Attachment representations in pre-adolescents at familial high risk of schizophrenia or bipolar disorder and population-based controls –: characteristics of attachment from middle childhood to pre-adolescence, and its relation to parental functioning and child mental disorder.

BACKGROUND: Development of secure attachment is crucial to establish and maintain healthy relationships with others throughout life. For parents with schizophrenia or bipolar disorder, challenged parental functioning may compromise the sensitive caregiving needed to establish secure child attachment. We aimed to examine pre-adolescent attachment, predictors related to caregiving, and middle childhood attachment predictors of pre-adolescent mental disorders.

METHODS: In a population-based nationwide cohort of 522 children of parents with schizophrenia or bipolar disorder and population-based controls, The Secure Base Script Test was used to assess attachment security at age 11 (N = 409). Parental caregiving and functioning were assessed with the Personal and Social Performance Scale and MC-HOME (age 7) and child mental disorder with K-SADS-PL (age 7 and 11). Story Stem Assessment Profile was used for age 7 attachment.

RESULTS: We found no differences between risk and control groups in prevalence of pre-adolescent secure attachment. Parental level of functioning and attachment security at age 7 significantly predicted more rich secure base content at age 11. Level of age 7 disorganization significantly predicted presence of mental disorder at age 11.

CONCLUSIONS: Overall, attachment of children at familial risk of schizophrenia or bipolar disorder did not differ from that of controls. Instead, parental functioning in middle childhood predicts pre-adolescent attachment, and may therefore serve as a focus for supporting healthy attachment development. Middle childhood disorganization might serve as a predictor of pre-adolescent mental disorder if other studies confirm our findings, and awareness hereof may be relevant for guiding intervention to support mental development.