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Joint attention and disorganized attachment status in infants at risk

Article  in  Development and Psychopathology · February 2002

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Development and Psychopathology, 14 (2002), 279–291
Copyright  2002 Cambridge University Press
Printed in the United States of America

Joint attention and disorganized attachment

status in infants at risk

ANGELIKA H. CLAUSSEN, PETER C. MUNDY, SANGEETA A. MALLIK,

AND JENNIFER C. WILLOUGHBY
University of Miami

Abstract
The development of joint attention skills is a major milestone of infancy. Recent research suggests that the
development of these skills may be affected by disorganized (D) attachment. This hypothesis was examined in a
longitudinal study of attachment and joint attention skill development in a sample of infants at risk for
developmental–behavioral morbidity. The results revealed that toddlers with D classifications initiated joint attention
with an experimenter significantly less often than did secure, or even other insecure, toddlers. However, no group
differences in the capacity to respond to the joint attention bids of others were observed in this study. These data
suggest that a disturbance in the tendency to initiate episodes of joint attention with others may be indicative of
early social–cognitive and social–emotional disturbance among infants affected by disorganized attachment status.
Theory and research is reviewed to suggest that an early impairment in joint attention facility may make a
significant contribution to risk for negative cognitive and emotional outcomes among these infants.

The development of the capacity to share or
coordinate attention with a social partner is a
major milestone of infancy (e.g., Bakeman
& Adamson, 1984; Bruner, 1981; Mundy &
Gomes, 1997; Tomasello, 1995). This broad
capacity is often referred to as “joint atten-
tion” skill development (e.g., Carpenter, Na-
gell, & Tomasello, 1998). The study of joint
attention skills is commonly associated with
theory on social cognition or language acqui-
sition, and it has provided important new per-
spectives on the nature of atypical, as well as
typical, early development (e.g., Baldwin, 1995;
Carpenter et al., 1998; Corkum & Moore, 1998;
Morales, Mundy, & Rojas, 1998; Mundy &
Neal, 2001; Sigman & Ruskin, 1999; Ulvund
The research described in this paper was conducted with
the support of DOE-OSE Grant H023C30079, NIMH/B-
Start Grant MH53975-01, SAMHSA Grant SPO8984, and
the philanthropy of Infants In Need (www.iin.org).
Address correspondence and reprint requests to: An-
gelika Claussen, Ph.D., Department of Psychology, Psy-
chology Annex, University of Miami, 5665 Ponce de
Leon Boulevard, Coral Gables, FL 33146-0720; E-mail:
aclaussen@miami.edu.
& Smith, 1996; Yoder, Warren, & McCath-
ren, in press). It is less well recognized, though,
that research on joint attention skills may also
contribute to a better understanding of the in-
tegration of social–emotional and cognitive
processes in infancy, especially as these affect
risk or vulnerability to psychopathology (Mundy
& Willoughby, 1998).
Significant individual differences in joint
attention skill development are evident in in-
fancy (Mundy & Gomes, 1998), and these in-
dividual differences may be determined by so-
cial processes, as well as factors associated
with cognition and temperament (Mundy &
Willoughby, 1996, 1998). Specifically, the
tendency of an infant to engage in social shar-
ing or joint attention may be affected by the
early social–emotional aspects of the care-
giving environment (Adamson & Russell, 1999;
Flanagan, Coppa, Riggs, & Alario, 1994;
Goldsmith & Rogoff, 1997; Mundy, Kasari,
& Sigman, 1992; Raver & Leadbeater, 1995;
Wachs & Chan, 1986).
Theory and research suggest that an in-
fant’s tendency to engage in joint attention

