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The First 20,000 Strange Situation Procedures: A Meta-Analytic Review

Psychological Bulletin
Authors:
Sheri Madigan at University of Calgary
Sheri Madigan
R. M. Pasco Fearon
R. M. Pasco Fearon
R. M. Pasco Fearon
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Marinus H. van IJzendoorn at University College London
Marinus H. van IJzendoorn
Robbie Duschinsky at University of Cambridge
Robbie Duschinsky
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Abstract

The Strange Situation Procedure (SSP) was developed five decades ago to assess infant–parent attachment relationships. Although the procedure itself has remained relatively constant in over 285 studies (20,720 dyads) conducted to date, there have been vast sociological changes during this time, and research foci shifts to studying diverse populations. Since its inception, the SSP has also been adopted in over 20 countries. In this meta-analysis, we collate this large body of work, with the objectives of producing reliable estimates of the distribution of the four SSP attachment classifications, assessing temporal trends and geographical differences, and determining if and when distributions are different across various populations. Results revealed that the global distribution of SSP attachment was 51.6% secure, 14.7% avoidant, 10.2% resistant, and 23.5% disorganized. There were no differences in the distribution among mothers and fathers, and no child age or sex differences. We found a temporal trend in which there was less avoidant attachment over time and there were attachment distribution differences between samples from North America versus other regions of the world, particularly Asia, Middle East/Israel and South America. We found higher rates of avoidant and disorganized attachment in populations with sociodemographic risks and higher rates of disorganized attachment in samples where parents had psychopathology and when the child experienced maltreatment or was adopted from foster or institutional care. The implications of these findings for future research and practice are discussed.
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The First 20,000 Strange Situation Procedures:
A Meta-Analytic Review
Sheri Madigan
1, 2
, R. M. Pasco Fearon
3
, Marinus H. van IJzendoorn
4, 5
, Robbie Duschinsky
6
,
Carlo Schuengel
7
, Marian J. Bakermans-Kranenburg
8
, Anh Ly
1
, Jessica E. Cooke
1, 2
,
Audrey-Ann Deneault
1, 2
, Mirjam Oosterman
7
, and Marije L. Verhage
7
1
Department of Psychology, University of Calgary
2
Alberta Children’s Hospital Research Institute
3
Centre for Family Research, Department of Psychology, University of Cambridge
4
Research Department of Clinical, Education and Health Psychology, University College London
5
Faculty of Medicine Nursing and Health Sciences, Monash University
6
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge
7
Clinical Child and Family Studies, Vrije Universiteit Amsterdam
8
Institute of Psychological, Social and Life Sciences, ISPA University
The Strange Situation Procedure (SSP) was developed five decades ago to assess infant–parent attachment
relationships. Although the procedure itself has remained relatively constant in over 285 studies (20,720
dyads) conducted to date, there have been vast sociological changes during this time, and research foci shifts
to studying diverse populations. Since its inception, the SSP has also been adopted in over 20 countries. In
this meta-analysis, we collate this large body of work, with the objectives of producing reliable estimates of
the distribution of the four SSP attachment classifications, assessing temporal trends and geographical
differences, and determining if and when distributions are different across various populations. Results
revealed that the global distribution of SSP attachment was 51.6% secure, 14.7% avoidant, 10.2% resistant,
and 23.5% disorganized. There were no differences in the distribution among mothers and fathers, and no
child age or sex differences. We found a temporal trend in which there was less avoidant attachment over
time and there were attachment distribution differences between samples from North America versus other
regions of the world, particularly Asia, Middle East/Israel and South America. We found higher rates of
avoidant and disorganized attachment in populations with sociodemographic risks and higher rates of
disorganized attachment in samples where parents had psychopathology and when the child experienced
maltreatment or was adopted from foster or institutional care. The implications of these findings for future
research and practice are discussed.
Public Significance Statement
This meta-analysis suggests that, worldwide, one in every two infants develops a secure attachment
relationship with their caregiver. Secure attachment is more likely to develop when fewer stressors are
imposed on the parent–infant dyad.
Keywords: strange situation procedure, infant attachment, parent–infant relationships
Supplemental materials: https://doi.org/10.1037/bul0000388.supp
The Strange Situation Procedure (SSP), first introduced by Ains-
worth and Wittig in 1969, has been one of the most widely used and
relied upon paradigms in child development research over the last
half-century. The SSP is a 21-min observational procedure that
involves two separations and reunions between an infant and their
parent or other caregiver. It assesses individual differences in
attachment behavior by presenting mild cues to danger (i.e., pres-
ence of a stranger; separation from a caregiver) in a seminaturalistic
but standardized context, which are expected to activate the “attach-
ment system.”These differences in attachment behavior are thought
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Sheri Madigan https://orcid.org/0000-0002-7536-3258
The authors Sheri Madigan and R. M. Pasco Fearon share first authorship.
