M. Fuertes et al.

: Infant Co ping, Still-Face,

European Maternal Behavior,
Psychologist
©2009; and14(4):320–331
2009 Vol. Attachment
Hogrefe Publishing

Infant Coping and Maternal

Interactive Behavior Predict
Attachment in a Portuguese Sample
of Healthy Preterm Infants
Marina Fuertes1,2, Pedro Lopes-dos-Santos2, Marjorie Beeghly1,3, and Ed Tronick1,4
1
Child Development Unit & Harvard Medical School, Boston, MA, USA, 2University of Porto, Porto,
Portugal, 3Wayne State University, Detroit, MI, USA, 4Department of Psychology, University of
Massachusetts Boston & Fielding Graduate University, Santa Barbara, CA, USA

Abstract. In this longitudinal study of a Portuguese sample of healthy preterm infants, the aim was to identify specific, independent
predictors of infant-mother attachment status from a set of variables including maternal education, maternal representations’ of infant
temperament, infant regulatory behavior (coping), and mothers’ interactive behavior in free play. The sample consisted of 48 medically
low-risk preterm infants and their mothers who varied in education. When infants were 1 and 3 months (corrected age), mothers described
their infants’ temperament using a Portuguese temperament scale (Escala de Temperamento do Bebé). At 3 months (corrected age),
infants’ capacity to regulate stress (coping) was evaluated during Tronick’s Face-to-Face Still-Face paradigm (FFSF). At 9 months
(corrected age), mothers’ interactive behaviors were evaluated during free play using the Crittenden’s Child-Adult Relationship Experi-
mental Index (CARE-Index). At 12 months (corrected age), infants’ attachment security was assessed during Ainsworth’s strange situ-
ation. Sixteen (33.3%) infants were classified as securely attached, 17 (35.4%) as insecure-avoidant, and 15 (31.3%) as insecure-resistant.
In bivariate analyses, multiple factors were significantly associated with attachment status. However, in hierarchical regression analyses,
only infant coping and maternal responsiveness were significant predictors of attachment status. These findings suggest that both infant
characteristics identifiable early in the first year, such as coping, and maternal characteristics such as sensitivity influence the process of
attachment formation.

Keywords: infant coping, mother-infant interaction, attachment

Introduction chologically withdrawn (Barnard & Kelly, 1990; Goldberg

Compared with the large number of studies on mother-in-
fant attachment in the USA, relatively few attachment stud-
ies have been carried out with European samples, especial-
ly in Mediterranean countries. Moreover, many European
attachment studies have not evaluated the effect of associ-
ated risk factors such as premature birth or low levels of
maternal education on attachment formation (van IJzen-
doorn, Goldberg, Kroonenberg, & Frenkel, 1992; van
IJzendoorn & Sagi, 1999). In the present longitudinal
study, we addressed this gap in the literature by evaluating
specific, independent predictors of attachment in a medi-
cally low-risk sample of prematurely born Portuguese in-
fants and their mothers with varying levels of education.
Previous research has indicated that preterm infants are less
alert, less attentive, less active, and less responsive than
infants born at full term (Crnic, Ragozin, Greenberg, Rob-
inson, & Basham, 1983; Goldberg & DiVitto, 1995), and
their mothers tend to be more intrusive, controlling or psy-
& DiVitto, 1995; Muller-Nix et al., 2004). Given that pre-
mature infants are more difficult to handle, we wondered
whether style of maternal interactive behavior with the in-
fant, infants’ ability to regulate stress, and demographic
factors predict attachment variation in this understudied
Portuguese sample.
Antecedents of Mother-Infant Attachment
Although multiple factors assessed during the infant’s first
year of life are linked with infants’ later attachment status,
the specific infant, maternal, dyadic, and contextual vari-
ables that independently predict attachment status remain
controversial. Classical attachment theorists have postulat-
ed that mothers’ sensitivity and warm responsivity to their
infants are primary factors determining the quality of the
infant-mother attachment relationship (Ainsworth, Bell, &
Stayton, 1974; Bowlby, 1969). In support of this hypothe-

European Psychologist 2009; Vol. 14(4):320–331 © 2009 Hogrefe Publishing

DOI 10.1027/1016-9040.14.4.320
 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
sis, investigators have shown that infants who receive more
positive and sensitive responses from their mothers during
the first year of life are more likely to be classified as se-
curely attached by the end of the first year, compared to
infants receiving less sensitive care (Ainsworth, Blehar,
Waters, & Wall, 1978; Grossmann, Grossmann, Spangler,
Suess, & Unzner, 1985; Isabella, 1993).
Others have argued that individual differences in infant
characteristics such as difficult temperament and arousal reg-
ulation underlie variations in infants’ attachment status (e.g.,
Kagan, 1984). Several investigators have shown that infants
who are better able to regulate their behavior and emotions
when stressed (Braungart-Rieker, Garwood, Powers, &
Wang, 2001; Cohn, Campbell, & Ross, 1991), and infants
whose mothers make more positive and stable reports of their
temperament (Benoit, Parker, & Zeanah, 1997; Bretherton,
Biringen, Ridgeway, Maslin, & Sherman, 1989; Cox, Hop-
kins, & Hans, 2000; Izard, Haynes, Chisholm, & Baak, 1991;
Kochanska, 1998; Zeanah, Benoit, Hirshberg, Barton, & Re-
gan, 1994) are more likely to be classified as securely at-
tached at the end of the first year, compared to infants whose
mothers report poorer regulatory behavior in their infants. In
addition, individual differences in infants’ emotionality (e.g.,
emotional responses such as joy, fear, and anger) are associ-
ated with infants’ attachment status (e.g., Kochanska & Coy,
2002). Nonetheless, neither maternal sensitivity (e.g., De
Wolff & van IJzendoorn, 1997) nor infant emotional reactiv-
ity alone adequately explains the findings on attachment for-
mation (e.g., Goldsmith & Alansky, 1987).
More recently, several researchers, including some at-
tachment theorists, have argued that a transactional, multi-
contextual approach is needed for predicting attachment
quality (e.g., Belsky, 2005; Cicchetti & Barnett, 1991; Crit-
tenden, 2000; Grossmann et al., 1985; Rutter, 1991; Sroufe,
1996, van den Boom, 1994; see also Cassidy & Shaver,
1999, for reviews). For instance, it was reported that both
the quality of maternal involvement with the infant and the
infant’s behavior, together with other contextual factors,
are significant predictors of attachment. In that study, infant
temperament was only indirectly associated with attach-
ment via its direct associations with the other infant and
maternal variables (Belsky, 2005).