279
280
with others is optimized in a responsive and
affectively positive caregiving environment
(Adamson & Russell, 1999; Wachs & Chan,
1986). Alternatively, less responsive and more
negatively toned caregiving may be less opti-
mal with regard to the infant’s development
of joint attention skills (Flanagan et al., 1994;
Goldsmith & Rogoff, 1997); that is, individ-
ual differences in infant joint attention skill
development reflect, in part, the degree to
which joint attention bids have become so-
cially rewarding for the child (Corkum &
Moore, 1998; Mundy & Willoughby, 1996;
1998).
This line of theory leads to the expectation
that infant joint attention skills may be asso-
ciated with qualitative aspects of caregiving,
including the emotional quality of the care-
giver–infant relationship, such as those as-
sessed by measures of attachment (Mundy &
Willoughby, 1996, 1998). However, although
some qualitative aspects of caregiving have
been found to be related to infant joint atten-
tion processes (Flanagan et al., 1994; Gold-
smith & Rogoff, 1997; Raver & Leadbeater,
1995), little research has directly examined
the relations between attachment and infant
joint attention skill development. The paucity
of this research is surprising given the puta-
tive central role of joint attention in the early
development of social and cognitive compe-
tence (Adamson, 1995; Tomasello, Kruger, &
Ratner, 1993) and the link between attach-
ment and the development of social and cog-
nitive competence (e.g., Thompson, 1999; van
Ijzendoorn, Dijkstra, & Bus, 1995). Indeed,
Schölmerich, Lamb, Leyendecker, and Fra-
casso (1997) have recently observed a relation
between attachment and social attention coor-
dination in mother–child interactions. In this
study, dyads that were classified as insecure at
13 months in the standard Ainsworth Strange
Situation paradigm were significantly less like-
ly than secure dyads to display either coordi-
nated face-en-face attention or coordinated
joint attention to objects. However, a robust
effect was evident only for infants classified
as disorganized. This may be because, among
indices of attachment status, disorganized
classification is indicative of more extreme
disturbance in social emotional development.
A. H. Claussen et al.
The validation of the D attachment classifi-
cation as a category used to describe atypical
infant attachment behavior has been a focus
of recent studies (van Ijzendoorn, Schuengel,
& Bakersman–Kranenburg, 1999). Current
views suggest that nonstrategic, disorganized
attachment behaviors arise from characteris-
tics of the environment, such as maltreatment
and unpredictable and/or fear evoking care-
giving, but may also be influenced by charac-
teristics within the child, such as behavioral
organization and cognition (Barnett, Butler, &
Vondra, 1999; Barnett, Ganiban, & Cicchetti,
1999; Carlson, 1998; Main, 1996; Lyons–
Ruth & Jacobvitz, 1999; Spangler, Fremmer–
Bombik, & Grossmann, 1996). Disorganized
attachment, though, is not considered to be a
function of children’s temperament (van Ij-
zendoorn et al., 1999).
Although secure attachment functions as a
protective factor, it appears as though the pri-
mary categories of insecure attachment (inse-
cure–avoidant and insecure–ambivalent) are
not always maladaptive or necessarily indica-
tive of risk (Belsky, 1999; Weinfield, Sroufe,
Egeland, & Carlson, 1999). The D classifica-
tion may be a more consistent attachment re-
lated risk index (Crittenden, 1999; van Ijzen-
doorn et al., 1999). Infants who experience
more extreme forms of insensitive caregiving
may lack the behavioral complexity to develop
organized strategies (Barnett et al., 1999; Crit-
tenden, 1999). Indeed, D attachment classifi-
cation may be viewed as a marker of risk for
maladaptive or psychopathological develop-
ment (Barnett et al., 1999; Greenberg, 1999;
Main, 1996) and predicts the presentation of
behavior problems in childhood (e.g., Carl-
son, 1998; Lyons–Ruth, Alpern, & Repacholi,
1993; Moss, Parent, Gosselin, Rousseau, &
St. Laurent, 1996; van Ijzendoorn et al., 1999).
Research also points to the association of dis-
organized attachment classifications with prob-
lems in interactive and communicative pro-
cesses (Moss, St. Laurent, & Parent, 1999;
Spangler & Grossman, 1999). Whereas secure
attachment is associated with positive aspects
of interactive competence (Thompson, 1999),
the disorganized pattern is associated with poor
interactive competence (Moss et al., 1999;
Solomon & George, 1999).
Joint attention and disorganized attachments