The authors acknowledge Cheri Nickel, Masters in Library and Informa-
tion Science (University of Calgary), for conducting the literature search for
this project.
Codebooks and scripts relevant to this submission can be found here at
https://osf.io/fr4e5/?view_only=2f1e35e7bebc4d28b12691a9d1a0ece4.The
data approach adopted the hierarchical linear modeling framework for
meta-analysis, in which individual data points are nested within studies.
This review was not preregistered.
Correspondence concerning this article should be addressed to Sheri
Madigan, Department of Psychology, University of Calgary, 2500 University
Avenue, Calgary, AB T2N 1N4, Canada. Email: sheri.madigan@ucalgary.ca
Psychological Bulletin
© 2023 American Psychological Association 2023, Vol. 149, Nos. 1–2, 99–132
ISSN: 0033-2909 https://doi.org/10.1037/bul0000388
99
... Therefore, the quality of a child's interactions and relationships with their primary caregivers has long-term implications for the child's development and well-being (Fearon et al., 2010;Groh et al., 2012Groh et al., , 2014. While parental psychopathology increases the risk of poor parent-child interaction quality and insecure parent-child attachment (Bernard et al., 2018;Madigan et al., 2023), it is also linked with early infant social withdrawal (Braarud et al., 2013;Smith-Nielsen et al., 2019;Stuart et al., 2022). Infant social withdrawal is found to be an early nonspecific risk factor for a range of developmental outcomes, such as behavioral problems, delayed language development, and attachment disorders Milne et al., 2009;Smith-Nielsen et al., 2019). ...
... Child-Mother Attachment Quality. Infant-mother attachment quality was assessed with the Strange Situation Procedure (SSP; (Ainsworth et al., 1978a), which is a well-validated and commonly used research experiment for evaluating the quality of attachment relationships when infants are 11-24 months of age (e.g., Madigan et al., 2023). Through experimental manipulations aimed at causing mild-to-moderate stress in the child, the procedure activates the child's attachment behavioral system, and the organization of their attachment behavior in relation to a primary caregiver (here, the birth mother) can be observed. ...
... The distribution of infant-mother attachment classifications in our study is in line with the recent meta-analysis by Madigan et al. (2023). While we found relatively high frequencies of disorganized attachment (22.5%), it is still similar to the meta-analysis (23%), and the meta-analysis further indicates that there is a higher rate of disorganized attachment in samples with psychopathology. ...
Evaluating the efficacy of Circle of Security-Parenting as an addition to care-as-usual in families affected by maternal postpartum depression and/or infant social withdrawal: A randomized controlled trial
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The Circle of Security – Parenting (COSP™) is a psychoeducational intervention aiming at fostering secure child-parent attachment relationships. In a randomized controlled trial, we investigate the effect of COSP™ as an adjunct to care-as-usual compared to only care-as-usual for at-risk families. Mothers and their 2–12-month-old infants were randomized into COSP™ +care-as-usual ( n = 197) for at-risk families in Copenhagen or only care-as-usual ( n = 100). At-risk status was either mothers diagnosed with postpartum depression and/or infants showed social withdrawal. The primary outcome was maternal sensitivity which was coded with the Coding Interactive Behavior. Our secondary outcomes were maternal reflective functioning, assessed with the Parental Reflective Functioning Questionnaire – Infant Version, and child-mother attachment, assessed with the Strange Situation Procedure. Results showed no significant differences between the RCT groups on either the primary or secondary outcomes (all p s ≥ .146). We discuss these findings in relation to the applicability and targeted population who can benefit from COSP™, and whether alternative programs would be more effective for at-risk families with infants.
View
... Quality of Attachment. The quality of the child's attachment to the main caregiver was assessed using the internationally recognized Ainsworth's SSP (Madigan et al., 2023). The SSP was administered during the 15-month visit (fifth PCPS calendar visit). ...
... This included data from middle-class (15 studies and more than 2000 children) and lower-class families (seven studies and 586 children). The data were from a North American, nonclinical population, and the proportion of secure/insecure children reported was similar to that reported in European countries, even conservative, considering a recent metaanalytical study (Madigan et al., 2023). Furthermore, Van IJzerdoon et al. (1999) present data on lower-class families. ...
... Therefore, the baseline information used here was derived from North American studies. Cross-cultural studies have shown that the proportion of secure children is similar across cultures, with variations in the proportion of Avoidant or Resistant children (Van IJzendoorn et al., 1999;Madigan et al., 2023). Therefore, analyses were conducted by grouping secure versus insecure to maximize the clarity and size of the groups. ...
