The Texas Medical Center Library DigitalCommons@TMC UT SON Dissertations (Open Access) School of Nursing Spring 5-2019 Impact of Adult Attachment Style on Outcome Trajectories in a Parent-Focused Early Language Development Intervention Cary Cain University of Texas Health Science Center at Houston-Cizik School of Nursing Follow this and additional works at: https://digitalcommons.library.tmc.edu/uthson_etd Part of the Nursing Commons Recommended Citation Cain, Cary, "Impact of Adult Attachment Style on Outcome Trajectories in a Parent-Focused Early Language Development Intervention" (2019). UT SON Dissertations (Open Access). 33. https://digitalcommons.library.tmc.edu/uthson_etd/33 This is brought to you for free and open access by the School of Nursing at DigitalCommons@TMC. It has been accepted for inclusion in UT SON Dissertations (Open Access) by an authorized administrator of DigitalCommons@TMC. For more information, please contact [email protected]. IMPACT OF ADULT ATTACHMENT STYLE ON OUTCOME TRAJECTORIES IN A PARENT-FOCUSED EARLY LANGUAGE DEVELOPMENT INTERVENTION A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN NURSING THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON CIZIK SCHOOL OF NURSING BY CARY M. CAIN, MPH, BSN, RN MAY, 2019 Dedication In memory of my father, William David Cain and grandparents, William Maurice and Lona Nadine Cain (Papa and Memaw) and James Edwin and Doris Gayle Jones (Daddy Ed and Mama Gayle) Therefore, since we are surrounded by so great a cloud of witnesses, let us also lay aside every weight, and sin which clings so closely, and let us run with endurance the race that is set before us, looking to Jesus, the founder and perfecter of our faith. To the only God, our Savior, through Jesus Christ our Lord, be glory, majesty, dominion, and authority, before all time and now and forever. Amen. iii Acknowledgements This work would not have been possible without the generosity and guidance of the Robert Wood Johnson Foundation Future of Nursing Scholars Program, secured at Cizik School of Nursing by Dr. Geri Wood. I am also grateful to the McGovern Foundation for generously funding the Cizik School of Nursing Accelerated PhD Program McGovern Scholarship. I owe much gratitude to my parents for their love, support, and sacrifices so that I can be at this point in my life. I thank them for instilling Christian values in me and for teaching me the importance of diligence and hard work. I am grateful for my mom’s continual prayers and encouragement. I thank my step-father for his support and especially his advice to me as I began this PhD journey. I am grateful for such amazing friends and family – Jana, Kyler, Ganesh, Orhue, Audrey, Marisa, Chad, Meredith, Jeff, and even Libby (my dog) – who have supported me through laughter and tears. I’m thankful for the prayers and support of my Christ the King community group and friends. I have been blessed to work with an incredible team at Texas Children’s and have learned so much from my colleagues – Dr. Greeley, Kim, Beth, Nancy, Maura, Yen, Angie, Lisa, John, and Richard – I appreciate their patience with me and allowing me to learn while working. I couldn’t have made it through this program without my sidekick (and unofficial advisor) Hilary and classmates Mary and Lai – the four of us are carrying each other through the finish line and I know we will continue to support each other as we continue our journeys. I thank my advisor and dissertation chairperson, Dr. Cathy Rozmus, for her guidance, patience, and support through the doctoral program. I would also like to thank iv Dr. Nikhil Padhye for his participation on my dissertation committee and invaluable contributions and advice. Thanks to Dr. Diane Santa Maria and Dr. Geri Wood for serving on my candidacy committee and for their valuable mentorship throughout my time in this program. In addition, I am grateful to the dedicated Cizik School of Nursing PhD faculty and staff, who are too numerous to count. Special gratitude is owed to my external advisor, Dr. Dorothy Mandell, for her willingness to mentor me, graciously giving of her time and patience to provide wisdom, guidance, and instruction. I admire how she applies her knowledge, and even her commitment in her personal life, to improve the lives of young children and families. I also would not have been able to complete the analysis in this dissertation without the guidance and expertise of Dr. Katharine Buek – I am so grateful that we crossed paths. Lastly, I wish to acknowledge the upWORDS team and families who contributed to this dissertation by participating in the upWORDS program. My hope is that by better understanding relationships in aggregate, we will be able to improve the lives of children and their families. v Cary Cain Impact of Adult Attachment Style on Outcome Trajectories in a Parent-focused Early Language Development Intervention May, 2019 Abstract Background: Disparities in early language development have been noted for children from low-income homes, which can impact their educational and health trajectory. The quantity and quality of language exposure in the home environment influences a child’s language development. Adult attachment style is a predictor of parenting behavior and could impact critical interactions between the parent and child. Evidence demonstrates that differences in adult attachment style impact program participation and outcomes in early childhood parenting programs delivered through home visitation. Aims: The aims of this study were to 1) explore the association of adult attachment style on intervention outcome trajectories from a group based, parent-focused early language development intervention and 2) evaluate the association of adult attachment style on intervention attendance. Methods: This exploratory study used data from a program evaluation of a group-based, parent-focused early language development intervention to examine the associations of adult attachment style on intervention attendance and parent-child interaction outcomes measured longitudinally. Parents of children (ages 0-24 months) were recruited to participate in a 13-week early language development program. A sample of program participants completed questionnaire data that included adult attachment style, depression symptoms, and sociodemographic information. Confirmatory and exploratory factor vi analyses were used to find three-factors of adult attachment style; relationship anxiety, discomfort with closeness, and relationships as secondary to achievements. Parent-child interaction was assessed by digital language processors recording child-directed speech and reciprocal interactions in the home environment weekly and parents reported average shared book reading weekly. Latent growth trajectories of parent-child interaction variables were identified through latent class growth analyses and regressed onto adult attachment style factors and covariates in order to determine the association of adult attachment style on the outcome trajectories. In addition, intervention attendance was regressed onto adult attachment style factors and covariates to understand the impact of adult attachment style on intervention attendance. Results: This study found three latent growth trajectories (high, middle, and low) for child-directed speech and two latent growth trajectories (high and low) for reciprocal interaction and shared book reading. This study found that discomfort with closeness had strong odds (OR: 2.602; p < .05) of attending 10 or more intervention sessions; however, discomfort with closeness was significantly associated with lower baseline and lower growth trajectory of reciprocal interactions between the parent and child (OR: .336, p < .001). Conclusions: Interventions supporting early language development are often targeted towards parents, as healthy development is fostered by parents’ provision of a supportive and cognitively stimulating home environment. Findings from this study suggest that adult attachment style does impact the effects of parent-focused language development programs and thus additional supportive measures may be needed for parents with insecure adult attachment styles to fully benefit from these types of programs. vii Keywords: Early Language Development, Adult Attachment Style, Latent Class Growth Analysis, Parent-Child Interaction, Child Development viii Table of Contents APPROVAL PAGE ............................................................................................................ ii DEDICATION ................................................................................................................... iii ACKNOLEDGEMENTS ................................................................................................... iv ABSTRACT ....................................................................................................................... vi SUMMARY OF STUDY ....................................................................................................1 PROPOSAL .........................................................................................................................3 Specific Aims .......................................................................................................................4 Background and Significance ..............................................................................................7 Research Design and Methods ...........................................................................................12