Samenvattingen bij de voorgeschreven artikelen van Brein en omgeving (UU) 21/22

What is motor behavior?

Motor behavior includes every kind of movement from involuntary twitches to goal-directed actions in every part of the body, in every physical and social context, from the beginning of life until the end. Movements depend on generating, controlling, and exploiting physical forces, and on core psychological functions. Perception and cognition are necessary to plan and guide motor behavior. Social and cultural factors spur and constrain motor behaviors.

How can we understand motor behavior in a developmental systems view?

According to a developmental systems view, motor behaviors need to be viewed in the bodily, environmental, and social/cultural context in which they occur. New motor skills bring new parts of the environment into play and provide new opportunities for learning and doing. Differences in the way caregivers structure the environment and interact with their children affect the form of new skills, the ages when they first appear, and the shape of their developmental trajectory.

What is posture?

Posture is the position in which the body is held while standing, sitting, or lying down. It is the most important motor action, because it is the foundation upon which the other motor skills are built. The emergence of most skills need to wait for the development of sufficient postural control. Posture must be sufficiently stable to allow movement of the extremities. Maintaining a stable posture sets up the necessary conditions for looking around, handling objects, going somewhere, or having conversations.

How does development in postural control provide a means for acquiring new knowledge about the world?

As infants learn to control their posture, they start to have many more opportunities to learn. Independent sitting facilitates more sophisticated bimanual object exploration, such as fingering, transferring, and rotating, which facilitates learning about the three-dimensionality of objects. Infants also start to have more attention for changes in object appearance, object size, multimodal information about objects, and other people´s intentions to grasp objects.

How do infants overcome gravity?

Generally speaking, infants go through a top down progression. They gain increasing control from head to toe, from the head, neck, shoulders, waist, to the hips. They eventually learn to tripod sit: sitting by stabilizing their torso with their arms between their outstretched legs. They then learn to sit independently without their hands supporting them, eventually gaining sufficient stability to manage destabilizing forces caused by turning the head, twisting the torso, and moving the arms.

What is dynamic postural control?

Dynamic postural control is the ability to maintain the center of mass within the base of support while the body is subjected to internal or external perturbations that are anticipated or not.

What is body sway?

Sometimes postures appear stationary, but they are not. The body gently sways back and forth within the base of support. A sway in one direction must be met by a muscle-induced compensatory sway in the opposite direction. Infant´s compensatory sways are excessive and they often stagger and fall. Visual information for body sway is extremely powerful, and infants are learning to use visual information for postural control.

What is locomotion?

Locomotion refers to movement or the ability to move from one place to another. Locomotion is not reflexive or hardwired, but improves with practice. Infants find different ways to solve the problem of moving and often come up with different creative solutions. Generating new forms of locomotion can involve cognitive skills such as problem solving, representing goals and spatial locations, and tool use.

What is the newborn stepping reflex?

When newborn are held upright with their feet on a hard surface, they move their legs in an alternating pattern that resembles walking. This is called the newborn stepping reflex. It usually disappears by two months of age and reappears at eight to ten months when infants begin walking with support. The reflex is caused as a newborns response to optic flow. Infants can deliberately modify their leg movements in various configurations that can be kinematically equivalent and produced by the same muscle, though they may look different. In reality, with daily practice in an upright posture, the stepping movements never disappear.

How do infants learn to walk?

On average, infants take their first walking steps at twelve months. Walking onset requires sufficient strength and balance to support the body on one leg as the other leg swings forward. Experience in standing, stepping, and moving upright facilitates gains in strength and balance and accelerates the onset of walking. The first steps are wobbly and uneven, with a wide stance between feet, a small front-to-back distance between steps, long periods when both feet are on the floor, and short periods when one foot is in the air. Children rapidly improve their walking skills as they discover the relevant parameters that control upright balance and propulsion.

How do infants learn to navigate obstacles?