Infant medical risk factors, such as premature birth, may
also contribute to attachment quality, although specific find-
ings vary depending on whether or not other risk factors were
present in the sample under investigation. In samples of rel-
atively healthy infants from well-educated middle-class sam-
ples, premature birth is not typically associated with a higher
rate of attachment insecurity (e.g., Easterbrooks, 1989; Frodi
& Thompson, 1985). However, when samples are character-
ized by additional risk factors such as low socioeconomic
status (Wille, 1991), low maternal education (Pederson &
Moran, 1996), comorbid infant health problems (Plunkett,
Meisels, Stiefel, Pasick, & Roloff, 1986), or maternal depres-
sion (Poehlmann & Fiese, 2001), premature birth is associat-
ed with a higher prevalence of insecure attachment (see also
Belsky, 2005, for a review).
© 2009 Hogrefe Publishing
321
These findings suggest that multiple factors contribute
to early attachment formation. Unfortunately, the partic-
ular set of variables measured in prior investigations on
attachment antecedents varies from study to study, and
the specific predictors of attachment quality remain un-
determined. Further longitudinal research investigating
multiple predictors of attachment is needed, especially in
understudied cross-cultural samples (van IJzendoorn &
Sagi, 1999).
The Present Study
The longitudinal analyses in the present study were carried
out on a Portuguese sample of medically low-risk prema-
turely born infants and their mothers from urban back-
grounds who varied in years of completed education. The
goal was to identify specific, independent predictors of in-
fant attachment status from a set of infant, maternal, and
demographic variables measured at multiple time points
during the infant’s first year of life.
Based on findings from prior research, we expected that
several factors including: higher medical or social risk status
(e.g., lower birth weight, lower maternal education), higher
maternal ratings of their infants’ difficult temperament, in-
fant’s poorer regulatory behavior during the stress of the
Face-to-Face Still-Face paradigm (FFSF), and lower mater-
nal sensitivity during dyadic play would be associated with a
higher prevalence of insecure attachment in this sample. To
identify independent predictors of attachment, hierarchical
regression analyses were used. Although the literature pro-
vides only limited guidance, our expectation was that both
maternal and infant factors would be independent predictors
of attachment status in this Portuguese preterm sample.
Method
Participants
Participants were 48 prematurely born infants (60.4%
male; 68.8% first born) and their adult, healthy mothers (M
age = 29.7 years; SD = 5.7; range: 18–42). Infant birth
weight ranged from 1100 to 2500 grams (M = 2095, SD =
.47) and their gestation ranged from 31 to 36 weeks (M =
33.9 weeks, SD = 1.73). Five minute Apgar scores ranged
from 7 to 10 (M = 9.24; SD = .88). Mother-infant dyads
were recruited in the Neonatal Unit Care of Matosinhos
Hospital, Porto, Portugal.
The participants were primarily Portuguese Caucasian
from urban, middle-class socioeconomic backgrounds
(45.8% were lower middle-class, 18.8% were middle-class,
and 35.4% were upper middle-class). All infants were
healthy and clinically normal at delivery as determined by
pediatric examination. No infants had sensory or neuromo-
tor disabilities, serious illnesses, or congenital anomalies.
European Psychologist 2009; Vol. 14(4):320–331
322 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
No parents had any known mental health or drug/alcohol
addiction problems. All infants lived with both parents in
the same household (six couples were unmarried).
Compared to other samples collected in Western countries,
maternal formal education was quite low in our study. Nev-
ertheless, according to the latest available data from the na-
tional census (INE, 2004), values are consistent with indices
for Portuguese women’s education: 20.8% completed up to 4
years (first grade of basic school), 16.7% completed 5 to 6
years (second grade of basic school), 25.0% completed 7 to
9 years (third grade of basic school), 10.4% completed 10 to
12 years (secondary school level), and 27.1% completed
more than 12 years and attained a college/university degree
(INE, 2004).
In typical Western countries, maternal education and
household income are highly positively correlated (e.g.,
Bugental & Happaney, 2004; Raikes & Thompson, 2005;
van IJzendoorn, Schuengel, & Bakermans-Kranenburg,
1999). However, a unique feature of Portuguese society
is that maternal education and family income are not nec-
essarily correlated. Indeed, despite their low educational
attainments, most mothers in the present study could be
characterized as being middle-class. In fact, most moth-
ers with lower education had higher income because they
ran small businesses (e.g., shops) or held relatively well-
paid jobs doing handicraft and skilled hand labor. The
dissociation of educational level and income in the pre-
sent sample make it possible to examine the impact of
each variable separately on attachment, as well as wheth-
er their interaction affects attachment.
Procedure
Over a 2-year period, a female research assistant contacted
potential participant mothers at the Neonatal Care Unit and
explained the study’s purpose and procedures. To deter-
mine eligibility, mothers were administered a brief inter-
view to collect demographic information. With the moth-
er’s consent, information from the infant’s perinatal health
status was abstracted from the hospital medical record. Of
60 eligible mother-infant dyads, 54 agreed to participate in
this longitudinal research and gave their informed consent.
Of these, three infants lost their eligibility for health rea-
sons, two families moved away from the area, and one case
was dropped from the study because of procedural prob-
lems, resulting in a final sample of 48 mother-infant dyads
with complete data at all longitudinal visits. The study aims
and procedures were approved by the Ethics Commission
and People Rights Protection of the Portuguese Health Unit
of Matosinhos Hospital.
Follow-Up Visit Procedures
The 48 mother-infant dyads participated in four laboratory
follow-up visits. The first visit took place when the infants
European Psychologist 2009; Vol. 14(4):320–331
were 1 month old (corrected for gestational age) in a med-
ical room at the Centro de Medicina Desportiva do Porto
(Sport Medicine Center of Porto). Each subsequent visit (at
3, 9 and 12 months of infant age, corrected for gestational
age) took place at the Developmental Psychology Labora-
tory of the Faculdade de Psicologia e Ciências da Educação
da Universidade do Porto (i.e., the School of Psychology
and Education of the University of Porto). At the 1- and
3-month visits, mothers reported on their infant’s temper-
ament. At the 3-month visit, mother-infant dyads were also
videotaped during the FFSF. At the 9-month visit, mother-
infant dyads were videotaped during a dyadic free play ses-
sion, and at the 12-month visit, infants’ quality of attach-
ment was assessed using the standardized strange situation
procedure (Ainsworth et al., 1978).