As with attachment, a disturbance of the
tendency to engage in social attention coordi-
nation may also contribute to relative vulnera-
bility among “at-risk” infants for problems in
adaptive social behavioral development (see
Mundy et al., 1992; Mundy & Willoughby,
1996, 1998; Sheinkopf, Mundy, Claussen, &
Willoughby, submitted). First, the common
connections of joint attention with language
(Tomasello, 1995) and language with child-
hood social competence (Beitchman, Hood, &
Inglis, 1990) suggest a path of association be-
tween joint attention and behavioral outcome.
In addition, though, joint attention skills may
serve a self-organizing function in early de-
velopment (Mundy & Neal, 2001) allowing
the young child to engage in, and benefit
from, the myriad social learning opportunities
presented both within and, ultimately, outside
the family in school or with peers (Adam-
son & Russell, 1999; Baldwin, 1995; Toma-
sello et al., 1993). However, the adequate de-
velopment of these skills may be dependent
on social cognitive processes, self-regulatory
processes and the social motivation to share
experience with others. Each of these domains
may be important to prosocial interactions and
the subsequent development of a positive sense
of relatedness to others (Mundy & Willough-
by, 1996, 1998). Therefore, infant joint atten-
tion skills may be expected to be associated
with individual differences in behavioral out-
come (Mundy & Willoughby, 1996, 1998).
Moreover, joint attention development may
be effected by variation in caregiver–infant
interactions (e.g., Flanagan et al. 1994). Thus,
it follows that the observation of a relation
between D attachment status and disturbed
joint attention skill may be extremely impor-
tant (Schölmerich et al., 1997). Impoverished
joint attention could reflect pathology in a do-
main of development that, in turn, contributes
to the risk status of children with D attach-
ment status.
The study of Schölmerich et al. (1997),
however, only indicated that one sample of
infants with D attachment behavior displayed
difficulties with social attention coordination
in interactions with their own caregivers. It
was not clear whether the social attention co-
ordination capacities of these babies might be
281
disrupted not only with their caregivers but
also with other social partners. The latter would
be evidence of a more generalized, and per-
haps pernicious, disturbance of their social
development. It was also not clear if the ob-
servations of Schölmerich could be replicated
with a different sample. To address these is-
sues, joint attention skill development was as-
sessed in this study of experimenter–infant in-
teractions in a sample of infants at risk for
developmental disturbance because of risk
factors associated with in utero cocaine expo-
sure. This particular kind of sample may be
expected to yield a significant number of D
classified dyads (Rodning, Beckwith, & How-
ard, 1991).
Based on the findings of Schölmerich et al.
(1997), this study examined the hypothesis
that infants with disorganized attachment sta-
tus would display more difficulty on measures
of social attention coordination than would
other infants in an at-risk sample. In conduct-
ing this study, though, two additional consid-
erations were important. First, although we
have outlined theory on social motivation fac-
tors in joint attention (Mundy & Willoughby,
1996, 1998), it is important to recognize that
another path of association between joint at-
tention and attachment may involve cognitive
aspects of development as well. Hypotheti-
cally, joint attention development may reflect
emerging representational capacities of the
infant (Tomasello, 1995; Werner & Kaplan,
1963). Similarly, secure attachment may serve
to facilitate early representation/symbolic de-
velopment (Slade, 1987). Therefore, any study
of the association of joint attention and attach-
ment may also need to consider variance shared
with measure of representational/cognitive de-
velopment.
Second, it is important to recognize that in-
fants display several different types of social
attention coordination skills (e.g., Bates, Be-
nigni, Bretherton, Camaioni, & Volterra, 1979;
Scaife & Bruner, 1975; Seibert, Hogan, &
Mundy, 1982). Although all infant attention
coordinating behaviors may reflect common
processes (Carpenter et al., 1998), several lines
of research suggest they also might reflect
unique integrations of processes (Mundy, Card,
& Fox, 2000; Mundy & Gomes, 1997, 1998).
282 A. H. Claussen et al.