Children generate the requisite perceptual information through exploratory movements, such as looking, touching, and testing various options. Learning does not transfer from earlier to later developing postures. Infants learn to generate and use perceptual information about the current status of their body relevant to the environment. They learn the relevant parameters for each new posture in development and the relevant exploratory behaviors for calibrating those parameters in new situations. Over weeks of experience with each posture, judgements improve so that infants attempt safe increments within their ability and avoid risky obstacles beyond their ability.

What is manual action?

The hands are used in a wide range of actions such as feeding, locomotion, body maintenance, communication, and play. Manual actions begin prenatally, but outside the womb, infants require a stable postural base to support arm movements and perceptual information to guide movements adaptively. Tools extend children´s manual abilities.

What is spontaneous motility?

Manual action appears long before birth. Fetuses can extend their arms, wiggle their fingers, clench their fists, explore their own bodies, such their thumbs, etc. Spontaneous arm and hand movements continue after birth.

How do infants learn to reach and grab?

Goal-directed reaching requires perceptual information about the location of the object vis-à-vis the hand. Initially reaches are jerky and crooked and it takes years before children´s reaches become as smooth and straight as those of an adult. Jerky trajectories may result in part from postural constraints and unanticipated reactive forces. Reaching precedes grabbing, because control of the arms precedes control of the hands. Prospective control of grasping based on visual information for object size, orientation, and substance appears months after infants begin reaching. With increased hand/finger control, infants adapt their grip configuration to object properties, but they do so after contacting the object, not during the reach.

Why is exploring objects a multimodal development?

With increasing skill, object exploration becomes increasingly multi-modal. At first, infants use their hands only to be able to look and mouth an object. As their grip strengthens, they can heft, rub, squeeze, and finger objects, as well as transfer objects from hand to hand and rotate them in front of their eyes. Hands begin to serve a complementary function. They can use one hand to support the object and keep it in view, while using the other to generate information about the object properties.

How can infants extend their abilities by using tools?

Tool use has its roots in early motor actions and relies on motor actions for its execution. Exploring relations between objects and surfaces sets the stage for using objects as effective tools. Tool use requires infants to perceive that a goal is beyond their abilities and to recognize that an object can serve as a means to augment their abilities. Then they need to execute the necessary movements to use the tool.

What is infant facial action?

All the parts of the face begin moving prenatally. After birth, infants continue to produce facial movements as they become integral to everyday functions. Swallowing is used to suckling, eating, and talking. Vocalizations and facial expressions are used for communication. Head and eye movements are used for visual exploration of the environment.

How do infants such, chew, and swallow?

Newborns must coordinate movements of the tongue, jaws, and lips to create suction, draw liquid into the mouth, pull the liquid into the pharynx, and divert the liquid to the esophagus while pulling air into the trachea. Chewing is more complicated. Infants rely on lateral jaw movements to do most of the chewing, whereas older children use rotary jaw movements and use the lips and tongue. Infants use the same chewing movements regardless of the type of food, whereas older children select the appropriate jaw movements and muscle forces based on the food consistency.

How do children learn to speak?

Facial expressions and vocalizations appear long before infants can speak. The movements needed for speech production are one of the most complex movements to learn. The jaws, lips, and tongue must be precisely positioned to shape each sound as air travels through the oral and nasal cavities. Infants rely primarily on jaw movements as they discover functional strategies to produce speech sound. As they gain better control over their lips and learn to incorporate those movements into the jaw movements, they are able to produce a greater variety of speech sounds.

How do infants develop their visual perception?

Looking involves coordination among body, head, and eyes. Newborns who cannot turn their heads tend to watch whatever happens to be in front of them. Even as posture improves, much of what infants see is opportunistic. Looking is more functional and adaptive when the eye, head, and body movements are more controlled. To track a moving object, infants must anticipate its speed and trajectory to keep their eyes moving at the right pace. As targets move too quickly, the eyes lag behind, and infants often make corrective saccades to catch up to the target. With practice, they use less corrective saccades.

