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. Author manuscript; available in PMC: 2022 Jun 1.
Published in final edited form as: Attach Hum Dev. 2020 Jan 16;23(3):239–256. doi: 10.1080/14616734.2020.1714676

Attachment Quality Assessed from Children’s Family Drawings Links to Child Conduct Problems and Callous-Unemotional Behaviors

Peter D Rehder 1, W Roger Mills-Koonce 2, Nicholas J Wagner 3, Bharathi J Zvara 2, Michael T Willoughby 4; The Family Life Project Key Investigators5
PMCID: PMC7363511  NIHMSID: NIHMS1550999  PMID: 31948359

Abstract

Objective.

Recently, there has been considerable research on the origins of childhood conduct problems (CP) and callous-unemotional (CU) behaviors, given that they increase risk for antisocial behavior and psychopathy throughout life. Early parent–child relationships may play an important role in the development of these problem behaviors. This study examined associations between children’s attachment representations and CP and CU behaviors during middle childhood.

Method.

At 1st grade, 1,292 children (57% European American, 42.5% African American, 0.5% other race; 50.9% girls) completed a drawing of their family, which was coded by trained raters to assess attachment representations. Using the coded drawings, children were classified into attachment groups. Primary caregivers reported on children’s CP and CU behaviors.

Results.

Children with disorganized representations showed more CP and CU behaviors than children with secure and resistant representations. Those with disorganized representations were more likely than those with secure representations to show clinical levels of CP without CU behaviors, CU behaviors only, and co-occurring CP and CU behaviors.

Conclusion.

These findings provide support for attachment disorganization as a correlate of child CP and CU behaviors and suggest that attachment representations are likely important proximal influences on children’s behavior. Implications and future directions are discussed.

Keywords: Attachment, Attachment Representations, Family Drawing, Conduct Problems, Callous-Unemotional Behaviors

Over the past decade, there has been considerable research on the origins of child conduct problems (CP) with and without callous-unemotional (CU) behaviors. Whereas children with conduct problems and low callous unemotional behaviors (CP-only) often display more reactive aggression, children with conduct problems and elevated callous-unemotional behaviors (CP+CU) tend to display more proactive aggression and are at higher risk for later antisocial behavior and psychopathy (Lynam, Caspi, Moffitt, Loeber, & Stouthamer-Loeber, 2007; Rowe et al., 2010). Callous-unemotional behaviors can be reliably observed in childhood and adolescence (Frick & Viding, 2009; Hawes et al., 2014; Hyde et al., 2013; Kimonis et al., 2016; Willoughby, Mills-Koonce, Gottfredson, & Wagner, 2014; Willoughby, Mills-Koonce, Waschbusch, & Gottfredson, & the Family Life Project Investigators, 2015; Willoughby, Waschbusch, Moore, & Propper, 2011) and numerous biological, cognitive, emotional, behavioral, and environmental characteristics that may be involved in the etiology of CU behaviors have been described (see Frick, Ray, Thornton, & Kahn, 2014 for a review). Elevated levels of CU behaviors have been used to identify a homogeneous subgroup of children with CP that display deficits in the experiences of guilt, empathy, and fear and are often characterized by an elevated reward-focus and insensitivity to punishment (Blair, Peschardt, Budhani, Mitchell, & Pine, 2006; Frick & White, 2008; Kotler & McMahon, 2005). As such, the designation of having elevated CU behaviors has been added as a qualifier for children with a diagnosis of conduct disorder in the DSM-5 (American Psychological Association, 2013), and research on the etiology of this behavioral phenotype has increased dramatically—including investigations of the possible roles of environmental factors early in life, such as parenting and parent–child relationship quality (Hyde et al., 2016; Pasalich, Dadds, Hawes, & Brennan, 2011; Mills-Koonce, Willoughby, Garrett-Peters, Wagner, Vernon-Feagans, 2016; Waller et al., 2012; Willoughby, Mills-Koonce, Propper, & Waschbusch, 2013; for review, see Waller, Gardner, & Hyde 2013).

The current study builds on this growing literature, and previous findings from the current sample, by examining concurrent measures of child attachment representations (assessed via children’s family drawings) as correlates of CP, CU behaviors, and their co-occurrence in middle childhood. Wagner and colleagues (2015) found that children’s representations of family dysfunction assessed from family drawings—including family pride, vulnerability, emotional distance, tension/anger, role reversal, and global pathology—were positively associated with CU behaviors. We extend these findings by using the same family drawings to assess children’s attachment representations with their primary caregivers as they relate to children’s CP and CU behaviors.

