment can affect child self-regulatory abilities (i.e., executive functioning and temperament). According to Vygotsky’s theory (1978) children first learn cognitive skills and behavior on a social level through interaction with more competent others (most often this will be the caregiver), before these skills become internalized. The notion that parents play a big role in child cognitive development is confirmed by research indicating that parenting stress affects child perception, problem solving skills, and language development (Magill-Evans & Harrison, 2001; Molfese et al., 2010). By providing a stable, structured, and predictive environment, parents foster the development of children’s self-regulatory abilities (Carlson, 2003; Schroeder & Kelley, 2010). Another way by which children learn from their parents is put forward by Bandura’s (1977) social learning theory, which states that children learn though observation of (the consequences of ) behavior, imitation, and modeling. Negative parental cognitions such as low levels of confidence in their parenting skills, may limit parents’ ability to appropriately reinforce children’s behavior or might cause them to refrain from interacting frequently with their child, hereby negatively affecting children’s behavior and development of social skills. Previous research has indeed shown that parenting self-efficacy is related to toddler negative behavior such as annoying and disruptive behavior, low compliance, and negative affectivity (Coleman & Karraker, 2003; Gross & Tucker, 1994). Only a few studies so far have examined the effect of early parental bonding on child outcomes. Maternal bonding at 2 months postpartum has been found to be related to infant social-emotional development at 6 months (Mason et al., 2011). In addition, parental feelings of bonding are related to infant attachment behavior at 12 months (Feldstein, Hane, Morrison, & Huang, 2004). Recently, a study has been published showing that maternal bonding in the first year is associated with child behavior problems at 5 years (Fuchs et al., 2016). As parental bonding seems to have meaningful effects on both parental cognitions as well as child development, parental cognitions may be a possible mechanism linking parental bonding to child outcomes. Studies examining postnatal bonding after the first year and exploring links with child cognitive development and self-regulation are lacking, as well as studies examining father-infant bonding.


1


Fathers: bonding, caregiving cognitions, and child development

Although father-infant bonding was already acknowledged in the revised work of Klaus and Kennel (parent-infant bonding) in 1982, subsequent research on parental bonding almost exclusively focused on mothers. However, growing evidence suggests that fathers also have important and independent effects on child outcomes (Lewis & Lamb, 2003; Ramchandani et al., 2013; Ramchandani, Stein, Evans, O’Connor, & Team, 2005). Yet, little is known about the process of bonding in fathers and its consequences for child development. A relatively recent study (Condon et al., 2013) found strong continuity of paternal bonding scores from pregnancy until 12 months postnatally and cross-sectional associations with paternal mental health and the quality of the partner relationship. These findings point to the importance of studying paternal bonding. Similarly, research on parental caregiving cognitions, including parenting stress and parenting self-efficacy, has largely neglected fathers. Especially in toddlerhood, these concepts have been understudied. One correlational study suggests that paternal self-efficacy is related to toddler behavior, however, associations were less strong than for mothers (Gross & Tucker, 1994). Furthermore, differences have been found in the predictors and levels of parenting self-efficacy (Salonen et al., 2009; Sevigny & Loutzenhiser, 2010) and parenting stress (Crnic & Booth, 1991) between mothers and fathers. As research increasingly demonstrates the vital and distinct role (i.e., different from maternal) of paternal involvement in child development, it is essential that future studies regarding parental bonding and caregiving cognitions include fathers. To sum up, previous findings regarding parental bonding and caregiving cognitions point out that these concepts are important for parental and child psychosocial functioning. However, the course of parental bonding, including the parental bond beyond the early postnatal period and its correlates, and the father-to-child bond are scarcely studied. In addition, associations between parental bonding and parenting cognitions, as well as between parental bonding, parenting cognitions and child development have been understudied and need to be addressed.

Aim and outline of the thesis

The aims of this thesis are threefold. The first aim is to provide more insight into the course and correlates of early parental bonding from pregnancy to toddlerhood. The second aim is to examine parental feelings and cognitions and their effect on child self-regulation. More specifically, associations of parental bonding, with parenting stress and self-efficacy, and with child executive functioning and temperament will be examined. The third aim is to experimentally examine child effects on parenting affect and cognitions. The first two aims are addressed with data from the prospective longitudinal cohort study “Expectant Parents” (“In


16 | Chapter 1

Verwachting”). The third aim is studied with an experimental design using a lifelike baby doll. A more detailed overview of all research aims, study designs, and corresponding concepts is presented in Table 1. After this introductory chapter, first, parental bonding patterns from pregnancy to toddlerhood and their correlates in the child-, parental-, and contextual domain are explored (Chapter 2). In Chapter 3, the mediating role of parenting stress in the association of early parental bonding with child executive functioning is examined. Chapter 4 focuses on the associations between early parental bonding, parenting self-efficacy, and child temperament. In addition, an experimental examination of child crying on affect and expected parenting-self-efficacy is presented in Chapter 5. Finally, a summary and general discussion of the findings and an overall conclusion are provided in Chapter 6.

Design of the studies

“Expectant Parents” studyThe first three studies of the present thesis are part of the prospective longitudinal cohort study “Expected Parents” (“In Verwachting”), which was aimed at investigating prenatal (risk) factors that influence the quality of pre- and postnatal parent-infant relationships and postnatal infant development. In this longitudinal study, a community-based sample of 409 mothers and 319 of their partners were followed from 15 weeks of gestation until their child was 24 months old. Participants were recruited through four midwifery practices in Eindhoven, the Netherlands. At baseline, the mean age of the mothers was 31.04 years (SD = 4.52; range 17-44) and the mean age of the fathers was 33.8 years (SD = 4.68; range 22 – 49). Most parents were of the Dutch nationality (79.1% of the mothers and 81.4% of the fathers) and were highly educated (59.8% of the mothers and 63.7% of the fathers had 9 or more years of education after primary school). Of the participants, 53.9% were first-time parents. The mean gestational age of the children at birth was 39.79 weeks (SD = 1.60; range 30-42) and children had a mean birthweight of 3420.5 grams (SD = 543.99). Approximately half (49.6%) of the children was male. In the present thesis, self-reported questionnaires from the measurement moments at 26 weeks of pregnancy, 6 months and 24 months postpartum were used. Sample sizes for the three individual studies differ slightly as only parents with complete data for at least two of the relevant measurement moments were included. A more detailed description of the study design, procedure, and participants is described in the published study protocol (Maas, Vreeswijk, de Cock, Rijk, & van Bakel, 2012) as well as in the individual studies in this thesis.


1


Tabl

e 1.

Ove

rvie

w o

f res

earc

h ai

ms,

stud

y de

sign

s, an

d re

leva

nt c

once

pts

of a

ll st

udie

s in

clud

ed in

this

thes

is

Chap

ter

Rese

arch

Aim

sD

esig

nCo

ncep

ts

Mea

sure

s In

form

ants

N

2(a

) to

exam

ine

the

rank

-ord

er s

tabi

lity

of b

ondi

ng

(b) t

o id

entif

y pa

rent

s w

ith d

istin

ct b

ondi

ng p

atte

rns

from

pre

gnan

cy to

todd

lerh

ood

(c) t

o ex

amin

e co

rrel

ates

of b

ondi

ng b

y co

mpa

ring

the

iden

tified

gro

ups

of p

aren

ts w

ith d

istin

ct

bond

ing

patt

erns

on

pare

ntal

-, ch

ild-,

and

cont

extu

al

char

acte

ristic

s.

Long

itudi

nal:

“E

xpec

tant

Pa

rent

s” st

udy

Pren

atal

par

enta

l bon

ding

Po

stna

tal p

aren

tal b

ondi

ng

Pare

ntal

-, ch

ild-,

and

cont

extu

al c

hara

cter

istic

s

MA

AS,

PA

AS

MPA

S, P

PAS

QBF

, STA

I, SA

D4,

RQ

-CV,

ICQ

, EC

BQ,

VGP,

NO

SI-K

Mot

hers

& fa

ther

s

Mot

hers

& fa

ther

s

Mot

hers

& fa

ther

s

Mot

hers

: 322

Fa

ther

s: 24

7

3(a

) to

exam

ine

the

asso

ciat

ion

of p

re- a

nd p

ostn

atal

bo

ndin

g w

ith p

aren

ting

stre

ss a

t 24

mon

ths

in b

oth

mot

hers

and

fath

ers

(b) t

o ex

amin

e th

e as

soci

atio

n be

twee

n ea

rly

mat

erna

l and

pat

erna

l bon

ding

and

chi

ld e

xecu

tive

func

tioni

ng in

todd

lerh

ood

and

the

med

iatin

g ro

le

of p

aren

ting

stre

ss.

Long

itudi

nal:

“E

xpec

tant

Pa

rent

s” st

udy

Pren

atal

par

enta

l bon

ding

Po

stna

tal p

aren

tal b

ondi

ng

Pare

ntin

g st

ress

C

hild

exe

cutiv

e fu

nctio

ning

MA

AS,

PA

AS

MPA

S, P

PAS

NO

SI-K

BR

IEF-

P

Mot

hers

& fa

ther

s

Mot

hers

& fa

ther

s

Mot

hers

& fa

ther

s M

othe

rs

Mot

hers

: 335

Fa

ther

s: 26

1

4(a

) to

exam

ine

the

effec

ts o

f pre

nata

l and

pos

tnat

al

pare

ntal

bon

ding

and

par

entin

g se

lf-effi

cacy

on

the

tem

pera

men

tal d

imen

sion

s ne

gativ

e aff

ect a

nd

effor

tful

con

trol

in to

ddle

rhoo

d

(b) t

o de

term

ine

whe

ther

par

entin

g se

lf-effi

cacy

is

a m

edia

tor i

n th

e as

soci

atio

n be

twee

n pa

rent

al

bond

ing

and

todd

ler t

empe

ram

ent.

Long

itudi

nal:

“E

xpec

tant

Pa

rent

s” st

udy

Pren

atal

par

enta

l bon

ding

Po

stna

tal p

aren

tal b

ondi

ng,

Pare

ntin

g se

lf-effi

cacy

C

hild

tem

pera

men

t

MA

AS,

PA

AS

MPA

S, P

PAS

PMPS

-E

ECBQ

Mot

hers

& fa

ther

s

Mot

hers

& fa

ther

s

Mot

hers

& fa

ther

s M

othe

rs &

fath

ers

Mot

hers

: 335

Fa

ther

s: 26

3

5(a

) to

exam

ine

the

effec

t of i

nfan

t cry

ing

on a

ffect

, an

xiet

y an

d ex

pect

ed p

aren

ting

self-

effica

cy in

a

cont

rolle

d se

ttin

g th

at is

as

real

istic

as

poss

ible

(b

) to

exam

ine

a po

ssib

le d

ose–

resp

onse

effe

ct

of in

fant

cry

ing

on a

ffect

, anx

iety

and

exp

ecte

d pa

rent

ing

self-

effica

cy

(c) t

o ex

amin

e po

ssib

le g

ende

r diff

eren

ces

in a

ffect

, an

xiet

y an

d ex

pect

ed p

aren

ting

self-

effica

cy a

s a

resp

onse

to in

fant

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.


18 | Chapter 1

Lifelike baby doll experiment A novel way to examine child effects on parental affect and cognitions is to use an infant simulator. In the fourth study of this thesis 116 students of Tilburg University were asked to babysit a lifelike programmable baby doll for 10 minutes. After random assignment to one of three conditions participants were exposed to either no crying, 5 minutes of crying, or 10 minutes of crying. Before and after the experiment participants completed questionnaires about their affect, state anxiety, and expected parenting self-efficacy. For this experimental study the RealCare® Baby II-Plus life-like programmable doll from Realityworks, Inc. was used. This programmable simulator doll that resembles a real infant and produces lifelike infant crying sounds, provides a unique opportunity to experimentally study child effects. Several studies so far have established that the infant simulator is suitable for use in parenting research (Bruning & McMahon, 2009; Voorthuis et al., 2013).


1


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Continuous feelings of love?

The parental bond from pregnancy

to toddlerhood

This chapter is published as:

de Cock, E. S. A., Henrichs, J., Vreeswijk, C. M. J. M., Maas, A. J. B. M., Rijk, C. H. A. M., & van Bakel, H. J. A. (2016). Continuous feelings of love? The parental bond from pregnancy to toddlerhood. Journal of Family Psychology, 30, 125-134, doi: 10.1037/fam0000138

Chapter 2


26 | Chapter 2

ABSTRACT

Both prenatal and postnatal parental bonding (i.e., the affective tie from parent to child) have important effects on parental and child functioning. However, research on the continuity and correlates of parental bonding is lacking. Therefore, the goal of the present study was to examine the stability of bonding levels and to explore distinct bonding patterns with a latent class analysis. Moreover, the correlates of these bonding patterns in the parental-, child-, and contextual domain were studied. Levels of maternal (N = 370) and paternal (N = 292) bonding and potential correlates were assessed at 26 weeks of pregnancy, 6 months, and 24 months postpartum. Results showed moderate stability of bonding from pregnancy to toddlerhood. For both mothers and fathers four distinct bonding patterns were found. Parents with low bonding patterns were characterized by increased anxiety and parenting stress, less partner support, less adaptive personality profiles, and children with difficult temperament. These findings indicate the importance of monitoring young children’s parents with poor levels of bonding as their bonding patterns remain stable from pregnancy until toddlerhood and because those parents experience problems in multiple domains.

Keywords: maternal bonding, paternal bonding, rank-order stability, correlates


2

Parental bonding from pregnancy to toddlerhood | 27

INTRODUCTION

The relationship of parents and their children in the first years of life, and even in the months before birth, has a major impact on child developmental outcomes, such as childhood cognitive and behavioral functioning (Belsky & Fearon, 2002). In comparison to the well-known research area of the child-to-parent attachment relationship (e.g., Sroufe, 2005), patterns and correlates of the early parent-to-child bond have been understudied (Redshaw & Martin, 2013). The parent-to-child bond can be defined as an affective tie from parent to child which stems from the caregiving system and is aimed at protecting the child (Solomon & George, 1996). We will use the term bonding to refer to the parent-to-child bond. Parental bonding includes both mental and behavioral components (Condon, 1993; Feldman, Weller, Leckman, Kuint, & Eidelman, 1999). According to the theoretical model by Condon (1993) the core of bonding is an emotional state (i.e., “love”) that is related to a set of needs or dispositions, including knowing, being with, avoiding separation and loss from, protecting, and gratifying needs of the child. These needs and dispositions of the parent may in turn elicit the expression of child directed behaviors. The process of parental bonding has its roots in pregnancy (Cranley, 1993). Parents already develop ideas and expectations about and feelings for their unborn child during pregnancy, which initiates the formation of a parental bond. This process continues after birth and even after the early postnatal period (Klaus, Kennell, & Klaus, 1995). Studies have shown that during pregnancy higher levels of bonding are related to better prenatal health practices and higher well-being of the child (Lindgren, 2001; Van den Bergh & Simons, 2009). Women with higher levels of prenatal bonding, for example, report less drug use and more positive prenatal health practices, including healthy sleep, exercise, and eating patterns. Prenatal feelings of bonding are also related to postnatal mother-infant interaction, with higher levels of maternal bonding predicting more parental involvement, sensitivity, and stimulation during interaction with their child (Siddiqui & Hagglof, 2000). Postnatally, maternal bonding is associated with maternal as well as child outcomes. Higher levels of bonding are associated with better adjustment to the maternal role (Müller, 1994), whereas lower levels of bonding are related to poor child social-emotional development (Mason, Briggs, & Silver, 2011). Although existing research suggests that bonding affects parental as well as child functioning, research focusing on the developmental course of parental bonding is lacking (Jansen, Weerth, & Riksen-Walraven, 2008). Most studies that do contain some information on the stability and change of parental (mostly maternal) bonding only study stability of either pre- or postnatal bonding. Mothers report a significant increase in feelings of bonding from the first to the second trimester and from the second to the third trimester of pregnancy (van Bussel, Spitz, & Demyttenaere, 2010a). Then, maternal bonding scores remain stable in


28 | Chapter 2

the postpartum period from 8-12 weeks to 20-25 weeks (van Bussel, Spitz, & Demyttenaere, 2010b). Condon and Corkindale (1998) found an increase in reported levels of bonding from 4 weeks to 4 months postpartum and no change in bonding levels from 4 months to 12 months. In another study, Condon, Corkindale, and Boyce (2008) examined father-infant bonding and found a small increase in paternal bonding from 6 months to 12 months. The stability of bonding scores was high in all abovementioned studies with correlation coefficients ranging from 0.48 to 0.79. To our knowledge only a few studies have focused on the association between pre- and postnatal bonding. Studies by Damato (2004) and Muller (1996) reported a moderate positive correlation between feelings of bonding during pregnancy and 1-2 months postpartum in mothers of singletons as well as twins. Furthermore, Leckman et al. (1999) examined the course of parental preoccupations (i.e., an intense mental focus on the infant and his/her needs), which is part of the concept of parental bonding (Condon, 1993). Leckman et al. (1999) observed an increase in preoccupations from early pregnancy to shortly after birth and a decrease from birth to 3 months postpartum for both mothers and fathers. From previous research we know that fathers have important and independent (above maternal) effects on child outcomes (Ramchandani et al., 2013; Ramchandani, Stein, Evans, O’Connor, & Team, 2005). Fathers’ engagement and sensitive interactive behavior with their children is an important predictor of positive behavioral and psychological child outcomes, including secure child attachment (Grossmann, Grossmann, Fremmer-Bombik, Kindler, & Scheuerer-Englisch, 2002; Sarkadi, Kristiansson, Oberklaid, & Bremberg, 2008). However, regarding the process of bonding in fathers and its consequences for child development little is known. In a recent study by Condon, Corkindale, Boyce, and Gamble (2013) the stability of the father-child bond was examined. At 23 weeks of pregnancy 311 first-time fathers completed the Paternal Antenatal Attachment Scale (Condon, 1993) while 241 and 220 fathers completed the Paternal Postnatal Attachment Scale (Condon et al., 2008) at 6 months and 12 months, respectively. A strong continuity of paternal bonding scores was found across the three assessment points. The process of bonding does not develop automatically or optimally for all parents. Minor problems or even severe disturbances in the parent-child bond can occur which may lead to suboptimal parental care or even child neglect or abuse (Brockington, Aucamp, & Fraser, 2006). To identify parents that are susceptible to bonding problems it is important to study correlates of bonding. Belsky (1984) suggested a process model of parenting which proposes that parental functioning is multiply determined by factors from three major domains: the personality/psychological well-being of the parent, characteristics of the child, and contextual sources such as stress and support. Previous research on bonding already identified several factors that might affect parents’ developing feelings of bonding, which can be divided into these three domains.


2


Parental characteristics such as personality, mental health (e.g. depression, anxiety), and attachment representations, have been associated with prenatal and early postnatal bonding. Mothers who were more extroverted, conscientious, and agreeable, reported a higher quality of the prenatal bond (Maas, Vreeswijk, Braeken, Vingerhoets, & van Bakel, 2014). Higher levels of depressive and/or anxiety symptoms of mothers during pregnancy are negatively related to the formation of the prenatal maternal bond (e.g., Condon & Corkindale, 1997; Maas et al., 2014). Parents’ own upbringing and early experiences with relationships also appear to have an effect on parent-child bonding. Mothers and fathers with positive recollections of their own upbringing reported more positive emotional bonding in the early postnatal period (Hall et al., 2014). Additionally, parents’ internal working models of attachment are related to parental responsiveness during parent-infant interactions and this association was even stronger for fathers than mothers (Van IJzendoorn, 1995). However, the association between parental (especially paternal) personality and mental health and postnatal bonding is less clear and needs further research. Child characteristics such as gestational age at birth, parity, and infant temperament have been found to be associated with prenatal and early postnatal parental bonding. Studies regarding the effects of preterm birth on parental bonding are inconclusive. According to Feldman and colleagues (1999), forming a bond with a prematurely born baby can be problematic as mothers of preterms showed less bonding behavior, but increased preoccupation with their baby compared to mothers of term born babies. In contrast, Hall et al. (2014) found higher levels of bonding in mothers, but not fathers, of preterm infants compared to parents of full-term infants. Increased feelings of bonding have also been found in parents of firstborn infants (Kim, Mayes, Feldman, Leckman, & Swain, 2013). First-time parents reported more positive thoughts about parenting and the baby, and higher degrees of preoccupation and worry than did experienced parents. For fathers, lower postnatal bonding levels have been found when fathers experienced their children to have a fussy or difficult temperament (Condon, Corkindale, Boyce, & Gamble, 2013). Lastly, concerning contextual sources that may influence parental feelings and behavior, partner support was found to be an important determinant. A better partner relationship is associated with higher levels of postnatal bonding in fathers and prenatal bonding in mothers (Condon & Corkindale, 1997; Condon et al., 2013). However, Maas et al. (2014) did not find a significant association between partner support and prenatal bonding in mothers. Overall, findings of previous studies are conflicting regarding certain possible correlates of bonding (e.g. gestational age, partner support). Additionally, most studies focused only on prenatal or maternal bonding and much less is known about correlates of postnatal and paternal bonding. Next to parent-, child-, and contextual influences on the maternal and paternal bond, partners might also affect the feelings of bonding of the other parent within the family


30 | Chapter 2

context. Barnett, Deng, Mills-Koonce, Willoughby, and Cox (2008), for example, found that parenting of one parent is influenced by parenting patterns of the other parent and they stressed the importance of examining parenting in a family context. In the present study we aim to gain more insight into the development and (dis)continuity of parental bonding from pregnancy to toddlerhood in both mothers and fathers. Toddlers strive for more autonomy and display more temper tantrums during the so-called ‘terrible twos’. These changes in the child may elicit stress in the parent and thus affect the parental bond (Crnic & Booth, 1991; Williford, Calkins, & Keane, 2007). Therefore, toddlerhood is an important period to study the development of the parental bond, in particular because previous research has neglected to do this. In addition, father involvement in caregiving typically expresses itself in play activities, which becomes more prominent at toddler age when children begin to speak and play (McBride & Mills, 1993). Overall, we expect to find a positive association between prenatal and postnatal feelings of bonding and a relative stability of these feelings over time for both mothers and fathers. The existing instruments measuring prenatal and postnatal bonding, respectively, are conceptually similar but comprise differently formulated items as bonding with a fetus is much more abstract (especially for fathers) than bonding with an actual infant. As a consequence, mean-level stability of parental bonding is hard to examine from the prenatal to postnatal period. In the present study, we therefore focus on the relative (or rank-order) stability of parental bonding during this time span. Using a latent class analysis, we also examine whether different groups of parents can be identified with distinct patterns of bonding from pregnancy to toddlerhood. By subsequently comparing groups of parents with different bonding trajectories on parental-, child-, and contextual characteristics we will study possible correlates of bonding patterns across time. These comparisons may allow identifying risk factors of poor parental bonding. Such a person centered approach, using latent class analysis, has not been used in previous research on parental bonding. Person-centered and variable-centered approaches can complement each other to fully address stability and patterns of parental bonding (Laursen & Hoff, 2006). In sum, the present study aims 1) to examine the rank-order stability of bonding; 2) to identify parents with distinct bonding patterns from pregnancy to toddlerhood; and 3) to examine correlates of bonding by comparing the identified groups of parents with distinct bonding patterns on parental-, child-, and contextual characteristics.


2


METHOD

Participants and ProcedureThe present study was part of an ongoing prospective longitudinal cohort study on prenatal (risk) factors of postnatal child development, parenting, and parent-infant relationships. The study is called ‘Expectant Parents’ and detailed information about the design and procedure of the complete study has been described elsewhere (Maas, Vreeswijk, de Cock, Rijk, & van Bakel, 2012). Parental bonding was assessed at three measurement moments; around 26 weeks (range 23-31) of pregnancy, and at approximately 6 (range 5.5-8) and 24 (range 23.5-26) months postpartum via postal questionnaires filled in by participating mothers and fathers. Only parents who participated in at least two measurement moments were included in the analyses of the present study. Of the 409 mothers and 319 fathers who originally agreed to participate in the study 322 mothers (78.7%) and 247 fathers (77.4%) were included in the final sample. Demographic characteristics of both parents and their children are presented in Table 1. Most parents were Dutch (mothers: 82.6%, fathers: 85.4%, Non-Dutch parents mostly had a Turkish, Moroccan, Antillean, or Moluccan background) and were highly educated (66.6% of the mothers and 68.7% of the fathers had more than 9 years of education after primary school). At 26 weeks of pregnancy the mean age of the mothers was 31.7 (SD = 4.1) and the mean age of fathers was 34.2 (SD = 4.4). Children (50.6% boys) were born at a mean gestational age of 39.8 weeks (SD = 1.6) with a mean birth weight of 3436.3 grams (SD = 532.1; n = 322).

Table 1. Descriptive Statistics of Mothers and Fathers in the Total Sample

Mothers (n = 370) M (SE)a

Fathers (n = 292) M (SE)a

Child characteristics

Child sex (boy) 50.1% 50.9%

Gestational age at birth (weeks) 39.78 (0.08) 39.83 (0.86)

Birth weight (grams) 3419.39 (28.33) 3426.86 (31.56)

Parity (first child) 55.4% 54.4%

Parental characteristics

Age 31.41 (0.23) 33.98 (0.26)

Education after primary school0-4 years5-8 years9 or more years

12.0%25.1%62.9%

10.6%24.5%64.9%

Ethnicity (Dutch) 81.3% 81.1%

Birth of sibling during study (yes) 14.8% 16.1%

Bonding characteristics

Prenatal bonding 75.50 (0.32) 65.96 (0.21)

Bonding at 6 months 83.36 (0.38) 76.70 (0.26)

Bonding at 24 months 79.78 (0.29) 74.08 (0.37)

Numbers represent means (M) and standard errors (SE) unless otherwise indicated.


32 | Chapter 2

MeasuresParental bondingMaternal and paternal bonding were assessed by self-report questionnaires. At 26 weeks of pregnancy, mothers completed the Maternal Antenatal Attachment Scale (MAAS; Condon, 1993), which consists of 19 items (Cronbach’s alpha = .77). Fathers completed the Paternal Antenatal Attachment scale (PAAS; Condon, 1993), which consists of 16 items (Cronbach’s alpha = .77). An example item of the MAAS and PAAS is “Over the past two weeks I have thought about, or been preoccupied with the baby inside me/the developing baby”. For both the maternal and paternal scale items were scored 1-5, with higher scores indicating higher levels of bonding. The sum score of the PAAS was divided by the total number of items (16) and multiplied by 19 to obtain sum scores that are comparable to the maternal bonding sum scores based on a 19-item bonding questionnaires. At 6 months and 24 months postpartum, maternal and paternal bonding were assessed with the Maternal Postnatal Attachment Scale (MPAS; Condon & Corkindale, 1998) and the Paternal Postnatal Attachment Scale (PPAS; Condon et al., 2008). In the MPAS and PPAS administered at 24 months the word “baby” was changed to “child”. An example item for both the MPAS and PPAS is “When I am not with the baby/child, I find myself thinking about the baby/child”. Both scales contain 19 items and are scored 1-5, with higher scores indicating higher levels of bonding. In our study, internal consistencies (Cronbach’s alpha) of the MPAS at 6 months and 24 months, and the PPAS at 6 months and 24 months ranged from 0.75 to 0.83. Most of the items of the prenatal and postnatal versions of the bonding questionnaires are semantically distinct in formulation or possible response categories. These differences are inevitable as the behavior of parents towards their unborn fetus essentially differs from their behavior towards their 6-24 months old child. For the maternal and paternal versions of the instrument most items (13 for the postnatal and 14 for the prenatal versions) are identical and the remaining items are focused on specific maternal or paternal behavior.

Potential correlates of bondingIn line with Belsky’s (1984) model of determinants of parenting potential correlates were chosen. According to this model parental personality/psychological health, child characteristics, and contextual factors are important correlates of parenting.

Parental personality/psychological health

Demographic characteristics and indicators of social inequality (i.e., low SES, ethnic minority) are known to negatively affect parenting and the parental bond (e.g.,Yarcheski, Mahon, Yarcheski, Hanks, & Cannella, 2009). Therefore, demographic information about the parents (age, education, ethnicity) and the birth of a sibling during the study period [yes/no],


2


was obtained via self-report questionnaires filled in around 26 weeks of pregnancy or at approximately 6 or 24 months postpartum. Parental level of education was categorized as ‘0-5 years’, ‘5-9 years’, or ‘9 years or more’ of education after primary school and parental ethnicity was dichotomized into ‘Dutch’ and ‘non-Dutch’. Personality was included as a correlate because previous research has found that all Big Five factors of personality are associated with parenting (de Haan, Decovic, & Prinzie, 2012). Personality of the parents was assessed at 26 weeks of pregnancy with the Quick Big Five (Vermulst & Gerris, 2005). This validated questionnaire consists of 30 statements with a scale from 1 (disagree strongly) to 7 (agree strongly; e.g. “quiet”, “creative”). The statements are divided into five subscales; Extraversion (α

mothers = .90, α

fathers = .87), Conscientiousness (α

mothers = .88,

αfathers

= .88), Agreeableness (αmothers

= .82, αfathers

= .83), Emotional Stability (αmothers

= .84, αfathers

= .78), and Resourcefulness (α

mothers = .79, α

fathers = .80).