Measures
Medical and Familial Demographic Information
Medical and demographic measures included delivery
method, infant Apgar score, gestational age, birth weight,
sex, parity, family socioeconomic status (SES), mother’s
age, and maternal years of completed education. To gain
statistical power, the measure for maternal years of educa-
tion was coded as a scale variable, ranging from 1 to 5
points. Cases with more than 12 years of education (i.e.,
mothers who were attaining or who had completed a col-
lege or university degree) received the highest score of 5.
Cases with 10 to 12 years of education (secondary school
level) received a 4. Those who had from 7 to 8 years of
education (third grade of basic schooling) received a 3,
whereas cases with 5 to 6 years (second grade of basic
schooling were assigned a 2. Lastly, participants who had
only up to 4 years of school received the lowest score of 1.
Maternal Report of Infant Temperament
At the 1- and 3-month visits, mothers described their in-
fants’ temperament using the Escala do Temperamento do
Bebé. Mothers were asked to rate nine aspects of their in-
fant’s current behavior (e.g., “my baby calms down”) using
a 7-point Likert scale (1 = very easy, 7 = very difficult). The
Escala do Temperamento do Bebé was previously evaluat-
ed in a sample of 127 healthy infants (60 preterms and 67
full-terms) at 1 and 3 months of age (Lopes dos Santos,
Fuertes, & Sanches-Ferreira, 2005). Items were factor an-
alyzed in each of both applications, yielding a single factor
(Difficult Behavior) that explained more than 60% of the
total variance (60.1% and 65.4%, respectively). Adequate
reliability estimates were found with Cronbach’s α coeffi-
cients ranging from .922 to .933 and with a test-retest cor-
relation of r = .793. Validity of the Escala do Temperamen-
to do Bebé was also successfully checked against other
Portuguese, validated measures of infants’ difficult behav-
© 2009 Hogrefe Publishing
 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
ior. Since the correlation between maternal ratings at the 1
and 3-month visits was high (r = .766), for the purposes of
the present investigation, scores at each visit were averaged
to yield a single summary measure of infant difficultness.
Infant Regulatory (Coping) Behavior
At the 3-month visit, infants’ capacity to regulate stress was
evaluated during Tronick’s FFSF (Tronick, Als, Adamson,
Wise, & Brazelton, 1978). Mother-infant dyads were vid-
eotaped during three successive 3-min episodes: (1) a nor-
mal face-to-face interaction, in which the mother was in-
structed to play with the infant as she typically would at
home, followed by (2) a 3-min still-face episode in which
the mother was instructed to look at the baby while keeping
a still (neutral) face and to refrain from talking, smiling, or
touching the baby, followed by (3) a second 3-min normal
reunion interaction, in which the mother was instructed to
resume normal play with the infant. The laboratory room
was equipped with an infant seat mounted on a table, an
adjustable chair for the mother, and two cameras (with mi-
crophones). One camera filmed the baby and the other one
filmed the mother. Both picture signals were transmitted
through a split-screen generator into a single camera to ob-
tain simultaneous frontal views of the mother and the in-
fant. The video recorder and the split-screen generator were
located in an adjoining equipment room.
Coding of Infant Behavior During the FFSF
The infants’ regulatory (coping) behavior during the three
episodes of FSFF was scored micro-analytically second-
by-second from videotapes by a trained coder using the
Infant Regulatory Scoring System (IRSS), a micro-analytic
and quantitative behavioral system (Tronick & Weinberg,
1990). The IRSS codes the infant’s direction of gaze, vo-
calizations, pick-me-up gestures, other gestures, self-com-
forting, distancing, and autonomic stress indicators.
In order to better discern individual differences, dis-
crete IRSS behaviors were scored on three a priori summary
dimensions describing the infant’s use of different coping
styles during the FFSF. Each infant behavior on a second-by-
second basis and was assigned to one of the three dimensions:
positive other-directed coping (PODC) reflects the infants’
tendency to elicit social interaction and exhibit positive affect
during the FFSF (i.e., infant looks at the mother’s face, looks
at the mother’s body, reaches toward or touches the adult,
makes positive vocalizations, or smiles); negative other-di-
rected coping (NODC) reflects the infants’ tendency to ex-
hibit negative affect and distancing behavior during the FFSF
(i.e., makes protest vocalizations, cries, arches or pushes
away from the mother, or attempts to escape from the mother
by turning away from the mother); and self-directed coping
(SDC) reflects the infant’s tendency to engage in SDC behav-
iors during the FFSF (i.e., infant mouths his or her hands,
© 2009 Hogrefe Publishing
323
mouths objects, closes his or her eyes, looks away from the
mother, self touches, squeezes one hand against the other).
The score on each dimension was not a simple addition of the
frequency of the behaviors, but was weighted to index to the
extent to which different behaviors in the dimension co-oc-
curred. One behavior in a dimension was scored as a 1, two
behaviors performed together were scored as 3, and 3 or
more behaviors occurring together received 5 points (more
than 3 behaviors was a rare situation). Therefore, the range in
each second is 0 to 5 points. This weighted system allows
assessing the relative degree of infants’ responses in a given
dimension. For example, simultaneously smiling, looking at
mother, and trying to reach her is considered a more positive
reaction in the positive other-directed PODC dimension than
merely looking at mother. In the present study, PODC was
not significantly correlated with NODC (Spearman ρ = .068;
ns) and SDC (Spearman ρ = –.038; ns). However, NODC and
SDC were significantly negatively correlated with each other
(Spearman ρ = –.358; p < .05).
Reliability. To evaluate intercoder reliability, an inde-
pendent coder masked to background variables and the
study’s hypotheses scored 15 randomly selected videotapes
(30.6% of the sample). The mean Cohen’s κ coefficient for
interrater agreement was 0.87. To evaluate intraobserver
reliability (coder drift), 15 randomly selected cases were
scored again by the first coder after a 6-month interval (κ =
0.89).
Infant-Mother Play Interaction
At the 9-month visit, infant-mother interactive behavior
during free play was scored from videotapes using the
Child-Adult Relationship Experimental Index (CARE In-
dex) (Crittenden, 2003) by a coder who was trained and
certified as reliable by Crittenden. A second trained observ-
er (blind to study details) independently scored 16 cases
selected randomly. The mean Cohen’s κ coefficient for in-
terrater agreement was high for both maternal (M κ = 0.90)
and infant (M κ = 0.85) scales (overall M κ = 0.87). Mean
κs for individual scales were 0.95 for maternal sensitivity,
0.91 for maternal control, 0.84 for maternal unresponsivity,
0.93 for infant cooperative behavior, 0.80 for infant com-
pliance, 0.88 for infant difficultness, and 0.80 for infant
passivity = .80.