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The foremost index of caregiving quality is child attachment, as supported by attachment theory. Research supports the relevance of early parenting interventions in improving child outcomes in attachment quality to promote public health because of their long-term effects on mental health and functioning. This study aimed at evaluating the impact on both parenting and child outcomes of the Parent–Child Psychological Support Programme® (PCPS), a community-based program individually tailored to parents and their infants during periodic center-based visits to promote attachment security. The evaluation involved two cohorts from “vulnerable populations” and used the resources embedded in the program design without interfering with the normal functioning of the service. From an evaluative research approach, the effects on mothers and children were assessed using a quantitative approach. Pre- and post-test measures (parenting questionnaires) and child attachment quality assessments through the Strange Situation Procedure were examined. The equivalence of the cohorts was verified and used as a baseline for parenting outcomes. PCPS participants demonstrated increased parental competence and self-efficacy, as well as reduced levels of parenting stress. Analysis of the two cohorts showed a significant difference in the number of visits and proxies for intervention, which were associated with the expected pre–post changes in parenting dimensions. The proportion of securely attached children was significantly higher in the “medium-high intervention” group than in the “no/low intervention” group (72.7% vs 54.5%). Furthermore, compared with international baselines, this proportion showed no differences in the “no-/low-intervention” group but demonstrated expected significant differences in the “medium-high intervention” group.
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... This group of variables were selected after screening the literature on the COVID-19 pandemic effects on infant social development, and based on the definition of confounder of confound blocker (Wysocki et al., 2022), to ascertain the specificity of the correlation between pandemic group and attachment behaviours in term and preterm infants. For example, the experience of the pandemic and attachment of term and preterm infants may vary based on proximal factors such as ethnicity (Madigan et al., 2023), neonatal health in preterm infants (López-Maestro et al., 2017) or distal factors such as socioeconomic risk (Dean et al., 2021). Thus, we considered infant ethnicity, co-morbidities of preterm birth and socioeconomic deprivation as potential covariates. ...
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... These findings corroborate the need to re-examine archival longitudinal samples to better understand the cases that are routinely excluded from analyses due to maternal SF violations. Given that maternal sensitivity is a moderate predictor of attachment security [20], we question whether highly sensitive mothers who break the SF to soothe their infants, in particular, should be excluded from this line of research [26]. Excluding mothers who violate the SF also means that, in each sample, a considerable number of infants classified as having a disorganized/disoriented attachment are removed from final analyses, which may mask infants' true attachment patterns. ...
The challenges of stillness: a longitudinal study about the associations between mothers’ violations of the still-face, infant patterns of regulatory behavior, mother-infant interactive behavior, and infant attachment
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Full-text available
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Background During the still-face (SF) episode of the Face-to-Face Still-Face paradigm (FFSF), mothers are instructed to remain still, unresponsive, and silent. However, some participants do not comply with these instructions, and researchers typically exclude them from their analyses. These mothers report feelings of anxiety and discomfort during SF. However, little is known about maternal SF violations and whether they are associated with other aspects of the mother-infant relationship. Aims In this experimental and longitudinal study, we compared mothers who violated the SF instructions to mothers who complied with them. We then focused on the group of mothers who violated the SF instructions, to investigate whether the type (i.e., those meant to soothe the infant vs. other violations), intensity (severe vs. mild), and form (verbal and non-verbal) of mothers’ SF violations in the FFSF at 3 months postpartum were associated with infant regulatory behavior in FFSF, mother-infant free-play behavior at the same age, infant attachment at 12 months, or other infant or maternal/familial characteristics. Methods The participants included 54 mothers identified as violating the SF instructions at 3 months and their infants, and 296 mothers who did not violate the SF instructions. At 3 months, mother-infant dyads were videotaped during two successive interaction tasks: an unstructured free-play task followed by the FFSF paradigm. At 12 months, infant attachment was assessed in the Strange Situation. Results Mothers who violated the SF were less sensitive during mother-infant free play than mothers who complied with the SF instructions, and their infants were more cooperative and less likely to exhibit a disorganized/disoriented attachment. Among mothers who violated the SF instructions, those who did so to soothe their infant exhibited higher sensitivity during free play, and their infants were more likely to exhibit a Social Oriented pattern of regulatory behavior during the FFSF, than mothers who violated the SF for other reasons. Furthermore, their infants were more cooperative during free play, and at 12 months, more likely to have a secure attachment, and less likely to have a disorganized/disoriented attachment. Conclusion Possibly, mothers who violate the SF to soothe their infants are more empathic and more likely to be a “safe haven” in stressful situations, contributing to secure relationships. However, mothers who violated SF for other reasons need further investigation and are linked with disorganized/disoriented infant attachment.
