Attachment and Emotion Regulation in Adolescents with FAS-Dysmorphism

Abstract

Children with fetal alcohol spectrum disorders (FASD) are frequently reported by caregivers and teachers to have difficulties in socio-emotional functioning. It has been suggested that deficits in emotion regulation underlie these deficits in socio-emotional functioning. Children with prenatal alcohol exposure (PAE) have also been found to demonstrate higher rates of insecure attachment, as well as disorganised attachment. Previous research proposes that the attachment relationship serves as a foundation for the development of emotion regulation. However, while this association has been examined in typically developing samples, the relation between attachment and emotion regulation has yet to be examined in individuals with FASD. Previous research has also suggested that a portion of individuals who are considered heavily exposed but are non-syndromal (HE) who do not present with the full phenotype characteristic of FAS or PFAS may nevertheless present with subtle facial dysmorphism only detectable using dense surface modelling and signature analyses of 3D facial images. Furthermore, it has been shown that HE children with this subtle facial dysmorphism perform more poorly on cognitive assessments than HE children who do not present with this subtle facial dysmorphism. These findings therefore suggest that presence of even subtle dysmorphism (i.e. only detectable on signature analyses of 3D facial images) consistent with FAS can be a good indicator of cognitive performance. Given this, the aims of the current study were to examine the association between FAS-dysmorphism and insecure as well as disorganised attachment. Furthermore, the study aimed to examine the extent to which FAS-dysmorphism was associated with emotion regulation difficulties in adolescence after controlling for the effects of attachment security in infancy. Participants included 77 adolescents (M age = 17.66, SD = .7): 13 with fetal alcohol syndrome (FAS), 12 with partial FAS (PFAS), 7 HE-dysmorphic (HE+), 18 HE-nondysmorphic (HE-) and 27 non- or minimally exposed controls. At the 13-month infant assessment, the mother-infant attachment relationship was assessed using the Ainsworth Strange Situation Paradigm (Hay, Jacobson, Molteno, Viljoen, & Jacobson, 2004; Jacobson & Jacobson, 2013). At the adolescent follow-up assessment, emotion regulation was assessed using two caregiver-report measures – the Emotion Regulation Checklist (ERC; Shields & Cicchetti, 1997) and the Affect Regulation Checklist (ARC; Moretti, 2003). Results showed that infants with FASdysmorphism+ did not demonstrate significantly higher levels of insecure and disorganised attachment than those in the FAS-dysmorphism- group. In terms of emotion regulation, FASdysmorphism+ did not significantly predict any of the adaptive or maladaptive emotion regulation subscales. However, insecure attachment predicted maladaptive emotion regulation, but not adaptive emotion regulation. These results suggest that while individuals with FASD are often reported to exhibit difficulties with emotion regulation, other variables, including IQ and attachment security in infancy, may explain some of the variation in the emotion regulation difficulties observed for individuals with FASD.