Parental state anxiety was assessed at 26 weeks of gestation (αmothers

= .92, αfathers

= .90) and at 4 months postpartum (α

mothers = .93, α

fathers = .91) with the state subscale of the State Trait

Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970), which consists of 20 statements with a scale from 1 (not at all) to 4 (very much; e.g. “I feel nervous”). At 24 months postpartum anxiety was assessed with the Symptoms of Anxiety-Depression index (Denollet, Strik, Lousberg, & Honig, 2006), which consists of 4 items with a scale from 1 (not at all) to 5 (very

much; e.g. “I feel tense”; αmothers

= .85, αfathers

= .79). The attachment style of parents was determined using the Relationship Questionnaire-Clinical Version (RQ-CV; Holmes & Lyons-Ruth, 2006), which consists of 5 statements about relationships with significant others from which parents choose the one that is most applicable. The five statements represent different attachment styles. Scores on the RQ were dichotomized into ‘securely attached’ when the ‘securely attached’ statement was chosen and ‘insecurely attached’ when one of the other statements was chosen.

Child characteristics

Birth complications (i.e., low birth weight, prematurity) are a source of concern for parents and may affect parenting. In addition, in previous studies, parity and the child’s gender were associated with parenting behavior and parental bonding (Karreman, Van Tuijl, Van Aken, & Dekovic, 2009; Maas et al., 2014). Therefore, information on the child’s gender, birth weight (in grams), gestational age (in weeks) at birth, and birth characteristics (parity [firstborn/laterborn]), was obtained from medical records reported by midwives. Child temperament was assessed through parent report at 6 months and 24 months with the Infant Characteristic Questionnaire (ICQ; Bates, Freeland, & Lounsbury, 1979) and the Early Childhood Behavior Questionnaire (ECBQ; Putnam, Gartstein, & Rothbart, 2006), respectively. The ICQ consists of 24 items which are rated from 1 (very easy) to 7 (difficult; e.g. “How easy or difficult has it been for you to calm or soothe your baby when he/she is upset?”; α

mothers =


34 | Chapter 2

.82, αfathers

= .81). The subscales Negative Affect (αmothers

= .64, αfathers

= .61) and Effortful Control (α

mothers = .75, α

fathers = .68) of the ECBQ were used in the present study and consist of 12 items

each with a scale ranging from 1 (never) to 7 (always; e.g. “When s/he was upset, how often did your child stay upset for 10 minutes or longer?”.

Contextual factors

At 6 months (αmothers

= .61, αfathers

= .65) and 24 months (αmothers

= .63, αfathers

= .63) partner support was assessed for both parents with a 7-item subscale of the Dutch Questionnaire on Family problems (Vragenlijst voor Gezinsproblemen, VGP; Koot, 1997) ranging from 1 (definitely does

not apply) to 3 (definitely or often applies; e.g. “my partner supports me too little”). A shortened, Dutch validated version of the Parenting Stress Index (Abidin, 1983), the Nijmeegse Ouderlijke Stress Index, was used to measure parenting stress at 24 months (NOSI-K; De Brock, Vermulst, Gerris, & Abidin, 1992). The NOSI-K consists of 25 items which are rated from 1 (totally disagree) to 6 (totally agree; e.g. “Parenting this child is harder than I thought”; α

mothers = .90, α

fathers = .91).

RESULTS

Statistical AnalysesPearson correlation coefficients were calculated to test the stability of bonding and were performed with IBM SPSS Statistics 19 for Windows. Missing data was imputed with multiple imputation generating 10 complete datasets for conducting analyses. After this, data was available for 370 mothers and 292 fathers. Furthermore, two 3-step latent class analyses (one for mothers and one for fathers) were performed in Latent Gold 5.0 (Vermunt & Magidson, 2005) with prenatal bonding, bonding at 6 months, and bonding at 24 months as indicators. Within Latent Gold missing values were handled with a Full Information Maximum Likelihood procedure. With these analyses possible classes of parents could be identified with distinct patterns of bonding over these three time periods. As it was not possible to examine mean level changes from pre- to postnatal bonding (because of differences in the questionnaires) and there were no cutoffs available, we have chosen latent class analyses to examine the continuity of bonding. First, the model fit for 1-6 classes was estimated and it was determined how many classes described the data best by considering goodness of fit indices (i.e. Bayesian Information Criterion, Akaike Information Criterion). In the second step the final model was re-estimated while classification information was saved. Finally, in the third step (taking into account uncertainty in the latent class assignments) we examined whether parent-, child-, and context characteristics differed for groups of parents with distinct patterns of bonding by means of Wald tests with a Bonferroni correction for multiple testing.


2


Descriptive StatisticsMean bonding scores for both mothers and fathers at all three measurement periods can be found in Table 1. Paired t-tests revealed that from 6 to 24 months bonding scores slightly but significantly decreased for both mothers (t = 7.09, p < .001) and fathers (t = 5.61, p < .001). Means of the pre- and postnatal versions of the Attachment Scales could not be directly compared as they contain different items. Correlations between bonding levels of mothers and fathers were weak to moderate and ranged from r = .10 and r = .28.

Stability of Bonding ScoresCorrelation analyses showed moderate stability between prenatal maternal bonding and postnatal maternal bonding at 6 months (r = .33, p < .001) as well as at 24 months (r = .32, p < .001), whereas the stability between the two postnatal maternal bonding scores was strong (r = .61, p < .001). For fathers, we found even higher levels of stability between pre- and postnatal bonding scores at 6 months (r = .56, p < .001) as well as at 24 months (r = .51, p < .001). The stability between the postnatal paternal bonding scores at 6 and 24 months can be considered high (r = .72, p < .001).

Patterns of BondingTwo latent class analyses were performed to examine patterns of bonding in both mothers and fathers. Variables included in these two analyses were the total scores on prenatal bonding, bonding at 6 months, and bonding at 24 months for mothers and fathers respectively.

MothersAccording to the information criteria (BIC, AIC, AIC3) a 3, 4, or 5-class model fitted the data of mothers best (Table 2). Therefore, a likelihood ratio test was performed to compare a 4-class model with the more simple 3-class model and the 5-class model with the 4-class model. Results demonstrated that the 4-class model fitted the data significantly better than the 3-class model, -2LL

diff = 26.86, p = .008. However, the 5-class model did not show

significant improvement above the 4-class model, -2LLdiff

= 18.97, p = .064. The final 4-class model (Figure 1) had a classification error of 20.0%. Class 1 consisted of 45.5% of the mothers who continuously showed relatively high feelings of bonding. Class 2 comprised 25.3% of the mothers who continuously showed relatively low feelings of bonding. Class 3 comprised 16.3% of the mothers whose reported bonding levels stayed between the high and low bonding scores and can therefore be considered intermediate. Class 4 consisted of the final 13.0% of the mothers who continuously report very high levels of bonding relatively to the other mothers. The finding that the four distinct patterns of bonding revealed by the latent class analyses were more or less parallel and did not show groups of mothers with clear


36 | Chapter 2

shifts from relatively high to low levels of bonding (or the other way around), confirming the previously found stability of bonding scores.

FathersThe best fit to the data of father according to the information criteria (BIC, AIC, AIC3) was a 3, 5, or 6-class model (Table 2). A likelihood ratio test comparing a 4-class model with the 3-class model showed a significant improvement, -2LL

diff = 39.37, p < .001, in favor of the 4-class

model. The likelihood ratio tests of the 5-class model compared to the 4-class model also showed significant improvement, -2LL

diff = 28.04, p < .001. The 6-class model compared to the

5-class model did not show significant improvement (Table 2).

Table 2. Fit statistics of the latent class analyses for mothers and fathers

BIC AIC AIC3 NparClassification error

-2LL difference

Mothers

1-Class model 6179.48 6156.00 6162.00 6 0.00 n/a

2-Class model 6078.05 6027.18 6040.18 13 0.13 n/a

3-Class model 6049.24 5970.97 5990.97 20 0.16 n/a

4-Class model 6063.77 5958.11 5985.10 27 0.20 26.86 (p = .008)

5-Class model 6086.59 5953.53 5987.53 34 0.21 18.97 (p = .064)

6-Class model 6120.16 5959.70 6000.70 41 0.20 n/a

Fathers

1-Class model 4973.30 4951.24 4957.24 6 0.00

2-Class model 4871.67 4823.87 4836.87 13 0.13

3-Class model 4832.25 4758.71 4778.71 20 0.14

4-Class model 4832.62 4733.35 4760.35 27 0.17 39.37 (p < .001)

5-Class model 4844.31 4719.31 4753.31 34 0.17 28.04 (p < .001)

6-Class model 4866.66 4715.91 4756.91 41 0.26 17.40 (p = .100)

However, inspection of the classes revealed no theoretically interesting additional fifth class on top of the model with 4 classes. In addition, the 4-class model still had sufficient numbers of fathers in each class (to adequately test for group differences), while an additional fifth class only contained a very small percentage (1.8%) of fathers. Therefore, a 4-class model with an estimated misclassification rate of 17.0% was adopted (Figure 1). Class 1 consisted of 46.9% of the fathers who continuously reported relatively intermediate levels of bonding. Class 2 comprised 34.9% of the fathers who continuously reported relatively high feelings of bonding. In Class 3 another 11.5% of the fathers reported continuously low bonding levels. Finally, Class 4 consisted of 6.7% of the fathers who continuously reported very high levels of bonding. Again, this finding of four parallel lines differentiating distinct patterns of bonding, adds evidence to the earlier findings of stability in bonding scores. Most parents did not seem


2


to shift from relatively high to low bonding scores (or the other way around) over time, but continuously experienced the same relative level of bonding.

50

55

60

65

70

75

80

85

90

95

26 weeks ofpregnancy

6 months 24 months

Mat

erna

l Bon

ding

Class 4 (13.9%)

Class 1 (44.9%)

Class 3 (16.8%)

Class 2 (24.4%)

50

55

60

65

70

75

80

85

90

95

26 weeks ofpregnancy

6 months 24 months

Pate

rnal

Bon

ding

Class 4 (6.5%)

Class 2 (35.5%)

Class 1 (45.6%)

Class 3 (12.4%)

Figure 1. Patterns of maternal and paternal bonding obtained from latent class analyses.

Note. Lines should not be interpreted as mean level changes, since the items of the MAAS/PAAS and MPAS/PPAS contain different items.

Correlates of BondingThe results of the third step of the analyses in Table 3 and 4 revealed important differences in parental characteristics, child characteristics, and contextual factors (e.g. stress and support) between the previously determined groups of parents with distinct bonding patterns.

Parental factorsMothers with low levels of bonding were significantly older (M = 33.0) than mothers with intermediate (M = 30.0) and very high (M = 29.64) levels of bonding. Although in all bonding


38 | Chapter 2

classes most parents were highly educated, the distribution of education levels differed significantly over the bonding classes. The lowest levels of education were observed in mothers and fathers with very high levels of bonding. In low, intermediate, and high paternal bonding classes a significantly higher percentage of fathers experienced the birth of another sibling during data collection compared to fathers with very high levels of bonding. The group of mothers with low levels of bonding was significantly less extraverted (M = 4.81) and agreeable (M = 5.44), than mothers with high (M = 5.31, M = 5.80 respectively) and very high levels of bonding (M = 5.64, M = 6.16 respectively). Mothers with intermediate (M = 5.75) and high bonding levels also scored significantly lower on agreeableness than mothers with very high bonding levels. Regarding conscientiousness, mothers with low (M = 4.91) and intermediate (M = 4.74) levels scored lower than mothers with very high levels of bonding (M = 5.61). Mothers with low levels of bonding were also less emotionally stable (M = 4.60) than mothers with high levels of bonding (M = 5.03). A similar pattern of results was found for fathers regarding differences in personality by bonding pattern group (Table 4). The pattern of results regarding anxiety in mothers revealed that mothers with low levels of bonding from pregnancy to toddlerhood experienced significantly more anxiety symptoms prenatally (M = 36.00) as well as at 4 (M = 33.71) and 24 months (M = 7.31) postpartum compared to mothers with high (M = 31.79, M = 25.67, M = 5.50, respectively) or very high levels of bonding (M = 30.07, M = 25.49, M = 4.41, respectively). Postnatally at 24 months, also mothers with an intermediate (M = 5.50) and high bonding pattern experienced significantly more anxiety symptoms than mothers with very high levels of bonding. Fathers with low levels of bonding only differed in feelings of anxiety at 4 months postpartum: Fathers with low levels of bonding experienced more anxiety (M = 34.40) than fathers with high (M = 29.54) or very high (M = 26.43) levels of bonding. However, fathers with intermediate levels of bonding also experienced more anxiety symptoms than fathers with high (regarding prenatal anxiety and anxiety at 4 months) and very high (regarding anxiety at 24 months) levels of bonding.

Child factorsNo differences between maternal bonding classes were found regarding child sex, gestational age at birth, birth weight, and parity. For fathers with very high levels of bonding their child was more likely to be the firstborn child, whereas for fathers with low levels of bonding the child was most likely to already have one (or more) sibling(s). Mothers in the low and intermediate bonding class reported more difficult temperament in their children at 6 months (M = 69.75) than mothers with high (M = 58.02) and very high (M = 49.19) levels of bonding. They also reported more negative affect (M = 2.78, M = 2.92) and less effortful control (M = 4.52, M = 4.73) at 24 months than mothers with very high levels of bonding (M = 2.34, M = 5.62). Also, mothers with low levels of bonding reported less effortful control than mothers with high levels of bonding. Fathers with low (M = 70.04) and intermediate (M = 66.17) levels of bonding


2


experienced a significantly more difficult temperament in their children at 6 months than fathers with high (M = 56.63) or very high (M = 51.73) levels of bonding. Fathers with low levels of bonding also reported lower levels of effortful control (M = 4.18) in their 24 months old toddlers than fathers with high (M = 4.98) or very high (M = 5.04) levels of bonding. In addition, fathers with intermediate bonding patterns reported more child negative affect (M = 2.86) and less child effortful control (M = 4.57) than fathers with high levels of bonding.

Contextual factorsFor partner support, results indicated that at 6 and 24 months significantly less partner support was experienced by mothers with a low (M = 8.23, M = 8.17) and intermediate (M = 8.35, M = 7.78) bonding pattern compared to mothers with very high (M = 9.38, M = 9.26) levels of bonding. Also, mothers with low levels of bonding experienced less partner support at 6 months than mothers with high levels of bonding (M = 9.16). Fathers with low levels of bonding reported less partner support at 6 months (M = 7.36) than fathers with intermediate (M = 8.71), high (M = 9.19), or very high (M = 9.15) levels of bonding. In addition, fathers with a low bonding pattern experienced less partner support at 24 months (M = 7.51) than fathers with high bonding levels (M = 9.26). Both mothers and fathers with low and intermediate bonding patterns experienced significantly more parenting stress than the parental groups with high and very high levels of bonding (see Table 3 and 4).

Partner variablesWe also tested for differences between the four groups of bonding patterns with respect to variables as reported by the other parent (i.e., bonding, partner support, parenting stress, parental attachment style, child temperament). Approximately the same pattern of bonding (prenatal and postnatal) was found in the partners. Mothers as well as fathers with lower levels of bonding also had partners with lower levels of bonding (Tables 3 and 4). Furthermore, father-reported parenting stress was higher for mothers with low (M = 41.50) and high levels (M = 41.70) of bonding compared to mothers with very high levels (M = 32.86) of bonding. Father-reported child temperamental difficulties at 6 months were higher in mothers with low levels of bonding (M = 67.01) compared to mothers with very high levels of bonding (M = 56.99). Father-reported child negative affect at 24 months was higher for mothers with low levels of bonding (M = 2.98) compared to mothers with high levels of bonding (M = 2.62). In addition, father-reported child effortful control at 24 months was lower for mothers with low (M = 4.49) and high levels (M = 4.63) of bonding than for mothers with very high levels of bonding (M = 5.19). Mother-reported partner support at 6 months was lower for fathers with low levels of bonding (M = 7.36) compared to fathers with intermediate (M = 8.71), high (M = 9.19), or very high (M = 9.15) levels of bonding. Other mother-reported factors did not differ between paternal bonding levels.


40 | Chapter 2

Tabl

e 3.

Par

ent-

, Chi

ld-,

and

Cont

extu

al C

orre

late

s of

Mat

erna

l Bon

ding

Pat

tern

s fro

m P

regn

ancy

to T

oddl

erho

od

Mot

hers

Clas

s 1

Hig

h le

vels

of

bond

ing

(45.

5%)

Clas

s 2

Low

leve

ls o

f bo

ndin

g (2

5.3%

)

Clas

s 3

Inte

rmed

iate

leve

ls

of b

ondi

ng (1

6.3%

)

Clas

s 4

Very

hig

h le

vels

of

bond

ing

(13%

)Si

gnifi

canc

e te

stin

g

Mat

erna

l cha

ract

erist

ics

Age

31.5

4 (0

.39)

a,b

33.0

1 (0

.58)

b30

.00

(0.7

2)a

29.6

4 (0

.68)

aW

ald

= 5

.94,

p =

.001

Educ

atio

n

0-4

year

s

5-8

year

s

9 or

mor

e ye

ars

11.2

%a

24.3

%

64.5

%

8.1%

a

28.3

%

63.6

%

6.7%

a

14.8

%

78.5

%

28.7

%b

34.4

%

36.9

%

Wal

d =

11.

71, p

= .0

08

Wal

d =

2.8

5, p

= .4

1

Ethn

icity

(Dut

ch)

84.3

%75

.7%

86.3

%75

.4%

Wal

d =

2.6

9, p

= .4

4

Birt

h of

sib

ling

durin

g st

udy

(yes

)11

.9%

19.7

%15

.1%

15.4

%W

ald

= 0

.96,

p =

.81

Pers

onal

ity

Extr

aver

sion

Cons

cien

tious

ness

Agr

eeab

lene

ss

Emot

iona

l Sta

bilit

y

Reso

urce

fuln

ess

5.31

(0.1

0)b

5.17

(0.0

9)a,

b

5.80

(0.0

5)b

5.03

(0.1

0)b

4.74

(0.0

9)

4.81

(0.1

6)a

4.91

(0.1

3)a

5.44

(0.1

0)a

4.60

(0.1

4)a

4.58

(0.1

1)

5.39

(0.2

1)a,

b

4.74

(0.2

3)a

5.75

(0.1

0)a,

b

4.77

(0.1

7)a,

b

4.66

(0.1

7)

5.64

(0.1

8)b

5.61

(0.1

6)b

6.16

(0.1

0)c

5.09

(0.1

8)a,

b

5.05

(0.1

8)

Wal

d =

12.

56, p

= .0

06

Wal

d =

16.

65, p

= .0

01

Wal

d =

29.

32, p

< .0

01

Wal

d =

8.6

5, p

= .0

34

Wal

d =

5.3

6, p

= .1

5

Pren

atal

anx

iety

31.7

9 (0

.71)

a36

.00

(1.1

5)b

34.1

6 (1

.39)

a,b

30.0

7 (1

.51)

aW

ald

= 1

5.61

, p =

.001

Post

nata

l anx

iety

4 m

onth

s

24 m

onth

s

25.6

7 (0

.63)

a

5.50

(0.2

8)b

33.7

1 (1

.45)

b

7.33

(0.5

8)c

28.8

8 (1

.66)

a,b

5.50

(0.6

6)b,

c

25.4

9 (1

.21)

a

4.41

(0.2

6)a

Wal

d =

31.

65, p

< .0

01

Wal

d =

30.

06, p

< .0

01

Att

achm

ent s

tyle

(sec

ure)

66.7

%58

.6%

72.8

%61

.0%

Wal

d =

1.6

0, p

= .6

6

Child

cha

ract

erist

ics

Chi

ld s

ex (b

oy)

53.4

%55

.1%

46.0

%34

.3%

Wal

d =

4.2

0, p

= .2

4

Ges

tatio

nal a

ge a

t birt

h (w

eeks

)39

.92

(0.1

3)39

.78

(0.2

1)39

.62

(0.2

9)39

.48

(0.3

0)W

ald

= 2

.05,

p =

.56

Birt

h w

eigh

t (gr

ams)

3404

.45

(48.

72)

3474

.33

(71.

06)

3455

.77

(92.

18)

3319

.10

(90.

84)

Wal

d =

2.2

3, p

= .5

3

Parit

y (fi

rst c

hild

)57

.2%

40.5

%66

.1%

64.8

%W

ald

= 6

.58,

p =

.087


2


Tabl

e 3.

Par

ent-

, Chi

ld-,

and

Cont

extu

al C

orre

late

s of

Mat

erna

l Bon

ding

Pat

tern

s fro

m P

regn

ancy

to T

oddl

erho

od (C

ontin

ued)

Mot

hers

Clas

s 1

Hig

h le

vels

of

bond

ing

(45.

5%)

Clas

s 2

Low

leve

ls o

f bo

ndin

g (2

5.3%

)

Clas

s 3

Inte

rmed

iate

leve

ls

of b

ondi

ng (1

6.3%

)

Clas

s 4

Very

hig

h le

vels

of

bond

ing

(13%

)Si

gnifi

canc

e te

stin

g

Tem

pera

men

t 6 m

onth

s58

.02

(1.2

5)b

69.7

5 (2

.01)

c65

.76

(2.6

3)c

49.1

9 (2

.06)

aW

ald

= 6

3.55

, p <

.001

Tem

pera

men

t 24

mon

ths

Neg

ativ

e aff

ect

Effor

tful

con

trol

2.51

(0.0

6)a,

b

5.05

(0.0

8)b

2.78

(0.0

9)b

4.52

(0.1

1)a

2.92

(0.1

9)b

4.73

(0.1

8)a,

b

2.34

(0.1

6)a

5.62

(0.1

1)c

Wal

d =

14.

64, p

= .0

02

Wal

d =

62.

72, p

< .0

01

Cont

extu

al fa

ctor

s

Part

ner s

uppo

rt

6 m

onth

s

24 m

onth

s

9.16

(0.1

2)b,

c

9.07

(0.1

6)b,

c

8.23

(0.2

4)a

8.17

(0.3

5)a,

b

8.35

(0.3

3)a,

b

7.78

(0.4

8)a

9.38

(0.1

6)c

9.26

(0.2

9)c

Wal

d =

25.

42, p

< .0

01

Wal

d =

16.

14, p

= .0

01

Pare

ntin

g st

ress

36.1

4 (1

.05)

b55

.01

(2.4

6)c

53.1

7 (4

.58)

c29

.28

(1.3

2)a

Wal

d =

123

.71,

p <

.001

Part

ner v

aria

bles

Pate

rnal

pre

nata

l bon

ding

65.5

6 (0

.72)

a63

.00

(0.9

7)a

67.9

5 (1

.64)

a,b

70.5

3 (1

.40)

bW

ald

= 2

0.21

, p <

.001

Pate

rnal

bon

ding

at 6

mon

ths

76.1

6 (7

.19)

a73

.04

(1.4

0)a

77.7

6 (1

.59)

a83

.25

(1.3

3)c

Wal

d =

31.

51, p

< .0

01

Pate

rnal

bon

ding

at 2

4 m

onth

s75

.10

(0.9

0)b

69.3

2 (1

.62)

a75

.10

(2.0

1)b

82.1

9 (1

.41)

cW

ald

= 4

1.96

, p <

.001

Pate

rnal

par

tner

sup

port

6 m

onth

s

24 m

onth

s

8.84

(0.1

6)

8.90

(0.1

9)

8.48

(0.3

1)

8.35

(0.3

9)

8.49

(0.3

2)

8.38

(0.5

3)

9.23

(0.2

3)

9.36

(0.2

9)

Wal

d =

6.6

3, p

= .0

85

Wal

d =

7.3

5, p

= .0

62

Pate

rnal

par

entin

g st

ress

41.5

0 (1

.78)

b49

.20

(2.9

9)b

41.7

0 (4

.13)

a,b

32.8

6 (1

.84)

aW

ald

= 2

9.01

, p <

.001

Pate

rnal

att

achm

ent s

tyle

(sec

ure)

67.2

%64

.1%

77.9

%72

.1%

Wal

d =

1.0

4, p

= .7

9

Tem

pera

men

t 6 m

onth

s (fa

ther

s)61

.10

(1.4

6)a,

b67

.01

(2.1

0)b

63.5

8 (3

.17)

a,b

56.9

9 (2

.20)

aW

ald

= 1

2.81

, p =

.005

Tem

pera

men

t 24

mon

ths

(fath

ers)

Neg

ativ

e aff

ect

Effor

tful

con

trol

2.62

(0.0

7)a

4.63

(0.0

9)a

2.98

(0.1

2)b

4.49

(0.1

0)a

2.86

(0.1

9)a,

b

4.74

(0.2

1)a,

b

2.64

(0.1

2)a,

b

5.19

(0.1

7)b

Wal

d (3

) = 8

.38,

p =

.039

Wal

d (3

) = 1

2.95

, p =

.005

Not

e. N

umbe

rs re

pres

ent m

eans

and

stan

dard

err

ors (

SE) u

nles

s oth

erw

ise

indi

cate

d. M

eans

with

diff

eren

t sub

scrip

ts a

re si

gnifi

cant

ly d

iffer

ent a

t p <

.017

(alp

ha B

onfe

rron

i co

rrec

ted)


42 | Chapter 2

Tabl

e 4.

Par

ent-

, Chi

ld-,

and

Cont

extu

al C

orre

late

s of

Pat

erna

l Bon

ding

Pat

tern

s fro

m P

regn

ancy

to T

oddl

erho

od

Fath

ers

Clas

s 1

Inte

rmed

iate

leve

ls

of b

ondi

ng (4

6.9%

)

Clas

s 2

Hig

h le

vels

of

bond

ing

(34.

9%)

Clas

s 3

Low

leve

ls o

f bo

ndin

g (1

1.5%

)

Clas

s 4

Very

hig

h le

vels

of

bond

ing

(6.7

%)

Sign

ifica

nce

test

ing

Pate

rnal

cha

ract

erist

ics

Age

34.5

6 (0

.43)

33.1

6 (0

.56)

34.8

0 (0

.76)

32.8

3 (1

.28)

Wal

d (3

) = 5

.98,

p =

.11

Educ

atio

n

0-4

year

s

5-8

year

s

9 or

mor

e ye

ars

3.3%

a

20.4

%

76.3

%

13.1

%a

30.9

%

56.0

%

14.7

%a,

b

18.8

%

66.5

%

41.6

%b

30.3

%

28.1

%

Wal

d (3

) = 1

4.77

, p =

.002

Wal

d (3

) = 3

.05,

p =

.38

Ethn

icity

(Dut

ch)

83.3

%83

.4%

73.6

%67

.4%

Wal

d (3

) = 3

.20,

p =

.36

Birt

h of

sib

ling

durin

g st

udy

(yes

)17

.4%

b17

.2%

b16

.0%

b0.

0%a

Wal

d (3

) = 2

1.85

, p<

.001

Pers

onal

ity

Extr

aver

sion

Cons

cien

tious

ness

Agr

eeab

lene

ss

Emot

iona

l Sta

bilit

y

Reso

urce

fuln

ess

4.64

(0.1

1)a

4.62

(0.1

2)a

5.70

(0.0

7)a,

b

5.21

(0.0

9)a

4.96

(0.1

0)

5.44

(0.1

4)b

4.65

(0.1

4)a

5.90

(0.0

7)b,

c

5.65

(0.1

0)b

5.24

(0.1

1)

4.37

(0.2

2)a

4.28

(0.2

6)a

5.21

(0.1

9)a

5.11

(0.2

1)a

4.88

(0.2

1)

5.43

(0.2

1)b

5.36

(0.2

3)b

6.28

(0.1

7)c

5.70

(0.2

1)a,

b

5.27

(0.2

4)

Wal

d (3

) = 3

4.88

, p <

.001

Wal

d (3

) = 1

1.76

, p

= .0

08

Wal

d (3

) = 2

5.25

, p

< .0

01

Wal

d (3

) = 1

6.27

, p

= .0

01

Wal

d (3

) = 5

.55,

p =

.14

Pren

atal

anx

iety

33.0

7 (0

.78)

b29

.17

(0.9

1)a

32.4

5 (1

.42)

a,b

30.2

7 (1

.84)

a,b

Wal

d (3

) = 1

1.21

, p =

.011

Post

nata

l anx

iety

4 m

onth

s

24 m

onth

s

29.5

4 (0

.72)

b,c

5.73

(0.2

9)b

26.4

3 (0

.82)

a

4.82

(0.2

1)a,

b

34.4

0 (2

.66)

c

6.00

(0.5

5)a,

b

26.4

3 (2

.00)

a,b

4.70

(0.2

8)a

Wal

d (3

) = 1

6.30

, p =

.001

Wal

d (3

) = 1

3.08

, p =

.005

Att

achm

ent s

tyle

(sec

ure)

69.3

%76

.0%

51.9

%61

.2%

Wal

d (3

) = 4

.78,

p =

.19

Child

cha

ract

erist

ics

Chi

ld s

ex (b

oy)

57.5

%43

.1%

56.4

%36

.1%

Wal

d (3

) = 4

.98,

p =

.17

Ges

tatio

nal a

ge a

t birt

h (w

eeks

)39

.97

(0.1

3)39

.68

(0.2

0)39

.87

(0.2

6)39

.59

(0.4

7)W

ald

(3) =

1.6

7, p

= .6

4

Birt

h w

eigh

t (gr

ams)

3503

.96

(56.