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... Studi menunjukkan mindfulness dapat menurunkan stres, kecemasan, dan burnout serta meningkatkan produktivitas (Kerseamaekers et al., 2018). Pendekatan seperti lokakarya (Sarazine et al., 2020), pelatihan (De Vibe dalam Madigan et al., 2023), terapi seni (Newland & Bettencourt, 2020), dan afirmasi positif (Ardiana et al., 2023;Putri et al., 2024;Siburian & Siburian, 2023) terbukti membantu mengelola tekanan psikologis. ...
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... Decades of extensive research illustrate that a secure caregiver-child relationship, a fundamental tenet of attachment theory, acts as a developmental safeguard against future adverse childhood mental and behavioral health outcomes (Groh et al., 2017). On the other hand, when children experience various forms of interpersonal trauma that leave them with ongoing distress or anxiety, or are exposed to cumulative socioeconomic risks (e.g., low education, low socioeconomic status, racial and ethnic minority status), they are at a higher risk of developing insecure or disorganized attachment (Madigan et al., 2023). This, in turn, can lead to elevated stress levels and long-lasting mental health issues (Groh et al., 2017). ...
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... The SSP (Ainsworth et al., 1978) is considered the gold standard measure in assessing attachment for children aged 12 to 20 months (Madigan et al., 2023), and reliability and predictive validity are well-established in U.S. and Western European populations (Solomon & George, 2016, p. 373). The procedure lasts approximately 20 min in eight consecutive 3-min episodes where the child plays in a room either with or without the mother and/or a stranger. ...
View
... The effect size was f 2 = 0.22 corresponding to a minimum effect size of R 2 = .17. In addition, results from a recent meta-analysis (Madigan et al., 2023) evaluating infant-parent attachment relationships in 2,720 dyads collected over 20 countries report the following sample size parameters: M = 72.2; median = 51.0; ...
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Ainsworth and colleagues, who developed the strange situation procedure (SSP), emphasized the importance of context in attachment research. However, cultural characteristics of infants’ behavior during the SSP have not been explored in detail. This study examined whether East-Asian infants would differ in crying during the SSP from Western infants. If so, we further examined which episodes (e.g., separation and reunion episodes) East-Asian infants would cry differently from Western infants. This study compared three East-Asian samples, one Koran ( n = 76) and two Japanese ( n = 44 and n = 81), with two Western samples, one US ( n = 106) and one Czech ( n = 63). The results consistently revealed that when infants were separated from their mothers for the second time and stayed alone in a strange room, both Korean and Japanese infants scored higher on crying compared with US infants. Subsequently, when a stranger entered the room, all East-Asian infants also scored higher on crying compared with US and Czech infants. Infants did not show different levels of crying in the reunion episodes, with the exception of one sample of Japanese infants that scored higher on crying compared with the Western samples of Czech and US infants during the second reunion episode. The findings suggest cultural differences in infants’ crying during the SSP.
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A meta-analysis of the distribution of preschool and early childhood attachment as assessed in the strange situation procedure and its modified versions
Article
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  • ATTACH HUM DEV
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Configurations of mother‐child and father‐child attachment as predictors of internalizing and externalizing behavioral problems: An individual participant data (IPD) meta‐analysis
Article
  • Jan 2022
An unsettled question in attachment theory and research is the extent to which children's attachment patterns with mothers and fathers jointly predict developmental outcomes. In this study, we used individual participant data (IPD) meta-analysis to assess whether early attachment networks with mothers and fathers are associated with children's internalizing and externalizing behavioral problems. Following a pre-registered protocol, data from 9 studies and 1,097 children (mean age: 28.67 months) with attachment classifications to both mothers and fathers were included in analyses. We used a linear mixed effects analysis to assess differences in children's internalizing and externalizing behavioral problems as assessed via the average of both maternal and paternal reports based on whether children had two, one, or no insecure (or disorganized) attachments. Results indicated that children with an insecure attachment relationship with one or both parents were at higher risk for elevated internalizing behavioral problems compared with children who were securely attached to both parents. Children whose attachment relationships with both parents were classified as disorganized had more externalizing behavioral problems compared to children with either one or no disorganized attachment relationship with their parents. Across attachment classification networks and behavioral problems, findings suggest (a) an increased vulnerability to behavioral problems when children have insecure or disorganized attachment to both parents, and (b) that mother-child and father-child attachment relationships may not differ in the roles they play in children's development of internalizing and externalizing behavioral problems.
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