Therefore, it may be important to include sev- they had complete data at the 12-, 15-, and 18-
eral measures of joint attention skills to better month assessments used in this study.
understand the extent of this domain’s associa- The sample was composed of 30 females
tion with attachment. Several terms have been and 26 males from varied racial/ethnic back-
used for different types of joint attention skills. grounds: 75% African American, 5% Hispanic,
In the nomenclature of this study, the relations 8% Haitian, 4% Caucasian, and 8% bi- or
between a measure of attachment and three dif- multiracial ethnicity. Infant birth weights
ferent types of skills were examined: (a) re- ranged from 1260 to 5620 g with an average
sponding to joint attention skill (RJA; Seibert of 2873 g (SD = 720). Two of the infants had
et al., 1982), which is the capacity to follow birth weights of less than 1500 g, 11 had birth
the direction of gaze and deictic gestures of weights of 1501–2500 g, and the remainder
others (also known as gaze and point follow- had birth weights higher than 2500 g.
ing; Carpenter et al., 1998); (b) initiating joint The adult who functioned as the child’s pri-
attention skill (IJA; Seibert et al., 1982), which mary caregiver also participated in the study.
describes the capacity to initiate attention coor- These included biological mothers (52%)—
dination to share the experience of an object or substance users who were receiving or had re-
event with others (also known as a protodeclar- ceived drug treatment. Of the children who
ative skill; Bates et al., 1979; Carpenter et al., were not in the custody of their mothers, 36%
1998); and (c) initiating behavior regulation/re- were with relatives (17% grandmothers, 13%
quest skill (IBR; Seibert et al., 1982) which de- fathers, 6% other relatives) and 12% were with
scribes the capacity to initiate attention coordi- foster/adoptive mothers. Primary caregivers usu-
nation to request aid in obtaining an object or ally also had legal custody of the child; 64%
event (also known as a protoimperative skill; cared for the child since birth, and another
Bates et al., 1979; Carpenter et al., 1998). 25% took custody by the time the child was
6 months old. Only one of the caregivers had
custody for less than 3 months at the time of
Method the assessment. In cases where there were
multiple caregivers in a family, the families
Participants were asked to identify the person who was
primarily responsible for the child’s care. Chil-
A sample of 56 high-risk infants prenatally ex- dren were predominantly from low socioeco-
posed to cocaine were enrolled in this study at nomic status (SES) backgrounds: 79% of the
the Linda Ray Intervention Center (LRIC). The sample received some form of public aid such
LRIC is a birth-to-3 years project, aimed at as Aid to Families with Dependent Children
preventing developmental delays and disorders (AFDC) and food stamps. The average level
through curriculum-based early educational in- of educational attainment for primary caregiv-
tervention (Scott, Hollomon, Claussen, & Katz, ers was 11th grade (SD = 2.6). All but four of
1998). The children in the present study were the cases were involved with child protective
recruited from the center-based (N = 46) and services and/or residential drug treatment pro-
home-based (N = 10) components of this early grams.
intervention project. The center-based compo-
nent consisted of 25 hr of weekly intervention
Procedure
in a day care and preschool setting. The home-
based component involved two 1.5-hr in-home, All procedures were conducted in assessment
child-focused educational intervention sessions rooms at the LRIC. Social attention coordina-
per week. However, 8 of the 10 infants who tion behaviors were assessed at 12 and 18
received the intervention in the home also at- months of age using the Early Social-Com-
tended day care and thus had exposure to alter- munication Scales (ESCS; Mundy, Hogan, &
native caregivers similar to the center-based Doehring, 1996; Seibert et al., 1982). Attach-
group. These infants were selected from a ment was assessed using the standard Strange
larger sample of infants in the LRIC because Situation paradigm at 15 months of age with
Joint attention and disorganized attachments 283

