Attachment quality, joint attention, and behavior outcome in infants prenatally exposed to cocaine

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Peter C. Mundy - Committee Chair


This study examined the associations among disorganized attachment quality, joint attention, and behavioral development in a sample of infants at-risk. Participants were 57 infants prenatally exposed to cocaine and their caregivers. Infants came from a low socioeconomic status background and were part of an intervention setting.When the infants were 12, 15, 18, and 36 months, they took part in laboratory visits. At 12 and 18 months, joint attention was assessed using the Early Social Communication Scales (ESCS). At 15 months, attachment between infant and caregiver was assessed using Ainsworth's Strange Situation procedure. At 36 months, cognitive development was measured using the Mental Scale of the Bayley Scales of Infant Development-Second Edition, and language development was assessed using the Reynell Developmental Language Scales. At 36 months, parents and intervention teachers completed the Adaptive Social Behavior Inventory (ASBI) and the Child Behavior Checklist (CBCL) that measure behavioral development. Associations between joint attention and behavioral outcome, attachment quality and behavioral outcome, and joint attention and attachment were explored. Attachment quality was significantly associated with parent-rated prosocial scores on the ASBI, and parent internalizing scores on the CBCL. Initiating Joint Attention (IJA) averaged at 12 and 18 months was significantly negatively correlated with parent internalizing, and externalizing scores on the CBCL. Furthermore, it was significantly negatively correlated with teacher aggressive scores on the CBCL and ASBI prosocial scores. Responding to Joint Attention (RJA) averaged at 12 and 18 months was significantly negatively correlated with internalizing scores on the parent CBCL. IJA at 18 months was associated with attachment quality. IJA and Attachment Quality uniquely contributed to the variance in parent-rated internalizing scores on the CBCL. However, when RJA was incorporated into the equation, RJA too significantly predicted parent internalizing scores on the CBCL above and beyond IJA and attachment quality. These results provide support to the hypothesis that both joint attention and attachment quality are unique predictors of behavioral outcome, especially internalizing behaviors, in an at-risk sample.


Psychology, Psychobiology; Psychology, Developmental

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