How can improving our understanding about the gastrointestinal system help to improve pediatric outcomes for children with medical conditions?

Many medical conditions are associated with poorer quality of life and adverse emotional and behavioral outcomes in children. The multiple systems that children are embedded within are often disrupted during illness, altering the typical course of development, which can further exacerbate symptoms and their consequences. These potentially negative implications for child well-being can be viewed as an opportunity to enhance the psychosocial context and improve pediatric outcomes. The gut microbiome refers to the vast and diverse array of microorganisms residing in the gastrointestinal tract and their collective genomes. There is evidence that it contributes to both physical and mental health.

How is the microbiome related to physical and mental health?

Research results have indicated several associations between the microbiome and physical and mental health:

• Disruptions to the microbiome and gut development are related to a range of health conditions, including asthma, IBS, cystic fibrosis, inflammatory bowel disease, and infant colic.
• Gut microbiome composition is associated with autism.
• The instability and immaturity of the gut microbiome from infancy to adolescence means it is more vulnerable to environmental insults, such as antibiotic use, stress, and infection.

What can be concluded after systematically reviewing the available evidence on the connection between the gut microbiome and mental health in children with physical illness?

No consistent pattern emerged. The gut microbiome differences at baseline and following interventions varied across studies and depended on the physical health condition and type of analysis conducted.

• Infants with colic showed to have an atypical microbial profile, including lower levels of bifidobacterium. Intervention had no effect on measures of the whole microbiome in infants with colic or IBS, although this may be partially attributable to the shallow depth of analyses´ resolution.
• Targeted analyses of lactobacilli and/or bifidobacteria suggested that the interventions enriched these beneficial taxa, while results were mixed for E. coli.
• Findings on psychosocial functioning varied. Only about half of the captured studies showed a positive effect of intervention on measures of infant distress.

What is neuroplacentology?

Neuroplacentology is the field that investigates placental connections to neurodevelopmental outcomes. Many evens can abruptly change the fetal´s brain environment. The developmental potential of the fetus can be compromised when the placenta fails to function properly. Placental failure can directly damage the developing brain or increase its susceptibility to injury, leading to permanent neurological disabilities.

What is fetal programming?

Fetal programming suggests that certain events occurring during critical points of pregnancy may cause permanent effects on the fetus and infant long after birth. Maternal health, nutrition, exposure to environmental factors, uteroplacental blood flow, placental transfer, and fetal genetic and epigenetic responses all contribute to programming.

How can placental events influence brain development?

At certain point the embryo and fetus are more vulnerable to stressful events and the impact of those events will vary depending on when they occur during gestation. Several placental events are distinguished:

• Preterm birth has big impacts on postnatal neurodevelopment and additional complications, such as infection, may cause bigger issues as well. Events before preterm birth, such as IUGR due to impaired placental function, may also enhance the risk of neurodevelopmental impairment in premature infants.
• Maternal infection has been implicated in the etiology of neuropsychiatric disorders, including ASD, generalized cognitive impairment, and schizophrenia. Direct infection of the placenta is associated with adverse outcomes in the embryo and fetus.
• The placental genetic program shows an abrupt shift in overall gene expression pattern in midgestation. Many genes that are highly expressed in placenta are also expressed in brain diseases.
• Hypermethylation and hypomethylation are placental factors that can cause neuropsychiatric disease.
• Placental dysfunction, or when the placenta is not protecting the developing fetus from maternal insults, can lead to inflammation, hypercoagulable placental state, or altered glucocorticoid levels. This may lead to fetal tissues being exposed to higher than normal glucocorticoid levels, suppressing cell proliferation, and inducing epigenetic changes.
• Maternal stressors, such as hypoxia or malnutrition, may directly impact the developing fetus or alter gene expression. The effect of maternal stress on the placenta may be amplified by the presence of comorbidities.

What is the role of the placenta in autism?