Attachment Quality, Conduct Problems, and Callous-Unemotional Behaviors

Attachment insecurity has been identified as a risk factor for antisocial and disruptive behavior problems (Shaw & Bell, 1993; Shaw & Vondra, 1995; van IJzendoorn, 1997), and children with disorganized and avoidant patterns of attachment have been found to be at increased risk for CP as many as 8 years later (Erickson, Sroufe, & Egeland, 1985; Lyons-Ruth, Easterbrooks, & Cibelli, 1997; Munson, McMahon, & Spieker, 2001). The nature of early parent–child relationships is internalized by children in numerous ways and influences the consolidation of behavioral, cognitive, and biological systems associated with later broad externalizing behaviors (Burgess, Marshall, Rubin, & Fox, 2003), hostile attribution biases (McElwain, Booth‐LaForce, Lansford, Wu, & Justin Dyer, 2008), and the stress-response systems (Hertsgaard, Gunnar, Erickson, & Nachmias, 1995; Spangler& Grossman, 1999). Similarly, attachment representations in middle childhood likely reflect the ongoing parent–child dynamic observed across childhood and are also implicated in developmental processes underlying concurrent and ongoing externalizing behaviors across middle childhood and early adolescence (Pasalich, Dadds, Hawes, & Brennan, 2012). Children with disorganized attachments likely experience the most extreme (Lyons-Ruth et al. 1999) and persistent (Mills-Koonce et al. 2008) levels of maladaptive parenting behaviors compared to both children with secure attachments and children with organized but insecure attachments (i.e., insecure-avoidant and insecure-resistant). Not surprisingly, children with disorganized attachments have consistently evidenced higher levels of aggression in middle childhood, above and beyond other familial factors (Lyons-Ruth, 1996).

Although there is a substantial literature on the associations between attachment and conduct problems, there is a small but growing literature linking attachment and CU behaviors, and an even smaller literature explicitly examining the co-occurrence of CP and CU behaviors. Despite limited empirical research, there are multiple theoretical reasons to believe that the developmental cascade culminating in CU and CP+CU may include parent–child attachment security as a source of resilience, or attachment disorganization as a source of risk. Attachment security is associated with greater empathic functioning, experiences of guilt, and conscience development in children (Kochanska, 1997; Laible, & Thompson, 2000; Mark, IJzendoorn, & Bakermans‐Kranenburg, 2002), characteristics that are specifically deficient among children high on CP+CU (de Wied, van Boxtel, Matthys, & Meeus, 2012; Muñoz, Qualter, & Padgett, 2011). These findings are consistent with evolutionary theories postulating that the ontogenetic roots of empathy within the mammalian brain arose as a function of the social bonds between caregiver and child (MacLean, 1985; Swain, Lorberbaum, Kose, & Strathearn, 2007), a developmental context that appears critical for the consolidation of neurobiological systems associated with empathic functioning (Shirtcliff, Vitacco, Graf, Gostisha, Merz, & Zahn‐Waxler, 2009). A collapse of this system early in life may result in deficits of empathic functioning, placing children at heightened risk for later CU behaviors.

Accordingly, the concept of attachment disorganization (resulting from the failure of children to organize their biological, cognitive, and behavioral activity around the behavioral contingencies of their caregivers), may be of critical significance. Children rated as having disorganized attachments display greater conduct problems over and above all other attachment classifications (Green & Goldwyn, 2002). As suggested by Lyons-Ruth (2007), disrupted parent–child interactions inherent in disorganized relations may impede the development of children’s abilities to understand the mental states of others and, as such, provide an early foundation for more extreme levels of behavior problems at later ages. More recently, multiple studies have demonstrated specific associations between attachment disorganization and CP+CU in early (Willoughby et al., 2011) and middle childhood (Bohlin, Eninger, Brocki, & Thorell, 2012; Pasalich et al., 2012). Each of these studies relied on elaborate and well-validated measures of attachment assessment, including the Ainsworth Strange Situation Paradigm in infancy (Ainsworth, Blehar, Waters, & Wall, 1978) and the Manchester Attachment Story Task (MCAST; Green, Stanley, Smith, & Goldwyn, 2000) and Doll Play Assessment (Solomon, George, & De Jong, 1995) in early and middle childhood. To our knowledge, the current study is one of the first to examine associations between attachment representations derived from children’s drawings of their families and child CP and CU behaviors.