the primary caregiver (Ainsworth, Bell, & Table 1. Brief description of the ESCS
Stayton, 1972). variables

ESCS. The ESCS is a 20-min videotaped Initiates joint attention

1) Makes eye contact while manipulating toy.
structured assessment designed to measure the
2) Alternates eye contact between active me-
development of a variety of nonverbal com- chanical toy and tester.
munication skills in the 6- to 30-month pe- 3) Points to active mechanical toy or distal ob-
riod. An experimenter and an infant, with the jects in testing room.
latter sitting in her caregiver’s lap or indepen- 4) Shows objects (raises objects toward the test-
er’s face).
dently in a child chair, were seated facing
Initiates behavior regulation
each other across a small table. A set of toys 1) Makes eye contact when object moved out
was visible to the child, but out of reach on of reach or reaches to objects out of reach.
the experimenter ’s side of the table. Posters 2) Makes eye contact while reaching to objects
were placed on the walls, 90° to the child’s out of reach.
3) Points to inactive objects on the table or to
left and right and 180° behind the child. A
the collection of visible but out of reach
video camera was positioned approximately toys.
10 feet behind the experimenter. The camera 4) Gives inactive toys to the tester (e.g., moves
was oriented to capture a three-quarter–face toys toward tester’s hands).
image of the child with a profile view of the Responds to joint attention
1) The percentage of trials the child correctly
experimenter, as well as the position of the
turns head and eyes in direction of tester’s
toys and posters. point. On side trials, direction of gaze must
The experimenter presented the child with shift beyond the tester’s extended finger (ap-
a sequence of activated wind up toys (three proximately 45° off midline). On behind tri-
trials); hand operated mechanical toys (three als, the child must turn head more than 90°
off midline.
trials); opportunities to play a tickle, turn-
taking game (two trials); opportunities to play
an object, turn-taking game, such as catch
with a ball (two trials); opportunities to take pointing gesture. The IBR scores refer to the
turns wearing a hat, comb, and glasses (three frequency with which the child uses eye con-
trials); and an opportunity to look at pictures tact, reaching, giving, and pointing to elicit
in a book with the tester (one trial). The tester aid in obtaining objects or reactivating ob-
also presented the child with requests to give jects. A more complete description of the be-
toys to the tester. Finally, the tester presented haviors observed within each category is pre-
the child with two sets of three trials in which sented in Table 1.
the tester attracted the child’s attention, and Reliability for the ESCS measures used in
then turned to visually fixate a wall poster, this study has been well established (e.g.,
while pointing at the poster and saying the Mundy et al., 2000; Mundy & Gomes, 1998;
child’s name three times with increasing em- Mundy, Kasari, Sigman, & Ruskin, 1995). Re-
phasis. Trials to the left, right, and behind the cent longitudinal data suggest that the ESCS
child were conducted in each set. measures of IJA and RJA display a significant
Observations of the tester–child interaction level of stability across multiple measures in
in the ESCS yielded frequency of behavior the second year (Mundy et al., 2000; Mundy
scores in three categories involving social at- & Gomes, 1998; Sigman & Ruskin, 1999).
tention coordination: IJA, RJA, and IBR. The For this study the interrater reliability of the
IJA scores refer to the frequency with which ESCS measures was estimated on 10 pairs of
the child uses eye contact, pointing, and show- independently rated video records. The in-
ing to share the experience of an active me- traclass correlations (single measure) among
chanical toy with the tester. The RJA scores these ratings were as follows: IJA, .86, p <
refer to the percentage of trials on which a .001; RJA, .79, p < .002; and IBR, .89, p <
child correctly turns her visual regard in the .001. There were no differences between the
direction of the tester’s visual regard and raters’ mean scores for each variable. Longi-
284
tudinal stability was evident for the RJA vari-
able (r = .29, p < .05), but not for the IJA or
IBR variables.
Attachment. A videotaped Strange Situation
procedure (Ainsworth et al., 1972), conducted
at 15 months of age with the child and the
primary caregiver at the LRIC, included two
episodes (3 and 6 min) in which infants were
briefly separated from their caregivers. This
procedure was conducted in a 12- × 12-foot
observation room and videotaped through a
one-way mirror. Videotaped data were cod-
ed to classify infant/caregiver dyads into avoid-
ant (A), secure (B), and ambivalent (C), based
on Ainsworth et al. (1972), or as disorganized
(D) according to Main and Solomon (1990).
The primary coder was P. M. Crittenden, who
was blind to infants’ scores on the ESCS and
other information regarding the sample other
than that the sample included children at risk.1
Thirteen tapes were also classified by the first
author to assess interrater reliability. Cohen’s
kappa was .69 (p < .001) for agreement on
the four major categories (A, B, C, and D),
and .67 (p < .01) for the D versus all others
distinction used in some of the data analyses.
Mental and language development. Mental
development for the children was assessed at
12 and 18 months of age using the Bayley
Mental Development Index (MDI; Bayley,
1994). The sample mean of the MDI was
89.48 (SD = 11.14) at 12 months and 88.04
(SD = 11.59) at 18 months. Caregiver report
of lexical level using the McArthur Commu-
nication Development Inventory (MCDI, Fen-
son et al., 1994) was used to estimate differ-
ences in language development at 18 months.
The reported expressive vocabulary (mean num-
ber of words spoken) was 7.4 (SD = 10.8).
1. Originally, the D category was further separated into
children who combined the two insecure strategies
(specifically, showing the A/C pattern as described by
Crittenden, 1985) and those who showed other signs
of disorganization (e.g., stilling). However, all but
three cases had such other signs of disorganization;
therefore, no further distinction was made between A/
C and other D patterns.
A. H. Claussen et al.
Results
Attachment classifications
Children were predominantly classified as in-
secure (A = 12, B = 5, C = 11, and D = 28).
None of the D cases were force classified as
secure in this sample.
To examine potential covariates, several
preliminary analyses were conducted. Type of
primary caregiver, specifically, whether chil-
dren were raised by mothers versus others,
was not related to attachment classifications.
Further, there was no effect for length of time
with the caregiver on attachment classifica-
tion. Attachment groups also did not differ
with respect to either their 12- or 18-month
MDI scores or their birth weights. The 18-
month MDI mean scores were: B = 92 (SD =
13.9), A = 89 (SD = 9.8), C = 88 (SD = 4.9),
and D = 87 (SD = 14.7). The percentage of
children with birth weights below 2500 g in
each group were also comparable: B (N = 1,
20%), A (N = 2, 17%), C (N = 3, 27%), and D
(N = 7, 25%). Additional preliminary analyses
also revealed no significant associations be-
tween home- versus center-based intervention
groups, racial/ethnic background, or caregiv-
ers’ years of education and attachment classi-
fication (including D vs. non-D comparisons)
or the social attention coordination measures
in this study. Therefore, these variables were
not considered further.
Social attention coordination
In general, this sample of children displayed
evidence of the development of social atten-
tion coordinating skill on all the ESCS mea-
sures. Means and standard deviations are re-
ported in Table 2. Developmental change was
most apparent with respect to IBR, F (1, 54) =
53.9, p < .001, and RJA, F (1, 54) = 83.4,
p < .001. There was also evidence, albeit less
robust, of change on the IJA measure from
12.1 at 12 months to 13.3 at 18 months, F (1,
54) = 3.2, p < .09. By way of comparison, the
18 months data in Table 2 may be compared
to data from 32 typically developing 18-month-
olds from higher SES families, who partici-
Joint attention and disorganized attachments 285

Table 2. Mean (SD) ESCS variable scores for the four attachment groups by age

Attachment Group

B Secure A Insecure C Insecure D Disorganized Total

ESCS Variables (N = 5) (N = 12) (N = 11) (N = 28) (N = 56)