Following the instructions in the CARE-Index manual,
each dyad was videotaped for an average of 3 min
(range = 2 to 5 min) during an unstructured free-play sit-
uation. The mothers were asked to play with their infant
in a natural manner. No specific instructions were given
about how to play. A standard set of toys was provided
for the dyad, arranged on a blanket on the floor of the
play room. The CARE-Index assesses three dimensions
of mother’s interactive behavior with the infant (sensi-
tive, controlling, and unresponsive), and four dimensions
of the infant’s interactive behavior with the mother (co-
operative, compulsive-compliant, difficult, and passive).
European Psychologist 2009; Vol. 14(4):320–331
324 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
Although the mother and infant are scored independently,
as required by Crittenden (2003), the coder scores each
partner from the perspective of the other partner (i.e., the
coder scores each partner taking into account the behav-
ior of the other partner). For instance, if the mother
smiles while the infant is distressed, the mother’s behav-
ior is considered insensitive whereas, if the mother smiles
in response to infant’s smile or attentive face, the moth-
er’s behavior is considered sensitive. Note that, although
the term “maternal sensitivity” often refers to an individ-
ual characteristic, in this scale it is operationalized as a
dyadic construct (Crittenden, 2003). Therefore, to avoid
redundancy in the analyses, we used only the maternal
scales to assess variations in the quality of mother-infant
interactive behavior in this paper.
Adequate discriminant validity of the CARE-Index
has been reported. Differential outcomes using the mea-
sure for middle class, low risk mothers, deaf mothers, low
income mothers, mothers with mental retardation, abu-
sive mothers, and neglectful mothers have been reported
in separate studies (Crittenden & Bonvillian, 1984). Al-
though the CARE-Index does not assess mother-infant at-
tachment directly, the maternal scales have been strongly
linked with attachment outcomes. In samples of typical
mother-infant dyads, maternal sensitivity was related to
secure attachment, maternal control to avoidant attach-
ment, and maternal unresponsivity to resistant attach-
ment (Crittenden, 1988).
Attachment
At the 12-month visit, infants’ attachment behavior with
the mother was videotaped during Ainsworth’s Strange Sit-
uation (Ainsworth et al., 1978). The Strange Situation is a
21-min laboratory paradigm involving a sequence of eight
episodes designed to place mild but increasing levels of
stress on the infant and dyad (i.e., being introduced to an
unfamiliar play room, interacting with an unfamiliar adult
stranger, and brief separations from and reunions with the
mother). Scoring of infant attachment from the videotapes
of the Strange Situation was accomplished by two trained
and reliable coders using traditional scoring guidelines de-
veloped by Ainsworth et al. (1978). All cases were scored
independently twice and classified as either secure, inse-
cure-avoidant, or insecure-resistant. Any disagreements in
attachment classification between the two coders were re-
solved in conference. Overall intercoder agreement for ma-
jor classification prior to conferencing was over 81%.
Analytic Plan
Three sets of statistical analyses were carried out to address
the goals of this study. First, the distribution of the three
attachment classifications (secure, insecure-avoidant, inse-
cure-resistant) in this Portuguese sample of healthy preterm
European Psychologist 2009; Vol. 14(4):320–331
infants was evaluated using univariate frequency analyses.
Second, the bivariate association between attachment clas-
sification (secure, insecure-avoidant, insecure-resistant)
and each potential predictor variable was evaluated. The
potential predictor variables included infant gender, birth-
weight, gestational age, Apgar scores, birth order, maternal
age, maternal education, SES, maternal representations of
the infants’ difficult temperament, scores on the three clas-
sifications of infant regulatory (coping) behavior (PODC,
NODC, SDC) during the FFSF at the 3-month visit, and
the three rated dimensions of mothers’ interactive behavior
observed during play at the 9-month visit. α was set at .05.
Third, the independent contributions of infant, maternal,
and demographic variables to infant attachment status were
evaluated using hierarchical regression analyses. Separate
regressions were used to predict each of the three attach-
ment patterns (secure, insecure-avoidant, insecure-resis-
tant). Only variables identified as being significantly asso-
ciated with attachment status in the bivariate analyses were
evaluated as potential predictors in these regressions.
Results
Distribution of Attachment Classifications
Of the 48 infants who participated in this longitudinal
study, 16 (33.3%) infants were classified as securely at-
tached, 17 (35.4%) as insecure-avoidant, and 15 (31.3%)
as insecure-resistant at 12 months (corrected age).
Bivariate Association Between Attachment
and Potential Predictor Variables
Infant Medical and Maternal/Familial
Demographic Variables
Contrary to our expectations, attachment status was not sig-
nificantly associated with infant biologic or medical vari-
ables, including gender, birth weight, gestational age, or
Apgar scores. Similarly, attachment status was not signifi-
cantly associated with most maternal or familial demo-
graphic variables including maternal age and SES. As hy-
pothesized, level of maternal education was significantly
related to attachment status, F(2, 45) = 4.93, p < .02, ηp2 =
.18. Multiple range testing using the least significant dif-
ference (LSD) test with α set at 0.05 showed that educa-
tional level was higher among mothers of both insecure-
avoidant (M = 3.50, SD = 1.59) and securely attached in-
fants (M = 3.47, SD = 1.33) than mothers of
insecure-resistant infants (M = 2.13, SD = 1.19). No signif-
icant difference in education level was found between
mothers of securely attached and insecure avoidant infants.
© 2009 Hogrefe Publishing
 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
Infants’ Difficult Temperament
As predicted, a significant association was observed be-
tween maternal representations of their infant’s difficult
temperament and infants’ attachment status at 12 months
(corrected age), with low effect sizes, F(2, 45) = 4.73, p <
.02, ηp2 = .17. Results of a LSD posthoc test (α set at 0.05)
indicated that infants classified as securely attached (M =
23.32, SD = 3.71) were perceived as being less difficult, on
average, than infants classified as insecure-avoidant (M =
27.67, SD = 4.26) or insecure-resistant (M = 28.94, SD =
7.80). The mean values difference between these two last
groups was not significant.
Infants’ Regulatory (Coping) Behavior in the FFSF
Infants’ mean score for PODC was 1.79 (SD = 1.15,
range = 0.15 to 4.75), 1.43 of NODC score (SD = 1.12,
range = 0.06 to 4.23), and 1.29 of SDC score (SD = 0.83;
range = 0.00 to 3.67).