51)

3334

.63

(65.

38)

3435

.57

(80.

13)

3349

.30

(122

.26)

Wal

d (3

) = 3

.77,

p =

.29

Parit

y (fi

rst c

hild

)49

.4%

a,b

63.0

% b

28.7

% a

89.4

%b

Wal

d (3

) = 1

3.09

, p =

.004


2


Tabl

e 4.

Par

ent-

, Chi

ld-,

and

Cont

extu

al C

orre

late

s of

Pat

erna

l Bon

ding

Pat

tern

s fro

m P

regn

ancy

to T

oddl

erho

od (C

ontin

ued)

Fath

ers

Clas

s 1

Inte

rmed

iate

leve

ls

of b

ondi

ng (4

6.9%

)

Clas

s 2

Hig

h le

vels

of

bond

ing

(34.

9%)

Clas

s 3

Low

leve

ls o

f bo

ndin

g (1

1.5%

)

Clas

s 4

Very

hig

h le

vels

of

bond

ing

(6.7

%)

Sign

ifica

nce

test

ing

Tem

pera

men

t 6 m

onth

s

Tem

pera

men

t 24

mon

ths

Neg

ativ

e aff

ect

Effor

tful

con

trol

66.1

7 (1

.24)

b

2.86

(0.0

7)b

4.57

(0.0

8)a,

b

56.6

3 (1

.67)

a

2.51

(0.1

0)a

4.98

(0.1

1)c

70.0

4 (2

.76)

b

2.86

(0.1

6)a,

b

4.18

(0.1

5)a

51.7

3 (2

.82)

a

2.66

(0.1

3)a,

b

5.04

(0.2

4)b,

c

Wal

d (3

) = 4

5.13

, p <

.001

Wal

d (3

) = 9

.55,

p =

.023

Wal

d (3

) = 2

6.96

, p <

.001

Cont

extu

al fa

ctor

s

Part

ner s

uppo

rt

6 m

onth

s

24 m

onth

s

8.71

(0.1

5)b

8.64

(0.2

1)a,

b

9.19

(0.1

7)b

9.26

(0.1

8)b

7.36

(0.4

4)a

7.51

(0.6

4)a

9.15

(0.3

2)b

8.92

(0.4

5)a,

b

Wal

d (3

) = 1

9.23

, p <

.001

Wal

d (3

) = 1

1.31

, p =

.010

Pare

ntin

g st

ress

47.5

0 (1

.79)

b31

.14

(1.6

3)a

55.2

3 (4

.85)

b33

.66

(2.2

2)a

Wal

d (3

) = 7

0.41

, p <

.001

Part

ner v

aria

bles

Mat

erna

l pre

nata

l bon

ding

75.4

0 (0

.56)

b76

.75

(0.7

1)b,

c70

.81

(1.5

0)a

80.6

4 (1

.56)

cW

ald

(3) =

25.

97, p

< .0

01

Mat

erna

l bon

ding

at 6

mon

ths

82.5

9 (0

.62)

a,b

84.1

0 (0

.66)

b80

.14

(1.3

5)a

89.5

1 (1

.30)

cW

ald

(3) =

34.

06, p

< .0

01

Mat

erna

l bon

ding

at 2

4 m

onth

s79

.51

(0.7

6)a

81.8

2 (1

.00)

a,b

79.2

6 (1

.50)

a86

.83

(1.7

4)b

Wal

d (3

) = 1

8.81

, p <

.001

Mat

erna

l par

tner

sup

port

6 m

onth

s

24 m

onth

s

9.02

(0.1

4)b

8.86

(0.1

7)

9.03

(0.1

4)b

8.86

(0.2

1)

7.93

(0.3

5)a

8.18

(0.5

1)

9.23

(0.2

4)b

9.11

(0.3

5)

Wal

d (3

) = 1

0.31

, p =

.016

Wal

d (3

) = 2

.40,

p =

.49

Mat

erna

l par

entin

g st

ress

42.0

2 (1

.55)

41.7

5 (2

.21)

47.1

0 (2

.87)

38.6

2 (3

.83)

Wal

d (3

) = 3

.97,

p =

.26

Mat

erna

l att

achm

ent s

tyle

(sec

ure)

71.4

%61

.9%

62.4

%74

.6%

Wal

d (3

) = 1

.58,

p =

.66

Tem

pera

men

t 6 m

onth

s (m

othe

r)61

.01

(1.4

4)60

.02

(1.9

7)68

.02

(2.5

7)60

.16

(5.0

3)W

ald

(3) =

7.2

7, p

= .0

64

Tem

pera

men

t 24

mon

ths

(mot

her)

Neg

ativ

e aff

ect

Effor

tful

con

trol

2.64

(0.0

7)

4.90

(0.0

8)

2.55

(0.0

8)

5.07

(0.1

1)

2.82

(0.1

4)

4.89

(0.1

5)

2.59

(0.1

8)

4.86

(0.2

2)

Wal

d (3

) = 3

.15,

p =

.37

Wal

d (3

) = 1

.72,

p =

.63

Not

e. N

umbe

rs re

pres

ent m

eans

and

stan

dard

err

ors (

SE) u

nles

s oth

erw

ise

indi

cate

d. M

eans

with

diff

eren

t sub

scrip

ts a

re si

gnifi

cant

ly d

iffer

ent a

t p <

.017

(alp

ha B

onfe

rron

i co

rrec

ted)


44 | Chapter 2

DISCUSSION

The present study examined the rank-order stability of bonding, bonding patterns, and correlates of bonding. It was found that feelings of bonding are relatively stable from pregnancy to toddlerhood for both mothers and fathers. Four classes of mothers and fathers with different bonding patterns were identified. The different classes of parents were only distinguished by mean level differences. Important differences were found in parental, child, and contextual characteristics between the various classes of parents with distinct bonding patterns. The results for mothers regarding the continuity of bonding are in accordance with previous literature where correlations of approximately .40 were found between prenatal and early postnatal maternal bonding at 1-2 months postpartum (Damato, 2004; Muller, 1996). For first-time fathers, Condon et al. (2013) found a correlation of .34 between pre- and postnatal bonding and .63 between bonding at 6 and 12 months, which is somewhat lower than the stability found in the present study (r’s between .52 and .72) including fathers of firstborn and later born children. The present study is the first to demonstrate stability of parental bonding from pregnancy until the age of 24 months after birth. In contrast to earlier studies reporting no change or a small positive mean level change in postnatal bonding scores in the first year of life (Condon & Corkindale, 1998; Condon et al., 2008; van Bussel et al., 2010b), the present study observed a small decrease in levels of reported bonding from 6 to 24 months postpartum in mothers as well as fathers. As children grow older they become more and more independent and need less protection and basic care, which might be reflected in the lower parental bonding scores at 24 months postpartum. With their growing autonomy, children develop a stronger will which can be hard for parents to deal with, especially around 24 months of age, an age period often referred to as the “terrible twos”. Not surprisingly, parenting stress appears to peak around this developmental age with lots of conflict between parent and toddler (Crnic & Booth, 1991; Williford et al., 2007). Parenting stress is an important determinant of parenting behavior and the parent-child relationship (Crnic & Booth, 1991). This is in accordance with the results of the present study showing that parents with lower levels of bonding experienced more parenting stress and a more difficult temperament in their children. In their studies, Condon and colleagues investigated the continuity of bonding scores over time by dividing the scores into quartiles (Condon, 1993; Condon et al., 2008). They examined whether low bonding at an earlier time was predictive of low bonding at a later time and reported the percentages of women and men shifting to another quartile over time. Although it is clinically very relevant to know whether parents shift from low/high bonding to high/low bonding or continuously report the same relative bonding levels, this is hard to evaluate. Clear cutoffs derived from large-scale representative population-based studies making it possible to distinguish between different types of parental bonding do not exist. In the present study,


2


we therefore used latent class analysis to identify groups of parents with distinct patterns of bonding based on their relative mean levels of reported bonding. No classes of parents were found with clear shifts in bonding levels (as can be concluded from the parallel lines in Figure 1) indicating that most parents show continuity in their degree of bonding and pattern of bonding across time. Bonding thus seems to be a relatively stable construct, as demonstrated in the current study by the identification of four stable groups of bonding patterns for both mothers and fathers that only differed in the intensity of bonding. Moreover, identifying variations in bonding patterns using latent class analyses made it possible to reveal important differences in parental, child, and contextual characteristics between four groups of parents with different bonding patterns and intensity. In comparison to the other three groups of mothers, mothers characterized by very high levels of bonding from pregnancy to toddlerhood were marked by the most adaptive personality characteristics (i.e., they were generally the most extraverted, conscientious, agreeable, and emotionally stable in comparison to the other types of maternal bonding patterns). They also experienced low levels of pre- and postnatal anxiety and parenting stress. Moreover, they experienced the most support from their partner and they experienced their children’s temperament as relatively easy. They also had partners with higher levels of bonding and lower levels of parenting stress and their partners perceived their child’s temperament as easier than partners of mothers with lower levels of bonding. Remarkably, mothers in this group were younger and more often had lower levels of education. Overall, mothers with very high levels of bonding were characterized by high psychosocial well-being, a supportive social context and (mentally) healthy children. A similar, but less pronounced, profile emerged regarding mothers with high levels of bonding from pregnancy to toddlerhood. Mothers with an intermediate bonding pattern had less adaptive psychosocial and personality characteristics than mothers with (very) high levels of bonding. That is, they were marked by lower levels of conscientiousness and agreeableness and reported more postnatal anxiety and parenting stress, less partner support and perceived their children’s temperament as more difficult than mothers with (very) high levels of bonding. Finally, mothers with continuously low bonding scores from pregnancy to toddlerhood had the most negative characteristics in terms of parental, contextual, and child factors. In comparison to mothers with higher bonding levels, they were less extraverted, conscientious, agreeable, and emotionally stable and experienced less partner support. Moreover, they reported more prenatal as well as postnatal anxiety and more parenting stress. They also indicated that their children had more temperamental difficulties (i.e., more negative affect and less effortful control) than children of mothers with higher levels of bonding patterns. In addition, their partners also reported lower bonding levels more parenting stress, and higher levels of temperamental problems in their children than partners of mothers with very high levels of bonding. In sum, these results suggest that mothers with low bonding patterns


46 | Chapter 2

across time display the most psychosocial problems, receive poor partner support and have children at risk of temperamental problems. This group of mothers and their children may thus benefit most from interventions focusing on the improvement of maternal psychosocial functioning and parent-child interactions and child functioning. For fathers, the parental, contextual, and child characteristics regarding the different types of bonding patterns from pregnancy to toddlerhood were similar, but sometimes less pronounced, to mothers with some exceptions: Age was not a discriminating factor in fathers. Children of fathers with very high levels of bonding were most often firstborns, whereas the children of fathers with low levels of bonding were most often laterborns. In addition, fathers with very high levels of bonding less often had another child during the study. Lastly, in comparison to maternal bonding patterns the various groups of paternal bonding did not differ in parental, contextual and child characteristics as reported by the other parent with one exception: Only mother-reported partner support was significantly different between paternal bonding classes (i.e., partners of fathers with low levels of bonding experienced the least partner support at 6 months). These gender differences, and the stronger effects found in mothers, could be explained by the fact that mothers are more often the primary caregiver and are generally more involved in the parenting of their child. For mothers no associations between either parity or giving birth to another child during the study and bonding were found. However, children of fathers with very high levels of bonding were most often firstborns and these men least often became a father of another child during the study. Probably, the very high levels of bonding of these fathers are a result of more involvement with their firstborn child. Another explanation may be fact that fathers’ attention does not have to be divided among multiple children. In addition, the birth of another child can be stressful and particularly fathers with low levels of bonding may find it challenging to find a new work-family balance, while for mothers this is more congruent with her role as a primary caregiver. Possibly fathers with low levels of bonding do not have the resources and coping skills to provide attention to all family members. Although there were some gender differences in terms of parental bonding patterns across time, our findings generally indicate that low levels of bonding in both mothers and fathers were associated with problems in all three domains of Belsky’s (1984) model (i.e. the parental, child, and contextual domain). These results can be explained in several ways. Psychosocial problems often co-occur in families, because they are related and can reinforce each other (Herwig, Wirtz, & Bengel, 2004). For example, anxiety symptoms and (parenting) stress might be experienced as particularly negative when there is low partner support to buffer the negative feelings. In addition, parenting stress can be more intense when the child has a difficult temperament. Moreover, it could be that these families have less resources to cope with daily hassles. Surprisingly, in the present study parents with low levels of bonding and many problems in several of these domains had the highest level of education. Possibly,


2


highly educated parents experience many demands in other areas of their life (e.g. work). However, it should be noted that educational levels were generally high in the present sample. Another explanation of the high rate of co-occurring problems in parents with low levels of bonding may be the genetic background of these parents, possibly predisposing them to problems in multiple areas of psychosocial functioning (Rende & Plomin, 1992). This might also explain why these parents had children with the highest level of temperamental problems, as temperament is strongly genetically determined (Saudino, 2005).

LimitationsThe current study had a number of limitations. First, the instruments used to assess prenatal and postnatal bonding contained different items. This did not allow examining the mean level changes in bonding scores over time. The development of one instrument to assess both pre- and postnatal bonding would lead to a great advancement of research on parental bonding. However, differences in items of the pre- and postnatal instruments are hard to avoid as the behavior of parents towards their unborn fetus and their 6-24 months old child is very different. During pregnancy the fetus may be perceived as very abstract and intangible, especially for fathers, whereas after birth the presence of the baby is prominent (e.g., the baby needs constant care and makes noises). In addition, data presented in the current study were for a large part based on self-report questionnaires, which can lead to response biases such as social desirability. However, the use of self-report questionnaires also has advantages in the field of bonding research as it makes it possible to assess both the cognitive and affective as well as the behavioral aspects of bonding. Most previous research into parental caregiving behavior or the parent-child relationship used observational measures that do not allow assessing mental (i.e., cognitive and emotional) aspects of parental bonding (Condon et al., 2013). Moreover, the cross-informant approach of the present study allowed studying correlates of parental bonding based on reports by the other parent. Ideally, future research should use a multi-informant approach based on self-report, cross-informant report, and observational measures to be able to simultaneously assess cognitive, affective, and behavioral aspects of parental bonding. In conclusion, the findings of the present study indicate the importance of early screening and possible need of interventions for parents with low levels of bonding in pregnancy and their offspring. Reported levels of bonding for both mothers and fathers were relatively stable from pregnancy onwards. Our results thus suggest that, without intervention, parents with relatively low bonding scores in pregnancy tend to remain in this category after their child is born. Both mothers and fathers with low levels of bonding during pregnancy and toddlerhood were characterized by less adaptive personality functioning and partner support, increased anxiety and parenting stress and children with difficult temperament in infancy and toddlerhood. These parents as well as their children are at increased risk for developing long-


48 | Chapter 2

term psychosocial or developmental problems respectively (Guerin, Gottfried, & Thomas, 1997; Herwig et al., 2004) and could benefit from the development and evaluation of family-based interventions to improve parental- and child functioning and parent-child interaction. However, before implementing such interventions, large-scale longitudinal studies with a long-term follow-up period should be conducted to confirm the present findings and study the effects of parental bonding on child development later in life.


2


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2




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Longitudinal associations between

parental bonding, parenting stress,

and executive functioning in

toddlerhood3Chapter 3


de Cock, E. S. A., Henrichs, J., Klimstra, T. A., Maas, A. J. B. M., Vreeswijk, C. M. J. M., Meeus, W. H. J., & van Bakel, H. J. A. (2017). Longitudinal associations between parental bonding, parenting stress, and executive functioning in toddlerhood. Journal of Child and Family Studies, 26, 1723-1733. doi: 10.1007/s10826-017-0679-7


56 | Chapter 3

ABSTRACT

Early executive functioning is an important predictor for future development of children’s cognitive skills and behavioral outcomes. Parenting behavior has proven to be a key environmental determinant of child executive functioning. However, the association of parental affect and cognitions directed to the child with child executive functioning has been understudied. Therefore, in the present study we examine the associations between parental bonding (i.e., the affective tie from parent to child), parenting stress, and child executive functioning. At 26 weeks of pregnancy, and at 6 months and 24 months postpartum the quality of the maternal (N = 335) and paternal (N = 261) bond with the infant was assessed. At 24 months, postnatal parenting stress and child executive functioning were measured by means of parent-report questionnaires. Results indicated that for both mothers and fathers feelings of bonding negatively predicted experienced parenting stress over time. In addition, for both parents a negative indirect effect of bonding on child executive functioning problems was found via experienced parenting stress. These findings indicate the importance of monitoring parents who experience a low level and quality of early parent-child bonding, as this makes them vulnerable to parenting stress, consequently putting their children at risk for developing executive functioning problems. Key words: maternal bonding, paternal bonding, prenatal bonding, parenting stress, executive functioning


3

Parental bonding, parenting stress, and executive functioning | 57

INTRODUCTION

In the first years of life, children are largely dependent on their caregivers, who primarily provide a child’s environmental context in this period. Particularly neurodevelopment is an ongoing and remarkably rapid process during the first two years of life (e.g., Fox, Calkins, & Bell, 1994; Knickmeyer et al., 2008) making the young child’s developing brain sensitive to environmental influences, such as early caregiving. Previous research suggests that early caregiving may significantly affect child neurodevelopmental outcomes (i.e., child (neuro)cognitive and behavioral outcomes; Knickmeyer et al., 2008). A suboptimal parental bond (i.e., the affective tie from parent to child) not only negatively affects later child outcomes but is also detrimental for parents themselves. For example, studies have shown that poorer parental bonding is associated with higher levels of parenting stress (de Cock et al., 2016; Mason, Briggs, & Silver, 2011). The present study examines the impact of pre- and postnatal parental bonding on parenting stress as well as the effect of parental bonding and parenting stress on early child executive functioning. Early executive functioning is a key child cognitive outcome and an important precursor for future development of children’s cognitive skills and behavioral outcomes. Executive functioning is an umbrella term for higher-order neurocognitive processes that organize and direct cognition, emotion, and behavior (e.g., Garon, Bryson, & Smith, 2008; Isquith, Crawford, Espy, & Gioia, 2005). These can be assessed as early as in infancy, and research shows that early individual differences in executive functioning are relatively stable over time (Carlson, Mandell, & Williams, 2004). When basic executive functions are suboptimally developed in toddlerhood and the preschool years, this negatively affects the development of more complex executive functioning, because the emergence of these higher-order skills is dependent on the achievement of simpler abilities. In this context, previous studies have shown that preschool executive functioning skills, such as inhibitory control and working memory, are predictive of school achievement (e.g., mathematical and reading abilities) in the first years of primary school as well as later in childhood (Blair & Razza, 2007; Clark, Pritchard, & Woodward, 2010). Poor preschool executive functioning has also been linked to childhood internalizing and externalizing problem behavior (e.g., Roman, Ensor, & Hughes, 2016; Sulik, Blair, Mills-Koonce, Berry, & Greenberg, 2015). Early executive functioning has a substantial impact on several important indicators of child psychosocial well-being and neurodevelopmental functioning, making it crucial to examine child executive functioning and its determinants early in life. Executive functioning is primarily associated with brain activation in prefrontal regions, which show prolonged development and rapid growth during the first two years of life (e.g., Anderson, Anderson, Jacobs, & Smith, 2008; Diamond, 2002). In this period, environmental factors such as parental behavior have a major impact on future child behaviors through their impact on the developing brain. Caregiving behavior fosters the development of children’s self-regulatory or executive functioning skills by providing the child with a predictive, orderly,


58 | Chapter 3

and stimulating environment (Carlson, 2003; Schroeder & Kelley, 2010). According to Vygotsky’s theory (1978), children learn to structure thinking processes from interpersonal interaction, most likely with their parents, before these become internal and they can manage individually without help. In addition, through social (i.e. parent-infant) interactions, elementary cognitive processes develop into more sophisticated higher-order cognitive processes. Thus, early social relationships and caregiving behavior are important for children’s development of executive functioning skills. Despite the fact that parental bonding is a key component of the caregiving relationship, this concept is still understudied. Parental bonding can be defined as a subjective experience of affection of the parent towards the child. The core of the parental bond is a feeling state (“love”) that eventually exposes itself in parental behavior (e.g., Condon, 1993; Condon & Corkindale, 1998). According to Condon’s theory, this process of parental feelings eventually expressing itself in behavior is facilitated by parents’ goal directed needs or dispositions to act (i.e. knowing, being with, avoiding separation and loss from, protecting, and gratifying needs of the child.). These dispositions can be considered indicators of parental bonding and are assessable through self-report. Already during pregnancy parental feelings, cognitions, and behavior towards the fetus begin to develop and can be validly and reliably assessed (e.g., Condon, 1993). This is referred to as the prenatal parental bond (or maternal fetal attachment) and this unique feature of parental bonding makes it distinct from, for example, the infant-mother attachment relationship which focuses on attachment behavior of the infant (Walsh, 2010). Previous longitudinal research shows that the prenatal parental bond is strongly related to the postnatal bond and the quality of parent-infant interaction (Damato, 2004; de Cock et al., 2016; Maas, de Cock, Vreeswijk, Vingerhoets, & van Bakel, 2016; Müller, 1996). Mothers with higher levels of prenatal bonding display more parental involvement, and more sensitivity and stimulation when interacting with their child in the first year after birth (Siddiqui & Hägglöf, 2000). Besides research on the association of bonding with actual parenting behavior, previous research also shows that parental feelings of bonding are associated with child outcomes. A lower quality of the postnatal bond, for example, has been found to be related to poorer later child social-emotional development and more difficult temperament (de Cock et al., 2016; Mason et al., 2011). Although parental bonding seems to be an important predictor of child outcomes, the association with child executive functioning has not yet been investigated. Previous research on parental predictors of child executive functioning has focused on parenting behaviors instead of parental feelings and cognitions. These studies found that more parental scaffolding or autonomy support, more parental sensitivity, more parental stimulation, and less parental control/discipline are to a greater or lesser degree related to better child executive functioning (for a review see Fay-Stammbach, Hawes, & Meredith, 2014). In these previous studies, different parenting and caregiving dimensions have been examined with different effects on child executive functioning, indicating that parents have a significant impact on their children’s


3


cognitive development in multiple ways. However, parental bonding, a potentially important cognitive and affective parental factor with a strong impact on parental behavior that can already be measured in the prenatal period, has not yet been studied in this context. A poor parental bond not only has detrimental effects on child outcomes, but also the parents themselves are affected. For some parents developing a bond with their child does not come naturally or optimally. Disturbances in forming a parental bond can be stressful for parents and can have a negative effect on parenting abilities and feelings of parental adjustment (Müller, 1994; Siddiqui & Hägglöf, 2000). Previous research, using a person-centered method, showed that a pattern of low bonding levels from pregnancy to toddlerhood is related to more parenting stress (de Cock et al., 2016). In addition, studies found that maternal bonding has a buffering effect in the association between postpartum depression and parenting stress (Mason et al., 2011; Reck, Zietlow, Müller, & Dubber, 2016). In these studies, also a direct association between maternal bonding and parenting stress was found in the early postnatal period. Although most parents of young children will experience some parenting daily hassles, parents who lack the feeling of a strong bond with their child might experience a higher degree of parenting stress. Similar to parental bonding, parenting stress has an effect on both the quality of parent-infant interaction and child outcomes. In a longitudinal study, Crnic, Gaze, and Hoffman (2005) found that cumulative early parenting stress negatively affects future parental behavior and the quality of parent-infant interaction. In the same study, higher levels of parenting stress were also found to be related to more child behavior problems at 5 years of age. Moreover, parenting behavior did not mediate this association, indicating a direct effect of parenting stress on child outcomes (Crnic et al., 2005). In addition, studies have shown that parenting stress is related to child cognitive development and executive functioning. For example, more parenting stress at 6 months has a negative effect on child cognitive development (e.g. perception, problem solving, language) at 12 months (Molfese et al., 2010). Moreover, in a cross-sectional study parenting stress has also been negatively linked to child executive functioning at 8-12 years (Joyner, Silver, & Stavinoha, 2009). Taken together, the findings of the abovementioned studies suggest a possible indirect effect of parental feelings of bonding on child executive functioning through parenting stress. Finally, most of the abovementioned studies only included mothers. Fathers are still underrepresented in research on parenting and the parent-infant relationship, while effects of father involvement on child developmental outcomes are significant and have been documented repeatedly (Ramchandani et al., 2013; Sarkadi, Kristiansson, Oberklaid, & Bremberg, 2008). Therefore, the role of fathers regarding the development of child executive functioning is important to examine. A study by Lucassen et al. (2015) shows distinct effects of maternal and paternal parenting on child executive functioning. The authors found that less maternal, but not paternal sensitivity, and harsher parenting by fathers, but not by mothers, was related to lower scores on child executive functioning at 3 years. Another study found


60 | Chapter 3

that both mothers’ as well as fathers’ sensitive and supportive parenting predicted children’s executive functioning at 3 years (Towe-Goodman et al., 2014). However, in most studies examining the effect of parenting on child executive functioning, maternal and paternal parenting effects are not studied separately. Rather they are analyzed together as one factor, which makes it impossible to observe a potential difference in effects. In addition, fathers tend to experience lower levels of bonding compared to mothers, and correlations between maternal and paternal bonding are only weak to moderate (de Cock et al., 2016; Hoffenkamp et al., 2012). Therefore, it is important to include fathers when studying the effects of parental variables on child outcomes and to examine paternal effects separately from maternal effects. Findings from previous research raise the question to what extent bonding is directly related to child executive functioning and to what extent this association might be mediated by parenting stress. We examine this by means of the following two research questions. First, we examine the association of pre- and postnatal bonding with parenting stress at 24 months in both mothers and fathers. We hypothesize that parental (prenatal) bonding levels are positively related to successive bonding levels and that parental bonding is negatively related to the experience of parenting stress. Research on parental bonding and parenting stress beyond the early postnatal period is lacking, despite the fact that toddlerhood (or “terrible two’s”) is an important and well-known stressful parenting period in which children put their parents to the test due to their increasing autonomy (e.g., Crnic & Booth, 1991). Second, we examine the association between early maternal and paternal bonding and child executive functioning in toddlerhood and the mediating role of parenting stress. We expect that parents who report lower levels of bonding, experience more parenting stress, and this in turn leads to more executive functioning problems in children at 2 years. Additionally, as previous research has demonstrated paternal influences on child executive functioning, we expect to find associations between parental bonding, parenting stress and child executive functioning for both mothers and fathers. By assessing executive functioning early in life, potential problems can be discovered in time which leaves more room for intervention. In addition, examining the determinants of early executive functioning also provides an opportunity to discover and monitor families at risk and children vulnerable for developing problems in their executive functioning abilities.

METHOD

Participants Only parents of whom data was available on at least two measurement moments were included in the analyses. This resulted in a final sample of 335 mothers and 261 fathers and their children (81.9% of the mothers and 81.8% fathers who originally agreed to participate). Little’s Missing Completely At Random test (1988) revealed a normed Chi-Square (χ2/df) of 1.85


3


and 0.44 for mother and father data, respectively. This indicates a good fit between sample scores with and without imputation according to guidelines by Bollen (1989). Therefore, missing data were imputed with multiple imputation generating 10 complete datasets for conducting analyses in IBM SPSS Statistics 22. At baseline (i.e., 26 weeks of pregnancy mothers and fathers were on average 31.7 (SD = 4.23, range 17 – 43) and 34.2 (SD = 4.47, range 23 – 50) years old. Most parents were highly educated, as 65.4% of the mothers and 67.3% of the fathers had 9 or more years of education after primary school. Furthermore, 83.2% of the mothers and 85.0% of the fathers were Dutch. Children (49.6% boys, 55.8% firstborns) were born at a mean gestational age of 39.8 (SD = 1.6) weeks and a mean birth weight of 3427.8 (SD = 538.5) grams. All parents signed informed consent before participating in the study. This study has been approved by the medical ethics committee of the St. Elisabeth hospital in Tilburg, the Netherlands (date: 13-08-2008, registration number: NL 23376.008.08).

ProcedureThe present study is embedded in the prospective longitudinal cohort study ‘Expectant Parents’, which focuses on prenatal (risk) factors of postnatal child development, parenting, and parent-infant relationships. Detailed information regarding design and procedure of the study has been described elsewhere (Maas, Vreeswijk, de Cock, Rijk, & van Bakel, 2012). In the current study, maternal and paternal bonding were assessed via postal questionnaires at 26 weeks of pregnancy, and at 6 months and 24 months postpartum. At 24 months, parents completed a questionnaire about parenting stress. Mothers also filled in a questionnaire about child executive functioning problems. Portions of the data used in the current study have been published before (de Cock et al., 2016). In this previous study, parental pre-and postnatal bonding was studied in association with multiple correlates in the parent- child- and contextual domain. However, parental bonding was studied by means of person-centered methods, which provided (four) patterns of bonding, instead of separate pre-and postnatal bonding variables as examined in the current study.