Initiating joint attention

12 months 11.0 (4.4) 9.5 (5.6) 14.8 (6.8) 12.4 (9.6) 12.1 (8.0)
18 months 20.6 (25.6) 14.8 (11.1) 16.7 (11.1) 10.1 (6.1) 13.3 (11.2)
Initiating behavior requesting
12 months 18.2 (9.6) 16.5 (10.0) 21.6 (16.8) 9.1 (5.6) 13.9 (10.9)
18 months 39.6 (13.3) 44.2 (21.0) 41.2 (18.5) 28.5 (15.2) 34.3 (18.1)
Total initiating behavior
12 months 29.2 (11.1) 26.0 (13.7) 36.5 (17.5) 21.5 (12.6) 26.1 (14.6)
18 months 60.2 (35.5) 59.1 (28.5) 57.9 (20.8) 38.6 (29.2) 48.7 (24.1)
Responding to joint attention
12 months (%) 53 (13.9) 30 (18.6) 30 (22.1) 34 (21.6) 34 (21)
18 months (%) 100 76 (23.2) 76 (15.6) 76.4 (34.4) 78 (27)

pated in a recent study (Mundy et al., 2000)
and displayed a mean IJA score of 17.5 (SD =
8.6), a mean RJA score of 83% (SD = 24%),
and a mean IBR score of 38.2 (SD = 12.4).
Few significant associations were observed
between the measures of social attention coor-
dination. Only the association between the
measures of IJA and IBR reached significance
at 18 months (r = .31, p < .05). These results
were consistent with previous data and theory
that suggest that, although infant measures of
social attention coordination reflect common
processes, they also reflect distinct or unique
sets of processes (Mundy et al., 2000; Mundy
& Gomes, 1998).
Attachment status and social
attention coordination
Because of the small number of B classifi-
cations (5), the first analyses utilized mixed
ANOVAs (Attachment Group × Age) to com-
pare infants with D classifications versus in-
fants with all other classifications (A, B, and
C) on the social coordination variables at 12
and 18 months. (The main effects for the age
observed in these analyses were reported in
the preceding section.) The ANOVA for the
IJA data revealed no main effect for attach-
ment status on IJA, a marginal effect for age,
and a significant Attachment (D vs. other
classifications) × Age interaction term, F (1,
54) = 4.25, p < .05. Infants classified as disor-
ganized displayed lower IJA scores at 18
months, but not at 12 months, than non-D in-
fants (see Table 2). Analyses of IBR yielded
a main effect for D versus other classifica-
tions, F (1, 54) = 18.33, p < .001, but no sig-
nificant interaction of Group × Age. D infants
displayed lower frequencies of IBR (see Table
2). Finally, ANOVA for RJA skills revealed no
significant main effects for attachment group
or interaction effects.2
The analyses of the four attachment groups
for IBR data again revealed a main effect for
Attachment Group, F (3, 52) = 5.97, p < .001.
Paired comparisons revealed that the D group
differed from the A and C infants at 12 and
18 months (p < .05, all comparisons). Finally,
no group or interaction effects were observed
for the RJA variable. However, the B infants
2. When data from the 4 (A, B, C, and D) attachment
groups were considered, neither the main effect for At-
tachment Group nor the interaction effect of Attach-
ment Group × Age was significant for IJA skill scores.
However, at 18 months the ordering of means was
much as expected with D infants displaying the lowest
scores, B infants the highest scores, and A or C infants
intermediate scores (see Table 2). A trend analysis of
this order effect revealed a significant linear effect
across the 18-month data, F (1, 55) = 4.71, p < .05.
However, none of the pairwise comparisons were sig-
nificant.
286 A. H. Claussen et al.

displayed better development on this measure specific to the cocaine/substance-exposed in-