In Table 1, descriptive statistics for positive other-direct-
ed coping, NODC, and SDC weighted scores are presented
according to infants’ attachment status.
As expected, results of one-way analyses of variance
(ANOVAs) showed that infants’ attachment status at 12
months (corrected age) was significantly linked to variations
in their coping style during the FFSF at 3 months (corrected
age), with moderate effect sizes: PODC, F(2, 45) = 10.55, p <
.001, ηp2 = .32; NODC, F(2, 45) = 8.49, p < .005, ηp2 = .27;
and SDC, F(2, 45) = 12.10, p < .001, ηp2 = .35; at 3 months
(corrected age).
Results of posthoc tests using the LSD procedure (α set
at 0.05) revealed that infants classified as secure at 12
months exhibited significantly more positive other-direct-
ed coping responses during the FFSF at 3 months (correct-
ed age) than infants classified as insecure-avoidant or inse-
cure-resistant at 12 months. No significant difference was
found between these latter two groups. On the other hand,
infants classified as insecure-resistant at 12 months exhib-
ited more NODC responses during the FFSF than infants
classified as either secure or insecure-avoidant (the differ-
Table 1. Means and standard deviations for infants’ coping
behavior score during the FFSF* by each second
at 3 months by attachment classification at 12
months
Infant coping style Attachment classification
at 3 months at 12 months
Insecure- Secure Insecure-
avoidant resistant
(N = 16) (N = 17) (N = 15)
Positive other-directed coping 1.20 (0.87) 2.65 (1.08) 1.47 (0.89)
Negative other-directed coping 0.78 (0.70) 1.26 (0.87) 2.21 (1.27)
Self-directed coping 2.09 (0.71) 1.19 (0.67) 0.73 (0.66)
*FFSF = Face-to-Face Still-Face paradigm.
© 2009 Hogrefe Publishing
325
ence between the latter two groups was not significant). In
turn, infants who were classified as insecure-avoidant at 12
months used more SDC responses to regulate their stress
during the FFSF than infants classified as secure or inse-
cure-resistant (the difference between the latter groups was
not significant).
Maternal Interactive Behavior During Free Play at
9 Months and Attachment
Mothers in this sample exhibited a wide range of scores on
the sensitivity, control, and unresponsivity scales. Scores
ranged from 2 to 12 on the 14-point maternal sensitivity
scale (M = 6.33; SD = 2.83). An equivalent large range was
observed for maternal control, with scores varying from 0
to 11 points (M = 4.56; SD = 3.34), and for maternal unre-
sponsivity, with scores varying from 0 to 12 points (M =
3.10; SD = 3.31).
Descriptive statistics for the three measures of maternal
interactive behavior during mother-infant free play at 9
months (corrected age) are provided in Table 2 by attach-
ment status.
As hypothesized, results of one-way ANOVAs showed
that infants’ attachment status at 12 months (corrected age)
was associated with all three measures of maternal interac-
tive behavior during mother-infant free play at 9 months
(corrected age), with large to moderate effect sizes: mater-
nal sensitivity, F(2, 45) = 45.78, p < .001, ηp2 = .67; mater-
nal control, F(2, 45) = 26.97, p < .001, ηp2 = .55; and ma-
ternal unresponsivity F(2, 45) = 14.40, p < .001, ηp2 = .39.
Results of LSD posthoc tests (α set at 0.05) indicated
that mothers of infants later classified as securely attached
at 12 months had higher sensitivity scores during mother-
infant play at 9 months (corrected age) than mothers of
insecure-avoidant or insecure-resistant infants (the differ-
ence in maternal sensitivity scores between the latter two
groups was not significant). Moreover, mothers of infants
classified as insecure-avoidant at 12 months were more
likely to be controlling with their infants during play at 9
months than mothers of infants classified as secure or in-
secure resistant (no significant difference in controlling be-
havior was found for mothers of infants in these latter two
Table 2. Means and standard deviations for ratings of ma-
ternal interactive behavior during mother-infant
free play at 9 months by attachment classification
at 12 months
Maternal interactive Attachment classification at 12 months
behavior at 9 months Insecure- Secure Insecure-
avoidant resistant
(N = 16) (N = 17) (N = 15)
Maternal sensitivity 4.88 (1.14) 9.41 (2.34) 4.40 (1.05)
Maternal control 7.94 (2.26) 2.29 (1.99) 3.53 (2.64)
Maternal unresponsivity 1.19 (2.56) 2.29 (2.56) 6.07 (2.81)
European Psychologist 2009; Vol. 14(4):320–331
326 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment

Table 3. Results of multinomial logistic regressions predicting secure, insecure-avoidant, and insecure-resistant attachment
at 12 months
Regression model Pseudo R2
Predicting attachment –2 log likelihood 1
LR* χ²(df) Significance level Cox & Snell Nagelkerke
Secure attachment
1. Maternal sensitivity 34.724 42.18 (2) p < .001 .585 .658
2. Infant positive other-directed coping 56.993 22.27 (4) p < .001 .635 .714
3. Infant difficult temperament 54.97 2.02 (6) ns .650 .732
Insecure-avoidant attachment
1. Maternal control 34.20 33.06 (2) p < .001 .498 .560
2. Infant self-directed coping 61.62 27.42 (4) p < .001 .598 .673
Insecure-resistant attachment
1. Maternal unresponsivity 43.43 21.04 (2) p < .001 .355 .399
2. Infant negative other-directed coping 73.89 30.46 (4) p < .001 .481 .591
3. Maternal education 67.73 6.16 (6) ns .543 .611
1
Intercepts included in the computation of the models. *LR = likelihood ratio.

groups). In turn, mothers of infants classified as insecure-
resistant at 12 months were more unresponsive to their in-
fants during play at 9 months, compared to mothers of in-
fants classified as secure or insecure-avoidant (no signifi-
cant difference in unresponsivity was found for mothers of
infants in these latter two groups).
Hierarchical Regression Analyses Results
Building on the results of the bivariate analyses, multino-
mial logistic regression was used to test for independent
predictors of attachment style. This statistical technique is
an extension of the maximum likelihood-based estimations
(MLE) procedure where the dependent variable is categor-
ical and has more than two nonordered categories (Hosmer
& Lemeshow, 2000).