MeasuresParental bondingAt 26 weeks of gestation, and at 6 and 24 months postpartum parents completed questionnaires about their feelings of parental bonding. To assess prenatal bonding, the Maternal and Paternal version of the Antenatal Attachment Scales were used (MAAS/PAAS; Condon, 1993). The MAAS consists of 19 items which are scored 1-5, with higher scores indicating higher levels of bonding. As the PAAS consists of 16 items (also scored 1-5) the sum score was divided by 16 and multiplied by 19 to obtain scores that are comparable to the maternal bonding sum scores based on a 19-item bonding questionnaire. An example item of


62 | Chapter 3

the MAAS/PAAS is “Over the past two weeks I have thought about, or have been preoccupied with the baby inside me/the developing baby”. Internal consistency of the MAAS and PAAS in the present study is sufficient (Cronbach’s alphas of .76 and .78, respectively). For postnatal bonding, we used the Maternal and Paternal version of the Postnatal Attachment Scales (MPAS/PPAS; Condon & Corkindale, 1998; Condon, Corkindale, & Boyce, 2008). Both scales consist of 19 items which are scored 1-5, with higher scores indicating higher levels of bonding. An example item for both the MPAS and PPAS is “When I am not with the baby/child, I find myself thinking about the baby/child”. Internal consistency of the MPAS and PPAS in the present study is sufficient to high (Cronbach’s alphas between .75 and .83).

Parenting stressTo assess parenting stress at 24 months an abbreviated, Dutch validated version of the Parenting Stress Index (Abidin, 1983), the Nijmeegse Ouderlijke Stress Index, was used (NOSI-K; De Brock, Vermulst, Gerris, & Abidin, 1992). The NOSI-K consists of 25 items which are rated from 1 (totally disagree) to 6 (totally agree), with higher scores indicating more parenting stress. Scores on all items were summed up to obtain a total score of experienced parenting stress. An example item is “Parenting this child is harder than I thought”. In the present study internal consistency of the NOSI-K for mothers and fathers was high (Cronbach’s alphas of .90 and .91 respectively).

Child executive functioning problemsAt approximately 24 months (M = 23.7, SD = 0.77, range 23-27), child executive functioning problems were assessed with the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P; Gioia, Espy, & Isquith, 2003), which was developed and validated for children aged 2-5 years. In the present study, mothers completed this instrument. For 63 items, mothers were asked to indicate how often (never, sometimes, often) the mentioned behavior of their child has been a problem during the past 6 months. Scores on a Likert scale ranged from 1-3, with higher scores indicating more executive functioning problems. In the current study the BRIEF-P total score (i.e., sum score of all items) was used as in preschool-aged children executive functioning skills are still intertwined and difficult to separate into different components (Espy, 2004; Isquith, Gioia, & Espy, 2004). An example item of the BRIEF-P is “Has trouble with activities or tasks that have more than one step”. Internal consistency of the BRIEF-P total score was found to be strong in the present study (Cronbach’s alpha = .93).

Statistical analysesTo examine the bivariate associations between all study variables, Pearson correlation analyses were conducted in IBM SPSS Statistics 22. In addition, a series of path models was performed in MPlus 7 (Muthén & Muthén, 1998-2015) to examine the associations between parental


3


bonding and parenting stress, and between parental bonding, parenting stress, and executive functioning. This was done for mothers and fathers separately. By using path models, multiple measurement occasions of parental bonding could be taken into account in one model predicting parenting stress. In addition, the possible mediating role of parenting stress in the association of parental bonding at 6 months and child executive functioning at 24 months could be examined within one path model, controlling for a possible mediating effect of parental bonding at 24 months. Missing values were handled by Full Information Maximum Likelihood (FIML) estimation. First, completely saturated models with all variables included were run. Covariates (gestational age, gender, parental age, parental education) were added to all the path models as predictors of the outcome variables. However, these covariates had no significant effect and did not alter the results of the models. Next, all non-significant paths (including covariates) were trimmed from the models, in line with other studies in the same research area (e.g., Östberg & Hagekull, 2000), which made it possible to assess model fit. Final models with significant associations are presented and interpreted.

RESULTS

Descriptive statistics and correlationsCorrelations among, and descriptive statistics of, the study variables are presented in Table 1. Pre- and postnatal maternal bonding were moderately positively correlated with each other. Prenatal bonding had a weak negative correlation and postnatal bonding a strong negative correlation with parenting stress, indicating that lower levels of bonding were associated with higher levels of parenting stress. In addition, lower levels of postnatal, but not prenatal, bonding were moderately associated with more executive functioning problems. Also, more parenting stress as experienced by the mother was strongly related to more child executive functioning problems. Fathers showed a similar pattern of correlations (see Table 1). However, no significant correlations were found between paternal bonding and child executive functioning problems. Maternal and paternal bonding were weakly to moderately correlated (over the three timepoints). In addition, a weak positive correlation was found between maternal and paternal parenting stress.

Parental bonding and parenting stressPath models were used to examine the associations between parental prenatal and postnatal bonding (at 6 and 24 months) and parenting stress at 24 months. First, paths between the bonding variables at three time points as well as paths between all bonding variables and parenting stress at 24 months were included in the model. Subsequently, non-significant paths were removed. Below, we present the final models.


64 | Chapter 3

Tabl

e 1.

Cor

rela

tions

Bet

wee

n M

ater

nal (

N =

335

) and

Pat

erna

l Bon

ding

(N =

261

), Pa

rent

ing

Stre

ss, a

nd C

hild

Exe

cutiv

e Fu

nctio

ning

Vari

able

sM

SD1

23

45

67

89

1. M

ater

nal p

rena

tal b

ondi

ng75

.46

6.30

-.3

35**

*.2

83**

*-.1

95**

-.090

.307

***

.298

***

.310

***

-.122

2. M

ater

nal b

ondi

ng a

t 6 m

onth

s83

.29

5.94

-.6

05**

*-.4

97**

*-.3

15**

*.1

92**

.259

***

.308

***

-.206

**

3. M

ater

nal b

ondi

ng a

t 24

mon

ths

80.6

46.

40-

-.635

***

-.312

***

.120

.229

***

.238

***

-.230

**

4. M

ater

nal p

aren

ting

stre

ss42

.55

13.1

4-

.587

***

-.042

-.102

-.122

.253

**

5. E

F pr

oble

ms

86.2

213

.94

--.0

14-.0

67-.1

27.2

26**

6. P

ater

nal p

rena

tal b

ondi

ng65

.76

7.10

-.5

54**

*.5

33**

*-.2

55**

7. P

ater

nal b

ondi

ng a

t 6 m

onth

s76

.60

7.47

-.7

21**

*-.4

35**

*

8. P

ater

nal b

ondi

ng a

t 24

mon

ths

74.5

66.

77-

-.510

***

9.Pa

tern

al p

aren

ting

stre

ss42

.56

13.0

1-

* p

< .0

5, *

* p

<.0

1, *

** p

< .0

01N

ote.

Cor

rela

tions

are

bas

ed o

n im

pute

d da

te to

mat

ch th

e sa

mpl

e si

ze o

f the

pat

h an

alys

es. M

eans

and

sta

ndar

d de

viat

ions

are

bas

ed o

n or

igin

al d

ata

(N b

etw

een

231

and

335

for m

othe

rs a

nd N

bet

wee

n 17

0 an

d 26

1 fo

r fat

hers

).


3


MothersThe fi nal path model for mothers (Figure 1) had an excellent fi t (χ2 = 0.163, df = 1, p = .686, RMSEA = .00, CFI = 1.00), and showed that prenatal bonding predicted postnatal bonding at 6 and 24 months. Postnatal bonding at 6 months also predicted bonding at 24 months. In addition, postnatal, but not prenatal, feelings of bonding were negatively related to experienced parenting stress in mothers at 24 months. Thus, higher levels of postnatal maternal bonding lead to lower levels of parenting stress. Although there was no direct path from prenatal bonding to parenting stress, the indirect paths through postnatal bonding at 6 months and at 24 months were signifi cant, as well as the indirect longitudinal path via bonding at 6 and 24 months (see Figure 1). This means that higher levels of prenatal bonding lead to higher levels of postnatal bonding at 6 and 24 months, which in turn lead to lower levels of parenting stress.

0.57 (0.05)***

MB24 MB6

0.11 (0.06)*

-0.05 (0.02)* -0.16 (0.06)*

-0.11 (0.02)***

-0.06 (0.03)*

-0.55 (0.06)***

MBP

PSM

0.34 (0.05)***

Figure 1. Standardized path coeffi cients and standard errors for the associations between maternal bonding and parenting stress. Dashed lines are used for indirect eff ects. * p < .05, ** p <.01, *** p < .001. MBP = Maternal Bonding Prenatally, MB6 = Maternal Bonding at 6 months, MB24 = Maternal Bonding at 24 months, PSM = Parenting Stress Mothers.

FathersFor fathers similar patterns were found regarding the associations between paternal bonding and parenting stress (Figure 2). Again, the fi nal model had a good fi t to the data (χ2 = 4.575, df = 2, p = .102, RMSEA = .070, CFI = .991). Paternal prenatal bonding prospectively predicted postnatal bonding at 6 and 24 months and bonding at 6 months predicted feelings of bonding at 24 months. Paternal postnatal bonding at 24 months, but not prenatal bonding or bonding at 6 months, was negatively associated with experienced parenting stress. Thus, higher levels of postnatal paternal bonding at 24 months were associated with lower levels of parenting stress in fathers. Although there was no direct path from paternal prenatal bonding to parenting stress, the indirect path through postnatal bonding at 24 months was signifi cant, as well as the indirect longitudinal path via bonding at 6 and 24 months (see Figure 2). This


66 | Chapter 3

means that higher levels of prenatal bonding lead to higher levels of postnatal bonding at 6 and 24 months and parental bonding at 24 months in turn is associated with lower levels of parenting stress.

-0.19 (0.03)***

-0.53 (0.05)***

0.55 (0.04)*** 0.64 (0.05)***

0.15 (0.06)* -0.08 (0.03)*

PBP PB6 PB24

PSF

Figure 2. Standardized path coeffi cients and standard errors for the associations between paternal bonding and parenting stress. Dashed lines are used for indirect eff ects. * p < .05, ** p <.01, *** p < .001. PBP = Paternal Bonding Prenatally, PB6 = Paternal Bonding at 6 months, PB24 = Paternal Bonding at 24 months, PSF = Parenting Stress Fathers.

Parental bonding and child executive functioning problemsA mediation model was tested to examine the mediation of parenting stress and parental bonding at 24 months in the association between parental bonding at 6 months and child executive functioning. The model included a direct path from parental bonding to child executive functioning, as well as indirect paths via bonding at 24 months and via parenting stress. Furthermore, the correlation between the two mediating variables was added to the model to assess their unique contribution. Although correlation analyses (Table 2) showed no signifi cant association between paternal bonding and child executive functioning, new recommendations for mediation analyses do not require a signifi cant direct eff ect for testing indirect (i.e., mediation) eff ects (Hayes, 2009; Rucker, Preacher, Tormala, & Petty, 2011). Therefore, mediation models were tested for both mothers and fathers.

MothersThe fi nal model (leaving out all non-signifi cant paths) for mothers had a good fi t to the data (χ2 = 4.161, df = 2, p = .125, RMSEA = .066, CFI = .994), and results (Figure 3) show that the (direct) association between maternal bonding at 6 months and child executive functioning problems that we observed in the correlation analyses was no longer signifi cant in the mediation model. In addition, the path between maternal bonding at 24 months and executive functioning problems was non-signifi cant, hence no mediation eff ect of postnatal bonding at 24 months


3


was found. However, the indirect eff ect via parenting stress was signifi cant, illustrating a mediation eff ect of parenting stress in the association between maternal bonding at 6 months and child executive functioning problems at 2 years. Higher levels of maternal bonding at 6 months are related to lower levels of parenting stress, which in turn are associated with less child executive functioning problems.

EF problems

-0.30 (0.04)***

0.61 (0.04)*** -0.50 (0.05)***

-0.50 (0.05)***

0.62 (0.04)***

MB6

MB24

PSM

Figure 3. Standardized path coeffi cients and standard errors for the associations between maternal postnatal bonding, parenting stress, and executive functioning problems. Dashed lines are used for indirect eff ects. * p < .05, ** p <.01, *** p < .001. MB6 = Maternal Bonding at 6 months, MB24 = Maternal Bonding at 24 months, PSM = Parenting Stress Mothers, EF = Executive Functioning problems.

FathersThe fi nal model for fathers (Figure 4) showed similar patterns of associations between bonding, parenting stress, and child executive functioning and also had a good fi t to the data (χ2 = 0.775, df = 2, p = .679, RMSEA = .000, CFI = 1.000). The non-signifi cant paths between paternal bonding at 6 and 24 months and child executive functioning were removed from the model and this eliminates postnatal bonding at 24 months as a possible mediator.

EF problems

-0.09 (0.04)**

-0.31 (0.07)***

0.20 (0.07)** -0.46 (0.06)***

0.73 (0.03)***

PB6

PB24

PSF

Figure 4. Standardized path coeffi cients and standard errors for the associations between paternal postnatal bonding, parenting stress, and executive functioning problems. Dashed lines are used for indirect eff ects. * p < .05, ** p <.01, *** p < .001. PB6 = Paternal Bonding at 6 months, PB24 = Paternal Bonding at 24 months, PSF = Parenting Stress Fathers, EF = Executive Functioning problems.


68 | Chapter 3

The indirect effect (i.e., mediation effect) of paternal bonding, via parenting stress, on child executive functioning was significant. This indicates that higher levels of paternal bonding at 6 months are related to lower levels of parenting stress, which in turn are associated with less child executive functioning problems.

DISCUSSION

The purpose of this study was to examine the associations between parental bonding, parenting stress, and child executive functioning. In line with our hypotheses, for both mothers and fathers, poorer prenatal bonding prospectively predicted poorer postnatal bonding, which in turn predicted more parenting stress. In addition, maternal bonding predicted child executive functioning problems, but this association was completely mediated by maternal parenting stress. For fathers, feelings of bonding also indirectly affected child executive functioning via parenting stress, however, no direct effect was found. Thus, parents with a lower quality of postnatal bonding were more vulnerable to parenting stress, which in turn was associated with more child executive functioning problems. Our first findings offer an extension of the little previous research on parental bonding and parenting stress by showing that prenatal feelings of bonding, through its association with postnatal bonding, are already related to parenting stress experienced in toddlerhood. In addition, we found that paternal bonding is related to parenting stress experienced by fathers, which to our knowledge had not been examined before. The finding that parental (postnatal) bonding is related to parenting stress is in accordance with previous research showing that in depressed mothers a better quality of the maternal bond reduced the experience of parenting stress (Reck et al., 2016). Mothers and fathers who feel less connected to their child might experience daily stresses related to parenting more as a burden than parents who do feel a strong connection with their child. Another explanation may be that some parents are less emotionally and cognitively preoccupied with their child because of, for example, chronic stresses or preoccupations with other life goals. Therefore, they may experience raising a child as more stressful. However, these explanations are speculative and should be tested in future research. The finding that there was no direct effect (only indirect) of prenatal bonding on parenting stress might be explained by the fact that the parental bond, although relatively stable, changes over time and is also strongly affected by the birth of their child. To our knowledge, the association between parental bonding and parenting stress had not been assessed before in a community based (non-clinical) sample including both mothers and fathers. In addition, the present study adds to the literature showing that the quality of the parental bond during pregnancy is already associated with parenting stress experienced later, through its association with postnatal bonding.


3


Regarding the finding that parental bonding is associated with parenting stress and this in turn is related to child executive functioning development, the present study extends previous research concerning parental (mostly maternal) effects on child executive functioning. Prior studies have already linked early parenting behavior, such as parental scaffolding, sensitivity, mind-mindedness, stimulation, and control, to later child executive functioning skills (Bernier, Carlson, & Whipple, 2010; Fay-Stammbach et al., 2014). As maternal and paternal bonding comprise behavioral, affective, and cognitive components (Condon & Corkindale, 1998), the present study shows that next to parental behavior, also parental feelings and cognitions are related to child executive functioning. Parenting stress mediated the association between poor maternal and paternal postnatal bonding and child executive functioning problems. Possibly, parenting stress expresses itself in (negative) parental behavior and parent-infant interaction and in this way influences child cognitive development. However, a study by Crnic et al. (2005) found no mediating effect of parenting behavior in the association between parenting stress and child outcomes (i.e., behavior problems) and the authors argue that parenting stress also has a direct effect on child functioning. Specifically, they argued that a stressful, chaotic, and less positive environment may have a detrimental effect on children’s development even if this negative parental behavior is not directed at the child. It has been increasingly demonstrated in previous research that early caregiving experiences have an impact on infant brain development and later child executive functioning (Fay-Stammbach et al., 2014; Kok et al., 2015). Brain plasticity and a prolonged and rapid development of prefrontal brain regions in the first two years of life create a window of opportunity for early environmental experiences to affect infant brain development and a recent study indeed showed that normative variations in mother-infant interaction are associated with frontal resting EEG power, considered indicative of brain development (Bernier, Calkins, & Bell, 2016). Another mechanism by which early parental caregiving may impact later child executive functioning is the child’s stress response system (Blair et al., 2011). Higher levels of parenting stress may create a stressful environment for children hereby influencing children’s stress levels which in turn can affect neurocognitive development. Furthermore, parents provide their children with an environmental context to develop executive functioning skills. Parents who experience low levels of bonding and increased levels of parenting stress may spend less time interacting with their children and engage less in cognitively stimulating activities (e.g., playing, singing, and reading) with them. In addition, a caregiving environment dominated by high levels of parenting stress may create a chaotic and disorganized home situation in which children are not able to optimally develop executive functioning skills, whereas better family organization and greater parental warmth are associated with an increase in self-regulation and executive functioning abilities (Eisenberg et al., 2005; Schroeder & Kelley, 2010; Vernon-


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Feagans, Willoughby, & Garrett-Peters, 2016). The proposed mechanisms are not mutually exclusive and may act in concert in shaping later child executive functioning. Future research is needed to examine the possible mechanisms by which early caregiving factors, such as parenting stress and bonding, affect child neurocognitive development.

Strengths and limitationsSome important strengths of the study are the longitudinal design already starting in pregnancy, the focus on early parental indicators and child outcomes, and the inclusion of both mothers and fathers. However, the present study also had some limitations. Although our model suggests that parental bonding affects the level of parenting stress, and this in turn has an effect on child executive functioning, we cannot rule out that the effects also act in a different direction. In the current study, parenting stress and child executive functioning were both assessed at 24 months, making it difficult to examine directionality. Indeed, previous research, using a cross-lagged model to examine directionality, showed that parenting predicts change in child executive functioning, but child executive functioning also predicted change in parenting quality (Blair, Raver, & Berry, 2014). However, a previous study by Reck et al. (2016) suggests that parental bonding is a stronger predictor of parenting stress rather than the other way around, confirming the direction of effect proposed in the present study. Cross-lagged models examining the association between parental bonding, parenting stress and child executive functioning could provide better insight into the direction of effects. Another limitation of the current study is the use of self-report questionnaires. Although all questionnaires were validated and parental feelings and cognitions can only be measured via self-reports, self-reported data is always prone to response bias (e.g., social desirability). Most previous research used performance-based tests of executive functioning, providing only a momentary evaluation that is susceptible to environmental effects. In contrast, the BRIEF-P offers a measure of executive functioning in the everyday context. Parental assessments of executive functioning may be more accurate than observers’ assessments because parents know their children best and see a wide range of behaviors in different contexts. In addition, young children may underperform during executive functioning tests administered by strangers due to shyness, possibly depending on the extent to which they are familiar with interacting with non-parental caregivers. Future research could focus on the potential effect of non-parental caregivers on child executive functioning as this was not explored in the present study. However, internal consistency and test-retest stability of the BRIEF-P are accurate, and correlations with other measures of attention and behavior are consistent (Gioia et al., 2003; Isquith et al., 2005). In addition, scores on the BRIEF-P are associated with objective measures of cognitive abilities and it has predictive validity in early childhood (Clark et al., 2010). We cannot completely rule out that maternal report on low maternal bonding, parenting stress and child executive functioning reflects a common negative or positive perceptual


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bias, and thus common method variance. However, a critical review of studies stating that mothers, who experience adverse psychological functioning, have distorted perceptions of their children’s problems points out that empirical evidence for this statement is questionable (Richters, 1992). In addition, no direct effect of paternal bonding on mother-reported child executive functioning problems was found. While analysis of the indirect effect via paternal parenting stress revealed a significant finding, the used method deviates from classical mediation analysis practice (requiring a significant direct effect), and results should be interpreted with caution. Although maternal reports are a valid portrayal of child functioning, including father reports of child executive functioning would enable a reduction of potential reporter bias by using a cross-informant approach. In addition, future research could combine parent reported and observational data on child executive functioning and include observational data on actual parenting behavior to further strengthen the present findings. In sum, the present study suggests that the quality of the pre- and postnatal parental bond is related to the amount of parenting stress that is experienced by both mothers and fathers. In addition, the level of parenting stress experienced is in turn related to later child executive functioning abilities. Parents who experience a lower quality bond with their child are more vulnerable to parenting stress, and their children are at risk for developing future executive functioning problems. These findings indicate a need for attention on the early parent-child relationship as experienced by the parents. Early intervention or prevention programs to improve the parental bond and reduce parenting stress could be beneficial for child cognitive development. Concepts addressing parental feelings and cognitions (e.g., bonding) should be incorporated in future research on determinants of child behavioral and (neuro)cognitive development. In addition, future longitudinal research should shed more light on the mechanisms involved in the associations of parental bonding and parenting stress with child executive functioning. This study demonstrates that, in addition to previously established relationships between parental behavior and child executive functioning, parental feelings and cognitions are important predictors of later child cognitive development as well.


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Östberg, M., & Hagekull, B. (2000). A structural modeling approach to the understanding of parenting stress. Journal of Clinical Child Psychology, 29, 615-625. doi:10.1207/S15374424JCCP2904_13

Ramchandani, P. G., Domoney, J., Sethna, V., Psychogiou, L., Vlachos, H., & Murray, L. (2013). Do early father–infant interactions predict the onset of externalising behaviours in young children? Findings from a longitudinal cohort study. Journal of Child Psychology and Psychiatry, 54, 56-64. doi:10.1111/j.1469-7610.2012.02583.x

Reck, C., Zietlow, A.-L., Müller, M., & Dubber, S. (2016). Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding. Archives of Womens Mental Health, 19, 473-482. doi:10.1007/s00737-015-0590-4

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Sarkadi, A., Kristiansson, R., Oberklaid, F., & Bremberg, S. (2008). Fathers’ involvement and children’s developmental outcomes: A systematic review of longitudinal studies. Acta Paediatrica, 97, 153-158. doi:10.1111/j.1651-2227.2007.00572.x

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Longitudinal associations between

maternal and paternal bonding,

parenting self-effi cacy and child

temperament

Chapter 4

This chapter is based on:

de Cock, E. S. A., Klimstra, T. A., Vreeswijk, C. M. J. M., Maas, A. J. B. M., Meeus, W. H. J., & van Bakel, H. J. A. (submitted). Longitudinal associations between maternal and paternal bonding, parenting self-effi cacy and child temperament.


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ABSTRACT

There is emerging evidence that, in addition to behavioral components, affective and cognitive components of parenting are also predictive of child outcomes. However, the effects of parental feelings and cognitions on child temperament have been understudied. In the present study, we examine the effect of parental bonding and parenting self-efficacy on the child temperamental dimensions negative affect and effortful control. In addition, we aim to determine whether parenting self-efficacy is a mediator in the association between parental bonding and child temperament. Maternal (N = 335) and paternal (N = 263) bonding was assessed at 26 weeks of pregnancy, and at 6 and 24 months postnatally. Parenting self-efficacy was assessed at 6 months after birth and both parents reported on their child’s negative affect and effortful control at 24 months. Results show that parental bonding is positively associated with effortful control and negatively with negative affect. Moreover, for both parents early bonding had a positive effect on their experienced parenting self-efficacy. For fathers, experienced parenting self-efficacy in turn predicted toddler negative affect. However, parenting self-efficacy did not play a role in explaining the association between bonding and child temperament. These results point to the importance of parental bonding for both parents and children.

Keywords: maternal bonding; paternal bonding; prenatal bonding; postnatal bonding; parenting self-efficacy; child temperament


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Parental bonding, parenting self-efficacy, and child temperament | 79

INTRODUCTION

Compared to parental behavior, the effects of parental feelings and cognitions on child development have been understudied. However, there is emerging evidence that these components of parenting have meaningful effects (Coleman & Karraker, 2000; Dix, 1991; Jones & Prinz, 2005). Early parental feelings of bonding have previously been linked to parenting stress and child social emotional development (de Cock et al., 2016; Mason, Briggs, & Silver, 2011). Also, parental cognitions about parenting self-efficacy have been studied in association with child outcomes, especially child temperament (Lipscomb et al., 2011; Verhage, Oosterman, & Schuengel, 2013). Although previous research makes it plausible that both parental feelings and parental cognitions affect child temperament, this possibility has not yet been investigated. Therefore, the present study examines the association of the early parent-to-child affective bond with child temperament and the mediating role of parenting self-efficacy.

Negative affect and effortful controlRothbart defines childhood temperament as relatively enduring individual differences in reactivity and self-regulation (Rothbart & Derryberry, 1981). Reactivity refers to the child’s behavioral and physiological reactions to changes in the environment. Self-regulation or effortful control refers to neural and behavioral processes (e.g., attention) that can serve to modulate reactivity (Rothbart & Derryberry, 1981). Temperament shows significant continuity from infancy and toddlerhood to middle childhood (Komsi et al., 2006; Putnam, Rothbart, & Gartstein, 2008) and is a precursor of later personality and social development (Caspi & Silva, 1995; Rothbart, 2007). In addition, in previous literature, links have been established for early temperament characteristics with child and adolescent behavior problems (Caspi, Henry, McGee, Moffitt, & Silva, 1995; De Pauw & Mervielde, 2010; Lonigan, Phillips, & Hooe, 2003; Muris & Ollendick, 2005). Especially the temperamental factors negative affectivity and effortful control, precursors of later Big Five personality traits neuroticism and conscientiousness (Rothbart, 2007), have been frequently studied and related to child outcomes (Muris & Ollendick, 2005). For example, in infancy, toddlerhood, and early childhood both high levels of negative affectivity and low levels of effortful control predict internalizing and externalizing problems in subsequent years (Gartstein, Putnam, & Rothbart, 2012). In particular, the combination of high levels of negative affectivity and low levels of self-regulation (or effortful control) to control this negative reactivity have a detrimental effect on child behavior problems (Eisenberg et al., 2000; Gartstein et al., 2012). Furthermore, the adult counterparts of negative emotionality and effortful control, neuroticism and conscientiousness, are key to adult functioning and have been related to a wide range of health-related (psychopathology, longevity) and achievement-related (i.e.,


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career success) outcomes (Kotov, Gamez, Schmidt, & Watson, 2010; Roberts, Kuncel, Shiner, Caspi, & Goldberg, 2007).

Parental bonding and child outcomesEven though temperament development shows continuity over time and is partly biologically determined, it is also subject to change, involving environmental experiences like caregiving influences (Rothbart & Derryberry, 1981; Saudino, 2005). As parents play a key role in the early child’s environment, their feelings, cognitions, and behavior can affect the development of their child’s temperament. During the early years, as children’s brains are still rapidly developing, caregivers provide the most important external source of stimulation and regulation and hereby might affect the development of temperament. While parenting competence is most often studied from a behavioral perspective, parental feelings and cognitions are also key components of parenting competence (Bugental & Johnston, 2000; Coleman & Karraker, 2000; Dix, 1991). Parental bonding and parenting self-efficacy are two potentially important types of feelings and cognitions in this regard, with established effects on child outcomes. According to Condon and colleagues (Condon, 1993; Condon & Corkindale, 1998; Condon, Corkindale, & Boyce, 2008) the parental bond, or the emotional tie from parent to child, is composed of affective, cognitive, and behavioral components. The core of parental bonding is affective (i.e., “love”) and gives rise to parental cognitions concerning the child that eventually expose themselves in parental behavior towards the child. This affective tie from parent to child already forms in the prenatal period, when parents develop feelings of love for their fetus (Condon, 1993; Condon & Corkindale, 1997). Although in previous research this prenatal bond is often referred to as maternal fetal attachment, it is actually conceptually distinct from attachment relationships as described in attachment theory, as these refer to the child-to-caregiver relationship from the child’s perspective (Walsh, 2010). The prenatal bond is an important early indicator of postnatal bonding and the quality of parent-infant interaction (de Cock et al., 2016; Maas, de Cock, Vreeswijk, Vingerhoets, & van Bakel, 2016; Müller, 1996; Siddiqui & Hägglöf, 2000). The very little research that has been done on the effects of parental bonding on child development suggests that poor parental bonding may have detrimental effects on child functioning. Lower levels of maternal bonding at 2 weeks and 14 months postpartum has been found to be a predictor of child behavior problems at age 5-6 years, even after taking maternal psychopathology into account (Fuchs, Möhler, Reck, Resch, & Kaess, 2016). In addition, a lower quality of maternal bonding at 2 months has been prospectively linked to child social emotional developmental outcomes at 6 months (Mason et al., 2011). However, the predictive effect of parental bonding on child temperament has not been extensively studied before. De Cock et al. (2016), using a person-centered technique, found that parents who consistently experienced less bonding with their baby from pregnancy to toddlerhood reported more difficult temperament at 6 months, and


4


more negative affectivity and less effortful control at 2 years. However, in this study it was not evaluated whether early parental bonding was predictive of later child temperament. In addition, parental warmth and positive expressivity have been found to predict children’s effortful control 2 years later (Eisenberg et al., 2005).