than the insecure groups at both age groups fants who participated in this study or was a
and the insecure groups displayed comparable more general parameter of development. How-
levels of performance on RJA (see Table 2). ever, the results of this study were consistent
The foregoing analyses indicated that the with a previous observation that toddlers with
D infants tended to display deficits relative to disorganized attachment status displayed dif-
all other groups on initiating coordinated at- ficulty with social attention coordination with
tention with others. To investigate whether their caregivers (Schölmerich et al., 1997).
these finding were associated with other im- The Schölmerich study did not involve sub-
portant factors in development, the ANOVAs stance-exposed infants, or even infants with a
were repeated using birth weight and cogni- discernable risk status for developmental mor-
tive development as assessed by the Bayley bidity. Hence, the combination of the observa-
MDI at 18 months as covariates. No signifi- tions of this study with those of Schölmerich
cant effects of these variables were observed et al. (1997) suggests (a) that some character-
in any of the analyses. istics of parental behavior that lead to a failure
To examine the hypothesis that associations to develop a coherent attachment strategy may
between attention coordination and attachment also undermine nascent joint attention skills.3
could be explained in terms of representa- and (b) that an association between disorga-
tional ability, these analyses were recomputed nized attachment status and joint attention
using the 18-month caregiver report of ex- may be a general development phenomenon
pressive vocabulary scores as a covariate. that is not specific to one type of sample. Fur-
Language measure, such as the MCDI, scores thermore, comparisons of the present results
may reflect general parameters of representa- with those of Schölmerich et al. (1997) also
tional development in toddlers (Bornstein & suggest that this association may be observed
Haynes, 1998). In addition, in this study the not only in a caregiver–infant paradigm but
difference between D versus other attachment also in an infant–tester paradigm. Thus, disor-
classifications on 18-month expressive vocab- ganized classification may be not only indica-
ulary scores approached significance, t(unequal tive of problems in interactive communicative
variances) = 1.78, p < .09. Infants classified processes between the child and the attach-
as D reportedly had fewer words at 18 months ment figure (Moss et al., 1999; Solomon &
(4.8, SD = 4.1) than did the other infants in George, 1999) but also a pervasive feature of
this study (10.3, SD = 14.8). Nevertheless, the interactive skills these children bring to
even after taking the expressive vocabulary bear with other social partners.
scores into consideration as a covariate, the Even with the consistency in observations
primary patterns of effects for the ANOVAs across these two studies, however, additional
of D versus non-D status were unchanged, research is needed before firm conclusions
with a significant interaction effect of Attach- may be reached regarding the degree to which
ment Status × Age for IJA, F (1, 51) = 4.01, attachment status and infant joint attention
p = .05, and a main effect for attachment sta- skills are linked, as well as the path of influ-
tus on IBR, F (1, 51) = 18.2, p < .001. ence of these two factors. The pursuit of addi-
tional research on this topic may be important
for several reasons. In particular, a better un-
Discussion
derstanding of the connections between joint
The results of this study yielded several im- attention and attachment may serve to im-
portant observations. First, the results of this prove our understanding of processes that link
study were consistent with the hypothesis that attachment with cognitive, as well as behav-
there may be an association between disorga- ioral, outcomes. To this end the following
nized attachment status and the development
of social attention behaviors in infants. With- 3. We thank an anonymous reviewer for suggesting this
out a control sample, it was not possible to concise and cogent interpretation of this aspect of the
directly examine whether this observation was results of this study.
Joint attention and disorganized attachments
speculative, but hopefully heuristic, theoreti-
cal interpretation of several aspects of the data
in this study is offered.
At all ages, but especially in infancy, the
capacity to engage in joint attention with
older social partners may contribute to an in-
teractive context that is prepotent with respect
to facilitating development. Early on, this no-
tion was proposed by Werner and Kaplan
(1963), who referred to episodes of joint at-
tention between caregiver and infant as the
primordial sharing situation, which stimulates
the development of symbolic thinking. More
recently, though, numerous authors have sug-
gested that the capacity for joint attention may
impact infants’ tendencies to engage in social
learning opportunities that promote their lan-
guage, intellectual, and social–cognitive devel-
opment (Adamson & Russell, 1999; Baldwin,
1995; Bruner, 1981; Rogoff, 1990; Tomasello
et al., 1993; Ulvund & Smith, 1996). This line
of research is of particular interest in light of
evidence for a relation between attachment and
language and cognitive development (e.g.,
van Ijzendoorn et al., 1995). To the degree
that joint attention development is associated
with optimal or less optimal attachment sta-
tus, joint attention skill development may play
a role in mediating or moderating the relations
of attachment to language and cognitive out-
comes.
A related line of argument emphasizes that
some aspects of joint attention, especially ini-
tiating joint attention skill, may be indicative
of the capacity to engage in episodes of posi-
tive intersubjectivity with others (Adamson &
Russell, 1999; Mundy & Hogan, 1994; Mun-
dy et al., 1992). In turn, the capacity to en-
gage in intersubjectivity may be a critical as-
pect of social–emotional development that
ultimately affects the ability of children to
establish an adaptive level of relatedness
with peers, teachers, and alternative caregiv-
ers (Mundy & Willoughby, 1996, 1998; Stern,
1985; also see Tronick, 1998). Thus, an atten-
uation of joint attention facility among infants
classified as D could be indicative of a dis-
turbance in the tendency of these children to
establish episodes of positive intersubjectivity
with others.
Such attenuation would be consonant with
287
the Main and Hesse (1990) theory of disorga-
nized attachment resulting from infants’ expe-
rience of frightened or frightening caregiver
behavior. Consequently, infants with disorga-
nized attachment may themselves be fearful