The Family Drawing Paradigm (FDP; Fury, Carlson, & Sroufe, 1997) involves simply asking children to draw their families using a blank sheet of paper and a standard set of colored markers, and then coding the images using a set of indicators for each attachment classification (Secure, Insecure-Avoidant, Insecure-Resistant, and Insecure-Disorganized). Although simpler than other existing assessments, family drawings may enable children to express emotions that they are unable to convey through interview or narrative tasks. Particularly during early and middle childhood, children may not be good at describing their thoughts and emotions verbally; and projective measures (like drawings) may provide ecologically valid information about their attachment representations that cannot be detected by other tasks (Goldner, Edelstein, & Habshush, 2015; Howard et al., 2017; Pace et al., 2015). In addition, the FDP is short, easy, and inexpensive to administer, relative to other attachment tasks. If the FDP demonstrates good construct and predictive validity, then it offers an opportunity for researchers and clinicians to measure children’s attachment representations more easily than with other tasks.

Empirical work by Fury et al. and others has shown moderate to strong construct validity of the FDP in assessing children’s attachment representations among diverse racial/ethnic and international samples (Behrens & Kaplan, 2011; Fury et al., 1997; Goldner & Scharf, 2011; Jin, Chung, & Hazen, 2018; Pianta, Longmaid, & Ferguson, 1999; Shiakou, 2012), longitudinal samples (Fury et al., 1997; Madigan, Ladd, & Goldberg, 2003; Roe, Bridges, Dunn, & O’Connor, 2006), post-institutionalized adopted samples (Howard et al., 2017; Pace, Zavattini, & Tambelli, 2015), and among victims of abuse (Piperno, Di Biasi, & Levi, 2007). Fury et al. (1997) found high concordance between attachment classifications made using the FDP when children were 8–9 years old and Strange Situation classifications from infancy. Madigan et al. (2003) replicated these findings comparing among 7-year-old children, with 80.5% of children’s attachment classifications from the FDP matching their Strange Situation classifications. Likewise, Jin and colleagues (2018) found positive associations between attachment classifications derived from the FDP and the MCAST among 7–9-year-old children. Untrained adults have also shown the ability to distinguish between the drawings of children with histories of disorganized parent–infant attachment from others, rating their drawings higher on disorganization, carelessness, family chaos, bizarreness, uneasiness, and dysfunction (Madigan, Goldberg, Moran, & Pederson, 2004). Although these findings suggest strong convergent validity of the FDP with more intensive and widely-used attachment measures, studies investigating convergent validity remain limited.

Several previous studies have examined the predictive validity of the FDP, but few have examined disorganization using the measure—often opting to test only outcomes of organized classifications (e.g., Fury et al., 1997; Pianta et al., 1999). However, consistent with findings from studies using widely-used attachment measures, Goldner and Scharf (2011) found that 8–12-year-old children whose family drawings were classified as disorganized showed more conduct problems than children whose drawings were classified as secure. Nevertheless, the preliminary evidence of convergent validity combined with the demonstrated predictive validity, ecological validity for use with young children, and considerable efficiency in execution and coding of the FDP make it a useful measure of attachment representations for both clinical and research purposes.

Current Study

The current study had two primary goals: (1) to replicate previous studies that have found links between attachment and CP and CU behaviors in early and middle childhood; and (2) to provide further evidence of the predictive validity of the FDP. To those ends, we examined group differences in parent ratings of CP and CU behaviors as a function of child attachment representation quality assessed by the FDP, and whether attachment representations were associated with the co-occurrence of CP and CU behaviors in middle childhood. We hypothesized that (1) children with secure attachment representations would display the lowest levels of CP and CU behaviors; (2) children with disorganized attachment representations would display the highest levels of CP and CU behaviors; (3) children with resistant and avoidant representations would display higher levels of CP and CU behaviors than children with secure representations and lower levels than those with disorganized representations, but their CP and CU behaviors would not differ from one another; and (4) children with disorganized attachment representations would be disproportionately represented among children with co-occurring CP and elevated CU behaviors. Child attachment representations, CP, and CU behaviors were measured concurrently when children were in 1st grade.

