Article summary with Mary Ainsworth’s legacy: a systematic review of observational instruments measuring parental sensitivity by Mesman a.o. - 2013

Who is Mary Ainsworth and what is reviewed in this article?

Mary Ainsworth researched a lot in the field of maternal sensitivity and contributed valuable results to the knowledge of parenting and child development. She contributed to the design and development of the Sensitivity-Insensitivity to Infant Signals and Communications scale, as part of the Maternal Care scales, based on the attachment theory. Most importantly, she introduced the concept of maternal sensitivity itself. Her work is still used in todays research. However, new measurements to measure parental sensitivity have been designed since then and also the construct sensitivity has been variously formulated and defined in the past years of research. Additionally, the focus of the target group, participants' age and observational settings varied in past research, contributing to differences in measurements and concept definition.

This systematic review aims to provide an overview of observational instruments that have been used to measure parental sensitivity. Furthermore, these instruments will be analyzed and compared to the original construct definition of Mary Ainsworth. Her definition of parental sensitivity requires the parents to notice the child’s signals, to interpret those signals correctly, and to respond to those signals in a prompt and appropriate manner. This definition refers to the acts of contingent responding, proximity to the child and appropriate parental interventions, as universal aspects of caregiving. Positive affect and warmth is not listed in her definition of sensitive parenting, but a specific scale was developed for this purpose.

Ainsworth’s studies were conducted by an observant in natural settings and based on naturalistic interactions, often at home of the observed families. It was mostly focused on mothers, as it was common at this time. Even though her scale has been used in non-Western countries, her studies were focused on observing Western families.

In the systematic review of this article, only global rating scales were examined and compared to Ainsworth’s scale.

How was the systematic review conducted?

Web of Science was used to search for literature regarding observational instruments, with help of keywords. After excluding irrelevant papers, 1014 papers were further screened for the use of global instruments of parental sensitivity, leaving 50 relevant papers for this study.

Eight instruments were found to be used most often in those publications.

A coding system for all eight scales was developed. The coded characteristics are:

1. Availability of the instrument
2. Age range for which the instrument was applicable
3. The observational setting
4. If the scale was used to code father sensitivity as well
5. If the scale has been used on non-Western countries as well
6. The inclusion of a single sensitivity scale and a composite sensitivity scale
7. Whether positive affect and warmth is included in the construct definition of sensitivity
8. Whether the instrument is linked with attachment quality

What were the results for each scale?

The Child-Adult Relationship Experimental Index (CARE-Index)

The CARE-Index measures sensitivity in adult-child interaction among toddlers and infants up to 36 months. With this scale maternal and paternal facial expressions, vocal expressions, position and body contact, expression of affection, pacing of turns, control and choice of activity is measured to evaluate sensitivity, control and unresponsiveness among parents. The scale is available for those who followed some training. Even though the scale’s description includes aspects of Ainsworth’s sensitivity description, it also explicitly includes warmth and affection, which is missing in Ainsworth’s scale. The CARE-Index was found to predict attachment security in several situations and several countries and to detect improvements in parental sensitivity after training.

Coding Interactive Behavior (CIB)  

The CIB measured different aspects of adult-child interactions, consisting of 22 scales. Different versions exist for different age ranges. CIB is used in free-play settings. The information material of this scale mentioned Ainsworth’s work. They also include attachment, and the attachment theory. CIB can be used to detect maternal sensitivity improvements after interventions and was also used in non-Western countries.

Emotional Availability Scales (EA Scales)

The EA is an often used scale to measure paternal and maternal sensitivity in free-play settings. The newest edition, the 4^th, can be used for children in an age range from 0-14 years. It is used on Western and non-Western countries and also relates to attachment. Changes in maternal sensitivity after training can be detected with BIC.

Erickson scales

The Erickson scales are a commonly used tool to code teacher-child interactions among toddlers and preschoolers. Included aspects in the scales are supportive presence, lack of respect for autonomy, hostility, clarity of instruction, sensitivity and timing of instructions and confidence. The first study using this scale grounded their theory in the attachment theory. Different aspects of sensitivity used in the Erickson scales are also used int Ainsworth’s concept constructions. The scales were found to be related to child attachment security in Western an non-Western countries and to detect maternal sensitivity improvements after training.

Global Ratings of Mother-Infant Interaction

This instrument was designed to measure mother-child interactions with 2-5 months-old infants in face-to-face settings. However, also father-child interactions have been assessed with this scale. The description of this scale includes aspects of Ainsworth’s original definition and also reflects positive affect. Infant attachment security and improvement in sensitivity can be detected with help of this scale.

Maternal Behavior Q-Sort (MBQS)

This instrument consist of 90 cards with written statements about maternal behaviors, sorted into 9 piles of 10 cards each, ranging from characteristics to uncharacteristic criterions. Originally developed to assess mother-infant interaction, MBQS is now additionally used to assess father-child interactions. Ainsworth’s work as explicitly mentioned to  be used as a foundation for the framework of this scale and the items on the cards include references to her work. The scores are highly correlated to Aintworth’s scale.

NICHD-SECCYD sensitivity scales

Several sensitivity scales were used to assess parental responsiveness to their infants with an age up to 24 months. The bundle of scales has been widely used in research. The framework of this scales includes important aspects of Ainsworth’s construct, but no particular mentioning of positive affect or warmth. It was found to assess infant attachment quality and child separation anxiety and to detect improvements in maternal sensitivity after training.

Parent-Child Early Relational Assessment (PCERA)

This rating scale is used to assess frequency, duration and intensity of adaptive behavior among infants up to the age of 12 months. Sensitivity is not assessed in a separate single scale and the work of Ainsworth is not used in the framework of this scale. Furthermore, PCERA was not found to be used in non-Western countries.

How can those result be summarized?

Of all eight analyzed instruments, only three were found to include a single global rating scale for sensitivity. The other five required to summarize the scores of other subscales. As a comparison; Ainsworth’s scale of sensitivity can be used as a single scale. Some scales broaden the construct of sensitivity and the age range of assessed children. Again, in other scales, e.g. CARE-Index, sensitivity as a construct was split up into subcategories, such as facial and bodily expressions. 7 out of 8 analyzed instruments included positive affect and warmth as an aspect of sensitivity, which differs from Ainsworth’s scale. The weight of this factor differs from each instrument.

Most instruments focused on early childhood, with exception of EA scales and CIB. If sensitivity is assessed among adolescents, it often is a follow up study, with first assessment during early childhood. All instruments, include those designed to measure maternal sensitivity in particular, are nowadays used to assess paternal sensitivity as well. Some studies, even designed for Western families, are also used on non-Western countries. During the process of this review, the authors asked themselves whether many different instruments to measure sensitivity are necessary, concluded that well-defined constructs would be beneficial for research.