Only those variables identified in the bivariate analyses
as being significantly associated with infant attachment sta-
tus using an α of 0.05 or less were retained in the regression
analyses. Eight variables met these criteria: maternal level
of education, maternal report of their infant’s difficult tem-
perament, the three summary measures of the infant’s ca-
pacity to regulate stress (coping) during the FFSF at 3
months, and the three ratings of mother interactive behav-
ior during free play at 9 months. All predictor variables,
however, could not be entered at the same time in a single
multinomial regression model for two reasons. First, the
obtained scores of the CARE-Index coding system for the
three dimensions of maternal interactive behavior (sensi-
tivity, control, and unresponsiveness) are linked measures.
Considering them together in the same model would violate
a critical assumption underlying multinomial logistic re-
gression. Second, the relatively small size of our sample
resulted in a decrease of the ratio of cases to independent
variables, which would lower power.
To address these issues, we carried out three separate
hierarchical regressions to predict each of the three attach-
ment patterns (secure, insecure-avoidant, insecure-resis-
tant). The selection of predictor variables included in each
regression model was based on the results from the LSD
post hoc tests in the one-way ANOVAs. However, not all
categories of variables qualified for retention in each re-
gression. Thus, the regression predicting secure attachment
status included three predictors: maternal sensitivity, infant
PODC, and infant difficult temperament. The regression
predicting insecure-avoidant attachment included two pre-
dictors: maternal control and infant SDC. The regression
predicting insecure-resistant attachment included three
predictors: maternal unresponsivity, infant NODC, and ma-
ternal education. These variables differentiated securely at-
tached infants from insecure-avoidant and insecure-resis-
tant infants without distinguishing the latter groups. How-
ever, in each analysis the retained predictor variables were
entered in the same order: (1) maternal interactive behavior
at 9 months, (2) infant coping style at 3 months, (3) infant
difficult temperament, and (4) maternal education. Because
the impact of any given measure in a MLE-based model is
not constant across values and cannot be interpreted inde-
pendently of other variable scores, parameters were esti-
mated through rescaled independent variables with values
changing between zero and one. Regression results are pre-
sented in Table 3.
In the regression predicting secure attachment, maternal
sensitivity (first step), infant PODC (second step), and infant
difficult temperament (third step) were evaluated as possible
predictors. Maternal sensitivity, with a likelihood ratio χ² of
42.18 with 2 degrees of freedom was statistically significant,
and PODC with a likelihood ratio χ² of 22.27 resulted in a
significant increment in R2. Both were retained as predictors.
Infant difficult temperament with a likelihood ratio of 2.02
did not lead to a significant increment in R2.
In the regression predicting insecure avoidant attach-
ment, maternal control (first step) and infant SDC (second

European Psychologist 2009; Vol. 14(4):320–331 © 2009 Hogrefe Publishing

 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
step) were evaluated as predictors. Both factors were re-
tained as significant independent predictors of insecure-
avoidant attachment. Maternal control was statistically sig-
nificant with a likelihood ratio χ² of 33.06 with 2 degrees
of freedom. Infant SDC had a likelihood ratio χ² of 27.42
with 4 degrees of freedom and contributed a statistically
significant increment in R2.
In the regression predicting insecure-resistant attach-
ment, maternal unresponsivity (first step), NODC (second
step), and maternal education (third step) were evaluated
as predictors. Maternal unresponsivity and infant NODC
were retained as significant predictors. Maternal unrespon-
sivity had a likelihood ratio χ² of 21.04 with 2 degrees free-
dom, and infant NODC had a likelihood ratio χ² of 30.46
with 4 degrees of freedom, leading to a significant gain in
R2. Maternal education, with a likelihood ratio of 6.16, did
not lead to a significant increment in R2.
Discussion
The analyses in this study were based on longitudinal data
collected in a Portuguese urban sample of medically low-
risk prematurely born infants and their healthy adult moth-
ers who were generally middle class but varied in years of
completed education. Our aim was to identify specific in-
fant, maternal, and demographic variables measured during
the first year of life that independently predicted infants’
attachment status at 12 months (corrected age) in this un-
derstudied sample.
Distribution of Attachment Classifications
In contrast to findings reported for healthy low-risk preterm
infants in better educated, middle-class samples in the US
(e.g., Easterbrooks, 1989; Frodi & Thompson, 1985), there
was an unexpectedly high prevalence of insecure attach-
ment in this sample of prematurely born Portuguese infants.
Thirty-two of the 48 (66.6%) infants were classified as in-
securely attached (35.4% avoidant, 31.3% resistant) at 12
months (corrected age).
The reason for the low prevalence of secure attachment
is unclear, especially given the paucity of normative data
for mother-infant attachment in the Portuguese culture. Re-
sults from a few attachment studies with healthy, middle-
class Portuguese samples using the Strange Situation indi-
cate that the prevalence of secure attachment varied be-
tween 45% and 50% (Costa, 2000; Soares et al., 1995;
Soares, Silva, Cunha, Costa, & Lopes dos Santos, 1998).
This is lower than that reported in international meta-ana-
lytic attachment research (van IJzenoorn & Kroonenburg,
1988), but higher than that found in the present study. In
other attachment research with Portuguese samples using
different methodology, i.e., the Attachment Q-Sort
(Vaughn et al., 2007) or the Adult Attachment Interview
© 2009 Hogrefe Publishing
327
(Soares & Dias, 2007), attachment distributions were sim-
ilar to those reported in international meta-analytic studies
and contrast with those in the present study (van IJzen-
doorn & Sagi, 1999).
Within the EU, mother-infant attachment has been stud-
ied primarily in Western European countries such as Ger-
many and Great Britain. Overall, approximately 66% of
infants in those countries exhibit secure attachment, which
is roughly comparable to that reported for middle-class
samples in the US (van IJzendoorn & Sagi, 1999). Yet the
percentage of secure attachment varies from country to
country within Western Europe. For instance, the percent-
age of securely attached infants ranges from 57% in Ger-
man samples to 75% secure in Great Britain samples (van
IJzendoorn & Sagi, 1999). This variation is consistent with
general findings from cross-cultural research, which indi-
cate that intracultural differences are higher than intercul-
tural differences (van IJzendoorn & Kroonenberg, 1988).
A unique aspect of our sample is the large range in moth-
ers’ years of completed education, which varied from 4 and
19 years. Nearly 63% of the mothers in this sample had not
attained a high school-level education. This is in striking
contrast to the higher level of education attained by moth-
ers in most attachment studies in other Western European
countries and in the US (van IJzendoorn & Kroonenberg,
1988; van IJzendoorn & Sagi, 1999), including low income
samples. We speculate that this low level of maternal edu-
cation may have contributed to the lower prevalence of se-
cure attachment in the present sample of preterm infants.