Methods

Participants

The Family Life Project is a large longitudinal study of children and families living in nonurban, lower income communities in the United States. Families and their newborns that lived in two major geographical areas of high rural poverty (including three counties in eastern North Carolina and three counties in central Pennsylvania) were recruited using a stratified random sampling procedure yielding a representative sample of 1,292 families recruited over a one-year period at the time mothers gave birth. The full sample included 549 African American (42.5%) children, 736 European American (57%) children, 7 children of other race (0.5%), 657 girls (50.9%), and 635 boys (49.1%). See Willoughby and colleagues (2013) and Garrett-Peters and Mills-Koonce (2013) for more information on the recruitment of the Family Life Project sample. Of the 1,292 families, 123 were missing data on all predictor variables. Independent sample t tests were estimated to compare mean differences on demographic measures between individuals who were missing data on all predictor variables to those with partial or complete data, and no significant differences were observed. Data from a total of n = 1166 children were used in the current analyses.

Procedures

Data were collected during home visits when children were in 1st grade. The visit consisted of child assessments and computerized interviews and questionnaires. Mothers answered questionnaires on child behaviors and children were asked to complete a drawing of their family. Participating children were asked to draw a picture of their family on a 12 × 18 sheet of blank white paper using a set of ten basic color felt-tip markers. In nearly all cases, the family drawings were completed in an area separate from the child’s parents or siblings. Prior to beginning the task, children were asked to draw a “person” using a pencil and a standard 8 X 10 sheet of white paper. This initial warm-up task was intended to promote a relaxed atmosphere and to assure the child that the task was not a test of drawing ability. Following the warm-up task, each child was asked to draw a picture of his or her family. No further direction was provided. After the drawing was completed, a research assistant asked the child to identify all persons included in the drawing and state their relation to the child. Drawings were labeled in pencil by the research assistant.

Measures

Attachment classification.

The coding system for analyzing children’s family drawings outlined originally by Kaplan and Main (1986), and adapted by Fury et al. (1997), was used to assess dimensions of attachment quality (i.e., security, avoidance, resistance, disorganization). Each dimension was coded for the presence or absence of eight items. Example items include “complete figures” and “figures grounded (not floating)” for security, “child and mother positioned far apart on page” and “omission of mother (or child)” for avoidance, “figures crowded or overlapping” and “unusually small figures” for resistance, and “figures scratched out” and “scrunched figures” for disorganization.

The classification criteria used by Kaplan and Main (1986) and Fury et al. (1997) were further adapted based on item-level analyses of the FDP conducted by Pianta and colleagues (1999) in order to model the four-way classification methods used in the Strange Situation. Specifically, dimension scores were created by summing the number of “present” items for each dimension, and then were used to assign participants to attachment classifications. If children had disorganization scores of ≥ 2, then they were classified as “Disorganized”. If children had avoidant scores of ≥ 2 and resistant and disorganization scores of < 2, then they were classified as “Avoidant”. If children had resistant scores of ≥ 2 and avoidant and disorganization scores of < 2, then they were classified as “Resistant”. If children had secure scores of ≥ 2 and avoidant, resistant, and disorganization scores of < 2, then they were classified as “Secure”. If children had resistant scores of ≥ 2 and avoidant scores of ≥ 2, but disorganization score of < 2, then they were classified as “A/C not D”. Lastly, if children had scores for all 4 dimensions as < 2, then they were designated as “unclassifiable”. This schema created 6 mutually exclusive and exhaustive categories. There were no children who were designated as “unclassifiable”, and only a small number of children (n=6) classified as A/C not D. These children were not included in the current analyses, both due to their small sample size and the conceptual ambiguity of their attachment quality. This approach resulted in a distribution of attachment classifications that would be expected in a population-based sample, like the Family Life Project.

All coders were trained and certified by W. Roger Mills-Koonce (the second author). Each drawing was coded independently by 2 trained coders; scores were compared, and discrepancies were resolved by consensus. The reliabilities of original dimensional scores were acceptable across dimensions and coder pairs (all ICC’s > .85) as was the agreement on major classifications (all kappas > .78).

Conduct problems.

Levels of conduct problems were rated by maternal primary caregivers using the Disruptive Behavior Disorder Rating Scale (DBDRS) at 1st grade. The DBDRS (Pelham, Gnagy, Greenslade, & Milich, 1992) is a DSM–IV-guided rating scale that includes subscales for assessing oppositional defiance (ODD), hyperactivity-impulsivity, conduct disorder (CD), and inattention. Oppositional defiant items assess various qualities including defiance, argumentativeness, and anger. Conduct disorder items focus on more disruptive behaviors such as aggression toward people and animals, destruction of property, theft, and serious violations of rules. Composite scores representing both oppositional defiant disorder and conduct disorder, what we broadly refer to as CP (Kimonis, Frick, & McMahon, 2014; Lorber, 2004), were calculated (α = .92). The psychometrics of the DBDRS have been evaluated (see Wright, Waschbusch, & Frankland, 2007) and it has shown validity with young children in at-risk, community samples (Pelletier, Collett, Gimpel, & Crowley, 2006). A continuous measure of conduct problems was used in all analyses.