Parental bonding and parenting self-efficacyThe quality of the parental bond has not only been linked to later child outcomes, but also to parental psychological functioning and behavior. Maternal (prenatal) bonding has been associated with maternal role adjustment, postnatal mother-infant interaction and maternal involvement (Müller, 1994; Siddiqui & Hägglöf, 2000). For both mothers and fathers, a lower quality of the parental bond has also been related to more parenting stress (de Cock et al., 2016; Mason et al., 2011). These findings suggest that parents who feel less connected to their child, have less confidence in their ability to carry out the parental role. Moreover, these parents may experience the child as more difficult. Feelings of parenting self-efficacy may therefore be an important and likely mechanism linking parental bonding and child temperament. However, the longitudinal association between both maternal and paternal bonding, feelings of parenting confidence or self-efficacy and child temperament has not been examined before. Consistent with Bandura’s theory on general self-efficacy (1977), parenting self-efficacy entails the (future) caregiver’s belief in or expectations concerning their ability to be successful in the parenting role (Coleman & Karraker, 1998). Feelings of parenting self-efficacy were found to be stable over time during pregnancy and in the postpartum period (Porter & Hsu, 2003). Moreover, strong associations have been found between feelings of parenting self-efficacy, actual parenting competence, parenting satisfaction, and child adjustment (for a review see Jones & Prinz, 2005). Research has further shown that parents who experience more confidence in their parenting skills, show more parental warmth and involvement towards their children (De Haan, Prinzie, & Deković, 2009; Teti & Gelfand, 1991). In addition, a review by Coleman and Karraker (1998) shows that parenting self-efficacy is often an important predictor of parenting quality, or a mediator between psychosocial variables (e.g., depression, marital support) and parental functioning. Thus, parenting self-efficacy is related to the ability to provide the child with a healthy caregiving environment and in this way possibly affects child development (Coleman & Karraker, 1998).

Parenting self-efficacy and child outcomesParenting self-efficacy has indeed, directly and indirectly (via parenting behavior), been linked to child behavior problems, socio-emotional functioning, and academic achievement (Jones & Prinz, 2005). According to social learning theory (Bandura & Walters, 1977), children learn


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and adjust their behavior patterns based on observing behavior of others (i.e., models) and observing the consequences of behavior (i.e., reinforcement). This reinforcement of behavior has the most impact when it meets the child’s needs. Self-efficacy theory (Bandura, 1977) poses that experienced self-efficacy determines the way of selecting, coping with, and persisting in difficult situations. Parents with low levels of confidence in their parenting role might not be able to manage difficult child temperament (i.e., high levels of negative reactivity and low levels of effortful control) in a sufficient way, hereby negatively influencing child behavior. This is confirmed by research showing that parenting self-efficacy is, cross-sectionally, linked to (parent-reported) toddler temperamental behavior, such as annoying and disruptive behavior, compliance, negative affectivity, and overall difficult temperament (Coleman & Karraker, 2003; Gross & Tucker, 1994). In a longitudinal study, Lipscomb et al. (2011), showed that decreases in parenting self-efficacy were related to increases in parent-reported child negative emotionality from 9 to 27 months. In addition, quasi-experimental research demonstrates that children whose mothers received an intervention with positive feedback to reinforce their parenting self-efficacy, were more easy and positive towards their mothers (Mouton & Roskam, 2015). To the best of our knowledge no previous longitudinal study specifically examined the effect of parenting self-efficacy on child effortful control. However, previous research does indicate that more general parenting practices (e.g., positive and negative control, responsiveness) are predictive of child effortful control and self-regulation (Karreman, van Tuijl, van Aken, & Deković, 2006, 2008). Most research on temperament and parenting self-efficacy has focused on the effect of a difficult temperament on subsequent feelings of parenting self-efficacy. Even experimental research shows that, for example, infant crying affects expected parenting self-efficacy (de Cock, Henrichs, Rijk, & van Bakel, 2015). However, there are also indications that parenting self-efficacy affects children’s temperament (Verhage et al., 2013). Verhage et al. (2013) examined the direction of effects by means of cross-lagged analyses and concluded that higher maternal parenting self-efficacy at 23 weeks of pregnancy and 3 months after birth predicted lower subsequent infant negative reactivity, whereas infant negative reactivity at 3 months was not significantly associated with parenting self-efficacy at 12 months. Moreover, these findings suggest that even maternal prenatal feelings of parenting self-efficacy, unbiased by child effects, have an effect on later child temperament. Thus, while often neglected in previous research, it is important to examine longitudinal associations of parenting self-efficacy with child temperament development. In addition, effortful control, believed to be an important protective factor in the development of behavior problems, has not yet sufficiently been investigated in association with parenting self-efficacy.


4


The present studyThere is some evidence that the parental bond and parenting self-efficacy predict child temperament, and that bonding and self-efficacy are associated. This makes it possible that bonding affects temperament via self-efficacy. However, this possibility has not been examined until now. Studying the effect of early parental bonding on parenting self-efficacy and subsequent toddler temperament problems, might uncover starting points for early prevention and intervention opportunities. Thereby, it might become feasible to stop a potential negative spiral leading to suboptimal child development. Another issue that is not yet sufficiently addressed by previous research studying parental effects on child temperament, is the role of fathers. Despite growing evidence that fathers play a key role in child development, they are still often ignored in research on parenting (Lewis & Lamb, 2003; Ramchandani et al., 2013). Therefore, little is known about the role of paternal bonding and paternal parenting self-efficacy on later child functioning. Some previous research shows that the association between self-efficacy and child temperamental behavior is similar for mothers and fathers (Lipscomb et al., 2011), while other research suggest stronger associations for mothers compared to fathers (Gross & Tucker, 1994). Parental early bonding patterns and their association to parent- child- and contextual factors, were found to be similar, although somewhat stronger for mothers (de Cock et al., 2016). In addition, since mothers and fathers interact with their children at different times and may elicit different behavior from them, it is important to take both parents’ perspectives into account. In the present study, we will examine the effects of prenatal and postnatal parental bonding and parenting self-efficacy on the temperamental dimensions negative affect and effortful control in toddlerhood. Furthermore, we will examine whether parenting self-efficacy is a mediator in the association between parental bonding and toddler temperament. Based on the findings of previous research, we hypothesize that early bonding and parenting self-efficacy are negatively related to child negative affectivity and positively to effortful control. In addition, we expect that parents with low levels of bonding also have lower confidence in their parenting skills, which in turn has a harmful effect on child temperament.

METHOD

Participants and procedureThe present study is part of the prospective longitudinal cohort study “Expectant Parents”, which is focused on prenatal (risk) factors of postnatal child development, parenting, and parent–infant relationships. A detailed description of the design and procedure of the complete study has been described elsewhere (Maas, Vreeswijk, de Cock, Rijk, & van Bakel, 2012). Maternal and paternal bonding was assessed at approximately 26 weeks of pregnancy,


84 | Chapter 4

and at 6 months and 24 months after birth via postal questionnaires. At 6 months postnatally, parents completed a questionnaire on parenting self-efficacy. Both parents reported on their child’s negative affect and effortful control via questionnaires at 24 months. Only parents of whom data was available on at least two measurement moments were included in the analyses. Of the 409 mothers and 319 fathers who originally agreed to participate in the study, 335 mothers (81.9 %) and 263 fathers (82.4%) were included in the final sample. Most of the parents were Dutch (mothers: 83.2%, fathers: 84.4%, Non-Dutch parents had a Turkish, Moroccan, Antillean, or Indonesian background) and were highly educated as 65.4% of the mothers and 67.4% of the fathers had 9 or more years of education after primary school. At baseline (i.e., 26 weeks of pregnancy) mothers and fathers were on average 31.7 (SD = 4.23, range 17 – 44) and 34.2 (SD = 4.47, range 23 – 50) years old, respectively. Children (49.6% boys, 55.8% firstborns) were born at a mean gestational age of 39.8 (SD = 1.6) weeks and had a mean birth weight of 3427.8 (SD = 538.5) grams. All parents signed informed consent before participating in the study. This study has been approved by the medical ethics committee of the St. Elisabeth hospital in Tilburg, the Netherlands (date: 13-08-2008, registration number: NL 23376.008.08).

MeasuresParental bondingAt 26 weeks of pregnancy, maternal bonding was assessed with the Maternal Antenatal Attachment Scale (MAAS; Condon, 1993), which consists of 19 items (Cronbach’s alpha = .76). Fathers completed the Paternal Antenatal Attachment Scale (PAAS; Condon, 1993), which consists of 16 items (Cronbach’s alpha = .78). An example item for both the MAAS and PAAS is “Over the past two weeks I have thought about, or have been preoccupied with the

baby inside me/the developing baby”. Postnatal bonding at 6 and 24 months was assessed with the Maternal/Paternal Postnatal Attachment Scales (MPAS/PPAS; Condon & Corkindale, 1998; Condon et al., 2008), which both consist of 19 items (Cronbach’s alphas between .75 and .83). An example item for both the MPAS and PPAS is “When I am not with the baby/child, I find myself

thinking about the baby/child”. For all bonding scales, items were scored 1-5 with higher scores indicating higher levels of bonding.

Parenting self-efficacySix months after the birth of their child, parents completed a questionnaire on parenting self-efficacy. The Perceived Maternal Parenting Self-Efficacy questionnaire (PMP S-E; Barnes & Adamson-Macedo, 2007) consists of 20 items which are rated on four-point scale (1= strongly

disagree, 4=strongly agree). A total score containing all items was used to represent parenting self-efficacy, as the scree plot of an exploratory factor analysis (EFA) clearly revealed a 1-factor solution and internal consistency of for both mothers and fathers was high (Cronbach’s alpha


4


of .94 and .95, respectively). An example item of the PMP S-E is “I am good at soothing my baby

when he/she becomes upset.”

Child negative affect & effortful controlAt 24 months, parents reported on their child’s negative affect and effortful control. These two temperament dimensions were assessed with the Early Childhood Behavior Questionnaire (ECBQ; Putnam, Gartstein, & Rothbart, 2006). In the present study, one item (When another

child took away his/her favorite toy, how often did your child not react with sadness?) was omitted because of negative inter-item correlations and a detrimental effect on internal consistency, which was probably caused by its complicated formulation. After this, the Negative Affect subscale was composed of 11 items and had sufficient internal consistency for both mothers and fathers (Cronbach’s alpha .68 and .65, respectively). An example item of this subscale is “When told that it is time for bed or a nap, how often did your child: react with anger?” The subscale Effortful Control was composed of 12 items and also had sufficient internal consistency for both mothers and fathers (Cronbach’s alpha .75 and .68, respectively). An example item of this subscale is “When playing alone, how often did your child play with a set of objects for 5 minutes or

longer at a time?” Items are scored 1 (Never) to 7 (Always) or “Not applicable” and higher scores (after reverse coding several items) indicate higher levels of negative affect or effortful control.

Statistical analysesDescriptive statistics and Pearson correlation analyses were conducted in IBM SPSS Statistics 22. R.J. Little’s Missing Completely At Random test (1988) indicated that the data of mothers (χ2 = 14.667, df = 19, p = .743) as well as fathers (χ2 = 15.178, df = 20, p = .766) were indeed missing at random. In order to obtain equal sample sizes for subsequent analyses, missing data were, therefore, imputed using the Expectation Maximization algorithm. We performed Structural Equation Modeling (SEM) in Mplus 7 (Muthén & Muthén, 1998-2015) to examine the associations between parental bonding, parenting self-efficacy, and child negative affect and effortful control. Separate models were estimated for mothers and fathers. Missing values were handled by Full Information Maximum Likelihood (FIML) estimation. By using SEM, multiple measurement occasions of parental bonding could be taken into account in one model predicting child negative affect and effortful control, while testing the mediating role of parenting self-efficacy. In addition, to obtain more reliable estimates of child negative affect and effortful control, mother and father reports were combined in latent factors. First, the items of the subscales negative affect and effortful control were loaded on two latent variables for each parent. Subsequently, the negative affect and effortful control latent variables of mothers and fathers were loaded on common latent variables “negative affect” and “effortful control”. To reduce model complexity and lower the number of parameters compared to the sample size, parcels (3 per construct) consisting


86 | Chapter 4

of multiple items instead of individual item indicators were used (T. D. Little, Cunningham, Shahar, & Widaman, 2002). These parcels were formed by means of item-to-construct balance, which entails that items with the highest factor loading (obtained from an EFA) are combined with items with lower factor loadings to obtain parcels that are equally balanced regarding diffi culty and discrimination (T. D. Little et al., 2002). After determining parcels for mother reports, the same parcels were used for father reports. An illustration of the model described can be found in Figure 1.

Prenatal bonding

NA

EC

Parenting self-efficacy

Bonding at 6 months

Bonding at 24 months

NA mother

NA father

EC mother

EC father

P1NA m

P2NA m

P3NA m

P1NA f

P2NA f

P3NA f

P1EC m

P2EC m

P3EC m

P1EC f

P2EC f

P3EC f

Figure 1. Illustration of the structural equation model examining the associations between (prenatal) bonding, parenting self-effi cacy, and child negative aff ect and eff ortful control

NA = Negative Aff ect, EC = Eff ortful Control, P1NAm = Parcel 1 Negative Aff ect mother, P2NAm = Parcel 2 Negative Aff ect mother, P3NAm = Parcel 3 Negative Aff ect mother, P1NAf = Parcel 1 Negative Aff ect father, P2NAf = Parcel 2 Negative Aff ect father, P3NAf = Parcel 3 Negative Aff ect father, P1ECm = Parcel 1 Eff ortful Control mother, P2ECm = Parcel 2 Eff ortful Control mother, P3ECm = Parcel 3 Eff ortful Control mother, P1ECf = Parcel 1 Eff ortful Control father, P2ECf = Parcel 2 Eff ortful Control father, P3ECf = Parcel 3 Eff ortful Control father


4


RESULTS

Descriptive statistics and correlationsCorrelations among, and descriptive statistics of, the study variables are presented in Table 1. Reported levels of maternal as well as paternal bonding showed moderate to strong correlations over time from pregnancy to toddlerhood. Prenatal and postnatal maternal and paternal bonding were moderately positively correlated with parenting self-efficacy. Furthermore, postnatal bonding and parenting self-efficacy were weakly negatively correlated with child negative affect as reported by the same parent. In addition, moderate to strong positive correlations were found between prenatal and postnatal bonding, parenting self-efficacy and child effortful control as reported by same parent. Moreover, some weak but significant cross-informant correlations were found. For mothers, postnatal bonding was negatively correlated with child negative affect as reported by fathers. In addition, prenatal maternal bonding and maternal bonding at 24 months were positively correlated with child effortful control reported by fathers. For fathers, only paternal bonding at 24 months was positively correlated with child effortful control as reported by mothers. Finally, moderate negative correlations were found between child negative affect and effortful control for both mother and father reports, and moderate positive correlations were found between maternal and paternal reports of negative affect and effortful control.

Parental bonding, parenting self-efficacy, and child negative affect and effortful controlStructural equation models were used to examine the associations between parental prenatal and postnatal bonding, parenting self-efficacy, and child negative affect and effortful control. The model as depicted in Figure 1 was estimated separately for mothers and fathers. In the maternal model, a non-significant negative residual variance was found for the maternal latent factor of “effortful control”. In the paternal model, negative residual variances were found for the paternal latent factors of “effortful control” and of “negative affect”. In these cases, the residual variance was fixed to zero. As the model fit of both the maternal as well as the paternal model was not yet acceptable, suggested modification indices were examined. Based on these suggestions, a correlation between the error terms of parcel 2 and 3 of paternal effortful control was added to both models to allow for shared variance between the parcels that was not explained by the latent factor effortful control.

MothersThe final model for mothers had an acceptable fit to the data (χ2 = 164.317, df = 90, p < .001; CFI = .913; RMSEA = .050) according to recommended guidelines (Hu & Bentler, 1999; Kline, 2015). Standardized coefficients of the final model for mothers can be found in Table 2 and Figure 2.


88 | Chapter 4

Tabl

e 1.

Des

crip

tive

stat

istic

s an

d co

rrel

atio

ns o

f pa

rent

al b

ondi

ng, p

aren

ting

self-

effica

cy, a

nd c

hild

neg

ativ

e aff

ect

and

effor

tful

con

trol

. Upp

er

tria

ngle

com

pris

es m

ater

nal d

ata,

low

er tr

iang

le c

ompr

ises

pat

erna

l dat

a.

Vari

able

sM

(SD

)M

othe

rs (N

=335

)M

(SD

)Fa

ther

s (N

=263

)1

23

45

67

8

1. P

rena

tal b

ondi

ng75

.46

(6.3

0)55

.37

(5.9

6)-

.335

***

.327

***

.264

***

-.002

.334

***

-.051

.222

***

2. B

ondi

ng a

t 6 m

onth

s83

.29

(5.9

4)76

.59

(7.4

3).5

54**

*-

.670

***

.420

***

-.166

**.3

86**

*-.1

30*

.099

3. B

ondi

ng a

t 24

mon

ths

80.6

6 (5

.78)

74.7

2 (6

.12)

.548

***

.787

***

-.3

55**

*-.2

43**

*.5

30**

*-.1

95**

.226

***

4. P

aren

ting

self-

effica

cy71

.45

(6.7

2)66

.31

(7.5

7).2

58**

*.4

79**

*.4

04**

*-

-.147

**.3

17**

*-.1

09.1

02

5. N

A m

othe

r 2.

41 (0

.50)

-.023

-.114

-.095

-.042

--.3

17**

*.3

34**

*-.0

66

6. E

C m

othe

r4.

93 (0

.58)

.098

.069

.127

*-.0

40-.3

17**

*-

-.174

**.3

82**

*

7. N

A fa

ther

2.

58 (0

.47)

-.069

-.192

**-.2

65**

*-.2

89**

*.3

34**

*-.1

74**

--.2

88**

*

8. E

C fa

ther

4.

68 (0

.52)

.252

***

.314

***

.398

***

.268

***

-.066

.382

***

-.288

***

-

* p

< .0

5, *

* p

< .0

1, *

** p

< .0

01

Not

e. D

ue to

diff

eren

ces

in it

em fo

rmul

atio

ns p

rena

tal a

nd p

ostn

atal

, as

wel

l as

mat

erna

l and

pat

erna

l, bo

ndin

g sc

ores

can

not b

e di

rect

ly c

ompa

red.


4

Parental bonding, parenting self-effi cacy, and child temperament | 89

-.458***

.084**

.443***

-.249**

.359***

.251** .260**

.552***

.261***

.335***

NA

EC

Bonding 6 months

Bonding 24 months

Prenatal bonding


Figure 2. Structural part of the fi nal maternal model on bonding, parenting self-effi cacy, and child outcomes. Dashed lines are used for relevant indirect eff ects.* p < .05, ** p < .01, *** p < .001.

Figure 2 shows signifi cant within-time correlations between maternal bonding and parenting self-effi cacy at 6 months (r = .359, p < .001), of maternal bonding at 24 months with child negative aff ect (r = -.249, p = .01) and eff ortful control (r = .443, p = < .001), and between the latent factors eff ortful control and negative aff ect (r = -.458, p < .001). More importantly, signifi cant prospective direct eff ects were found of maternal prenatal bonding on maternal postnatal bonding and parenting self-effi cacy at 6 months. In turn, postnatal bonding at 6 months predicted postnatal bonding at 24 months. Thus, mothers with higher levels of prenatal bonding experienced higher levels of bonding and parenting self-effi cacy six months postpartum. In addition, mothers with more feelings of bonding in infancy experienced higher levels of bonding in toddlerhood. Moreover, maternal prenatal bonding and postnatal bonding had signifi cant direct eff ects on child eff ortful control. This indicates that children of mothers who experienced a higher quality of early bonding had higher levels of eff ortful control. All other direct paths were non-signifi cant (see table 2). Although parenting self-effi cacy did not mediate the association between prenatal bonding and child temperament, the indirect eff ect of prenatal bonding on eff ortful control via bonding at 6 months was signifi cant (β = .084, p = .003; Figure 2). Thus, the positive eff ect of prenatal bonding on child eff ortful control is (partly) mediated by higher levels of early postnatal bonding.


90 | Chapter 4

Tabl

e 2.

Sta

ndar

dize

d co

effici

ents

(sta

ndar

d er

rors

) of t

he a

ssoc

iatio

ns b

etw

een

mat

erna

l (pr

enat

al) b

ondi

ng, m

ater

nal p

aren

ting

self-

effica

cy, a

nd

child

neg

ativ

e aff

ect a

nd e

ffort

ful c

ontr

ol

Mat

erna

l bon

ding

6

mon

ths

Mat

erna

l par

entin

g se

lf-effi

cacy

M

ater

nal b

ondi

ng

24 m

onth

sN

egat

ive

affec

tEff

ortf

ul c

ontr

ol

β (S

E)p-

valu

eβ

(SE)

p-va

lue

β (S

E)p-

valu

eβ

(SE)

p-va

lue

β (S

E)p-

valu

e

Mat

erna

l pre

nata

l bon

ding

.335

(.04

8)<

.001

.261

(.05

2)<

.001

.094

(.05

6).0

92.0

79 (.

095)

.410

.260

(.07

6).0

01

Mat

erna

l bon

ding

6 m

onth

sn/

an/

an/

an/

a.5

52 (.

049)

< .0

01-.1

59 (.

099)

.111

.251

(.07

7).0

01

Mat

erna

l par

entin

g se

lf-effi

cacy

n/a

n/a

n/a

n/a

.067

(.05

6).2

26-.1

12 (.

096)

.245

.112

(.07

8).1

51

Tabl

e 3.

Sta

ndar

dize

d co

effici

ents

(sta

ndar

d er

rors

) of t

he a

ssoc

iatio

ns b

etw

een

pate

rnal

(pre

nata

l) bo

ndin

g, p

ater

nal p

aren

ting

self-

effica

cy, a

nd c

hild

ne

gativ

e aff

ect a

nd e

ffort

ful c

ontr

ol

Pate

rnal

bon

ding

6

mon

ths

Pate

rnal

par

entin

g se

lf-effi

cacy

Pa

tern

al b

ondi

ng

24 m

onth

sN

egat

ive

affec

tEff

ortf

ul c

ontr

ol

β (S

E)p-

valu

eβ

(SE)

p-va

lue

β (S

E)p-

valu

eβ

(SE)

p-va

lue

β (S

E)p-

valu

e

Pate

rnal

pre

nata

l bon

ding

.553

(.04

3)<

.001

.255

(.05

8)<

.001

.157

(.06

1).0

10.0

51 (.

101)

.615

.197

(.09

9).0

47

Pate

rnal

bon

ding

6 m

onth

sn/

an/

an/

an/

a.6

20 (.

058)

< .0

01-.1

06 (.

106)

.320

.106

(.10

7).3

20

Pate

rnal

par

entin

g se

lf-effi

cacy

n/a

n/a

n/a

n/a

.033

(.05

7).5

59-.1

98 (.

094)

.035

.022

(.09

5).8

22


4

Parental bonding, parenting self-effi cacy, and child temperament | 91

FathersThe fi nal model for fathers also had an acceptable fi t to the data, χ2 = 170.496, df = 90, p < .001; CFI = .905; RMSEA = .058. Standardized coeffi cients of the fi nal model for fathers are presented in Table 3 and Figure 3. Signifi cant within-time correlations were found between paternal bonding and parenting self-effi cacy at 6 months (r = .415, p < .001), of paternal bonding at 24 months with child negative aff ect (r = -.202, p = .018) and eff ortful control (r = .287, p = .001), and between the latent factors negative aff ect and eff ortful control (r = -.398, p = <.001; Figure 3).

-.050†

-.202*

.287**

-.398***

.415*** .197*

-.198*

.620***

.255***

.157*

.553***

Prenatal bonding

Bonding 6 months


Bonding 24 months

NA

EC

Figure 3. Structural part of the fi nal paternal model on bonding, parenting self-effi cacy, and child outcomes. Dashed lines are used for relevant indirect eff ects.

† p < .10, * p < .05, ** p < .01, *** p < .001.

Moreover, Figure 3 shows that paternal prenatal bonding signifi cantly predicted postnatal bonding at both 6 and 24 months, as well as paternal parenting self-effi cacy. This means that fathers with higher levels of bonding during pregnancy also experience higher levels of bonding after childbirth and feel more confi dent about their parenting self-effi cacy. In turn, early paternal postnatal feelings of bonding at 6 months predicted paternal bonding in toddlerhood. In addition, paternal prenatal bonding signifi cantly predicted child eff ortful control. This indicates that children of fathers with more feelings of bonding during pregnancy tend to have higher levels of eff ortful control as reported by their parents. Furthermore, paternal parenting self-effi cacy signifi cantly predicted child negative aff ect, indicating that children of fathers with more parenting self-effi cacy had lower levels of negative aff ect. All other direct paths were non-signifi cant (see Table 3).


92 | Chapter 4

To test for a mediating effect of parenting self-efficacy, the indirect effect of prenatal bonding via parenting self-efficacy on negative affect was examined. Results showed that paternal parenting self-efficacy did not significantly mediate the association between prenatal bonding and child negative affect (β = -.050 p = .059; Figure 3). However, a p-value of .059 suggests a trend towards statistical significance.

DISCUSSION

The present study examined the effect of early parental bonding on child temperament and the role of parenting self-efficacy in this association. The findings revealed that for mothers and fathers, a higher quality of pre- and postnatal bonding positively affects future and current toddler effortful control and that a higher quality of postnatal bonding is associated with less toddler negative affect. Moreover, for both parents early bonding had a positive effect on their experienced parenting self-efficacy. However, in contrast to the hypothesis, parenting self-efficacy did not play a role in explaining the association between bonding and child temperament. Only for fathers, experienced parenting self-efficacy predicted toddler negative affect, but the indirect effect from paternal bonding via parenting self-efficacy to child negative affect was only marginally significant.

Parental bonding and child temperamentThe results regarding parental bonding, parenting self-efficacy and child temperament suggest that parental affect (i.e., bonding) is a stronger predictor of child negative affect and effortful control than parental cognitions (i.e., self-efficacy) as most correlations with parenting self-efficacy disappeared when parental bonding was included in the model. For mothers, prenatal bonding had both a direct as well as indirect effect, via postnatal bonding, on child effortful control. The importance of parental emotions regarding the child has been underscored by Dix (1991). He proposes that parental emotions are barometers of parenting quality (and therefore indirectly also child developmental outcomes) and influence parental motivation, cognition, and expressive behaviors. Parental affect, according to Dix, is key to the parent-child relationship and central to communication. Affective parental communication subsequently elicits affect in children, helps processing of parental messages, and provides information about parental intentions, which in turn elicits cooperative child behavior. The finding that parental bonding predicts child outcomes is in accordance with the scarce literature prospectively linking parental bonding to child social-emotional development and behavior problems (Fuchs et al., 2016; Mason et al., 2011). Moreover, the present findings extend this literature by relating maternal and paternal bonding to child temperamental factors negative affect and effortful control in particular.