Research suggests a correlation between placental architecture and later ASD. Studies examining the placenta of mothers who were at higher risk of having a child with autism revealed anatomical variations, such as fewer branch points, thicker and less tortuous arteries, better extension to the surface boundary, smaller branch angles, and thicker and rounder placentas. The correlations suggest that placentas may reflect or create an adverse environment for fetal brain development. Other studies suggest a link between placental epigenetic modification to ASD, for example through pesticide exposures that alter placental DNA methylation and vitamin D deficiency.

What is the role of the placenta in schizophrenia?

Research suggests an association between maternal viral illnesses in early gestation with later development of schizophrenia in the child. Maternal infection may permanently affect the placenta and fetus either through altered gene expression or epigenetic modification. There is also a genetic risk for schizophrenia. A subset of the most significant genetic variants associated with schizophrenia, combined with the ability of the brain cells to respond to stress, may determine the final phenotype.

What is the role of the placenta in mood disorders?

The developing brain is very sensitive to glucocorticoids which play an important role in neuronal maturation. Many maternal stressors, such as depression, trauma, and malnutrition, can alter maternal glucocorticoid levels and affect the placenta. Also, poor placental function that is associated with IUGR can alter fetal glucocorticoid exposure. Maternal mood disorders are associated with disruption of placental enzymes that regulate maternal-fetal glucocorticoid and serotonin transfer. This may lead to abnormal neurodevelopment and potentially to mood disorders in the child.

What is the role of the placenta in disorders of executive functioning?

Research shows that learning difficulties and behavioral problems are significantly associated with deficits in executive functioning and are thought to be caused by prefrontal lobe dysfunction. Especially premature neonates show executive function deficits in childhood or adult life. There are differences between late premature neonates that were medically and purposely delivered versus those that were spontaneously born. Those who were delivered for medical indications had higher levels of childhood attention problems. It suggests that pregnancy complications that motivated medical intervention, complications that are primarily due to placental dysfunction and fetal growth restriction, can increase the risk of executive functioning deficits.

What are disruptive behaviour disorders?

Most of the children who receive psychiatric care are in therapy because of disruptive behaviours. Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are the best examples of diagnoses of clinically disruptive behavioural patterns. Early identification and treatment of children with disruptive behaviour disorders is crucial. There are great differences in the frequency, intensity and kind of symptoms that mark the onset of the disorder. Almost all children with CD also have an ODD diagnosis. Comorbid ADHD is also very prevalent among children with disruptive behaviour disorders.

What factors increase the risk of developing a disruptive behaviour disorder?

Several different environmental as well as genetic factors can contribute to the risk of developing a disruptive behaviour disorder.

The clearest case of an environmental exposure that predisposes to DBDs is exposure to active maternal smoking during pregnancy. Children from economically disadvantaged neighborhoods manifest DBDs more often, a phenomenon that is referred to as the neighborhood effect. Neighborhood disadvantage is also associated with exposure to neighborhood violence, which independently increases DBD risk. Children exposed to chronic violence also have faulty processing of interpersonal cues, with more negative and hostile attributions about others’ behavior, leading to increased aggression. There are indirect associations between family income and children’s behavioral problems mediated by maternal depression and parental stress: Exposure to maternal depression during infancy increases preschool children’s likelihood of developing DBDs, likely mediated by the effects of disengaged, harsh, or overly permissive parenting. Parental stress is another environmental risk factor for developing a disruptive behaviour disorder. 

Positive parenting techniques include close monitoring of the child, positive reinforcement, and regular engagement. These techniques are associated with decreased DBD risk, and are taught in parent management training programs used for prevention and treatment of preschool ODD and CD.  

Disruptive behaviour disorders cluster in families with ADHD, CD, ODD and depression. Recent studies have also investigated genetic polymorphisms that may predispose to DBDs through interaction with childhood adversity. Polymorphisms in the 5-hy- droxy-tryptamine transporter–linked polymorphic region (5HTTLPR) and monoamine oxidase A (MAOA) gene are the most intensely investigated. The S allele results in decreased production of serotonin transporters, and thus decreased serotonin clearance from the synaptic cleft. Although not all research supports this finding, some 5HTTLPR studies found that the S allele increases vulnerability to externalizing disorders in the context of childhood adversity.