Callous-unemotional behaviors.

Callous-unemotional behaviors were assessed with the Inventory of Callous-Unemotional Traits (ICU; Essau, Sasagawa, & Frick, 2006), a series of 24 items on a 4-point Likert scale developed from other highly established clinical assessments (e.g., APSD, PCL-YV). Examples of items from the measure include “does not care who s/he hurts to get what s/he wants” and “seems cold and uncaring to others”, “expresses his/her feelings openly” (reverse-scored) and “does things to make others feel good” (reverse-scored). The ICU has demonstrated validity among normative and clinical samples of both children (Hawes et al., 2014, Willoughby et al., 2015) and adolescents (Essau et al., 2006). Initial investigations into the factor structure of the ICU suggested a bifactor model, which included a general factor (on which all items loaded) and three specific subfactors. Although there has been some variation across samples, a recent meta-analysis found that the reliable variance in the ICU subfactor scores were strongly influenced by the general factor, suggesting that, across samples, the ICU total score best represents the CU behavior construct (Ray & Frick, 2018). Thus, we calculated composite mean scores that represent an average of primary caregivers’ responses on all items (Cronbach’s α = .88).

Joint Occurrence of Conduct Problems and Callous-Unemotional Behaviors

In addition to examining covariation among continuous measures of the behavioral outcomes, the current study examined the prediction of clinically significant groups of children with high and low levels of CP and CU behaviors. Following clinical guidelines (APA, 2013), children were designated as having high CP if their primary caregiver reported three or more CD symptoms and/or four or more ODD symptoms on the DBDRS (other children were designated as low CP). Children were designated as having elevated CU behaviors if they scored in the 90th percentile or above on the ICU. Although there are no set guidelines that designate clinical levels of CU behaviors, we were confident that the 90th percentile cutoff used designates children showing very high levels of CU behaviors in the clinical range. Based on these cutoffs, four CP/CU groups were created: (1) children with low conduct problems and low CU behaviors (no-CP/CU, n = 854), (2) children with high conduct problems and low CU behaviors (CP-only, n = 20), (3) children with low conduct problems and high CU behaviors (CU-only, n = 97), and (4) children with high conduct problems and high CU behaviors (CP+CU, n = 35).

Analytic strategy.

The proposed hypotheses were addressed using structural equation modeling (SEM) methods. The SEM models were fit using Mplus 8 (Muthén & Muthén, 1998–2017). Multivariate path analysis was used to assess attachment representation group differences in the prediction of continuous measures of CP, EP, and CAL behaviors. In addition, a multinomial logistic path analysis was used to assess group differences in the likelihood of showing elevated levels of CP and CU behaviors, and their co-occurrence. Given the complex sampling design of the Family Life Project, analyses utilized individual probability weights associated with oversampling of low-income and African American families and stratification on income, state, and race. Additional model covariates included child sex and the child age in months at the first-grade visit. Because individual probability weights and stratification were implemented in the current analyses, SEM models were estimated using a robust maximum likelihood estimator (MLR). Missing data were handled using full information maximum likelihood methods (Enders & Bandalos, 2001). The Satorra-Bentler scaled (mean-adjusted) chi-square difference test was used to compare these conditional models (saturated) to their respective null models, in which the effects of the predictors on the outcomes were constrained to zero (Satorra & Bentler, 2001).

Results

Descriptive Statistics

Bivariate correlations among variables are presented in Table 1. Continuous attachment scores (secure, avoidant, resistant, disorganized) were included in the correlation table to support interpretation. The Secure attachment score was negatively associated with CP, the Avoidant attachment score was positively associated with CP and CU behaviors, the Resistant score was marginally positively associated with CP and CU behaviors, and the Disorganized attachment score was positively associated with CP and CU behaviors. Following the classification criteria outlined, the largest attachment group was the Secure group (n = 423; 48.1%), followed by the Disorganized (n = 181; 20.6%), Resistant (n = 144; 16.4%), and Avoidant groups (n = 131; 14.9%). With respect to the CP/CU groups, most children in the sample showed low levels of CP/CU (84.9%), followed by children meeting CU-only (9.6%), CP+CU (2.0%), and CP-only criteria (3.5%), respectively.

Table 1.