4


A possible explanation for the associations between early parental bonding and child temperament is provided by previous research suggesting that parental modeling of negative emotionality (i.e., in the case of poor bonding) and parental reactions to children’s emotions shape children’s future emotional responses (Denham, Mitchell-Copeland, Strandberg, Auerbach, & Blair, 1997). In addition, the experience and expression of more positive emotionality towards the child and more parental warmth creates a more favorable caregiving environment for children in which they can develop self-regulatory skills such as effortful control (Dix, 1991; Eisenberg et al., 2003; Eisenberg et al., 2005). Even before birth, a better quality of the parental bond towards the fetus is related to a better prenatal caregiving environment (e.g., better health behavior) for the developing child (Van den Bergh & Simons, 2009). In addition, previous research has repeatedly shown that a more stressful prenatal environment can affect postnatal child temperamental behavior (Buitelaar, Huizink, Mulder, de Medina, & Visser, 2003; Henrichs et al., 2009; Van den Heuvel, Johannes, Henrichs, & Van den Bergh, 2015). As low levels of prenatal bonding often go together with perceived stress (e.g., anxiety, depression; Alhusen, 2008; Maas, Vreeswijk, Braeken, Vingerhoets, & van Bakel, 2014; Yarcheski, Mahon, Yarcheski, Hanks, & Cannella, 2009), this might explain the association between prenatal bonding and child effortful control. While bonding during pregnancy, infancy, and toddlerhood consistently was associated with toddler effortful control, only cross-sectional associations were found between parental bonding and toddler negative affect. This might be explained by the previous finding that effortful control is more sensitive to the environment than the reactive part of temperament (i.e., negative emotionality; Eisenberg & Morris, 2002). In addition, behavioral genetics studies demonstrate that the (negatively valenced) reactive part of temperament (e.g., distress to novelty, distress to limitations, emotionality, activity) is mostly determined by genes, while aspects of the regulative part of temperament, such as soothability and attention, were determined by shared environment only (Goldsmith, Lemery, Buss, & Campos, 1999; Schmitz, Saudino, Plomin, Fulker, & DeFries, 1996).

Parental bonding and parenting self-efficacyAnother contribution of the present study is the finding that early prenatal and postnatal bonding are associated with parents’ perceived parenting self-efficacy. Prenatal and early postnatal parental bonding can be seen as the earliest forms of parental feelings and cognitions, and these are associated with parental identity formation and parental role attainment (Habib & Lancaster, 2006; Rogan, Shimed, Barclay, Everitt, & Wylli, 1997). In nursing research, Rubin (1967) first introduced the theoretical framework of maternal role attainment, which was further elaborated on by Mercer (1981). This framework describes psychological processes that occur during pregnancy and the postpartum period (Walker, Crain, & Thompson, 1986). Although both the formation of a bond with the infant, as well as developing confidence in parenting


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are both important aspects of maternal identity formation and maternal role attainment, their association is scarcely studied. One study reports a cross-sectional correlation between maternal confidence and maternal bonding at 1 month postpartum (Williams et al., 1987). When parents do not feel a strong emotional connection to their child and as a result do not have a clear image of themselves as parents, this might create insecurity about their ability to parent. In contrast, when the formation of the parental bond (i.e., the affective part of the parental role) is successful, parenting self-efficacy (i.e., a cognitive aspect of the parental role) might also develop more naturally. Moreover, when parents feel a strong bond during pregnancy, this might result in, for example, gathering information about pregnancy and the developing child (Condon, 1993). When parents feel well-prepared this might lead to increased confidence in parenting.

Parenting self-efficacy and child temperament Although early parental bonding was found to be related to the temperamental dimensions negative affect and effortful control in toddlerhood and also to experienced parenting self-efficacy, the association between parental bonding and child temperament was not explained by parenting self-efficacy. Little evidence was found for direct effects of parenting self-efficacy on child temperament, ruling out a mediating effect of parenting self-efficacy. Only for fathers a direct effect (but no mediation) was found between parenting self-efficacy and subsequent negative affect. Findings regarding the association between parenting self-efficacy and child outcomes have been inconsistent. For example, whereas multiple studies did find links between parenting self-efficacy and child outcomes (for a review see Jones & Prinz, 2005), Slagt, Deković, de Haan, van den Akker, and Prinzie (2012) found no predictive effect of parenting sense of competence on children’s behavior. In addition, Coleman and Karraker (2003) found that general parenting self-efficacy was not related to toddler adjustment, whereas task-related parenting self-efficacy was. These findings might be explained by the consideration that it is not just feelings of competence that determine actual parenting competence. Parents can report low self-efficacy based on unwarranted insecurities about their parenting skills or report higher parenting self-efficacy to respond in a socially desirable way. This view is supported by research of Conrad, Gross, Fogg, and Ruchala (1992) showing that only the combined effect of maternal knowledge of child development and maternal parenting confidence was related to the quality of mother-child interactions. Mothers who were the most knowledgeable and confident had the most positive interactions, whereas mothers who felt most confident but knew the least about parenting and child development showed the least positive interactions. The direct effect between self-efficacy and toddler negative affect for fathers that was found in the present study, is in line with a recent study linking fathers’ perceived parenting competence to infant negative affect at 4 months of age (Potapova, Gartstein, & Bridgett,


4


2014). Parenting behavior could be a possible mechanism explaining the link that was found between paternal parenting self-efficacy and child negative affect as parenting self-efficacy has previously been associated with actual parenting competence (Jones & Prinz, 2005). Moreover, low paternal parenting self-efficacy can also directly affect children’s emotionality, as children are faced with their father’s feelings of insecurity and might react to them in a negative way. Fathers with less confidence in their parenting skills, or who in general feel less confident, might also perceive their child’s temperament to be more difficult. However, as maternal and paternal reports on child temperament were combined in the present study, this explanation is less likely. The difference that was found between mothers and fathers regarding the association between parenting self-efficacy and child temperament in the present study, could be explained by the fact that fathers generally, and also in the present study, experience less confidence in their parenting than mothers do (Hudson, Elek, & Fleck, 2001). As a result, fathers may exert a stronger detrimental effect. Taken together, the results concerning the associations between parental bonding, parenting self-efficacy and toddler temperament suggest that parental bonding and parenting self-efficacy have unique effects on child temperament. The association of parental bonding with toddler negative affect and effortful control is not explained by parenting self-efficacy. Instead, parental bonding affects both parental cognitions (i.e., parenting self-efficacy) as well as child functioning. These findings point to the importance of parental bonding for both parents and children. Future research is needed, however, to explore other mechanisms explaining the association between parental bonding and child temperament.

Strengths and limitationsAn important strength of the present study is its longitudinal design, starting in pregnancy. Whereas postnatal assessments of parental feelings and cognitions can already be affected by child characteristics and behavior, making it hard to determine the direction of effects, parental reports of prenatal bonding are unaffected by child effects. Another strength is the inclusion of both mothers and fathers as compared to previous studies that typically focused on mothers only. In addition, maternal and paternal reports of child negative affect and effortful control were combined as latent factors to reduce reporter bias. Mothers and fathers interact with their child in different ways, at different times, and in different contexts. Combining their reports provides a more complete picture of the child’s behavior that is less affected by the, potentially biased, view of only one observer. However, although parental bonding and parenting self-efficacy can only be assessed via self-report, these measures, as well as parental reports on temperament are prone to reporter bias such as social desirability. Future research should therefore ideally incorporate an additional observer, for example teacher reports, or observational measures of temperament to further limit reporter bias and assess children’s temperament in diverse contexts.


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While parent effects on child temperament have been established in previous longitudinal research (Verhage et al., 2013), much of the previous work on this topic is either cross-sectional or examines only child effects on parenting self-efficacy. In the present study, bidirectional effects cannot be ruled out as parenting self-efficacy was measured at 6 months after birth and could already be influenced by child effects. According to Bandura’s (1977) theory of self-efficacy, individuals can acquire more self-efficacy when they experience successes. Parents of children with difficult temperament might experience little success and as a result do not improve in their parenting self-efficacy. Low levels of parenting self-efficacy in turn can have a detrimental effect on child temperament development, creating a vicious circle. Additional longitudinal research (e.g., using a cross-lagged design) is needed to further determine directionality of effects. Besides the aforementioned considerations, another limitation of the present study is the relatively low-risk sample consisting of highly educated parents and children born without severe birth complications (e.g., extreme prematurity or low birth weight). As previous research points out that sensitive parenting is especially crucial for children with a difficult temperament (Bradley & Corwyn, 2008; Slagt, Dubas, Deković, & van Aken, 2016) the effects found in the present study might even be more pronounced in a high-risk sample, particularly including children with difficult temperament. In addition, measurements of parental feelings, cognitions, and behavior should be combined in longitudinal research to examine whether parental feelings and cognitions directly or indirectly affect child temperament.

Conclusion

To conclude, this study provides insight into the associations between early parental bonding, parenting self-efficacy, and children’s temperamental dimensions negative affectivity and effortful control. Although parental bonding appeared to be a stronger predictor of child temperament, fathers’ parenting self-efficacy also affected child negative affectivity. As child temperament is a key precursor for personality and psychosocial functioning in later childhood and even adulthood, the present findings provide important indications for early intervention. Moreover, the quality of the parental bond is related to early postnatally experienced parenting self-efficacy in both mothers and fathers. Thus, next to having an impact on child development, parental feelings of bonding also affect parents themselves. Research on the association between parental bonding and child functioning is still scarce and should be expanded to further strengthen the present findings and to explore other possible mechanisms explaining this association. Our findings show that the development and evaluation of early intervention programs to assist parents adjusting to parenthood and to help parents become aware, and if necessary improve, the emotional connection to their (unborn) child could be beneficial for both parental as well as child psychological functioning.


4


The findings of the present study support the notion that child temperament is subject to environmental influences and that parental feelings and cognitions are important in studying child development.


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Baby please stop crying:

An experimental approach to infant

crying, aff ect, and expected

parenting self-effi cacy

Chapter 5


de Cock, E. S. A., Henrichs, J., Rijk, C. H. A. M., & van Bakel, H. J. A. (2015). Baby please stop crying: An experimental approach to infant crying, aff ect, and expected parenting self-effi cacy. Journal of Reproductive and Infant Psychology, 33, 414-425, doi:10.1080/02646838.2015.1024212


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ABSTRACT

ObjectiveThe present study examines the effect of infant crying on parental affect, state anxiety and parenting self-efficacy in an experimental setting.

BackgroundInfant crying causes distress and feelings of incompetence in many parents. These frustrating parental feelings can lead to suboptimal caregiving behaviour or even child abuse. Studies focusing on the effects of infant crying experience causality issues, since parental behaviour can also increase infant crying.

MethodsOne hundred and sixteen students of Tilburg University were asked to babysit a lifelike crying doll for 10 minutes. With three conditions participants were exposed to either no crying, 5 minutes, or 10 minutes of crying.

ResultsParticipants in the crying conditions experienced more negative affect, state anxiety, and felt less confident about their ability to parent in the future.

ConclusionThese findings have implications for parents of newborn babies who experience distress and feelings of incompetence, caused by infant crying.

Key words: infant crying, affect, state anxiety, parenting self-efficacy, experiment


5

Infant crying, affect, and expected parenting self-efficacy | 107

INTRODUCTION

Infant crying represents a major concern of many young parents for which they often ask support and seek medical advice. Excessive or frequent infant crying is related to great parental distress, frustration, and maternal postnatal depressive symptomatology (Kaley, Reid, & Flynn, 2011; St James Roberts & Halil, 1991). These negative feelings may subsequently result in both suboptimal parent-infant interaction and marital discord (Meijer & van den Wittenboer, 2007; Räihä, Lehtonen, Huhtala, Saleva, & Korvenranta, 2002). In severe cases parents can even resort to child abuse to stop their infant’s crying (Reijneveld, van der Wal, Brugman, Hira Sing, & Verloove-Vanhorick, 2004). Next to feelings of distress, parents may feel incompetent as a parent when they are unable to comfort their infant. They experience a serious loss of confidence in their parenting behaviour (Oberklaid, 2000). Stifter and Bono (1998) showed that mothers of excessively, inconsolably crying infants reported less maternal self-efficacy, feeling less competent as a mother, and more feelings of guilt about leaving their child than mothers of infants who cried less. Causality issues in previous research limit knowledge of the association between infant crying, parental distress and parenting self-efficacy, since parental caregiving behaviour in turn also impacts infant behaviour (Hane & Fox, 2006). Infants of parents who experience high levels of stress and social isolation during pregnancy, and who feel insecure after birth, are more likely to cry excessively (Rautava, Helenius, & Lehtonen, 1993). Research on infant crying usually takes place in a naturalistic setting, with parent and infant (cry) characteristics affecting the results. The amount of infant crying is mainly assessed by parental self-report. This may be biased when parents are extremely distressed by infant crying. Experimental research with standardized setups may resolve causality and self-report problems and provide more insight into underlying mechanisms of the association between infant crying and parental distress and self-efficacy. Research which already used more standardized paradigms, with audio- and video segments of infant crying, has mainly focused on acoustic features of the cry and its effect on caregiving responses (e.g., time until picking up the baby), or on the rating of infant distress (Wood & Gustafson, 2001; Zeifman, 2004). Additionally, one study used tapes with a recorded crying sound in combination with an infant doll to examine women’s responses to infant crying while babysitting the doll (Gustafson & Harris, 1990). Most women (mothers and non-mothers) first tried to soothe the infant and subsequently tried to remove the cause of distress (e.g., feeding )(Gustafson & Harris, 1990). To our knowledge these paradigms have not yet been extensively used to study effects of infant crying on parenting sense of competence and distress. Previous work by Leerkes (2010) and Donovan, Leavitt, and Taylor (2005) used a more controlled study design, but this work only provided indirect evidence suggesting negative effects of infant crying on parenting self-efficacy. Leerkes (2010) found a negative correlation between expectant mothers’ negative emotions (e.g., irritation, anger, and anxiety) as a


108 | Chapter 5

response to video clips of a crying infant and expected parenting efficacy. Donovan, Leavitt, and Taylor (2005) manipulated the degree of infant difficulty with an audiotaped infant’s cry to which mothers had to respond by pressing a button (representing an action to try to soothe the infant). In addition, mothers’ degree of self-efficacy (i.e., illusory control) was assessed using laboratory observations. Only in the difficult infant condition mothers with high illusory control, which reflects an unrealistic overestimation of perceived control, displayed reduced sensitivity. However, these studies did not examine the direct effect of infant crying on maternal parenting self-efficacy using a real life simulation setting mimicking exposure to infant crying as realistic as possible. Incorporating such an approach, the present experimental study aims to gain more insight into the direct effect of infant crying on affect, anxiety, and parenting self-efficacy by manipulating the amount of infant crying using a lifelike baby doll with a recorded crying sound. This doll is normally intended for educational purposes and intervention programs to prevent teenage pregnancy (Didion & Gatzke, 2004). Using this doll Bruning and McMahon (2009) found that exposure to 9 minutes of crying increased women’s negative affect and state anxiety compared to exposure to a non-crying doll or no doll at all. Although the effect of infant crying on caretaking self-efficacy was not quantitatively investigated in the study of Bruning & McMahon (2009), a qualitative inspection of participants’ comments suggested a possible impact of infant crying on parents’ perceived confidence in parenting. With the present study we extend this previous work by quantitatively examining the effect of crying on standardized self-reports of parenting self-efficacy. Previous work suggests that parenting self-efficacy buffers against parenting stress and plays a crucial role in the development of parent-child relationships and child development (Bloomfield & Kendall, 2012; Jones & Prinz, 2005). Another extension of previous work is that our study tested a possible dose-response effect on affect, anxiety, and parenting self-efficacy by including two conditions varying in crying period. Inconsistent results regarding gender differences in caregivers’ response to infant crying have been reported. Frodi, Lamb, Leavitt, and Donovan (1978) found no differences in blood pressure and skin conductance in response to videotape presentations of crying infants between mothers and fathers. This was the case for responses to a stimulus baby as well as for perceptions of their own child. Boukydis and Burgess (1982) also found no gender differences in arousal in response to audiotaped infant crying. In contrast, Out, Pieper, Bakermans-Kranenburg, and Van Ijzendoorn (2010) observed a higher increase in heart rate in males than females during infant crying episodes. Because of these inconsistent findings we will also examine whether gender moderates the effects of infant crying on affect, anxiety, and parenting self-efficacy. In sum, this experimental study with a promising new real life simulation method will shed more light on the causal effect of infant crying on parental mood and sense of competence,


5


which in turn could help healthcare professionals providing support and advice to parents. The aims of this study are threefold: (a) to examine the effect of infant crying on affect, anxiety and expected parenting self-efficacy in a controlled setting that is as realistic as possible; (b) to examine a possible dose-response effect of infant crying on affect, anxiety, and expected parenting self-efficacy and (c) to examine possible gender differences in affect, anxiety, and expected parenting self-efficacy as a response to infant crying.

METHOD

Participants and procedureParticipants were undergraduate psychology students (N = 116, 78 females; M

age= 20.12,

SDage

= 2.08, range 18-27) from Tilburg University who voluntarily took part in this study in exchange for course credits. Only participants 18 years or older and without children were included. After signing informed consent, participants were randomly assigned to one of three conditions. In all conditions participants were asked to take care of a lifelike programmable baby doll for 10 minutes, according to the following instruction given by a research assistant: “This is Robin. Robin is three months old. We ask you to take care of Robin for 10 minutes, Robin is

a doll but behaves like a real baby, so we ask you to treat Robin as you would treat your own baby.

When you want to pick up the baby make sure you support the head just like you would with a real

baby.” The last sentence of the instruction was necessary to ensure the doll would not start crying due to lack of head support and interfere with the standardized crying conditions. After this instruction the research-assistant put the doll into a crib and then left the laboratory room of the developmental lab of Tilburg University. The quiet laboratory room was furnished with a desk, a chair, and participants had the opportunity to read a magazine. In condition 1 (control condition) the doll only made a few noises but did not cry, in condition 2 the doll cried for 5 minutes with a short break in between (two times 2.5 minutes of crying with 2 minutes break and 1 minute of silence before and after), and in condition 3 the doll cried for 10 minutes continuously. Within each condition the participants experienced exactly the same amount and intensity of crying. Before and after the experiment all participants received questionnaires in which they were asked to report about their feelings before and during the experiment, respectively. This study was approved by the Ethics Committee of Tilburg University.

MeasuresThe RealCare® Baby II-Plus lifelike programmable doll from Realityworks, Inc (www.realityworks.com) was used. This doll has very realistic features, weighs approximately 6 pounds, and produces a naturalistic crying sound. The doll was connected to a computer with a wireless


110 | Chapter 5

usb-stick. For this study the demonstration function of the software was used to allow standardized programming during periods of 10 minutes. The Dutch translation of the Positive and Negative Affect Scale (PANAS; Tellegen, Watson, & Clark, 1988) was administered to assess the participants’ affect before and during the experiment. The PANAS consists of 20 statements (e.g., “distressed”) with response categories ranging from 1 ‘Very slightly or not at all’ to 5 ‘Extremely’. Reliability of the Positive and Negative Affect subscales was high (α’s ranging from .81 - .88). State anxiety was assessed using the state subscale of the validated Dutch version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970; Van der Ploeg, Defares, & Spielberger, 2000). This subscale comprises 20 items (e.g., “I am worried”) with response categories ranging from 1 ‘Not at all’ to 4 ‘Very much so’. The internal consistency the Dutch State Anxiety subscale was good before and after the experiment (α’s of .93 and .94). An adapted Dutch version of the Perceived Maternal Parenting Self-Efficacy (PMPS-E; Barnes & Adamson-Macedo, 2007) was used to assess expected feelings of parenting self-efficacy (e.g., ‘I can tell when my baby is sick’ was adapted to ‘I expect I can tell when my baby is sick’). The PMPS-E consists of 20 items with response categories ranging from 1 ‘Strongly disagree’ to 4 ‘Strongly agree’. In the current study, reliability was excellent (α = .93). The PMPS-E was only administered before the experiment in a second round of data collection. Therefore, data on self-efficacy prior to the experiment was only available for 68 participants. Participants of the first and second round of data collection did not differ in sample characteristics (i.e., gender, age, and outcome variables) as indicated by independent t-tests and χ2-tests.

RESULTS

Statistical analysesThe change in positive and negative affect, state anxiety, and expected parenting self-efficacy was calculated by subtracting the baseline scores (reported before the experiment) from the scores reported after the experiment (indicating how the participants felt when taking care of the doll). These difference scores (Table 1) were used as the dependent variables in four analyses of variance (ANOVA) with condition as a factor. To examine whether gender moderated the effect of infant crying on distress and self-efficacy, we included the interaction between gender and condition in the analyses. When significant effects of condition were found Tukey post hoc tests were subsequently conducted.


5


Tabl

e 1.

Mea

ns a

nd s

tand

ard

devi

atio

ns (

betw

een

brac

kets

) of

Pos

itive

Affe

ct, N

egat

ive

Affe

ct, S

tate

Anx

iety

, and

Par

entin

g Se

lf-Effi

cacy

for

eac

h co

nditi

on.

Cond

ition

1N

o cr

ying

(n=3

9)Co

nditi

on 2

5 m

in c

ryin

g (n

=39)

Cond

ition

310

min

cry

ing

(n=3

8)

Pre

Post

diffe

renc

epr

epo

stdi

ffere

nce

pre

post

diffe

renc

e

Posi

tive

Affe

ct27

.67

(4.9

3)26

.41

(6.8

7)-1

.26

(6.6

2)27

.42a (6

.31)

26.5

8 (7

.49)

-1.0

1 (5

.17)

28.9

7 (6

.72)

25.4

4 (8

.05)

-3.5

3**

(6.7

9)

Neg

ativ

e A

ffect

14.6

9 (4

.62)

13.8

7 (4

.43)

-0.8

2 (4

.95)

14.5

8a (4.5

3)17

.43

(5.7

6)3.

05**

* (4

.38)

14.4

7 (4

.61)

18.8

9 (6

.36)

4.42

***

(6.3

3)

Stat

e A

nxie

ty40

.16

(8.8

7)39

.00

(10.

32)

-1.1

6 (1

0.99

)37

.03

(8.8

7)46

.41

(10.

42)

9.38

***

(8.3

1)38

.53

(9.1

7)50

.50

(10.

17)

11.9

7 **

* (1

1.14

)

Self-

Effica

cy59

.96b (6

,95)

61.7

2 (7

.96)

-0.1

3b (3.2

2)59

.70b (5

.80)

57.6

7 (7

.07)

-2.7

8b * (4

.97)

60.5

9b (7.2

9)57

.84

(7.3

6)-3

.00b **

(4.4

6)

Not

e. T

he c

hang

e be

twee

n ba

selin

e an

d po

st e

xper

imen

t sco

res

was

ana

lyse

d us

ing

paire

d sa

mpl

es t-

test

s.*

p <

.05,

**

p <

.01,

***

p <

.001

a.

n =

38

due

to m

issi

ng d

ata

b. E

xpec

ted

pare

ntin

g se

lf-effi

cacy

was

onl

y as

sess

ed b

efor

e th

e ex

perim

ent i

n a

seco

nd ro

und

of d

ata

colle

ctio

n, th

eref

ore

data

repo

rted

her

e is

onl

y fro

m a

ppro

xim

atel

y ha

lf of

the

part

icip

ants

(n=

68).


112 | Chapter 5

Preliminary analysesMeans and standard deviations of the study variables by condition are presented in Table 1. To account for the few missing values in the data we computed mean weighted mean sum scores for each outcome measure by multiplying raw mean scores by the number of items on each questionnaire. One person in the 5-minute condition did not complete the PANAS before the experiment, resulting in 115 subjects for analyses based on the PANAS. At baseline no differences were found among the three groups in positive affect, F(2, 112) = 0.73, p = .484, negative affect, F(2, 112) = 0.02, p = .978, state anxiety, F(2, 113) = 1.12, p = .331, and parenting self-efficacy, F(2,65) = 0.11, p = .900. Data were skewed for Negative Affect and State Anxiety. In addition to the analyses described below we therefore performed non-parametric Kruskall- Wallis tests (for post hoc analyses we used Mann-Whitney U tests with Bonferroni correction), which revealed the same results.

Positive and negative affectTo examine the effect of crying (i.e., condition as main factor) on the change in positive and negative affect two ANOVA’s were performed. For positive affect, no significant effect of condition was found, F(2, 111) = 1.95, p = .147, η2 = .034, whereas condition significantly affected Negative Affect F(2, 111) = 10.51, p < .001, η2 = .159. Tukey post hoc tests showed a significant difference between the control condition (no crying) and the 5-minute condition, M

diff = 3.87, p = .004, and between the control condition and the 10-minute condition, M

diff

= 5.24, p < .001. The 5-minute condition did not differ from the 10-minute condition, Mdiff

= 1.37, p = .480. This indicates that the increase in negative affect from baseline (pre-test) to post-test was larger for participants exposed to 5 or 10 minutes of crying than it was for the participants not exposed to crying. Figure 1 illustrates the effect of condition on positive and negative affect.

State anxietyChange in state anxiety significantly differed across conditions of crying, F(2, 112) = 19.21, p < .001, η2 = .255. According to post hoc tests the control and the 5-minute condition, M

diff =

10.54, p < .001, and the control and 10-minute condition significantly differed, Mdiff

= 13.13, p < .001. The 5-minute and 10-minute conditions did not differ significantly, M

diff = 2.59, p =

.476. Thus, the increase in state anxiety from pre-test to post-test was larger for participants exposed to either 5 or 10 minutes of crying than it was for the participants not exposed to crying (see Figure 1).


5


-4-3-2-10123456

Posi

tive

Affe

ct

-4-3-2-10123456

Neg

ativ

e Af

fect

-4-202468

10121416

Stat

e An

xiet

y

-4

-3

-2

-1

0

1

2

3

4

Pare

ntin

g Se

lf-Ef

ficac

y

Control Condition

5-minute Condition

10-minute Condition

Figure 1. Bar graphs illustrating the effect of Condition on Positive Affect, Negative Affect, State Anxiety, and Expected Parenting Self-Efficacy. Error bars show standard errors of the mean.

Expected parenting self-efficacyThe amount of crying (condition) also had an effect on participants expected parenting self-efficacy, F(2,64) = 3.16, p = .049, η2 = .090. However, post hoc tests did not show significant differences between the control condition and the 5-minute condition, M

diff = 2.65, p = .091,

between the control condition and the 10-minute condition, Mdiff

= 2.87, p = .065, or between the 5-minute and 10-minute condition, M

diff = 0.22, p = .984. A lack of power might explain the

non-significant post hoc tests, because parenting-self efficacy before the experiment was only assessed in a second round of data collection and difference scores were only available for 68 participants. Therefore, we also performed an ANOVA with post-experiment scores as these were available for all participants (N=116). Results revealed a significant effect of condition, F(2, 112) = 3.63, p = .030, η2 = .061. Tukey post hoc tests revealed a significant difference in expected parenting self-efficacy between the control condition and the 5-minute condition, M

diff = 4.05, p = .040. No significant difference was found between the control condition and

the 10-minute condition, Mdiff

= 3.88, p = .054, and between the 5-minute and 10-minute conditions, M

diff = 0.18, p = .994. Participants exposed to 5 minutes of crying were less confident

about their future ability to parent than participants who were not exposed to crying (Figure 1).


114 | Chapter 5

Tabl

e 2.

Diff

eren

ces

betw

een

mal

es a

nd fe

mal

es in

pos

itive

and

neg

ativ

e aff

ect,

stat

e an

xiet

y, a

nd p

aren

ting

self-

effica

cy a

nd d

iffer

ence

sco

res

per

cond

ition

.

Cond

ition

1 (N

o cr

ying

) Co

nditi

on 2

(5 m

in c

ryin

g)

Cond

ition

3 (1

0 m

in c

ryin

g)

Tota

l Sam

ple

Fem

ales

(n

=27)

Mal

es

(n=1

2)p-

valu

eaFe

mal

es

(n=2

5)M

ales

(n

=14)

p-va

luea

Fem

ales

(n

=26)

Mal

es

(n=1

2)p-

valu

eaFe

mal

es

(n =

78)

Mal

es

(n =

38)

p-va

luea

Posi

tive

Affe

ct

Pre

Pos

t

Diff

eren

ce

27.5

9 (5

.08)

27.1

1 (6

.53)

0.48

(6.2

7)

27.8

3 (4

.80)

24.8

3 (7

.65)

-3.0

0 (7

.34)

.890

.346

.279

28.1

3 (6

.48)

27.9

0 (7

.20)

-0.4

4 (4

.68)

26.2

1 (6

.07)

24.2

1 (7

.67)

-2.0

0 (5

.97)

.375

.142

.375

28.7

7 (6

.92)

25.3

5 (7

.81)

-3.4

2 (7

.80)

29.4

2 (6

.54)

25.6

7 (8

.92)

-3.7

5 (4

.09)

.787

.911

.892

28.1

6 (6

.13)

26.7

8 (7

.18)

-1.4

6 (6

.48)

27.7

4 (5

.86)

24.8

7 (7

.88)

-2.8

7 (5

.84)

.727

.196

.260

Neg

ativ

e A

ffect

Pre

Pos

t

Diff

eren

ce

15.2

2 (5

.06)

13.1

5 (4

.14)

-2.0

7 (4

.41)

13.5

(3.2

9)

15.5

0 (4

.81)

2.00

(5.1

3)

.288

.128

.125

15.0

8 (5

.13)

17.3

2 (6

.08)

2.54

(4.4

8)

13.7

1 (3

.24)

17.6

4 (5

.36)

3.93

(4.2

1)

.376

.869

.353

15.1

5 (4

.96)

18.6

9 (6

.71)

3.54

(6.6

2)

13.0

0 (3

.49)

19.3

3 (5

.79)

6.33

(5.4

2)

.185

.777

.210

15.1

6 (4

.98)

16.3

3 (6

.14)

1.26

(5.