in interactions with others. Indeed, anecdotal
observations indicated that many of the D in-
fants appeared fearful, wary, and inhibited in
the behavior on the ESCS. Indeed, their wari-
ness and tendency to vigilantly monitor the
tester may be one reason why these infants
did relatively well on IJA at 12 months, when
passive eye contact measures are primary (see
Table 1). Alternatively, they displayed little
of the more active sharing behaviors, such as
showing, indicative of IJA at 18 months.
A relatively chronic state of fear and wari-
ness may be highly detrimental to the early
social interaction and social learning proclivi-
ties of infants classified as disorganized. This,
in turn, may contribute to risk for negative
outcomes in this group of children. In point
of fact, an important hypothesis that can be
derived from the data in this initial study is
that a disturbance of joint attention skill and
associated tendencies to experience episodes
of positive intersubjectivity with others is a
major fulcrum around which early disruption
of social skill revolves in infants without co-
herent attachment strategies. Tronick (1998)
and Stern (1985) have described how a dis-
turbance in facility with intersubjectivity in
infancy may play a developmental role in psy-
chopathology. Similarly, we have suggested
that joint attention, and related intersubjective
disturbance, in infants with atypical or inse-
cure attachment may contribute to a chronic
attenuation of a self-organizing tendency of
these children to engage caregivers or other
social partners in ways that are optimal, not
only for their cognitive and linguistic devel-
opment, but their emotional development as
well (Mundy & Willoughby, 1996, 1998).
The importance of this hypothesis warrants
further inquiry. The results of this study raise
several issues, which need to be considered in
subsequent research on this topic. First, differ-
ent types of joint attention skills may be more
or less strongly associated with attachment,
necessitating the use of multiple measures of
joint attention in research of this kind. In this
288
study, for example, attachment status was as-
sociated with a disturbance in the develop-
ment of the tendency to initiate coordinated
attention with an unfamiliar tester, rather than
the tendency to respond to the attention coor-
dinating bids of a tester. This lack of consis-
tency may indicate that a general disturbance
of attention regulations was not responsible
for the association between disorganized at-
tachment status and initiating joint attention
because such a mechanism would presumably
have been manifest in responding to joint at-
tention as well. If not a general aspect of so-
cial attention coordination, what processes
were responsible for the specific patterns of
association observed in this study?
To understand this aspect of the data, it may
be useful to consider the suggestion that the
cognitive, self-regulatory, and motivational
demands of initiating versus responding to so-
cial attention coordination acts are different
(Landry, Smith, Miller–Loncar, & Swank,
1997; Mundy et al., 2000; Mundy & Gomes,
1997). In responding acts, the social partner
provides a framework that elicits and perhaps
organizes the social behavior of the infant
(Landry et al., 1997). That is, responding to
joint attention performance may involve basic
and less volitional attention regulation systems
that emerge relatively early in development
(Moore, 1999; Mundy et al., 2000). Alterna-
tively, initiating social attention coordination
may involve a more volitional, self-organizing
aspect of attention management (Ulvund &
Smith, 1996) that possibly reflects the devel-
opment of a later emerging executive atten-
tion management system (Landry et al., 1997;
Mundy et al., 2000). Some support for these
notions has been provided by recent obser-
vations that the brain correlates of initiating
joint attention and responding to joint atten-
tion are different in the 14- to 18-month pe-
riod (Mundy et al., 2000).
Finally, it must be recognized that the very
small sample of infants classified as secure
could have affected the results of this study.
Indeed, the present results point to a relation
between a lack of organized attachment be-
havior and joint attention, rather than associa-
tion between joint attention and secure or in-
secure attachment per se. Additional research
A. H. Claussen et al.
will be necessary to determine the degree to
which joint attention is associated with attach-
ment security, as opposed to the failure of
some infants to construct a coherent attach-
ment strategy. Indeed, the trend analysis of
the means of the 18-month IJA in this study
were ordered such that all insecure groups
displayed lower values on this variable than
did infants classified as secure. Thus, it may
be that with a larger number of secure classifi-
cations, relative differences in the joint atten-
tion development among secure and norma-
tive insecure patterns may be observed.
A long-standing and well-recognized liter-
ature documents the importance of attachment
theory and research for understanding the so-
cial–emotional and social–cognitive develop-
ment of young children (e.g., Ainsworth et al.,
1972; Bretherton, 1985; van Ijzendoorn et al.,
1995). A more recent, and perhaps less well-
recognized, set of research and theory has also
begun to highlight the potential significance
of infant joint attention process and skill ac-
quisition for the social, emotional, and cogni-
tive development of children (e.g., Adamson,
1995; Adamson & Russell, 1999; Bakeman &
Adamson, 1984; Baldwin, 1995; Flanagan et
al., 1994; Goldsmith & Rogoff, 1997; Mundy
& Gomes, 1998; Mundy & Willoughby, 1996,
1998; Raver & Leadbeater, 1995; Tomasello,
1995). In this study, we have taken an initial
step in evaluating the degree to which the the-
ory and research in these areas may be inte-
grated to yield a more detailed understanding
of critical elements of early social develop-
ment.
The results in this regard were provocative,
but preliminary. They suggest that part of the
risk affecting infants with disorganized at-
tachment status involves an attenuation of the
development of the capacity, or tendency, to
initiate bids to coordinate social attention. Ini-
tiating some of these types of bids in the sec-
ond year of life has been linked to language
cognitive and behavioral development in sev-
eral studies (e.g., Mundy & Gomes, 1998;
Sheinkopf et al., submitted; Ulvund & Smith,
1996). Thus, some aspects of the risk atten-
dant to disorganized attachment may derive
from an associated impairment in social atten-
tion coordination among these children. Addi-
Joint attention and disorganized attachments
tional research must follow, perhaps along the
lines briefly outlined in this discussion, in or-
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