Bivariate Correlations

1 2 3 4 5 6 7 8 9 10 11
1. Child racea –
2. Child sexb 0.00 –
3. Statec −0.50** −0.08* –
4.Child age −0.15** −0.01 −0.04 –
5. Income-to-needs ratio −0.33** −0.06 0.17** 0.05 –
6. Avoidant score 0.14** −0.11** −0.08* −0.04 −0.09* –
7. Secure score −0.09** 0.14** −0.05 0.03 0.00 −0.39** –
8. Resistant score −0.01 −0.04 0.02 −0.05 0.00 0.07 −0.19** –
9. Disorganized score 0.16** −0.10** −0.02 −0.02 −0.06** 0.28** −0.43** 0.28** –
10. CU behaviors 0.14** −0.10** −0.09** −0.05 −0.18** 0.10** −0.06 0.07† 0.12** –
11. Conduct problems 0.02** −0.05 0.04 −0.05 −0.16** 0.11** −0.09** 0.08† 0.14** 0.56 –
Number 1166 1166 1166 893 1163 881 881 879 880 1008 1006
Mean 0.23 0.49 0.59 87.04 2.18 0.94 6.20 1.09 0.75 0.64 0.27
Standard deviation 0.42 0.50 0.49 3.16 1.59 0.90 1.46 1.12 1.19 0.41 0.34
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Note.

a

0 = European American, 1 = African American.

b

0 = male, 1 = female.

c

0 = North Carolina, 1 = Pennsylvania

*

p < .05,

**

p < .01;

†

p < .10

Attachment Group Differences in Continuous Measures of CP and CU behaviors

Multivariate path analysis was used to assess associations between children’s attachment representations and continuous measures of CP and CU behaviors. Attachment classification was dummy coded in order to compare groups. Table 2 presents the unstandardized and standardized estimates, standard errors, and 95% confidence intervals. After controlling for demographic covariates, children with Disorganized attachment representations had more CP behaviors than children with Secure and Resistant attachment representations, but showed only marginally greater CP behaviors than children with Avoidant attachment representations. No significant differences in CP behaviors were observed among children with Secure, Avoidant, or Resistant representations.

Table 2.

Maximum Likelihood Estimates of Associations Among Attachment Classification, Conduct Problems, and Callous-Unemotional Behaviors

Parameter Effects
b SE β 95% CI
Conduct Problems
 Disorganized vs. Secure .123** .037 .139 .051 – .195
 Disorganized vs. Avoidant .089† .048 .101 −.005 – .184
 Disorganized vs. Resistant .109** .041 .124 .028 – .191
 Secure vs. Avoidant −.034 .040 −.049 −.111 – .044
 Secure vs. Resistant −.014 .031 −.020 −.075 – .048
 Avoidant vs Resistant .020 .044 .019 −.067 – .107
Callous Behaviors
 Disorganized vs. Secure .145*** .041 .136 .064 – .225
 Disorganized vs. Avoidant .057 .057 .053 −.055 – .168
 Disorganized vs. Resistant .137* .053 .128 .033 – .24
 Secure vs. Avoidant −.088† .048 −.106 −.183 – .007
 Secure vs. Resistant −.008 .043 −.010 −.038 – .111
 Avoidant vs Resistant .080 .058 .064 −.035 – .194
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Note.

*

p < .05;

**

p < .01;

***

p < .001;

†

p < .10

Children with Disorganized representations showed more CU behaviors than children with Secure and Resistant representations, but did not differ from children with Avoidant representations. Children with Avoidant representations showed marginally more CU behaviors than children with Secure representations. No significant differences in CU behaviors were observed between children with Secure and Resistant representations, or with Avoidant versus Resistant representations.

Prediction of Clinically Significant and Co-Occurring CP and CU Behaviors

Next, multinomial logistic path analysis was used to examine associations between children’s attachment classifications and clinically significant levels of CP and CU behaviors, and their co-occurrence. The overall conditional model fit significantly better than the null model, χ2 (15) = 29.45, p < .05. Based on the findings from the path analysis using continuous outcomes, a priori contrasts compared the likelihood of meeting CP-only, CU-only, or CP+CU criteria to the likelihood of showing no elevated CP or CU behaviors among children with Secure versus Disorganized Representations. As compared to children with Secure representations, children with Disorganized representations were 5.85 times more likely to meet CP-only criteria, b = 1.77, SE = .74, p = .017, CI = [0.32 – 3.22], and 3.28 times more likely to meet CP+CU criteria, b = 1.19, SE = .47, p = .012, CI = [0.27 – 2.11], but were not more likely to meet CU-only criteria, b = .485, SE = .36, p = .173, CI = [−0.21 – 1.18]. Of course, it is possible that the direction of effects between attachment representations and CP and CU behaviors could be reversed, given the lack of temporal precedence. However, we ran a competing model with children’s CP and CU behaviors at 48 months old predicting their 1st grade attachment representations and neither significantly predicted those representations. Although the fit of the central analyses is indistinguishable from competing models with attachment representations as the outcome, our confidence in the hypothesized direction of effects is improved by this supplementary analysis and existing research.