78)

13.4

2 (3

.26)

17.5

(5.4

2)

4.08

(5.0

9)

.028

*

.321

.012

*

Stat

e A

nxie

ty

Pre

Pos

t

Diff

eren

ce

41.0

4 (1

0.08

)

38.0

7 (1

0.73

)

-2.9

6 (1

1.52

)

38.1

8 (8

.88)

41.0

8 (9

.43)

2.91

(8.8

1)

.402

.408

.125

38.1

2 (9

.03)

45.8

4 (1

0.21

)

7.72

(8.0

8)

35.0

7 (8

.55)

47.4

3 (1

1.11

)

12.3

6 (8

.14)

.310

.654

.095

40.7

3 (9

.66)

49.5

8 (1

0.47

)

8.85

(11.

12)

33.7

5 (5

.83)

52.5

0 (9

.60)

18.7

5 (7

.96)

.027

*

.418

.009

**

40.0

0 (9

.58)

44.4

0 (1

1.44

)

4.40

(11.

60)

35.6

3 (7

.91)

47.0

3 (1

0.88

)

11.3

9 (1

0.32

)

.017

*

.240

.002

**

Self-

Effica

cy

Pre

Pos

t

Diff

eren

ce

62.4

4 (6

.30)

b

63.6

3 (6

.60)

0.50

(3.6

0)b

54.2

9 (4

.89)

b

57.9

2 (9

.32)

-1.5

7 (1

.51)

b

.006

**

.022

*

.161

59.3

3 (5

.39)

b

57.9

2 (8

.48)

-2.6

0 (4

.73)

b

60.3

8 (6

.84)

b

57.2

1 (3

.60)

-3.1

3 (5

.72)

b

.692

.720

.816

62.0

0 (7.1

7)b

59.6

2 (6

.69)

-1.9

3 (4

.18)

b

57.5

7 (7.0

9)b

54.0

0 (7

.54)

-5.2

9 (4

.46)

b

.191

.027

*

.102

61.2

8 (6

.34)

b

60.4

6 (7

.58)

-1.3

0 (4

.31)

b

57.5

5 (6

.59)

b

56.2

6 (7

.05)

-3.3

2 (4

.42)

b

.028

*

.005

**

.078

a. In

depe

nden

t sam

ples

t-te

sts

wer

e us

ed to

com

pare

sco

res

of m

ales

and

fem

ales

b. E

xpec

ted

pare

ntin

g se

lf-effi

cacy

was

onl

y as

sess

ed b

efor

e th

e ex

perim

ent i

n a

seco

nd ro

und

of d

ata

colle

ctio

n, th

eref

ore

data

repo

rted

her

e is

onl

y fro

m a

ppro

xim

atel

y ha

lf of

the

fem

ales

(n=

16) a

nd m

ales

(n=

8).


5


Gender differences ANOVA’s showed that males in comparison to females had a larger increase in Negative Affect, F(1, 111) = 7.10, p = .009, η2 = .060 and state anxiety, F(1, 112) = 12.17, p = .001, η2 = .098, from pre-test to post-test, and a lower level of expected parenting self-efficacy after the experiment, F(1, 112) = 8.08, p = .005, η2 = .067, (across all conditions; see Table 2). Comparing baseline, post experiment, and difference scores of affect, anxiety, and expected parenting self-efficacy revealed no consistent differences between males and females (Table 2). Males reported lower anxiety than females at baseline but a higher increase of anxiety during the crying episode (within condition 3). Males also reported lower parenting self-efficacy than females at baseline (within condition 1) and after the experiment (within condition 1 and 3). Finally, gender did not moderate any effect of amount of crying (condition) on positive and negative affect, state anxiety, and expected parenting self-efficacy.

DISCUSSION

The present experimental study provides evidence that infant crying can elicit distress in young adults and cause feelings of expected parenting incompetence. Participants babysitting a doll that cried for 10 minutes reported significantly more negative affect and state anxiety than participants babysitting a quiet doll. Even exposure to only 5 minutes of crying caused more negative affect, more state anxiety and less perceived parenting self-efficacy than exposure to a non-crying doll. Effect sizes of these findings can be considered medium to large (η2’s ranged from 9 to 24%) according to guidelines of Cohen (1988) and are comparable to those found by Bruning and McMahon (2009) for affect and anxiety. We found no evidence for a dose-response effect of infant crying on affect, anxiety, and parenting self-efficacy, as there were no significant differences between the 5 and 10 minute conditions. Gender did not moderate the effect of infant crying on affect, state anxiety, and parenting self-efficacy. However, we did find main effects of gender indicating a higher increase in negative affect and state anxiety while taking care of the lifelike doll, and a lower level of expected parenting self-efficacy after exposure to the doll for males compared to females independent of the amount of crying. Our findings correspond to previous research conducted in more naturalistic settings, which showed an association between infant crying, distress and feelings of insecurity and incompetence in parents (e.g., Papoušek & Von Hofacker, 1998). However, in natural settings, causality issues cannot be ruled out suggesting that the association of parental distress and low perceived self-efficacy with infant crying may be bidirectional (i.e., parental stress and low perceived self-efficacy may worsen infant crying or vice versa making it a vicious circle over time) (Donovan, Leavitt, & Taylor, 2005; Helseth & Begnum, 2002). By manipulating infant crying using a lifelike doll and assigning participants randomly to the conditions we overcame


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causality issues limiting previous findings. Additionally, using a programmable doll and a sample of young adults without children eliminates confounding factors such as varying cry characteristics of real infants, parent characteristics (e.g., distress from previous crying behaviour), and possible effects of the relationship between parent and child. The use of a student sample and a programmable crying doll provide advantages, but may also limit the generalizability to parents and their infants. During the experiment, participants cared for the doll in a very realistic way (e.g., picking up, rocking, and reading a picture book to the baby), which provides support for the authenticity of the situation. In addition, Gustafson and Harris (1990) concluded that mothers and non-mothers responded very similar when babysitting an infant doll. In a recent study Voorthuis et al. (2013) examined the potential of using an infant simulator in parenting research and concluded that the doll is considered fairly realistic by participants and provides a great opportunity to investigate causality issues in parenting research. Nevertheless, experimental research and naturalistic research should complement each other to fully understand the association between infant crying and parental distress. The use of a lifelike doll provides a new and promising method to experimentally study infant crying and possibly other aspects of parenting such as caregiving behaviour. Previous research suggests differences between mothers and fathers in responding to their infants crying. In general, fathers experience more problems (e.g., anxiety and concern), as a result of infant crying, than mothers (Wilkie & Ames, 1986). In the present study no differences were found between males and females concerning the effect of crying condition on change in distress and expected parenting self-efficacy. Surprisingly, also no consistent differences were found between males and females regarding their baseline or post experiment scores. We did find some main effects indicating a higher increase in negative affect and state anxiety while taking care of the lifelike doll, and a lower level of expected parenting self-efficacy after exposure to the doll for males compared to females. However, these findings are based on small sample sizes and should be interpreted with caution. Although findings from this study are short-term effects assessed briefly after the crying exposure, parents of infants who cry excessively over a long period of time are continuously at risk of experiencing distress and feeling incompetent as parents. Future studies should examine long-term effects of infant crying on parental distress, subsequent caregiving behaviour and the parent-infant relationship. For clinical practice the present results may add importance to the acknowledgement of distress and feelings of incompetence that parents may experience as a result of their infant’s crying behaviour.


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REFERENCESBarnes, C. R., & Adamson-Macedo, E. N. (2007).

Perceived maternal parenting self-efficacy (PMP S-E) tool: Development and validation with mothers of hospitalized preterm neonates. Journal of advanced nursing, 60, 550-560. doi: 10.1111/j.1365-2648.2007.04445.x

Bloomfield, L., & Kendall, S. (2012). Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme. Primary Health Care Research & Development, 1, 1-9. doi: 10.1017/S1463423612000060

Boukydis, C. Z., & Burgess, R. L. (1982). Adult physiological response to infant cries: Effects of temperament of infant, parental status, and gender. Child development, 1291-1298. doi: 10.2307/1129019

Bruning, S., & McMahon, C. (2009). The impact of infant crying on young women: A randomized controlled study. Journal of Reproductive and Infant Psychology, 27, 206-220. doi: 10.1080/02646830802350856

Cohen, J. (1988). Statistical power analysis for the behavioral sciencies (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

Didion, J., & Gatzke, H. (2004). The Baby Think It Over™ Experience to Prevent Teen Pregnancy: A Postintervention Evaluation. Public Health Nursing, 21, 331-337. doi: 10.1111/j.0737-1209.2004.21406.x

Donovan, W., Leavitt, L., & Taylor, N. (2005). Maternal self-efficacy and experimentally manipulated infant difficulty effects on maternal sensory sensitivity: a signal detection analysis. Developmental psychology, 41, 784-798. doi: 10.1037/0012-1649.41.5.784

Frodi, A. M., Lamb, M. E., Leavitt, L. A., & Donovan, W. L. (1978). Fathers’ and mothers’ responses to infant smiles and cries. Infant Behavior and Development, 1, 187-198.

Gustafson, G. E., & Harris, K. L. (1990). Women’s responses to young infants’ cries. Developmental psychology, 26, 144.

Hane, A. A., & Fox, N. A. (2006). Ordinary variations in maternal caregiving influence human infants’ stress reactivity. Psychological Science, 17, 550-556. doi: 10.1111/j.1467-9280.2006.01742.x

Helseth, S., & Begnum, S. (2002). A comprehensive definition of infant colic: parents’ and nurses’ perspectives. Journal of Clinical Nursing, 11, 672-680. doi: 10.1046/j.1365-2702.2002.00643.x


Kaley, F., Reid, V., & Flynn, E. (2011). The psychology of infant colic: A review of current research. Infant Mental Health Journal, 32, 526-541. doi: 10.1002/imhj.20308

Leerkes, E. M. (2010). Predictors of maternal sensitivity to infant distress. Parenting: Science and Practice, 10, 219-239. doi: 10.1080/15295190903290840

Meijer, A. M., & van den Wittenboer, G. L. (2007). Contribution of infants’ sleep and crying to marital relationship of first-time parent couples in the 1st year after childbirth. Journal of Family Psychology, 21, 49. doi: 10.1037/0893-3200.21.1.49

Oberklaid, F. (2000). Persistent crying in infancy: a persistent clinical conundrum. Journal of paediatrics and child health, 36, 297-298. doi: 10.1046/j.1440-1754.2000.00516.x

Out, D., Pieper, S., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2010). Physiological reactivity to infant crying: a behavioral genetic study. Genes, Brain and Behavior, 9, 868-876. doi: 10.1111/j.1601-183X.2010.00624.x

Papoušek, M., & Von Hofacker, N. (1998). Persistent crying in early infancy: A non-trivial condition of risk for the developing mother–infant relationship. Child: care, health and development, 24, 395-424. doi: 10.1046/j.1365-2214.2002.00091.x


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Räihä, H., Lehtonen, L., Huhtala, V., Saleva, K., & Korvenranta, H. (2002). Excessively crying infant in the family: Mother–infant, father–infant and mother–father interaction. Child: care, health and development, 28, 419-429. doi: 10.1046/j.1365-2214.2002.00292.x

Rautava, P., Helenius, H., & Lehtonen, L. (1993). Psychosocial predisposing factors for infantile colic. BMJ: British Medical Journal, 307, 600-604.

Reijneveld, S. A., van der Wal, M. F., Brugman, E., Hira Sing, R. A., & Verloove-Vanhorick, S. P. (2004). Infant crying and abuse. The Lancet, 364, 1340-1342. doi: 10.1016/S0140-6736(04)17191-2

Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

St James Roberts, I., & Halil, T. (1991). Infant crying patterns in the first year: normal community and clinical findings. Journal of Child Psychology and Psychiatry, 32, 951-968. doi: 10.1111/j.1469-7610.1991.tb01922.x

Stifter, C. A., & Bono, M. A. (1998). The effect of infant colic on maternal self-perceptions and mother--infant attachment. Child: care, health and development, 24, 339-351. doi: 10.1046/j.1365-2214.2002.00088.x

Tellegen, A., Watson, D., & Clark, L. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of personality and social psychology, 54, 1063-1070.

Van der Ploeg, H., Defares, P., & Spielberger, C. (2000). Handleiding bij de zelfbeoordelingsvragenlijst. Een Nederlandstalige bewerking van de Spielberger State-Trait Anxiety Inventory. Lisse, Swets.

Voorthuis, A., Out, D., van der Veen, R., Bhandari, R., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2013). One doll fits all: validation of the Leiden Infant Simulator Sensitivity Assessment (LISSA). Attachment & human development, 15, 603-617. doi: 10.1080/14616734.2013.820897

Wilkie, C. F., & Ames, E. W. (1986). The relationship of infant crying to parental stress in the transition to parenthood. Journal of Marriage and the Family, 545-550.

Wood, R. M., & Gustafson, G. E. (2001). Infant crying and adults’ anticipated caregiving responses: Acoustic and contextual influences. Child development, 72, 1287-1300. doi: 10.1111/1467-8624.00348

Zeifman, D. M. (2004). Acoustic features of infant crying related to intended caregiving intervention. Infant and Child Development, 13, 111-122. doi: 10.1002/icd.344




Summary and general discussion6Chapter 6



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Summary and general discussion | 123

Whereas parental behavior and its effects on child developmental outcomes have been extensively studied, parental feelings and cognitions have received less attention. Nevertheless, previous research suggests that parental emotions and cognitions have important effects on subsequent child development (Bugental & Johnston, 2000; Dix, 1991; Jones & Prinz, 2005). Especially parental bonding (i.e., the affective tie from parent to child) is a neglected research area with only a few studies looking into the impact of the parental bond on future child development. Therefore, the goal of this thesis was to provide more insight into parental bonding from pregnancy to toddlerhood and to extend knowledge on the impact of parental bonding on parental caregiving cognitions and child self-regulation. More specifically, the aims of this thesis were (a) to provide more insight into the course and correlates of parental bonding from pregnancy to toddlerhood, (b) to examine parental feelings and cognitions and their effect on child self-regulation, and (c) to examine child effects on parental affect and caregiving cognitions with an experimental design. In this final chapter, the main findings of the various studies will be summarized and discussed, after which methodological considerations and implications for theory and future research will be provided. Lastly, this chapter will end with a general conclusion.

Summary of main findings

In the first study (Chapter 2) of this dissertation, the stability of parental bonding from 26 weeks of pregnancy until 24 months after birth was examined. In addition, groups of parents with distinct bonding patterns over time were identified. By subsequently comparing these groups on parental-, child-, and contextual characteristics, the correlates of these identified bonding patterns were studied. For both mothers and fathers, moderate rank-order stability was found between prenatal and postnatal bonding, whereas high stability was found between postnatal bonding at 6 and 24 months postpartum. The latent class analyses revealed four distinct maternal and paternal bonding patterns (i.e., labeled “low”, “intermediate”,

“high”, and “very high”) showing parallel mean-level trajectories, suggesting that between-group differences were stable across time. Moreover, parents with lower levels of bonding were characterized by less adaptive personality functioning, as they were less extraverted, conscientious, agreeable, and emotionally stable in comparison to parents exhibiting other types of bonding patterns. They also received less partner support, experienced increased anxiety, parenting stress, and had children with more difficult temperament in infancy and toddlerhood. Thus, findings in Chapter 2 suggest that maternal as well as paternal bonding are relatively stable from pregnancy to toddlerhood and are associated with psychosocial well-being in the parental-, child-, and contextual domain. The second study (Chapter 3) focused on associations between pre- and postnatal bonding and parenting stress at 24 months postpartum. In addition, the possible mediating


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role of parenting stress in the association between early bonding and child executive functioning was examined. Path models for both mothers and fathers showed that more feelings of prenatal bonding were predictive of more feelings of postnatal bonding, which in turn were associated with less parenting stress. Moreover, a lower quality of maternal and paternal bonding at 6 months was predictive of subsequent child executive functioning problems at 24 months, via increased experience of parenting stress. To sum up, the findings indicate that parents with a lower quality of early bonding were more vulnerable to parenting stress, which in turn was associated with more child executive functioning problems. In the third study (Chapter 4), the associations between pre- and postnatal bonding, parenting self-efficacy and the child temperamental dimensions negative affectivity and effortful control at 24 months were examined. To obtain a more reliable rating of child temperament, maternal and paternal ratings of negative affectivity and effortful control were combined in latent factors. Results for both mothers and fathers illustrated that a higher quality of pre- and postnatal bonding positively affected future and current toddler effortful control and that a higher quality of postnatal bonding was associated with less toddler negative affect. In addition, for both parents early bonding affected experienced parenting self-efficacy, whereas only for fathers parenting self-efficacy predicted toddler negative affectivity. However, parenting self-efficacy did not explain the association between bonding and child temperament. These findings point to the importance of parental bonding for both parents and children. The fourth study (Chapter 5) aimed to examine, in an experimental setting, the effect of infant crying on affect, anxiety and expected parenting self-efficacy. In addition, dose-response and gender effects were studied. Psychology students were asked to babysit a lifelike programmable doll for 10 minutes and were randomly assigned to one of three conditions (i.e., no crying, 5 minutes of crying, 10 minutes of crying). Questionnaires about affect, anxiety, and expected parenting self-efficacy were completed before and after the experimental condition. Results showed that, compared to exposure to a non-crying doll, exposure to 5 or 10 minutes of crying caused more negative affect, more state anxiety and less perceived parenting self-efficacy. However, no differences were found between the 5-minute and 10-minute condition, indicating that exposure to a longer crying period did not have additional effects. In addition, males and females were equally affected by exposure to crying with regard to affect, anxiety, and expected parenting self-efficacy. However, main effects of gender were found, indicating a higher increase in negative affect and state anxiety while taking care of the lifelike doll (regardless of crying condition), and a lower level of expected parenting self-efficacy after exposure to the doll for males compared to females. Although long-term effects need to be further explored in future research, these findings stress the importance of acknowledging the effects of infant crying on parental distress and feelings of parenting competence.


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An overview of the main findings per study can be found in Table 1. The findings of the different studies will be integrated and discussed in the next section of this chapter.

Table 1. Overview of the main findings per study.

Chapter Findings

Chapter 2 - Feelings of maternal as well as paternal bonding were relatively stable from pregnancy to toddlerhood.

- For both mothers and fathers, 4 distinct bonding patterns were identified, which were only distinguished by mean level differences.

- Parents with weaker bonding patterns were characterized by increased anxiety and parenting stress, less partner support, less adaptive personality profiles, and children with a more difficult temperament.

Chapter 3 - Poorer prenatal bonding prospectively predicted poorer postnatal bonding, which in turn predicted more parenting stress.

- A lower quality of maternal bonding was related to more subsequent child executive functioning problems, via increased maternal parenting stress.

- For fathers, feelings of bonding also indirectly affected child executive functioning via parenting stress, however, no direct effect was found.

Chapter 4 - For mothers and fathers, a higher quality of pre- and postnatal bonding positively affected future and current toddler effortful control, and a higher quality of postnatal bonding was associated with less toddler negative affect.

- For both parents early bonding had a positive effect on their experienced parenting self-efficacy.

- Parenting self-efficacy did not play a role in explaining the association between bonding and child temperament.

- Only for fathers, experienced parenting self-efficacy predicted toddler negative affect

Chapter 5 - Exposure to infant crying caused more negative affect, more state anxiety and less perceived parenting self-efficacy than exposure to a non-crying doll.

- No difference was found between the 5-minute and 10-minute condition, indicating that exposure to a longer crying period did not have additional effects on affect, anxiety and parenting self-efficacy.

- Males and females were equally affected by exposure to crying with regard to affect, anxiety, and expected parenting self-efficacy

- Compared to females, males showed a higher increase in negative affect and state anxiety while taking care of the life-like doll, and a lower level of expected parenting self-efficacy after exposure to the doll, independent of the amount of crying.


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Integration and discussion of research findings

The course and correlates of parental bonding from pregnancy to toddlerhoodThe first aim of this thesis was to provide more insight into the course and correlates of parental bonding. The findings in Chapter 2 showed that for both mothers and fathers parental bonding is relatively stable from pregnancy to the postnatal period, and even more so during the postnatal period. This stability and predictive value of parental bonding was confirmed by the associations between prenatal and postnatal bonding at 6 and 24 months found in Chapter 3 and Chapter 4. These findings regarding the course of parental bonding are congruent with previous findings and extend existing literature. While previous work already established associations between feelings of maternal bonding during pregnancy and the first two months after birth (Damato, 2004; Müller, 1996), the present thesis demonstrates that these associations extend to 6 and 24 months postpartum and are also present for fathers. This indicates that early parental (prenatal) bonding has long-term effects and is even related to parental feelings beyond the early postnatal period. In addition, fathers should not be neglected in future studies examining parental feelings bonding, as current findings indicate similar results for paternal bonding as compared to maternal bonding. Mean-level changes from pre- to postnatal bonding could not be examined due to differences in measurement instruments. In contrast to the literature regarding the early postnatal period (i.e., first year), in the present thesis a slight decrease in bonding scores from 6 months to 24 months was found. Condon and Corkindale (1998) found an increase in bonding from 4 weeks to 4 months postpartum and no change in bonding from 4 months to 12 months, whereas van Bussel, Spitz, and Demyttenaere (2010b) also found stability in the early postnatal period. The decrease in parental bonding found in the present thesis, might reflect growing independence and autonomy of children from infancy to toddlerhood, as they increasingly require less parental care. In addition, the toddler phase (or “terrible two’s”) can be a difficult caregiving period for parents, as their toddler’s developing independence is often accompanied by frequent temper tantrums. This likely makes it more challenging to feel an affective bond towards the child. Multiple correlates of parental bonding in the parental, child and contextual domain were identified in this thesis. These correlates nicely come together in Chapter 2, where they were examined in relation to parental bonding profiles. Regarding the parental domain, it was found that parental personality (i.e., extraversion, conscientiousness, agreeableness, emotional stability) and pre- and postnatal anxiety symptoms were correlated with parental bonding. Personality has previously been presented as an important predictor of establishing social relationships (e.g., Asendorpf & Wilpers, 1998). In addition, depressive and/or anxiety symptoms have been found to prevent an optimal formation of a (antenatal) maternal bond (e.g., Condon & Corkindale, 1997). In the child domain, parent reported child temperament was


6


found to be associated with feelings of bonding in parents in the present thesis. In fathers, this association had been shown before, as a lower quality of postnatal bonding was found when fathers experienced their children to have a more fussy or difficult temperament (Condon, Corkindale, Boyce, & Gamble, 2013). Lastly, in Chapter 2, the quality of parental bonding was also related to contextual factors, as expressed by experienced parenting stress and partner support. This is in accordance with previous studies linking maternal postnatal bonding to experienced parenting stress (Mason, Briggs, & Silver, 2011; Reck, Zietlow, Müller, & Dubber, 2016). In addition, while previous findings regarding partner support and parental pre-and postnatal bonding were inconclusive (Condon & Corkindale, 1997; Condon et al., 2013; Maas, Vreeswijk, Braeken, Vingerhoets, & van Bakel, 2014), the current results suggest that parents with low levels of bonding from pregnancy to toddlerhood reported lower levels of partner support. To sum up, parents who reported very strong feelings of bonding from pregnancy to toddlerhood were characterized by the most adaptive profiles, whereas parents with low levels of bonding were characterized by the most negative parental, contextual and child factors. Additionally, cross-informant associations were found, indicating that parents with low levels of bonding also had partners with low levels of bonding, high levels of parenting stress, and low partner support. Moreover, Chapter 3 and Chapter 4 additionally demonstrate that early parental bonding is not only associated with the aforementioned factors, but also predictive of later parenting stress, parenting self-efficacy and child self-regulatory abilities (i.e., executive functioning and temperament). From previous research on parenting it is known that parental psychosocial problems often co-occur and might reinforce each other (Herwig, Wirtz, & Bengel, 2004). For example, when there is low partner support, other parental stresses, such as anxiety symptoms might be even more pronounced since there is no buffer in their social environment. Additionally, the experience of parenting stress can be worse when the child has a more difficult temperament. Also, in his model of parenting, (Belsky, 1984) already proposed that parenting was multiply determined by parental, child, and contextual factors. The present findings correspond to these notions and add parental bonding as an important correlate and predictor of parental and child psychosocial functioning. Taken together, parents who experience low levels of bonding can be seen as an important risk-group with possible problems in multiple domains. This group might benefit most from interventions aimed at improving psychosocial functioning and the parent-child relationship. However, more research is needed to establish the effectiveness of potential intervention programs before conclusions can be drawn.


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Parental bonding and caregiving cognitions and their effect on child self-regulationThe second aim of this thesis was to examine parental feelings and cognitions and their effect on child self-regulation. From Chapter 3 and Chapter 4, it is clear that parental bonding is an important predictor of child self-regulation. Prospective associations were found between (prenatal) bonding and both cognitive (i.e., executive functioning) as well as behavioral (i.e., temperament) aspects of self-regulation. The effects were not limited to maternal bonding but paternal bonding appeared to be an important predictor as well. Although some previous studies suggest that parental bonding is associated with child outcomes, research on this topic is surprisingly limited. The parent-to-child bond has previously been linked to future behavioral problems (Fuchs, Möhler, Reck, Resch, & Kaess, 2016) and problems with social emotional development (Mason et al., 2011). The present thesis adds executive functioning problems, and a less adaptive child temperament as negative child outcomes that are affected by suboptimal levels of parental bonding. Parental bonding could affect the development of child self-regulation in several ways. When parents experience a stronger bond with their child, this might lead to more investment in caregiving activities (e.g., more involvement and interaction). Indeed, Dix (1991) states that parents’ positive emotions regarding the child motivate them to comfort, protect, stimulate, and discipline their child. Already during pregnancy, more maternal bonding is related to better prenatal health behavior of the mother, thus promoting a better prenatal caregiving environment (Lindgren, 2001). In addition, theories on social learning state that children learn from observation (Bandura & Walters, 1977) and through interaction (Vygotsky, 1978). Early in life parents are the most important role models and interaction partners of children. Low parental bonding might lead to less (positive) interaction between parent and child, hereby limiting optimal development of self-regulatory skills. Findings from a meta-analytic review by Rueger, Katz, Risser, and Lovejoy (2011), confirm that parents with low positive affect spend less time interacting and engaging with their children, whereas positive parental emotions lead to more social engagement and expression of parental warmth. Moreover, results from the present thesis show that a lower quality of bonding not only affects children, but also parents themselves. Feelings of (prenatal) bonding were found to be related to parenting stress and parenting self-efficacy. Therefore, these parental caregiving cognitions are additional possible mechanisms explaining the association between parental feelings of bonding and child development. Some evidence for this mediating role of caregiving cognitions was found, but results were slightly inconclusive. While parenting stress was found to be a significant mediator in the association between postnatal bonding and child executive functioning problems, parenting self-efficacy did not significantly mediate between bonding and child temperament. Only for fathers, experienced self-efficacy was


6


related to toddler negative affect and there was some evidence for an indirect effect from paternal bonding to negative affectivity via self-efficacy. These findings could be explained in several ways. While the experience of parenting stress likely affects parental behavior directly, self-efficacy might operate in a more complex manner. A parent who feels insecure about his or her parenting skills might still objectively provide good quality care. Alternatively, it might be possible that executive functioning (i.e., a more cognitive component of self-regulation) is more closely and strongly related to parental cognitions than child temperament (i.e., a more affective and behavioral component of self-regulation). Taken together, the findings of Chapter 2, Chapter 3, and Chapter 4 of the present thesis show that parental bonding is important for both parents and children. Moreover, the results of the studies in this thesis suggest that parental bonding is a more important component of parenting (or the parent-child relationship) than parental caregiving cognitions. Parental feelings of bonding appear to affect and precede parental experiences of parenting stress and self-efficacy. In addition, both direct as well as indirect effects of parental bonding were found on later child outcomes. Previous research and theories also advocate that parental feelings or affect precede parental cognitions and behavior (e.g., Dix, 1991). As mentioned before, parental emotions directly influence parents’ behavior towards their children by increasing social engagement and the expression of warmth (Rueger et al., 2011). Parental cognitions can be seen as an underlying mechanism, linking parental affect to subsequent parental motivations and behavior. When parents experience negative or less positive affect (i.e., a lower quality of bonding) they tend to negatively interpret their child’s behavior and in turn will react in a more negative way (Bugental & Johnston, 2000; Dix, 1991). In the same manner, when parents feel less of a bond with their child, this likely causes parents to perceive parenting as more stressful and decreases confidence in their parenting skills. Moreover, parental affect is of key importance in establishing a healthy parent-child relationship, the processing of parental messages, communicating parental intentions, and eliciting reciprocal affect of children (Dix, 1991). All of these factors in turn influence child developmental outcomes. Thus, parental bonding clearly has a central role in determining parental cognitions as well as child outcomes and there are some indications that parental caregiving cognitions mediate between feelings of bonding and child self-regulation. However, the potential mechanisms explaining the effects of parental bonding on child outcomes still require further study.