Prior studies on attachment formation in preterm samples
indicate a greater prevalence of insecure attachment only
when other risk conditions are present, such as low SES
(Pederson & Moran, 1996; Wille, 1991). It is likely that the
consequences of premature birth combined with additional
risk factors such as low maternal education put infants and
caregivers in “double jeopardy” for forming insecure at-
tachments. Indeed, our results indicate a significant link
between maternal education and the insecure-resistant at-
tachment pattern.
Factors Linked to Mother-Infant Attachment
in Bivariate Analyses
Results of bivariate analyses indicated that both maternal
and infant behavioral variables measured during the first
year of life were associated with infants’ attachment status
at 12 months, but (contrary to our expectations) infant bi-
ologic variables (e.g., gestational age, birth weight) were
not. This pattern of findings may reflect the relatively low
medical-risk status of the infants in the current sample. Of
the demographic variables evaluated in this study (e.g.,
SES, maternal age), only level of maternal education was
significantly related to attachment. Specifically, mothers of
infants classified as insecure-resistant had completed sig-
European Psychologist 2009; Vol. 14(4):320–331
328 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
nificantly fewer years of education than mothers of infants
from the other two attachment groups.
As expected, mothers of securely attached infants per-
ceived their infants as being less difficult in temperament
at 1 and 3 months (corrected age), compared to mothers of
insecurely attached infants. These findings corroborate the
results of previous studies in which mothers of securely
attached infants were more likely to give positive descrip-
tions of their infants’ temperament than mothers of inse-
curely attached infants (Benoit et al., 1997; Bretherton et
al., 1989; Cox et al., 2000; Izard et al., 1991; Kochanska,
1998; Zeanah et al., 1994). Vaughn and Bost (1999) and
others have suggested that this association may be strongly
influenced by the quality of the mother’s interactions with
their infant, in a manner similar to Crittenden’s argument
that maternal sensitivity is actually a dyadic measure (Crit-
tenden, 2003).
Similarly, variations in infants’ coping behavior during
the FFSF at 3 months were linked with infants’ attachment
status at 12 months. Infants classified as having secure at-
tachment at 12 months exhibited more PODC responses
during the FFSF at 3 months, compared to infants classified
as having insecure attachment. In turn, infants classified as
insecure-resistant at 12 months exhibited more NODC re-
sponses during the FFSF than either infants classified as
having secure or insecure-avoidant attachment. In turn, in-
fants classified as insecure-avoidant at 12 months engaged
in more SDC behaviors during the FFSF at 3 months, com-
pared to infants with the other two attachment patterns.
Although understudied, a few studies also have reported
links between variations in infant affective regulation dur-
ing FFSF and later attachment status. However, specific
results vary. Cohn et al. (1991) found that 6-month-old in-
fants who made positive elicitations to the mother during
the still-face episode of the FFSF were more likely to be
securely attached at 12 months. However, no relation was
reported between other types of infant coping behavior and
insecure attachment patterns. Braungart-Rieker et al.
(2001) found that the amount that infants exhibited nega-
tive arousal during the still-face episode of the FFSF at 4
months of age was related with level of distress exhibited
during the Strange Situation in later infancy, rather than
with secure vs. insecure attachment status per se. Specifi-
cally, infants who cried less during the FFSF were more
likely to be classified as having either the B1 or B2 patterns
of secure attachment, or as insecure-avoidant. Each of these
attachment patterns are associated with less infant distress
during the Strange Situation. Conversely, infants who cried
more during the FFSF were later classified as having either
the B3 or B4 patterns of secure attachment or insecure-re-
sistant attachment. In another study, variations in discrete
infant behaviors observed during the FFSF, such as infant
gaze, self-touch, or facial expressions differentiated infants
later classified as having secure vs. avoidant attachment
(Koulomzin et al., 2002).
Our study adds to this research and is unique in finding
a significant association between specific styles of infant
European Psychologist 2009; Vol. 14(4):320–331
coping behavior (PODC, NODC, SDC) during the FFSF
and specific attachment patterns (secure, insecure-avoid-
ant, and insecure resistant). To our knowledge, our study is
the first to sort infants’ reactions during each of the three
episodes of the FFSF at 3 months into these distinct sum-
mary styles of behavior. These styles were identified from
individual behaviors derived from the IRSS, a microana-
lytic and quantitative behavioral system with more than 20
discrete infant behaviors, scored in each episode of the
FFSF. Thus, it was possible to examine whether different
styles of infant coping during the FFSF were effective pre-
dictors of attachment style.
Consistent with an extensive literature relating maternal
sensitivity to the infant during the first year of life and in-
fant attachment at 12 months (e.g., Ainsworth et al., 1978;
Isabella, 1993), we found that mothers of infants later clas-
sified as secure were more sensitive with their infants dur-
ing mother-infant play at 9 months (corrected age), than
mothers of infants later classified as insecure-attached. We
extended this research by showing associations between
specific maternal behaviors during play at 9 months and
attachment patterns at 12 months: Mothers of infants later
classified as insecure-avoidant were more controlling dur-
ing mother-infant play at 9 months than mothers of infants
later classified as secure or insecure-resistant. In turn,
mothers of infants later classified as insecure-resistant were
more unresponsive to their infants than mothers of infants
later classified as secure or insecure-avoidant. These find-
ings corroborate similar findings reported in the attachment
literature (see Ainsworth et al., 1978; Cassidy & Shaver,
1999). It is unclear, however, why there were no significant
group differences in maternal controlling behavior between
mothers of secure vs. insecure-resistant infants, or in ma-
ternal unresponsivity between mothers of secure and inse-
cure-avoidant infants. This lack of significant group differ-
ences may reflect, in part, the CARE-Index scoring system.
In fact, this scale challenges the coder to distribute 14
points across three categories: maternal sensitivity, mater-
nal control, and maternal unresponsivity. Thus, mothers
with high scores on a specific scale have necessarily low
points on the two other scales. For example, mothers of
securely attached infants with high scores on maternal sen-
sitivity also have a low score on control. At the same time,
mothers of resistant-attached infants, by scoring high on
unresponsivity, have low scores on control as well. There-
fore, the differences in control behavior between these two
groups of mothers are not high enough to be significant.