What brain abnormalities are associated with disruptive behaviour disorders?

Disruptive behaviour disorders are accompanied with certain structural and functional abnormalities in the brain. There has not been executed a lot of research towards the brain structural and functional abnormalities in children with a disruptive behaviour disorder. However, it was established that children with ODD and CD have smaller bilateral amygdalae and insulae, as well as decreased brain activity in these areas on functional MRI. Decreased volume in the right striatum, left medial and superior frontal gyrus, and left precuneus were also found. Children with comborbid ADHD and ODD display decreased response inhibition and working memory. Children with a disruptive behaviour disorder also display more risk-taking behaviours. This behaviour is associated with decreased orbitofrontal cortex reactivity to reward in these children.

How can psychologists assess a disruptive behaviour disorder?

The Achenbach System of Empirically Based Assessment (ASEBA) is one of the most comprehensive report forms for assessment of DBDs, and there is a version for children 1.5 to 5 years of age. In addition to an ODD Diagnostic and Statistical Manual of Mental Disorders (DSM)–oriented scale and emotionally reactive and aggressive behavior syndrome scales, the ASEBA also screens for comorbid conditions. The Disruptive Behavior Diagnostic Observation Schedule is an observational method of assessing preschool disruptive behavior. 

How are disruptive behaviour disorders treated within psychotherapy?

Psychosocial interventions are the first-line treatments for preschool DBDs. Examples are Parent Management Training-Oregon Model, parent-child interaction therapy and the IY program.

• The Parent Management Training-Oregon Model (PMTO) focuses on training caregivers rather than focusing on the child directly. In the PMTO model, children’s disruptive behaviours result in part from parents’ unintentional reinforcement of children’s use of coercive methods to obtain what they want. The program involves a concerted effort to reshape parenting techniques, paring down reliance on coercion and focusing instead on positive reinforcement for prosocial behaviour.

• Parent-child interaction therapy (PCIT) is a dyadic therapy method focusing on the ways in which parent-child interactions can improve parents’ and children’s abilities to regulate strong emotions. Parents learn ways to engage positively with their children via praise and reflection, and how to ignore negative behaviors

• In the Incredible Years (IY) program, therapists observe parent-child interactions through a 1-way mirror, then discuss observed maladaptive interactional styles. In later sessions, therapists coach parents through interactions with their children, delivering instructions via earpiece.

What is the definition of empathy?

Empathy refers to the capacity to comprehend the minds of others, to feel emotions outside our own, and to respond with concern, kindness, and care to others’ suffering. It is a relational construct and central in the formation and maintenance of social bonds. Individual differences in empathic ability and the tendency to be empathic have significant implications for social functioning across development:

• In childhood, low empathy is associated with poor peer relationships, hostility, and bullying.

• In adolescence, low empathy manifests in aggression and antisocial behaviour.

• In adulthood, this deficit is associated with child abuse, violence, and psychopathy.

On the other hand, greater empathy is associated with social competence and prosocial behaviour across the lifespan. Individual differences in empathy result from the complex interweaving of a child’s biological predisposition and environment. Theories of empathic development have emphasized the role of parenting: Children’s level of empathy may be seen as a product of specific parenting behaviours such as authoritativeness, gentle discipline, inductive reasoning, and sensitive responding to children’s distress. In line with attachment theories, parents’ sensitive responses to children’s distress serve as a key antecedent to children’s healthy social and emotional development. Research demonstrates that behavioral and physiological indicators of self-regulation are positively associated with children’s empathy and prosocial behavior, whereas personal distress is negatively related or unassociated with empathy and prosociality. 

How does empathy develop during early attachment?

