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The Relationship Between Prenatal Alcohol Exposure and Infant/Child-Caregiver Attachment: A Scoping Review
David J Gilbert1, Alan D Price1, Penny A Cook1
1School of Health and Society, University of Salford, Manchester M5 4WT, UK.
Insights
Prenatal alcohol exposure (PAE) may impact infant attachment, potentially through infant irritability and caregiver interactions. However, research is limited, with mixed findings on the PAE-attachment link. More studies are needed to clarify this relationship.
Area of Science:
- Psychology
- Neuroscience
- Developmental Pediatrics
Background:
- Secure infant/child-caregiver attachment is vital for social-emotional development and long-term outcomes.
- Prenatal alcohol exposure (PAE) presents complex challenges for children, often compounded by early life adversity.
- Existing evidence suggests a potential increased risk of insecure attachment in children with PAE, but findings are inconsistent.
Purpose of the Study:
- To systematically review and synthesize the existing literature on the relationship between prenatal alcohol exposure (PAE) and infant/child attachment.
- To identify gaps in the current research and highlight areas for future investigation.
Main Methods:
- A systematic literature search was conducted across seven academic databases.
- The review followed PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines.
- Eleven studies (published 1987-2021) met the inclusion criteria, with quality assessments performed.
Main Results:
- Five of the eleven included studies found a significant relationship between PAE and insecure or disorganized attachment.
- Two of these studies indicated that infant irritability and caregiver-infant interaction mediated the PAE-attachment link.
- The remaining six studies found no significant association between PAE and attachment.
Conclusions:
- There is a notable lack of published research specifically examining the link between PAE and attachment.
- Preliminary evidence suggests potential mediating factors like infant irritability and caregiver-infant interaction, but findings are not definitive.
- Further research is crucial, particularly studies incorporating the impact of early life adversity and recent neurodevelopmental insights.
Abstract:
Introduction: Secure infant/child-caregiver attachment is crucial for the development of social and emotional functioning and can affect long-term outcomes, such as adult relationships, but it may also be influenced by prenatal and early childhood risk factors. Children with a history of prenatal alcohol exposure (PAE) have a complex spectrum of strengths and difficulties and often have the additional risk of early life adversity. There is some evidence that children with PAE are at increased risk of insecure attachment, but it is unclear whether this is consistent or why it is the case. No published review has focused on the relationship between PAE and attachment. Methods: A systematic search of seven academic databases using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines was undertaken by two reviewers to identify primary studies that have focused on the relationship between PAE and attachment. Quality assessments were undertaken using the Quality of Observational Cohort and Cross-Sectional Studies tool, and the report was written following the PRISMA-ScR checklist. Results: A total of 4199 records were returned from the database searches. A total of 11 studies (eight peer-reviewed papers and three dissertations), published between 1987 and 2021, met the criteria. Five studies showed that PAE was related to insecure or disorganised attachment, two of which showed that infant irritability and caregiver-infant interaction mediated this relationship. The other six studies found no significant relationship between PAE and attachment. Conclusions: This scoping review demonstrates that there is a dearth of published research on this topic, and none that takes advantage of more recent understanding of the relationship between adverse childhood experiences and neurodevelopmental disorders. There is some evidence that PAE may impact the attachment relationship via caregiver-infant interaction and infant irritability, but further studies, including those that assess the additional impact of early life adversity, are needed.
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