Specific Predictors of Attachment in
Multivariate Analyses
The contributions of maternal interactive behavior, infant
coping behavior, maternal representation of infants’ tem-
perament, and maternal education to attachment status
were evaluated using multinomial logistic regression anal-
© 2009 Hogrefe Publishing
 M. Fuertes et al.: Infant Coping, Still-Face, Maternal Behavior, and Attachment
yses. As hypothesized, both maternal interactive behavior
with the infant during mother-infant free play at 9 months
and infants’ regulatory (coping) behavior during the FFSF
at 3 months were independent predictors of specific attach-
ment patterns at 12 months. Specifically, secure attachment
was predicted by a higher level of maternal sensitivity to
the infant during play and infants’ greater use of a PODC
style during the FFSF. In contrast, insecure-avoidant at-
tachment was predicted by a higher level of maternal con-
trolling (intrusive) behavior during play and infants’ ten-
dency to exhibit a SDC style during the FFSF. In turn, in-
secure-resistant attachment was predicted by a higher level
of maternal unresponsive behavior with the infant during
play and infants’ tendency to exhibit a NODC style during
the FFSF.
Classical attachment theorists have highlighted maternal
sensitivity, and temperament theorists have highlighted in-
fant reactivity, as central factors predicting attachment se-
curity. Our findings suggest that both of these factors play
an important role in attachment formation this low-risk pre-
term sample. Our findings are also consistent with findings
from an international meta-analytic review that showed
that maternal sensitivity alone explains only a relatively
modest amount of the variance in attachment status (e.g.,
De Wolff & van IJzendoorn, 1997).
Several limitations of our study must be acknowledged.
The relatively small sample size prevented us from evalu-
ating potential indirect as well as direct effects of maternal,
infant, and demographic variables on infants’ attachment
formation. Additional longitudinal research with larger
samples is needed to investigate how multiple factors from
different levels of analysis – and the complex interplay
among them – may contribute to individual differences in
infant attachment status. Indeed, we still do not know how
variations in maternal sensitivity to preterm infants early in
life contributes to infants’ ability to cope with stressors dur-
ing the FFSF in early infancy, and vice versa, and how
biologic and demographic risk factors affect these dynam-
ic, transacting variables.
Another limitation is that the specific characteristics of
this sample (e.g., an urban Portuguese sample of healthy
preterm infants and their mothers varying in level of edu-
cation) may have contributed to the higher-than-expected
rate of insecure attachment in this sample and preclude our
generalizing the results to other samples. Further studies on
larger samples of Portuguese preterm infants varying in
level of biologic risk are needed. On the other hand, the
sample’s unique characteristics may also be viewed as a
major strength. Our study is the first study to evaluate lon-
gitudinally the specific, independent predictors of attach-
ment in this understudied Mediterranean culture.
In sum, this research indicates that, although several fac-
tors are associated with attachment in bivariate analyses,
only a few were retained as significant predictors of attach-
ment status in multivariate analyses. Our findings corrob-
orate prior attachment research in highlighting the impor-
tance of maternal sensitivity in attachment formation, but
© 2009 Hogrefe Publishing
329
also indicate that infant styles of coping with stressors dur-
ing early infancy also plays an important role. In the present
study, both factors were significant independent predictors
of later attachment styles. In a recent paper, Tronick (2006)
has hypothesized that the parent-infant dyad’s ability to re-
pair interactive errors, a measure related to and more spe-
cific than maternal sensitivity, is linked to the development
of infants’ capacities to cope with stress, and that, recipro-
cally, mothers of infants with greater coping capacities may
find it easier to engage in sensitive parenting.
Our results may also be helpful to professionals who
provide intervention services to young babies and may con-
tribute to the development of more accurate evidence-
based practice models. In particular, our findings suggest
that careful consideration of both infants’ coping with
stress and the quality of mothers’ interactive behavior with
their infant should be considered in designing more effec-
tive interventions. Our findings suggest that such interven-
tions need to be specific with respect to both the forms of
coping exhibited by the infant and the quality of parental
interactive behavior exhibited by the parent. Both factors
were significantly and independently associated with infant
attachment formation in this study.
Acknowledgments
The first author was supported by a postdoctoral fellowship
from Fundação para a Ciência e Tecnologia (SFRH/BPD/
26726/2006) and a postdoctoral fellowship from the Child
Development Unit, Children’s Hospital, Harvard Medical
School, Boston. The researchers would like to thank the
families that participated in this study. We are also grateful
to Joana Barreiros, Sandra Carneiro, Raquel Corval, Carla
Guedes, and Gustavo Mendes, who helped carry out the
procedures; Sandra Carneiro, who independently scored
the FFSF data, and Hélia Soares who coded the CARE-In-
dex for reliability.
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About the authors
Marina Fuertes, Ph.D., is a Research Associate in the Child De-
velopment Unit at Harvard Medical School (Boston, MA, USA)
and chief of an early intervention team (Gabinete de Apoio ao
Desenvolvimento Infantil e à Família – GADIF) in Lisbon, Por-
tugal. Her scientific interests include mother-infant attach-
ment, risk and resilience processes in child development, and
evolutionary psychology.
Pedro Lopes dos Santos, Ph.D., is a psychologist teaching as As-
sociate Professor in the Psychology Department of Oporto Uni-
versity, Portugal. His scientific interests include mother-infant at-
tachment, infant special needs, and theoretical developmental
models.
Marjorie Beeghly, Ph.D., is Associate Professor in Psychology at
Wayne State University (Detroit, MI, USA), Lecturer in Pediatrics
at Harvard Medical School, and Senior Research Associate at
Children’s Hospital, both Boston, MA, USA. Her research eval-
uates how biologic and social risk and resilience factors alter tra-
jectories of communicative and socioemotional development in
groups of children at risk for developmental problems because of
stressors such as premature birth, poverty, intrauterine drug ex-
posure, developmental disorders, violence exposure, child mal-
treatment, or maternal psychopathology.
Ed Tronick, Ph.D., is Distinguished University Professor of Psy-
chology at the University of Massachusetts, Lecturer in Pediatrics
at Harvard Medical School, Director of the Child Development
Unit at Children’s Hospital, Boston, MA, USA, and on the Faculty
at Fielding Graduate University, Santa Barbara, CA, USA. His
prime research focus is on the social emotional develop-
ment of infants in the context of parent-infant interaction in the
US and other cultural communities
Marina Fuertes
Child Development Unit, Children’s Hospital
1295 Boylston Street, Suite 320
Boston, MA 02215
USA
Tel. +1 617 355-3545
Fax +1 617 730-0074
E-mail marina.fuertes@childrens.harvard.edu
European Psychologist 2009; Vol. 14(4):320–331