Discussion

The current study examined associations between 1st-grade children’s attachment representations, measured via family drawings, and their parent-reported levels of CP and CU behaviors. Consistent with hypotheses 1 and 2 and partially so with hypothesis 3, we found that children with disorganized representations showed more CP and CU behaviors than children with secure and resistant representations, but not those with avoidant representations. Children with avoidant representations also showed marginally more CU behaviors than children with secure representations. Finally, with respect to our fourth hypothesis, those with disorganized representations were more likely than those with secure representations to show clinical levels of CP without CU behaviors, as well as co-occurring CP and CU behaviors. These findings provide further support for attachment disorganization as a correlate of (and potential etiological contributor to) CP and CU behaviors in childhood.

Attachment Disorganization, Conduct Problems, and Callous-Unemotional Behaviors

Numerous existing studies have found associations between early attachment disorganization and/or disorganized attachment representations and externalizing behavior, with meta-analyses suggesting moderate effect sizes for both disorganization across various measures (d = 0.18–0.34; Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010) and representational measures, specifically (d = 0.58; Madigan, Brumariu, Villani, Atkinson, & Lyons-Ruth, 2016). As mentioned previously, only a handful of previous studies have examined links to CU behaviors (Bohlin et al., 2012; Pasalich et al., 2012; Willoughby et al., 2011). The current study extends these findings by demonstrating associations of disorganized representations with both CP and CU behaviors in 1st grade. This consistency with previous findings suggests that disorganized attachment is likely a robust correlate of externalizing behaviors across ages and measurement protocols. However, further research is needed to gain better understanding of the developmental mechanisms through which disorganized representations promote both CP and CU behaviors.

Attachment representations reflect children’s perceptions of their caregivers as a secure base for exploration and for safety in times of need (Bretherton, 1995; Fearon et al., 2010; Main, Kaplan, & Cassidy, 1985), as well as their expectations of others’ behavior (Sroufe, Egeland, Carlson, & Collins, 2005). Little is known about how disorganized representations lead to externalizing behavior, but various potential mechanisms exist. For example, disorganized representations may result in an inability to understand and/or predict social others’ emotions and behaviors. This may be reflected in emotion recognition deficits (e.g., anger bias and poor recognition, generally), which have been repeatedly associated with CU behaviors (Dadds, Jambrak, Pasalich, Hawes, & Brennan, 2011; Kimonis et al., 2016; Rehder et al., 2017). Further, children with disorganized representations may be less adept at observing and understanding prosocial behavior modeled by social others (Guttmann-Steinmetz & Crowell, 2006), making them less likely to show empathy and more likely to engage in antisocial behavior. Finally, a perceived inability to rely on caregivers for emotion support characterized by disorganized representations may lead to poor development of self-regulatory skills (including emotion regulation) in early life (Cassidy, 1994), which are strongly influenced by caregivers’ behavior (Calkins, 2007; Sameroff, 2010). Poor self-regulation, in turn, has been linked with both CP and CU behaviors (Calkins, 2007; Willoughby et al., 2013).

It should be noted that children with avoidant representations showed marginally more CU behaviors than children with secure representations. Likewise, children with disorganized and avoidant representations did not show significantly differing levels of CU behaviors. Thus, similar developmental mechanisms may link both disorganized and avoidant attachment with CU behaviors. For example, children with avoidant representations may spend less time attending to the emotions and behavior of their parents (and social others, in general) than children with secure representations, potentially hindering their learning about emotions and prosocial behavior. Likewise, early learning of self-regulatory skills may be disrupted by avoidant representations, given that the behavioral phenotype characterizing avoidant attachment involves diverting attention and/or retreat from parents during times of distress (Pallani et al., 2018). Although this effect was consistent with previous research showing that disorganized and avoidant attachments are associated with greater risk for CP than secure and resistant attachments (Erickson et al., 1985; Lyons-Ruth et al., 1997; Munson et al., 2001), we caution against interpreting the difference between children with avoidant versus secure representations because the effect was only marginally significant. Nevertheless, future research should attempt to replicate associations of both disorganization and avoidance with problem behavior (especially CU behaviors) and, critically, attempt to delineate the developmental mechanisms that characterize those associations.