According to attachment theories, infants’ expression of need, distress, or bids for closeness, referred to as attachment behaviors, are aimed at eliciting proximity, protection, and comfort of their attachment figures in times of threat, referred to as caregiving behaviours. Attachment theory states that all infants possess an adaptive, biologically based tendency to forge an attachment bond to a close caregiver, and that infants’ own social behavior will grow from the foundation of this primary relationship. These early patterns of interaction between infant and caregiver shape enduring mental representations of social relationships, what Bowlby termed internal working models (IWMs). IWMs organize cognitive processing of social information, inform emotional and physiological responses to threat, and guide social behavior across development. Secure and insecure IWMs differentially shape psychological functioning throughout childhood, with securely attached children consistently demonstrating greater social competence and better quality peer relationships than their insecure peers.

From an attachment perspective, we view empathy as arising out of the experience of relational security, in complex interaction with moderators at multiple levels of analysis. Cognitive models, language, emotional and self-regulatory capacities, neurobiological programming and parenting antecedents are mechanisms of influence in the relationship between early attachment and empathy.

• Recently, attachment researchers have proposed that the secure IWM may be an important mediator of the link between attachment and empathy. Secure base scripts reflect specific knowledge of how caregiving events typically proceed. Secure attachment may provide a salient behavioral script, activated in times of threat, for how to recognize and respond empathically to others’ bids for help. Furthermore, secure adult attachment is associated with positive IWMs of self and others in ways relevant to empathy.
• Language may function as an additional mechanism linking attachment to empathic development. Parents’ and children’s use of emotion-focused language, in turn, has been linked to children’s empathy and concern for others.
• Dimensions of emotional functioning are also thought to play a key role in understanding the link between attachment and empathy. Measures of emotional competencies such as emotion recognition and understanding, affective resonance, effortful control, and self-regulation are central to empathic responding across development, allowing children to see, interpret, and feel others’ emotions without becoming overly distressed themselves. Attachment theory proposes that security lays the foundation for children’s capacity to regulate emotions: Securely attached children are better able to regulate emotion, as assessed via physiological, behavioural, and questionnaire measures.
• A growing body of literature demonstrates that attachment experiences shape biological responses to threat, with secure attachment generally predicting less neuroendocrine and physiological reactivity to stressors. Child attachment insecurity predicts lower vagal regulation, as indexed by respiratory sinus arrhythmia (RSA). RSA has been repeatedly linked to empathic behaviour. Furthermore, over time, attachment-related experiences also become biologically embedded by programming HPA-axis reactivity.
• Parents’ sensitive responsiveness to children’s distress is a key building block of secure attachment. Related evidence shows that parents’ own empathy predicts secure child attachment.

In addition to socialization, attachment likely interacts with other moderating factors at multiple levels of analysis.

• At the individual level, child gender, genetics, and temperament may influence the degree to which attachment contributes to empathic development.
• At the group level, gender and group norms for empathic responding, as well as the group membership of the target, may moderate the link between attachment and empathy.
• Finally, at the societal level, cultural factors likely moderate the degree to which attachment is influential in children’s empathic development. 

Importantly, each of the mediating and moderating processes described occur in the context of the developing child, and it is likely that the relation between attachment and empathy is developmentally constructed. The proposed link between attachment and empathy may be indirect, working through multiple mediating mechanisms in a cascade of influences over time. It also may take time for this relationship to consolidate, and therefore may be weakest in infancy, when children’s capacity for emotion regulation and cognitive representation are primitive.

How does empathy develop during preschool years?

Research on attachment and empathy in infants and toddlers to date is sparse, providing only preliminary evidence for a link between security and empathy in young children. The link between attachment and empathy is weakest in infancy, when representations and self-regulatory abilities are still consolidating.

