Attachment disorganization among children in Neonatal Intensive Care Unit: Preliminary results Marie-Hélène Pennestri a , Hélène Gaudreau a , Andrée-Anne Bouvette-Turcot a , Ellen Moss b , Vanessa Lecompte b , Leslie Atkinson c , John Lydon d , Meir Steiner e,f , Michael J. Meaney a, ⁎, on behalf of the Mavan Research Team a Ludmer Center for Neuroinformatics and Mental Health, McGill University, Hôpital Douglas, Projet MAVAN, Bureau E-4107, 6875 Boulevard Lsalle, Verdun H4H 1R3, Canada b Department of Psychology, Université du Québec à Montréal, C.P. 8888 Succursale Centre-Ville, Montreal H3C 3P8, Canada c Department of Psychology, Ryerson University, 350 Victoria Street, Toronto M5B 2K3, Canada d Department of Psychology, McGill University, Stewart Biology Building, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Canada e St. Joseph's Hospital, Hamilton L8N 4A6, Canada f Department of Psychiatry, McMaster University, 50 Charlton Ave. E., Hamilton L8N 4A6, Canada abstract article info Article history: Received 28 March 2015 Received in revised form 28 June 2015 Accepted 10 July 2015 Available online xxxx Keywords: Neonatal Intensive Care Unit Attachment Child development Neonate Background: Preterm children have been reported to be at higher risk to develop attachment insecurity. Aims: The present study aimed to investigate potential differences in attachment security between newborns who were sent to Neonatal Intensive Care Unit (NICU) and those who were not, in a population of full-term children. Study design: Participants (162 mother–child dyads) were part of a longitudinal study (MAVAN). Twenty-three of these children received special care at birth (NICU group). Attachment security was assessed at 36 months with the Strange Situation Procedure. Socio-economic status (SES), birth weight, maternal mood, maternal sensitivity, mental/psychomotor developmental indexes, Apgar scores, presence of complications during delivery and infant general health were assessed. Results: In the No-NICU group, 55.4% of children were securely attached, 24.5% were insecure and 20.1% were disorganized. However, in the NICU group, 43.5% of children were securely attached, 8.7% were insecure and 47.8% were disorganized (χ 2 = 9.0; p = .01). The only differences between the 2 groups were a lower Apgar, more respiratory infections and more visits to walk-in clinic/hospital (p's b .05) and a trend for lower SES and more ear infections in the NICU group. Logistic regressions revealed an odds ratio of 6.1 (p = .003) of developing a disorganized attachment after a stay in NICU, when controlling for these confounding variables. Conclusion: Newborns who were admitted to NICU have an odds ratio of about 6 to develop a disorganized attachment at 36 months. These preliminary results support the importance of supportive parental proximity and contact with the infant in the NICU and possible after-care. © 2015 Published by Elsevier Ireland Ltd. 1. Introduction Attachment is described as the emotional and enduring bond be- tween infant and the caregiver [1–3]. Securely attached children are able to use their attachment figure as a haven of safety and a secure base to explore the environment contrary to insecurely attached chil- dren [4]. Insecure-avoidant children tend to avoid proximity to their mothers and minimize the expression of their negative emotions [4,5], whereas insecure-ambivalent children show resistance as well as de- pendence toward their attachment figure [4,6]. Secure, ambivalent and avoidant infants are considered to show organized attachment strategies in the sense that they have developed a consistent, coherent, behavioral strategy which is adaptive for relationship continuity with their parental figure. However, a fourth group of infants have been iden- tified, who show disorganized attachment, i.e. they fail to show an orga- nized strategy for seeking proximity to the attachment figure in times of distress [7]. These infants display bouts or sequences of behaviors that seemingly lack a goal and often appear contextually bizarre and inco- herent. Children showing disorganized attachment have the highest risk among all attachment groups for later psychopathology [8,9]. Although still controversial, preterm children, particularly those with neurological impairment, have been reported to be at risk for dys- functional attachment relationships [10,11]. Although the majority of studies do not show a higher proportion of insecure vs. secure attach- ment in preterm samples [11–13], a recent study has shown a higher prevalence of disorganized attachment in preterm as compared to Early Human Development 91 (2015) 601–606 ⁎ Corresponding author at: McGill University, Department of Psychiatry, Institut Universitaire en Santé Mentale Douglas, 6875, Boul. Lasalle, Pavillon Perry, Verdun H4H 1R3, Canada. http://dx.doi.org/10.1016/j.earlhumdev.2015.07.005 0378-3782/© 2015 Published by Elsevier Ireland Ltd. 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