The Family Drawing Paradigm as a Measure of Attachment Representations

The current study provides further support for the FDP as a measure of attachment representations. By demonstrating associations of disorganized and avoidant representations with CP and CU behaviors, our findings suggest concurrent validity of the FDP, given that these associations would be expected based on previous theoretical and empirical work (Madigan et al., 2016). Although the FDP is simpler than more intensive representational measures, it is shorter and less expensive to administer than many other measures designed for young children, making it a suitable research and clinical instrument (Wagner et al., 2015). It may be particularly useful when researchers are attempting to minimize participant burden. Further, it may be of use during early to middle childhood, when play no longer provides an adequate context for assessing attachment, but children are not competent at describing their feelings verbally (Fury et al., 1997).

Limitations

The current study has some notable limitations. First, the cross-sectional nature of the data does not enable us to establish the direction of effects between attachment representations and CP and CU behaviors. Although attachment representations would, theoretically, be expected to precede CP and CU behaviors, it is also possible that CP and CU behaviors influence children’s attachment representations (e.g., children showing callousness might be more likely to think of their relationships with their caregivers in negative terms). However, the competing model we analyzed supports the hypothesized direction of effects. Nevertheless, future studies should utilize longitudinal data to establish temporal precedence in order to provide further support for the contributions of disorganized representations to CP and CU behaviors.

Second, the modest effect sizes reported for the significant associations found are of note. The development of CP and CU behaviors is a complex phenomenon that involves various coacting influences at multiple levels of analysis (Gottlieb & Lickliter, 2007), including genetics, child characteristics and behavior, and environmental influences (Frick et al., 2014; Waller et al., 2012). Any one predictor of CP and CU behaviors likely does not provide an adequate explanation of their etiologies. Further, children may develop these problem behaviors through different developmental mechanisms that differ from child to child, and that may or may not involve disorganized attachments, making it important to investigate how multiple influences coact over time to promote these problem behaviors (Rehder et al., 2017). Nevertheless, children in the current study with disorganized representations showed much greater likelihood of meeting CP-only and CP+CU criteria (odds ratios ranging from 2.20–6.33), suggesting that attachment disorganization presents a clinically meaningful risk for these problem behaviors.

Finally, as noted previously, the FDP is a less intensive measure than other attachment representation measures and may not as accurately classify children’s representations. Although our findings provide further support for its construct validity and offer an ecologically valid window into attachment processes for young children, they should not be over-interpreted. Continued replication is needed to provide greater confidence in the validity of the FDP and, when feasible, it would likely be beneficial to utilize more intensive measures of attachment representations.

Conclusion

The current study is one of the first to demonstrate associations between disorganized attachment representations and CP and CU behaviors in middle childhood, as well as the co-occurrence of CP and CU behaviors. These findings demonstrate the importance of parenting and parent–child relationships in the early development of these psychopathological behaviors. However, future research is needed to better understand the developmental mechanisms that explain the influence of disorganization, as well as other risk factors that coact with it to promote CP and CU behaviors. Examination of these potentially varied developmental pathways provide the opportunity to identify multiple points of prevention and intervention on these psychopathologies.

Acknowledgements

This work was supported by the National Institute of Child Health and Human Development (NICHD; 1PO1HD39667, 2PO1HD039667). Cofunding was provided by the National Institute of Drug Abuse, National Institutes of Health (NIH) Office of Minority Health, NIH Office of the Director, National Center on Minority Health and Health Disparities, and the Office of Behavioral and Social Sciences Research. The Family Life Project Key Investigators include Lynne Vernon-Feagans, Martha J. Cox, Clancy Blair, Peg Burchinal, Linda Burton, Keith Crnic, Ann Crouter, Patricia Garrett-Peters, Mark Greenberg, Stephanie Lanza, W. Roger Mills-Koonce, Cynthia Stifter, Emily Werner, and Michael Willoughby. This work was supported in part by predoctoral fellowship provided by the NICHD (T32-HD07376) through the Center for Developmental Science, University of North Carolina at Chapel Hill, to Peter D. Rehder. We also thank the many families and research assistants who made this study possible.

Footnotes

Disclosure Statement

No potential conflict of interest was reported by the authors.

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