Child effects on parental affect and caregiving cognitionsThe third aim of this thesis was to examine child effects on parental affect and caregiving cognitions with an experimental design. In natural settings, parental and child (relational) effects cannot completely be separated. Therefore, directionality of effects is hard to determine. To rule out parental and relational effects, in the experimental study of Chapter 5


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an infant simulator was used to examine child effects (i.e., infant crying) on parental distress and expected parenting self-efficacy. Results of this experimental study point out that even a short amount of infant crying might cause distress in young adults and decreases their expected parenting self-efficacy. These findings correspond to previous research conducted in natural settings, showing, for example, that both mothers of infants classified as moderate (> 2 hours of crying per day) or extreme (> 5 hours of crying per day) criers experienced more distress and less parenting self-efficacy than mothers of low crying infants (Papoušek & Von Hofacker, 1998). The high similarity in findings from the experimental study in Chapter 5 and findings from research in natural settings, potentially indicates ecological validity of these kind of experimental designs. Moreover, triangulation of the research findings, combining the results from natural and experimental designs, provides strong confidence for the presence of child effects on parental affect and cognitions. Although further research into long-term effects of infant crying is still needed, these results point to the importance of acknowledging infant crying as a significant cause of parental distress and feelings of incompetence and promote the use of an infant simulator for experimental studies on child effects.

Methodological considerations

When interpreting the findings of the present thesis several methodological considerations should be taken into account. First, while the large prospective longitudinal study used in Chapter 2, Chapter 3, and Chapter 4, provides important strengths, it also contains some limitations. The participants portray a relatively low-risk sample consisting mostly of highly educated parents and children born without severe birth complications. Although the established associations might be more pronounced in a more high-risk sample, the present findings suggest that even in a normative sample, relationships between bonding and parental and child outcomes are present and important. Attrition or dropout is a common problem in longitudinal studies. As in the “Expectant Parents” study parents were re-approached for the measurement moment at 24 months for which they did not receive reimbursement, the drop-out rate was relatively high. At the sixth measurement moment at 6 months, 83.4% of the mothers (N= 341) and 84.0% of the fathers (N = 268), who originally agreed to participate were still included in the study. For the follow-up measurement wave at 24 months, 285 mothers and 246 fathers were re-approached as these parents previously gave consent to be contacted for follow-up research. Of these parents, 248 mothers (87.0%) and 186 fathers (75.6%) returned the questionnaires. To retain the highest possible sample size, missing values were handled with Full Information Maximum Likelihood and (multiple) imputation procedures. The use of these procedures to impute missing values was justified for the relevant studies by Little’s (1988) Missing Completely at Random tests, which indicated a good fit between sample scores with and without imputation.


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As the questionnaires to assess pre- and postnatal bonding contain different items, mean-level changes in bonding over this period could not be examined. Parents’ behavior and thoughts regarding their unborn fetus and their 6-24 months old child are very different (e.g., picturing what the fetus would look like vs. actually taking care of the baby), making it hard to avoid item differences. However, the development of one instrument to measure both pre- and postnatal bonding could greatly improve research on parental bonding. Moreover, higher correlations were found between postnatal bonding scores than between pre- and postnatal bonding, which could be partly explained by the difference in measurement instruments. Nevertheless, a recently developed 5-item parental bonding scale using the same items pre- and postnatally, also found higher correlations between postnatal measurements as compared to correlations between pre- and postnatal bonding (Cuijlits et al., 2016). Reliability and validity of this new instrument should, however, still be examined. Another potential limitation of the studies in the present thesis is the use of self-report questionnaires to assess parental feelings and cognitions as these are prone to response bias such as social desirability. Indeed, some studies have found small positive correlations between scores on a social desirability instrument and maternal bonding scores (van Bussel, Spitz, & Demyttenaere, 2010a; van Bussel et al., 2010b). However, observational studies are not suitable to assess mental (i.e., affective and cognitive) aspects of parenting and the parent-child relationship. Furthermore, low correlations are found between mother reports and nurses’ reports on bonding, indicating the need to ask parents themselves about their feelings of bonding (Bienfait et al., 2011). Additionally, child self-regulation outcomes were based on parental self-report rather than observational data. In Chapter 3, only mothers reported on their child’s executive functioning problems which might also lead to reporter bias. However, the finding of cross-informant associations (e.g., between bonding in fathers and executive functioning problems reported by mothers) suggest that the findings are not merely caused by reporter bias. Moreover, the presence of significant cross-informant associations might even strengthen the conclusions regarding bonding and child outcomes. In Chapter 4, both mothers and fathers reported on their child’s temperament and cross-informant correlations were found between maternal bonding and child temperament as reported by fathers. To increase reliability in the outcome variable, mother and father reports of temperament were combined in a latent factor. As parents see a wide range of their child’s behaviors in different contexts parental assessments of child self-regulation may be more accurate than observers’ assessments at a single timepoint. Nevertheless, a multi-informant approach, combining self-report and observational measures to simultaneously assess affective, cognitive, and behavioral components of parenting as well as child outcomes would be the ideal approach for future research. A final methodological consideration is the issue of causality. Although in Chapter 3 and Chapter 4, parental bonding is presumed to have a subsequent effect on child self-regulation


132 | Chapter 6

and a longitudinal design is used, child effects on parental feelings and cognitions cannot be ruled out. In this regard, a strength of the studies in Chapter 2, Chapter 3, and Chapter 4 is the inclusion of prenatal bonding, as child effects do not yet play a role during pregnancy. In Chapter 5, child effects were uniquely examined, using an infant simulator and an experimental design, excluding parental effects and the possible influence of a parent-infant relationship.

Implications for theory and future research

The findings of the present thesis have several implications for existing theory and future research. Next to the already established importance of parental behavior for child development, the present thesis shows that parental feelings and cognitions are also substantial predictors of child outcomes. Especially parental bonding proved to play an important role in the psychological wellbeing of both parents as well as children. Future studies should focus more on these affective and cognitive domains of parenting to strengthen the present findings and to further assess their influence on other aspects of child development. In addition, the mechanisms by which parental bonding affects child outcomes (e.g., self-regulation) need further exploration. In the present thesis, parental cognitions (i.e., parenting stress and self-efficacy) were examined as possible mechanisms, however, other mechanisms (e.g., parental behavior) should also be studied. In Chapter 2, Belsky’s (1984) model describing determinants of parenting was applied to parental bonding. Belsky proposes that parental functioning is multiply determined by factors in the following three domains: parental psychological resources, characteristics of the child, and contextual sources of stress and support. These three domains can be interpreted and assessed in different ways. In the present thesis, the model was applied to examine the correlates of parental bonding. Among the variables examined in the present thesis, were parental personality and psychosocial functioning (i.e., parental domain), child temperament (i.e., child domain), and partner support and parenting stress (i.e., contextual domain). The findings in Chapter 2 clearly confirm the structure of Belsky’s model for determining parental bonding, as several factors in the parental-, child-, and contextual domain were found to be correlates of parental bonding profiles. However, as the research design used to examine these correlates in Chapter 2 was correlational, no conclusions can be drawn regarding causality. Future research looking into the determinants or consequences of parental bonding should take into account potential (risk) factors in all three domains. Furthermore, the findings from Chapter 4 provide support for the notion that parent-reported child temperament is at least partly determined by environmental factors as parental bonding appears to affect child negative affectivity as well as effortful control. Childhood temperament has been found to be strongly influenced by genetics, with twin studies reporting heritability estimates between .20 and .60 for parent-reported as well as rater-


6


observed temperament (Saudino, 2005). However, these estimates also suggest that there is room for environmental influences. Particularly in the second year of life child temperament is marked by change, which is attributed to environmental factors as opposed to genetics (Saudino, Plomin, & DeFries, 1996). According to both studies, non-shared environmental influences (e.g., differential parental treatment) are most important in this regard. As parental feelings of bonding are unique for each individual child, the findings in this thesis confirm the effect of non-shared caregiving influences (i.e., parental bonding) on child temperament. Most previous research focused on the effects of child temperament on parental feelings and behavior. However, the findings of Chapter 4 suggest that parental feelings (i.e., parental bonding) can also affect child temperament. Future research, taking into account both directions of effect, is needed to further disentangle the directionality of the association between parenting and child temperament. Moreover, the present thesis highlights the essential role of fathers in the parent-to-child relationship and subsequent child development. The influence of fathers has been understudied in previous research on parenting and the parent-child relationship, as most studies exclusively focus on mothers. However, there is growing evidence that fathers play an important role in children’s early environment as well (Lewis & Lamb, 2003; Ramchandani et al., 2013; Ramchandani, Stein, Evans, O’Connor, & Team, 2005). The present thesis demonstrates that fathers, although their bonding levels are somewhat lower, show similar bonding patterns as mothers. In addition, correlates of these bonding patterns are also comparable to mothers, although associations were sometimes less pronounced. Just like maternal bonding, paternal bonding was found to be prospectively associated with paternal caregiving cognitions and child-self regulation (i.e., executive functioning and child temperament). It is therefore strongly suggested that future studies include both mothers and fathers in their sample. Lastly, in Chapter 5, some evidence for child effects on parental affect and cognition was found. Studies using an infant simulator to examine child effects in a controlled manner can contribute to theory regarding the direction of effects in parenting research. However, more research is needed to further disentangle the interplay between parent and child effects. Particularly, the influence of child characteristics on the formation of the early parental bond have not been examined before. Prospective longitudinal studies using a cross-lagged design could be implemented to accomplish this goal.


134 | Chapter 6

General conclusion

To conclude, the present thesis provides insight into the prospective associations between parental feelings, caregiving cognitions, and their impact on child self-regulation. Relative stability was found in feelings of parental bonding from pregnancy to toddlerhood. Moreover, a lower quality of bonding was related to less adaptive parental psychological well-being, child functioning, and a less optimal social environment. Additionally, maternal as well as paternal bonding predicted later child self-regulatory abilities, either directly or indirectly via parental caregiving cognitions. This implies that, without intervention, parents with low levels of bonding during pregnancy will continue to experience low levels of bonding postnatally. Moreover, these parents and their children are at increased risk for experiencing psychosocial problems and less optimal developmental outcomes, respectively. Therefore, the correlates of bonding in the parent-, child-, and contextual domains that were proposed in the present thesis might be used for early screening to identify parents susceptible to bonding problems. Some evidence exists that interventions in which parents are educated about the parental bond (e.g., explaining the concept and benefits of a strong parental bond and teaching behaviors to improve the parental bond) improve the quality of parental bonding (e.g., Abasi, Tafazzoli, Esmaily, & Hasanabadi, 2013). However, longitudinal studies with a longer follow-up period are necessary before such interventions can be implemented on a large scale. From birth onwards, child characteristics may affect parental feelings and cognitions and should be taken into account in future research and practice. The present thesis showed that the parental bond, which can already be observed in pregnancy, is important for both parental as well as child psychological well-being. Therefore, the parental bond, as well as its impact on parental psychosocial functioning and child development, and its underlying mechanisms, highly deserve further attention by researchers and healthcare professionals.


6


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Cuijlits, I., van de Wetering, A., Potharst, E., Truijens, S., van Baar, A., & Pop, V. (2016). Development of a Pre- and Post-natal Bonding Scale (PPBS). Journal of Psychology and Psychotherapy, 6. doi: 10.4172/2161-0487.1000282

Damato, E. G. (2004). Prenatal attachment and other correlates of postnatal maternal attachment to twins. Advances in Neonatal Care, 4, 274-291. doi: 10.1016/j.adnc.2004.07.005

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Herwig, J. E., Wirtz, M., & Bengel, J. (2004). Depression, partnership, social support, and parenting: interaction of maternal factors with behavioral problems of the child. Journal of Affective Disorders, 80, 199-208. doi: 10.1016/S0165-0327(03)00112-5


Lewis, C., & Lamb, M. E. (2003). Fathers’ influences on children’s development: The evidence from two-parent families. European journal of psychology of education, 18, 211-228. doi: 10.1007/BF03173485

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Maas, A. J. B. M., Vreeswijk, C. M., Braeken, J., Vingerhoets, A. J., & van Bakel, H. J. (2014). Determinants of maternal fetal attachment in women from a community-based sample. Journal of Reproductive and Infant Psychology, 32, 5-24. doi: 10.1080/02646838.2013.853170

Mason, Z. S., Briggs, R. D., & Silver, E. J. (2011). Maternal attachment feelings mediate between maternal reports of depression, infant social-emotional development, and parenting stress. Journal of Reproductive and Infant Psychology, 29, 382-394. doi: 10.1080/02646838.2011.629994

Müller, M. E. (1996). Prenatal and postnatal attachment: A modest correlation. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25, 161-166. doi: 10.1111/j.1552-6909.1996.tb02420.x

Papoušek, M., & Von Hofacker, N. (1998). Persistent crying in early infancy: A non-trivial condition of risk for the developing mother–infant relationship. Child: care, health and development, 24, 395-424. doi: 10.1046/j.1365-2214.2002.00091.x

Ramchandani, P., Domoney, J., Sethna, V., Psychogiou, L., Vlachos, H., & Murray, L. (2013). Do early father–infant interactions predict the onset of externalising behaviours in young children? Findings from a longitudinal cohort study. Journal of Child Psychology and Psychiatry, 54, 56-64. doi: 10.1111/j.1469-7610.2012.02583.x

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van Bussel, J. C. H., Spitz, B., & Demyttenaere, K. (2010a). Reliability and validity of the Dutch version of the maternal antenatal attachment scale. Archives of Womens Mental Health, 13, 267-277. doi: 10.1007/s00737-009-0127-9

van Bussel, J. C. H., Spitz, B., & Demyttenaere, K. (2010b). Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Archives of Womens Mental Health, 13, 373-384. doi: 10.1007/s00737-009-0140-z





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Zwangerschap en de transitie naar ouderschap gaan samen met ingrijpende veranderingen in het leven van ouders. Deze veranderingen brengen vaak sterke nieuwe emoties en complexe mentale processen met zich mee. Gevoelens en cognities (gedachten en opvattingen) van ouders kunnen, evenals het gedrag van ouders, een belangrijke invloed hebben op de ontwikkeling van kinderen. Ondanks het belang van deze gevoelens en cognities is er in de wetenschappelijke literatuur minder aandacht aan besteed dan aan de invloed van gedrag van ouders op de ontwikkeling van (jonge) kinderen. Met name onderzoek naar de kwaliteit van de affectieve band die ouders al vanaf de zwangerschap opbouwen met hun (ongeboren) kind, is relatief beperkt. Dit terwijl de ervaren band tussen een ouder en kind een belangrijke en unieke mogelijkheid biedt voor vroege interventie en/of preventie van (toekomstige) problemen in de ouder-kind relatie en hiermee mogelijk ook in de ontwikkeling van kinderen. Het doel van dit proefschrift, zoals besproken in Hoofdstuk 1, was daarom ook om meer inzicht te krijgen in het verloop en de determinanten van de affectieve band van ouders met hun kind vanaf de zwangerschap tot de peutertijd. Daarnaast had dit proefschrift tot doel om de impact van de ouder-kind band op de cognities van ouders rondom het ouderschap en op de ontwikkeling van zelfregulatie bij kinderen te onderzoeken. De eerste drie studies die worden beschreven in dit proefschrift zijn onderdeel van de prospectieve, longitudinale cohortstudie ‘In Verwachting’ (Maas, Vreeswijk, de Cock, Rijk, & van Bakel, 2012). Deze studie is gericht op het onderzoeken van prenatale (risico)factoren en de invloed hiervan op de kwaliteit van de pre- en postnatale ouder-kind relatie en de postnatale ontwikkeling van kinderen. In de ‘In Verwachting’ studie zijn hiervoor 409 moeders en 319 partners gevolgd vanaf 15 weken zwangerschap tot 24 maanden na de geboorte.

In Hoofdstuk 2 van dit proefschrift is de stabiliteit van de ouder-kind band onderzocht vanaf 26 weken zwangerschap tot 24 maanden na de geboorte. Daarnaast zijn ouders met verschillende onderliggende patronen in het verloop van de ouder-kind band geïdentificeerd. Deze groepen ouders zijn vervolgens vergeleken op verschillende ouder-, kind-, en omgevingskarakteristieken. Uit de analyses bleek dat voor zowel moeders als vaders de kwaliteit van de ouder-kind band postnataal van 6 maanden tot 24 maanden zeer stabiel was, maar dat deze van de zwangerschap tot na de geboorte ook al relatief stabiel was. Dit betekent dat ouders die in de zwangerschap de band met hun ongeboren kind als minder sterk ervaren deze ook na de geboorte als minder sterk ervaren. Ook bleek dat ouders konden worden ingedeeld in vier groepen op basis van hun patronen met betrekking tot het verloop van de moeder-kind en vader-kind band. Er waren ouders van wie de relatie met hun baby van de zwangerschap tot de peutertijd kon worden geclassificeerd als “lage kwaliteit” tot “heel hoge kwaliteit”. Ouders uit de groep met een kwalitatief minder goede band bleken een minder adaptief persoonlijkheidsprofiel te hebben dan ouders die een hogere kwaliteit ouder-kind band ervaarden. Deze ouders waren minder extravert, minder consciëntieus,


142 | Samenvatting

minder vriendelijk en minder emotioneel stabiel. Ook ondervonden deze ouders minder steun van hun partner, rapporteerden ze meer angstgevoelens, meer opvoedingsstress, en een moeilijker temperament bij hun kinderen tijdens de baby- en peutertijd. De bevindingen van Hoofdstuk 2 tonen hiermee het belang aan van het monitoren van ouders die een kwalitatief minder goede ouder-kind band ervaren, aangezien deze gevoelens stabiel blijven van de zwangerschap tot de peutertijd en samen kunnen gaan met psychosociale problemen in meerdere domeinen (ouder, kind en omgeving).

De focus van Hoofdstuk 3 lag op het onderzoeken van de samenhang tussen de pre- en postnatale ouder-kind band, opvoedingsstress van ouders en het executief functioneren van het kind op 24 maanden. Uit de resultaten bleek dat minder sterke gevoelens voor de baby tijdens de zwangerschap, gerelateerd waren aan een minder goede kwaliteit van de ouder-kind relatie na de geboorte. Deze minder goede relatie bleek vervolgens samen te hangen met meer stress rondom de opvoeding. Bovendien bleek ook dat een minder sterke band met de baby op 6 maanden, samenhing met problemen met het executief functioneren van het kind op 24 maanden en dat dit verband werd verklaard door meer stress in de opvoeding. De bevindingen uit dit hoofdstuk suggereren dus dat de ervaring van een kwalitatief minder sterke band met hun baby ouders meer kwetsbaar maakt voor het ervaren van stress tijdens het opvoeden. Dit lijkt er vervolgens voor te zorgen dat kinderen op den duur meer problemen laten zien met betrekking tot de regulatie van hun gedrag zoals impulsief reageren, van streek raken bij nieuwe situaties of overdreven reageren op kleine problemen.

In Hoofdstuk 4 zijn de relaties tussen de pre- en postnatale ouder-kind band, het zelfvertrouwen dat ouders hebben in hun ouderschapskwaliteiten, en het temperament (negatieve affectiviteit en zelfregulatie) van kinderen op 24 maanden onderzocht. Voor een meer betrouwbare weerspiegeling van temperament zijn de rapportages van moeders en vaders hierbij samengenomen. De resultaten lieten zien dat zowel voor moeders als vaders, een hogere kwaliteit van de pre- en postnatale ouder-kind band een positief effect had op de latere zelfregulatie (effortful control) van hun kind. Ook was een hogere kwaliteit ouder-kind band na de geboorte gerelateerd aan minder negatief affect bij het kind. Daarnaast werd gevonden dat de vroege ouder-kind band van invloed is op het vertrouwen van ouders in hun ouderschapskwaliteiten (parenting self-efficacy). Ondanks het negatieve verband dat werd gevonden tussen vaders vertrouwen in het ouderschap en negatief affect bij het kind, werd voor zowel moeders als vaders de samenhang tussen de ouder-kind band en het temperament van hun kind niet verklaard door het vertrouwen in ouderschapskwaliteiten. Samengevat laten de resultaten zien dat de vroege ouder-kind band niet alleen van belang is voor het vertrouwen van ouders in hun ouderschap maar ook voor de ontwikkeling van jonge kinderen op het gebied van regulatie van gedrag en emoties.


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Tot nu toe werden gevoelens en cognities van ouders rondom het ouderschap vooral onderzocht en verklaard vanuit het perspectief en vanuit kenmerken van de ouder. Vanaf de geboorte hebben echter ook het gedrag en karakteristieken van het kind een invloed op deze gevoelens en cognities van ouders. De laatste studie, beschreven in Hoofdstuk 5, had als doel om te onderzoeken wat het effect van huilen van de baby heeft op het emotioneel welbevinden en (toekomstig) vertrouwen in het ouderschap. Hiervoor werd een experimenteel design gebruikt waarbij psychologie studenten werd gevraagd om 10 minuten te zorgen voor een levensechte babypop. Studenten werden willekeurig ingedeeld in één van de drie condities (d.w.z. niet huilen, 5 minuten huilen, 10 minuten huilen) en vulden zowel voor als na het experiment vragenlijsten in over hun emoties (affect), angsten en hun vertrouwen in toekomstige ouderschapskwaliteiten. De resultaten lieten zien dat studenten die moesten zorgen voor een babypop die 5 of 10 minuten huilde, meer negatief affect, meer angsten en minder vertrouwen in hun toekomstige ouderschap rapporteerden dan studenten die voor een rustige baby (die niet huilde) moesten zorgen. Vervolgonderzoek is nodig om de lange-termijn effecten van langdurig huilen van baby’s te onderzoeken, maar de huidige bevindingen wijzen duidelijk op het belang van het erkennen van de effecten van huilgedrag van baby’s op het emotioneel welbevinden van ouders en hun vertrouwen in het ouderschap. In Hoofdstuk 6 zijn de belangrijkste resultaten van dit proefschrift samengevat, waarbij methodologische beperkingen van het onderzoek zijn aangekaart en implicaties voor theorie en toekomstig onderzoek zijn besproken. De bevindingen van dit proefschrift geven meer inzicht in de verbanden die er zijn tussen de wijze waarop ouders de band met hun baby ervaren, de cognities die ouders rondom het ouderschap hebben, en de zelfregulatie vaardigheden van kinderen. De kwaliteit van de band met de baby zoals ervaren door de ouders bleek relatief stabiel vanaf de zwangerschap tot de peutertijd. Bovendien bleek een lagere kwaliteit van de band samen te hangen met verminderd psychosociaal welbevinden van de ouders, een moeilijker temperament van het kind, en een suboptimale sociale omgeving (minder partner support en meer opvoedingsstress). Belangrijk was dat de band die zowel moeders als vaders met hun baby ervaarden gerelateerd bleek te zijn aan de ontwikkeling van het kind op het gebied van zelfregulatie. Deze samenhang bleek zowel direct als indirect via cognities van ouders rondom het ouderschap verklaard te kunnen worden. Daarnaast liet de laatste studie ook zien dat kind kenmerken (zoals huilen) de gevoelens en cognities van ouders beïnvloeden. Samengenomen laat dit proefschrift zien dat de ouder-kind band, die zich al tijdens de zwangerschap vormt, belangrijk is voor het psychologisch welbevinden van ouders zowel als voor de ontwikkeling van kinderen. Het is daarom van belang dat onderzoekers en professionals in de praktijk aandacht (blijven) schenken aan het in kaart brengen en monitoren van de kwaliteit van de band die ouders met hun (ongeboren) baby ervaren om zodoende vroege bijsturing en advisering mogelijk te maken.



List of publications



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List of publications | 147

de Cock, E. S. A., Henrichs, J., Klimstra, T. A., Maas, A. J. B. M., Vreeswijk, C. M. J. M., Meeus, W. H. J., & van Bakel, H. J. A. (2017). Longitudinal associations between parental bonding, parenting stress, and executive functioning in toddlerhood. Journal of Child and Family Studies, 26, 1723-1733. doi: 10.1007/s10826-017-0679-7

de Cock, E. S. A., Henrichs, J., Vreeswijk, C. M. J. M., Maas, A. J. B. M., Rijk, C. H. A. M., & van Bakel, H. J. A. (2016). Continuous feelings of love? The parental bond from pregnancy to toddlerhood. Journal of Family Psychology, 30, 125-134. doi:10.1037/fam0000138

Maas, A. J. B. M., de Cock, E. S. A., Vreeswijk. C. M. J. M., Vingerhoets, A. J. J. M., & van Bakel, H. J. A. (2016). A longitudinal study on maternal fetal attachment and postnatal maternal sensitivity. Journal of Reproductive and Infant Psychology, 34, 110-121. doi:10.1080/02646838.2015.1112880

de Cock, E. S. A., Henrichs, J., Rijk, C. H. A. M., & van Bakel, H. J. A. (2015). Baby please stop crying: An experimental approach to infant crying, affect, and expected parenting self-efficacy. Journal of Reproductive and Infant Psychology, 33, 414-425. doi:10.1080/02646838.2015.1024212

Maas, A. J. B. M., Vreeswijk, C. M. J. M., de Cock, E. S. A., Rijk, C. H. A. M., & van Bakel, H. J. A. (2012). “Expectant Parents”: Study protocol of a longitudinal study concerning prenatal (risk) factors and postnatal infant development, parenting, and parent-infant relationships. BMC

Pregnancy and Childbirth, 12, 46. doi:10.1186/1471-2393-12-46

de Cock, E. S. A., Emons, W. H. M., Nefs, G. M., Pop, V. J. M., & Pouwer, F. (2011). Dimensionality and scale properties of the Edinburgh Depression Scale (EDS) in patients with type 2 diabetes mellitus: The DiaDDZOB Study. BMC Psychiatry, 11, 141. doi:10.1186/1471-244X-11-141.

Submitted for publicationde Cock, E. S. A., Klimstra, T. A., Vreeswijk, C. M. J. M., Maas, A. J. B. M., Meeus, W. H. J., & van Bakel, H. J. A. (submitted). Longitudinal associations between maternal and paternal bonding, parenting self-efficacy and child temperament.



About the author



A

About the author | 151

Evi Sophia Antonia de Cock was born on March 11th, 1987 in Veldhoven, the Netherlands. In 2005, after she finished secondary school at Pleincollege van Maerlant in Eindhoven, she started a Bachelor in Psychology & Health at Tilburg University. After she graduated cum laude in 2008 she continued her education with the Research Master Social and Behavioral Sciences at Tilburg University. During her studies at Tilburg University, she was a teaching-assistant at the department of Methodology & Statistics. After graduating cum laude in 2010, Evi started working as a lecturer and researcher for the department of Developmental Psychology at Tilburg University. In 2012, she received the University Teaching Qualification and became a PhD-candidate. From October 2015 until April 2016, Evi was a junior policy officer at The Netherlands Organisation for Scientific Research (NWO) in The Hague, after which she continued her PhD-project. Currently, Evi works as a lecturer and (postdoctoral) researcher at the department of Developmental Psychology at Radboud University, Nijmegen.

Evi Sophia Antonia de Cock is geboren op 11 maart 1987 in Velhoven, Nederland. In 2005, nadat ze de middelbare school heeft afgerond aan het Pleincollege van Maerlant in Eindhoven, start ze met de Bachelor Psychologie en Gezondheid aan de Universiteit van Tilburg. Nadat ze hiervan cum laude afstudeert in 2008, vervolgt ze haar opleiding met de Research Master Social and Behavioral Sciences aan dezelfde universiteit. Tijdens haar opleiding aan de Universiteit van Tilburg werkt Evi ook als onderwijsassistent bij het departement Methoden en Technieken van Onderzoek. Nadat Evi cum laude afstudeert in 2010, start ze als docent en onderzoeker bij het departement Ontwikkelingspsychologie aan de Universiteit van Tilburg. In 2012 ontvangt ze de Basis Kwalificatie Onderwijs en krijgt ze een baan als promovenda. Van oktober 2015 tot april 2016 werkt Evi als junior beleidsmedewerker bij de Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO) in Den Haag, waarna ze haar promotieonderzoek voortzet. Op dit moment werkt Evi als docent en (postdoc)onderzoeker bij het departement Ontwikkelingspsychologie aan de Radboud Universiteit in Nijmegen.




LOVE BEFO

RE FIRST SIGH

T Parental bonding from pregnancy to toddlerhood

Evi S.A. de Cock

LOVE BEFORE FIRST SIGHTParental bonding from pregnancy to toddlerhood

Evi S.A. de Cock

UITNODIGING

voor het bijwonen van de openbare verdediging

van mijn proefschrift

LOVE BEFORE FIRST SIGHT

Parental bonding from pregnancy to toddlerhood

Op vrijdag 8 september 2017 om 14:00 uur

in de Aula van Tilburg University,

Cobbenhagen gebouw, Warandelaan 2, 5037 AB Tilburg

Na afloop bent u van harte welkom op de receptie ter plaatse

Evi de [email protected]

PARANIMFENMargot BenninkJanneke Maas

Charlotte Vreeswijk

Vragen? Mail naar [email protected]

14765_EdeCock_OM.indd 1 25-07-17 14:24

Documents

Tilburg University Love before first sight de Cock, Evi · Rubin (1967) first introduced maternal bonding as part of her theory on maternal role attainment. During this process of