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Distress Regulation in Infancy: Attachment and Temperament in the Context of Acute Pain

Horton, Rachel E. PhD*; Riddell, Rebecca Pillai PhD*,†,‡; Flora, David PhD*; Moran, Greg PhD§,‖; Pederson, David PhD§

Journal of Developmental & Behavioral Pediatrics: January 2015 - Volume 36 - Issue 1 - p 35–44
doi: 10.1097/DBP.0000000000000119
Original Article

Objective: The relationship between attachment, temperamental fear, and pain-related distress was examined in a sample of 130 caregiver-infant dyads to explore the differential susceptibility hypothesis.

Method: Infant distress was measured during routine immunization at 12 months, and attachment and temperamental fear were measured at 12 to 18 months (meanage = 13.74, SD = 1.35) using the Strange Situation Procedure and parent-rated Infant Behavior Questionnaire—Revised, respectively.

Results: Immediately before immunization, avoidant infants exhibited significantly less distress than secure infants. Temperamental fear moderated the relationship between attachment and regulation; under conditions of high temperamental fear, avoidant infants regulated distress more slowly than secure infants, whereas under conditions of low temperamental fear, secure infants regulated distress more slowly than avoidant and disorganized infants.

Conclusion: The findings suggest that attachment interacts with extremes in temperamental fear to produce differences in the regulation of distress. The results partially support the differential susceptibility hypothesis.

*Department of Psychology, York University, Toronto, Canada;

Hospital for Sick Children, Toronto, Canada;

Department of Psychology, University of Toronto, Toronto, Canada;

§Department of Psychology, University of Western Ontario, London, Canada;

Aga Khan University, Nairobi, Kenya.

Address for reprints: Rebecca Pillai Riddell, PhD, CPsych, Department of Psychology, Faculty of Health, York University, The O.U.C.H. Lab, 2038 Sherman Health Sciences Building, Toronto, Ontario, M3J 1P3 Canada. e-mail:

This study was supported by a CIHR New Investigator Award, along with funding from the Canadian Institutes of Health Research (CIHR) Pain in Child Health (PICH) training initiative, the Ontario Graduate Scholarship (OGS) program, and the Lillian Wright Maternal-Child Health Scholarship program at York University.

Disclosure: The authors declare no conflict of interest.

Received June , 2014

Accepted October , 2014

© 2015 by Lippincott Williams & Wilkins