As children enter the preschool years, their empathic capacities become increasingly selective, reflecting greater understanding of display rules, gender norms, and contextual factors such as group membership and the proximal causes for others’ distress. The evidence on attachment-related differences in empathy in preschool children is particularly mixed, and appears to depend upon study design and methodology: Longitudinal studies employing observational measures of children’s empathy have generally found that preschoolers with secure attachment histories are more likely to respond empathically to strangers and peers in distress. In contrast, mixed and null results have emerged from cross-sectional studies and studies assessing preschoolers’ empathy toward their mothers or siblings. The evidence from this developmental period suggests that attachment-related differences in empathy may indeed be developmentally constructed, with differences emerging principally from longitudinal investigations. Data also point to the importance of contextual and methodological moderators, given evidence that a child’s relationship to the target—as well characteristics of the target such as maternal mental health— represent important moderators of the link between attachment and empathy.

How does empathy develop in school-aged children? 

In early and middle childhood, the focus of children’s social world begins to shift toward peers, yet attachment to parents continues to influence children’s everyday interactions. Emotion regulation appears to be a key mechanism linking attachment with social functioning in middle childhood. Middle school students’ self-reports of attachment and empathy together were found to predict their role in bullying situations. Furthermore, insecure IWMs of attachment in early and middle childhood have been associated with increased risk for callous-unemotional traits, foremost among which are lack of empathy and poor attunement to others’ emotions.

How does empathy develop in adolescence?

The period of adolescence is marked by the increasing importance of peers, who may at times provide a secure base for the adolescent or call upon the adolescent to provide a secure base for them in times of distress. Adolescent research has consistently demonstrated a positive association between secure attachment and empathy. The majority of studies to date, however, have employed cross-sectional designs and self-report assessments of attachment and empathy, raising concerns regarding shared method variance and highlighting the need for more longitudinal, observational work in this developmental period. Nevertheless, this body of work helps to build a bridge linking earlier studies of attachment and empathy in childhood with the robust findings on security and empathy in adulthood. Across numerous studies utilizing a variety of methodologies, adult attachment researchers have repeatedly demonstrated an association between security and empathy for others in distress. The strong evidence in adulthood, coupled with the promising research in adolescence, suggest that studying the developmental roots of empathy from an attachment perspective is indeed a worthwhile pursuit. 

What recommendations for future research can be made?

The body of work examining attachment and empathy in childhood is surprisingly small, and the evidence is mixed. There are multiple possible explanations for these mixed findings.

• Firstly, the proposed link between attachment and empathy may be developmentally constructed.
• Aside of this, it is also likely that any influence attachment may exert on empathy would be indirect, operating through multiple mediating mechanisms in a developmental cascade.
• Third, the methodology used to measure both attachment and empathy varies widely across development, with observational measures most common in the first years of life, use of adult-report increasing in preschool, and self-report dominating in adolescence.
• Fourth, beyond target characteristics, attachment may interact with additional moderators in the prediction of empathy. More specifically, evidence suggests that children with high reactivity temperamental traits or certain genes are differentially susceptible to their caregiving environment.
• Finally, we must bear in mind the possibility that attachment is in fact unrelated to children’s empathy, and that the positive results to date can be explained by a third variable or by measurement error.

What directions can be advised for future research?

Several directions can be advised for future research towards the development of empathy.

• First, understanding empathy in childhood from any perspective requires taking a developmental approach.  
• Future examination of attachment and empathy requires appropriate and careful measurement of each construct, particularly given the wide variation in methodologies used to study both attachment and empathy in children. 
• Then, integrating behavioural and biological indices of children’s responses to naturalistic displays of distress may be optimal for capturing empathy.
• Fourth, future research should go beyond simple direct effects to examine potential indirect pathways and mediating mechanisms linking attachment and empathy.
• Fifth, it will be important to examine potential moderators of the link between attachment and empathy, and to examine attachment itself as a moderator of other influences on children’s empathy, such as socialization. In addition to parent- and child-level moderators, research may benefit from greater sensitivity to the role of context and culture in shaping children’s relationships to their caregivers, as well as their empathic development.
• In order to test potential causal links between attachment and empathy, researchers could employ experimental designs.
• Finally, future research should examine potential implications of the model proposed here for intervention.